Association of Institutional Financial Support of a Core Teaching Faculty With Educational Productivity FREE

To the Editor: Academic medical centers are challenged to identify faculty incentives for teaching and educational scholarship.^1- 3 The Core Teaching Faculty (CTF) model at Wake Forest University School of Medicine has goals to improve medical education similar to those for teaching academies.^4- 5 We analyzed scholarly contributions and curriculum delivery before and during CTF funding to assess salary support as an incentive for educational productivity.

The CTF model focuses on curricular innovation, faculty development, and educational scholarship. Members are involved in teaching and provide annual productivity reports. Internal committees work to achieve curriculum development goals. Faculty apply for membership and are selected by the medical school dean. CTF budgets in 2005 through 2007 were $18 000 per year. Faculty financial support began July 2007 with up to 20% full-time-equivalent support per member to incentivize educational productivity. Total support in 2007-2009 averaged $304 100 per year (3% of dean's office $13.4 million/y budget).

CTF members active for 1 or more years July 2005 through June 2009 were included in the analysis. Educational productivity was evaluated before financial support (academic years 2005-2006 and 2006-2007; prefunding era) and after initiation of support (academic years 2007-2008 and 2008-2009; funding era). We analyzed teaching records, productivity reports, publication databases, and curriculum vitae. Curriculum delivery measures included curriculum hours and teaching, preclinical small group facilitation, and student standardized patient evaluations. Educational products included internal curricular enhancements, external presentations, book chapters, published abstracts, journal publications, electronic publications, and extramural grant funding for educational projects. The Wake Forest University School of Medicine institutional review board approved this project with waiver of informed consent.

Forty-four faculty were CTF members: 25 the entire 4 years (57%); 7 during the prefunding era only (16%); 8 during the funding era only (18%); and 4 during a portion of both eras (9%). Of the members, 28 (64%) were men, 23 (52%) were associate or full professor, 28 (68%) held an MD or DO degree, 12 (27%) were in divisions of the internal medicine department, and 19 (43%) had an academic leadership position. Teaching records, productivity reports, and publication databases were available for 100% of participants. Curriculum vitae were available for supplemental information in 86% of participants.

While receiving funding, curriculum hours (per 2 years) by CTF faculty increased 263 hours (13%), small group facilitating increased 677 hours (21%), and student performance evaluations increased 172 hours (76%) (Table 1). Additional CTF curriculum and small group hours replaced non-CTF faculty, allowing greater standardization of small groups and decreased faculty recruiting. Performance evaluation included 120 additional hours from increased class sizes, as well as replacing time from other faculty.

Internal curricular enhancements (per 2 years) increased from 11 to 22 and external presentations increased from 90 to 114. Peer-reviewed journal publications increased 175% (from 8 to 22), and new extramural grant funding for educational projects increased 145% (from $2 658 159 to $6 508 601) (Table 2). Eight CTF members (18%) had more journal publications, and 5 CTF members (11%) had more educational grants (including 2 previously unfunded grantees).

Study limitations including self-reporting and study design preclude establishing causation between funding for protected time, scholarship, and promotions; better findings in the funding era could reflect in part increased faculty experience and having established a track record securing grants. However, improvements in a variety of scholarly activities support a causal link.

These findings suggest that institutional financial support for faculty effort may be an effective incentive for increasing educational productivity. The only category that did not increase was published abstracts. However, this was balanced by increased journal publications and extramural grants, which are weighted more heavily for promotions. If these findings can be replicated at other institutions, increased extramural funding may make the CTF model financially attractive as an institutional investment.