Implementing medical teaching policy in university hospitals

Abstract

Within the unique and complex settings of university hospitals, it is difficult to implement policy initiatives aimed at developing careers in and improving the quality of academic medical teaching because of the competing domains of medical research and patient care. Factors that influence faculty in making use of teaching policy incentives have remained underexplored. Knowledge of these factors is needed to develop theory on the successful implementation of medical teaching policy in university hospitals. To explore factors that influence faculty in making use of teaching policy incentives and to develop a conceptual model for implementation of medical teaching policy in university hospitals. We used the grounded theory methodology. We applied constant comparative analysis to qualitative data obtained from 12 semi-structured interviews conducted at the Radboud University Medical Center. We used a constructivist approach, in which data and theories are co-created through interaction between the researcher and the field and its participants. We constructed a model for the implementation of medical teaching policy in university hospitals, including five factors that were perceived to promote or inhibit faculty in a university hospital to make use of teaching policy incentives: Executive Board Strategy, Departmental Strategy, Departmental Structure, Departmental Culture, and Individual Strategy. Most factors we found to affect individual teachers’ strategies and their use of medical teaching policy lie at the departmental level. If an individual teacher’s strategy is focused on medical teaching and a medical teaching career, and the departmental context offers support and opportunity for his/her development, this promotes faculty’s use of teaching policy incentives.

Developing and rewarding teachers as educators and scholars: remarkable progress and daunting challenges

“…Another example of a competency‐based recognition programme is the Royal College of Physicians and Surgeons of Canada Diploma programme for clinician educators, which is certification for a focused area of competence . Research related to teacher qualification programmes is just beginning with studies on the impact of such policies and on the participants …”

“…To reform academic reward systems, lessons learned from implementation science may be instructive as a guide for structural transformation: engage key stakeholders, conduct effectiveness studies and broadly disseminate research syntheses . The challenge before us is to communicate the knowledge synthesis in this article to key stakeholders in the academic hierarchy, to study the impact of existing policies on educators using expanded metrics, and to change department and institutional policies related to academic promotions, retention, salary standards and performance expectations of faculty members . ‘Successful dissemination of new programs and ideas in medical education takes active educational leadership, personal contacts, dedication, hard work, rigorous measurement, and attention to implementation science principles.’ We concur that strong and persistent advocacy will be required to overcome historical, cultural and institutional policies and practices.…”

“…51,52 Another example of a competencybased recognition programme is the Royal College of Physicians and Surgeons of Canada Diploma programme for clinician educators, which is certification for a focused area of competence. 53 Research related to teacher qualification programmes is just beginning with studies on the impact of such policies 54,55 and on the participants. 56 In summary, the key components of educator knowledge, skills for practice and identity formation as educators are known, as are the strategies for their development.…”

Hospital-wide education committees and high-quality residency training: A qualitative study

“…Implementation of CQI for PGME might be challenging, since it might be perceived as burdensome, bureaucratic or as interfering by clinical departments [ 20 – 22 ]. The clinical environment has proven to be rather unreceptive to educational policy when education is considered to be secondary to patient care and medical research [ 23 ]. Examining implementation of similar hospital-wide bodies for clinical governance, literature shows the importance of aligning organizational and departmental levels to impact patient outcomes [ 24 ].…”

<p>Coaching by design: exploring a new approach to faculty development in a competency-based medical education curriculum</p>

“…However, participation in faculty development is voluntary. Challenges identified in the uptake of these activities include teaching falling in priority compared to patient care, administration and research commitments, limited training as clinical educators56 and the complex setting of university hospitals with increased competing demands for attention 57. Therefore, faculty development programming must be relevant, accessible, desirable, feasible and be seen to be valued by the institution.…”