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What Does It Mean To Be Academic?
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When I speak with students and residents, I often hear the term “academic,” as in “that residency program is very academic” or that “attending is very academic.” I once heard a student use the phrase in a somewhat pejorative manner, describing that they were looking for a residency program that was not academic – as in – “this program doesn’t do any hands-on work, and the residents just learn everything out of a book.” I hear this term used all the time – I use it myself. But what does it mean to be “academic?” What are the characteristics of an academic doctor, and how can those of us who desire it function academically?
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I did a very quick and nonacademic search on Google for academic and found these definitions: 1. “of or relating to education and scholarship” or 2. “not of practical relevance; of only theoretical interest.” I’m not wild about the second definition because it implies that the theory behind something is not important and is disconnected from reality. This definition is along the same lines as the student’s comment described above. So, let’s focus more on the first definition.
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“The general definition among the medical community of an academic doctor is one who teaches and does research while participating in clinical medicine.”
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The larger field of medicine considers an academic physician as one who teaches and does research while participating in clinical medicine. Does this have to be true for all of us? I’m not so sure, but as an assistant professor at a university (someone who fits this particular definition) I’m well aware that the medical college system in the United States doesn’t know what to make of us.
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“The medical college system in the United States doesn’t know quite what to make of academic doctors.”
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I once attended the American Association of Medical Colleges’ (AAMC) yearly conference. This is the national governing body for allopathic medical schools, similar to our American Association of Colleges of Podiatric Medicine (AACPM). One of the best-attended sessions was about the uncertain position of the clinical professor in terms of obtaining tenure. Since tenure has previously been an advancement system for research/basic science professors, none of the medical universities have figured out what to do with those of us who spend more time in clinic than the research lab (I actually spend ZERO minutes/year in a research lab). What is an academic? Even the medical schools don’t know.
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Since no one seems to have codified what it truly means to be an academic doctor – or more to the point a doctor who is academic – I’m going to pull out my scalpel and take a stab at it. While describing the characteristics below, I have in my mind’s eye certain doctors with whom I have had personal experience. There are a few doctors that embody what I define as “academic.”
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Characteristic 1: Foundationally Oriented
The dean of my college, Dr Lawrence Harkless, well known to many of us in the profession as a consummate academician, often espouses looking back at the basic science behind that which we are treating. For example, if we are discussing when to safely begin motion of a joint after a tendon transfer, Dr Harkless would ask, “What is the tendon healing process and how does this apply to your timeline?” Looking at the basic science would tell us that at approximately three weeks a tendon is strong enough to sustain passive motion. Additionally, motion causes tendon to heal in a longitudinal manner rather than haphazardly, resulting in a stronger tendon. Academically examining the healing process allows us to answer the clinical question. There is a foundation for everything, and looking back to that often helps us answer our questions.
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“Academic Clinician Characteristic #1 – Examines the foundation, the basic science, the evidence, allowing them to make the best clinical decisions.”
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Characteristic 2: Deconstructionalization
I’m sorry. I couldn’t help myself. That word makes almost no sense, but the grammarian in me took over. I had to have some fun! Let’s make that “deconstruction.” One of my partners at Western University, Jonathan Labovitz, DPM, is most adept at breaking a complex problem down into its constituent parts, and using that information to make a decision. We once had a conversation about teaching the treatment of a complex foot and ankle deformity to a student. He asked the student to break the deformity down to each of the three planes and figure out from there how to address each part. By deconstructing any complex problem into its constituent parts, the academic physician moves beyond a knee-jerk response to a more thoughtful, analytical one.
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“Academic Clinician Characteristic #2 - Breaks a problem down into its constituent parts and uses that information to make a thoughtful, analytical clinical decision.”
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Characteristic 3: Evidence-Based
I once saw a lecture by Dr Doug Richie, of Richie brace fame. He was giving a lecture about hallux rigidus. In a manner that I don’t often see at our national lectures he took us all through the current research evidence. Each slide referenced some study that I hadn’t previously read. This was in contrast to the typical podiatry national lecture in which the speaker throws up a bunch of pictures of his or her surgeries, telling us what he did, with no actual scientific evidence to back up his assertions. The academic clinician bases their patient care on sufficient evidence coupled with one's own experience and their patient’s values.
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“Academic Clinician Characteristic #3 – Uses data collected and analyzed properly according to accepted academic standards to back up their own experiences to make the best clinical decisions.”
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Characteristic 4: Questioning
The academic physician is always skeptical and questions the status quo. “Why do we use this classification?” she asks. “Is there a better way to do that surgery?”, he inquires. They probe for the best answer, seeking out the explanation. He uses his mind to logically think through a process to discover the truth. She does research to move the profession forward. Instead of simply believing what some sage has told them these professionals go beyond mindlessly agreeing and actively seek the answers. If it weren’t for Dr Kevin Kirby’s questioning attitude, we would have no understanding about rotational equilibrium concepts and/or their applications to foot orthosis therapy and foot and ankle surgery.
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“Academic Clinician Characteristic #4 – Constantly questions and re-examines accepted principles and in doing so, continues to move the clinical knowledge base forward.”
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Characteristic 5: Excellent Communicator
Above all, the academic physician takes all of the above characteristics, uses them to provide the best care, and communicates those outcomes to those behind him or her. She teaches someone. He spreads the knowledge, evidence, and questioning attitude to students, residents, and the public. Without this last characteristic, it is impossible to advance knowledge beyond the self.
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“Academic Clinician Characteristic #5 – Teaches where s/he has learned to students, residents, and the public.”
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Now, I’ll bet that most of us either have someone who fits these characteristics or are that person. Think about all of those people who came before you and taught you something. Many of us had that attending who was truly academic. I had a couple of them when I was a resident and tried to mimic their excellence. I usually came up ridiculously short, but it was worth making the effort. I’ll bet some of you fit these characteristics perfectly. If you do, then you’re an academic, regardless of whether or not you work in an academic setting. If this isn’t you, then I suggest giving it try. Do you do a certain thing because that’s what you were taught? Think of some issue you come in contact with, and ask a question.
“You can practice academically too. Try looking back to the foundations of that thing that you always do the same way because that is “how you were taught”. Deconstruct it into its component parts, find the evidence, question that evidence for validity, and then alter your methods accordingly. This practice will make you a better doctor, and those around you better doctors as well.”
Try looking back to the foundations of that thing and then deconstruct it into its component parts, find the evidence, question that evidence for validity, and then alter your methods accordingly. If you don’t already teach trainees, then call up your local residency program or closest podiatry college and offer to help, putting these five characteristics of acedemic clinicians into practice. You with then have become an academic physician, and you’ll see just how exciting the practice of podiatric medicine really is.
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