Faculty Effort Research Articles

Introduction to Special Issue on Increasing Participation in Higher Education STEM Programs

This special issue highlights the work of several higher education practitioner–scholars who describe their approaches to facilitating participation in STEM courses and programs. Writing from the standpoint of chemistry, mathematics, and ecology in publicly supported universities, the authors discuss their pedagogical or curricular choices with reference to the broader structures and systemic considerations that sometimes limit and sometimes enable faculty effort. In this editorial, we reflect on the ways in which these authors invoke their own practitioner agency to establish equity-based innovations in higher education STEM settings.

Three Commonly Utilized Scholarly Databases and a Social Network Site Provide Different, But Related, Metrics of Pharmacy Faculty Publication

Scholarly productivity is a critical component of pharmacy faculty effort and is used for promotion and tenure decisions. Several databases are available to measure scholarly productivity; however, comparisons amongst these databases are lacking for pharmacy faculty. The objective of this work was to compare scholarly metrics from three commonly utilized databases and a social networking site focused on data from research-intensive colleges of pharmacy and to identify factors associated with database differences. Scholarly metrics were obtained from Scopus, Web of Science, Google Scholar, and ResearchGate for faculty from research-intensive (Carnegie Rated R1, R2, or special focus) United States pharmacy schools with at least two million USD in funding from the National Institutes of Health. Metrics were compared and correlations were performed. Regression analyses were utilized to identify factors associated with database differences. Significant differences in scholarly metric values were observed between databases despite the high correlations, suggestive of systematic variation in database reporting. Time since first publication was the most common factor that was associated with database differences. Google Scholar tended to have higher metrics than all other databases, while Web of Science had lower metrics relative to other databases. Differences in reported metrics between databases are apparent, which may be attributable to the time since first publication and database coverage of pharmacy-specific journals. These differences should be considered by faculty, reviewers, and administrative staff when evaluating scholarly performance.

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.

Practice and Dissemination of Motivational Interviewing: A Psychology Internship Curriculum.

Sufficient training in substance use issues has been identified as a common gap in professional psychology graduate training. Satisfactory training in evidence-based practices has also been identified as a common gap for providers who care for individuals with substance use problems. The "practice and dissemination" curriculum we developed seeks to address both of these gaps during the predoctoral internship training year by first training psychology interns to competently deliver motivational interviewing (MI) to individuals with substance use problems and then train community providers and volunteers to do so. From 2012-2013, a total of 55 community providers and volunteers from a homeless shelter, a substance use treatment facility, and a community mental health facility received training in MI through this curriculum by attending continuing education events delivered by 17 psychology interns. Evaluation of the dissemination portion of the curriculum as part of an exempt educational research project revealed that community providers were able to achieve significant increases in MI knowledge, readiness to implement MI, and MI skill as assessed with a video analogue measure by the end of the workshop. They also reported satisfaction with the workshop. These evaluation findings provide preliminary support for the curriculum as a novel and efficacious way to disseminate MI to community providers. Research is necessary to determine long-term outcomes of such training and to identify strategies to overcome potential barriers such as the substantial faculty effort necessary to implement the intensive curriculum.

Responsibility Center Budgeting as a Mechanism to Deal with Academic Moral Hazard

Universities face inherent informational asymmetries. These make university budgeting prone to various challenges including moral hazard. The last forty years has seen some large research- intensive universities move from centralized incremental budgeting to decentralized Responsibility Center Budgeting (RCB). It is assumed that a faculty chooses a level of costly effort in generating revenue for the university. The level of faculty effort is not observable by the central administration. When there is no revenue uncertainty or when the faculty is not risk averse, pure RCB is best from the perspective of the administration. The intuition is that pure RCB fully aligns financial responsibility with academic authority, that is, it makes the faculty the residual claimant. Once the faculty is risk averse, partial RCB is optimal. Partial RCB provides a balance between providing the right incentives to the faculty and the university reducing the revenue risk faced by the faculty.

Responsibility Center Budgeting as a Mechanism to Deal with Academic Moral Hazard

Universities face inherent informational asymmetries. These make university budgeting prone to various challenges including moral hazard. The last forty years has seen some large research- intensive universities move from centralized incremental budgeting to decentralized Responsibility Center Budgeting (RCB). It is assumed that a faculty chooses a level of costly effort in generating revenue for the university. The level of faculty effort is not observable by the central administration. When there is no revenue uncertainty or when the faculty is not risk averse, pure RCB is best from the perspective of the administration. The intuition is that pure RCB fully aligns financial responsibility with academic authority, that is, it makes the faculty the residual claimant. Once the faculty is risk averse, partial RCB is optimal. Partial RCB provides a balance between providing the right incentives to the faculty and the university reducing the revenue risk faced by the faculty.

Assessing the Training Costs and Work of Diagnostic Radiology Residents Using Key Performance Indicators – An Observational Study

To quantify the costs and work of diagnostic radiology (DR) residents using the radiology key performance indicator turn-around time (TAT) as the outcome measure. In an Institutional Review Board-approved study, the annual cost of a DR resident was determined using salary, benefits, and a cost allocation of faculty effort. The volume of cases reported in the 2015-16 academic year and median and interquartile range (IQR) TAT for a trainee preliminary (Complete to Prelim, C-P) or an attending final (Complete to Final, C-F) radiology report were measured and stratified by time of day and patient location. Wilcoxon rank-sum tests were used (significance, p values < 0.05). The annual cost of a DR resident was $99,109, 34% greater than direct salary/benefits and 27% of the direct salary/benefits cost of an attending. The total per minute cost of rendering care was $4.36 with both trainee ($0.70/minute) and faculty ($3.66/minute). Residents participated in 139,084/235,417 (59%) imaging studies. The C-P TAT was 74 (IQR, 27-180) minutes compared to 51 (IQR, 18-129) minutes C-F TAT of faculty working alone and C-F TAT of 213 (IQR, 71-469) minutes with a resident (p < 0.001). The C-P TAT vs C-F TAT between 4 pm-9 am and weekends with residents is 44 (IQR, 18-119) minutes vs 60 (IQR, 18-179) minutes without. The cost of training DR residents exceeds the salary and benefits allocated to their training. Residents increase the absolute professional labor cost of caring for a patient. Overall TAT is slower with residents but the care delivered by residents after-hours is faster.

Can Nonclinician Raters Be Trained to Assess Clinical Reasoning in Postencounter Patient Notes?

Clinical reasoning is often assessed through patient notes (PNs) following standardized patient (SP) encounters. While nonclinicians can score PNs using analytic tools such as checklists, these do not sufficiently encompass the holistic judgments of clinician faculty. To better model faculty judgments, the authors developed checklists with faculty-specified scoring formulas embedded in spreadsheets and studied the resulting interrater reliability (IRR) of nonclinician raters (SPs and medics) and student pass/fail status. In Study 1, nonclinician and faculty raters rescored PNs of 55 third-year medical students across 5 cases of the 2017 Graduation Competency Examination (GCE) to determine IRR. In Study 2, nonclinician raters scored all notes of the 5-case 2018 GCE (178 students). Faculty rescored all notes of failing students and could modify formula-derived scores if faculty felt appropriate. Faculty also rescored and corrected scores of additional notes for a total of 90 notes (3 cases, including failing notes). Mean overall percent exact agreement between nonclinician and faculty ratings was 87% (weighted kappa, 0.86) and 83% (weighted kappa, 0.88) for Study 1 and Study 2, respectively. SP and medic IRRs did not differ significantly. Four students failed the note section in 2018; 3 passed after faculty corrections. Few corrections were made to nonfailing students' notes. Nonclinician PN raters using checklists and scoring rules may provide a feasible alternative to faculty raters for low-stakes assessments and for the bulk of well-performing students. Faculty effort can be targeted strategically at rescoring notes of low-performing students and providing more detailed feedback.

Rethinking Assessment of Student Clinician Learning: A Collaborative Faculty Effort

Purpose This article describes a collaborative clinical faculty effort to develop and pilot observation-based formative assessment tools for faculty use during clinical supervision. The purposes of the pilot project were to create the tools and to evaluate faculty perceptions of developing and using the assessment tools. Method Data were collected using a rating scale, a focus group, and a questionnaire. Two formative assessment tools were designed following qualitative data analysis, and faculty subsequently piloted the tools in the clinic. Results Three clinical faculty who piloted the tools reported positive feedback regarding the tool development and implementation processes. Overall, clinical faculty perceived that the assessment tools improved their formative feedback to students. Conclusion Limitations, future directions, and implications are presented with recommendations for investigations in other settings.

The Current State of Research Capacity in US Family Medicine Departments.

Capacity for conducting family medicine research has grown significantly since the specialty was founded. Many calls to increase this capacity have been published, but there has been no consistent, systematic, and longitudinal assessment. This survey was designed to gather baseline data with an easily replicable set of measures associated with research productivity that can guide and monitor the impact of efforts to build research capacity in US departments of family medicine (DFMs). We surveyed family medicine department chairs regarding departmental research capacity using well-established empirical measures of capacity (trained research faculty, infrastructure, research leadership, and funding) and a self-assessment. We used bivariate analyses to assess correlation between the empirical measures and the self-assessed stage of research capacity. Self-assessed capacity was significantly associated with every empirical measure. High-capacity departments have more research-trained faculty, more faculty effort, utilize more research "laboratories," have more faculty serving on federal peer-review panels, more faculty as principal investigators, devote more internal funding to research, and garner larger amounts of funding from more external funding sources than moderate or minimal-capacity departments. US DFMs have made great strides over the past half century in building research capacity. However, much more capacity in family medicine and primary care research is needed to produce new knowledge necessary to improve the health and health care of the nation. Periodic measurement using the simple, replicable, and valid minimum measures of this study provides an opportunity to establish longitudinal tracking of change in research capacity in US DFMs.

Less Than/More Than: Issues Associated with High Impact Online Teaching and Learning

The increased presence of online education in higher education in the United States continues to challenge educators in their perceptions of teaching and learning experiences in virtual environments. While critiques of online education typically focus on its “less than” shortcomings, this literature review encourages educators to take a “more than” approach when providing institutional support. Online education provides beneficial outcomes for faculty, students, and administration when viewed for its potential in providing innovative teaching and learning. The financial challenges involved in providing these practices are addressed to justify investment in faculty effort, organizational support and professional development, and equitable student support.

Assessment of General Education: An Unexpected (but Effective) Faculty Development Opportunity

AbstractThis chapter describes a collective faculty effort to administer, proctor, score, and interpret student work that created an unexpected opportunity for deep discussions of teaching, learning, and assessment.

Author response: The state of academic neurology departments in the United States, 2016: A national survey.

Dr. Meador highlights a growing national problem, which the data in my editorial1 only briefly touched upon: How can the academic missions of teaching and research be adequately met when the clinical workload of our evolving system has grown to monopolize the vast majority of faculty effort? Dedicated academic funding to support student and resident education is used in some institutions, but is often insufficient to cover faculty effort. Research has become ever more dependent on large and uninterrupted grant support for individual researchers, with NIH funding (and its attached larger indirect cost support funds) becoming the mark of success and often the absolute requirement for career survival at many institutions. The health care revolution radically cut clinical reimbursement (a former source of support to all academic missions); in the future, medical education will likely be radically altered to reduce cost and the research enterprise will likely become even more of an “eat-what-you-kill” endeavor. Academic leaders and faculty should start to deeply engage with their own institutions, government, and national organizations to make their voices heard and to secure a seat at the table to help guide how this new order is structured.

The Effect of Participation in a Small-Group Discussion Session on Medical Student Learning of Intestinal Pathophysiology

Medical students are faced with the challenge of assimilating a large amount of content in a short period of time. They are motivated to look for the most efficient approach to learning and to perform well on their national licensing examinations. Medical schools are driven by accrediting agencies to reform their curriculum to increase active and collaborative learning opportunities. This prospective study evaluated the performance outcomes of an active small-group instructional session on benign colonic disorders between students who attended the session and those who did not. All students had access to the same materials and the recordings of the session through the university’s learning management system. Performance was determined by a 12-question pre-/posttest as well as the related items on the course’s final examination. All students performed significantly better on the posttest compared to the pretest (“Yes” attended and “No” did not attend: pre/post p < 0.001). There was no difference between the two groups on posttest performance (p = 0.59) or on the related questions on the final examination [Yes/No, 83.7/85.6% (p = 0.56)]. However, students who attended the session had a lower score on the remainder of the examination than those who did not attend the session [Yes/No, 81.8/85.0% (p = 0.04)] suggesting that the in-class small-group activity may have had a protective effect on performance. This study showed that participation in an active learning session was non-inferior and may benefit students that would have otherwise had lower performance justifying the large faculty effort in designing and delivering this modality.

Effective Learner-Centered Approach for Teaching an Introductory Digital Systems Course

In the Internet era, students have increasingly lost interest in traditional lectures; as a consequence, their learning motivation and exam performance have decreased. The widespread adoption of learner-centered teaching methods that address this issue faces certain barriers, including: 1) the significant faculty effort necessary to prepare e-learning materials; 2) significant extra time required for active online communication with students; 3) student resistance to taking an active role in their education; and 4) lecturers’ common belief that learner-centered teaching activities do not allow discussion of all the required topics. This paper presents a case study based on one offering of an introductory digital systems course taught with a combination of learner-centered strategies selected to overcome these barriers and improve student performance. These measures included: 1) improving the student-teacher relationship; 2) applying intriguing, inductive, and counterintuitive approaches to introducing new concepts; 3) adopting puzzle-based quizzes integrated with peer instruction; 4) using an audience response system; 5) replacing certain lectures with tutorials; 6) reducing course duration; and 7) using a graphics tablet. The results obtained demonstrate significant improvements in lecture attendance and in student performance. The author believes that the approach presented here can benefit other engineering educators in similar courses.

What works in promoting and maintaining diversity in nursing programs.

The presence of a registered nurse (RN) workforce that is culturally and linguistically familiar with underrepresented minorities promotes effective health care for patients. A lack of diversity in the nursing education pipeline has led to a lack of diversity among registered nurses. This qualitative descriptive study explored faculty perceptions of factors that attracted and maintained a diverse nursing student body at three different universities with large percentages of minority students. Websites were evaluated for diversity and audio-taped telephone interviews were conducted with nursing faculty using a semistructured set of open-ended questions. College location, online courses, community outreach programs, the presence of a diverse faculty and students, faculty accessibility, and financial aid with low college costs were identified as common factors in attracting and retaining minority students. Barriers included the cost for low socioeconomic status students, inadequate primary and secondary educational preparation, inherent bias in the institution, competition from other schools, admission policies, and limited diversity in leadership and faculty. Commitment to improving and maintaining diversity in nursing programs requires a sustained faculty effort to make the programs fit for the minority student.

Contributions of Academic Emergency Medicine Programs to U.S. Health Care: Summary of the AAAEM-AACEM Benchmarking Data.

The societal contribution of emergency care in the United States has been described. The role and impact of academic emergency departments (EDs) has been less clear. Our report summarizes the results of a benchmarking effort specifically focused on academic emergency medicine (EM) practices. From October through December 2016, the Academy of Academic Administrators of Emergency Medicine (AAAEM) and the Association of Academic Chairs of Emergency Medicine (AACEM) jointly administered a benchmarking survey to allopathic, academic departments and divisions of emergency medicine. Participation was voluntary and nonanonymous. The survey queried various aspects of the three components of the tripartite academic mission: clinical care, education and research, and faculty effort and compensation. Responses reflected a calendar year from July 1, 2015, to June 30, 2016. Of 107 eligible U.S. allopathic, academic departments and divisions of emergency medicine, 79 (74%) responded to the survey overall, although individual questions were not always answered by all responding programs. The 79 responding programs reported 6,876,189 patient visits at 97 primary and affiliated academic clinical sites. A number of clinical operations metrics related to the care of these patients at these sites are reported in this study. All responding programs had active educational programs for EM residents, with a median of 37 residents per program. Nearly half of the overall respondents reported responsibility for teaching medical students in mandatory EM clerkships. Fifty-two programs reported research and publication activity, with a total of $129,494,676 of grant funding and 3,059 publications. Median faculty effort distribution was clinical effort, 66.9%; education effort, 12.7%; administrative effort, 12.0%; and research effort, 6.9%. Median faculty salary was $277,045. Academic EM programs are characterized by significant productivity in clinical operations, education, and research. The survey results reported in this investigation provide appropriate benchmarking for academic EM programs because they allow for comparison of academic programs to each other, rather than nonacademic programs that do not necessarily share the additional missions of research and education and may have dissimilar working environments.

Does Academic Blogging Enhance Promotion and Tenure? A Survey of US and Canadian Medicine and Pediatric Department Chairs.

BackgroundElectronic educational (e-learning) technology usage continues to grow. Many medical journals operate companion blogs (an application of e-learning technology) that enable rapid dissemination of scientific knowledge and discourse. Faculty members participating in promotion and tenure academic tracks spend valuable time and effort contributing, editing, and directing these medical journal blogs.ObjectiveWe sought to understand whether chairs of medicine and pediatric departments acknowledge blog authorship as academic achievement.MethodsThe authors surveyed 267 chairs of US and Canadian medicine and pediatric departments regarding their attitudes toward the role of faculty participation in e-learning and blogging in the promotion and tenure process. The survey completion rate was 22.8% (61/267).ResultsA majority of respondents (87%, 53/61) viewed educational scholarship as either important or very important for promotion. However, only 23% (14/61) perceived importance to faculty effort in producing content for journal-based blogs. If faculty were to participate in blog authorship, 72% (44/61) of surveyed chairs favored involvement in a journal-based versus a society-based or a personal (nonaffiliated) blog. We identified a “favorable group” of chairs (19/59, 32%), who rated leadership roles in e-learning tools as important or very important, and an “unfavorable group” of chairs (40/59, 68%), who rated leadership roles in e-learning tools as somewhat important or not important. The favorable group were more likely to be aware of faculty bloggers within their departments (58%, 11/19 vs 25%, 10/40), viewed serving on editorial boards of e-learning tools more favorably (79%, 15/19 vs 31%, 12/39), and were more likely to value effort spent contributing to journal-based blogs (53%, 10/19 vs 10%, 4/40).ConclusionsOur findings demonstrate that although the majority of department chairs value educational scholarship, only a minority perceive value in faculty blogging effort.

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.

Benchmarking Academic Anatomic Pathologists: The Association of Pathology Chairs Survey

The most common benchmarks for faculty productivity are derived from Medical Group Management Association (MGMA) or Vizient-AAMC Faculty Practice Solutions Center® (FPSC) databases. The Association of Pathology Chairs has also collected similar survey data for several years. We examined the Association of Pathology Chairs annual faculty productivity data and compared it with MGMA and FPSC data to understand the value, inherent flaws, and limitations of benchmarking data. We hypothesized that the variability in calculated faculty productivity is due to the type of practice model and clinical effort allocation. Data from the Association of Pathology Chairs survey on 629 surgical pathologists and/or anatomic pathologists from 51 programs were analyzed. From review of service assignments, we were able to assign each pathologist to a specific practice model: general anatomic pathologists/surgical pathologists, 1 or more subspecialties, or a hybrid of the 2 models. There were statistically significant differences among academic ranks and practice types. When we analyzed our data using each organization’s methods, the median results for the anatomic pathologists/surgical pathologists general practice model compared to MGMA and FPSC results for anatomic and/or surgical pathology were quite close. Both MGMA and FPSC data exclude a significant proportion of academic pathologists with clinical duties. We used the more inclusive FPSC definition of clinical “full-time faculty” (0.60 clinical full-time equivalent and above). The correlation between clinical full-time equivalent effort allocation, annual days on service, and annual work relative value unit productivity was poor. This study demonstrates that effort allocations are variable across academic departments of pathology and do not correlate well with either work relative value unit effort or reported days on service. Although the Association of Pathology Chairs–reported median work relative value unit productivity approximated MGMA and FPSC benchmark data, we conclude that more rigorous standardization of academic faculty effort assignment will be needed to improve the value of work relative value unit measurements of faculty productivity.