Development and implementation of a relative value scale for teaching in emergency medicine: the teaching value unit

Relative value units exist for measuring clinical productivity. Limited objective measures exist, however, for nonclinical activities, specifically teaching.

To develop an objective measure of teaching productivity linked to a performance-based incentive plan.

Teaching goals and objectives were identified before the 1998-1999 academic year. Teaching value units (TVUs), objective measures for quantifying teaching activities, were developed and assigned based on an estimation of time needed to complete each activity and weighted for importance to the teaching mission. Each physician was allocated teaching time based on past performance and future goals. Targeted TVUs necessary to meet expectations were proportionate to allocated teaching time. Teaching productivity was defined as a percentage of targeted TVUs achieved. Incentive dollars for teaching were distributed based on percentage of targeted TVUs achieved, weighted individually for teaching load.

Teaching productivity was evaluated over a three-year period. In year 1, mean TVUs allocated/physician were 181 units (range 25 to 449). Four of 18 physicians (22%) met expectations. The mean individual TVUs achieved were 54% of expected (range 0% to 114%). By year 3, mean TVUs allocated/physician were 179 (range 45 to 629). Twelve of 22 physicians (55%) met expectations. The mean individual TVUs achieved were 82% of expected (range 11% to 146%). Between year 1 and year 3, group productivity increased from 73% to 88%, and mean individual productivity increased from 54% to 82% (p = 0.01).

The development of a TVU-based system enabled objective quantification and monitoring of a broad range of teaching activities. The TVU-based system linked to an incentive plan helped to increase individual and group teaching productivity.