Careers in Medicine: Teaching
A NextGen Pathways in Medicine Article
From an Interview with Charles J. Hatem, M.D., Mount Auburn Hospital
Charles J. Hatem, M.D.
Education is one of three parts of the traditional tripartite mission of medicine (along with clinical care and research). "Doctor and teacher mean the same thing. One cannot practice medicine without an engagement of the teaching role," says Dr. Hatem. Whether as a primary care physician (PCP) or a specialist, this role as a teacher in the delivery of medicine applies to interactions with patients, students, interns, residents, house staff, and also fellow faculty. Teaching, whether in the lecture hall, examination room, or "grand rounds" setting, is a fundamental function of physicians seeking to deliver the best care and contribute to the maintenance and improvement of the field of medicine.
A few decades ago, there were no easily defined roles or set paths for physicians who also wanted to be teachers. According to Dr. Hatem, teaching, unlike research, was rarely a vehicle for advancement in academic medicine. As such, physicians incorporate medical education into their practice of medicine in a variety of ways and with varying levels of time commitment: some contribute only nominal amounts of teaching time, while others devote most of their time to teaching medical students and residents. Participating in teaching often depends on the physician's relationship and proximity to an academic institution as well as the academic institution's policies on compensating teachers. In some institutions like Harvard Medical School, physician-teachers are typically not paid for the hours they spend teaching classes at the medical school: they exchange teaching hours for the title of "Professor" and membership in the institution's medical network. This sometimes makes it difficult for physicians who work for managed care organizations to participate in medical school education, especially when they must sacrifice clinic time in exchange for teaching time (i.e. the physician would see fewer patients since he or she would be spending part of his time teaching a course). However, some medical schools are beginning to make efforts to obtain funding to financially compensate their teachers for the teaching hours they contribute. Furthermore, some proximity and time constraints can be overcome when medical students on their rotations and residents are sent out to clinics to learn from practicing physicians.
While teaching, particularly with respect to teaching patients about their conditions and how to manage them, is an essential part of practicing medicine, effective teaching often requires additional training and experiences than those provided during medical school. Physicians must deal with the logistical challenges and the "reality of caring for people at the same time while teaching." Besides having an excellent understanding of basic clinical skills, a physician aspiring to teach should also engage in the growing variety of courses and fellowships aiming to improve the teaching ability of physicians (within the context of adult learning). Additionally, physicians who are also teachers must also learn to create a safe and intellectually active learning environment, one that encourages a close dialogue between teachers and students from which both can stay up to date. "There's an ever-renewing supply of medical young who are asking new questions. 'Why is this so? What is the evidence for what you say?' It helps one stay current, and helps you be honest in saying, 'I don't know, but let's go find the answer.'" This stimulus, according to Dr. Hatem, is an important contribution to his growth as a physician as well as his intellectual and professional well-being.
Despite the challenges, Dr. Hatem emphasizes that "teaching is an enormously rewarding thing to
do. There is the doubly rewarding professional role to care for patients and to illuminate concepts
for the medical young, helping them become better doctors." He describes it as a "multiplier
effect": by helping others become good physicians, one can help more patients than a single
physician alone can treat. 
Lester Leung is the Editor-in-Chief and Founder of the Next Generation and a member of the Harvard College Class of 2006.
Charles Hatem, MD is the Harold Amos Professor of Medicine at Harvard Medical School, Director of Faculty Programs in Medical Education at the Shapiro Institute for Education and Research, and Director of Medical Education at Mount Auburn Hospital. He also maintains an active office and inpatient clinical practice in primary care adult medicine. Dr. Hatem has served as Director of the Rabkin Fellowship in Medical Education since its inception in 1998, which is devoted at providing faculty skills needed in the world of the clinician-teacher.