Date Published: November 16, 2016
Publisher: Springer Netherlands
Author(s): Rik Engbers, Cornelia R. M. G. Fluit, Sanneke Bolhuis, Marieke de Visser, Roland F. J. M. Laan.
Within the unique and complex settings of university hospitals, it is difficult to implement policy initiatives aimed at developing careers in and improving the quality of academic medical teaching because of the competing domains of medical research and patient care. Factors that influence faculty in making use of teaching policy incentives have remained underexplored. Knowledge of these factors is needed to develop theory on the successful implementation of medical teaching policy in university hospitals. To explore factors that influence faculty in making use of teaching policy incentives and to develop a conceptual model for implementation of medical teaching policy in university hospitals. We used the grounded theory methodology. We applied constant comparative analysis to qualitative data obtained from 12 semi-structured interviews conducted at the Radboud University Medical Center. We used a constructivist approach, in which data and theories are co-created through interaction between the researcher and the field and its participants. We constructed a model for the implementation of medical teaching policy in university hospitals, including five factors that were perceived to promote or inhibit faculty in a university hospital to make use of teaching policy incentives: Executive Board Strategy, Departmental Strategy, Departmental Structure, Departmental Culture, and Individual Strategy. Most factors we found to affect individual teachers’ strategies and their use of medical teaching policy lie at the departmental level. If an individual teacher’s strategy is focused on medical teaching and a medical teaching career, and the departmental context offers support and opportunity for his/her development, this promotes faculty’s use of teaching policy incentives.
The literature describes different policy initiatives aimed at developing careers in academic medical teaching (AMEE; AERA; Engbers et al. 2013, 2014, 2015; Jaarsma 2012; RCPSC; Schofield et al. 2010; Sorinola et al. 2013; Steinert et al. 2012). Successful implementation depends on faculty making use of these teaching policy incentives.
Analysis revealed that there were five factors, or themes, that were perceived to promote or inhibit faculty in a university hospital in making use of teaching policy incentives: Executive Board Strategy, Departmental Strategy, Departmental Structure, Departmental Culture, and Individual Strategy.
The consistent implementation of medical teaching policy is influenced by the financing system for undergraduate medical education used at the RUMC (see Box 3). On the one hand, respondents reported that PL grants provided a financial incentive for departments to focus on medical teaching and for faculty to make use of teaching policy incentives. According to one Head of Department:The financial side of things is very important, of course, for money is a way to make things happen. So this PL grant makes it possible for someone to be a PL and to spend time on education. (P9, 177)On the other hand, the same Head of Department reported that financial targets imposed by the Executive Board (see Box 3) affected the department’s financial decision-making priorities, inhibiting its focus on medical teaching:This means: making choices. Well, that’s what we’re trying to do. You can’t do everything. We can’t do everything, but the Executive Board does expect us to achieve a certain turnover, so we’re caught in a squeeze there. If it was up to us, we’d say: ‘Let’s get rid of some consultation hours.’ But we can’t do that because we wouldn’t be making enough money. So this is a problem. (P9, 108)
For medical teaching policy to be rooted in departments, a certain degree of follow-up is necessary to make sure departments get and stay involved. The departmental numbers of TQs, PLs, and SIRPMEs, however, appear not to be discussed in the quarterly appraisals of departments, while patient care and medical research are always on the agenda. If departmental involvement in medical teaching policy is not evaluated, this could negatively affect their implementation strategy with regard to medical teaching policy. As a manager from a clinical department put it:I feel that relations between the Executive Board and the department have always been minimal in the matter of education. We try to make it a high-priority issue so we tell them: ‘Dear Executive Board, why don’t you just make education an item on your agenda in one of your quarterly meetings once a year and ask the departments what they’re up to.’ Because, you know, we’ve got information we can feed them. I think things may change with the introduction of the new curriculum, so I’m wondering what’ll happen in these meetings. Will the Executive Board just take note of a department’s report? Or will they discuss what the report implies, so they can have a genuine dialogue with this department? (P11, 336)
We found factors that promote or inhibit individual teachers in a university hospital in making use of teaching policy incentives on three different levels: the individual level, the departmental level, and the institutional level. The individual and departmental levels mutually influenced each other; the institutional level influenced the departmental level.