Counternarratives that illuminate faculty agency: A five-year longitudinal qualitative study of physician educators in academic medicine

Abstract

Purpose

Physician educators are often expected to direct educational programs and assume roles that conform to field norms for career advancement but that may not afford meaningful work for educators. The purpose of this study was to describe and analyse the perspectives and actions taken by physician educators in response to tension between feeling compelled to direct an educational program and doing educationally meaningful work.

Methods and Materials

We used data from a longitudinal study and focused on three participants who, over the course of the five-year study, offered significant insights into how physician educators act in ways that run counter to expectations for career advancement. Our narrative analysis entailed organizing data from interview transcripts into time-ordered displays, weaving data into counternarratives that were edited by participants, and using the theory of faculty agency (and its key constructs, strategic perspectives and strategic action) to thread the stories together.

Results

In each counternarrative, the participant deliberated their sense of being a physician educator (strategic perspectives) and when expectations became untenable, they did what they needed to do to engage in meaningful work (strategic action) rather than comply with expectations for career advancement in academic medicine. For one participant, faculty agency meant leaving academic medicine; for another, it meant reducing clinical time so that unpaid time could be devoted to education; and for another, it meant opting not do direct a reputable education program.

Conclusions

Faculty agency is a useful theoretical lens for conceptualizing how physician educators navigate their careers in academic medicine. Counternarratives that illuminate faculty agency offer stories that describe alternate career paths and portend a different future for physician educators.

Keywords:

• Agency
• career mobility
• counternarrative
• longitudinal research
• qualitative research

Acknowledgements

The authors wish to thank the physician educators who graciously shared their stories.

Disclosure statement

The authors report there are no conflicts of interest.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Dorene F. Balmer

Dr. Dorene F. Balmer is Professor, Department of Paediatrics, Perelman School of Medicine at the University of Pennsylvania, and Co-Director of Research on Education at the Children’s Hospital of Philadelphia, Pennsylvania, USA.

Samuel A. Rosenblatt

Dr. Samuel A. Rosenblatt is Assistant Professor, Department of Anaesthesia and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

A. Emiko Blalock

Dr. A. Emiko Blalock is Assistant Professor, Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA.