Recognizing Work at the Coalface of Education: Valuing Clinician-Teachers

The three major pillars of activity of any academic medical centre (AMC) are patient care, generation of new knowledge, and teaching. In terms of promotions and recognition, however, these pillars have not been equal: success of an individual faculty member is often measured largely in terms of publications of new research findings and grant support for basic science or clinical investigation, whereas promotion up through the ranks on the basis of patient care and teaching has often been slow or even non-existent.

So, what’s their motivation?  Clearly, it’s not riches (!) or fame. I would argue that it has to do with a love of teaching itself. For many faculty members, teaching is not just a question of transferring knowledge or coaching the acquisition of skills; instead, it is a question of participating in an important and meaningful way in the development of a learner’s professional self-identity—to have an impact on, and to bear witness to, the process by which a learner becomes a healthcare professional who practices medicine with excellence, compassion, and justice. For many faculty, the opportunity to play such a critical role in this development is in itself worthwhile—despite the long hours, the relative lack of prestige and remuneration, and unfortunately all too often, the lack of formal recognition.

Clearly, the validation and valuation of teaching should be—and is—a top priority for the Department and Faculty of Medicine. But how do we achieve this goal? I think that part of the answer lies in the concept of Creative Professional Activities (CPAs). This is a way of documenting activities and work product in education and patient care—such as curricular innovations and offerings, new teaching approaches and resources, new evaluation techniques or new clinical guidelines—that do not necessarily fit into the rather restrictive category of publications. First pioneered at U of T, CPAs do not exist in most other peer schools (for example, no such mechanism for teachers or clinicians existed at my former institution, the University of Michigan) and represent one of the four major types of activities that may serve as the basis for promotion (the other three being research, education, and administration). While this approach to academic promotion represents a fairly major advance for clinician-teachers, many faculty are not aware of the full potential of CPAs in this process, and CPAs as currently conceived do not provide sufficient evidence of the full measure of the impact of teaching on learners and on their professional development.

So, what’s the answer? In short, it’s not clear. One approach is to develop better ways of registering the impact of the work of teaching—for example, through documentation of the adoption of a new teaching approach by another teacher in another department or institution or the record—in the form of a letter or email for example—from a learner who said that her ultimate career choice was greatly influenced by her wanting to emulate a teacher’s example.  But there are more ways to recognize and celebrate teachers and their work.

Another consideration: there are also many clinician teachers at community health centres for whom academic promotion is not a priority. How do we as a department acknowledge and reward their passion for teaching as well?

To this end, Dean Trevor Young has invited Dr. Alison Freeland, the Vice Dean for Medical Education (Regional) and myself to study in depth how to better value clinician-teachers at the University of Toronto Faculty of Medicine. Working with department chairs and vice chairs for education, we have identified an Advisory Group of clinician-teachers and educators at different stages in their careers, in both full-time and part-time positions, in the “downtown” hospitals and community affiliates, who will assist and guide us in this ambitious work. Through focus groups and surveys, we wish to go to the source—clinician-teachers themselves—to ask what it is that motivates them and what would help recognize their tremendous work and achievements. We wish to use these conversations to develop recommendations for the departments and the Faculty of Medicine to make changes that will more effectively celebrate the critically important work of teachers at the coalface where doctors are created.

I would be delighted to hear from you with comments, questions, and suggestions about this subject! Please don’t hesitate to contact me if you wish to contribute to this important conversation.