Recognizing clinical faculty's contributions in education.

OBJECTIVE: A faculty productivity profile system was designed to recognize faculty's contributions to administrative, educational, and research activities. It has long been recognized that clinical faculty receive little recognition or compensation for their efforts in education. Our surgery department previously had in place a recognition program for research achievements, but not for educational contributions. The new system was designed to recognize and reward all aspects of faculty contributions, including education. DESCRIPTION: The faculty productivity profile is a simple Excel document sent to each faculty member once a year. We piloted the program for the first time in 2001, recognizing faculty's contributions for the previous year. The pilot began with the formation of a committee whose first function was to identify all possible opportunities for faculty to participate as educators at our institution. This included giving lectures, participating in faculty development programs, serving as mentors, interviewing student or resident candidates, serving in administrative educational roles (e.g., clerkship or residency director), giving oral exams, or attending conferences and journal club. The committee then developed a point scale assigning each activity or contribution a value on a scale of 0-25. Each activity was then listed on the Excel form. Faculty were to fill in the number of times each activity was performed and this was multiplied by the points to obtain a weighted value. Point values for conferences were determined by percentage of conferences attended for a year (i.e., for grand rounds, those attending 0-49%, 50-75%, 75-90%, and more than 90% received 0, 20, 40, and 60 points, respectively). Points were also assigned for teaching awards and high scores on student and resident evaluations. After approval by the committee and the department chairman, the form was presented at a faculty meeting. Each faculty member then received a floppy disk with the form and was asked to complete the form and attach a supporting copy of his or her CV. The form required only input of numbers or a "yes" or "no." After submission, the clerkship coordinator input additional data from a database of conference attendance and student evaluations. Points were then calculated for each faculty member based upon his or her contributions and each activity's weighted value. A dinner was held to recognize outstanding faculty contributions. All faculty completing the form were invited and recognized and those with outstanding contributions received awards. DISCUSSION: Teaching medical students and residents is a rewarding experience; however, it requires significant time and effort. Faculty who feel their contributions are unrecognized may be more likely to burn out and less likely to continue contributing. We believe it is worthwhile to recognize faculty contributions in all areas, including education. Our pilot program had excellent participation due to the ease of using the form. We believe it has improved faculty morale and willingness to participate. We are continuing the program and plan to evaluate its impact on encouraging continued participation in teaching.     

Beyond borders: building global health programs at McGill University Faculty of Medicine.

Globalization has irrevocably altered the determinants of health as well as the delivery of health care. Although these changes have been increasingly recognized by governments and funding agencies, and despite the large and growing interest in global health topics among faculty and students, many medical educational programs lack courses or programs in this important area. At McGill University Faculty of Medicine, the Global Health Programs (GHP) were established to build research and training capacity in global health locally and internationally, to stimulate individuals to work in related fields and topics, and to facilitate partnerships with institutions around the world. These goals are addressed through programs that foster communication among interested faculty and students; provide resources such as project databases and easily accessed, centrally located reference materials; and provide both financial and consultative support for faculty and student initiatives. Important lessons learned in building GHP at McGill include (1) the need for a dedicated senior faculty member to lead the program while promoting activities and initiatives, (2) the need for resources to begin new projects, and (3) a willingness to work with others to achieve common goals. Most medical schools already have faculty engaged in and students interested in global health activities. By bringing interested individuals together with a modest infusion of additional resources and creativity, it is possible to develop programs that provide exciting global health educational opportunities for the medical school community and beyond.     

The relation of faculty academic activity to financing sources in a department of medicine

Academic medical departments confront important changes in funding sources and consequent pressure to change faculty activities. Valid information has often been lacking concerning the existing relations of faculty activity to funding sources. We examined those relations in the Stanford Department of Medicine through a combination of randomized observations of faculty and faculty self-reports over a period of one year. For an average 62-hour workweek, there was approximate consonance between types of activities and sources of salary support. Sensitivity analyses indicated that even sizable errors in self-reports would not have changed the outcomes substantially. Over 60 per cent of the activity involved "joint products," representing two or more categories of activity. There was wide variation in activities and fund sources between divisions. Per full-time faculty equivalent, research generated far more income than the most lucrative specialty practice; thus, at least in this type of department, attempts to compensate for lost research revenue by intensifying clinical practice will probably fail and undermine present research activities. The method of analysis used here may be useful in improving prospective planning by departments and by larger medical-policy bodies, particularly in the public sector.     

Changing environment and the academic medical center: the Johns Hopkins School of Medicine

Both academic and economic goals must be served by the academic health center. In response to ongoing stresses on medicine, the Johns Hopkins School of Medicine and the Johns Hopkins Hospital rapidly developed and implemented an expanded system of medical care. Vertical integration included provision of both acute and chronic care facilities and both primary and specialty care, as well as insurance products, in particular a health maintenance organization. Horizontal integration was accomplished by acquisition of or affiliation with other hospitals. The realignment of medical resources and patients shifted the locus of medical education somewhat, from the traditional hospital setting to the ambulatory care setting (in which many students and residents will eventually practice anyway). In addition, many physicians in the new settings are not traditional Johns Hopkins faculty members. Results of educational efforts in these altered circumstances so far have been mixed, partly because the capacity of the individual center to train students and residents is necessarily limited, and the fragmentation of the system makes inevitable problems of quality control and management. These issues are being worked out. The drain on faculty resources for research imposed by the need to expand clinical practice has been offset by a system of awards for research to faculty members. Efforts are being made to sustain the excellence of the traditional Johns Hopkins faculty's reputation while assuring doctors newly affiliated with the Hopkins system that they are no less important to the system. Opportunities to learn and to teach more economical medicine while retaining quality are discussed.     

California dreaming? A new start for regenerative medicine in the Golden State. Interview with Dr. Zach Hall

The California Institute for Regenerative Medicine (CIRM) was established in 2004 with the passage of Proposition 71, the California Stem Cell Research and Cures Initiative. The statewide ballot measure, which provided US$3 billion in funding for stem cell research at California universities and research institutions, was approved by California voters, and called for the establishment of an entity to make grants and provide loans for stem cell research, research facilities and other vital research opportunities. Here, Dr Zach Hall, Interim President of the CIRM, outlines the ethos and aspirations of the CIRM to Regenerative Medicine. Dr Hall trained as a basic neuroscientist and became a faculty member and department chair at the University of California, San Francisco. In 1994, he was appointed Director of National Institute of Neurological Disorders and Stroke within the National Institutes of Health, and was responsible for a research program that awarded more than US$500 million a year in grants and contracts. Since that time, he has held senior positions in research administration within both the University of California, San Francisco, where he was Executive Vice Chancellor, and the University of Southern California. Full information about the CIRM can be found at www.cirm.ca.gov.     

Using utility theory to optimize a salary incentive plan for grant-funded faculty.

PURPOSE: Few salary incentive plans for academic health center faculty funded primarily by research grants exist, and hence the optimal structure for such plans is uncertain. The author examined the impact of incentives and the optimal structure for a salary incentive plan for a group of research faculty at the Yale University School of Medicine (Yale). METHOD: A three-part instrument was delivered to a convenience sample of 40 faculty to determine the impact of their risk aversion on two salary plans. Utility theory was used to quantify their preferences for the Expense Model (salary bonuses are paid from direct costs of the research award) and the No Expense Model (salary increases are funded from another source). Outcomes were projected for both models over a range of funding probabilities. RESULTS: In all, 27 faculty responded. On average, Yale faculty had risk-averse (and therefore unfavorable) attitudes towards the Expense Model, with substantial variability in response depending on rank. In contrast, Yale faculty had more homogeneous risk seeking (and therefore favorable) responses to the No Expense Model. Cost recoveries were greatest for the No Expense Model. CONCLUSIONS: Utility modeling demonstrated that the optimal incentive payment for the Expense Model is substantially greater than for the No Expense Model, and increases as the probability of obtaining funding with diligent effort declines. For purposes of both equity and efficacy, the No Expense Model appears preferable to the Expense Model. Modeling can be used to determine optimal incentive-plans and bonus-payment magnitudes for research faculty.     

Measuring faculty effort and contributions in medical education.

A national panel on medical education was appointed as a component of the AAMC's Mission-based Management Program and charged with developing a metrics system for measuring medical school faculty effort and contributions to a school's education mission. The panel first defined important variables to be considered in creating such a system: the education programs in which medical school faculty participate; the categories of education work that may be performed in each program (teaching, development of education products, administration and service, and scholarship in education); and the array of specific education activities that faculty could perform in each of these work areas. The panel based the system on a relative value scale, since this approach does not equate faculty performance solely to the time expended by a faculty member in pursuit of a specific activity. Also, a four-step process to create relative value units (RVUs) for education activities was developed. This process incorporates quantitative and qualitative measures of faculty activity and also can measure and value the distribution of faculty effort relative to a school's education mission. When adapted to the education mission and culture of an individual school, the proposed metrics system can provide critical information that will assist the school's leadership in evaluating and rewarding faculty performance in education and will support a mission-based management strategy in the school.     

Creating a mission-based reporting system at an academic health center.

The authors developed a Web-based mission-based reporting (MBR) system for their university's (UC Davis's) health system to report faculty members' activities in research and creative work, clinical service, education, and community/university service. They developed the system over several years (1998-2001) in response to a perceived need to better define faculty members' productivity for faculty development, financial management, and program assessment. The goal was to create a measurement tool that could be used by department chairs to counsel faculty on their performances. The MBR system provides measures of effort for each of the university's four missions. Departments or the school can use the output to better define expenditures and allocations of resources. The system provides both a quantitative metric of times spent on various activities within each mission, and a qualitative metric for the effort expended. The authors report the process of developing the MBR system and making it applicable for both clinical and basic science departments, and the mixed success experienced in its implementation. The system appears to depict the activities of most faculty fairly accurately, and chairs of test departments have been generally enthusiastic. However, resistance to general implementation remains, chiefly due to concerns about reliability, validity, and time required for completing the report. The authors conclude that MBR can be useful but will require some streamlining and the elimination of other redundant reporting instruments. A well-defined purpose is required to motivate its use.     

The UCSF Academy of Medical Educators.

The Academy of Medical Educators at the University of California, San Francisco (UCSF), was established in 2000 to (1) foster excellence in teaching, (2) support teachers of medicine, and (3) promote curricular innovation. A membership organization, it recognizes five categories of educational activity: direct teaching, curriculum development and assessment of learner performance, advising and mentoring, educational administration and leadership, and educational research. Excellent medical student teaching and outstanding accomplishment in one or more areas of educational activity qualify a teacher for membership. Candidates prepare a portfolio that is reviewed internally and by national experts in medical education. Currently 37 faculty members, 3% of the entire school of medicine faculty, belong to the academy. The academy's innovations funding program disburses one-year grants to support curricular development and comparisons of pedagogical approaches; through this mechanism, the academy has funded 20 projects at a total cost of $442,300. Three fourths of expended funds support faculty release time. Faculty development efforts include promotion of the use of an educator's portfolio and the establishment of a mentoring program for junior faculty members built around observation of teaching. The Academy of Medical Educators vigorously supports expanded scholarship in education; the academy-sponsored Education Day is an opportunity for educators to present their work locally. Recipients of innovations-funding program grants are expected to present their work in an appropriate national forum and are assisted in doing this through quarterly scholarship clinics. The Academy of Medical Educators has been well received at UCSF and is enhancing the status of medical education and teachers.     

Implementing a comprehensive relative-value-based incentive plan in an academic family medicine department.

The authors describe the implementation and first three years (1997-1999) of a department-wide incentive plan of the Department of Family Medicine at the State University of New York at Buffalo School of Medicine and Biomedical Sciences. By using a consensus approach, a representative elected committee designed a clinical relative value unit (explained in detail) that could be translated to equally value and reward faculty efforts in patient care, education, and research and which allowed the department to avoid the imposition of a model that could have undervalued scholarship and teaching. By 1999, the plan's goal of eight patient-care-equivalent points per four-hour session had been exceeded for pure clinical care. Clearly, only a small financial incentive was necessary (in 1999, an incentive pool of 4% of providers' gross salary) to motivate the faculty to be more productive and to self-report their efforts. Long-term productivity for pure clinical care rose from 9.8 points per session in 1997 to 10.4 in 1999. Of the mean total of 3,980 points for the year 1999, the contribution from teaching was 1,146, or 29%, compared with 25% in 1997. For scholarship, the number of points was 775, or 20%, in 1999, compared with 11% in 1997. The authors describe modifications to the original plan (e.g., integration of quality measures) that the department's experience has fostered. Problems encountered included the lack of accurate and timely billing information from the associated teaching hospitals, the inherent problems of self-reported information, difficulties of gaining buy-in from the faculty, and inherent risks of a pay-for-performance approach. But the authors conclude that the plan is fulfilling its goal of effectively and fairly quantifying all areas of faculty effort, and is also helping the department to more effectively demonstrate clinical productivity in negotiations with teaching hospitals.     

The difficulty of sustaining curricular reforms: a study of "drift" at one school.

In 1997, five years after a major curricular reform at the University of Michigan Medical School, the authors revisited the Goals for Medical Education (written by faculty to guide the reform process) to identify factors that had facilitated or hindered their achievement. By reviewing responses to identical questionnaires circulated to faculty in 1993 and again in 1997, they learned that considerably more lectures were being used to deliver curricular content in the first-year curriculum than the faculty thought was ideal, and that less social science, humanities, and ethics material was being presented in the first year than the faculty thought was ideal. The authors also learned that consensus between faculty basic scientists and faculty clinicians about the content that would make up an ideal first-year curriculum had diverged since adoption of the new curriculum. Movement toward decreasing the amounts of social sciences, humanities, and ethics in the first year of medical school was particularly pronounced among the basic scientists, who felt this material was being taught prematurely and at the expense of essential basic science content. In contrast, by 1997 much closer agreement had developed between the two groups regarding time they would allocate for lectures; this agreement unfortunately reflected a stagnation in the adoption of active learning methods. Movement toward increasing the amount of time for lectures in the first-year curriculum was particularly pronounced among the clinicians, who reported feeling more and more pressured to bring in clinical revenues. Based on faculty comments and the school's experience with centralized governance and centralized funding, the authors propose a direct linkage between institutional funding to departments and the teaching effort of faculty in the departments, and sufficient, centralized funding to relieve pressure on faculty and to foster educational creativity. They maintain that this may be the most effective way to guarantee ongoing innovation, support interdisciplinary teaching, and subsequently move the curriculum and teachers completely away from content that is isolated within traditional department structures. At the same time they acknowledge that changing faculty attitudes presents a challenge.     

The Mayo Clinic's Clinician-Educator Award: A program to encourage educational innovation and scholarship.

In 1998, the Board of Governors of the Mayo Clinic requested that the Education Committee design and implement a program to grant time and resources to clinical faculty to support the development of educational projects. The essence of the resulting Clinician-Educator Award Program is the concept of using funding to award time and resources for educational projects judged to be meritorious by an impartial, peer-review-based faculty mentoring process. The authors report early experiences with the program, which was enthusiastically accepted by faculty, to provide a model to help other academic health centers, especially those with salary-based faculty, to facilitate educational innovation and scholarship despite the growing constraints on academic clinicians' time and resources.     

An online discussion for medical faculty: an experiment that failed.

OBJECTIVE: Although online discussion groups are being used with increasing frequency in undergraduate and postgraduate education, their usefulness in faculty development has not been explored. The goal of this innovation was to offer an online discussion group following a faculty development workshop in order to reinforce workshop concepts and to allow participants to seek advice related to specific teaching and learning problems. We also wanted to assess the benefits of this educational tool. DESCRIPTION: We originally wanted to implement an online discussion group following a one-day workshop "The "Problem" Resident: Whose Problem Is It?" However, once this proposal was presented to our academic administrators, they asked us not to implement the discussion group because of concerns related to confidentiality and due process. They were worried that an online discussion might replace the faculty's evaluation and promotion guidelines, that teachers might no longer go to the "right" person to discuss a problem, and that we would give teachers a false sense of security. To respect these concerns, we changed the discussion topic and decided to implement an online discussion following a workshop "Promoting Interaction in Small-group Teaching." We chose this venue because it was less "emotionally charged" and because online discussions are seen as a potential adjunct to small-group teaching. We introduced the idea of a facilitated WebCT group discussion at the end of the workshop, and gave faculty members clear instructions on how to access the discussion group. Most of the workshop participants liked the idea of a follow-up to the workshop, but they preferred an e-mail listserv. We therefore decided to offer the WebCT discussion group to half of the participants, and an e-mail listserv to the others. To initiate the discussion, we posted several issues for both groups, and we awaited the participants' responses. To our surprise, only two individuals (8%) responded on the e-mail listserv, after several attempts to stimulate discussion. DISCUSSION: In looking back at our "medical experiment" we were disappointed that our efforts to facilitate an online discussion following a faculty development workshop were not successful. However, based on personal reflections and conversations with a number of the workshop participants, we feel that some important lessons were learned. Time and competing demands clearly pose a major barrier. In addition, the "perceived need" of the initiative is critical. Our faculty members did not see the need for discussing interactive small-group teaching techniques online. Faculty members' comfort with technology must also be considered. Many of our teachers were not familiar with the potential uses of online learning. Moving faculty development beyond workshops also remains a challenge. With these lessons in mind, we plan to initiate another online discussion with faculty members, based on a need that they have defined around a topic that they have identified as critical to their own development as faculty members. We continue to believe that follow-up activities are essential in faculty development and that we need to further assess the potential value of this educational method.     

A computerized faculty time-management system in an academic family medicine department.

The authors describe the development, implementation, and evaluation of a computerized faculty time-management system (FTMS) in the Department of Family Medicine at the University of North Carolina-Chapel Hill. The FTMS is presented as an integrated set of computerized spreadsheets used annually to allocate faculty time across all mission activities of the department. It was first implemented in 1996 and has been continuously developed since then. An iterative approach has been used to gain consensus among faculty about time resources needed for various tasks of all missions of the department. These time-resource assumptions are used in the computerized system. Faculty time is allocated annually by the department vice chair in negotiation with individual faculty, making sure that the activities planned do not exceed the work time each faculty member has available for the year. During this process, faculty preferences are balanced against department aggregate needs to meet mission commitments and obligations. The authors describe how the computerized FTMS is used for faculty time management and career development, department planning, budget planning, clinical scheduling, and mission cost accounting. They also describe barriers and potential abuses and the challenge of building an organizational culture willing to discuss faculty time openly and committed to developing a system perceived as fair and accurate. The spreadsheet file is available free from the authors for use in other departments.     

Culturally sensitive and effective psychologists: a challenge for the 1980s

A random sample of accredited graduate psychology departments and internship programs were surveyed to examine current efforts at integrating ethnic minority content into curricula and training. Additional information was sought on faculty development efforts and needs relative to integration of such content. Of the 121 department chair respondents, 80 affirmed inclusion of ethnic minority content in curricula. Integration was mainly found through provision of elective courses. Seventy internship directors responded, with 45 acknowledging ethnic minority content in their programs. However, only 36% of this content was found in "most of the program." Over 30% of both the departments and internship programs reported no efforts to integrate ethnic minority content into curricula or training. Faculty development efforts in both the academic and applied settings were also found to be minimal. However, the need existed to provide faculty with basic resource materials, guidelines, and approaches, as well as training in integrating ethnic minority content. Department chairs perceived summer institutes for faculty as a mechanism for fulfilling ethnic minority content requirements. Internship directors perceived continuing education programs as most advantageous. Issues regarding the implications of the apparent dearth of ethnic minority content in psychology are discussed.     

Faculty development. An essential consideration in curriculum change

Our experience suggests that curricular innovation, such as that proposed in Physicians for the 21st Century--the General Professional Education of Physicians report--often causes the faculty to reexamine both their career and their personal goals. For some faculty members, major career changes can result when major curricular innovation occurs in a department. The department planning curricular change should have a comprehensive faculty development program ready to deal in a fair and effective way with both the curricular and the personal issues that arise. The faculty should, first, be brought into active participation early in the development of the new curriculum. Next, the faculty should be trained in teaching methods required by the new curriculum. Finally, counseling and even alternative career choices should be made available for any faculty members who are doubtful about their roles in the new curriculum. Departments lacking such a program may experience problems that interfere with well-intended improvements in the curriculum. The faculty development program described here contributed to our faculty's enthusiastic adoption of an innovative pathology curriculum.     

Academic ranks and medical schools of underrepresented minority faculty in family medicine departments.

PURPOSE: To examine academic rankings and educational backgrounds of underrepresented minority (URM) family medicine faculty and compare their academic ranks with national trends. The authors also determined the extent to which international and historically black educational institutions contributed URM faculty to family medicine. METHOD: In 1999 questionnaires were sent to 129 family medicine departments asking for academic ranks and educational institutions attended by their URM faculty. Comparisons were made between URM faculty's academic ranks and all family medicine faculty, medical school minority faculty, and medical school faculty. RESULTS: A total of 80% of URM faculty were assistant professors or instructors, and 4.4% were professors. URM family medicine faculty had significantly lower rankings compared with medical school minority faculty and all family medicine faculty. URM family medicine faculty at historically black medical schools were more likely to have received their degrees from historically black undergraduate institutions and medical schools than were URM family medicine faculty at non-historically-black medical schools. CONCLUSIONS: URM family medicine faculty appear to experience a double disadvantage: being minority and working for family medicine departments. Their academic ranks remain far below those of both minority medical school faculty and family medicine faculty, a discouraging finding considering the current shortage of URM faculty in family medicine departments. Historically black medical schools cannot address the shortage alone, so non-historically-black medical schools need to both recruit URM faculty and follow up with appropriate mentoring of those faculty.