Qualitative assessment of the impact of health care reform on the availability of clinicians for preclinical medical instruction

Purpose: Over the past 5 years, Calgary clinicians experienced the restruct uring of health care delivery and a move to a presentation-based curriculum at the University of Calgary. Course coordinators have noted increased dif ficulty in recruiting clinical lecturers at the preclinical undergraduate l evel This study was designed to evaluate the relative importance of factors that may influence the time clinicians spend teaching at this level Summary: This descriptive survey was conducted within the University of Cal gary, Faculty of Medicine, a teaching institution affiliated with the Calga ry Regional Health Authority which is responsible for the delivery of healt h care within the City of Calgary. Basic scientists, residents, and adjunct medical professionals were excluded from a list of lecturers for the acade mic year 1996-97, leaving a target population of 386. Respondents were stra tified according to university appointment, specialty, type of medical trai ning, and hours taught in the 1996-97 academic year. Dependent variables in cluded the financial constraints, time constraints, health care reform, cha nges in the undergraduate medical education curriculum, and lack of recogni tion on availability for teaching. Written comments were also categorized a nd analyzed according to the same variables. A response rate of 79% (n = 305) was achieved. Of the respondents, 52% agre ed that recent reform has made it more difficult to teach; full-time facult y were less likely to agree compared to non-full-time faculty (60% vs. 44%; nonparametric median test, chi(2) = 6.18 p = .046). Twice as many family p hysicians reported that financial constraint was a factor (66%) when compar ed to other specialists, whereas relatively few full-time faculty noted it to be a concern (12%) when compared to major part-time (43%) and non-full-t ime/major part-time appointees (66% chi(2) = 23.4 p < .0001). Clinicians re porting the most teaching hours (more than 30) were most likely to describe an increase in teaching hours (61%). Nonfaculty members were less aware of the recent curricular changes (73%); however, more family physicians felt that these changes had a positive impact on willingness to teach (10%) comp ared to surgical (8%) and nonsurgical specialists (9%; chi(2) = 6.07 p = .0 48). Forty-five percent of respondents agreed that they would be more willi ng to teach if offered some form of recognition. Two thirds of written comm ents suggested that recognition should be nonmonetary (e.g.,faculty promoti on, acknowledgment). Conclusions: The experience at the University of Calgary suggests that avai lability of teachers for preclinical undergraduate medical education has di minished as a result of health care reform. Family physicians have been aff ected the most, and the clinical environment will make it even more difficu lt to involve this important group of teachers in undergraduate medical edu cation.