Table 2.

Summary of recommendations addressing motivations and barriers experienced by physicians

	Recommendations
Motivations
Intrinsic motivations	• Program developers may want to consider promoting the rewards of teaching and remind physicians that they have a unique opportunity to inspire students and help influence the future of patient care
Extrinsic motivations	• Have teaching contributions systematically recorded and compiled in a teaching portfolio or departmental database • Involve clinical-educators in curriculum development and educational policy • Compensate physicians for lost time/income as a result of teaching
Barriers/challenges
Decreased productivity/increased length of day	• Reduce average daily patient list sizes to allow for protected teaching time • Compensate physicians for lost time/reduced list sizes • Give physicians significant advance notice of dates when students will be present, allowing them to alter their schedules and notify their staff if necessary
Lack of compensation	• Five major elements that are seen as essential to have in a faculty teaching program in order to establish equitable salaries for all physicians involved: accepted standards of adequate performance; systematic review of the performance of academic staff; mechanisms for rewarding excellence; structured and effective means of providing assistance to those whose performance is suboptimal; and options for sanctions against those whose performance is consistently suboptimal8
Patient concerns/ethical issues	• Identify the student before seeking patient consent for teaching • Ask the student to seek patient consent • Physician can model the skill of seeking consent in difficult circumstances • Physician should always maintain patient confidentiality in teaching consultations of sensitive information • Students should be given clear instructions as to appropriate behavior prior to commencing a clinical placement • Student expectations and responsibilities should be made clear prior to commencing a placement
Lack of clinician-educator confidence	• Physicians should be granted ample opportunity to increase their skills as teachers, lecturers, coaches, mentors, and evaluators regardless of whether they are in a tertiary medical center or in the community • In order to continue improving or meet a certain standard, clinician-educators need feedback on the effectiveness of their teaching coupled with opportunities to improve in areas of weakness • Universities should make expected teaching contributions clear at least a year in advance • Teacher training should not simply be an option for select clinician-educators looking to improve their skills, but rather a requirement for all those with regular teaching duties

Note: Data from Cook D. Study of Clinical Teachers in Canadian Faculties of Medicine. The Association of Faculties of Medicine of Canada; 2009. Available from: https://www.afmc.ca/pdf/Study%20of%20Clinical%20Teachers%20-%20Discussion%20Paper.pdf. Accessed October 11, 2014.⁸