Evaluation of current situation in career development and training of teaching physician

Background: Extreme competition for grant funding or publications to gain career promotion in aliated hospital has outsized negative effects on doctor to gain career promotion in China these years. This research seeks to explore the relationships between evaluation of teaching physician and their actual aptitude towards career promotion. Methods: This study was offered to all teachers and medical students at Shanghai General Hospital aliated to Shanghai Jiao Tong University. A web-based survey was conducted to identify individuals’ aptitude to teaching physician. A total of 140 participants entered and nished the study. Questions consisted of how teaching physician is assessed, the percentage of clinical, scientic work and teaching grant funding/awards/publications of teaching physician as well as attitude towards training in teaching. Results: Teaching physicians tried to satisfy scientic research or grant funding/awards/publications requirements and failed to apply time on teaching, thus affect the teaching quality. Teaching training can serve as an approach to ensure career growth and advancement in medical education. Teaching physicians should be equipped with teaching skills and educational administration in teaching curriculum development. Conclusions: We recommend the outstanding teaching physician should not only be equipped with clinical skills, but also be full of teaching enthusiasm and methods as well as improved the quality of teaching through training.

1. It is important to administrate teaching environment and policies to provide career chances for teaching physician.
2. Evaluations was made for teaching activity and quality about personal strategic planning of the manuscript-and fund-focusing on professional development. 3. Clinical training provides a foundation of the course in medical education, where teachers gather to participate in sessions and workshops.

Background
Frequently, traditional medical school put emphasize on the basic medical knowledge. Even though in recent years, PBL (Problem-Based Learning), CBL (Case-Based Learning) and simulated teaching have been carried out, most of them are still limited, which lack of actual clinical training like making diagnosis, treatment and grasping surgical skills. Moreover, the practice of medicine is a complex endeavor involving the application of a broad array of knowledge and skills, especially the medical uncertainty including biomedical ethics and gaining the doctor-patient relationship at bed-side. Thus graduate medical education is the rst step in training physicians capable of critical skills, knowledge, and independent patient care in the clinical training (1).
In China, the majority of the teaching work is conducted by the rst-line clinicians in the teaching hospital, who need to undertake the task of medical, scienti c research and teaching work at the same time.
Because of the potentially overwhelming of clinical work, attendance at a substantial teaching remains more di cult. Even more in recent years, the scienti c work occupied a certain amount of effort and proportion in daily work and career promotion evaluation, the hyper-competition for scienti c publications and grant funding in a liated hospital has become a debated discussion in China these years and has outsized negative effects on doctors to gain career promotion (2). Doctors tried to satisfy scienti c research requirement and failed to apply time on teaching, thus affect the teaching quality. This situation needs to be changed, therefore building a successful professional career in the teaching physician is rewarding but challenging, especially in the dynamic and competitive environment of today's modern society.
Career opportunities including development of career plans, focusing on career goals, implementation of career steps, and evaluation of career success. Ross.E believed that one of the rst issues was to resolve the need to better de ne the career expectations for individuals (3). With today's growing focus on the translation of basic science into clinical practice, the demand for teaching physician is likely to grow.
Thus teaching physician was specially categorized in Shanghai General Hospital a liated to Shanghai Jiao Tong University, which has led to multiple choice of career paths. Other career paths categories are clinical physician, scienti c physician, and combined clinical-scienti c physician, which are mainly focus on whose corresponding specialized regions. Nevertheless, no matter what type the doctor is, his main responsibility is to undertake clinical work. The hospital both provide promotion paths and require regular assessments for teaching physician. For teaching physicians, in addition to responsible for clinical medical diagnosis and treatment in daily work, at the same time they focus on teaching which required the doctors should be equipped with teaching methods. On the other hand, the participation of the clinicians in the teaching team has ensured excellent teachers with enthusiasm and improved the quality of teaching through training.
In this article, we de ned teaching physician category and take the reader through a potential framework for establishing duties and professional development for career advancement in graduate medical education. The primary aim of this study was to characterize the status of career promotion of teaching physicians in China in order to equip doctors with required teaching skills. Secondary aim was to assess the aptitude from students and doctors to teaching physicians and identify performance on teaching physicians. Thus 27 interview questions were based on current situation of teaching physician and their career development model that framed key elements associated with curriculum of evaluations, recommendation, interactions, memberships in organizations, continuing medical education. We also discuss the steps involved in percentage in clinical work, scienti c research, grant funding/awards/publications, and establishing methods to training in academic professional presentations. Our hypothesis is that there is a positive correlation between effect and belief in an educational eld.

Interview Administration
Our study included web-based questionnaires of the teachers and students in Shanghai General Hospital

Discussion
Teaching is an integral part of medicine and an essential clinical doctor responsibility, teaching physicians are vital to the graduate medical education. Teaching medical students and residents are key components of a doctor's role. Obviously, it is important that there are clear metrics for teaching excellence attributable to individual academic teaching performance. However, there remained to be explored that how teachers are formally prepared for their teaching role: Who are the ideal teachers? What are the teacher's day-to-day duties? What will be the major focus?
Graduate medical education (GME) de ned typical teaching physician' work including 3 main duties: delivering high quality, safe, and e cient patient care; providing comprehensive physicians-in-training education; and contributing to scholarship. Each of these duties has regulatory aspects with which the teaching physician must comply (1). Teaching physicians involves following these standards, they spend a great deal of time reviewing each patient's medical care accompanied by a resident who observes their activities (4). The residents even achieve competence through the efforts of teaching physicians, who are mentors, advisors, role models, instructors, evaluators, and safety o cers (1).
Thus, with today's focus on the translation of basic science discoveries into clinical practice, the demand for teaching physicians is growing. Teaching physicians play a central role in advancing residents initiatives and promoting a culture of education among new physicians. An educational teacher pathway is regarded as an independent area of specialization in teaching, which is an option for those who has the potential for teaching effort. In our investigation, 91.43% of the interviewers are from the teaching hospital, among them 40% are teaching physicians. 88.57% con rmed there are teaching physicians in their hospital, 71.43% felt it is necessary to set the type of teaching physician.
Frequently, as one considered to develop as medical educators, he established his priority and mission to be able to navigate his career. Especially for those who desire education as a major component of their careers should combine educational theory, operating, and simulation research. For example, we recommend the rst step for any developing surgeon educator is to master one's abilities as a surgeon, followed closely or simultaneously by mastering one's abilities as a teacher. Without the former though, the latter is of no use (5). Thus, surgeon educator should encompass and excellence in clinical surgery, and well integrate the science knowledge and skill acquisition into surgical training and administration since they are not only responsible for developing clinical skills, but also required to become adept at teaching. Additionally, some teaching physicians have speci c teaching responsibilities within their subdisciplines. As to the obstetrics and gynecology department, the surgical skills requires hand to hand teach, the professional goals of teaching physicians are to advise the best clinical and operative skills to residents in graduate medical education. Therefore, educational doctor should be equipped with experiences, perspectives, and skills that make them appealing in medical education nationally. Ultimately, an appointments, promotion system is not responsive to the needs of faculty working across clinical care and research, particularly when it comes to evaluating team may have trouble being promoted (3). The teaching physician is a part-time faculty member, they would even competition for funding from full-time PhD investigators (3). When investigators split their time between clinical activities and research, they are not likely to fully meet the target metrics of either full-time researchers or full-time clinicians. We analyzed interviewers' responses to these questions, even 68.57% of the respondents from programs thought the appropriate science research proportion of teaching physician should be 20%, which is corresponded with the evaluation for teaching physician's promotion in our hospital. 77.14% regarded the teaching physician should also be equipped with the scienti c research ability in order to teach students. While another 2.86% reported although scienti c research is important, the reason why they choose to be a teaching physician is to safe effort on scienti c research.
On the other hand, the hospital also recommended teaching grant funding/awards/publications as the speci c promotion requirements for teaching physician. Since it seems the recipients of grant funding were more successful in career promoting than those individuals without grant funding on most career achievement measures, in recent years, there existed the phenomenon that doctors only focus on teaching grant funding/awards/publications, but don't actually do teaching work. As more awards are made, the teaching physician faculty candidates increase career promotion and gain training, observation, or education in order to be fully successful. Most of us regarded the use of grants as promotion criteria is cruelly unfair, although 80% of respondents regarded that they should put emphasize on the actual teaching problems rather than take the level of grant funding/awards/publications as the only evaluation, 8.57% indicated 80% teaching physicians only focus on grant funding/awards/publications, while do not actually engage in teaching work. Thus 28.57% agreed the purpose to be educational doctor is for career promotion, so they regarded grant funding/reward/publication is the most important. The reason might be that 71.42% indicated they are happy to teach, however time is limited, they need to gain grant funding/awards/publications for career promotion instead of daily teaching work. 48.57% reported there is no other evaluation way, grant funding/awards/publications are fair in evaluation, only 22.86% believed it is very reasonable.
These above severe situation need to be changed, Mark Hayter believed that only focusing on publishing an internationally excellent paper or wining a large competitive research grant or even successfully supervise PhD students, ignore actual teaching, might be a dark art worthy of inclusion in education curriculum (6). In theory, it would be ideal for all surgical residency applicants to have high technical aptitude-among other nontechnical skills essential for the professional development of an effective surgeon (7). Development of skills to become a successful medical professional, including professional behavior, goal setting, establishing and maintaining self-esteem, time management and teamwork (8).
We referenced that perceived professional competence among clinical research coordinators recommended three career constructs including career engagement (CE), career planning (CP), and career satisfaction (CS) were selected to represent career orientation (9). Career engagement (CE) represented the degree of proactively exhibiting different career behaviors to enhance career development, is of theoretical, organizational, and personal importance (10). Career planning (CP) represents a facet of career self-management that includes setting clear career-related goals and developing speci c strategies needed to achieve those goals (11). Career satisfaction (CS) refers to an internally de ned indicator of career outcomes. Thus career goals would be relatively accepted within the current institutional culture on the medical curriculum committee if professional development opportunity was offered to teaching physicians. The distant goals focus on technology, educational theory, curriculum development, accreditation, assessment, feedback, quality improvement. Strategic career planning has recently entered the academic curriculum as part of faculty development educational programs.
Efforts to promote career satisfaction, reduce burnout, and facilitate retention need to be expanded beyond early career interventions and may need to be tailored by career stage. Previous literature has shown that dissatis ed physicians are also at higher risk for professional burnout, which is a potential barrier to successful health care reform (12). Therefore, we should also provide a way for teaching physicians to report their satisfaction when educating. It is through the development of clear, objectively measurable teaching related outputs and quality evidence that we can be unequivocal when we answer the question; 'who is the best teacher in your school'. Students' feedback and qualitative evaluations of their tutorial should also be available to judge teaching effectiveness and quality in individual promotion and career progression cases(6). In our investigation, regarding attitude towards integration through teaching, 34.29% greatly promoted, 57.14% have a positive effect. 48.57% believed the most important quality of an educational doctor were: devote to the teaching work, good at getting along with students, bene t students from clinical knowledge, while no one thought good at speeches and teaching competitions are the most important quality of an educational doctor. 34.29% agreed with the statement "Educational physician is important to guide the educational team". Furthermore, 74.29% indicated teaching physicians should update the teaching concept regularly to bring students new and meaningful teaching experience. As a sensitivity analysis, 40% observed teaching is related to the teacher's appearance, teaching state and speaking tone can be trained; 20% considered theoretical and clinical knowledge is more important. Then what is the difference between a teaching physician and general teacher? 74.29% felt teaching physician is both a teacher and doctor, who should be equipped with good theoretical and clinical knowledge. 17.14% indicated teaching physician is much more busier than no-medical teacher, who should ensure patients' safety during teaching.

Conclusion
Our study illustrates unique challenges for career teaching physicians. As more and more career opportunities and challenges arise during the next 10 years, teaching physicians will be better prepared by knowing the basic tenets of strategic career planning. This study has a number of limitations. There are areas for further research which are beyond the scope of this study. These could include consideration of differences between graduates of different type of doctors. Additionally, certi cations, continuing medical education, course evaluations, awards, and other potentially relevant information could be received later.

Consent for publication
Our work has not been published elsewhere in any other language previously, it is not under consideration for publication elsewhere. The publication of our work is approved by all authors and tacitly or explicitly by the responsible authorities. YY has made a signi cant contribution to the conception, design, execution, or interpretation of the reported study. All the authors ensured that we have written entirely original works.
Availability of data and materials The datasets used during the current study are available from the corresponding author on reasonable request.