Office of Faculty Development, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.
Department of Educational Development and Research, Faculty of Medicine, University of Maastricht, Maastricht, The Netherlands.
Med Educ. 2021 May;55(5):614-624. doi: 10.1111/medu.14422. Epub 2020 Dec 9.
When medical education programs have difficulties recruiting or retaining clinical teachers, they often introduce incentives to help improve motivation. Previous research, however, has shown incentives can unfortunately have unintended consequences. When and why that is the case in the context of incentivizing clinical teachers remains unclear. The purposes of this study, therefore, were to understand what values and motivations influence teaching decisions; and to delve deeper into how teaching incentives have been perceived.
An interpretive description methodology was used to improve understanding of the development and delivery of teaching incentives. A purposeful sampling strategy identified a heterogenous sample of clinical faculty teaching in undergraduate and postgraduate contexts. Sixteen semi-structured interviews were conducted and transcripts were analyzed using an iterative process to develop a thematic structure that accounts for general trends and individual variations.
Clinicians articulated interrelated and dynamic personal and environmental factors that had linear, dual-edged and inverted U-shaped impacts on their motivations towards teaching. Barriers were frequently rationalized away, but cumulative barriers often led to teaching attrition. Clinical teachers were motivated when they felt valued and connected to their learners, peers, leadership, and/or the medical education community. While incentives aimed at producing these connections could be perceived as supportive, they could also negatively impact motivation if they were impersonal, inequitable, inefficient, or poorly framed.
DISCUSSION/CONCLUSION: These findings reinforce the literature suggesting that it is necessary to proceed with caution when labeling any particular factor as a motivator or barrier to teaching. They take us deeper, however, towards understanding how and why clinical teachers' perceptions are unique, dynamic and fluid. Incentive schemes can be beneficial for teacher recruitment and retention, but must be designed with nuance that takes into account what makes clinicians feel valued if the strategy is to do more good than harm.
当医学教育项目在招募或留住临床教师方面遇到困难时，他们通常会引入激励措施来提高教师的积极性。然而，之前的研究表明，激励措施可能会带来意想不到的后果。在激励临床教师的背景下，这种情况何时以及为何会发生尚不清楚。因此，本研究的目的是了解哪些价值观和动机影响教学决策；并更深入地研究教学激励措施是如何被感知的。
采用解释性描述方法来提高对教学激励措施的制定和实施的理解。采用有针对性的抽样策略，确定了在本科和研究生教学环境中教授的临床教师的异质样本。进行了 16 次半结构化访谈，使用迭代过程分析转录本，以开发一个主题结构，该结构考虑到了一般趋势和个体差异。
临床医生阐明了相互关联且动态的个人和环境因素，这些因素对他们的教学动机产生了线性、双刃剑和倒 U 形的影响。障碍经常被合理化，但累积的障碍往往导致教学人员流失。当临床教师感到自己受到重视，并与学习者、同事、领导和/或医学教育界建立联系时，他们就会受到激励。虽然旨在建立这些联系的激励措施可能被认为是支持性的，但如果它们是不人性化、不公平、低效或框架不佳的，它们也可能对动机产生负面影响。
讨论/结论：这些发现强化了文献表明，在将任何特定因素标记为教学的激励因素或障碍时，有必要谨慎行事。然而，它们让我们更深入地了解了为什么临床教师的看法是独特的、动态的和多变的。激励计划可以有助于教师的招聘和留任，但必须在设计时考虑到激励因素的细微差别，要考虑到激励因素如何使临床医生感到自己的价值所在，如果激励策略要带来更多的好处而不是坏处的话。
