#20 - What are we worth? - The PAPERs Podcast

#20 – What are we worth?

September 19, 2023

Episode Host: Linda Snell

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Episode article:

Poncelet, A., Collins, S., Fiore, D., Rosenbluth, G., Loeser, H., Sawaya, G. F., Teherani, A., & Chang, A. (2023). Identifying Value Factors in Institutional Leaders’ Perspectives on Investing in Health Professions Educators. JAMA Network Open, 6(2), e2256193. https://doi.org/10.1001/jamanetworkopen.2022.56193

This episode was recorded at AMEE Glasgow 2023 with a LIVE audience.

In this episode, we look at different ways leaders ascribe value (beyond monetary value) to the growth and work of health professions educators. It is important as it suggests how we as educators can use these perspectives to advocate for support of educators and their work.

Background

I chose this paper as

it is from a clinical journal (JAMA), open access;
unlike most of what we present it discusses teachers, specifically health professions educators (HPEs), from the perspective of ‘value’ of these clinician educators (CEs) to academic and clinical systems, and systems leaders.
It discusses a framework new to me – VMM or Value Measurement Methodology, and touches on leadership, economics, and academic, strategic, and societal value domains of education.

There is reciprocity between health education and health care in that excellence in one linked to excellence in the other. Yet HPEs are often undervalued in the academic milieu. Decisions on supporting educator investment programs (EIPs) such as internal grants, educator stipends or endowed chairs are often made by leaders with backgrounds in clinical administration or biomedical research. So funding for education individuals and education innovation can be easily threatened – from a business perspective there is no ‘direct’ ROI, especially if the investment includes training educators and supporting their growth and their work. So what else do HPEs bring to the system? Perhaps a different approach or framework is needed if we are to talk to our leaders.

The purpose of this study is to, using the VMM, “explore the value factors … that health professions leaders placed on educator investment including intramural programs that invest in educator growth and education innovation.”

Method

A bit of background on VMM (1): it presents value factors in 5 domains: individual (benefits individual recipient), financial (costs, revenues), operational (improves system operations, e.g., decreased length of stay), social or societal (benefits group or society), and strategic or political (advances institution’s mission, strategic goals, priorities, or mandates e.g. patient safety). [A bit reminiscent of Boleman and Deal’s 4 frames. (2)] The VMM framework has not been applied to academic EIPs.

Qualitative study, using semi-structured interviews of the perspectives of leaders at multiple levels (eg, deans, department chairs, and health system leaders, with a range of experience and disciplines), of UCSF (an urban academic health professions institution and its affiliated systems). The interview guide reflected and defined the 5 VMM factors, adapted for education, and used local exemplars. The guide was piloted but not validated. Thematic analysis was used with a constructivist orientation.

A nice reflexivity statement for the varied backgrounds and perspectives of authors, who “engaged in regular, reflective discussion, which enabled us to consider or challenge each other’s assumptions when interpreting findings.”

Results/Findings

Interviewed 29 leaders of varied levels and backgrounds (5 campus or university leaders; 3 health systems leaders; 6 health professions school leaders; 15 department leaders).

The leaders expanded on the 5 VMM domains; with most important being individual factors and education programs.

Individual factors: the impact on faculty career, stature, and personal and professional development.

Financial factors: tangible support, the ability to attract additional resources, and the importance of these investments as a monetary input rather than output.

Operational factors: educational programs, faculty recruitment & retention.

Social and societal factors: scholarship and dissemination benefits to the external community & to the internal community of faculty, learners, and patients.

Strategic and political factors: impact on culture and symbolism, innovation, and organizational stature & success.

Comments

The authors conclude that ‘leaders do find value in funding educator investment programs, in multiple domains beyond direct financial return on investment’ and recognize EIPs generate benefits to institution and community.

A pure economic model is too narrow a tool to measure valued outcomes of the academic education mission. A paragraph in the discussion uses terms like ‘economic imperialism’, ‘economic power’ over education, ‘hegemony’ and proposed a move to a more holistic model.

Different value factors may inform advocacy for investments, feedback to leaders in terms they understand and appreciate, and getting relevant metrics for program evaluation.