Sustaining undergraduate medical education leadership: An AAIM statement on protected time and support for internal medicine clerkship directors

Brian Kwan, MD, Temple Ratcliffe, Eve Merrill, MD, Rebecca Berman, MD, Kathleen Cooney, MD, Nancy Masucci, MD, Jill Servánt, MS, Irsk Anderson, MD

Introduction
For over two decades, the Alliance for Clinical Education (ACE), a multi-disciplinary organization focusing on excellence in clinical medical education and composed of undergraduate medical education (UME) leaders from eight medical specialties, has recommended a 0.5 full-time equivalent (FTE) allotment for clerkship directors to support the full range of responsibilities associated with directing a clerkship. Despite this long-standing guidance, many institutions under-allocate time for the clerkship director role. Based on results from nationally representative surveys conducted by the Alliance for Academic Internal Medicine (AAIM), approximately 15.2% of internal medicine clerkship directors reported having 0.2 FTE or less from 2020 to 2024. Concurrently over the past 20 years, the demands of the position have progressively increased, driven in part by growing class sizes, expansion of clinical sites, and a heightened focus on Liaison Committee on Medical Education (LCME) standards. Findings from annual surveys further underscore the urgency of this issue: from 2020 through 2024, an average of 33.2% (range: 24.8-37.4%) of internal medicine clerkship directors screened positively for burnout. During that same timeframe, an average of 55.9% (range: 53.1-59.1%) of internal medicine clerkship directors reported that they had considered resigning in the past year. Among those internal medicine clerkship directors who reported to have considered resigning, an average of 27.4% (range: 20.0-36.7%) reported that they were “somewhat” or “very likely” to resign in the next 12 months.

The following discussion of contemporary internal medicine clerkship director roles and responsibilities as well as recommendations about clerkship director support is intended to help departments make thoughtful, transparent investments in the undergraduate medical education (UME) mission and ensure sustained support for UME leadership. A 0.5 FTE allocation would enable clerkship directors to effectively conduct their educational and administrative responsibilities in today’s complex academic health systems.