Perspectives in Biology and Medicine

TEACHING AWARDS AND DEPARTMENTAL LONGEVITY: ISAWARD- WINNING TEACHING THE "KISS OF DEATH" IN AN ACADEMIC DEPARTMENT OF MEDICINE? JOHN N. AUCOTT, * JULIE COMO, and DAVID C. ARONf Clinician-educators play an important role in academic medical centers [1-3] . Yet, they must maintain this role in a changing and difficult environment . On the one hand, academic medical centers must deliver health care in an increasingly competitive business climate, competing clinically with a sophisticated and organized group of community physicians. On the other hand, the increasingly competitive environment for research funding selects for increased faculty focus towards being either a clinician or a scientist , but not both [4-6]. Moreover, teaching activity does not contribute directly to the bottom line of the department, hospital, or medical school [6] . Although education is intrinsic to the missions of medical schools and academic medical centers, the United States and other countries have recognized that teaching has not been at the center [7-10]. The importance and difficulty of retaining excellent teachers in this environment has contributed to an evolution in the traditional approaches to faculty advancement and tenure [11, 12]. Despite this, there are perceptions that teaching is notvalued as highly as research [10, 1 1, 13-15] . Moreover , the proliferation of strategies to reward and recognize clinical teaching faculty's contributions suggest that retention of excellent clinical teachers is problematic. In fact, anecdotal evidence suggests the possibility that recognized teaching excellence is actually detrimental to an individual 's academic career [10]. However, there are no published data on the attrition of excellent teachers from medical school faculty. In order to asCorrespondence : David C. Aron MD, MS, Institute of Health Care Research, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106-4961. *Department of Medicine, Johns Hopkins University School of Medicine. !Department of Medicine, Case Western Reserve University School of Medicine and Medical Service VA. Medical Center, Cleveland, OH.© 1999 by The University of Chicago. All rights reserved. 0031-5982/99/4202-1095$01.00 280 Aucott et al. ¦ Teaching Awards and Departmental Longevity sess the attrition rate of excellent teachers, we examined the departmental longevity of winners of the "Teacher of the Year" award at one academic institution. One might anticipate that teaching excellence of this magnitude would be associated with prolonged membership in the department. Remarkably, we found that winning this coveted award is associated with local academic failure, i.e. departure from the department's full-time faculty . Methods The study population consisted ofthe full-time faculty in the Department of Medicine at University Hospitals of Cleveland/Cleveland Veterans Affairs Medical Center from 1977 through 1997 (consisting of 100 to 160 faculty at any given time). Winners of the "Teacher of the Year" award were identified from plaques on display in the department's offices. This award is made based on a vote of the housestaff of the combined University Hospitals of Cleveland/Cleveland Veterans' Affairs Medical Center internal medicine residency program. The year of entry into the study was considered to be the year of the award. For multi-award winners, the year of entry was the year of the first award. A control group was created by taking a random sample of contemporaneous full-time Department of Medicine faculty who had not won the award. Faculty eligible for the control group were identified from faculty lists corresponding to the years of the winners and a random number generator was used to select the sample. Sampling without replacement was performed. Since the number of award winners was constrained, four controls were chosen per award winner to increase the power of the study. The final sample resulted in a power of 0.66 to detect a two-fold difference in frequency offaculty remaining in the department at three years, with alpha = 0.05. Demographic information and other faculty characteristics were obtained from departmental records. Frequency offaculty remaining in the department at three years was analyzed by chi square test. The three-year time frame was chosen for two reasons: (1) it is the length of time for internal medicine residency training , i.e. the departmental longevity of those who vote for the award; and (2) this period...