LAUSR

Lack of Reform in Supporting Teaching Excellence In the Academic Medical Centre (AMC) context, physicians withmajor clinical teaching and patient care responsibilities are referred to as clinical teachers. In this article, AMCs are understood as institutions that include medical schools and hospitals that are organizationally and administratively affiliated with these schools. Clinical teachers are critical determinants of the quality of learning and clinical care, but many are not naturally competent teachers nor are they adequately trained to teachmedical students and residents. Supporting the training and development of teachers to meet standards of teaching excellence is therefore critical to learner development and to the provision of high-quality patient care. Over the past 30 years, there have been many scholarly and institutional attempts to support clinical teachers in their pursuit of the high standards that constitute teaching excellence. Examples of these supportive efforts include faculty development (FD) programs specifically designed to foster teachers’ excellence and the dramatic increase in the use of teaching portfolios as a means to document teaching achievements. However, the current shared reality is that many AMCs are still not supporting teaching excellence in parity with excellence in research and clinical practice. Inequities in the priority and support for teaching can traditionally be found in the structures, processes, and cultures that are reflected in institutional policies and practices. The lack of true reform and persisting inequity in the priority and support for teachingexcellence inAMCs is largelyattributed tononsupportive institutional cultures that continue to devalue teaching. The main purpose of this article was to highlight the low priority and poor support for clinical teaching excellenceand tooutlinewaysof generating solutions that may help to inform policy and practice changes to raise the epistemic value of clinical teaching in AMCs. The first objective was to outline the key elements of a hidden curriculum(HC) that contribute to the inequities in the support for clinical teaching excellence. This is performed by demonstrating the utility of the HC as a conceptual lens to reveal the hidden factors behind the devaluing of clinical teaching. This will deepen the understanding of the cultural and structural etiology of the inequities experienced by clinical teachers. The second objective was to suggest practical ways that medical schools can identify local barriers to the support of clinical teaching to inform targeted local clinical teaching policy and practice changes. In sum, we suggest that a local needs assessment plan as a part of a quality improvement project, and a research study that may be conceptually generalizable to other institutional contexts, is an integral part of any solution generating pathway that seeks to enhance support of our clinical teachers.