Education Value Units in Medical Education: A Scoping Review

Abstract

Purpose On the basis of the tripartite mission of patient care, research, and education, a need has arisen to better support faculty in non-revenue-generating activities, such as education. As a result, some programs have developed education value unit (EVU) systems to incentivize these activities. The purpose of this scoping review is to analyze the existing literature on EVUs to identify current structures and future directions for research. Method The authors conducted a literature search of 5 databases without restrictions, searching for any articles on EVU systems published from database inception to January 12, 2022. Two authors independently screened articles for inclusion. Two authors independently extracted data and all authors performed quantitative and qualitative synthesis, consistent with best practice recommendations for scoping reviews. Results Fifty-eight articles were included. The most common rationale was to incentivize activities prioritized by the department or institution. Of those reporting funding, departmental revenue was most common. The majority of EVU systems were created using a dedicated committee, although composition of the committees varied. Stakeholder engagement was a key component for EVU system development. Most EVU systems also included noneducational activities, such as clinical activities, scholarship activities, administrative or leadership activities, and citizenship. Incentive models varied widely but typically involved numeric- or time-based quantification. EVUs were generally seen as positive, having increased equity and transparency as well as a positive impact on departmental metrics. Conclusions This scoping review summarizes the existing literature on EVU systems, providing valuable insights for application to practice and areas for future research.

In Search of a “Metric System” for Measuring Faculty Effort: A Qualitative Study on Educational Value Units at U.S. Medical Schools

“…One approach would be for AHCs to share and build upon each other’s EVU systems, with an intention to tailor existing EVU resources for their own institutions. In our interviews, participants neither shared resources nor drew from the existing literature, which aligns with a recent review identifying few initiatives using formal evidence to inform their approach 10 …”

“…In our interviews, participants neither shared resources nor drew from the existing literature, which aligns with a recent review identifying few initiatives using formal evidence to inform their approach. 10 We also identified a tension in how faculty defined or did not define themselves as educators, which, in some cases, resulted in reduced faculty acceptance of EVUs. The development of a strong educator identity at an AHC is challenging for a variety of reasons, including the sense that one's educator identity when compared with their physician or researcher identities is subordinate in prestige and compensation.…”

“…Reviews have synthesized the literature on EVUs, which consists largely of single-center case-study interventions that lack standardization and longitudinal reporting 10–13 . As Gottlieb described in his scoping review on EVUs, “what the ideal system is remains elusive.” 10 (p15) Studies report multiple approaches to what activities should “count” for EVUs, how these activities should be measured and related data captured, and how these activities are related to clinical and research endeavors. Studies show that EVUs can be counted using a time-based approach, 14,15 in which a 2-hour lecture counts as 2 EVUs, or event-based, 9 in which a 2-hour lecture counts as 1 EVU.…”

Educational Relative Value Units as a Measure of Academic Productivity: A Systematic Review

“…Broadly address scholarship: The faculty who are teaching students and residents are largely doing so in clinical realms. Scholarship for such faculty needs to be addressed broadly, such as in the framework proposed by Boyer (Discovery, Application, Integration, Teaching/Learning) [ 42 ]. As noted in Table 5 , we assumed that if scholarly productivity was measured, at least in terms of grants, papers and presentations, the scholarship of teaching and learning and other educational pursuits would have been captured, but none of the papers reviewed specifically identified how scholarship writ large, as in the Boyer framework [ 43 ], was identified, and our assumption may not be correct.…”

“…The Centers for Medicare and Medicaid Services [ 44 ], especially through their work with the American Medical Association’s RVS Update Committee [ 45 ], have simplified the task of applying very specific wRVU values to procedures. In contrast, there are limited extant lists of the many educational activities that should be assigned eVU values [ 42 ]. Although not published, the University of Virginia School of Medicine has a detailed plan for their eVU structure [ 46 ].…”