Chair's Column: Teaching and Education: Results from the 2017 Faculty Survey

May 1, 2018
Dr. Gillian Hawker
Gillian HawkerThe University of Toronto is known throughout the world for the quality of its education of physicians. The Department of Medicine places great emphasis on education and takes tremendous pride in the fact that the vast majority of faculty are consistently rated in the very good-to-excellent range on teaching evaluations, and the vast majority of graduates from DoM training programs rate their experiences as excellent. We do not, however, wish to rest on our laurels and instead want to ensure that the faculty who dedicate their lives to teaching receive the recognition that they deserve.

A major part of the 2017 Department of Medicine Faculty Survey was devoted to examining the opinions of faculty members in several domains that relate to teaching and education. Faculty member views were gathered about the quantity of teaching that they perform, about various aspects of the teaching evaluations that they receive, and about their perceptions of how their teaching and education scholarship is valued by their hospitals, divisions, Department, and Faculty of Medicine.

Overall, 414 departmental faculty members responded. Clinician teachers (CTs) were the largest job description grouping (36.9%), followed by clinician scientists (CSs 24.3%) and clinician investigators (CIs, 22.6%). Clinician educators (CEs 7.4%) and clinicians in quality and innovation (CQIs 5.2%) constituted smaller groupings.

Key Themes

Quality of Teaching

More than 80% of faculty members in each of the academic description of CE, CI, and CS felt that the quantity of teaching that they were delivering was just right, or if anything, too little. In contrast, a substantial proportion of CTs (21%) and C-QIs (37%) responded with lower satisfaction regarding the amount of teaching they are asked to deliver and responded that they were doing too much teaching. The Faculty Survey also provided respondents with the opportunity to comment qualitatively on these issues. Their qualitative comments reinforced the perception that teaching is distributed unevenly across divisions and subgroups even within academic position descriptions. For example, even though CTs are by definition expected to engage in more teaching than CSs or CIs, many reported to be doing a disproportionate amount of teaching within each division, even compared to other CTs. Thus, there is a perception that there are a certain subgroup of CTs or CQIs upon whom the bulk of the teaching falls.

Teaching Evaluations

With respect to teaching evaluations, a substantial proportion of DOM faculty felt that they received inadequate numbers of teaching evaluations: this ranged from 60% of CTs and 53% of CQIs to 48% of CEs, 42% of CIs, and 27% of CSs. Narrative comments suggested that faculty involved in ambulatory, emergency, and elective teaching were especially affected. However, it was encouraging to find that most respondents agreed or strongly agreed that their evaluations from trainees reflected the time they spent teaching, the quality of teaching they provided, and the feedback that they provided to learners. However, most faculty felt that their evaluations from trainees were affected by broader structural and systemic issues in the educational system, such as increased clinical work loads. Notably, approximately 40% of respondents agreed or strongly agreed that their evaluations were influenced by concerns of possible retribution by learners for constructive (negative) feedback, which could have implications in terms of promotions. Thirty-one percent of faculty survey respondents felt they had received an unfair teaching evaluation. Of those, 18% underwent an appeal process and of those filing an appeal only 40% felt there was an adequate resolution.

How Teaching and Education are Valued

The Faculty Survey examined faculty member perceptions of how their teaching and educational scholarship are valued at different levels. The majority of respondents agreed or strongly agreed that their teaching contributions (60-65%) or scholarship (55%) were valued by their colleagues and their primary hospital division head. These percentages progressively dropped as respondents considered being valued by their primary hospital Physician-in-Chief and DDD, and by the Department of Medicine leadership (Chair and Vice Chair). The lowest percentage of all, only 12% of faculty members, felt that their teaching contributions or scholarship were valued by research institutes.

Narrative comments made by survey participants revealed a perception that teaching was undervalued compared to education scholarship. Also, as per above, there were several comments about a lack of transparency in assigning teaching opportunities and in distributing teaching awards.

Summary of What We’ve Learned

With respect to quantity of teaching, the DoM revised its teaching expectations for each academic position description approximately two years ago, and we are making further revisions to incorporate the type of teaching activities faculty will be engaging in for Competence by Design (CBD). We are also developing processes to track teaching and ensure the fair distribution of teaching responsibilities across divisions and across academic position descriptions to ensure that faculty are able to meet expectations and receive recognition for their work. Although the majority of faculty feel as though the evaluations they have received reflect the quality, time, and efforts they have spent teaching, there are nonetheless challenges with receiving an adequate number of evaluations, especially in ambulatory and emergency medicine settings. Faculty members also have concerns that constructive or critical feedback to learners may result in retaliation and problems with teacher assessment and promotion. The importance of valuing educational scholarship and as importantly, the work of faculty who engage with learners “at the coalface of education,” i.e., on the wards, in clinics, and in the emergency departments, have been underscored in the faculty responses.

Status Report and Recommendations

  • We have developed teaching expectations for each academic position description, which are posted on line. We will also be working in collaboration with divisions and hospitals to implement a template for annual review of faculty to identify disproportionate teaching loads to ensure equitable distribution of efforts and identification and support of excellent teachers.
  • Working groups have been struck to develop clear departmental guidelines regarding learner-faculty interactions and to explore how we can shift the culture of teaching from the traditional “fear-to-fail” assessments to one in which longitudinal conversations can occur in safe and supportive environments with the aim of improvement first and foremost and without fear of retribution. Part of this effort also involves a critical look at the accuracy and utility of learner assessments of faculty and the development of additional ways to assess, enhance and reward high-quality teaching by faculty in the Department.
  • We have made major revisions of the faculty teaching evaluation systems (MedSIS and POWER) in order to make reporting on performance to individual faculty members and hospital and university education leads more “user-friendly,” timely, and impactful for promotions. This is an iterative process with further refinement in response to feedback from individual faculty members, PICs, and division directors.
  • We are pilot testing encounter-based teaching evaluations via a point-of-care app to overcome many of the challenges that faculty face who teach predominantly in ambulatory clinic or emergency department settings. These evaluations of teachers may complement the formative evaluations of residents and provide opportunities for longitudinal conversations about improving clinical care in the context of Competence by Design.
  • We are reviewing and revamping all selection processes for leadership positions in the DoM—including educational leadership and opportunities—and for residency and fellowships in order to enhance equity and transparency on both faculty and trainee levels. This effort also includes improving communications within the DoM regarding the posting of new leadership opportunities in the Department and Faculty of Medicine, improving representation of a diversity of perspectives in search processes, and addressing ways to mitigate the effects of implicit bias in selection procedures.

We are completing a report in collaboration with the Dean’s Office, Faculty of Medicine (FoM) to understand and increase the acknowledgment and valuing of the work of clinician teachers. This includes critical reviews of processes and metrics in evaluations and promotions of clinician teachers, as well as recommendations for improvements in evaluations, rewarding dedication and excellence in teaching, improved communications between the DoM, FoM and individual teachers regarding faculty development opportunities.

Many thanks to Drs. Danny Panisko and Arno K. Kumagai for their contributions to this column.