A national panel on medical education was appointed as a component of the AAMC's Mission-based Management Program and charged with developing a metrics system for measuring medical school faculty effort and contributions to a school's education mission. The panel first defined important variables to be considered in creating such a system: the education programs in which medical school faculty participate; the categories of education work that may be performed in each program (teaching, development of education products, administration and service, and scholarship in education); and the array of specific education activities that faculty could perform in each of these work areas. The panel based the system on a relative value scale, since this approach does not equate faculty performance solely to the time expended by a faculty member in pursuit of a specific activity. Also, a four-step process to create relative value units (RVUs) for education activities was developed. This process incorporates quantitative and qualitative measures of faculty activity and also can measure and value the distribution of faculty effort relative to a school's education mission. When adapted to the education mission and culture of an individual school, the proposed metrics system can provide critical information that will assist the school's leadership in evaluating and rewarding faculty performance in education and will support a mission-based management strategy in the school.
Medical school deans and faculties now recognize that changes in the organization, financing, and delivery of health care services have the potential to undermine the financial status and traditional roles of medical schools and teaching hospitals, thereby threatening the viability of their academic missions. In response, leaders of these institutions are striving to establish management strategies that will allow them to better meet the challenges these changes pose. They recognize that management decisions must be based on more complete and accurate information than is available at present, particularly information about the effort and contributions that faculty make to the individual missions of the medical school. To achieve this goal, deans and faculties must develop policy guidelines and metrics (i.e., measurement) systems that will allow them to measure and reward faculty effort and contributions in education, research, patient care, and service.
To assist deans and faculties in their efforts to transform their management practices, in 1998, the Association of American Medical Colleges embarked on a major new initiative, the Mission-based Management (MBM) Program. As part of this program, the Association established expert panels on medical education, research, and patient care to provide guidance in how medical school deans and faculties might approach the challenges of establishing guidelines and metrics systems that can serve their new management strategies. In implementing a mission-based management approach that aims in some rational manner to align the resources available to a school with its institutional missions, faculty effort and contributions to a school's education mission must be adequately recognized and accounted for.
As the members of the Medical Education Panel, we wrote this article to present a framework that the dean and faculty of an individual school can use to develop a metrics system for measuring faculty effort and contributions to their school's education mission. We endorse as a fundamental principle that each medical school should establish guidelines and a metrics system that are consistent with the particulars of its education mission and how that mission relates to the tradition and culture of the institution. Accordingly, the framework presented in this report should be viewed simply as a tool that can assist deans and faculties to achieve their goals. In preparing this report, our intent was to provide a metrics system that exceeds what most institutions have adopted, or are planning to adopt, for the evaluation of faculty performance in education, hoping that this approach would allow an individual school to use the report to develop or expand a metrics system that serves its needs.
After reviewing metrics systems developed by a small number of medical schools, we embraced the view that there are advantages to adopting a system of measurement that employs a relative value scale to distinguish among the various ways that the individual faculty member contributes to a school's mission. Using this approach a value, or weight, is assigned to each of the variables to be measured-in this case, education activities-thereby creating a relative value unit (RVU) for each activity. These values are calculated using formulas (shown later in this article) that take into account such variables as the time and effort involved in each activity, the level of the faculty member's experience and skill, and the importance to the school's mission of each activity. The units are relative to one another when taken in the aggregate to form a relative value scale. An important advantage of this approach is that faculty effort and contributions, whether those of individual faculty members or of groups of faculty, are not equated solely to the time expended in pursuit of a specific activity.
To provide a framework for this approach, List 1 presents a comprehensive review of the specific education activities that faculty might conduct, and classifies these activities into four major categories of education work: teaching; development of educational products; education administration and service; and scholarship in education. The work of faculty members in student admission or student affairs is not included in this document, but some institutions may choose to include those activities. While teaching is the cornerstone of education, the four categories serve to recognize other work in education that is important to students and schools. Placing different types of education activities into work categories also allows a school to consider the relative value of each work category to its education mission. After defining the education activities and their work categories, we set forth steps, described below, that a school might follow in developing a metrics system for education based on a relative-value-scale approach.