Increasing Promotion of Women Faculty in Academic Medicine: Impact of National Career Development Programs

Background: Three national career development programs (CDPs)-Early and Mid-Career Programs sponsored by the Association of American Medical Colleges and the Hedwig van Ameringen Executive Leadership in Academic Medicine sponsored by Drexel University-seek to expand gender diversity in faculty and institutional leadership of academic medical centers. Over 20 years of success and continued need are evident in the sustained interest and investment of individuals and institutions. However, their impact on promotion in academic rank remains unknown. The purpose of the study is to compare promotion rates of women CDP participants and other faculty of similar institutional environment and initial career stage. Methods: The study examined retrospective cohorts of 2,719 CDP participants, 12,865 nonparticipant women, and 26,810 men, from the same institutions, with the same degrees, and first years of appointment in rank. Rates of promotion to Associate and Full Professor ranks in respective cohorts of Assistant and of Associate Professors were compared using Kaplan-Meier survival curves and log-rank tests, and logistic regression adjusting for other predictors of academic success. Results: In adjusted analyses, participants were more likely than men and non-participant women to be promoted to Associate Professor and as likely as men and more likely than non-participant women to be promoted to Full Professor within 10 years. Within 5 years, CDP participants were more likely than nonparticipant women to be promoted to Associate Professor and as likely as to be promoted to Full Professor; in the same interval, participants were promoted to both higher ranks at the same rates as men. For both intervals, nonparticipant women were significantly less likely than men to be promoted to either rank. Conclusions: The higher rates of promotion for women participating in national CDPs support the effectiveness of these programs in building capacity for academic medicine.

Should Institutions Disclose the Names of Employees with Covid-19?

Prestigious University is a large, private educational institution with a medical school, a university hospital, a law school, and graduate and undergraduate colleges all on a single campus. In the face of the Covid‐19 pandemic, students were told during spring break to return to campus only briefly to retrieve their belongings. Classes then went online. On March 23, 2020, the faculty, students, and staff were emailed the following by the university's director of infection control and public health:

We have become aware that a Prestigious University staff member has tested positive for the virus that causes Covid‐19. The individual, who was last on campus on March 16, is now in isolation at their permanent residence and is doing well clinically. The university has already identified those members of our community who may have been in close contact with this individual, and we are working to notify them. Further, this individual's local health department has a protocol for identifying people who have been in direct contact with anyone testing positive for Covid‐19 (such as this Prestigious University staff member) so that they can self‐quarantine and watch for COVID‐19 symptoms for a period of 14 days from their last contact with the infected individual.

A professor in the Philosophy Department has asked the ethicists at the medical school whether such contact tracing suffices. “Don't the members of the community deserve to know who this is? Isn't there a mandate to identify this person in order to maximize public health benefits and slow the spread of this deadly virus?”

14 Years Later: A Follow-Up Case-Study Analysis of 8 Health Professions Education Scholarship Units

PURPOSE

Internationally, health professions education scholarship units (HPESUs) are often developed to promote engagement in educational scholarship, yet little is known about how HPESUs change over time or what factors support their longevity. In hopes of helping HPESUs thrive, this study explored factors that shaped the evolution of 8 HPESUs over the past 14 years.

METHOD

This study involved retrospective case-study analysis of the 8 American, Canadian, and Dutch HPESUs profiled in a 2004 publication. First, the research team summarized key elements of HPESUs from the 2004 articles, then conducted semistructured interviews with the current unit directors. In the first set of questions, directors were asked to reflect on how the unit had changed over time, what successes the unit enjoyed, what enabled these successes, what challenges the unit encountered, and how these challenges were managed. In the second set of questions, questions were tailored to each unit, following up on unique elements from the original article. The team used Braun and Clarke's 6-phase approach to thematic analysis to identify, analyze, and report themes.

RESULTS

The histories of the units varied widely-some had grown by following their original mandates, some had significant mission shifts, and others had nearly disappeared. Current HPESU directors identified 3 key factors that shaped their HPESU's longitudinal development: the people working within and overseeing the HPESU (the need for a critical mass of scholars, a pipeline for developing scholars, and effective leadership), institutional structures (issues of centralization, unit priorities, and clear messaging), and funding (the need for multiple funding sources).

CONCLUSIONS

Study findings offer insights that may help current HPESU directors to strategically plan for their unit's continued development. Tactically harnessing the factors identified could help directors ensure their HPESU's growth and contend with the challenges that threaten the unit's success.

Characteristics of Academic-Affiliated Health Systems

PURPOSE

Changing market forces increasingly are leading academic medical centers (AMCs) to form or join health systems. But it is unclear how this shift is affecting the tripartite academic mission of education, research, and high-quality patient care. To explore this topic, the authors identified and characterized the types of health systems that owned or managed AMCs in the United States in 2016.

METHOD

The authors identified AMCs as any general acute care hospitals that had a resident-to-bed ratio of at least 0.25 and that were affiliated with at least one MD- or DO-granting medical school. Using the Agency for Healthcare Research and Quality 2016 Compendium of U.S. Health Systems, the authors also identified academic-affiliated health systems (AHSs) as those health systems that owned or managed at least one AMC. They compared AMCs and other general acute care hospitals, AHSs and non-AHSs, and AHSs by type of medical school relationship, using health system size, hospital characteristics, undergraduate and graduate medical education characteristics, services provided, and ownership.

RESULTS

Health systems owned or managed nearly all AMCs (361, 95.8%). Of the 626 health systems, 230 (36.7%) met the definition of an AHS. Compared with other health systems, AHSs included more hospitals, provided more services, and had a lower ratio of primary care doctors to specialists. Most AHSs (136, 59.1%) had a single, shared medical school relationship, whereas 38 (16.5%) had an exclusive medical school relationship and 56 (24.3%) had multiple medical school relationships.

CONCLUSIONS

These findings suggest that several distinct types of relationships between AHSs and medical schools exist. The traditional vision of a medical school having an exclusive relationship with a single AHS is no longer prominent.

Adapting rapid assessment procedures for implementation research using a team-based approach to analysis: a case example of patient quality and safety interventions in the ICU

BACKGROUND

Innovations to improve quality and safety in healthcare are increasingly complex, targeting multiple disciplines and organizational levels, and often requiring significant behavior change by those delivering care. Learning health systems must tackle the crucial task of understanding the implementation and effectiveness of complex interventions, but may be hampered in their efforts by limitations in study design imposed by business-cycle timelines and implementation into fast-paced clinical environments. Rapid assessment procedures are a pragmatic option for producing timely, contextually rich evaluative information about complex interventions implemented into dynamic clinical settings.

METHODS

We describe our adaptation of rapid assessment procedures and introduce a rapid team-based analysis process using an example of an evaluation of an intensive care unit (ICU) redesign initiative aimed at improving patient safety in four academic medical centers across the USA. Steps in our approach included (1) iteratively working with stakeholders to develop evaluation questions; (2) integration of implementation science frameworks into field guides and analytic tools; (3) selecting and training a multidisciplinary site visit team; (4) preparation and trust building for 2-day site visits; (5) engaging sites in a participatory approach to data collection; (6) rapid team analysis and triangulation of data sources and methods using a priori charts derived from implementation frameworks; and (7) validation of findings with sites.

RESULTS

We used the rapid assessment approach at each of the four ICU sites to evaluate the implementation of the sites' innovations. Though the ICU projects all included three common components, they were individually developed to suit the local context and had mixed implementation outcomes. We generated in-depth case summaries describing the overall implementation process for each site; implementation barriers and facilitators for all four sites are presented. One of the site case summaries is presented as an example of findings generated using the method.

CONCLUSIONS

A rapid team-based approach to qualitative analysis using charts and team discussion using validation techniques, such as member-checking, can be included as part of rapid assessment procedures. Our work demonstrates the value of including rapid assessment procedures for implementation research when time and resources are limited.

Is Academic Medicine Ready for Term Limits?

The use of term limits in politics and business has been proposed as a means to refresh leadership, encourage innovation, and decrease gender and racial disparities in positions of power. Many U.S. states and the executive boards of businesses have incorporated them into their constitutions and bylaws; however, studies in politics and business have shown that implementing term limits has had mixed results. Specifically, research in politics has shown that term limits have had a minimal effect on the number of women and minorities elected to office, while research in business indicates term limits do increase innovation. Additionally, term limits may have unintended negative consequences, including inhibiting individuals from developing deep expertise in a specific area of interest and destabilizing institutions that endure frequent turnover in leaders. Given this conflicting information, it is not surprising that academic medical centers (AMCs) in the United States have not widely incorporated term limits for those holding positions of power, including deans, presidents, provosts, and department heads. Notably, a few AMCs have incorporated such limits for some positions, and faculty have viewed these positively for their ability to shape a more egalitarian and collaborative culture. Drawing on studies from academic medicine, politics, and business, the author examines arguments both for and against instituting term limits at AMCs. The author concludes that despite strong arguments against term limits, they deserve attention in academic medicine, especially given their potential to help address gender and racial disparities and to encourage innovation.

Improving the trustworthiness, usefulness, and ethics of biomedical research through an innovative and comprehensive institutional initiative

The reproducibility crisis triggered worldwide initiatives to improve rigor, reproducibility, and transparency in biomedical research. There are many examples of scientists, journals, and funding agencies adopting responsible research practices. The QUEST (Quality-Ethics-Open Science-Translation) Center offers a unique opportunity to examine the role of institutions. The Berlin Institute of Health founded QUEST to increase the likelihood that research conducted at this large academic medical center would be trustworthy, useful for scientists and society, and ethical. QUEST researchers perform "science of science" studies to understand problems with standard practices and develop targeted solutions. The staff work with institutional leadership and local scientists to incentivize and support responsible practices in research, funding, and hiring. Some activities described in this paper focus on the institution, whereas others may benefit the national and international scientific community. Our experience, approaches, and recommendations will be informative for faculty leadership, administrators, and researchers interested in improving scientific practice.

Accelerating Medicines Partnership: Organizational Structure and Preliminary Data From the Phase 1 Studies of Lupus Nephritis

The Accelerating Medicines Partnership (AMP) Lupus Network was established as a partnership between the National Institutes of Health, pharmaceutical companies, nonprofit stakeholders, and lupus investigators across multiple academic centers to apply high-throughput technologies to the analysis of renal tissue, urine, and blood from patients with lupus nephritis (LN). The AMP network provides publicly accessible data to the community with the goal of generating new scientific hypotheses and improving diagnostic and therapeutic tools so as to improve disease outcomes. We present here a description of the structure of the AMP Lupus Network and a summary of the preliminary results from the phase 1 studies. The successful completion of phase 1 sets the stage for analysis of a large cohort of LN samples in phase 2 and provides a model for establishing similar discovery cohorts.

Trends in Tenure Status in Academic Family Medicine, 1977-2017: Implications for Recruitment, Retention, and the Academic Mission

PURPOSE

Tenure status has important implications for medical school faculty recruitment and retention and may affect educational quality, academic freedom, and collegiality. However, tenure trends in academic family medicine are unknown. This study aimed to describe trends in tenure status of family medicine faculty overall and by gender and status of minorities underrepresented in medicine (URM) in Liaison Committee on Medical Education-accredited medical schools.

METHOD

Association of American Medical Colleges Faculty Roster data were used to describe trends in tenure status of full-time family medicine faculty, 1977 to 2017. Bivariate and trend analyses were conducted to assess associations and describe patterns between tenure status and gender, race, and ethnicity. Interdepartmental variations in tenure trends over the years were also examined.

RESULTS

Among family medicine faculty, the proportions of faculty tenured or on a tenure track dropped more than threefold from 1977 (46.6%; n = 507/1,089) to 2017 (12.7%; n = 729/5,752). Lower proportions of women and URM faculty were tenured or on a tenure track than male and non-URM faculty, respectively. But the gaps among them were converging. Compared with other clinical departments, family medicine had the highest proportion of faculty (74.6%; n = 4,291/5,752) not on a tenure track in 2017.

CONCLUSIONS

Proportion of tenure positions significantly decreased among family medicine faculty in U.S. medical schools. While gaps between male and female faculty and among certain racial/ethnic groups remained for family medicine tenure status, they have decreased over time, mainly because of a substantial increase in nontenured positions.

Understanding Interpersonal and Organizational Dynamics Among Providers Responding to Crisis

Patient rescue occurs in phases: recognizing the problem, communicating the concern, and treating the complication. To help improve rescue, we sought to understand facilitators and barriers to managing postoperative complications. We used a criterion-based sample from a large academic medical center. Semistructured interviews (n = 57) were conducted, which were audio-recorded and transcribed verbatim. Thematic analysis and consensus coding was performed using NVivo 11. We used a framework matrix approach to synthesize our coding and identify themes that facilitate or impede rescue. Clinicians identified root causes for delays in care, such as recognizing patient deterioration, knowing whom to contact and when, and reaching the correct decision-making provider. This study identified significant variation in communication processes across providers caring for surgical patients. Targeted interventions aimed at improving and standardizing these aspects of communication may significantly influence the ability to effectively identify and escalate care for postoperative complications.

A Faculty Development Model that Promotes Success of Early Career Faculty in Academic Medicine

INTRODUCTION

Medical school offices of faculty development aim to facilitate the academic growth of junior faculty by fostering independent research, enhancing teaching skills, and bolstering career opportunities. The Rush Research Mentoring Program aims to achieve this goal at Rush University medical center by offering a broad resource armamentarium and creating an environment that fosters productive relationships between mentees and mentors. This article describes the program's structure, evaluation, outcomes, and the university vision for its future.

METHODS

The program's contributions to the overall success of the University were measured by scholarly productivity, intramural and extramural funding, junior faculty retention, and mentee satisfaction with the program from its inception in 2006 until 2018.

RESULTS

Over 12 years, mentees have collectively received 639 grants. Of the 130 mentees who have completed the 5-year program and transitioned to program alumni, 65% have been retained as faculty members, with 40% receiving promotions to associate professor and 5% to full professor. Mentees report frequent use of the available resources and high satisfaction with the program.

DISCUSSION

We anticipate that structured mentoring programs with institutionally supported professional development activities and strategic mentor-mentee partnerships can be successfully adopted at similar academic medical centers.

Effectiveness of a Faculty Mentor Development Program for Scholarship at an Academic Health Center

INTRODUCTION

Mentors are in short supply at academic health centers (AHCs). The effectiveness of training mentors (without preselection for their research skills) to support faculty mentees in scholarly activities at AHCs is not well known.

METHODS

The University of New Mexico Health Sciences Center has a two-component program to develop effective mentors for scholarship for faculty mentees. It has an online component supplemented by an optional face-to-face (F2F) component. Study outcomes included changes in self-reported knowledge scores for online users and Mentoring Competency Assessment scores for F2F users.

RESULTS

One hundred five mentors, mostly women associate professors, used the online program. Online users demonstrated improvement in self-reported knowledge scores. Thirty-eight users additionally completed the F2F program-63% on a clinician-educator track and none with a National Institutes of Health-funded K-award mentee. The self-reported Mentoring Competency Assessment composite score rose from 4.3 ± 1.0 to 5.5 ± 0.8 (paired t = 7.37, df = 37, P < .001) for the F2F participants, with similar improvement noted in the clinician-educator subgroup.

DISCUSSION

Users of the online and F2F components of the program improved their self-assessed knowledge and mentoring skill, respectively, demonstrating the effectiveness of the program. Such programs may help AHCs enhance the scholarship and the diversity of their scientific and clinician-educator workforce.

Effectiveness of integrative medicine group visits in chronic pain and depressive symptoms: A randomized controlled trial

BACKGROUND

Current treatment options for chronic pain and depression are largely medication-based, which may cause adverse side effects. Integrative Medical Group Visits (IMGV) combines mindfulness techniques, evidence based integrative medicine, and medical group visits, and is a promising adjunct to medications, especially for diverse underserved patients who have limited access to non-pharmacological therapies.

OBJECTIVE

Determine the effectiveness of IMGV compared to a Primary Care Provider (PCP) visit in patients with chronic pain and depression.

DESIGN

9-week single-blind randomized control trial with a 12-week maintenance phase (intervention-medical groups; control-primary care provider visit).

SETTING

Academic tertiary safety-net hospital and 2 affiliated federally-qualified community health centers.

PARTICIPANTS

159 predominantly low income racially diverse adults with nonspecific chronic pain and depressive symptoms.

INTERVENTIONS

IMGV intervention- 9 weekly 2.5 hour in person IMGV sessions, 12 weeks on-line platform access followed by a final IMGV at 21 weeks.

MEASUREMENTS

Data collected at baseline, 9, and 21 weeks included primary outcomes depressive symptoms (Patient Health Questionnaire 9), pain (Brief Pain Inventory). Secondary outcomes included pain medication use and utilization.

RESULTS

There were no differences in pain or depression at any time point. At 9 weeks, the IMGV group had fewer emergency department visits (RR 0.32, 95% CI: 0.12, 0.83) compared to controls. At 21 weeks, the IMGV group reported reduction in pain medication use (Odds Ratio: 0.42, CI: 0.18-0.98) compared to controls.

LIMITATIONS

Absence of treatment assignment concealment for patients and disproportionate group attendance in IMGV.

CONCLUSION

Results demonstrate that low-income racially diverse patients will attend medical group visits that focus on non-pharmacological techniques, however, in the attention to treat analysis there was no difference in average pain levels between the intervention and the control group.

TRIAL REGISTRATION

clinicaltrials.gov NCT02262377.

Positioning the Work of Health Professions Education Scholarship Units: How Canadian Directors Harness Institutional Logics Within Institutional Orders to Convey Unit Legitimacy

PURPOSE

Health professions education scholarship unit (HPESU) leaders often struggle to articulate their impact within local contexts. Previous research has described what markers of success and institutional logics to consider when crafting statements of impact; there is a need to clarify how HPESU leaders convey their messages to navigate competing demands. This study examined how leaders argue the legitimacy of their HPESUs' activities.

METHOD

The institutional logics perspective offered a lens for understanding how legitimacy claims are constructed through larger institutional orders. Interviews with leaders from 12 Canadian HPESUs discussed their unit's work, the stakeholders that leaders sought to satisfy, and how they defined success. Data were generated in 2011-2012 and analyzed anew in 2017-2018. The authors inductively analyzed the data, using institutional logics and institutional orders as sensitizing concepts to identify the linguistic constructions harnessed by participants.

RESULTS

HPESU leaders engaged with 2 dominant logics: research and service. These aligned with institutional orders: the profession and community, respectively. While a few HPESU leaders deployed only one logic throughout the course of an interview, many engaged with more than one, compartmentalizing logics specific to different audiences and activities or blending logics to create novel ways of framing their work.

CONCLUSIONS

The institutional logics available in a context vary. What constitutes a compelling legitimacy claim is different from one institutional context to the next. The authors identify strategies that leaders used to position their HPESU for success and discuss the basis on which these claims are made.

Securing a Network for a Research-Intensive, Referral Academic Medical Center: University of Kentucky HealthCare as a Case Study

Over the last 15 years, UK HealthCare, the clinical enterprise of the University of Kentucky, has undertaken 3 clinical strategic plans to secure its position as a research-intensive, referral academic medical center. The first plan, titled Securing the Traditional Marketplace (2005-2010), focused on building advanced subspecialty programs on campus while pursuing partnerships with providers in UK HealthCare's traditional marketplace, eastern Kentucky. The second plan, Expanding the Footprint (2010-2015), recognized that UK HealthCare needed to cover a population base of 5 to 10 million people to support its subspecialty programs. These 2 strategic plans were successful and achieved 4 outcomes: a doubling of annual discharges, a dramatic increase of transfers/external referrals, a significant increase in the case mix index, and impressive growth in subspecialty programs. The third clinical strategic plan, Preparing for Change (2015-2020), has expanded UK HealthCare's gains in the face of rapidly changing reimbursement systems and delivery models. The pillars of this plan are responding to consumerism, strengthening hallmark programs through service lines, "hard wiring" relationships with partnering organizations including establishing the Kentucky Health Collaborative, and building infrastructure to deal with risk-based reimbursement. UK HealthCare is trying to spearhead a rational system of care for Kentucky rather than a system that rations care. Halfway through the third clinical strategic plan, UK HealthCare has seen increased discharges, transfers, and clinical expansion in its hallmark programs, building evidence that well-thought business practices can lead to improved public policy.

Building Social Capital to Foster Interprofessional Education: The Interprofessional Educator Academy

Interprofessional education (IPE) is promoted as a necessary precursor to the implementation of the collaborative practices in patient care thought to improve teamwork and communication among health care providers, patients, their families, and communities. Yet barriers to IPE persist, due largely to a lack of understanding on the part of health care team members about the norms and practices of health professions outside their own. A by-product of social interactions within groups and networks, social capital is a collective asset that contributes to the development of trust, innovation, and coordination of efforts toward mutual goals. Duke AHEAD (Academy for Health Professions Education and Academic Development), an interprofessional educator academy, is examined through the lens of social capital theory as a viable means of breaking down barriers to IPE, thereby improving patient care.

Association of Physician Characteristics With Perceptions and Experiences of Gender Equity in an Academic Internal Medicine Department

IMPORTANCE

The persistence of inequities that disadvantage women physicians remains empirically underexplained. Understanding the cultural factors that are associated with disparities in harassment, discrimination, remuneration, and career trajectory are critical to addressing inequities.

OBJECTIVES

To explore how physicians perceive the climate for women physicians and compare perceptions and experiences of gender inequity among physicians based on characteristics including gender, faculty status, parental status, and years in practice.

DESIGN, SETTING, AND PARTICIPANTS

This sequential, explanatory, mixed-methods qualitative study used the Culture Conducive to Women's Academic Success (CCWAS; range 45-225, with higher scores indicating better perceived culture toward women), followed by individual semistructured interviews with physicians at the Department of Medicine of the University of Calgary. All 389 physician members of the Department of Medicine, including academic and clinical physicians and those of any gender, were invited to participate in the survey and interview phases.

MAIN OUTCOMES AND MEASURES

The culture within the department for women physicians was assessed using the CCWAS score. Scores were compared between respondents' gender and years in practice. Interviews with physicians were used to further explore findings from the CCWAS and to understand experiences and perceptions of gender disparities.

RESULTS

A total of 169 of 389 physicians completed the survey (response rate, 43.4%; 102 [59.9%] women; 65 [38.9%] men; and 2 [1.2%] who did not disclose gender); 28 participants (7.2%) elected to participate in an interview (22 [78.6%] women; 6 [21.4%] men). Women physicians perceived the culture of the department toward women as significantly worse than men physicians (median [interquartile range] CCWAS score, 137.0 [118.0-155.0] vs 164.5 [154.0-183.4]; P < .001). Physicians with more than 15 years in practice perceived the culture toward women as significantly more favorable than physicians with 15 years or less in practice (median [interquartile range] CCWAS score, 157.0 [138.8-181.3] vs 147.0 [127.5-164.3]; P = .02). Qualitative data demonstrated that experiences of junior women (ie, physicians who graduated medical school after 1996, when an equal number of men and women in medical school was achieved in Canada) and perceptions of senior men (ie, those who graduated before 1996) were most different; junior women reported high rates of discrimination and harassment, while senior men perceived that the Department of Medicine had achieved gender equity.

CONCLUSIONS AND RELEVANCE

In this study, senior men physicians' perceptions of gender equity were different from lived experiences of gender inequity reported by junior women physicians. This demographic mismatch between perceptions and experiences of gender equity in medicine may explain the lack of action by leaders and decision-makers in medicine to mitigate disparities.

Establishing an investigational drugs and research residency at an academic medical center

PURPOSE

The development, structure, and implementation of an innovative residency program designed to help meet a growing need for pharmacists with specialized expertise in investigational drug use and clinical research are described.

SUMMARY

Clinical research has become an increasingly complex field, but prior to 2017 there were no U.S. specialty residency training programs focused on pharmacists' role in drug development and the care of patients enrolled in clinical trials. In 2016 Johns Hopkins Hospital (JHH) launched an initiative to develop residency training standards specific to the areas of investigational drug use and clinical research. The residency development process consisted of creation of a residency development committee; a needs assessment, including formation of a diverse panel of internal and external experts to guide identification of key competency areas and development of residency goals and objectives; design of the program's structure, including a framework for required and elective rotations; submission of an application for pre-candidate status to the ASHP Commission on Credentialing; and recruitment efforts.

CONCLUSION

The JHH investigational drugs and research residency, a combined PGY1 and PGY2 program with 5 competency areas, 14 goals, and 49 objectives, was granted pre-candidate status by ASHP in November 2016. The first resident began the program in June 2017.

Is One-Pen, One-Patient Achievable in the Hospital? A Quality Improvement Project to Reduce Risks of Inadvertent Insulin Pen Sharing at a Large Academic Medical Center

BACKGROUND

The Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and Institute for Safe Medicine Practices (ISMP) have issued warnings regarding the risk of potential transmission of blood-borne diseases if an insulin pen is used for more than one person. Many hospitals continue to use insulin pens due to their benefits of decreased risk of dosing error and improved work efficiency. Best practices for insulin pen use have been published; however, little is known about how these perform in hospitals.

METHODS

This article describes a multifaceted quality improvement project to address the safety issues of single-patient insulin pens. Major interventions included adding patient-specific bar coding on insulin pens, redesign of labels, systematic removal of discharged patients' medications, and ongoing staff education.

RESULTS

Self-reported events of insulin pen sharing events over 40 months showed a significant increase in the number of patient-days between events. The significant change occurred after implementation of patient-specific bar code scanning. There was a gradual decrease in latent errors found during medication drawer audits, and nursing compliance with patient-specific bar code scanning improved over time, reaching 90% on the last recorded month. Of 35 expert recommendations for insulin pen safety, 28 directly affected pen sharing-8 had been implemented prior to this project, and 20 had been implemented by the conclusion.

CONCLUSION

Insulin pen use is highly complex in hospital settings where multiple steps provide opportunities for error. To protect patients, all gaps need to be reviewed, and interventions that address major contributing factors are required to ensure safe insulin pen use.

Strategic Planning in Health Professions Education: Scholarship or Management?

Strategic planning, in its various forms, is an evaluation practice that is ubiquitous in academic medicine. However, published reports of strategic planning at academic health centers usually ignore theory. In a 2017 strategic planning exercise at the Wilson Centre, a scholarly model evolved using a theoretical framework and a research approach rather than a conventional management model, which typically identifies outcomes and how to achieve them. After completing this exercise, the authors considered the larger questions of the assumptions underpinning different models of strategic planning and strategic planning's value to academic medicine. To elaborate on these questions, the authors examine relevant literature and set out the Wilson Centre's emergent scholarly model. They describe the main features of the scholarly model, including ways it differs from a management approach and from the typical approach to strategic planning in the authors' experience and in the field of health professions education research. The authors also share lessons learned as a means to encourage consideration by other academic organizations.

Does Strategic Planning Matter?

In this Invited Commentary, the author examines the history, use, and effectiveness of strategic planning in higher education, academic medicine, and nonprofit settings. Strategic planning is a process by which an organization differentiates itself from its direct or emergent competition to achieve its mission. This form of planning is distinct from operational planning, in which an organization identifies the ways in which it will continuously improve. Many organizations employ a combination of strategic planning and operational planning but use the former term to describe their planning process without a clear definition or conceptual framework.The empirical literature across disciplines has not demonstrated that strategic planning leads to positive organizational outcomes. Over the modern history of academic medicine in the United States, strategic planning may have had limited impact on organizational outcomes because of favorable environmental circumstances that catalyzed growth and innovation regardless of planning efforts. In the current environment, organizational and departmental leaders need to define trade-offs between the various opportunities that they confront; allow for both planned and emergent strategy formulation; avoid platitudes and fluff; and focus on operational excellence.Theories from anthropology suggest that strategic plans may be more important for what they express than what they produce. Repetition of the themes and language of strategy in formal and informal discourse can have a decisive effect on the culture of the organization. Strategic planning, therefore, matters for its effect on organizational values, rituals, and ability to move the organization in new directions.