How to Succeed as a Clinician Educator
Grand Rounds
April 12, 2007
Neil A Kurtzman, MD
Grover Murray Professor
University Distinguished Professor
Texas Tech University Medical Center
• What is a clinician educator?
• Any clinician who teaches medicine
• A clinician teacher who doesn’t earn his
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keep from grants or practice
This is a problem we’ll come back to
• A clinician whose main focus is teaching
• Undergraduates
• Residents
• Fellows
• Other physicians
• Is a clinician educator a new track?
• Just as music student studies Bach,
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Mozart, and Beethoven without expecting
to equal them, it’s useful to study the great
clinician educators of the past
I’ll pick two
One from the 19th century
One from the 20th
• William Osler 1848-1919
• Donald Seldin 1920• ? 21st century
William Osler
The Four Doctors
Sargent 1905
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Born Ontario, Canada
Originally planned to enter the ministry
MD McGill University 1872
Started first journal club ever as a student
Chair of Clinical Medicine U of P 1884
Chief of Staff Johns Hopkins Hospital 1889
First Professor of Medicine 1893
Regius Professor of Medicine, Oxford 19051919
• Started the first medical residency
• Wrote the first modern textbook of
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medicine
Brought third year students to the bedside
Inveterate prankster
Prodigious reader
Embodies the ideal of the humanistic
physician
“He who studies medicine without books
sails an uncharted sea, but he who studies
medicine without patients does not go to
sea at all.”
Donald Seldin
1995
• Born Brooklyn, NY 1920
• BA NYU 1940
• MD Yale 1943 (first in his class)
• PG training under John Peters (his most
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important influence) at Yale
Instructor at Yale 1948 following two years
in the Army
John Peters – Seldin’s mentor
• Testified against the Nazi doctors at
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Nuremberg – 1946
Associate Professor Southwestern
Medical School – 1951
Chairman 1952 – 1987
Still Professor of Medicine
Similarities and Differences
• Both rose to important positions at an
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early age
Both extremely well educated
Neither did cutting edge research, though
many of their students did
Both built departments from scratch
Both seem to have mastered virtually all of
medicine
• Both placed great value on the importance
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of research at the medical university
Both had enormous impact on their
schools
Both inspired generations of students
Their students became leaders of
American Medicine at all levels
• Both were legendary teachers
• Osler a bedside teacher
• Seldin best in the conference room
• Seldin spent his entire career at one
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institution
Osler friendly and avuncular
Seldin sharp, intolerant of ignorance
• Osler warm
• Seldin outwardly cool, but actually
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encouraging and supportive once you got
his attention
Seldin a ruthlessly accurate judge of talent
which he separated from personality
• Both attracted the brightest students, but
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for different reasons
Osler a prolific writer
Seldin preferred speaking to writing
He talked in paragraphs
Terrified students while attracting the best
of them
• His lasting achievement is his students
• Though he repeatedly insisted they were
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no better than any others
And they weren’t
Thus he must have had a special impact
on them
Hence the importance of a great clinician
educator
• Enrico Fermi 1901 – 1954
• Professor of Physics at 24
• Nobel Prize for Physics at 37
• Built the first atomic reactor
• Known for the brilliant simplicity with which
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he solved problems
Fermi reasoning
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Both Osler and Seldin were great educators
though very different
An educator succeeds when he inspires
students to learn on their own
Which is the only way you really learn anything
This is especially important in medicine since
most of what you learn as a student is outdated
when you complete graduate training
• While you can’t make a silk purse out of a
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sow’s ear it takes skill to make one out of
silk
So how does one become a clinician
educator?
Often happens by accident
No one path
• There’s no standard widely accepted
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definition of what a clinician educator is
There’s no obvious way to pay for them
They don’t get grants and generate
indirect costs
When they’re educating they’re not
generating clinical revenue
• Thus, it’s easy for them to be seen as an
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economic drag on the department
That’s because the medical school is
unlike any other component of the
university
Clinical faculty are not paid to teach
They’re expected to generate income
while working for less money than they
could make in practice
• There’s a word for this
• Crazy
• There has to be a non-economic reward
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for this
Recognition
Making a difference
• Each department of medicine will have to
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decide what defines a clinician educator
How will he be paid?
How many does the department need?
How many can it afford?
How much of a subsidy will the other
faculty be willing to provide?
• How will we know if he’s doing a good job?
• What’s expected of him?
• The purpose of a university is the
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acquisition and transmittal of knowledge
We seem to have concentrated on the
former at the expense of the latter
2006
• “Clinician educators are poised to do
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collaborative clinical and translational
research but are still under pressure for
clinical productivity.”
As of 2000 at least half of all medical
schools affirmed the values of their
faculty’s educational activity, with many
schools providing detailed advice to faculty
members as they assembled their best
educational materials for promotion
packets (AAMC website)
No mention of money
• Everybody wants clinician educators
• No one really know how to define them
• No way to pay for them
• I can only suggest how this business
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should be organized
But until there’s a national consensus on
what a clinician educator is nothing will
happen
Until there’s money there’ll be no
consensus
• Medicine is being suffocated by paperwork
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and over-administration
Medical education is setting the paper on
fire
A lecture at our school by a noted medical
historian failed to gain CME credit
because the paper work was
unsatisfactory
Today a clinician teacher is apt to spend
more time preparing objectives and
questions than teaching
• Not only is the perfect the enemy of the
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good
But the good has become the enemy of
the good
How much making things better can we
stand?
We never ask before we regulate
• A cadre of clinician educators would find
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more support for a subsidy if they
assumed this administrative burden
CME should be run by clinician educators
Perhaps the IRB as well
These would lessen the amount salary
required from clinical work
Should make both operations more
palatable to all faculty
• Clinician educators, in the main, should be
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generalists
But they should pursue scholarship
Which I will define as excluding studying
education
• He who can, does; he who cannot,
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teaches - GB Shaw
He who can’t do either teaches teachers –
anonymous
• He who can’t do either, teaches Gym –
Woody Allen
• I give no credit for studying studying
• Thus a clinician educator should study
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something peculiar to medicine
Clinical trials
Scholarly reviews
Collaborative research with laboratory
based colleagues
Meta-analyses
Outcomes research
• Medical economics
• Ethics
• Politics
• Clinical vignettes for basic science
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textbooks
Test questions and evaluations
Anything but education
• Curriculum
• We have to have one
• Except when we don’t
• James Scholar Program at the University
of Illinois
Harry Jacobson ’72
Vice Chancellor for Medical Affairs
Vanderbilt University
Melvin Laski’76
Professor of Medicine
TTUHSC
• Write the best one you can and then resist
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the urge to scrub it for a new one
Why do medical schools constantly rewrite
their curricula?
I would advise that a curriculum can be
rewritten only after the dean’s been on the
job for 10 years
What not do
• No Department of Education
• No heavy administrative structure
• No certifying processes
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hearing from you, but we need you to make one last plea to your Members of Congress. Please take a moment
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Background Information – NIH is in Danger of being Flat Funded in FY2007:
Congressional leaders have indicated that they plan to fund most agencies at their FY2006 funding levels. This
action would result in NIH being flat-funded in FY2007. Flat funding NIH in FY2007 would actually amount
to a three percent reduction (in inflation-adjusted terms) for the agency.
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program. Congressional leaders are planning to increase funding levels for the programs and agencies they
regard as priorities. The elimination of congressional earmarks is allowing for this redistribution of funds. At
one time, it appeared that the odds of NIH receiving a significant increase in FY2007 were not high, but it is
becoming increasingly evident that the research community’s message is being heard on Capitol Hill.
REQUIRED ACTION: CONTACT YOUR SENATORS AND REPRESENTATIVE
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• Background Information – NIH is in
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Danger of being Flat Funded in FY2007
From FY 98 to 06 the NIH Budget has
increased 110%
Now $28.7 billion
How much should the NIH budget be?
Apparently 100% of GDP
• What’s the real mission of the NIH?
• Eternal youth and immortality
• Which is why everybody loves it
• What would happen is all research
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stopped
In the developed world – very little
• But what if education stopped?
• Nothing would work
• Compare the budget for medical education
with that of the NIH if you want to see what
people really value
[T]he clinical scholar, the academic core of
the department, is an individual who
advances first-rate clinical science and at
the same time is competent in clinical
medicine and in teaching.
Donald Seldin 2003
The ideal college is Mark Hopkins on one
end of a log with a student on the other.
James A Garfield (Later US President) 1871
“Every man who is educated at all, is, and
must be self-educated….It is for the want
of understanding this properly, that
expectations are entertained of
instructors….Young men will not set
themselves efficiently at work until they
feel that there is an all important part
which they must perform for themselves,
and which no one can do for them…. It is
his (an instructor’s) power to give an
impulse to the minds of his pupils and
induce them to labor.”
Mark Hopkins 1836
• The medical school must establish a culture of
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excitement in biomedical science
There are many healers in society, but the
only healer who brings medical science to the
patient is the physician
The clinical educator must demonstrate the
meaningful application of medical science to
medical students
• When you care for the sick there are
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ethical and humane constraints
Only the clinician educator can
demonstrate the artful interaction between
ethics and medicine and between
compassion and technology
Borrowed from Seldin 2003
• Institutional loyalty
• The alumni often have it
• But the faculty and the school seem to
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have lost it
If we’re going to have a culture of
excitement about biomedical science we’ll
have to find it (loyalty)
• Thus there is no one right way to be a
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successful clinician educator
Each physician who succeeds in this path
will have to find his own way
Perhaps the old model of a clinician who
does research and teaches is still the best.
Thank you Sandra