Incentives for clinical teachers: On why their complex influences should lead us to proceed with caution

Abstract

Introduction: When medical education programs have difficulties recruiting or retaining clinical teachers, they often introduce incentives to help improve motivation.Previous research, however, has shown incentives can unfortunately have unintended consequences. When and why that is the case in the context of incentivizing clinical teachers remains unclear. The purposes of this study, therefore, were to understand what values and motivations influence teaching decisions; and to delve deeper into how teaching incentives have been perceived.Methods: An interpretive description methodology was used to improve understanding of the development and delivery of teaching incentives. A purposeful sampling strategy identified a heterogenous sample of clinical faculty teaching in undergraduate and postgraduate contexts. Sixteen semi-structured interviews were conducted and transcripts were analyzed using an iterative process to develop a thematic structure that accounts for general trends and individual variations.Results: Clinicians articulated interrelated and dynamic personal and environmental factors that had linear, dual-edged and inverted U-shaped impacts on their motivations towards teaching. Barriers were frequently rationalized away, but cumulative barriers often led to teaching attrition. Clinical teachers were motivated when they felt valued and connected to their learners, peers, leadership, and/or the medical education community. While incentives aimed at producing these connections could be perceived as supportive, they could also negatively impact motivation if they were impersonal, inequitable, inefficient, or poorly framed.Discussion/Conclusion: These findings reinforce the literature suggesting that it is necessary to proceed with caution when labeling any particular factor as a motivator or barrier to teaching. They take us deeper, however, towards understanding how and why clinical teachers' perceptions are unique, dynamic and fluid. Incentive schemes can be beneficial for teacher recruitment and retention, but must be designed with nuance that takes into account what makes clinicians feel valued if the strategy is to do more good than harm. | 615WISENER Et al.

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

“…In the Canadian context however, there was no such trend as two papers were published in 1990-99, 15,72 one paper in 2000-2009, 73 and three in 2010-2020. 30,74,75 Canada is tied for the most publications (3) between 2010-2020 with the USA, which conversely saw a significant decrease in publications in this period (-16) (Table 3). As shown in Table 3, primary research articles and position papers contributed a similar number of publications in each time period.…”

“…109 Eleven papers (25.6%) were published between 1990 and 1999, 15,16,72,76,81,92,97,98,100,101,108 23 papers (53.5%) were published between 2000 and 2009, 3,73,[77][78][79][80][82][83][84][86][87][88][89][90][91][93][94][95]99,[102][103][104]106 and nine papers (20.9%) were published between 2010 and 2020. 7,30,74,75,85,96,105,107,109 105 includes a multi-site study that reports findings from three countries in Asia. d NLM refers to commentary, editorial comment, viewpoint, perspective type papers as work consisting of a critical/explanatory note written to discuss, support, or dispute other works previously published e The source of information refers to the target participants in primary research articles (e.g., clinician teachers) and to the authors of position papers.…”

“…Type and source of information: Over half (22/43; 51.2%) of the papers we reviewed were primary research articles, most of which were quantitative, published in the 2000-2009 period, and originating out of the US (Table 2). These primary research articles reported information from a variety of sources: 12/22 (54.5%) from clinician teachers; 15,75,76,[82][83][84][86][87][88]105,107,109 7/22 (31.8%) from students and residents; 76-81,106 5/22 (22.7%) from organizational leaders and decision-makers such as deans and promotion committee chairs. 15,72,73,85,108 The remaining 21/43 reviewed papers (48.8%) were comment and opinion type papers from experts, such as faculty with clinical experiences or medical education researchers.…”

Finding alignment between numbers and values in medical education

“…After Wisener et al studied which factors motivate clinician educators to teach, they cautioned, 'incentives generally seemed to elicit unintended consequences when they were impersonal, inequitable, inefficient, or lacked appropriate framing'. 3 For instance, monetary incentives, although intended to compensate for the opportunity cost of time spent teaching, were felt by some of their subjects to be grossly inadequate to the point of being insulting. A similar finding was observed in a study by Martinez et al where some of the faculty members felt that financial incentives missed the point by failing to address the underlying need for more time.…”

“…In the realm of medical education, responsiveness towards teaching incentives has been shown to vary depending on individual and organisational factors. After Wisener et al studied which factors motivate clinician educators to teach, they cautioned, ‘incentives generally seemed to elicit unintended consequences when they were impersonal, inequitable, inefficient, or lacked appropriate framing’ 3 . For instance, monetary incentives, although intended to compensate for the opportunity cost of time spent teaching, were felt by some of their subjects to be grossly inadequate to the point of being insulting.…”