Niches, Itches, and Medical Education

Stop for a moment and define the word, ‘niche’.

[ pause… ]

Do you have a niche? How did your niche become your niche? Was it always part of your DNA? Did a mentor inspire your niche? And why does it matter if you have a niche at all?

Image from

The Oxford Learners’ Dictionary defines ‘niche’ as, “a comfortable or suitable role, job, [or] way of life”. I favor this definition of niche because of the inclusion of the word, ‘comfortable’. One might be well-suited or well-trained to perform a specific job, but that doesn’t necessarily mean they enjoy their work or are comfortable in their role. Comfort implies happiness, authenticity, and -- potentially -- joy.

Medical educators encourage trainees and junior faculty members to identify professional niches that they can develop over time. The argument is simple: working in domains related to your clinical role adds variety to your day-to-day schedule. Variety is the spice of life, and in medicine, a variety of tasks may reduce professional burnout. 

Expertise in domains such as patient safety, research, administration, medical education, and quality improvement are all examples of professional niches that physicians pursue within medicine. Medical schools deliberately design longitudinal curricula that provide students with experiences in such domains. Both Stanford School of Medicine and Northwestern Feinberg School of Medicine offer ‘concentrations’ aimed at niche development.

Residency programs offer similar longitudinal curricula, however the outcomes of these programs take many years to study. Northwestern Emergency Medicine launched ‘The Academic Colleges’ program in 2006, with a focus on just three career paths: Research, Administration, and Education. Program evaluation of their Education College occurred after 10 years of ‘graduates’, through interviews with program alumni, faculty members, and current residents. Expertise in four areas of medical education were identified as key outcomes of the program: educator skills and learning theory, education research methodology, educational program administrative, and collaboration. Read more about this program evaluation published in AEM Education & Training in 2017.

If you are an educator who directs a similar ‘scholarly tracks’ program, consider how you might conduct an evaluation of your curriculum and identify meaningful, longitudinal, learning outcomes. Here are some program evaluation resources from BMJ 2003 and Medical Teacher 2012 (AMEE Guide No. 67) to get you started.

As for itches… Merriam Webster describes the relatively recent trend from NICH to NEESH. I’m sticking with niches and itches -- seems classic.

August 11, 2019

Co-Authors of Original Article: Benjamin Schnapp, MD, MEd – University of Wisconsin and Abra Fant, MD, MS - Northwestern University.