Educational Alliance Research Articles

Moving Toward a Standardized National Family Medicine Subinternship Curriculum: Results From a CERA Clerkship Directors Survey.

Although the subinternship (sub-I) is considered integral in many medical schools' curricula, family medicine does not have standardized course recommendations. Given the variable nature of this clinical experience, this study investigated the potential role of a standardized sub-I curriculum in family medicine. Questions about sub-Is were created and data were gathered and analyzed as part of the 2019 Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) survey of family medicine clerkship directors. The survey was distributed via email to 126 US and 16 Canadian recipients between June 19, 2019 and August 2, 2019 through the online program SurveyMonkey. A total of 101 (71.1%) of 142 clerkship directors responded to the survey. Most (84.2%) schools require sub-Is. There was a positive association between students matching into family medicine and having family medicine sub-Is at residency programs (P<.001). There was no relationship between higher family medicine match rates and the presence of family medicine sub-Is at nonresidency sites (P=.48) or having an advanced ambulatory rotation requirement (P=.16). A sub-I is a way to further expose students to family medicine, and increasing sub-I positions at residency programs may influence the number who pursue the specialty. Creation of a standardized sub-I curriculum presents an opportunity to enhance a critical educational experience in family medicine.

Psychological safety in feedback: What does it look like and how can educators work with learners to foster it?

Feedback conversations play a central role in health professions workplace learning. However, learners face a dilemma: if they engage in productive learning behaviours (such as asking questions, raising difficulties, offering opinions or contesting ideas), they risk exposing their limitations or offending the educator. This highlights the importance of psychological safety in encouraging learners to candidly engage in interactive dialogue and the co-construction of knowledge. Previous research has recommended that building safety, trust or an educational alliance is key to productive feedback encounters. Yet it is unclear how to translate this into practice. Hence our research question was: What does psychological safety look like in workplace feedback and how can educators work with learners to foster it? We analysed 36 videos of routine formal feedback episodes in clinical practice involving diverse health professionals. A psychologically safe learning environment was inferred when learners progressively disclosed information and engaged in productive learning behaviours during the conversation. We used thematic analysis to identify associated educator strategies, which seemed to promote psychological safety. Four themes were identified: (a) setting the scene for dialogue and candour; (b) educator as ally; (c) a continuing improvement orientation, and (d) encouraging interactive dialogue. Educators approaches captured within these themes, seemed to foster a psychologically safe environment by conveying a focus on learning, and demonstrating respect and support to learners. This study builds on claims regarding the importance of psychological safety in feedback by clarifying what psychological safety in workplace feedback conversations might look like and identifying associated educator approaches. The results may offer educators practical ways they could work with learners to encourage candid dialogue focused on improving performance.

Agreement between trainees and supervisors on first-year entrustable professional activities for anaesthesia training

BackgroundEntrustable professional activities (EPAs) are commonly developed by senior clinicians and education experts. However, if postgraduate training is conceptualised as an educational alliance, the perspective of trainees should be included. This raises the question as to whether the views of trainees and supervisors on entrustability of specific EPAs differ, which we aimed to explore. MethodsA working group, including all stakeholders, selected and drafted 16 EPAs with the potential for unsupervised practice within the first year of training. For each EPA, first-year trainees, advanced trainees, and supervisors decided whether it should be possible to attain trust for unsupervised practice by the end of the first year of anaesthesiology training (i.e. whether the respective EPA qualified as a ‘first-year EPA’). ResultsWe surveyed 23 first-year trainees, 47 advanced trainees, and 51 supervisors (overall response rate: 68%). All groups fully agreed upon seven EPAs as ‘first-year EPAs’ and on four EPAs that should not be entrusted within the first year. For all five remaining EPAs, a significantly higher proportion of first-year trainees thought these should be entrusted as first-year EPAs compared with advanced trainees and supervisors. We found no differences between advanced trainees and supervisors. ConclusionsThe views of first-year trainees, advanced trainees, and supervisors showed high agreement. Differing views of young trainees disappeared after the first year. This finding provides a fruitful basis to involve trainees in negotiations of autonomy.

Is the Accreditation in Medical Education an Opportunity or a Burden?

The accreditation process (AccP) is both an opportunity and a burden for medical schools—which one it becomes depends on how medical schools recognize and utilize the AccP. In other words, if a medical school recognizes the AccP only as a formal procedure or as a means for continuing medical education, it will be a burden for the medical school. However, if a medical school recognizes the real and positive value of the AccP, it can be both an opportunity and a tool for developing medical education. The educational value of the AccP is to improve the quality, equity, and efficiency of medical education, along with increasing the options of choice. In order for the AccP to contribute to the development of medical education, accrediting agencies and medical schools must first be recognized as part of an “educational alliance” working together towards common goals. Secondly, clear guidelines on the accreditation standards should be periodically reviewed and shared. Finally, a formative evaluation using self-evaluation as a system that can utilize the AccP as an opportunity to develop medical education must be introduced. This type of evaluation system could be developed through collaboration among medical schools, academic societies for medical education, and the accrediting authority.

Awareness of Meaning in Life is Protective Against Burnout Among Family Physicians: A CERA Study.

Burnout is considered a public health crisis among physicians and is related to poor quality of life, increased medical errors, and lower patient satisfaction. A recent literature review and conceptual model suggest that awareness of life meaning, or meaning salience, is related to improved stress and coping, and may also reduce experience of burnout. This study examined associations among meaning salience, burnout, fatigue, and quality of life among family medicine residency program directors. Data were collected via an online survey administered by the Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA; n=268, response rate of 45.4%) in December 2018. Program directors completed measures of meaning salience, burnout, fatigue, and quality of life. Data were analyzed using Spearman correlations and path analysis. Program directors who reported greater experienced meaning salience also reported significantly less burnout (β=-.40, P<.001) and less fatigue (β=-.38, P<.001), which were then both significantly associated with greater quality of life (Ps<.001). Program directors who reported greater meaning salience also reported greater quality of life (β=.21, P<.001). Additionally, there were significant indirect associations between meaning salience and quality of life through less burnout and fatigue (β=.26, P<.001). The potential for increasing physicians' awareness of their sense of meaning as a means to prevent or decrease burnout is underresearched and warrants further study. Both preventive measures (eg, wellness curricula) and interventions with already-distressed physicians may encourage regular reflection on meaning in life, especially during busy workdays.

Academic Detailing From Medical Students: Part of a Plan to Emphasize Feedback in One Clerkship.

Medical schools have an enduring need to provide ongoing faculty development and to foster educational alliances between teachers and learners, so that feedback provided to learners is both frequent and of high quality. We hypothesized that medical students trained as academic detailers with a mission to increase the emphasis on feedback could serve in this role during our clerkship, while still being evaluated as students in our clerkship rotation. The family medicine clerkship at Mayo Clinic School of Medicine launched a revised curriculum in 2016 in which students were taught how they might build an educational alliance with preceptors, were taught characteristics of high-quality feedback, and practiced requesting more useful feedback when initial quality was poor. After utilizing a clerkship-specific curriculum with small group sessions on receiving feedback, and training students and preceptors on the SNAPPs model, students were then directed to request feedback from their preceptors and model successful feedback conversations for preceptors. The study evaluated the medical students' summative evaluations to compare the rate from the preintervention year (2015-2016) and the intervention year (2016-2017) at which preceptors added comments on students' use of feedback. Preceptors' written comments about students seeking feedback increased at about a four-fold rate (74.4% vs 18.8%, P<.001) after implementing a suite of changes to our clerkship curriculum. Using medical students to change preceptor behaviors was an important part of our suite of interventions. This intervention directed preceptor attention toward our instructional goal of increased medical student feedback.

Identifying and Remediating Quality Issues at Clinical Teaching Sites: A CERA Clerkship Directors Survey

Background and Objectives: Family medicine clerkship directors must secure an adequate number of teaching sites while maintaining or improving the quality of teaching. This survey details how family medicine clerkship directors identify community-based clinical sites with performance challenges, types of challenges, and whether a remediation option exists for struggling clinical sites or preceptors. This study also investigates the relationship between clerkship structure and problems with maintaining high-quality teaching sites. Methods: Data were gathered and analyzed as part of the 2018 Council of Academic Family Medicine’s (CAFM) Educational Research Alliance (CERA) survey of family medicine clerkship directors. Results: There was a significant relationship between ease/difficulty of identifying clinical sites and paying preceptors (P=.032). A lower proportion of sites where a system is in place for remediation reported it being difficult to identify clinical sites (70.0% vs 92.2%, respectively, P=.011). Having a remediation system in place was also associated with less removal of sites (2.5% removed three or more sites vs 25% removed three or more sites, respectively, P=.005). Conclusions: Medical education leaders can explore payment to incentivize community-based preceptors in schools where identifying clinical sites is a challenge. Offering centralized preceptor development activities from medical schools, geared toward the importance of evaluations, balancing learners and opportunities for student engagement, may overcome some of the identified challenges. Medical schools may also consider providing additional time and support for clerkship directors to assist with tracking teaching quality at sites, and to assist struggling preceptors prior to removing them from teaching.

Grade Inflation in the Family Medicine Clerkship.

Medical educators perceive grade inflation to be a serious problem. There is some literature discussing the magnitude of the problem and ways to remediate it, but little literature is available in the field of family medicine. We sought to examine what methods of remediating grade inflation have been tried by family medicine clerkship directors, and what factors influence the chosen method of addressing this problem. We conducted a national Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) survey of family medicine clerkship directors, inquiring about their perceptions of the seriousness of grade inflation, whether it was perceived as a remediable problem, and what methods had been tried within the last 3 years to address this problem. The response rate was 69%. Clerkship directors' perceptions that grade inflation is a serious problem either nationally or in their own clerkship did not correlate with how they weighted the objective versus subjective portions of the clerkship grade. Clerkship directors who agreed that grade inflation was a remediable problem had a higher percentage of nonexamination objective criteria and a lower percentage of subjective criteria in their grading formula. Clerkship directors who agreed grade inflation is a problem in their clerkship were more likely to have tried giving feedback to graders on grade distribution than those who didn't think grade inflation was a problem. Family medicine clerkship directors perceive grade inflation to be a serious problem, both at a national level and in their clerkships. Various methods of addressing grade inflation have been tried by family medicine clerkship directors.

Training Residents in Maternal Depression Care to Improve Child Health: A CERA Study.

Untreated maternal depression negatively impacts both the mother and her children's health and development. We sought to assess family medicine program directors' (PDs) knowledge and attitudes regarding maternal depression management as well as resident training and clinical experience with this disorder. Data were gathered through the Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) national survey of family medicine PDs in US and Canadian programs, from January through February, 2018. Surveys were completed by 298 PDs (57.1% response rate) who were majority male (58.9%) and white (83.8%). Nearly all (90.2%) PDs agreed that family physicians should lead efforts to minimize the impact of maternal depression on child well-being. According to PD report, in the family medicine clinics where residents train, most (77.3%) have a clinic process that ensures that routine screening for depression occurs, and 54.4% do some screening of mothers during pediatric visits. Only 18.2% report routinely taking steps to minimize the impact of the mothers' depression on child well-being. Finally, 41.3% of PDs reported being familiar with the literature on the impact of maternal depression on children; self-reported familiarity was significantly associated with more comprehensive resident training on this topic. Family medicine residency program directors are supportive of training in maternal depression, though their current knowledge is variable and there are opportunities to enhance care of mothers and children impacted by this common and serious disorder.

La alianza educativa escuela/familia y los grupos de chat de padres: una mirada a la situación italiana

The call for collaboration between the school and the family is a constant of many educational centers, however, its meaning is rarely defined and not always the measures adopted to support it at the pragmatic level are adequate, registering from both sides problematic situations of des-alliance. In this contribution, the coordinates of the educational alliance are analyzed, highlighting the latest advances and prefiguring resolution scenarios from a theoretical and methodological point of view. In particular, the most adressed topic that appears with more and more force in the dynamics between families and educational and school services: The use of the progenitors of new communication technologies. These new forms of relationship, although they have positive aspects, are characterized by a communication little filtered, very immediate and, often, emotional, having an impact on the educational relationship, generating more problems and urging the need for a type of project-action from the educational institutions.

La alianza educativa escuela/familia y los grupos de chat de padres: una mirada a la situación italiana

La llamada a la colaboración entre escuela y familia es una constante de muchos centros educativos, sin embargo, raramente se define su significado y no siempre las medidas de apoyo pragmático son adecuadas, registrándose desde ambas partes situaciones problemáticas de des-alianza. En esta contribución se analizan las coordenadas de la alianza educativa destacando los últimos avances y prefigurando escenarios de resolución desde un punto de vista teórico y metodológico. En particular, se aborda una temática que se presenta cada vez con más fuerza en las dinámicas entre familias y centros educativos: se trata del uso por parte de los progenitores de las nuevas tecnologías de comunicación. Estas nuevas formas de relación, aunque tienen aspectos positivos, se caracterizan por una comunicación poco filtrada, muy inmediata y, a menudo, emocional, repercutiendo a la relación educativa, generando más problemas y haciendo urgente algún tipo de proyecto-acción por parte de las instituciones educativas. The call for collaboration between the school and the family is a constant of many educational centers, however, its meaning is rarely defined and not always the measures adopted to support it at the pragmatic level are adequate, registering from both sides problematic situations of des-alliance. In this contribution, the coordinates of the educational alliance are analyzed, highlighting the latest advances and prefiguring resolution scenarios from a theoretical and methodological point of view. In particular, the most adressed topic that appears with more and more force in the dynamics between families and educational and school services: The use of the progenitors of new communication technologies. These new forms of relationship, although they have positive aspects, are characterized by a communication little filtered, very immediate and, often, emotional, having an impact on the educational relationship, generating more problems and urging the need for a type of project-action from the educational institutions.

Technology Use to Deliver Faculty Development: A CERA Study.

Technology provides a platform to help address individualized training needs for community preceptors who are separated from the campus and pressured to achieve clinical productivity goals. This study explores technology use and support for delivering faculty development to community preceptors. This cross-sectional study was part of the 2017 Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) annual survey of family medicine clerkship directors in the United States and Canada. The majority of respondents (n=62, 68.9%) agreed or strongly agreed that "using technology is critical to the successful delivery of faculty development to community preceptors." Only one-third (n=31) agreed or strongly agreed that their institution offers them adequate support to create and deliver technology-mediated faculty development or offers adequate support to community preceptors for accessing and using technology. Clerkship directors need institutional support to provide effective faculty development to preceptors via technology. The opportunity exists for institutions, national organizations, and professions to collaborate across disciplines and health professions on technology-based faculty development to support a level of quality and engagement for faculty development that is consistent with the levels we bring to student education.

Entrustable Professional Activity Utilization: A CERA Study of Family Medicine Residency Program Directors.

Entrustable professional activities (EPAs) is a novel assessment framework in competency-based medical education. While there are published pilot reports about utilization and validation of EPAs within undergraduate medical education (UME), there is a paucity of research within graduate medical education (GME). This study aimed to explore the landscape of EPAs within family medicine GME, particularly related to the understanding of EPAs, extent of utilization, and benefits and challenges of EPAs implementation as an assessment framework within family medicine residency programs (FMRPs) in the United States. A cross-sectional survey, as part of the 2017 Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA) Family Medicine Residency Program (FMRP) Director omnibus online survey was conducted in fall, 2017. ACGME-accredited FMRP directors were invited by email to participate. The survey response rate was 53.1% (267/503). Overall, 90.1% (237/263) of FMRP directors were aware of EPAs as an assessment framework and 82.8% (197/238) understood the principles of EPAs, but 39.9% (95/238) were not confident in utilizing EPAs. Only 15.1% (36/238) of FMRP directors reported currently employing EPAs as an assessment tool. Identified benefits of EPAs use included increased transparency and congruence of expectations between learners and FRMP as well as facilitation for formative feedback. Identified barriers of EPA incorporation included difficulty integrating EPAs into the current assessment framework and faculty development. While EPAs are well recognized and understood by FMRP directors, there is significant lack of utilization of this assessment framework within FMRP in the United States.

La ninna nanna e le attività di cura per l'educazione e lo sviluppo dei bambini e delle bambine

This reflection aims to illustrate the Lullaby as an important ritual activity by caregivers for the emotional and cognitive development of the child (Imberty, 2000, pp. 449-462). The memory of specific experiences and their spatial and temporal contextualization are the basis for the construction of authentic structures of knowledge (Cambi, 2006). Ritual activities, like the use of Lullabies also represent a possible shared educational instrument, thus constituting the educational alliance between parents and educators (Annacontini, 2010). The lullaby is one of the oldest rituals in the history of music and education (Delalande, 1995, Baroni, 1997). Early records indicate that the lullaby also embraces the synchronic, specific and privileged communicative and narrative character between adult and child (Acone, 2017), which Stern (1998, 2008) asserts to occur from the baby’s ninth month, and which he describes as the ideal means to achieve the intersubjective participation of affections and emotions. Repetition plays an important constructive role in the Lullaby and variation is mostly achieved by the improvisation of the performer – the communicative interaction using the Lullaby (singing) plays a fundamental role in the early communication between child and the parent/caregiver. This is expressed through the simplest and most common musical practice: singing (La Face Bianconi, 2011). Singing the child to sleep in an environment where he feels safe and secure, represents an important, yet complex behavioural element of a child’s ability to form meaningful relationships – relationships characterized by trust and wellbeing (Minerva, F. P., & Frabboni, F. 2014). The rituals to make them fall asleep (even at home), the routines, as well as the presence of transitional objects (reassuring and related to everyday life like dolls, teddy bears, pieces of clothing) (Winnicott, 1986, 2012), are tools for the child to enter into a relationship of trust with the caregiver, all expressive and important signs that the child feels safe within his environment (De Serio, 2012). The condition of sleep indicates the child’s acceptance of his new environment and situation and constitutes the presence of trust and security – a condition of readiness for peace of mind and sleep (Sharmahd, N., Stradi MC. 2009). Sleep, an omnipresent element in generating energy, necessary for physical growth and development, is an important element throughout the life of the child, as well as of adult (Ulivieri & Dozza, 2016), through positive memories of sleep, and falling to sleep, the child learns and assimilates important experiences that translates and transforms into valuable knowledge and skills, in music, too.

A systematic review of supervisory relationships in general practitioner training.

The educational alliance is argued to be at the heart of supervision in medical education. This review aims to map the research field and develop a conceptualisation of the nature of such educational alliances within postgraduate supervision for general practitioners. An integrative review of the international literature on supervision from 2011 to 2018 was undertaken, and papers assessed for relevance and quality. Data analysis incorporated framework analysis techniques. Bordin's working alliance-based model of supervision was used as a springboard for synthesis, as well as allowing for the emergence of new ideas, theories and concepts from the literature. A total of 49 full texts were included for analysis. There was evidence of the importance of trust, agreement and bond in accordance with Bordin's model. The results also highlighted the importance of greater clarity on supervisory goals, and the tasks to support these goals, to effectively address competing priorities and roles within supervision. Non-hierarchical relationships were advocated, although supervisors must remain impartial in their assessment and monitoring roles. The influence of the wider practice community and situated learning through legitimate peripheral participation are documented. A model of General practice (GP) supervision is proposed that integrates the findings. GP supervision requires a greater emphasis than is suggested by the working alliance model, both on the clarity of expectations and the appreciation of the multiple roles and competing priorities of both trainee and supervisor. Furthermore, as GP supervision develops within the rising workload of contemporary general practice, the role of the wider community of practice may become more prominent. We have adapted the working alliance model for postgraduate General practice (GP) supervision, emphasising the explicit sharing of expectations relating to goals, tasks and roles to facilitate negotiation and agreement.

How Much Do Family Medicine Residency Programs Spend on Resident Recruitment? A CERA Study

Resident recruitment is one of the most important responsibilities of residency programs. Resource demands are among the principal reasons for calls for recruitment reform. The purpose of this study was to provide a national snapshot of estimated costs of recruitment among US family medicine programs. The aim was to provide data to assist programs in securing and allocating resources to manage the increasingly challenging recruitment process. Questions were part of a larger omnibus survey conducted by the Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA). Specific questions were asked regarding how many interviews each program offered and completed; interview budget; additional funds spent on recruitment; reimbursements; and resident, faculty, and staff hours used per interviewee. The response rate was 53% (277/522). Program directors estimated that residents devoted 6.4 hours (95% CI 6, 7) to each interview, faculty 5.6 hours (95% CI 5, 6), and staff 4.4 hours (95% CI 4, 5). The average budget for interviewing per program was $17,079 (±$19,474) with an additional $8,274 (±$9,615) spent on recruitment activities. The average amount spent per applicant was $213 (±$360), with $111 (±$237) in additional funds used for recruitment. Programs were more likely to pay for interviewee meals (82%) and lodging (59%) than travel (3%). As individual programs face increasing pressure to demonstrate value for investment in recruiting, data generated by this national survey enables useful comparison to individual programs and sponsoring organizations. Results may also contribute to national discussions about best practices in resident recruitment and ways to improve efficiency of the process.

The Salome Ensemble: Rose Pastor Stokes, Anzia Yezierska, Sonya Levien, and Jetta Goudal

The Salome Ensemble: Rose Pastor Stokes, Anzia Yezierska, Sonya Levien, and Jetta Goudal

Perceptions of Parenting Residents Among Family Medicine Residency Directors.

Parenting during residency is increasingly common, and resident parents face unique demands on their time and emotional and cognitive resources. Physicians at all levels of training perceive negative impacts of parenting on career and family life. Surveys of program directors (PDs) in other specialties reveal concern about performance and quality of life of parenting residents. The primary aims of this study were to examine family medicine PDs' perceptions of parenting residents' performance and the adequacy of parenting support structures. Data were collected from the 2017 Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA) Family Medicine Residency Program Directors survey. Directors provided the number and status of parenting residents and rated adequacy of parenting resources, resident performance, and impact of parenting on residents using a Likert scale. Results were compared between male/female PDs and male/female residents. Response rate was 57.1%. Less than half of PDs reported adequate parenting support structures in their program (46%). Over 40% of PDs reported that 81%-100% of female residents who take parental leave end up extending their residency training, the most common response category. PDs did not report gender-based differences in performance of parenting residents. PDs most often reported significantly worse well-being for female parenting residents but perceived improved well-being of male parents. Less than half of family medicine PDs feel their program has adequate parenting resources. Female parenting residents commonly extend residency training. PDs perceive parenting negatively impacts well-being of female residents, but not male residents.

Burnout and Resiliency Among Family Medicine Program Directors.

Nearly one-half (46%) of physicians report at least one symptom of burnout. Family medicine residency program directors may have similar and potentially unique levels of burnout as well as resiliency. The primary aims of this study were to examine burnout and resiliency among family medicine residency directors and characterize associated factors. The questions used were part of a larger omnibus survey conducted by the Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA) in 2016. Program and director-specific characteristics were obtained. Symptoms of burnout were assessed using two single-item measures adapted from the full Maslach Burnout Inventory, and level of resiliency was assessed using the Brief Resilience Scale. The overall response rate for the survey was 53.7% (245/465). Symptoms of high emotional exhaustion or high depersonalization were reported in 27.3% and 15.8% of program directors, respectively. More than two-thirds of program directors indicated that they associated themselves with characteristics of resiliency. Emotional exhaustion and depersonalization were significantly correlated with never having personal time, an unhealthy work-life balance, and the inability to stop thinking about work. The presence of financial stress was significantly correlated with higher levels of emotional exhaustion and depersonalization. In contrast, the level of resiliency reported was directly correlated with having a moderate to great amount of personal time, healthy work-life balance, and ability to stop thinking about work, and negatively correlated with the presence of financial stress. Levels of emotional exhaustion, depersonalization, and resiliency are significantly related to personal characteristics of program directors rather than characteristics of their program.

Satisfaction, Motivation, and Retention in Academic Faculty Incentive Compensation Systems: A CERA Survey.

The use of incentive compensation in academic family medicine has been a topic of interest for many years, yet little is known about the impact of these systems on individual faculty members. Better understanding is needed about the relationship of incentive compensation systems (ICSs) to ICS satisfaction, motivation, and retention among academic family medicine faculty. The Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA) conducted a nationwide survey of its members in 2013. This study reports the results of the incentive compensation question subset of the larger omnibus survey. The overall response rate was 53%. The majority (70% [360/511]) of academic faculty reported that they are eligible for some type of incentive compensation. The faculty reported moderate satisfaction, with only 38% being satisfied or highly satisfied with their ICS. Overall mean motivation and intent to remain in their current position were similar. The percentage of total income available as an incentive explained less than 10% of the variance of those outcomes. Faculty perceptions of appropriateness of the measures, understanding of the measurement and reward systems, and perception of due process are all related to satisfaction with the ICS, motivation, and retention. ICSs are common in academic family medicine, yet most faculty do not find them to motivate their choice of activities or promote staying in their current position. Design and implementation are both important in promoting faculty satisfaction with the ICS, motivation, and retention.