Motivating and Rewarding Teaching Keeping the Teachers Teaching

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Motivating and Rewarding TeachingKeeping the
Teachers Teaching

• Academy of Distinguished Educators
• University of Virginia School of Medicine
• January 25, 2005

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Rewarding Teaching in Medicine
There is nothing new under the sun.
Ecclesiastes

• Pay
• Perks
• Praise
• Promotion

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At present the universities are as uncongenial to
teaching as the Mojave Desert to a clutch of
Druid priests. If you want to restore a Druid
priesthood, you cannot do it by offering prizes
for Druid-of-the-Year. If you want Druids, you
must grow forests.
Creating a Culture of Educational
Excellence
Arrowsmith
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Creating an Educational Culture of Excellence is
Like Preparing to Win the World Series

• Recruit third basemen not utility infielders
• Great Spring Training
• Pay incentive bonuses
• Give awards for Golden Gloves, RBIs, home runs,
  ERA..
• Provide organizational support to make them feel
  like family

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Balancing the Effort
Research and Education
Clinical Practice
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Academic Surgery as Seen Through the Eyes of
Faculty

• Clinical Contributions
• Substantial financial rewards
• Systematic way of measuring activities
• Direct link between activities and financial
  rewards
• Tenuous link to promotion
• Few benefits to national reputation

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Academic Surgery as Seen Through the Eyes of
Faculty

• Research Contributions
• Minor immediate financial rewards (discretionary
  funds available to investigator)
• Systematic way of measuring activities
• Direct link between actions and rewards
• Direct link to promotion (delayed rewards)
• Major benefits to national reputation

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Academic Surgery as Seen Through the Eyes of
Faculty

• Teaching Contributions
• No immediate financial rewards
• System for measuring activities perceived as
  ambiguous
• No direct link between actions and financial
  rewards
• Link to promotion is tenuous
• Few benefits to national reputation

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Recruit MVPS from Other Teams
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Professional Organizations as Organized Anarchy

• Highly competent individuals
• Guided by personal and professional norms
• Prefer to control their own work
• Distrust bureaucracy and administration

Stephen Bodgewic, PhD
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Managing and Leading Professional People

• Hiring
• Motivation
• Performance evaluation
• Managing information
• Dealing with reduced effectiveness
• Fostering creativity
• Managing creative tension

Stephen Bodgewic, PhD
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If you have the right people on the bus, the
problem of how to motivate and manage people goes
away.
Collins, Good to Great, 2001
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The Importance of Spring Training
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SIU Surgery Faculty Development Program for New
Faculty

• Teaching in the OR
• Microskills of Clinical Teaching
• Teaching in the Clinic
• Performance Evaluation
• Giving Effective Feedback
• Giving a Presentation
• Dossier Development for Promotion and Tenure

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Modules for Residents As Teachers Program

• Setting Expectations
• Resident as Coach Microskills of Teaching
• Evaluating Resident/Student Performance
• Teaching Psychomotor Skills
• Clinic Teaching and Questioning Skills
• Effective Feedback
• Teaching at the Bedside
• Leadership Skills for Residents
• Dunnington DaRosa Academic Medicine, June
  1998

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Surgical Education Fellowships

• Current sites
• New York University
• Southern Illinois University
• University of Toronto
• All offer concomitant Masters degreein Education
• Fellowships offered for residents after PGYIII
  year

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Opportunities for Training in Educational
Leadership and Research

• Surgeons as Educators Course (ACS)
• Surgical Education Research Fellow-ship (ASE)
• Masters in Education degrees for working faculty
• Partnership, collaboration with Ph.D.educators
  in Medical Education Units

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How do we Incentivize Teaching Effort?
Hoow
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Purposes of Educational Metric SystemsA Study of
41 Medical Schools

• Provide a systematic, rational method for
  distributing tuition, state and other dollars to
  departments
• Track resources spent on teaching activity
• Address chairs mistrust of the deans hidden
  pools of money
• Counteract the myth that faculty cannot afford to
  teach
• Provide incentive for faculty teaching
• Make the educational mission more visible

Mallon and Jones, Acad Med, Feb, 2002
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Challenges in Measuring Educational Effort

• Lack of a culture data
• Fear of leadership by numbers
• In search of the Holy Grail
• Whats quality got to do with it? ( how much but
  not how well)
• Simplicity (failure often from elaborate
  complexity)

Mallon and Jones, Acad Med, Feb, 2002
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Methods of Measuring Faculty Teaching
Contributions

• Method No. of
  Institutions
• Contact hours 7
• Contact hours plus 15
• prep time
• Credit hours only 1
• Relative value units 18

Mallon and Jones, Acad Med, Feb 2002
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The Academic Incentive Program
SIU Department of Surgery
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What is not Included in the AIP?

• Clinical productivity measured in RVUs thru the
  Practice Plan
• Educational activity performed as part of
  clinical activity
• Work rounds
• Clinic teaching
• Teaching in the operating room

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SIU Department of SurgeryAcademic Incentive
Program

• Department-wide incentive credits for
• 53 educational activities
• 21 research activities
• 29 service activities
• 5 of professional receipts allocated
• Quarterly incentive bonuses awarded
• Program revised annually

Williams, Dunnington and Folse, Acad Med, Feb,
2003
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Activity List With Incentive Points
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Observations of an Academic Incentive Program

• Academic Credits Earned 22 per month (Range
  9-42)
• Quarterly incentive bonuses averaged 784 per
  month (Range 36-2043)
• Incentive bonuses resulted in an average 2.2
  increase in total compensation for ten faculty
  members with the most academic incentive points
  (Range 1.2-3.7)

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How Productive are Faculty at Different Academic
Ranks?
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Key Features of an Academic Faculty Compensation
Plan

• Fair
• Transparent
• Equitable for rank and geographic region (AAMC,
  MGM)
• Incentive-based for clinical practice
• Rewards academic contributions
• Congruent with mission

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Distribution of Academic Credits Earned
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What is your overall level of satisfaction with
the Academic Incentive System?
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To be an effective academic incentive, the amount
of money allocated needs to be increased.
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Why Develop an Academic Incentive Program?

• To operationalize the academic mission of the
  department
• To maintain balance among missions (clinical
  practice, research and teaching) at division and
  departmental level
• To assure that all significant individual
  contributions are recognized and rewarded
• To provide systematic measurement for promotion
  and tenure decisions

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Faculty Performance Evaluation that
Operationalizes the Mission and Strategic Plan

• Clinical practice
• Scholarly work
• Teaching
• Community service
• Leadership
• Professional behavior

Ratings by self, Division Chair, Department Chair
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Provide Generous Recognition and Rewards
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Departmental Recognition and Awards

• Annual Top Ten Faculty for RVUs
• Annual Top Ten Academic Incentive Faculty
• Annual Excellence in Clinical Practice Awards
  (5)
• Annual Resident Research Day
• Junior Faculty Researcher of the Year
• Senior Faculty Researcher of the Year
• Research Mentor of the Year
• Annual Surgical Education Grand Rounds

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Annual Surgical Education Grand Rounds

• Visiting Professor of Education
• Faculty and Resident Teaching Awards
• Excellence in Student Teaching
• Excellence in Resident Teaching
• Housestaff Teacher of the Year
• Faculty Teacher of the Year for Students
• Faculty Teacher of the Year for Residents
• Community Teacher of the Year

Awarded to all reaching defined criteria
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Organizational Support to Promote Teaching
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Teaching Academies for Enhancing the
Institutional Culture

• Medical College of Wisconsin
• University of Illinois at Chicago
• Mayo Clinic
• UCSF
• University of Florida
• Baylor
• Harvard
• Mount Sinai
• University of Virginia

Irby, Acad Med, August, 2004
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Teaching Academies for Enhancing the
Institutional Culture

• Increasing recognition for teaching
• Advocates for accelerated advancement of teachers
• Expanding curricular innovations
• Advancing educational scholarship
• Providing resources for teaching
• Instilling pride in medical education

Irby, Acad Med, August, 2004
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Faculty Leadership of the Educational Programs

• Residency Program Directors
• Associate Program Directors
• Director of Surgical Skills Lab
• Clerkship Director, Associate Director
• Year I, II, IV Student Program
• Directors

Prepare future educational leadership
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Leadership Training Series

• Creating shared vision
• Building trust and teamwork
• Managing time and priorities
• Negotiation and conflict management
• Mentoring and coaching

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SIU Department of SurgeryStaff for Educational
Infrastructure Department of eight divisions
with residency programs in General Surgery,
Orthopedics, ENT, Plastic Surgery and Urology

• Ph.D. Educator (Vice-Chair, Educational Affairs)
• Program Coordinators for General Surgery,
  Orthopedics, Plastic Surgery, Urology and ENT
• Performance Improvement Coordinator
• Surgical Clerkship Administrative Coordinator
• Two Nurse Educators
• Nurse Coordinator, Surgical Skills Laboratory
• Surgical Education Fellows (US and International)

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Creating the Culture to Keep the Teachers
TeachingSummary

• Recruit for great teaching
• Systematic resident and faculty development of
  teaching skills
• Academic incentives
• Recognition and reward on par with recognition
  for research and clinical practice
• Provide the infrastructure to attract faculty to
  teaching and educational scholarship

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Discovering the Joy of Teaching

• How to lead an awe-full life and avoid losing
  your marvels

Pearsall, Arch Surg, August, 2004