What is the problem and what is known about it so far?
Physicians involved in teaching have higher job satisfaction. Nevertheless, most academic departments have difficulty recruiting and retaining teachers, particularly in primary care where practice management and compensation issues can create a tension to the teaching mission.

Why did the researchers do this particular study?
Researchers hypothesized that one's self identification as a teacher is measurable. Quantifying teacher identity might be useful in recruiting/retaining clinician teachers. The group's previous studies demonstrated that teacher identity can be considered in 7 elements: a) feeling intrinsic satisfaction from teaching, b) having knowledge and skill about teaching, c) belonging to a group of teachers, d) feeling a responsibility to teach, e) sharing clinical expertise with learners, f) receiving rewards for teaching, and g) believing that being a physician means being a teacher.

Who was studied?
Pediatrics, Family Medicine and Medicine preceptors (n=153) from a preclinical longitudinal course were studied. Faculty represented full-time, community teaching affiliate employees, and private practice.

How was the study done?
A physician self-reported survey was created to measure the strength of each of these elements. Respondent data, including demographics, years of practice and teaching, faculty status, financial compensation, and faculty development training, were collected for stratification reasons. The survey consisted of 4 items for each of the 7 elements along with 4 items measuring "global teacher identity". The 32 items were scored on a Likert scale (1=SD, 5=SA). Physician focus groups and instrument pilot testing ensured the content of each group of 4 questions was representative of the element being measured. Researchers compared responses of teachers with and without salary support and faculty development training. Comparisons were done on self-reported "realities" and "desired outcomes" of teaching.

What did the researchers find?
The response rate was 83%, composed of 24% pediatricians, 37% internists, and 39% family physicians; 43% had completed faculty development programs. Strength of each item toward teacher identity was measured by magnitude of mean score. These ranked as follows: 1) Sharing clinical expertise – (4.35), 2) Feeling intrinsic satisfaction from teaching – (4.29), 3) Believing that being a doctor means being a teacher – (4.26), 4) Feeling responsibility to teach – (4.15), 5) Having knowledge and skill about teaching – (3.70), 6) Belonging to a group of teachers – (3.61), and 7) Receiving rewards for teaching – (3.55). When comparing "realities" and "desired outcomes", two items demonstrated large, statistically significant differences. One was, "The medical school rewards my teaching" and "I would like to be rewarded for my teaching." The other was "I feel part of a community of teachers" and "I would like to be part of a community of teachers." Salaried physicians and participants in faculty development programs scored significantly higher than non-salaried, non-participants in "global teacher identity" and on many individual elements.

What were the limitations of the study?
Only physicians who were actively teaching were studied. The instrument may not be generalizable to those who do not teach. Furthermore, the high mean scores for each element may have been influenced by the high prevalence of faculty development participants. This study was performed at UMass, known for great faculty development and committed teachers.

What are the implications of the study?
As in other studies, it was shown that teacher identity can vary a great deal based on outside forces such as salary support and belonging to a group of teachers, not simply attitudes of individuals. Given that the survey instrument is largely a self-report of attitudes, one could see using this to identify those who feel responsibility to teach and derive satisfaction from teaching. Once identified, it seems clear that belonging to a group, having available faculty development, and some reward system (not necessarily monetary), could help to retain this identified group of teachers.

So let's think about this a minute: can we identify an analogy? Wait! What about COMSEP? Belonging to a group, available faculty development and the reward of professional and, to no small degree, emotional support. No wonder we've done a good job making people see the clerkship director position as a career. Proof of principle... BZM