Recently, as we were preparing for our daughter’s first day of school, we came across the philosophy of the educator, Ellen Moir,1 who has identified distinct phases of a first-year teacher. These phases seemed familiar, comparable to our own experiences as academic physicians. Early on, as fledgling faculty members we ran the full gamut of emotions from hope and excitement to anxiety and loneliness.2 While it is clear that newly minted physicians face a number of difficult hurdles, there is very limited guidance as to how to best cope. Unfortunately, all of this leads to an unacceptably high rate of turnover, moral injury3 and academic “burnout”.4
The momentous first year on faculty is when formal training ends and the first “real” job begins. Among the many lessons we learned during our first few years, the ones that ended up being most important were also rather unexpected. We describe our experience and offer tidbits to coping with these phases.
Anticipation: “I have been training for 10 years for this day”
The evolution of the academic model has birthed several new career paths, yet the noble aspiration of being a “Triple Threat” (excelling in clinical care, education and research) exists, especially, as a naive junior faculty member. Although it is admirable to strive towards that goal of excelling in all the above paths, the outcome often, is less than ideal with hesitation to commit to any one pathway fully. As junior faculty, it is important to consider your pathway in the context of time, resources, and finances. Every university is unique, and it is important to make an early effort to understand the nuances of the institutional structure. As academic physicians, the metric we often use to discuss appointments is “protected time” with incomplete attention to the mentoring team or plan. The modern model of academic research is the “team science” approach; one is far more successful if a team of mentors is built early. Although this phase of anticipation begins with the initial euphoria of being prepared, it is humbled by the realization that learning, in medicine, never ends.
Survival: “Yes I can be on the committee” “Yes I can take call” “Yes I can teach the course”
Junior faculty are eager to please and end up overextending themselves. While saying yes may be necessary in some cases, learning to say no is equally important. Junior faculty should not feel obliged to be the “first responder” to every question posed to the collective group. This can be especially challenging if the new faculty members trained at the same institution. Effective mentorship can be helpful here. A mentor who clearly stakes out boundaries and puts expectations into writing can reduce the burden of saying no. Most importantly, it is imperative to stay true to yourself, for example, if basic science is your passion then pursue it without the added distraction of helping with every clinical project that comes along. Without focus, you can be left feeling like you’re drowning in work, so overwhelmed that nothing seems achievable.
Disillusionment: “I am not sure I am made for this”
The imposter syndrome, a psychological pattern in which an individual doubts their accomplishments and has a persistent internalized fear of being exposed as a “fraud”, is an increasingly recognized phenomenon in medicine that is more common in women but also affects men.5 Junior faculty may have their first ever run in with this syndrome specifically during their first year. For the clinician-scientist this includes lack of funding in the competitive environment.6 Clinician-educators on the other hand may feel like second-class citizens in comparison due to the inadequately defined success metrics.7 These experiences, can lead faculty to question their own commitment and competence. Much emphasis is placed on finding the right mentor, but in fact having a network of mentors may be more ideal to help navigate this phase.
Rejuvenation: “Finally something worked “
This phase begins with achieving a success metric seen as meaningful by not only the faculty, but also the people in leadership positions. These wins could range from grant funding, awards, recognition etc. This phase does add credibility to the “Matthew effect”8 a term coined by Merton to describe how success begets more success. Unfortunately, a mechanism driving the Matthew effect is participation, whereby early stage failure inhibits participation in further competition through discouragement and lack of resources. Having a peer group is vital to share experiences and coping strategies during this phase as persistence often gets rewarded. In theory you may take variable time to achieve this phase, but the hallmark of this phase is when one begins to find their focus.
Reflection: “Who am I, who do I want to become, and how do I get there?”
It is well known that we rarely learn only from experience, but in fact learn from reflecting on that experience. Many universities have individual development plans (IDP’s) that help faculty document their goals and reassess them on a yearly basis leading to higher goal achievement.9,10 One unique perspective was shared in a TED talk by Atul Gawande about using a professional coach.11 Typically utilized later in life a coach may be an investment divisional leadership should build in for junior faculty. In fact, the utilization of a coach early in one’s career may allow for strategies to develop a focused approach to career goals while reducing burnout.12 Additionally, coaching often gives a third-party objective perspective on navigating the politics of academics (new to the junior faculty) while also honing on specific skill sets to achieve their professional objectives.
Resilience: “Resiliency is not something you have, but something you do”
Resilience is the ability to bounce back from stressful situations. For many of us the challenging and exciting time as a junior faculty has been compounded by a time like ‘no other’ in recent history. The recent SARS COV-2 pandemic has no doubt taken a huge toll on frontline physicians. The vicissitudes of the pandemic may be even more disorienting for the junior faculty as they may be juggling additional clinical time, have their ongoing research studies/educational initiatives halted and increased responsibility at home all along managing their own emotions and fears. The potential adverse effects on academic productivity due to the pandemic are yet to be fully realized however, a strategy junior faculty can employ in a time of apparent disarray is to identify and seize the innumerable opportunities that the pandemic has provided. As a few examples, showcasing effective leadership in the clinical world, innovating the educational curriculum utilizing technology and pivoting their research skill set to areas that are in dire need. Creating opportunities where seemingly none exist can catapult junior faculty to roles of responsibility not otherwise imagined.
Collectively these phases and perspectives are intended to be a thought-provoking exercise for faculty “to seek” as well as universities, “to provide” support and resources during the crucial evolutionary phases of a junior faculty member.
Nandita R. Nadig, Assistant Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, USA.
Satish N. Nadig, Associate Professor of Surgery, Microbiology and Immunology, Division of Transplant Surgery, Medical University of South Carolina, USA.
Competing interests: none declared.
- Ellen Moir. New teacher development for every inning 2019 [Available from: https://newteachercenter.org/wp-content/uploads/NewTeacherDevelopmentEveryInning.pdf.
- Stupnisky RH, Pekrun R, Lichtenfeld S. New faculty members’ emotions: a mixed-method study. Studies in Higher Education 2016;41(7):1167-88. doi: 10.1080/03075079.2014.968546
- Talbot SG DW. Physicians aren’t ‘burning out’: they’re suffering from moral injury. 2018 [Available from: www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury.
- Pololi LH, Krupat E, Civian JT, et al. Why are a quarter of faculty considering leaving academic medicine? A study of their perceptions of institutional culture and intentions to leave at 26 representative U.S. medical schools. Acad Med 2012;87(7):859-69. doi: 10.1097/ACM.0b013e3182582b18 [published Online First: 2012/05/25]
- LaDonna KA, Ginsburg S, Watling C. “Rising to the Level of Your Incompetence”: What Physicians’ Self-Assessment of Their Performance Reveals About the Imposter Syndrome in Medicine. Acad Med 2018;93(5):763-68. doi: 10.1097/ACM.0000000000002046 [published Online First: 2017/11/09]
- National Institute of Health Grants and Funding. Physician -Scientist workforce report. [Available from: https://report.nih.gov/workforce/psw/challenges.aspx.
- Sabel E, Archer J, Early Careers Working Group at the Academy of Medical E. “Medical education is the ugly duckling of the medical world” and other challenges to medical educators’ identity construction: a qualitative study. Acad Med 2014;89(11):1474-80. doi: 10.1097/ACM.0000000000000420 [published Online First: 2014/07/24]
- Merton RK. The Matthew effect in science. The reward and communication systems of science are considered. Science 1968;159(3810):56-63. [published Online First: 1968/01/05]
- Rimmer A. How do I prepare a personal development plan? BMJ 2018;363:k4725. doi: 10.1136/bmj.k4725 [published Online First: 2018/11/15]
- Vanderford NL, Evans TM, Weiss LT, et al. Use and effectiveness of the Individual Development Plan among postdoctoral researchers: findings from a cross-sectional study. F1000Res 2018;7:1132. doi: 10.12688/f1000research.15610.2 [published Online First: 2018/12/07]
- Gawande A. Want to get geat at something? Get a coach, 2016, october 16. [Available from: https://www.ted.com/talks/atul_gawande_want_to_get_great_at_something_get_a_coach?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare.
- Dyrbye LN, Shanafelt TD, Gill PR, et al. Effect of a Professional Coaching Intervention on the Well-being and Distress of Physicians: A Pilot Randomized Clinical TrialEffect of a Professional Coaching Intervention on the Well-being and Distress of PhysiciansEffect of a Professional Coaching Intervention on the Well-being and Distress of Physicians. JAMA Internal Medicine 2019 doi: 10.1001/jamainternmed.2019.2425