Educational Value Unit Research Articles

In Search of a "Metric System" for Measuring Faculty Effort: A Qualitative Study on Educational Value Units at U.S. Medical Schools.

Faculty at academic health centers (AHCs) are charged with engaging in educational activities. Some faculty have developed educational value units (EVUs) to track the time and effort dedicated to these activities. Although several AHCs have adopted EVUs, there is limited description of how AHCs engage with EVU development and implementation. This study aimed to understand the collective experiences of AHCs with EVUs to illuminate benefits and barriers to their development, use, and sustainability. Eleven faculty members based at 10 AHCs were interviewed between July and November 2022 to understand their experiences developing and implementing EVUs. Participants were asked to describe their experiences with EVUs and to reflect on benefits and barriers to their development, use, and sustainability. Transcripts were analyzed using thematic analysis. EVU initiatives have been designed and implemented in a variety of ways, with no AHCs engaging alike. Despite differences, the authors identified shared themes that highlighted benefits and barriers to EVU development and implementation. Within and between these themes, a series of tensions were identified in conjunction with the ways in which AHCs attempted to mitigate them. Related to barriers, the majority of participants abandoned or paused their EVU initiatives; however, no differences were identified between those AHCs that retained EVUs and those that did not. The collective themes identified suggest that AHCs implementing or sustaining an EVU initiative would need to balance benefits and barriers in light of their unique context. Study findings align with reviews on EVUs and provide additional nuance related to faculty motivation to engage in education and the difficulties of defining EVUs. The lack of differences observed between those AHCs that retained EVUs and those that did not suggests that EVUs may be challenging to implement because of the complexity of AHCs and their faculty.

A Review on the Use of the Educational Value Unit (EVU) among Teaching Hospitals

(1) Background: In recent years, medical institutions across the U.S. have implemented a points system based on the Educational Value Unit (EVU) to assess and reward faculty for their educational efforts. The purpose of this narrative review is to summarize the current literature on EVU systems and to evaluate their utility in the U.S. healthcare system. (2) Methods: We searched the Ovid MEDLINE, Embase, Web of Science, and PubMed databases to identify literature describing the inception of EVU systems and current systems implemented by U.S. academic medical centers and medical schools. In total, a combined 48 studies and abstracts pertaining to EVU systems were reviewed, and a combined 26 published studies and abstracts from 1999 to 2022 pertaining to EVU systems were included. (3) Results: To our knowledge, at least 40 U.S. academic medical centers have used an educational metrics system, of which 21 institutions have published studies describing EVU systems in one or more of their medical departments. The outcomes associated with these self-described EVU systems are the focus of this study. EVU systems increase the number of faculty who meet baseline educational requirements, promote educational productivity, redistribute educational burden and funding among faculty members, and shift physician priorities towards education. The monetary reward associated with EVU systems is unlikely to be a significant factor contributing to these changes; instead, intrinsic motivation and a sense of academic responsibility play a larger role. (4) Conclusions: EVU systems are an effective way to evaluate and reward individual and departmental educational efforts in U.S. academic medical centers and medical schools. The adoption of EVUs will likely become more commonplace as U.S. academic medical centers and medical schools place additional emphasis on medical education.

In search of a "metric system" for measuring faculty effort: A qualitative study on educational value units at medical schools in the United States - Interview Guide

In search of a "metric system" for measuring faculty effort: A qualitative study on educational value units at medical schools in the United States - Interview Guide

Narrative Review of Clinical Productivity and Teaching in Emergency Medicine.

Emergency medicine educators are subject to external pressures to increase clinical productivity while maintaining quality teaching. Strategies to mitigate this perceived conflict include alterations in staffing and incentive compensation with educational value units. There is a paucity of information describing the effect of clinical demands on teaching metrics in emergency medicine. We performed a narrative review of the literature describing the relationship between clinical productivity and teaching evaluations of emergency medicine faculty and residents. We searched PubMed and Google Scholar for peer-reviewed articles describing emergency medicine clinical productivity metrics, teaching metrics, and the relationship between them. Seven articles met inclusion criteria. While most articles utilized relative value units (RVUs) per hour, other outcomes metrics were heterogeneous. Almost all studies utilized retrospective data and took place at academic teaching hospitals. Despite variability in statistical analysis, no studies found a relationship between clinical productivity and teaching metrics. Multiple articles identified characteristics of faculty that were associated with improved teaching metrics independent of clinical demands. The available literature does not support the concept that increased clinical productivity conflicts with quality teaching. A subset of faculty was identified who excelled at both. Next research steps should include developing shared standards for assessment of clinical productivity and educational quality that can be used to collect data at multiple sites at academic and community clinical settings; a secondary outcome includes measuring the effects of additional teaching attendings and educational value units.

Establishing an educational value unit to promote teaching in an academic unit

In academic health centers, education remains an incompletely supported and funded mandate. In an attempt to promote education and better support educational endeavors of faculty, some academic health centers and departments have conceived of a metric, the educational value unit (eVU), to begin to "quantify" teaching. What goes into this metric, its intended goals and the logistics of its implementation vary considerably among centers. This practical advice paper highlights the various lessons learned from a review of the limited published literature on eVU systems supplemented with our personal experience in implementing a successful eVU system in the Department of Pediatrics at our institution, to help guide others who may be interested in doing that same. Even in limited-resource settings, our hope is that these lessons can serve as a guide on how to better quantify and reward teaching, whether through monetary or nonfiscal incentives and recognition.

Faculty Preferences in Clinical Education Recognition: A Survey of Faculty at 3 Institutions

Purpose: Innovative studies have created proposals for measuring productivity using Relative Value Unit (RVU) or Educational Value Unit (EVU) systems, but little attention has been given to faculty preferences for rewarding educational activity. This study assesses perceptions of educational value and reward preferences for educational involvement of faculty at 3 different hospital systems affiliated with 1 medical school. Method: A 25-question electronic survey was sent to clinical faculty across 3 distinct hospital systems affiliated with a Midwestern medical school in spring 2015. Results were analyzed using the Kruskal-Wallis test and free text comments were reviewed for common themes. Results: A total of 4325 surveys were distributed and 361/467 (77%) of the surveys opened were completed for an overall response rate of 8%. Of the respondents 55% were employed by the primary affiliate hospital. Most respondents believed some method of recognition for educational activities should be in place at their institution. Overall, clinical faculty believed their own hospital systems valued education less than the school of medicine and their departments did. Most faculty gave highest preference for academic recognition, reduction in RVU requirements, or an adoption of an EVU system. Conclusion: Most faculty preferred reduced RVU requirements, adoption of an EVU system, or some method of academic recognition to reward educational activity. Differences in results between hospital systems suggest institutional climate may influence faculty preferences.

Should dental school faculty be measured and compensated using academic productivity models? Two viewpoints.

Operationalizing faculty contributions in ways that align with organizational mission can be difficult, particularly when monetizing effort. Conventional compensation methods may result in faculty effort going undefined, resulting in more subjectivity in recognition and compensation. Inequities lead to faculty marginalization, fragmentation, decreased motivation, and attrition. Dental faculty retirements are expected to increase, as 81% of men and 19% of women faculty aged 60 years and older in 2015-2016. We present opposing perspectives on the use of educational value units (EVUs) in academic dentistry. The first viewpoint articulates that such models improve recruitment and retention by objectifying (a) faculty performance measurement, (b) academic productivity improvements, and (c) compensation determination. The counterpoint suggests EVUs are deterrents to faculty retention due to challenges with objectively quantifying performance measures, a potential inherent bias linked to gender, and the undervaluing of teaching quality or collaborative practices.

Are All Teaching Activities Valued the Same? Their Relative Worth Is in the Eye of the Beholder.

The pressures for generating revenue from clinical activities dissuade clinician-educators from teaching; taking the steps to develop an educational value system is a way to recognize and perhaps support education. We compared the perceived educational value of diverse pedagogical activities during clinical training from students, residents, and faculty in medical and surgical specialties. Between 2016 and 2017, a survey among medical students, residents, and faculty from medical (internal medicine, pediatrics) or surgical (general surgery, obstetrics and gynecology) departments was conducted at an academic medical center that sponsors 88 training programs. Participants ranked teaching activities relative to their perceived teaching importance. In total, 156 subjects participated (48 core teaching faculty, 68 residents, and 40 medical students). Teaching in the wards was the highest-ranked teaching activity for medical (mean 1.6) and surgical specialties (mean 1.9). For medicine and pediatrics, active teaching activities were ranked higher (mean 2.9, 95% confidence interval [CI] 2.8-3.0) than passive teaching activities (mean 5.3, 95% CI 5.1-5.5, P < 0.001). Similarly, for surgery and obstetrics and gynecology, active teaching activities were ranked higher (mean 3.6, 95% CI 3.3-3.9) than passive teaching activities (mean 5.2, 95% CI 4.8-5.5, P < 0.001). Medical students, residents, and faculty across specialties have a high degree of agreement regarding the ranking of diverse pedagogical activities; such correlation will facilitate the interpretation of educational value units across specialties.

Analyzing Dental Students' Clinic Production Using Time-Based Relative Value Units: Ten-Year Cross-Cohort Mapping.

The analysis of dental students' clinical production/participation has been used to assess whether a prospective graduate is capable of unsupervised and independent practice (that is, competent to perform that practice). This method and others have inherent biases that may not accurately reflect whether the student has mastered the associated concepts and techniques required for dentistry. The aim of this study was to assess an informatics system that assigned curriculum meta-tags with time-based relative educational value units (ReVUs) to each clinical procedure performed by Medical University of South Carolina (MUSC) students. The system has been used since 1998, but for this study the complete data sets for the MUSC graduating classes of 2007 through 2016 were mapped using microcompetency codes for the dental procedures. In total, 421,494 procedures were formatted and analyzed using software developed to aggregate disparate data sets from clinical activities into a common format for evaluation. The results showed that the ten classes (cohorts) were very consistent with cohort high ReVUs averaging 7,317.1 points, cohort mean ReVUs being 5,180.2 points, and cohort low ReVUs averaging 3,381 points. A detailed analysis of student effort by dental subspecialty found that preventive activities represented 13.4%, patient assessment 32.6%, periodontology 2.8%, restorative dentistry 16.3%, prosthodontics 21.9%, endodontics 6.7%, and oral surgery 5.7% of the total points in the clinical part of the curriculum. In this system, point thresholds can be easily generated to monitor students' progress towards competence for each defined competency and thus assess their progress towards acquiring the skills required for unsupervised, independent practice.

Educational Value Units: A Mission-Based Approach to Assigning and Monitoring Faculty Teaching Activities in an Academic Medical Department.

Increasing emphasis on revenue generation could jeopardize the fundamental notion of what it means to be faculty. Despite being a core mission, education is often marginalized in academic medical departments, and expectations of faculty effort in this area are often vague. A potential solution is mission-based budgeting (MBB), which refers to the allocation of resources based on core-mission-related priorities. From December 2012 to March 2013, the authors developed an educational value unit (EVU) system (using an MBB approach) to assign and monitor teaching activities related to the core departmental educational mission at the Department of Emergency Medicine, Johns Hopkins Medicine. EVUs were based on learner contact time, with one EVU equal to roughly one hour of in-person time with medical students or residents. Core education faculty vetted the proposed system; educational leaders determined the total EVUs needed and assessed the impact of their equitable distribution among faculty; and faculty members selected preferences and were assigned EVU obligations. For academic year 2013-2014, 5,896 EVUs were distributed among 54 faculty. At the end of the year, complete EVU data were available for 47 faculty. Of these, only 6 failed to complete their assigned EVU obligations. All core teaching activities were covered, and educational efforts were distributed more equitably across faculty. The system is being refined, with an emphasis on incorporating learner outcome metrics, refining the teaching grid, incorporating failure to meet EVU obligations into yearly faculty evaluations, and disseminating the system to other departments and institutions.

Capturing Psychologists' Work in Academic Health Settings: The Role of the Educational Value Unit (EVU).

This paper describes how psychology faculty positions in academic health centers (AHCs) have evolved to meet the changing needs in healthcare. In that context, the roles of psychologists have expanded significantly to include a wide array of clinical responsibilities, teaching and supervisory roles, administrative functions, research initiatives, and academic scholarship. Traditionally, faculty compensation plans have been calculated through the use of Relative Value Units which are primarily based on clinical service delivery, hence, incomplete when attempting to account for these growing academic responsibilities. This paper reviews the need to expand the ways in which the work provided by psychologists is appropriately identified and compensated for in AHCs. Drawing upon six models utilized in other areas of medical education, this paper describes the potential utility of incorporating Educational Value Units as a metric for capturing this expanding set of academic responsibilities and systematically incorporating them into a psychologist's job design. Recommendations for future considerations are provided.

Introduction to the Second Section of the Special Issue: Invited Papers from the 2015 APAHC Conference.

This issue of the Journal of Clinical Psychology in Medical Settings includes a continuation of the special issue of Invited Papers based on presentations at the 2015 conference of the Association of Psychologists in Academic Health Centers (APAHC). The first installment of this special issue was published in December 2015. APAHC is an organization devoted to representing the interests and providing professional support and networking for psychologists working in Academic Health Centers (AHCs). Our biennial conference highlights the multiple aspects of our work in AHCs including clinical service, teaching, and research, as well as matters concerning the business of practice and professional identity for psychologists in these settings. The 2015 conference was held in Atlanta, Georgia in February with the theme, ‘‘Academic Health Centers in the Era of Interprofessionalism: Multifaceted Contributions of Psychology.’’ A complete overview of the conference is available in the introduction to the December special issue of JCPMS (Shaffer & Shahane, 2015). Because the APAHC conference tends to be fairly small relative to the estimated nearly 5000 psychologists practicing in academic health centers across the United States (Robiner, Dixon, Miner, & Hong, 2014), we followed the conference with these special issues of JCPMS to disseminate this highly pertinent information more broadly. Manuscripts published in the two sections of the special issue reflect themes related to expanding psychologists’ work through telehealth; capturing the value of psychologists’ clinical, administrative, and educational work; patient centered medical homes and integrated care; and professional development. The December 2015 section of the special issue included five manuscripts addressing psychologists’ roles in patient centered medical homes, measuring clinical and administrative outcomes, transformational leadership, and psychology licensure implications of telehealth. The current section has three manuscripts, one of which gives a broad overview of professional development issues and the other two of which address more specific administrative issues. In their article titled ‘‘Psychologists in Academic Health Centers: Being, Visible, Relevant, and Integral,’’ Barry Hong and William Robiner discuss how early and mid-career psychologist can thrive in AHCs. Eugene D’Angelo and Katie Gallagher’s article, ‘‘Capturing Psychologists’ Work in Academic Health Settings: The Role of the Educational Value Unit (EVU),’’ reviews how psychologists have been historically compensated, as well as alternative models that incorporate the many facets of psychologists’ work pertaining to education in AHCs. Last, Samuel Hubley and Benjamin Miller discuss the ‘‘Implications of Healthcare Payment Reform for Clinical Psychologists in Medical Settings’’ and give an overview of promising alternative payment models in integrated care. As the 2015 conference co-chairs and guest editors of the corresponding special issue of JCPMS, we are keenly aware of the power of the APAHC community and grateful to our many colleagues who had hands in the success of these ventures. First, we would like to thank our esteemed colleagues who contributed doubly by presenting in Atlanta and writing manuscripts for the special issue. & Laura A. Shaffer laura.shaffer@virginia.edu

Recruiting primary care physicians to teach medical students in the ambulatory setting: a model of protected time, allocated money, and faculty development.

Medical schools face barriers to recruiting physicians to teach in the ambulatory setting for many reasons, including time required to teach, loss of productivity when learners are present, and physicians' uncertainty about how to teach. In 2012, the primary care department of the University of Queensland-Ochsner Clinical School (UQ-OCS) implemented an innovative model for recruiting primary care physicians to teach students in their clinics. The model's three-pronged approach allows protected teaching time, allocates tuition money to reimburse physicians for teaching via educational value unit (EVU) tracking, and includes a faculty development program. In the first two years of EVU tracking (academic years 2012 and 2013), 5,530 EVUs were provided by 48 primary care faculty teaching 60 students at 11 sites. In academic year 2013, the first year in which tuition dollars were available to fund teaching by primary care faculty, over $120,000 in tuition money was transferred to the department to pay for EVUs. No faculty in 2012 or 2013 experienced a change in salary as a result of teaching activities. Faculty development workshops have been well attended. The general practice clerkship has been the top-rated third-year clerkship by students for the first three years of clinical rotations at the UQ-OCS. A qualitative study to describe the barriers to and solutions for recruiting physicians to teach students in ambulatory settings is planned. Other studies will evaluate the effectiveness of faculty development efforts and the impact of students' presence on patients' access to clinic appointments.

Implementation of an Education Value Unit (EVU) System to Recognize Faculty Contributions.

IntroductionFaculty educational contributions are hard to quantify, but in an era of limited resources it is essential to link funding with effort. The purpose of this study was to determine the feasibility of an educational value unit (EVU) system in an academic emergency department and to examine its effect on faculty behavior, particularly on conference attendance and completion of trainee evaluations.MethodsA taskforce representing education, research, and clinical missions was convened to develop a method of incentivizing productivity for an academic emergency medicine faculty. Domains of educational contributions were defined and assigned a value based on time expended. A 30-hour EVU threshold for achievement was aligned with departmental goals. Targets included educational presentations, completion of trainee evaluations and attendance at didactic conferences. We analyzed comparisons of performance during the year preceding and after implementation.ResultsFaculty (N=50) attended significantly more didactic conferences (22.7 hours v. 34.5 hours, p<0.005) and completed more trainee evaluations (5.9 v. 8.8 months, p<0.005). During the pre-implementation year, 84% (42/50) met the 30-hour threshold with 94% (47/50) meeting post-implementation (p=0.11). Mean total EVUs increased significantly (94.4 hours v. 109.8 hours, p=0.04) resulting from increased conference attendance and evaluation completion without a change in other categories.ConclusionIn a busy academic department there are many work allocation pressures. An EVU system integrated with an incentive structure to recognize faculty contributions increases the importance of educational responsibilities. We propose an EVU model that could be implemented and adjusted for differing departmental priorities at other academic departments.

Valuing the Education Mission: Implementing an Educational Value Units System

Valuing the Education Mission: Implementing an Educational Value Units System

University of Michigan Medical School

University of Michigan Medical School

Medical Education in the United States and Canada, 2010

The authors present an overview of the educational programs, infrastructure to support them, and the assessment strategies of 128 medical schools in the United States and Canada, based on reports submitted by those schools and published in this supplement to Academic Medicine. The authors explore many important changes that have occurred since the publication of the Flexner Report in 1910 as well as the progress that is evident since a similar collection of medical school reports was published in September 2000, also as a supplement to Academic Medicine. Drawing on the reports, the authors summarize, among other topics, the advances that have taken place in the support for faculty, the funding of medical student education, changes in pedagogy and assessment, and the expansion of medical education to distributed models and regional campuses.The authors observe that the reports from the 128 schools illustrate that medical student education has undergone and continues to undergo substantive change, has advanced markedly since the reforms stimulated by the Flexner Report, and has continued to evolve during the past decade. The reports illustrate the strength of support for the educational programs, even in a time of financial constraints, and the increasing recognition of the scholarly contributions of faculty through teaching. The authors provide examples of the changes in pedagogy and new topics in the required curriculum in the past decade and describe selected highlights of the 128 educational programs.

Aligning Compensation with Education: Design and Implementation of the Educational Value Unit (EVU) System in an Academic Internal Medicine Department

The authors report the development of a new metric for distributing university funds to support faculty efforts in education in the department of internal medicine at the University of Kansas School of Medicine. In 2003, a committee defined the educational value unit (EVU), which describes and measures the specific types of educational work done by faculty members, such as core education, clinical teaching, and administration of educational programs. The specific work profile of each faculty member was delineated. A dollar value was calculated for each 0.1 EVU. The metric was prospectively applied and a faculty survey was performed to evaluate the faculty’s perception of the metric. Application of the metric resulted in a decrease in university support for 34 faculty and an increase in funding for 23 faculty. Total realignment of funding was US$1.6 million, or an absolute value of US$29,072 ± 38,320.00 in average shift of university salary support per faculty member. Survey results showed that understanding of the purpose of university funding was enhanced, and that faculty members perceived a more equitable alignment of teaching effort with funding. The EVU metric resulted in a dramatic realignment of university funding for educational efforts in the department of internal medicine. The metric was easily understood, quickly implemented, and perceived to be fair by the faculty. By aligning specific salary support with faculty’s educational responsibilities, a foundation was created for applying mission-based incentive programs.

Aligning Compensation with Education: Design and Implementation of the Educational Value Unit (EVU) System in an Academic Internal Medicine Department

The authors report the development of a new metric for distributing university funds to support faculty efforts in education in the department of internal medicine at the University of Kansas School of Medicine. In 2003, a committee defined the educational value unit (EVU), which describes and measures the specific types of educational work done by faculty members, such as core education, clinical teaching, and administration of educational programs. The specific work profile of each faculty member was delineated. A dollar value was calculated for each 0.1 EVU. The metric was prospectively applied and a faculty survey was performed to evaluate the faculty's perception of the metric. Application of the metric resulted in a decrease in university support for 34 faculty and an increase in funding for 23 faculty. Total realignment of funding was US$1.6 million, or an absolute value of US$29,072 +/- 38,320.00 in average shift of university salary support per faculty member. Survey results showed that understanding of the purpose of university funding was enhanced, and that faculty members perceived a more equitable alignment of teaching effort with funding. The EVU metric resulted in a dramatic realignment of university funding for educational efforts in the department of internal medicine. The metric was easily understood, quickly implemented, and perceived to be fair by the faculty. By aligning specific salary support with faculty's educational responsibilities, a foundation was created for applying mission-based incentive programs.