LAUSR

Each July, newly minted physicians arrive for residency training with their unique professional aspirations, dreams, and hopes. These aspirations often extend beyond the role of clinician to roles such as researcher, advocate, educator, innovator, or leader. Nurturing professional development in these areas is essential in order to graduate physicians who are passionate about their work and equipped to innovate. Yet, our graduate medical education and healthcare systems often fail them. Burnout is endemic, starts early in medical education and rises with each year of training. Burnout erodes not only patient care but also physician ideals, meaning, and purpose [1, 2]. More than ever, society needs physicians who are engaged in their work, i.e., experience meaning and purpose, and who are engaged in inquiry and innovation, i.e., participate authentically in scholarship of discovery, integration, teaching, and/or application [3]. Graduate medical education (GME) programs have sought to address this need by implementing predefined tracks to support career development in specific areas, including research, medical education, global health, quality and safety, and leadership [4–6]. Research tracks, with their mission to create physician scientists, are the most developed and typically include substantial protected time, mentorship, accountability, curriculum, and funding [4]. The non-research tracks typically combine didactic sessions, participation in a community of practice, and a mentored project. However, these tracks often do not include significant (if any) longitudinal protected time, rely upon “extra-curricular” effort and possess varying degrees of structure, mentorship, and accountability [5]. Thus, for the vast majority of residents who do not aspire to become a physician scientist, there are often fewer opportunities to develop their professional identity beyond that of clinician. The absence of robust non-research tracks designed around residents’ core passions has several deleterious consequences. First, our graduates may not be prepared and empowered to utilize scholarly methods to solve real-world problems, a capability essential even for graduates who do not intend to practice in academic settings. This may limit, to the detriment of patient care, our graduates’ capacity to perform roles that health systems now require of physicians in areas such as quality improvement, patient safety, care delivery design, or education [7–10]. Second, GME programs that do not adequately nurture professional identity development may have negative impacts on professional resilience. Residents who are not supported in discovering their niches may be at greater risk for burnout later in their career. We know that physicians who spend at least 20% of their effort on work that they are passionate about are at lower risk for burnout [11]. To address this gap, we developed an academic track, the Pathways to Expertise Program (PEP). PEP improves upon existing models by leveraging design principles from the professional development literature in general and successful research tracks in particular: protected time, faculty mentorship, self-directed engagement, robust near-peer community of practice, and accountability. In this study, we describe the design and preliminary results of PEP.