The authors describe their findings from a study that (1) identified 41 medical schools or medical school departments that used metric systems to quantify faculty activity and productivity in teaching and (2) analyzed the purposes and progress of those systems. Among the reasons articulated for developing these systems, the most common was to identify a rational method for distributing funds to departments. More generally, institutions wanted to emphasize the importance of the school's educational mission. The schools varied in the types of information they tracked, ranging from a selective focus on medical school education to a comprehensive assessment of teaching activity and educational administration, committee work, and advising. Schools were almost evenly split between those that used a relative-value-unit method of tracking activity and those that used a contact-hour method.
This study also identified six challenges that the institutions encountered with these metric systems: (1) the lack of a culture of data in management; (2) skepticism of faculty and chairs; (3) the misguided search for one perfect metric; (4) the expectation that a metric system will erase ambiguity regarding faculty teaching contributions; (5) the lack of, and difficulty with developing, measures of quality; and (6) the tendency to become overly complex. Because of the concern about the teaching mission at medical schools, the number of institutions developing educational metric systems will likely increase in the coming years. By documenting and accounting financially for teaching, medical schools can ensure that the educational mission is valued and appropriately supported.
By the end of the 1990s, Ludmerer wrote, medical education was by far the most endangered part of the medical school's traditional mission. 1 Korn noted that the centrality of a general education, both medical and scientific, has become attenuated, and the education of medical students has become to many faculty a distraction. 2 Numerous task forces, committees, and groups have recognized the need for medical colleges to fortify their commitment to the educational mission. The 1984 recommendations of the General Professional Education of the Physician (GPEP) Committee urged that deans and departmental chairmen should elevate the status of the general professional education of medical students to assure faculty members that their contributions to this endeavor will receive appropriate recognition. 3 A decade later, the ACME-TRI report acknowledged the difficulty of recognizing faculty contributions to education because of the complexity in documenting that activity: Many faculty members believe that there are inadequate criteria to evaluate and insufficient measures to document teaching efforts. 4
To reinforce its concern for the educational mission, the 1984 GPEP report 3 also recommended that each medical school establish a distinct budget for its educational program, although it is not clear that any schools did so in the years immediately following. 5 Instead, teaching continued to be viewed as a byproduct of other activities, entangled in the cross-subsidies and deal-making among dean, department, practice plan, and hospital. However, with mounting financial pressures in the 1990s-reduced patient care reimbursements, growing regulatory burdens, and cost-sharing research requirements-some institutions began to adopt mission-based budgeting and management practices, in which costs and revenue streams are identified for each mission area. Mission-based management requires that schools track faculty effort and activity in teaching, research, clinical care, administration, and service. 6 Prompted by an attraction to mission-based management, institutional leaders began to consider how to measure teaching activity and effort. In February 2000, an expert panel, convened by the Association of American Medical Colleges (AAMC) as part of its Mission-based Management Program, provided a blueprint for developing a relative-value-scale approach to this task. 7
Nearly 20 years after the GPEP report, a decade after the ACME-TRI report, and with the increasing interest in mission-based management, has there been progress in the methods to document teaching efforts? Have schools of medicine devised ways to calculate faculty contributions to the educational mission? Since 1995, a number of articles have described individual attempts to develop measurement (i.e., metric) systems to track faculty activity and effort in teaching and educational areas. 8-15 While some of these systems described in the literature have been successfully implemented and used to make decisions-about allocation of resources, faculty compensation, curriculum planning, and faculty evaluation and promotion-in other cases, the systems as described were never implemented or are still in the planning stages. 8-11 In this report, we present data and discuss findings on the current development and use of systems to measure faculty activity and effort in teaching activities at U.S. and Canadian medical colleges. After briefly outlining the methods used in data collection and analysis, we present findings about the types and purposes of these metric systems, the frequency and degree of implementation, and emerging themes about the experiences with developing such systems.