Teaching Awards and Reduced Departmental Longevity: Kiss of Death or Kiss Goodbye. What happens to Excellent Clinical Teachers in a Research Intensive Medical School?

Context: Although medical education is the unique mission of academic medical centers and medical schools, there is a perception that research is valued more than teaching. Objective: To determine in a group of excellent teachers (1) job satisfaction; (2) differences in perceptions among those who remained in the department compared to those who left; and (3) where those who left went. Design, setting, participants: Survey of all Department of Medicine “Clinical Teacher of the Year” award-winners in an academic medical center. Outcome measurements: Satisfaction scale: 5=extremely satisfied to 1=extremely dissatisfied; perception scale: 5=valued most highly to 1=not valued at all). Results: Thirteen winners (48%) left the department. Of the 10 in the clinical track 6 went into private practice. Award-winning faculty who remained in the department had significantly higher satisfaction ratings (mean+1SD) than those who left for all three activities – teaching (3.8+0.6 vs.1.8+0.7 [p < 0.001]), research (3.3+0.7 vs. 2.0+1.1 [p=0.003]), and clinical (3.5+0.5 vs. 1.7+0.7 [p < 0.001]). In general, winners were most satisfied with various aspects of teaching; areas of highest dissatisfaction related to support for education. Research was rated most highly and teaching least valued {Mean (StdErr)= 4.2(0.1) and 2.8(0.1)}. There were no differences in perceptions between award winners who left and those who stayed. Conclusions: Teaching excellence is a perishable commodity. Greater effort is needed to retain the best clinical teachers within academic medical centers. Education is the mission that sets academic medical centers and medical schools apart from other entities such as non-teaching hospitals and research institutes. Dissenting voices notwithstanding, cogent arguments have been made to combine the important missions of research and clinical care with teaching. Educating physicians, as opposed to “basic” science researchers, requires clinical teachers. Given the increasingly competitive financial environment, there has been a reduction in time devoted to medical education by physicians in private practice. Likewise, the financial realities within medical schools and their affiliated academic medical centers have negatively affected teaching efforts of full-time faculty. Yet the need for talented clinical teachers remains and their recruitment and retention has necessitated a variety of approaches that range from emphasis on the intrinsic rewards of teaching to more tangible recognition and monetary rewards. One study of two institutions indicated that half the faculty who taught in the clinical setting were not considered role models and numerous anecdotes suggest that there is a perception among medical school faculty that teaching is neither appreciated nor rewarded. Excellence in teaching, according to the AAMC, is considered in decisions of promotion and tenure, only if traditional criteria are unmet (emphasis ours). Clinician-educator faculty tracks with their own criteria for promotion and tenure have been established. A survey of chairs of departmental promotions committees suggested that teaching is considered an important determinant of promotion and tenure, however, there is considerable skepticism among rank and file faculty members. A survey of family practice department leaders and associate professors revealed that while both considered publications to be the most important factor in decisions about promoAron DC, Aucott JN, Papp KK. Teaching awards and reduced departmental Med Educ Online [serial online] 2000;5:3. Available longevity: Kiss of death or kiss goodbye? What happens to excellent from URL http://www.med-ed-online.org. Clinical teachers in a research intensive medical school? 2 tion and tenure, associate professors ranked the importance of teaching significantly lower than did departmental leaders. Others have documented the perceptions that research counts far more than teaching. We recently showed that teaching excellence as evidenced by winning a “Teacher of the Year Award” was not associated with a survival advantage in the academic environment. In fact, shortterm (3-year) “survival, ” i.e. time of award to time of departure from the department was significantly decreased among teaching award winners. We found this ironic in a medical school with a reputation for having a longstanding commitment to medical education. This short term “survival” of those honored with this reward was significantly lower when compared to a contemporaneous sample of non-awardwinning faculty even after adjusting for age, faculty rank, tenure status, and career track. However, we did not examine the reasons that award winners left the department. Questions have been raised about the implications of these findings. It is plausible that award-winning faculty may have been recruited by other academic departments of medicine and continued fulfilling careers in academic medicine. It is also possible that award winners changed career paths because of or in spite of their interest in teaching. The purpose of this study is to answer some lingering questions about these faculty members: (1) how satisfied were they with aspects of their profession at the time of the award? (2) were there differences in perceptions among those who remained in the department compared to those who left? and (3) where did award winners who chose to leave the department go and why?