Rewards for teaching excellence: practice in South African medical schools

Prioritizing Clinical Teaching Excellence: A Hidden Curriculum Problem

There have been many initiatives to improve the conditions of clinical teachers to enable them to achieve clinical teaching excellence in Academic Medical Centres (AMC). However, the success of such efforts has been limited due to unsupportive institutional cultures and the low value assigned to clinical teaching in comparison to clinical service and research. This forum article characterizes the low value and support for clinical teaching excellence as an expression of a hidden curriculum that is central to the cultural and structural etiology of the inequities clinical teachers experience in their pursuit of clinical teaching excellence. These elements include inequity in relation to time for participation in faculty development and recognition for clinical teaching excellence that exist within AMCs. To further compound these issues, AMCs often engage in the deployment of poor criteria and communication strategies concerning local standards of teaching excellence. Such inequities and poor governance can threaten the clinical teaching workforce's engagement, satisfaction and retention, and ultimately, can create negative downstream effects on the quality of patient care. While there are no clear normative solutions, we suggest that the examination of local policy documents, generation of stakeholder buy-in, and a culturally sensitive, localized needs assessment and integrated knowledge translation approach can develop a deeper understanding of the localized nature of this problem. The findings from local interrogations of structural, cultural and process problems can help to inform more tailored efforts to reform and improve the epistemic value of clinical teaching excellence. In conclusion, we outline a local needs assessment plan and research study that may serve as a conceptually generalizable foundation that could be applied to multiple institutional contexts.

Attributes of excellent clinician teachers and barriers to recognizing and rewarding clinician teachers' performances and achievements: a narrative review

BACKGROUND

Over the last 31 years, there have been several institutional efforts to better recognize and reward clinician teachers. However, the perception of inadequate recognition and rewards by clinician teachers for their clinical teaching performance and achievements remains. The objective of this narrative review is two-fold: deepen understanding of the attributes of excellent clinician teachers considered for recognition and reward decisions and identify the barriers clinician teachers face in receiving recognition and rewards.

METHODS

We searched OVID Medline, Embase, Education Source and Web of Science to identify relevant papers published between 1990 and 2020. After screening for eligibility, we conducted a content analysis of the findings from 43 relevant papers to identify key trends and issues in the literature.

RESULTS

We found the majority of relevant papers from the US context, a paucity of relevant papers from the Canadian context, and a declining international focus on the attributes of excellent clinician teachers and barriers to the recognition and rewarding of clinician teachers since 2010. 'Provides feedback', 'excellent communication skills', 'good supervision', and 'organizational skills' were common cognitive attributes considered for recognition and rewards. 'Stimulates', 'passionate and enthusiastic', and 'creates supportive environment', were common non-cognitive attributes considered for recognition and rewards. The devaluation of teaching, unclear criteria, and unreliable metrics were the main barriers to the recognition and rewarding of clinician teachers.

CONCLUSIONS

The findings of our narrative review highlight a need for local empirical research on recognition and reward issues to better inform local, context-specific reforms to policies and practices.

Twelve tips for turning quality assurance data into undergraduate teaching awards: A quality improvement and student engagement initiative

Data on teaching awards in undergraduate medical education are sparse. The benefits of an awards system may seem obvious at first glance. However, there are also potential problems relating to fairness, avoidance of bias, and alignment of the awards system with a wider strategy for quality improvement and curriculum development. Here, we report five- year single center experience with establishing undergraduate teaching awards in a large academic teaching hospital. Due to lack of additional funding we based our awards not on peer review but mainly on existing and very comprehensive quality assurance (QA) data. Our 12 tips describe practical points but also pitfalls with awards categories and criteria, advertising and disseminating the awards, the actual awards ceremony and finally embedding the awards in the hospital's wider strategy. To be truly successful, teaching awards and prizes need to be carefully considered, designed and aligned with a wider institutional strategy of rewarding enthusiastic educators.

The design and utility of institutional teaching awards: a literature review

BACKGROUND

Institutional teaching awards have been used widely in higher education since the 1970s. Nevertheless, a comprehensive review of the literature on such awards has not been published since 1997.

AIM

We conducted a literature review to learn as much as possible about the design (e.g., formats, selection processes) and utility (e.g., impact on individuals and institutions) of teaching awards in order to provide information for use in designing, implementing, or evaluating award programs.

METHODS

We searched electronic databases for English-language publications on awards for exemplary teaching. Targeted publications included descriptions and/or investigations of award programs, their impact, and theoretical or conceptual models for awards programs. Screening was conducted by dual review; a third reviewer was assigned for disagreements. Data were analyzed qualitatively. Results were summarized descriptively.

RESULTS

We identified 1302 publications for initial relevancy screening by title and abstract. We identified an additional 23 publications in a follow-up search. The full text of 126 publications was reviewed for further relevance. A total of 62 publications were identified as relevant, and of these 43 met our criteria for inclusion. Of the 43, 19 described the design features of 24 awards; 20 reports discussed award utility. Nomination and selection processes and benefits (e.g., plaques) varied as did perceived impact on individuals and institutions.

CONCLUSION

Limited evidence exists regarding design and utility of teaching awards. Awards are perceived as having potential for positive impact, including promotions, but may also have unintended negative consequences. Future research should investigate the impact of awards on personal and professional development, and how promotion and tenure committees perceive awards.

Student perceptions of evaluation in undergraduate medical education: A qualitative study from one medical school

BACKGROUND

Evaluation is an integral part of medical education. Despite a wide use of various evaluation tools, little is known about student perceptions regarding the purpose and desired consequences of evaluation. Such knowledge is important to facilitate interpretation of evaluation results. The aims of this study were to elicit student views on the purpose of evaluation, indicators of teaching quality, evaluation tools and possible consequences drawn from evaluation data.

METHODS

This qualitative study involved 17 undergraduate medical students in Years 3 and 4 participating in 3 focus group interviews. Content analysis was conducted by two different researchers.

RESULTS

Evaluation was viewed as a means to facilitate improvements within medical education. Teaching quality was believed to be dependent on content, process, teacher and student characteristics as well as learning outcome, with an emphasis on the latter. Students preferred online evaluations over paper-and-pencil forms and suggested circulating results among all faculty and students. Students strongly favoured the allocation of rewards and incentives for good teaching to individual teachers.

CONCLUSIONS

In addition to assessing structural aspects of teaching, evaluation tools need to adequately address learning outcome. The use of reliable and valid evaluation methods is a prerequisite for resource allocation to individual teachers based on evaluation results.

Medical education in sub-Saharan Africa: a literature review

OBJECTIVES

This review synthesises research published in the traditional and 'grey' literature to promote a broader understanding of the history and current status of medical education in sub-Saharan Africa (SSA).

METHODS

We performed an extensive review and analysis of existing literature on medical education in SSA. Relevant literature was identified through searches of five traditional medical databases and three non-traditional or grey literature databases featuring many African journals not indexed by the traditional databases. We focused our inquiry upon three themes of importance to educators and policymakers: innovation; capacity building, and workforce retention.

RESULTS

Despite the tremendous heterogeneity of languages and institutions in the region, the available literature is published predominantly in English in journals based in South Africa, the UK and the USA. In addition, first authors usually come from those countries. Several topics are thoroughly described in this literature: (i) human resources planning priorities; (ii) curricular innovations such as problem-based and community-based learning, and (iii) the 'brain drain' and internal drain. Other important topics are largely neglected, including: (i) solution implementation; (ii) programme outcomes, and (iii) the development of medical education as a specialised field of inquiry.

CONCLUSIONS

Medical education in SSA has undergone dramatic changes over the last 50 years, which are recorded within both the traditionally indexed literature and the non-traditional, grey literature. Greater diversity in perspectives and experiences in medical education, as well as focused inquiry into neglected topics, is needed to advance medical education in the region. Lessons learned from this review may be relevant to other regions afflicted by doctor shortages and inequities in health care resulting from inadequate capacity in medical education; the findings from this study might be used to inform specific efforts to address these issues.

Maximizing the value of feedback for individual facilitator and faculty development in a problem-based learning curriculum

BACKGROUND

Recruiting and retaining facilitators in problem-based learning requires considerable staff development. Providing meaningful feedback to individual facilitators should contribute to improved management of the tutorial group.

AIM

To ascertain the value ascribed by facilitators to feedback they received (based on student input) regarding their performance in the small group tutorial in a new problem-based learning curriculum.

METHODS

Thirty-seven facilitators from a purposive sample, selected for their facilitation experience during the 2001-2003 period, completed a comprehensive survey regarding their experiences. The aspect currently being reported deals with the perceived usefulness of the feedback they received from students and from Faculty following the evaluation of their participation in the small group tutorial. Data are reported for medically qualified and non-medically qualified facilitators.

RESULTS

Both clinical (50%) but more notably the non-clinical (70%) facilitators found the feedback (individual facilitator and general report) useful. Facilitators generally preferred the qualitative comments provided by students in the open-ended section of the evaluation to the Likert scale items. Student comments were valued for the specific direction they offered facilitators to reflect and improve on their management of the small group. For this feedback to be more useful, however, facilitators believed that it needed to be completed by more students who took time to critically engage with the criteria and reflect more honestly on their experiences. In addition, facilitators requested for feedback reports to be made available sooner such that they could improve their facilitation skills for the next group of students.

CONCLUSIONS

Both qualitative and quantitative feedback are important for facilitator development and training. While quantitative feedback is important for summative purposes (e.g. quality assurance and promotion), individual student comments provide more formative feedback, allowing facilitators to reflect on and improve their management of the small group. In order for the feedback to be valid, the majority of students had to participate. Facilitators should receive feedback in time to allow them to modify their activities for the new group.

The development of a more equitable approach to resource allocation and manpower planning for undergraduate teaching in a UK medical school

CONTEXT

Resource allocation and manpower planning in the clinical faculty of a UK medical school.

PURPOSE

To design a model, which is perceived to be fair, to determine indicative undergraduate teaching budgets to departments within the school from university resources and to specialty care groups of the main university hospital from service increment for teaching (SIFT) resources, and to aid manpower planning.

METHOD

The student load for each department is measured in full-time-equivalent student numbers (FTEs) for each specialty and compared with the total load for the whole curriculum to derive each department's percentage share of available undergraduate teaching resources. Data on staff numbers available for teaching, both from the school and NHS, are also included. Student load and teaching capacity are then compared.

RESULT

Undergraduate teaching resources relate to student load in the resource allocation process, and changes to the course are automatically reflected. Staff data, when compared with student load, facilitate rational planning of establishment levels to meet the teaching needs of the undergraduate curriculum. Of the respondents to a survey of heads of departments and the faculty's management board, 88% agreed that it was a better approach to resource allocation than the previous historical basis. PRESENT LIMITATIONS AND SCOPE FOR DEVELOPMENT: Data are currently entered manually but will be transmitted electronically in the future via the Web. Further consideration will be given to the possible inclusion in the model of weighting factors for different types of teaching and to how appropriate measures of quality may be incorporated into the resource allocation process.

CONCLUSION

The model, despite some limitations, is a cost-effective and pragmatic management tool.

Profile of medical student teaching in radiology: teaching methods, staff participation, and rewards

RATIONALE AND OBJECTIVES

The purpose of this study was to collect demographic information about radiology departments and rewards for teaching activities, as well as the impact of new digital imaging methods on teaching.

MATERIALS AND METHODS

Two surveys were conducted of directors of medical school clerkships in radiology. The initial survey focused on numbers of staff and students, courses taught, and perception of rewards for teaching. The follow-up survey more specifically addressed teaching methods.

RESULTS

Sixty-nine (50%) of the initial surveys sent to 139 departments and 46 (39% of a total of 119) of the follow-up surveys were returned. Clerkship directors spent an average of 9 hours per week teaching and performing administrative tasks, with most given no additional time off. Eighty-four percent of departments provide either no or insignificant rewards for teaching. Many departments have integrated the use of computers in teaching, and most have computers that students use during the radiology course. At the same time, digital imaging and picture archiving and communication systems (PACS) are used, or will be used within 1 year, in most departments.

CONCLUSION

Clerkship directors receive little compensation in terms of time and rewards for medical student teaching. Teaching methods are evolving in response to the increasing use of computers, digital imaging, and PACS for at least part of the workload in most radiology departments.