Attributes of excellent clinician teachers and barriers to recognizing and rewarding clinician teachers’ performances and achievements: a narrative review

. 2022 May 3;13(2):57–72. doi: 10.36834/cmej.73241

Coding Concepts^a	Definition
Cognitive Attributes
Provides feedback	Excellent clinician teachers assess and evaluate trainees and peers, providing clear, prompt, constructive and effective feedback.^60,63,65
Excellent communication skills	An excellent clinician teacher has highly developed communication skills to interact with patients, families, members of the health care team, and students. Clinician teachers with excellent communication skills also articulate their thought processes used to make clinical decisions with clarity and in language their learner understands. They are able to provide clear, simple and logical explanations. In addition, excellent clinician teachers can use effective illustrations and anecdotes.^{53,60–62,65}
Good supervision	Excellent clinician teachers provide direct and competent supervision and direction to trainees. High-performing clinician teachers delegate and actively engage trainees, giving them opportunities to carry out procedures.^{53,60,62,63,65,130}
Well-organized	An excellent clinician teacher is well organized and prepared for teaching, has sound instructional plans set out for teaching. A well-organized clinician teacher also specifies and defines objectives and expectations.^53,60,131
Clinical competence	An excellent clinician teacher demonstrates clinical competence and aptitude, technical expertise, ability to make good judgements and quick decisions, and clinical reasoning skills. These excellent teachers further demonstrate skills in managing patients and applying research evidence in clinical practice.^53,60,62,63
Self-evaluates	An excellent clinician teacher reflects on their teaching, making use of reflective processes, logs, diaries, the exchange of ideas, dialogue, and discussion. An excellent teacher is also sensitive and welcoming of student, resident and peer feedback on their teaching and clinical performance.^60,130
Professional	An excellent clinician teacher demonstrates professionalism and commitment to lifelong learning, training and development as both a physician and as a teacher. An excellent clinician teacher also has high standards of professional and personal values in relation to patients and their care and takes pride in their work.^60,62,65,130
Medical knowledge	An excellent clinician teacher demonstrates knowledge and expertise, mastery of subjects, knowledge of general medicine, and understanding of the multicultural society in which medicine is practiced.^53,60,62,63
Scholarly	An excellent clinician teacher effectively conducts research and understands various research methods.^60,131
Administration skills	An excellent clinician teacher demonstrates skills in administrative roles.^53,60
Non-cognitive Attributes
Stimulates	An excellent clinician teacher motivates, inspires and encourages trainees to learn the practice of medicine. Excellent teachers inspire learners to think beyond facts and to ask questions. Excellent teachers also stimulate learners’ intellectual curiosity and self-directed learning. Excellent teachers further facilitate students’ clinical reasoning and encourage learners’ independence of thought.^60,62
Passionate and enthusiastic	Excellent clinician teachers have enthusiasm and passion for both medicine and teaching. Enthusiastic teachers are positive, maintain eye contact, nod, and are genuinely thrilled to be teaching.^{53,60–62,130,131}
Creates supportive environment	Excellent clinician teachers create a positive and supportive learning environment by being supportive. They exhibit patience, humility, openness to suggestions and questions. Excellent clinician teachers also give latitude to learners to discover their own style and develop own method of practice.^53,61
Adapts teaching	Excellent clinician teachers are alert to gaps and deficiencies in trainee’s education and are able/flexible to adapt teaching to learner’s specific needs and levels. They also provide individual attention and an individualized teaching approach to trainees.^53,60,131
Is respectful and personable	Excellent clinician teachers are friendly/polite, tactful, and do not belittle learners and patients. Excellent clinician teachers are also respectful of different cultures and backgrounds.^60,63,65,131
Is approachable	Excellent clinician teachers are available, approachable and willing to help. These teachers provide time to students for discussions, questions and explanations.^60,61,131
Role models	Excellent clinician teachers are aware that trainees are constantly watching their actions and behaviors (good and bad). For that reason, these teachers role model good professionalism, competence, and attitudes. These teachers set good examples through their behaviors and actions and behave in a manner that is consistent with what they express as good clinical care. They also explicitly articulate the process behind their actions. Excellent clinician teachers also realize the importance of modeling humanistic behaviors such as empathy and compassion.^{60,63,65,130,131}
Barriers to receiving adequate recognition and rewards for clinician teachers’ performances
Teaching undervalued	The literature indicates that clinician teachers are not recognized and rewarded as well as colleagues focusing on research and patient care.^29,116,125 Little or no value placed on teaching in comparison to research and clinical service, with teaching accomplishments carrying less significance.^116,125 Recognition and rewards policy and practices are usually better developed for faculty who do not focus on teaching in medical schools that devalue teaching.²⁹
Unclear criteria	Poorly defined and unclear criteria are a challenge for teachers since the expectations for excellent performance tend to be vague.^3,84 The criteria can be inconsistent and incongruent with the job descriptions, roles and skills/training of clinician teachers. The clarity and objectivity of recognition and reward selection processes is damaged by poor criteria and definitions of teaching excellence.^3,40 Decisions about recipients of rewards for high performance can thereby appear arbitrary and/or capricious.
Unreliable evaluation metrics	Insufficient measures, and few valid and reliable tools to evaluate teaching.^3,15,93 A common example is the reliance on student and resident ratings and testimonials as metrics to ascertain teaching excellence.^15,30 These concerns are founded on findings of trainees’ struggles to separate average or competent from high-performing faculty, along with their propensity to rate based on grades and amiability.¹³² The lack of sensitive metrics to adequately assess performance obscures what teaching excellence is, and can complicate the pathway to teaching excellence.
Lack of reward/recognition opportunities	In some institutions there are no or a limited number of recognition and rewards, especially extrinsic rewards, available for teaching faculty, meaning that some excellent teachers may not get acknowledged for their accomplishments.^3,108 In these institutions, recognition and rewards are mainly more common for non-teaching accomplishments, even among teaching faculty.
Poor administrative support	Lack of administrative support during reward application procedures, which can be complex and timely.^29,30,125
Inaccessibility of mentors	Absence of mentors or senior educators to guide less experienced clinicians.^90,110
Non-conducive clinical teaching environment	In clinical settings, clinician teachers are often required to work in tense, non-conducive environments where clinical demands and productivity are prioritized ahead of teaching.^55,110 This can be reflected by the architecture of the physical space.¹³³
Culture clash	Conflicting and incongruent values, beliefs and norms between students, clinician teachers, organizational leaders, reward committee chairs, and/or the institution at large.^3,82,84 For example, clinician teachers’ views of the importance of teaching may not be concordant with the views of promotion committees.⁸⁴
External pressure	Factors outside of the control of clinician teachers that can impact their work. Clinician teachers can experience institutional financial constraints for teaching and time constraints for participation in developmental programs.^83,90,92 Clinician teachers can also experience tensions and role conflicts in the clinical environment.
Cumbersome	Application process for rewards can be perceived to be very time consuming and complex for already busy clinician teachers.^3,30
Disconnection	Clinicians can feel detached with their institution and departmental leaders, and with the recognition and reward system of their local institution.^75,82,84 Some clinicians can perceive that their institution has a poor understanding of faculty needs and daily realities.^75,84

^aOur coding concepts are informed by the information presented in previous reviews, seminal primary research reports and opinion papers. However, given the overlap in the meaning of the codes across the numerous papers, the codes used in this review are adapted to reflect our interpretation of the codes.