National survey examines faculty views on incentives and competency integration in Saudi health education

A national survey of health sciences faculty in Saudi Arabia has found that the single most powerful driver of whether communication, teamwork, leadership and other non-technical skills actually make it into the classroom is not the weight of research expectations but whether faculty believe teaching performance counts toward their promotion. The study, published as a research article in BMC Medical Education, surveyed 537 faculty members drawn from a random national sample and examined, for the first time in a direct empirical design, whether institutional incentive structures are associated with the self-reported integration of non-technical competencies in health professions curricula. The findings arrive at a moment when medical, nursing and pharmacy schools worldwide are under pressure to produce graduates who are not only scientifically competent but also skilled at collaborating across disciplines, navigating difficult conversations and leading under stress.

The researchers, led by Aziza Alshahrani of the Department of Pharmacology at King Khalid University with colleagues from the university’s clinical pharmacy, pharmaceutics and pharmacognosy departments and the Saudi Commission for Health Specialties, conducted a cross-sectional survey between 2 and 27 October 2025. The questionnaire was distributed electronically by the Saudi Commission for Health Specialties to a random sample of 13,800 practitioners across the Kingdom, of whom 537 completed the survey, a response rate of 3.9 percent. That low response rate is a significant caveat, and the authors are careful to acknowledge it, since faculty who chose to respond may hold systematically different views from those who did not. Still, the sampling frame, drawn from the national regulator of health professions, gives the study an unusually broad institutional reach for research on health professions education in the region.

The survey instrument asked respondents about their perceptions of two key incentive structures: whether teaching performance was relevant to promotion decisions, and whether research was perceived as more highly rewarded than teaching. It also measured self-reported integration of five non-technical competency domains: communication skills, teamwork, leadership and management, interpersonal skills, and customer service skills. To analyze integration, the team constructed a composite score calculated as the mean of the five domain items, a scale that demonstrated strong internal consistency with a Cronbach’s alpha of 0.87, well above the conventional 0.70 threshold for reliability in social science measurement. Institutional supports and barriers, including access to professional development and perceived administrative workload, were also assessed as potential correlates.

The analytical approach combined non-parametric tests with multivariable linear regression, adjusted for academic rank, institution type, professional experience and role load, allowing the researchers to isolate the association between incentive perceptions and competency integration while holding career stage and working conditions constant. In a methodological twist that reflects the changing landscape of research practice, the inferential analyses were conducted using an artificial intelligence platform that generates and executes Python code, a workflow that allows researchers to specify statistical procedures in natural language while the platform writes, runs and iterates on the underlying code. The regression model, using ordinary least squares estimation, explained approximately 12 percent of the variance in integration scores, a modest but meaningful proportion for a study of complex organizational behavior in higher education.

The results told a clear and somewhat surprising story. Faculty who perceived teaching performance as relevant to promotion reported significantly higher integration of non-technical competencies even after multivariable adjustment. Conversely, perceiving research as more highly rewarded than teaching was not significantly associated with integration at all. In other words, the conventional narrative that research dominance crowds out teaching innovation by actively suppressing it did not hold; instead, the presence or absence of teaching recognition was what mattered. Integration was highest wherever teaching was perceived as valued, regardless of whether research was also perceived as rewarded, and it was lowest in the configuration the researchers describe as research valued but teaching not. Professional development access emerged as the strongest correlate of integration in the entire model, while perceived administrative workload, despite frequent anecdotes about its corrosive effect on educational effort, was not significantly associated with integration outcomes.

These findings carry real weight for health workforce policy. Non-technical competencies have been identified for decades as critical to patient safety and health system performance: communication failures contribute to avoidable medical error, poor teamwork undermines emergency response, and deficits in leadership and management hamper the efficient delivery of care. Yet regulatory frameworks and accreditation bodies have repeatedly observed that the integration of these competencies into curricula remains uneven across institutions and professions. What has been missing, as the authors note, is empirical evidence linking the organizational environment in which faculty work to the educational choices they make. This study provides that link, suggesting that the incentive architecture of an institution is not background noise but an active determinant of curriculum content.

The mechanism is intuitive. Faculty members in health professions education are typically clinicians and scientists first, juggling patient care, research programs and teaching responsibilities under conditions of finite time. When promotion committees reward publications and grant funding while treating teaching as a service obligation, rational faculty allocate effort accordingly, and competencies that require sustained curricular development, role-playing exercises, simulation-based training and longitudinal assessment are the first to be squeezed out. Conversely, when teaching excellence is visibly tied to career advancement, faculty have a concrete institutional reason to invest in the pedagogical work that non-technical competency integration demands. The strong association with professional development access reinforces this interpretation: faculty who can attend workshops, obtain training in instructional methods and receive ongoing support are better equipped to embed these competencies in their courses.

The authors are appropriately cautious about causality. The cross-sectional design means that direction of effect cannot be established; it is possible that faculty who already integrate non-technical competencies perceive their institutions as more teaching-friendly, rather than the reverse. The reliance on self-reported measures introduces the possibility of social desirability bias, with faculty potentially overreporting integration practices they believe are expected of them. And the 3.9 percent response rate, while not uncommon for large electronic surveys of busy professionals, limits the generalizability of the estimates. The study also relies on perceptions of incentives rather than documented promotion criteria, which means the association reflects how institutional signals are received rather than how policies are formally written.

Even so, the policy implication that emerges is unusually actionable and, perhaps, reassuring for research-intensive institutions. The data do not suggest that institutions must demote research in order to elevate teaching; perceiving research as rewarded was not itself harmful. The configuration associated with the poorest outcomes was the one in which research was valued but teaching was not, and the authors conclude that adding teaching recognition alongside existing research recognition, rather than substituting one for the other, is the direction most worth testing. This framing matters because it reframes the perennial tension between teaching and research not as a zero-sum battle requiring institutions to pick sides, but as an additive problem solvable through complementary recognition structures, teaching-focused promotion pathways, awards, and explicit criteria that value curriculum innovation alongside scholarly output.

The study was reviewed and approved by the Research Ethics Committee of King Khalid University and supported by the Saudi National Institute of Health and the Saudi Commission for Health Specialties. Its timing is notable: Saudi Arabia is investing heavily in transforming its health education and workforce systems, and the findings speak directly to institutions worldwide grappling with how to translate competency frameworks, which exist in abundance on paper, into teaching practice. As health systems continue to confront communication failures, teamwork breakdowns and leadership gaps that no laboratory test can detect, this survey offers a reminder that the curriculum students actually experience is shaped less by what educators know is important and more by what their institutions make it worth their while to teach. The next step, the authors suggest, is prospective testing, ideally interventional studies in which institutions deliberately add teaching recognition to their promotion criteria and measure whether non-technical competency integration rises in response. Until then, the message to deans and promotion committees is clear: the fastest lever for changing what happens in the classroom may be changing what counts when faculty careers are decided.