|PRACTICAL ADVICE PAPER
|Year : 2021 | Volume
| Issue : 3 | Page : 109-112
Establishing an educational value unit to promote teaching in an academic unit
Lavjay Butani, Jennifer Plant
Department of Pediatrics, University of California Davis, Sacramento, CA, USA
|Date of Submission||30-Dec-2018|
|Date of Decision||22-Dec-2021|
|Date of Acceptance||22-Feb-2022|
|Date of Web Publication||26-Apr-2022|
Department of Pediatrics, University of California Davis Medical Center, Ticon 2, Room 348, 2516 Stockton Boulevard, Sacramento, CA 95817
Source of Support: None, Conflict of Interest: None
Background: In academic health centers, education remains an incompletely supported and funded mandate. In an attempt to promote education and better support educational endeavors of faculty, some academic health centers and departments have conceived of a metric, the educational value unit (eVU), to begin to “quantify” teaching. What goes into this metric, its intended goals and the logistics of its implementation vary considerably among centers. Lessons Learned: This practical advice paper highlights the various lessons learned from a review of the limited published literature on eVU systems supplemented with our personal experience in implementing a successful eVU system in the Department of Pediatrics at our institution, to help guide others who may be interested in doing that same. Even in limited-resource settings, our hope is that these lessons can serve as a guide on how to better quantify and reward teaching, whether through monetary or nonfiscal incentives and recognition.
Keywords: Educational support, incentivization, mission-based budgeting, value
|How to cite this article:|
Butani L, Plant J. Establishing an educational value unit to promote teaching in an academic unit. Educ Health 2021;34:109-12
| Background|| |
Education remains an incompletely supported mandate due to increasing costs that have led academic centers to prioritize clinical revenue generation and pursuit of research grants. This has contributed to mission conflict among clinical faculty who face challenges in pursuing their passion to teach. To address this issue, as part of a mission-based budgeting system, the concept of an educational value unit (eVU) has been proposed, as a first step in promoting the educational mission. Based on our own experience in developing an eVU, as a consequence of a strategic planning process embarked upon by our Department, and a review of the literature, we highlight key considerations for academic units to think about when introducing an eVU system.
| Lessons from the Literature Review|| |
While a comprehensive review of the eVU literature is beyond the scope of this paper, key considerations from the literature include the following:
- Importance of establishing a shared vision that a current need to bolster education exists within the unit. Without a sense of need or urgency, best-laid plans can falter. Drivers for developing an eVU system have been: creation of a new academic unit, arrival of a new leader interested in empowering faculty, faculty dissatisfaction,,, desire to increase educational output, or to improve institutional reputation and faculty promotion. These should be capitalized upon to get stakeholders engaged. Stakeholders will typically include teaching faculty,, those who allocate funding (Department Chairs and Deans), clerkship, residency and fellowship program directors, and the learners themselves; others could include financial administrators and Faculty Promotions Committees
- Clearly articulating the intended goal of the eVU. In published reports, such goals have been quite diverse: to align funds flow with teaching efforts,,, to equitably distribute Departmental teaching among faculty,, to increase educational output and quality, or realign it to the educational mission,,, and to recognize exceptional educators
- Defining which educational activities to include in the metric. Probably one of the most contentious issues and one that needs much thought and alignment with the local needs and intended goals (much like the process that we engage in for curriculum development) is how to define “education” for the purpose of the metric. One framework to help select elements for inclusion in the eVU is the Association of American Medical College's (AAMC) categories of educational scholarship: teaching, curriculum development, mentoring/advising, educational administration/leadership, and learner assessment. In addition, there may be unique local needs that are important to address from the perspective of stakeholders that are not addressed by the above categories such as attendance at key educational conferences or educational service work (educational committee membership). The category of teaching merits additional attention since it typically accounts for most of the educational activity of faculty and also due to the complexity in quantifying it. Classroom teaching is easier to measure and therefore to include in the metric. Most eVU systems are “time-based;” many credit educators based on direct contact time spent in the classroom,, with some giving additional credit to preparation time and some differentiating between single versus regularly recurring presentations. Yet others have gone a step further and assigned a teaching value multiplier to give more credit for teaching tasks of a higher complexity or involving more advanced learners., While bedside teaching often forms the bulk of the educational efforts of the faculty, it is more challenging to quantify due to the challenge of teasing out how much time spent at the bedside involves direct provision of patient care and how much is “teaching;” many systems do not assign credit for this., It is also important to clarify whether to restrict credited educational efforts that are directed toward a core group of learners or a wider and more inclusive learner group
- Considering a quality component to the metric. many eVU systems lack a quality component due to the difficulty in collecting valid assessments of educator performance.,,, Most educational programs routinely assess learner reaction data; even though these may be influenced by extraneous factors, they are easy to quantify and end up being used when an attempt is made to include quality of teaching in the metric. Academic units interested in using more robust quality measures can use toolkits such as one based on the aforementioned AAMC framework on educational scholarship,
- Deciding on how the eVU data will be used. eVU systems have been used to reward efforts or to institute corrective measures. Published eVU systems have been used to provide compensation to faculty by buying out their clinical time or through incentive payments,,, and recognizing teaching excellence in the form of awards. Less frequently described outcomes include decreasing faculty salary for not meeting expectations and documenting failure to meet expectations in annual faculty evaluations. Having clear understanding of the implications of the metric among all stakeholders is key to successfully implementing a system and getting buy-in planning for the actual implementation
- It is important to decide what data to collect to gauge the success of the eVU system. In addition to stakeholder reaction, that is often reported,, data collected should be aligned with the goals of the individual program.,, The means of gathering data to calculate the eVU also needs to be agreed upon and in published reports has included utilizing a web-based platform, or an electronic or paper system. Another issue is to determine how much data to track centrally (e.g., attendance at conferences) and how much to rely on self-report. Dedicated administrative support may be important to help gather and process the eVU data from faculty based on the scope of the program.
| Our Implementation Processes|| |
The driver for the development of our eVU metric was the arrival of a new Department Chairperson who organized a strategic planning retreat of all faculty to engage them in the various aspects of the academic mission of our institution. Every faculty member was assigned, based on their interests and expertise, to one of several task forces; as coleaders of the education task force, we solicited from all faculty priority areas to focus on to further the Department's educational mission. The development of a metric to better quantify teaching efforts of faculty and raise these efforts to the same level as clinical and research efforts, rose to the highest priority level and leading us to direct our attention to developing an eVU system. We identified and recruited various stakeholders (clerkship directors, chief residents, residency program leadership, and key educators), into a smaller workgroup that was tasked with moving the project forward. The group reviewed the aforementioned literature and extensively discussed various possible goals for the eVU and decided, as the first step, to use the system to recognize and reward exceptional educators and education by the Department's faculty. Our system was designed to reward efforts through end-of-year incentive bonuses with no consequences for not meeting eVU expectations, with the recognition that over time, the system could evolve and be used for holding all faculty accountable for a minimum amount and quality of teaching. We used the AAMC framework on educational scholarship to guide the inclusion of elements in our eVU system. Due to our philosophy that clinical teaching is an expectation of all faculties, and our goal to reward exceptional teaching, as opposed to all teaching, we did not include clinical teaching efforts in our eVU system. The main elements in our eVU system were classroom teaching, mentoring, educational leadership, and learner assessment. For classroom teaching, we adopted a system based on direct contact time similar to some systems reported in the literature,, with preassigned credit given for the preparation of the teaching sessions. We chose not to adjust the credit based on the number or level of learners present during these sessions. However, based on our needs, we did decide that our primary learners would be our own school's medical students and our departmental residents, fellows, and faculty. To not disincentivize other educational endeavors (such as those directed toward learners outside our health-care system), we used a tiered approach, giving credit to other teaching but only after faculty had met a preset threshold of teaching directed toward the primary group.
We also restricted credit to only those educational sessions that met some minimal criteria-having clear goals and objectives that were articulated in advance, and sessions that included learner assessment of the teaching quality. In terms of educational administration/leadership, some faculty members at every institution will hold positions such as residency program director and clerkship director. Consideration of whether to assign eVUs for the work performed by faculty in these roles, that are typically supported by protected time, is needed. Our system was designed to reward unrecognized and unsupported efforts and so we gave eVU credit only for leadership work not otherwise financially supported. Time spent in mentorship-related activities was self-reported by faculty. We did not include educational research efforts in our eVU metric since a parallel research value unit was developed by the Department where such efforts were credited.
A local need for us was to encourage faculty to attend and participate in some key Departmental conferences; credit for attendance was given for these conferences (such as Grand Rounds, morning report, and resident conference sessions). Another need, that we gave credit for, was to gather frequent structured clinical observations of pediatric resident performance and provision of written feedback to the learners and the residency program.
In addition to using a quantity metric, we also started work on including a quality component. In our system, we assigned additional eVU credit to faculty who met a “quantity threshold” and who were in the top two quartiles of performance based on learner reaction data. The “quantity threshold” was established based on our teaching needs as determined by the stakeholder group and was set at 100 h per academic year per faculty.
We designed a spreadsheet to reflect the most common educational activities in our Department and provided open text boxes for others. Data available at a programmatic level were self-reported by faculty (such as attendance at conferences) and verified if needed. The spreadsheets were sent out electronically to faculty to complete at the end of the academic year and returned by us; additional clarification was sought, as needed, if reported data were unclear. The final data (total hours of time spent in educational efforts) were used by the Department to reward faculty as part of the incentive plan approved by the institution.
| Reflections on our Process and Lessons Learned by us|| |
We are in the 9th year of implementation of our eVU system; each year, the system has resulted in the identification and rewarding of a subset of faculty educators (about a 1/3rd of all faculty in our Department) based on teaching efforts and to some extent teaching quality. Challenges faced by us and the next steps, where are heading include:
- Dissatisfaction expressed by faculty who has not received any eVU credit and the perception that the 100 h threshold is too high and unreachable for most faculty. This comes at a time where we are under a new Department leadership (new Department Chair). As a result, the goals of our current eVU systems are being comprehensively revisited and are likely to change based on current stakeholder needs. Having the willingness and flexibility to do so is essential. A related issue is the decision not to credit clinical (bedside) teaching activities for the reasons mentioned above. Whether this decision is revisited in our new system (and how it might change) remains to be determined
- Quality metrics – our current quality metrics remain sparse and are not a satisfactory measure of true educational quality. This remains a holy grail, so to speak, and one that deserves constant attention. Whether a system of peer-observation of faculty teaching could overcome this and be conducted in a safe and feasible manner, has been discussed and is worthy of consideration, and lastly
- The workload of our current incentive systems, that are intended to reward nonclinical missions (teaching, research, and service), are significant, both for faculty who have to complete the submit the data (three separate requests are sent to faculty from the 3 task force leads; each system has a different philosophy and approach) and for those who must review the data and check its accuracy and completeness. A more seamless and centralized process for administering the data collection is needed for sustaining such efforts and is in the works, along with administrative support (which currently is lacking); also in the works is an attempt to align the educational, research, and service value units such that they have a shared philosophy and approach.
In summary, tracking educational effort and linking it to outcomes remains a cultural shift. Such changes should happen gradually and with frequent communication with stakeholders, as we have done using the venue of faculty meetings, to solicit feedback and make changes. The eVU program should be revisited periodically to ensure that it stays true to its goals and adjusts to new circumstances to ensure its continued success. Regardless of how the eVU metric is ultimately is used (fiscal or nonfiscal rewards for faculty) its benefits can be impressive, most noticeably the attention that the very creation of the system shines on the educational mission. However, it is also important to be wary of unintended consequences of such a system, such as the disincentivizing of faculty to teach by providing extrinsic rewards for what is inherently an intrinsically motivating activity.
Financial support and sponsorship: None
Conflicts of interest
There are no conflicts of interest.
| References|| |
Pololi L, Kern DE, Carr P, Conrad P, Knight S. The culture of academic medicine: Faculty perceptions of the lack of alignment between individual and institutional values. J Gen Intern Med 2009;24:1289-95.
Watson RT, Romrell LJ. Mission-based budgeting: Removing a graveyard. Acad Med 1999;74:627-40.
Kotter JP. Leading Change. Boston, Mass.: Harvard Business School Press; 1996.
Denton GD, Griffin R, Cazabon P, Monks SR, Deichmann R. Recruiting primary care physicians to teach medical students in the ambulatory setting: A model of protected time, allocated money, and faculty development. Acad Med 2015;90:1532-5.
Bland CJ, Wersal L, VanLoy W, Jacott W. Evaluating faculty performance: A systematically designed and assessed approach. Acad Med 2002;77:15-30.
Stites S, Steffen P, Turner S, Pingleton S. Aligning clinical compensation with clinical productivity: Design and implementation of the financial value unit (FVU) system in an academic department of internal medicine. Acad Med 2013;88:946-51.
Mezrich R, Nagy PG. The academic RVU: A system for measuring academic productivity. J Am Coll Radiol 2007;4:471-8.
Mallon WT, Jones RF. How do medical schools use measurement systems to track faculty activity and productivity in teaching? Acad Med 2002;77:115-23.
Regan L, Jung J, Kelen GD. Educational value units: A mission-based approach to assigning and monitoring faculty teaching activities in an academic medical department. Acad Med 2016;91:1642-6.
Ma OJ, Hedges JR, Newgard CD. The academic RVU: Ten years developing a metric for and financially incenting academic productivity at Oregon Health & Science University. Acad Med 2017;92:1138-44.
Jarrell BE, Mallot DB, Peartree LA, Calia FM. Looking at the forest instead of counting the trees: An alternative method for measuring faculty's clinical education efforts. Acad Med 2002;77:1255-61.
Simpson D, Fincher RM, Hafler JP, Irby DM, Richards BF, Rosenfeld GC, et al.
Advancing educators and education by defining the components and evidence associated with educational scholarship. Med Educ 2007;41:1002-9.
Yeh MM, Cahill DF. Quantifying physician teaching productivity using clinical relative value units. J Gen Intern Med 1999;14:617-21.
Baldwin C, Chandran L, Gusic M. Guidelines for evaluating the educational performance of medical school faculty: Priming a national conversation. Teach Learn Med 2011;23:285-97.
Chandran L, Gusic M, Baldwin C, Turner T, Zenni E, Lane JL, et al.
Evaluating the performance of medical educators: A novel analysis tool to demonstrate the quality and impact of educational activities. Acad Med 2009;84:58-66.