Counternarratives that Illuminate Faculty Agency: A Longitudinal Qualitative Study of Physician Educators in Academic Medicine

Abstract

Physician educators are often expected to direct educational programs to advance their careers in academic medicine; however, what happens when physician educators’ internal sense of being an educator does not fit with expectations? Using longitudinal qualitative data, we composed three counternarratives that illuminate agentic perspectives and actions of physician education. Our narrative analysis of longitudinal data occurred in 3 phases: organizing data from interview transcripts into time-ordered displays; weaving data into counternarratives that were edited by participants; applying O’Meara’s conceptualization of faculty agency as both strategic perspective and strategic action. For one participant, faculty agency meant grappling with misaligned values and then leaving academic medicine for a job in private practice. For another, faculty agency meant striving to return to his baseline self as an educator and then reducing clinical work so time (albeit unpaid) could be spent on educational projects. For yet another, faculty agency meant recognizing that that a program leadership role was a poor fit and opting out of that role. In sum, participants deliberated their sense of being a physician educator (strategic perspectives) and when expectations became untenable, they did what they needed to do to advance their own career (strategic action). Our findings provide counternarratives that communicate insight and possibility for how physician educators might advance alternate careers in medical education and offer dynamic ways to understand agency in academic medicine.