How important is money as a reward for teaching?

Exploring the viewpoint of faculty members of medical sciences universities about effective factors on their organizational retention: a qualitative study

BACKGROUND AND AIM

Faculty retention in medical sciences universities is one of the most important values for the survival of the educational system. This study aimed to explore the viewpoint of faculty members of medical sciences universities in Iran about effective factors affecting their organizational retention.

METHODS

Qualitative study using deep interviews collected by maximum variation sampling. A purposively selected sample of 15 faculty members was recruited throughout two Iranian medical sciences universities (Tehran University of Medical Sciences and Kerman University of Medical Sciences) during 2021-22.

RESULTS

Qualitative data analysis provided 3 main categories and 10 sub-categories. Three main categories were identified that affected the faculty's organizational retention included individual factors, institutional factors, and socio-political factors.

CONCLUSION

Factors that contribute to the improvement of faculty retention encompass various aspects. These include consideration given to the personal and social requirements of faculty members, support provided by the organization along with effective resource management, a fair and transparent organizational structure, and the maintenance of political stability both within the university and the nation.

Neglecting physician desires to teach at an academic medical facility: A mixed method investigation of the consequences

PURPOSE

Recent findings have suggested that physicians who spend more time participating in their most meaningful job activities (e.g. teaching) are less likely to experience burnout. The current study aimed to expound upon this finding, focusing specifically on the role of teaching in promoting meaning and preventing burnout.

METHOD

A total of 428 physicians at a large academic healthcare institution completed an online survey that included measures of burnout and other relevant variables. In the second part of this study, 20 physicians participated in interviews with the aim of expounding upon and contextualizing the findings from Part 1.

RESULTS

Results from Part 1 suggested that although meaningfulness derived from teaching was associated with reduced burnout, this association was only true for those who indicated that clinical teaching was among the most meaningful parts of being a physician. In addition, physicians were less likely to spend time working on their most meaningful job activity when it was teaching. Part 2 illustrated why teaching in the clinical environment can be so meaningful and protective against burnout.

CONCLUSIONS

Many physicians are unable to teach due to the increasing demands of medical institutions, which may contribute to the increasing levels of burnout in healthcare providers.

Assessing Physician Resident Contributions to Outpatient Clinical Workload

BACKGROUND

Graduate medical education is centered in hospitals despite a care system where patients mostly receive their care in an outpatient setting. Such gaps may exist because of inadequate funding for residency positions in community and hospital-based clinics.

OBJECTIVE

Determine if physician residents' contribution to outpatient workload offsets their costs for supervision, salary, and fringe benefits as residents acquire skills to become independent practitioners.

RESEARCH DESIGN

VA's electronic patient records from 2005 through 2018 were analyzed using generalized linear mixed models to estimate resident and staff contributions to workload in relative value units.

MEASURES

Resident participation rate is resident contributed workload net of supervision as a percent of total clinic workload. Productivity is per diem resident workload as a percent of per diem staff workload. Efficiency is per dollar resident workload as a percent of per dollar staff workload. Progressive independence is annual rate of change in resident productivity.

RESULTS

Average participation rates varied by specialty from 6% to 22%, with 11% (primary care) and 13% (psychiatry). Productivity rates ranged from 21% to 94%, with 57% (primary care) and 61% (psychiatry). Efficiency rates varied from 0.63 to 3.81, with 1.69 (primary care), 1.89 (psychiatry). Progressive independence rates varied from 2.7%/year (psychiatry) to 39.7%/year (specialty care).

CONCLUSIONS

Although residents rotating through most VA clinics generate revenue to cover their direct costs as they learn, some federal subsidies may be necessary to encourage hospital- and community-based clinics to accept residents from the less profitable primary care and mental health specialties.

How does the introduction of a new year three GP curriculum affect future commitment to teach? An evaluation using a realist approach

In western countries, there is a trend towards increasing amounts of undergraduate medical education being delivered in General Practice (GP). However, many medical schools report difficulties with the recruitment and retainment of GP clinical teachers. Newcastle University recently introduced a new year three GP curriculum, involving an increased quantity of community-based teaching and changes to the responsibilities of GP clinical teachers. We sought to explore and explain how this curricular change affects the future teaching commitment of year three GP clinical teachers. We adopted a realist approach. We firstly developed a candidate theory of how the new curriculum may affect future teaching commitment. Data collection and analysis then involved interviews of 10 GP teachers to refine this theory and produce a final Programme Theory. The results suggest that different teachers are affected in different ways, influenced by practice and individual contexts. Some parts of the new curriculum tend to reduce future teaching commitment, whereas other aspects tend to increase commitment. Mechanisms include changes to autonomy and sense of value. The results allow medical schools to better understand how GP teacher retention can be facilitated during curricular change. We make numerous recommendations, including advocating a team-based approach to teaching, paying attention to teacher autonomy, and considering patient contact in relation to generalist, primary care-orientated medicine as a core component of GP teaching.

Adapting Teaching to the Clinical Setting

Adapting teaching to the clinical setting is most successful when the teacher and trainee are able to work alongside of each other allowing the cognitive apprenticeship model to be embraced. Six tools of experiential learning as components of this framework are described including scaffolding, modeling, coaching/supervision, articulation, reflection, and exploration. These tools provide useful guidance for supervisors to teach in clinical settings. Inherent in this process is the concept of validation of the trainees and includes the importance of supervisors cultivating nonjudgmental acceptance of themselves. Optimal teaching and learning in the clinical environment requires investment of time and resources.

Changes to the ACGME Common Program Requirements and Their Potential Impact on Emergency Medicine Core Faculty Protected Time

The Accreditation Council for Graduate Medical Education (ACGME), which regulates residency and fellowship training in the United States, recently revised the minimum standards for all training programs. These standards are codified and published as the Common Program Requirements. Recent specific revisions, particularly removing the requirement ensuring protected time for core faculty, are poised to have a substantial impact on emergency medicine training programs. A group of representatives and relevant stakeholders from national emergency medicine (EM) organizations was convened to assess the potential effects of these changes on core faculty and the training of emergency physicians. We reviewed the literature and results of surveys conducted by EM organizations to examine the role of core faculty protected time. Faculty nonclinical activities contribute greatly to the academic missions of EM training programs. Protected time and reduced clinical hours allow core faculty to engage in education and research, which are two of the three core pillars of academic EM. Loss of core faculty protected time is expected to have detrimental impacts on training programs and on EM generally. We provide consensus recommendations regarding EM core faculty clinical work hour limitations to maintain protected time for educational activities and scholarship and preserve the quality of academic EM.

The North Carolina Community Preceptor Experience: Third Study of Trends Over 12 Years

PURPOSE

To measure community-based preceptors' overall satisfaction and motivations, the influence of students on preceptors' practices, and compare with 2005 and 2011 studies.

METHOD

North Carolina primary care preceptors across disciplines (physicians, pharmacists, advanced practice nurses, physician assistants) received survey invitations via e-mail, fax, postcard, and/or full paper survey. Most questions in 2017 were the same as questions used in prior years, including satisfaction with precepting, likelihood to continue precepting, perceived influence of teaching students in their practice, and incentives for precepting. A brief survey or phone interview was conducted with 62 nonresponders. Chi-square tests were used to examine differences across discipline groups and to compare group responses over time.

RESULTS

Of the 2,786 preceptors contacted, 893 (32.1%) completed questionnaires. Satisfaction (816/890; 91.7%) and likelihood of continuing to precept (778/890; 87.4%) remained unchanged from 2005 and 2011. However, more preceptors reported a negative influence for patient flow (422/888; 47.5%) in 2017 than in 2011 (452/1,266; 35.7%) and 2005 (496/1,379; 36.0%) (P < .0001), and work hours (392/889; 44.1%) in 2017 than in 2011 (416/1,268; 32.8%) and 2005 (463/1,392; 33.3%) (P < .0001). Importance of receiving payment for teaching increased from 32.2% (371/1,152) in 2011 to 46.4% (366/789) in 2017 (P < .0001).

CONCLUSIONS

This 2017 survey suggests preceptor satisfaction and likelihood to continue precepting have remained unchanged from prior years. However, increased reporting of negative influence of students on practice and growing value of receiving payment highlight growing concerns about preceptors' time and finances and present a call to action.

Do Academic Health Care Systems Really Value Education? A Survey of Academic Plastic Surgeons

BACKGROUND

Although education is critical to the mission of academic medical centers in the United States, it is often not quantified and monetized as are their research and clinical missions. We undertook this survey to assess the perceived valuation of educational endeavors of plastic surgeon faculty at the U.S. academic medical centers.

METHODS

A survey using Qualtrics software (Qualtrics, Provo, UT) was distributed to faculty members of the American Council of Academic Plastic Surgeons by electronic mail in February 2015. A total of 16 questions included both demographic information and Likert-item questions of perception of valuation of educational activities. For analysis, responses were grouped according to an adapted Net Promoter Score including "unsupportive" (0-6), "neutral" (7-8), and "supportive" (9-10).

RESULTS

Sixty-five surveys were completed out of a total of 406, with an overall response rate of 16%. Kruskal-Wallis statistical analysis demonstrated that region and rank were not significant in perception of hospital or departmental support for educational activities. Respondents rated their departments as more supportive than their institutions (P < 0.05), and average perceived value rating of institutions was "unsupportive." Financial support was associated with higher ratings with respect to support of institutions and departments. Mid-career faculty displayed a trend toward lower ratings of perception of support.

CONCLUSIONS

The majority of respondents perceived their institutions and departments as unsupportive of educational effort. Direct compensation to physicians for teaching efforts may improve faculty retention in academia and reduce physician burnout.

Recruitment and Retention of Community Preceptors

BACKGROUND

Recruiting and retaining community-based pediatricians for teaching medical students has been explored through the lens of preceptors and educational leaders. The purpose of this study was to explore the perspective of pediatric department chairs, a key stakeholder group charged with maintaining teaching capacity among a faculty.

METHODS

In 2015, members of the Association of Medical School Pediatric Department Chairs and Council on Medical Student Education in Pediatrics joint task force disseminated a 20-item survey to pediatric department chairs in the United States and Canada. Topics included demographics, incentives offered to community pediatricians, and the perceived value and feasibility of such incentives. Data were analyzed using descriptive statistics and χ² to compare categorical variables.

RESULTS

Pediatric department chairs from 92 of 145 (63% response rate) medical schools returned the survey. Sixty-seven percent reported difficulty recruiting or retaining preceptors, and 51% reported high-reliance on preceptors for the ambulatory portion of the pediatrics clerkship. Almost all (92%) cited competition from other programs for the services of community preceptors. The provision of incentives was correlated with perceived feasibility (R² = 0.65) but not their perceived value (R² = 0.12). Few (21%) chairs reported providing financial compensation to preceptors. The provision of compensation was not related to reliance but did vary significantly by geographical region (P < .001).

CONCLUSIONS

Pediatric departments rely heavily on community-based pediatricians but face competition from internal and external training programs. The perspective of department chairs is valuable in weighing interventions to facilitate continued recruitment and retention of community preceptors.

Can state-supported interprofessional coalitions cure preceptor shortages?

The shortage of clinical preceptors compromises the current and future supply of healthcare providers and patient access to primary care. This article describes how an interprofessional coalition in South Carolina formed and sought government support to address the preceptor shortage. Some states have legislated preceptor tax credits and/or deductions to support the clinical education of future primary care healthcare providers. As a result of the coalition's work, a bill to establish similar incentives is pending in the South Carolina legislature.

Resources Used to Teach the Physical Exam to Preclerkship Medical Students: Results of a National Survey

PURPOSE

To examine resources used in teaching the physical exam to preclerkship students at U.S. medical schools.

METHOD

The Directors of Clinical Skills Courses developed a 49-question survey addressing resources and pedagogical methods employed in preclerkship physical exam curricula. The survey was sent to all 141 Liaison Committee on Medical Education-accredited medical schools in October 2015. Results were averaged across schools, and data were weighted by class size.

RESULTS

Results from 106 medical schools (75% response rate) identified a median of 59 hours devoted to teaching the physical exam. Thirty-eight percent of time spent teaching the physical exam involved the use of standardized patients, 30% used peer-to-peer practice, and 25% involved examining actual patients. Approximately half of practice time with actual patients was observed by faculty. At 48% of schools (51), less than 15% of practice time was with actual patients, and at 20% of schools (21) faculty never observed students practicing with actual patients. Forty-eight percent of schools (51) did not provide compensation for their outpatient clinical preceptors.

CONCLUSIONS

There is wide variation in the resources used to teach the physical examination to preclerkship medical students. At some schools, the amount of faculty observation of students examining actual patients may not be enough for students to achieve competency. A significant percentage of faculty teaching the physical exam remain uncompensated for their effort. Improving faculty compensation and increasing use of senior students as teachers might allow for greater observation and feedback and improved physical exam skills among students.

Factors connected with professional satisfaction and dissatisfaction among nutrition teacher

Teacher satisfaction can be reflected in the success of higher education institutions to provide meaningful learning to their students. This study analyzed the professional satisfaction of nutrition teachers at a federal institution of higher education by identifying the factors that generated satisfaction and dissatisfaction for them and also the feelings that they envisioned for themselves at the end of their careers. This is a descriptive and exploratory study with a qualitative approach. A questionnaire and semi-structured interviews were performed. The results showed that 72.7% of the teachers were satisfied with their profession. In relation to satisfaction were considered: the fulfillment of a vocation; research and extension activities; the development and recognition of students and society; learning; autonomy; flexibility; and relationships with students. In relation to dissatisfaction were considered: overloading due to work, administration, bureaucratic duties and assistance; lack of interest and respect from students; relationships with colleagues and managers; devaluation in the role of teaching; large classes and poor physical infrastructure. The respondents expressed a positive attitude and had no desire to leave their profession. Further studies are required regarding factors leading to satisfaction and dissatisfaction for teachers, in order to contribute to their productivity and well-being.

Recruiting and Retaining Community-Based Preceptors: A Multicenter Qualitative Action Study of Pediatric Preceptors

PURPOSE

The recruitment and retention of community preceptors to teach medical students is difficult. The authors sought to characterize the underlying motivational factors for becoming a preceptor and to identify strategies for recruiting and retaining community-based pediatric preceptors.

METHOD

This multicenter qualitative action study included semistructured interviews with community-based pediatric preceptors affiliated with 12 institutions from August to December 2015. Only active preceptors were included, and participating institutions were diverse with respect to geographic location and class size. Interviews were conducted over the telephone and transcribed verbatim. Six investigators used deidentified transcripts to develop a codebook. Through a constant comparative method, codes were revised as data were analyzed and disagreements were resolved through discussion. All investigators organized the themes into dimensions.

RESULTS

Fifty-one preceptors were interviewed. Forty-one themes coalesced into four dimensions: (1) least liked aspects of teaching, (2) preparation to teach, (3) inspiration to teach, and (4) ways to improve recruitment and retention. Time constraints and patient care demands were the most commonly cited deterrents to teaching. Successful preceptors balanced their clinical demands with their desire to teach using creative scheduling. External rewards (e.g., recognition, continuing medical education credit) served as incentives. Internal motivation inspired participants to share their enthusiasm for pediatrics and to develop longitudinal relationships with their learners.

CONCLUSIONS

Changes in health care delivery have imposed more time constraints on community-based preceptors. However, this study identified underlying factors motivating physicians to volunteer as preceptors. Strategies to recruit new and retain current preceptors must be collaborative.

Why do surgeons teach? A qualitative analysis of motivation in excellent surgical educators

INTRODUCTION

Given that teaching is so vital to the maintenance of the medical profession, it is surprising that few authors have examined the factors which motivate physicians and surgeons to engage in this activity.

AIM

It was the aim of this study to examine the factors which motivate excellent surgical educators to teach.

METHODOLOGY

Grounded theory methodology was used to analyze transcribed semi-structured interviews. The top 20 ranked surgical educators at the University of Alberta were invited to participate. In total, 15 surgeons of various specialties were interviewed.

RESULTS

There were five main factors which motivate surgeons to teach. These were: (1) a sense of responsibility to teach future physicians (2) an intrinsic enjoyment of teaching (3) the need to maintain and expand one's own knowledge base (4) watching students develop into competent practicing physicians and playing a role in their success, and (5) fostering positive lifelong professional relationships with learners.

DISCUSSION

This is the first study in surgery to use an explorative qualitative methodology. This framework of motivating factors can be used to guide professional development activities. The framework represents motivating factors for those known to be effective teachers only. We plan to use this information to engage more surgeons in teaching by providing a basis for promoting education as part of a busy surgical practice.

Exploring the Teaching Motivations, Satisfaction, and Challenges of Veterinary Preceptors: A Qualitative Study

Optimization of clinical veterinary education requires an understanding of what compels veterinary preceptors in their role as clinical educators, what satisfaction they receive from the teaching experience, and what struggles they encounter while supervising students in private practice. We explored veterinary preceptors' teaching motivations, enjoyment, and challenges by undertaking a thematic content analysis of 97 questionnaires and 17 semi-structured telephone interviews. Preceptor motivations included intrinsic factors (obligation to the profession, maintenance of competence, satisfaction) and extrinsic factors (promotion of the veterinary field, recruitment). Veterinarians enjoyed observing the learner (motivation and enthusiasm, skill development) and engaging with the learner (sharing their passion for the profession, developing professional relationships). Challenges for veterinary preceptors included variability in learner interest and engagement, time management, and lack of guidance from the veterinary medicine program. We found dynamic interactions among the teaching motivations, enjoyment, and challenges for preceptors. Our findings suggest that in order to sustain the veterinary preceptor, there is a need to recognize the interplay between the incentives and disincentives for teaching, to foster the motivations and enjoyment for teaching, and to mitigate the challenges of teaching in community private practice.

Benefits and barriers among volunteer teaching faculty: comparison between those who precept and those who do not in the core pediatrics clerkship

BACKGROUND

Community-based outpatient experiences are a core component of the clinical years in medical school. Central to the success of this experience is the recruitment and retention of volunteer faculty from the community. Prior studies have identified reasons why some preceptors volunteer their time however, there is a paucity of data comparing those who volunteer from those who do not.

METHODS

A survey was developed following a review of previous studies addressing perceptions of community-based preceptors. A non-parametric, Mann-Whitney U test was used to compare active preceptors (APs) and inactive preceptors (IPs) and all data were analyzed in SPSS 20.0.

RESULTS

There was a 28% response rate. Preceptors showed similar demographic characteristics, valued intrinsic over extrinsic benefits, and appreciated Continuing Medical Education (CME)/Maintenance of Certification (MOC) opportunities as the highest extrinsic reward. APs were more likely to also precept at the M1/M2 level and value recognition and faculty development opportunities (p<0.05). IPs denoted time as the most significant barrier and, in comparison to APs, rated financial compensation as more important (p<0.05).

CONCLUSIONS

Community preceptors are motivated by intrinsic benefits of teaching. Efforts to recruit should initially focus on promoting awareness of teaching opportunities and offering CME/MOC opportunities. Increasing the pool of preceptors may require financial compensation.

A 3-year medical curriculum

The cost of medical education keeps rising while physician shortages loom, student diversity is threatened, and maldistribution continues to affect the physician workforce. The author discusses the rationale for a 3-year undergraduate medical curriculum with reduced costs and proposes a structure with funding for it. Medical educators may consider the issues raised and continue scholarly discussion to promote sustainable, cost effective medical education to address future physician workforce needs.

The present conditions of clinical clerkship management in Korea

PURPOSE

This study investigated the present conditions of clinical clerkship management in Korea to make recommendations for it.

METHODS

The data were collected between April 15 and May 30 in 2009 using questionnaires that were sent to the clerkship directors of 41 colleges of medicine and medical graduate schools.

RESULTS

The elective course system was established in 78% of the institutions; the 6 core specialties were found in all medical schools. The duration of clerkship was longest in internal medicine, followed by surgery, pediatrics, obstetrics and gynecology, psychiatry, and emergency medicine. There were differences between the planning and monitoring agencies. Preclinical courses existed in 92.7% of the institutions. However, much more remains to be done ie, with regard to the issues of student assessment in clinical clerkship, faculty development programs for the faculty and residents, incentive systems for educational involvement, provisions for yearly systematic clerkships, integration of basic-clinical science-medical humanities, and community-based education.

CONCLUSION

Because clinical clerkship education is very important as a core curriculum, curriculum planning and its management must be given adequate attention. The following measures are suggested: elective systems that allow students to choose by career planning; concerns over faculty development programs for residents as a teacher; consensus on the concept, objectives, duration, content, evaluation tools of pre-clinical clerkship and clinical clerkship, and student well-being; and emphasis on community-based education.