Faculty perceptions of a financial incentive to promote engagement in surgical education: a qualitative study

Abstract Purpose Education remains a central pillar of academic surgery, but engagement remains variable among academic surgeons. The purpose of the study was to explore faculty perception of factors that promote or inhibit engagement in surgical education, including a previously implemented education incentive program. Methods Semi-structured interviews were conducted with surgical faculty from a single academic institution. Anonymized interview transcripts were separately coded by 4 study authors. Faculty were asked about engagement in education, participation in an education incentive program, and completion of Entrustable Professional Activities (EPA) assessments. Interviews were conducted until thematic saturation was achieved. Results The study cohort consisted of 22 academic surgeons. Participants varied by gender, career stage, surgical subspecialty, institutional affiliation, and educational involvement. Fifteen (68.2%) interviewees had participated in the institution’s education incentive program. Eight (36.4%) interviewees had completed at least one EPA assessment. Among the 15 faculty members who participated in the education incentive program, six (40%) had completed an EPA assessment. Our analysis identified three themes: 1) Motivation to teach is intrinsic and not affected by financial bonuses; 2) Penalties can motivate teaching but elicit strong negative emotions; 3) Time and recognition are stronger motivators than money. Participants perceived that the financial incentives did not promote engagement in education and did not change their behavior. Conclusion Faculty believe engagement in education is driven by intrinsic factors, rather than financial rewards. This study generates the hypothesis that programmatic efforts to promote engagement in surgical education may benefit from additional protected time for educational activities and demonstrating the department’s commitment to the educational mission. Future research should evaluate the efficacy of non-monetary incentives, such as protected time and formal recognition for engagement in education.