1. Georgetown University School of Medicine Educational Value Unit (EVU) Getting Paid for What You Do: Developing a System to Quantify Faculty Non-clinical Academic Activities Steven M. Schwartz, MD Andrea Cammack, MEd Georgetown University School of Medicine STFM Pre-doctoral Education Conference Portland, OR ~ January 2008

2. Georgetown University School of Medicine Scenarios  You are a predoctoral director overseeing several courses with a wide range of teaching and administrative duties. Most of your dozen or so faculty feel overworked but you do not know how their time is spent you want to accurately assess their time.

3. Georgetown University School of Medicine Scenarios  You are a clerkship director developing a new or expanded clerkship with several types of didactic sessions you wish to make a staffing plan, to determine your needs and budget. Special skills are required for some sessions.  You are the chair wanting to demonstrate to the Dean your teaching contributions to the med school and solidify or increase your tuition funding

4. Georgetown University School of Medicine Scenarios  You are predoc director and wish to justify the need for new hires. You need to demonstrate what programs/service you currently provide, what your with to provide and the staffing shortfall (need)

5. Georgetown University School of Medicine Purpose/Advantages WHO?  faculty members  course directors  pre-doctoral director  Chair  Dean WHY?  define staffing and budgetary needs  define scope of work  orient newly hired faculty  reorganize and reassign faculty duties  conduct Annual Performance Evaluations (APE)  perform time management and career planning  other…

6. Georgetown University School of Medicine Workshop Objectives  Understand EVU system, its values and challenges  Identify participants’ needs  Start developing own EVU system

7. Georgetown University School of Medicine Background  Mission-Based Management  Teaching, Research, Clinical Care, Administration and Service  To develop a rational method for distributing funds  Emphasize the educational mission  Institutional, Departmental and Faculty level purpose Mallon W, Jones R, (AAMC) Acad. Med 2002;77:115-123

8. Georgetown University School of Medicine EVU/RVU Systems  Contact Hour Method  Direct contact only  Contact plus preparation and evaluation  RVU method (RBRV)

9. Georgetown University School of Medicine EVU systems - Challenges 1.Lack of Data management culture 2.Skepticism 3.Misguided search for perfect metric 4.Expectation it will erase ambiguity 5.Lack of quality measure 6.Tendency to become overly complex

10. Georgetown University School of Medicine Pre-doctoral Division Chart

11. Georgetown University School of Medicine Background of our EVU System  Drafted by Dr. Louis Jacques  Developed by Dr. John Gimpel  Implemented by Dr. Steven Schwartz in 2003  Revised with faculty and course directors in 2005

12. Georgetown University School of Medicine Toward the EVU  Identify goals and components of metric  Identification of duties to be tracked  Implementation strategy

13. Georgetown University School of Medicine Identify Goals and Metric  What problem were we trying to solve?  Who was our audience?  What were we measuring (Time, experience, “value” bonus/rate)  What to track? How specific  What was our unit of measurement?

14. Georgetown University School of Medicine Defining EVU 0.1 EVU = 2 hours (smallest unit of measure) 1 EVU = 20 hours 10 EVU = 200 hours or ½ day per week annualized 100 EVU= 2000 hours or 100% FTE Variation +/- 10%

15. Georgetown University School of Medicine Identification of duties  List duties  Categorize  Negotiating EVU for specific duties  Modifiers?

16. Georgetown University School of Medicine Assigning EVUs to Activities

17. Georgetown University School of Medicine Implementation  Who decides?  Where to keep data  How to update  Frequency of update  Frequency of dist  What to do with the data?  Address over and under performers?  Negotiation for $$  Evaluation

18. Georgetown University School of Medicine Implementation of our System  Managed by Pre-doctoral director and coordinator  Distributed twice a year  2 copies of report (current and planning)  Faculty reviews and returns modifications  Annual FTE/EVU report to track divisional efforts over time Year04-0505-0606-0707-08 Pre-doc Total FTE487.15464.05426.95417.55

19. Georgetown University School of Medicine Faculty feedback Year: Respondents: Spring 2006 n=8 Fall 2007 n=6 Questions:AverageRangeAverageRange The report is easy to understand. 2.751-51.671-2 The report is comprehensive in outlining my duties. 21-32 The report clearly lists what my pre-doctoral education duties are. 1.881-31.161-2 The EVU units evaluate the task time accurately. 31-51.831-2

20. Georgetown University School of Medicine Faculty Feedback (continued) When to receive report:  Once a year (March, prior to APE)  Twice a year (March/April before APE and October to verify duties) Comments:  “Gives you an outline of what you think you do vs. what pre- doc thinks. Difficult format.”  “Beneficial to be on “same page” regarding what I’m being paid to do by the Dept. Less useful in that it’s hard to standardize EVUs for teaching (e.g. some prepare hours for small group, some do it ‘off the cuff’.)  “It is very beneficial in negotiating responsibilities with supervisors. It is also helpful for me personally to carefully weigh whether to take on new responsibilities. It is useful in updating my CV. I don’t really find a down side to it. Great work!!!”

21. Georgetown University School of Medicine Activity #1  Identifying Goals and Metric

22. Georgetown University School of Medicine Activity # 2  Conflict and Negotiating Resolution

23. Georgetown University School of Medicine Activity #3  Implementation Strategies

24. Georgetown University School of Medicine Challenges  Time intensive  Right application:  Excel vs. database (e.g. Access)  Online database; tracking duties www.chainbridgetech.com/GeorgetownStaff  Add clinical and research type of duty

25. Georgetown University School of Medicine Bibliography  Academic Medicine Management Series: Mission-Based Management http://www.academicmedicine.org/pt/r e/acmed/mbm.htm;jsessionid=HXjTLSz DzT8Pt9LK23Y19fRsP2pQ0JB8slvPvLnhQ dWvnX5Q2TGT!- 1334708310!181195628!8091!-1

26. Georgetown University School of Medicine Bibliogaphy  Mallon W, Jones, R “How do medical Schools Use Measurement systems to Track Faculty Activity and Productivity in Teaching?” Acad. Med. 2002;77:115-123  Jarrell, et al. “Looking at the Forest Instead of Counting the Trees: An Alternative Method for Measuring Faculty ﾕ s Clinical Education Efforts” Mission-based Management, Acad. Med 2002  Bardes CL, Hayes JG. Are the teachers teaching? Measuring the educational activities of clinical faculty. Acad Med. 1995; 70:25  Stites S, Vansaghi L, Pingleton S, et al. Aligning compensation with education: design and implementation of the Educational Value Unit (EVU) system in an academic internal medicine department. Acad Med. 2005;80:1100

27. Georgetown University School of Medicine Bibliography  Khan & Simon, “Development and Implementation of a Relative Value Scale for the Teaching in Emergency Medicine: The Teaching Value Unit”Acad Emerg Med 2003;10(8):904-907  Bardis CL et al, “Measuring Teaching: a Relative Value Unit Scale in Teaching” Teaching and Learning in Medicine 1998; 10(1) 40-43  Yeh M., Cahil D., “Quantifying Physician Teaching productivity Using Clinical Relative Value Units” J Gen Int Med 1999;14:617-621