How can clinician-educator training programs be optimized to match clinician motivations and concerns?

Figures & data

Table 1 Summary of motivations and barriers identified in literature review

	Proportion of reviewed articles	Examples
Motivations
Intrinsic motivations	29/38 (76%)	• Enjoyment in observing outcomes of teaching • Appreciation for new perspectives gained from students • Sense of duty • Self-reflection on own skills
Extrinsic motivations	15/38 (39%)	• Financial compensation • Teaching awards • University appointments • Teaching workshops
Barriers/challenges
Decreased productivity	17/38 (45%)	• Lack of time to work with students • Increased pressure to generate salary through patient care instead of teaching • Presence of students had negative impact on patient flow in practice • Fewer patients seen per day
Increased length of day	8/38 (21%)	• Work took longer to complete in presence of students • Average length of day increased between 46 and 51 minutes
Lack of compensation	10/38 (26%)	• Level of pay inadequate for time commitment involved • Presence of medical students leads to fewer patients seen and subsequent loss of income from lack of billing • Many institutions do not reward financially
Patient concerns/ethical issues	9/38 (24%)	• Patients may be reluctant to divulge information in presence of student • Students may have poor attitudes that negatively impact patient care • Incompetent medical students may put patients at risk
Lack of clinician-educator confidence	9/38 (24%)	• Physician “short-cuts” in physical exam were not appropriate for students to learn • Feelings that clinical knowledge is too inadequate to teach • Lack of support from practice partners to teach • Perceived lack of training as a teacher

Table 2 Summary of recommendations addressing motivations and barriers experienced by physicians

	Recommendations
Motivations
Intrinsic motivations	• Program developers may want to consider promoting the rewards of teaching and remind physicians that they have a unique opportunity to inspire students and help influence the future of patient care
Extrinsic motivations	• Have teaching contributions systematically recorded and compiled in a teaching portfolio or departmental database • Involve clinical-educators in curriculum development and educational policy • Compensate physicians for lost time/income as a result of teaching
Barriers/challenges
Decreased productivity/increased length of day	• Reduce average daily patient list sizes to allow for protected teaching time • Compensate physicians for lost time/reduced list sizes • Give physicians significant advance notice of dates when students will be present, allowing them to alter their schedules and notify their staff if necessary
Lack of compensation	• Five major elements that are seen as essential to have in a faculty teaching program in order to establish equitable salaries for all physicians involved: accepted standards of adequate performance; systematic review of the performance of academic staff; mechanisms for rewarding excellence; structured and effective means of providing assistance to those whose performance is suboptimal; and options for sanctions against those whose performance is consistently suboptimal^Citation8
Patient concerns/ethical issues	• Identify the student before seeking patient consent for teaching • Ask the student to seek patient consent • Physician can model the skill of seeking consent in difficult circumstances • Physician should always maintain patient confidentiality in teaching consultations of sensitive information • Students should be given clear instructions as to appropriate behavior prior to commencing a clinical placement • Student expectations and responsibilities should be made clear prior to commencing a placement
Lack of clinician-educator confidence	• Physicians should be granted ample opportunity to increase their skills as teachers, lecturers, coaches, mentors, and evaluators regardless of whether they are in a tertiary medical center or in the community • In order to continue improving or meet a certain standard, clinician-educators need feedback on the effectiveness of their teaching coupled with opportunities to improve in areas of weakness • Universities should make expected teaching contributions clear at least a year in advance • Teacher training should not simply be an option for select clinician-educators looking to improve their skills, but rather a requirement for all those with regular teaching duties

Note: Data from Cook D. Study of Clinical Teachers in Canadian Faculties of Medicine. The Association of Faculties of Medicine of Canada; 2009. Available from: https://www.afmc.ca/pdf/Study%20of%20Clinical%20Teachers%20-%20Discussion%20Paper.pdf. Accessed October 11, 2014.⁸

CookDStudy of Clinical Teachers in Canadian Faculties of MedicineThe Association of Faculties of Medicine of Canada2009 Available from: https://www.afmc.ca/pdf/Study%20of%20Clinical%20Teachers%20-%20Discussion%20Paper.pdfAccessed October 11, 2014

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