Pay to Play: Does Financial Incentive Motivate Faculty Completion of Resident Clinical Evaluations?

Clinical feedback is a cornerstone of emergency medicine resident education and a neccesity for mapping resident ACGME milestones. Furhtermore, written resident evaluations will increase in importance with a transition to competency based medical education for EM residencies. Many EM residencies struggle with timely completion of written shift evaluations due to multiple factors, which negatively impacts assessment of learner progression through residency. We hypothesized that a financial incentive and educational curriculum would improve the quantity of written resident feedback.

This two year longitudinal study implemented a financial incentive of $1800 per annum for completion of >75% of resident evaluations and participation in a 2-hour educational feedback curriculum. In the second year of the study we removed the educational curriculum, but maintained the financial incentive of $1800. We evalauted the number of completed resident evaluations across 3 continuous academic years (Baseline, Intervention Year 1, and Intervention Year 2). We report results using descriptive statistics and a linear mixed effects model to evaluate the change in numbers of submitted resident evaluations by attending by year.

Forty attending physicians were included as our study population. Two attending physicians were excluded as they did not work in the system during the baseline year. The number of resident evaluations increased from 1944 to 2685 in intervention year 1 and 2638 in intervention year 2. Linear mixed effects modeling showed statistically significant increases of 8.68 (95% CI 3.8-13.5, p<0.001) evaluations per attending per year. When comparing financial incentive with educational intervention versus financial incentive alone, there is no significant decrease in number of evaluations submitted.

Implementation of an educational and financial incentive significantly increased the number of written evaluations for residents. Additionally, the removal of educational programming, while maintaining financial incentives in year 2 of the study maintained a statistically significant number of resident evaluations. Our findings suggest attending physicians respond well to financial incentives to complete residency evaluation tasks.