The continued evolution of faculty appointment and tenure policies at U.S. medical schools

The importance of organizational justice in ensuring research integrity

The professional behavior of scientists, for good or ill, is likely associated with their perceptions of whether they are treated fairly in their work environments, including their academic department and university and by relevant regulatory bodies. These relationships may also be influenced by their own personal characteristics, such as being overcommitted to their work, and by the interactions between these factors. Theory also suggests that such associations may be mediated by negative or positive affect. We examined these issues using data from a national, mail-based survey administered in 2006 and 2007 to 5,000 randomly selected faculty from biomedical and social science departments at 50 top-tier research universities in the United States. We found that perceptions of justice in one's workplace (organizational justice) are positively associated with self-report of "ideal" behaviors and negatively associated with self-report of misbehavior and misconduct. By contrast, researchers who perceive that they are being unfairly treated are less likely to report engaging in "ideal" behaviors and more likely to report misbehavior and misconduct. Overcommitment to one's work is also associated with negative affect and interacts with perceptions of unfair treatment in ways that are associated with higher self-report of misbehavior. Thus, perceptions of fair treatment in the work environment appear to play important roles in fostering-or undermining-research integrity.

Predictors of job satisfaction among academic faculty members: do instructional and clinical staff differ?

OBJECTIVES

This study aimed to identify and compare predictors of job satisfaction between instructional and clinical faculty members.

METHODS

A 61-item faculty job satisfaction survey was distributed to 1898 academic faculty members at the University of Michigan Medical School. The anonymous survey was web-based. Questions covered topics on departmental organisation, research, clinical and teaching support, compensation, mentorship, and promotion. Levels of satisfaction were contrasted between faculty members on the two tracks, and predictors of job satisfaction were identified using linear regression models.

RESULTS

Response rates for the instructional and clinical faculty groups were 43.1% and 46.7%, respectively. Clinical faculty members reported being less satisfied with how they were mentored and fewer reported understanding the process for promotion. There was no significant difference in overall job satisfaction between the two faculty groups. Surprisingly, clinical faculty members with mentors were significantly less satisfied with how they were mentored and with career advancement, and were significantly less likely to choose an academic career if they had to do it all over again compared with instructional faculty mentees. Additionally, senior-level clinical faculty members were significantly less satisfied with their opportunities to mentor junior faculty members compared with senior-level instructional faculty staff. Significant predictors of job satisfaction for both groups included areas of autonomy, meeting career expectations, work-life balance, and departmental leadership. In the clinical track only, compensation and career advancement variables also emerged as significant predictors of overall job satisfaction.

CONCLUSIONS

Greater emphasis must be placed on faculty members' well-being at both the institutional level and the level of departmental leadership. Efforts to enhance job satisfaction and improve retention are more likely to succeed if they are directed by locally designed assessments involving department chairs and are specifically aimed at fostering more effective mentoring relationships and increasing the opportunities available for career advancement activities such as research work. Our findings show that these strategies can have significant impacts on job satisfaction and the retention of clinical track faculty members.

Learning about teams by participating in teams

PURPOSE

As the work of academic health centers becomes increasingly oriented toward teams and collaboration, professional development in effective team skills becomes increasingly important. The authors sought to determine whether a transdisciplinary program for enhancing teamwork was effective in educating individual team members to translate lessons into productive outcomes of their own institutions' teams.

METHOD

Between 2006 and 2008, the authors used the Learning in Teams model of collaborative team development to design and implement two applications of a national professional development program for members of academic organizations' teams. The purpose of the program was to foster individual skill development in collaborative teamwork. Using pre/post surveys to determine changes in team functioning over the course of the program, the authors evaluated participants' perceptions of the effectiveness of their professional development programs' learning teams and of their home institutions' teams. They analyzed narrative reports of participants' institutional teams' progress for elements including team task management, member dynamics, and institutional outcomes.

RESULTS

Pre/post self-assessments of team performance and participants' progress reports on their home teams revealed enhancement of team skills, including clarifying team charge, exploring team purpose, and evaluating team process. Program participants improved their team skills and enhanced productivity of their institutions' teams.

CONCLUSIONS

The Learning in Teams model can support individual team skills development, enhance institutional team performance in academic health centers, and provide a basis for research in team skills development and team process improvement. It can be adapted to various programs to enhance skills in teamwork.

How, when, and why do physicians choose careers in academic medicine? A literature review

PURPOSE

Medicine has different pathways in which physicians pursue their vocation. Clinical practice, research, and academia are common paths. The authors examined the literature to identify research-based factors influencing physicians to choose a career path in academic medicine.

METHOD

In the fall of 2006, the authors searched the PubMed database from 1960 to 2006 using the term career academic medicine. Review of articles resulted in the identification of nine themes relating to academic medicine career paths. The authors summarized the important and relevant articles to capture what the literature contributed as a whole to the larger question, "How, when, and why do physicians choose an academic career in medicine?"

RESULTS

A synthesis of articles revealed that (1) values are essential to understanding the decision to enter a career in academic medicine, (2) factors associated with academic medicine career choice include research-oriented programs, gender, and mentors and role models, (3) an obstacle to pursuing this career path is loss of interest in academic careers during residency as residents learn about factors associated with academic careers in medicine, and (4) debt may be a barrier to choosing an academic career in medicine for some individuals in some specialties.

CONCLUSIONS

Despite the study findings, the larger question (stated above) remains essentially unanswered in the literature. The authors propose a call to action by various professional groups and organizations to use rigorous and complex research efforts to seek answers to this very important question.

The full-time clinical faculty: what goes around, comes around

In his 1910 report entitled Medical Education in the United States and Canada, Abraham Flexner advanced an ideal model of medical education that included a university-based, full-time, salaried faculty whose time was devoted to teaching and research. This article traces the evolution of the "full-time" concept for clinical faculty and describes factors that have affected its implementation. Between 1910 and the 1930s, the full-time system for clinical faculty was implemented at a limited number of medical schools, but lack of financing made the system generally unworkable. The implementation of the "geographic" full-time concept during the 1940s to 1960s allowed faculty to be considered full-time while earning much of their income from clinical practice. Even then, there were concerns that medical schools would bring pressure on such faculty to increase their clinical activity for the purpose of supporting the institution. After the rise of private and public payers, clinical practice income came to be an explicit and increasingly important source of medical school revenue. This stimulated a significant expansion in the number of full-time clinical faculty over the next 40 years. In the 100 years following the Flexner Report, clinical faculty became "full-time" and "salaried," but not in the way Flexner imagined. Instead of deriving their salaries from the resources of the medical school, they are significantly contributing to institutional financing through their practice. Flexner's concern about the "distraction" of clinical practice interfering with faculty participation in education has come full circle, remaining a primary issue in medical education today.

The prevalence and practice of academies of medical educators: a survey of U.S. medical schools

PURPOSE

Academies of medical educators can be defined as formal organizations of academic teaching faculty recognized for excellence in their contributions to their school's education mission and who, as a group, serve specific needs of the institution. The authors studied the characteristics of academies, including the processes for admission, selection, and retention of academy members; the types of faculty who are academy members; program goals; benefits offered by academies to the individual and to the institution; funding sources and amounts; and the rapid increase in academies since 2003.

METHOD

In 2008, the authors sent an online questionnaire to 127 U.S. medical schools. Responses were analyzed using descriptive statistics. To determine differences between groups, multivariate analysis of variance was performed. Correlation analysis (Pearson r) was used to identify association between variables. Effect size was determined using eta squared (eta2).

RESULTS

Thirty-six of the 122 responding schools (96% response rate) reported having academies; 21 schools had initiated academies since 2003, and 33 schools were planning or considering academies. There was a statistically significant difference between academies established before 2004 and in 2004 regarding benefits offered to individuals, membership terms and maintenance requirements, and goals.

CONCLUSIONS

Rogers' theory of the diffusion of innovation may explain the recent spread of academies. When beginning or reexamining existing academy programs, institutions should consider goals, application process, benefits offered to members as well as the institution, expendable resources, and means of support, because the final product depends on the choices made at the beginning.

Institutions' expectations for researchers' self-funding, federal grant holding, and private industry involvement: manifold drivers of self-interest and researcher behavior

BACKGROUND

Private industry involvement is viewed as tainting research with self-interest, whereas public funding is generally well regarded. Yet, dependence on "soft money" also triggers researcher and university self-interest. No empirical research has compared these factors' effects on academic researchers' behaviors.

METHOD

In 2006-2007, a survey was mailed to 5,000 randomly selected biomedical and social science faculty at 50 top-tier research universities in the United States. Measures included a university's expectations or nonexpectations that researchers obtain external grant funding, the receipt or nonreceipt of public research funding, any relationships with private industry, and research-related behaviors ranging from the ideal, to the questionable, to misconduct.

RESULTS

Being expected to obtain external funding and receiving federal research funding were both associated with significantly higher reports of 1 or more of 10 serious misbehaviors (P<.05) and neglectful or careless behaviors (P<.001). Researchers with federal funding were more likely than were those without to report having carelessly or inappropriately reviewed papers or proposals (9.6% versus 3.9%; P<.001). Those with private industry involvement were more likely than were those without to report 1 or more of 10 serious misbehaviors (28.5% versus 21.5%; P=.005) and to have engaged in misconduct (12.2% versus 7.1%; P=.004); they also were less likely to have always reported financial conflicts (96.0% versus 98.6%, P<.001).

CONCLUSIONS

The free play of university and individual self-interests, combined with and contributing to the intense competition for research funding, may be undermining scientific integrity.

The road less traveled: combining an MD and PhD to establish a research program in biomedicine

Developing an academic career in fields closely related to medicine is challenging. In this paper, various aspects of establishing, growing, and maintaining a viable program are discussed, with the examples from personal experience. The importance of understanding funding resources, the funding environment, institutional resources, and mentorship will be emphasized.

Medical school deans' perceptions of organizational climate: useful indicators for advancement of women faculty and evaluation of a leadership program's impact

PURPOSE AND METHOD

The authors surveyed U.S. and Canadian medical school deans regarding organizational climate for faculty, policies affecting faculty, processes deans use for developing faculty leadership, and the impact of the Executive Leadership in Academic Medicine (ELAM) Program for Women.

RESULTS

The usable response rate was 58% (n = 83/142). Deans perceived gender equity in organizational climate as neutral, improving, or attained on most items and deficient on four. Only three family-friendly policies/benefits were available at more than 68% of medical schools; several policies specifically designed to increase gender equity were available at fewer than 14%. Women deans reported significantly more frequent use than men (P = .032) of practices used to develop faculty leadership. Deans' impressions regarding the impact of ELAM alumnae on their schools was positive (M = 5.62 out of 7), with those having more fellows reporting greater benefit (P = .01). The deans felt the ELAM program had a very positive influence on its alumnae (M = 6.27) and increased their eligibility for promotion (M = 5.7).

CONCLUSIONS

This study provides a unique window into the perceptions of medical school deans, important policy leaders at their institutions. Their opinion adds to previous studies of organizational climate focused on faculty perceptions. Deans perceive the organizational climate for women to be improving, but they believe that certain interventions are still needed. Women deans seem more proactive in their use of practices to develop leadership. Finally, deans provide an important third-party judgment for program evaluation of the ELAM leadership intervention, reporting a positive impact on its alumnae and their schools.

Evaluating the performance of medical educators: a novel analysis tool to demonstrate the quality and impact of educational activities

PURPOSE

Traditional promotion standards rely heavily on quantification of research grants and publications in the curriculum vitae. The promotion and retention of educators is challenged by the lack of accepted standards to evaluate the depth, breadth, quality, and impact of educational activities. The authors sought to develop a practical analysis tool for the evaluation of educator portfolios (EPs), based on measurable outcomes that allow reproducible analysis of the quality and impact of educational activities.

METHOD

The authors, 10 veteran educators and an external expert evaluator, used a scholarly, iterative consensus-building process to develop the tool and test it using real EPs from educational scholars who followed an EP template. They revised the template in parallel with the analysis tool to ensure that EP data enabled valid and reliable evaluation. The authors created the EP template and analysis tool for scholar and program evaluation in the Educational Scholars Program, a three-year national certification program of the Academic Pediatric Association.

RESULTS

The analysis tool combines 18 quantitative and 25 qualitative items, with specifications, for objective evaluation of educational activities and scholarship.

CONCLUSIONS

The authors offer this comprehensive, yet practical tool as a method to enhance opportunities for faculty promotions and advancement, based on well-defined and documented educational outcome measures. It is relevant for clinical educators across disciplines and across institutions. Future studies will test the interrater reliability of the tool, using data from EPs written using the revised template.