Faculty Vitality-Surviving the Challenges Facing Academic Health Centers: A National Survey of Medical Faculty

Leaders' Perspectives on Approaches and Challenges in Enacting Faculty Vitality in the Contemporary Landscape of Academic Medicine: A Deductive Thematic Analysis

Continual changes in organizational structures within medical schools have contributed to the expanded scope and the centralization of faculty affairs offices, which support faculty administration and supportive functions. Using qualitative interviews, we investigated the perspectives of academic medicine faculty affairs leaders regarding their offices' priorities in sustaining faculty vitality in the face of current and anticipated challenges. A semi-structured interview protocol based on the researchers' practical knowledge, informed by the study's research inquiries, and pertinent academic literature guided the interviews. Deductive thematic analysis approach was used to identify the patterns and themes across the interviews. Our analysis revealed a central theme: the pivotal nature of the leader's role in strengthening faculty identity. Additionally, three sub-themes emerged concerning the leader's role in nurturing faculty well-being within today's academic medicine context: redefining faculty role, acknowledging and appreciating faculty contributions, and maintaining faculty engagement through a whole-person approach. Faculty affairs leaders describe widening roles with an emerging focus on a whole-person approach valuing the diverse contributions of faculty across the academic mission, supporting professional development, reflecting the individual motivations of faculty, and championing institutional processes that holistically evaluate and recognize faculty contributions.

Group peer mentoring to improve faculty connections and enhance mentoring networks

BACKGROUND

Difficulty finding mentors and forging connections in academic departments can be challenging and became even more so when the COVID-19 pandemic reduced opportunities for informal networking. Even as restrictions on in-person meetings eased, many faculty preferred meetings to remain virtual. Because some of the most powerful predictors of faculty vitality are positive professional relationships and feelings of inclusion and belonging to an institution, attending to faculty needs in this area is important to mitigate undesired lingering consequences.

APPROACH

We created structured peer mentoring groups for our department's physicians and psychologists that meet virtually. Groups span career stages, academic appointments and clinical interests. The purpose was to establish a deeper culture of mentoring, increase feelings of connection to a supportive community within the department, facilitate career planning and enhance the development of skills necessary in academic medicine such as teaching skills, scholarly productivity and personal wellness.

EVALUATION

A survey conducted after the first year of the programme was completed by 70% of eligible faculty (31/45). Ninety-six percent felt the programme had created an inclusive and appreciative culture, 86% met faculty members they had never met before and 79% sought mentoring advice from a colleague they would not usually have interacted with in that manner. All participants appreciated hearing their colleagues' perspectives on topics they do not typically discuss.

IMPLICATIONS

Departmentally based group peer mentoring that spans career stages and interests can facilitate faculty connections and enhance a supportive culture of mentorship.

Psychological safety and perceived organizational support in emergency medicine residencies

Background

The clinical learning environment (CLE) is a key focus of the Accreditation Council of Graduate Medical Education. It impacts knowledge acquisition and professional development. A previous single-center study evaluated the psychological safety and perceived organizational support of the CLE across different specialties. Building on this work, we explored and evaluated psychological safety and perceived organizational support across multiple heterogeneous emergency medicine (EM) residencies to identify trends and factors affecting perceptions of the CLE.

Methods

Using the Psychological Safety Scale (PSS) and Survey of Perceived Organizational Support (SPOS), residents from seven U.S. EM residencies were surveyed using REDCap software from September through November 2021, with 300 potential respondents. As an adjunct to these surveys, three open-ended questions were included regarding features of their learning environments.

Results

A total of 137 out of 300 residents completed the survey. The overall response rate was 45.7%. There was a variable response rate across programs (26.0%-96.7%). Pooled results demonstrate an overall positive perception of CLEs, based on positive mean responses (i.e., "Members of my department are able to bring up problems and tough issue" had a mean of 4.2 on a 5-point Likert scale). Open responses identified teaching, collegiality, and support from program leadership as supportive features of the CLE. Confrontational interdisciplinary communication, a sense of being devalued, and off-service rotations were identified as threats or areas for improvement to the CLE.

Conclusions

PSS and SPOS scores were generally positive in this multi-institution study, consistent with the prior single-institution study indicating that EM is often considered psychologically safe and supportive. EM training programs can consider using the PSS/SPOS to audit their own programs to identify areas for improvement and foster supportive features already in place.

Group peer mentoring is effective for different demographic groups of biomedical research faculty: A controlled trial

INTRODUCTION

Improved mentoring of midcareer researchers in medical schools has been identified as an important potential avenue for addressing low vitality and high burnout rates in faculty, and the scarcity of both underrepresented minority (URM) faculty and women in biomedical research. To address the need for widescale effective mentoring, we sought to determine whether a group peer mentoring intervention (C-Change Mentoring and Leadership Institute) for early midcareer research faculty was effective for different demographic groups in a controlled trial.

METHODS AND MATERIALS

Thirty-five diverse early midcareer faculty and 70 propensity-matched (PM) control subjects matched to intervention subjects on a) study inclusion criteria; b) gender, race, and ethnicity, degree, rank, years of experience, publications, grants; and c) pretest survey outcome variables, participated in the intervention. The C-Change Participant Survey assessed vitality, self-efficacy in career advancement, research success, mentoring others, valuing diversity, cognitive empathy, and anti-sexism/anti-racism skills at pretest and intervention completion. Analysis using multiple regression models included outcome pretest values and indicator variables for intervention, gender, URM status, and MD vs. PhD. Hypotheses regarding differential effectiveness of the intervention by demographic group were tested by including cross-product terms between the demographic indicator variables and the intervention indicator. Missing data were addressed using chained equations to create 100 data sets.

RESULTS AND DISCUSSION

The intervention participants had significantly higher (favorable) scores than PM controls for: self-assessed change in vitality; self-efficacy for career advancement, research, and mentoring others; cognitive empathy; and anti-sexism/racism skills. The benefits of the intervention were nearly identical across: gender, URM vs non-URM faculty, and degree MD/PhD, except vitality significantly increased for non-URM subjects, and not for URM faculty. Self-assessed change in vitality increased for URM and non-URM.

CONCLUSION

The intervention worked successfully for enhancing vitality, self-efficacy and cross-cultural engagement across different demographic groups of biomedical research faculty.

Randomized controlled trial of a group peer mentoring model for U.S. academic medicine research faculty

Introduction

Midcareer is a critical transition point for biomedical research faculty and a common dropout point from an NIH-funded career. We report a study to assess the efficacy of a group peer mentoring program for diverse biomedical researchers in academic medicine, seeking to improve vitality, career advancement, and cross-cultural competence.

Methods

We conducted a stratified randomized controlled trial with a waitlist control group involving 40 purposefully diverse early midcareer research faculty from 16 states who had a first-time NIH R01 (or equivalent) award, a K training grant, or a similar major grant. The yearlong intervention (2 to 3 days quarterly) consisted of facilitated, structured, group peer mentoring. Main study aims were to enhance faculty vitality, self-efficacy in achieving research success, career advancement, mentoring others, and cultural awareness and appreciation of diversity in the workplace.

Results

Compared to the control group, the intervention group's increased vitality did not reach statistical significance (P = 0.20), but perceived change in vitality was 1.47 standard deviations higher (D = 1.47, P = 0.03). Self-efficacy for career advancement was higher in the intervention group (D = 0.41, P = 0.05) as was self-efficacy for research (D = 0.57, P = 0.02). The intervention group also valued diversity higher (D = 0.46, P = 0.02), had higher cognitive empathy (D = 0.85, P = 0.03), higher anti-sexism/racism skills (D = 0.71, P = 0.01), and higher self-efficacy in mentoring others (D = 1.14, P = 0.007).

Conclusions

The mentoring intervention resulted in meaningful change in important dimensions and skills among a national sample of diverse early midcareer biomedical faculty. This mentoring program holds promise for addressing the urgencies of sustaining faculty vitality and cross-cultural competence.

Are researchers in academic medicine flourishing? A survey of midcareer Ph.D. and physician investigators

Introduction

Midcareer research faculty are a vital part of the advancement of science in U.S. medical schools, but there are troubling trends in recruitment, retention, and burnout rates.

Methods

The primary sampling frame for this online survey was recipients of a single R01 or equivalent and/or K-award from 2013 to 2019. Inclusion criteria were 3-14 years at a U.S. medical school and rank of associate professor or two or more years as assistant professor. Forty physician investigators and Ph.D. scientists volunteered for a faculty development program, and 106 were propensity-matched controls. Survey items covered self-efficacy in career, research, work-life; vitality/burnout; relationships, inclusion, trust; diversity; and intention to leave academic medicine.

Results

The majority (52%) reported receiving poor mentoring; 40% experienced high burnout and 41% low vitality, which, in turn, predicted leaving intention (P < 0.0005). Women were more likely to report high burnout (P = 0.01) and low self-efficacy managing work and personal life (P = 0.01) and to be seriously considering leaving academic medicine than men (P = 0.003). Mentoring quality (P < 0.0005) and poor relationships, inclusion, and trust (P < 0.0005) predicted leaving intention. Non-underrepresented men were very likely to report low identity self-awareness (65%) and valuing differences (24%) versus underrepresented men (25% and 0%; P < 0.0005). Ph.D.s had lower career advancement self-efficacy than M.D.s (P < .0005).

Conclusions

Midcareer Ph.D. and physician investigators faced significant career challenges. Experiences diverged by underrepresentation, gender, and degree. Poor quality mentoring was an issue for most. Effective mentoring could address the concerns of this vital component of the biomedical workforce.

A Review on the Use of the Educational Value Unit (EVU) among Teaching Hospitals

(1) Background: In recent years, medical institutions across the U.S. have implemented a points system based on the Educational Value Unit (EVU) to assess and reward faculty for their educational efforts. The purpose of this narrative review is to summarize the current literature on EVU systems and to evaluate their utility in the U.S. healthcare system. (2) Methods: We searched the Ovid MEDLINE, Embase, Web of Science, and PubMed databases to identify literature describing the inception of EVU systems and current systems implemented by U.S. academic medical centers and medical schools. In total, a combined 48 studies and abstracts pertaining to EVU systems were reviewed, and a combined 26 published studies and abstracts from 1999 to 2022 pertaining to EVU systems were included. (3) Results: To our knowledge, at least 40 U.S. academic medical centers have used an educational metrics system, of which 21 institutions have published studies describing EVU systems in one or more of their medical departments. The outcomes associated with these self-described EVU systems are the focus of this study. EVU systems increase the number of faculty who meet baseline educational requirements, promote educational productivity, redistribute educational burden and funding among faculty members, and shift physician priorities towards education. The monetary reward associated with EVU systems is unlikely to be a significant factor contributing to these changes; instead, intrinsic motivation and a sense of academic responsibility play a larger role. (4) Conclusions: EVU systems are an effective way to evaluate and reward individual and departmental educational efforts in U.S. academic medical centers and medical schools. The adoption of EVUs will likely become more commonplace as U.S. academic medical centers and medical schools place additional emphasis on medical education.

Physician Health and Wellness

Physician health and wellness is a complex topic relevant to all pediatricians. Survey studies have established that pediatricians experience burnout at comparable rates to colleagues across medical specialties. Prevalence of burnout increased for all pediatric disciplines from 2011 to 2014. During that time, general pediatricians experienced a more than 10% increase in burnout, from 35.3% to 46.3%. Pediatric medical subspecialists and pediatric surgical specialists experienced slightly higher baseline rates of burnout in 2011 and similarly increased to just under 50%. Women currently constitute a majority of pediatricians, and surveys report a 20% to 60% higher prevalence of burnout in women physicians compared with their male counterparts. The purpose of this report is to update the reader and explore approaches to pediatrician well-being and reduction of occupational burnout risk throughout the stages of training and practice. Topics covered include burnout prevalence and diagnosis; overview of national progress in physician wellness; update on physician wellness initiatives at the American Academy of Pediatrics; an update on pediatric-specific burnout and well-being; recognized drivers of burnout (organizational and individual); a review of the intersection of race, ethnicity, gender, and burnout; protective factors; and components of wellness (organizational and individual). The development of this clinical report has inevitably been shaped by the social, cultural, public health, and economic factors currently affecting our communities. The coronavirus disease 2019 (COVID-19) pandemic has layered new and significant stressors onto medical practice with physical, mental, and logistical challenges and effects that cannot be ignored.

Supporting Midcareer Women Faculty in Academic Medicine Through Mentorship and Sponsorship

Midcareer women faculty face unique career challenges that may benefit from mentorship and sponsorship, yet such programs focused on the needs of this career phase are scarce in academic medicine. Many midcareer faculty require intentional and individual career planning to choose a path from the broad array of options in academic medicine. Ambiguous promotion criteria, increased workloads because of service or citizenship tasks, and a lack of sponsorship are among the barriers that inhibit midcareer faculty's growth into the high-visibility roles needed for career advancement. In addition, issues faced by women midcareer faculty members may be further exacerbated by barriers such as biases, a disproportionate share of family responsibilities, and inequities in recognition and sponsorship. These barriers contribute to slower career growth and higher attrition among women midcareer faculty and ultimately an underrepresentation of women among senior leadership in academic medicine. Here, we describe how a mentoring program involving individuals (eg, mentors, mentees, and sponsors) and departments/institutions (eg, deans and career development offices) can be used to support midcareer faculty. We also provide recommendations for building a mentoring program with complementary support from sponsors targeted toward the specific needs of women midcareer faculty. A robust midcareer mentoring program can support the career growth and engagement of individual faculty members and as a result improve the diversity of academic medicine's highest ranks.

Value, Support, and Advancement: An Organization's Role in Faculty Career Intentions in Academic Medicine

Purpose

Faculty engagement in academic medical centers is essential to advancing efficient healthcare delivery, research productivity, and organizational quality. The authors used turnover theory to empirically examine factors that influence faculty engagement, including both aspirational and attrition-related career intentions.

Methods

Using a convergent, mixed methods design, the authors surveyed 284 faculty at a large Midwestern public university's school of medicine in Fall 2015, Fall 2016, and Spring 2017. The study's questionnaire included a series of scales which informed three outcome variables (promotion aspirations, leadership aspirations, and intent to leave the organization) and four groups (role strain, work-family conflict, organizational commitment and support, and departmental commitment and support) of predictor variables, all of which have been previously validated with medical faculty populations. The scales were followed by open-ended questions which allowed respondents to further elaborate on their experiences in their organization related to each outcome variable. The authors used a hierarchical multiple regression model to assess the effect of each of the four groups of predictor variables on the outcome variables and then employed an iterative thematic analysis of open-ended responses to further elucidate faculty's reported experiences.

Results

Organizational commitment and support were significantly associated with faculty's promotion aspirations, leadership aspirations, and intentions to leave the organization. Thematic analysis of participant responses to open-ended questions further revealed the specific career development support faculty desired, mainly, streamlined and transparent promotion and leadership processes; clear guidance to maneuver these processes; holistic professional development opportunities; feeling valued; and supports for clinical and administrative tasks.

Conclusion

Advancing organizational policy that supports infrastructure for evidence-based interventions and programming for the intentional career development of faculty is an important aspect of a proactive talent development and retention model in academic medical centers.

High Psychosocial Work Demands, Decreased Well-Being, and Perceived Well-Being Needs Within Veterinary Academia During the COVID-19 Pandemic

Higher psychosocial work demands in veterinary and academic professions are associated with decreased occupational, physical, and mental well-being. COVID-19 introduced far-reaching challenges that may have increased the psychosocial work demands for these populations, thereby impacting individual- and institutional-level well-being. Our objective was to investigate the psychosocial work demands, health and well-being, and perceived needs of faculty, staff, residents and interns at the Ontario Veterinary College, in Ontario, Canada, during COVID-19. A total of 157 respondents completed a questionnaire between November 2020 and January 2021, that included the Third Version of the Copenhagen Psychosocial Questionnaire (COPSOQ-III) and open-text questions on perceived needs for well-being. Results showed that COPSOQ-III dimensions of quantitative demands, recognition, sense of community, burnout, stress, and depressive symptoms, were significantly worse in our study population than the Canadian norm. Quantitative and emotional demands, health and well-being (including depressive symptoms, stress, cognitive stress, somatic stress, and burnout), and work-life conflict were also reported to have worsened since the COVID-19 restrictions for most respondents. Females and caregivers had higher odds of experiencing increased work demands, and decreased health and well-being, compared to males and non-caregivers. However, male caregivers experienced worsened supervisor relations, compared to female caregivers. Social capital also worsened for clinical and part-time employees, compared to full-time and non-clinical employees. Respondents identified increased workload support, community-building, recognition of employees' capacities and personal needs, flexible work schedules, and consistent communication, as strategies to increase well-being during COVID-19 and generally. Overall, our findings suggest that COVID-19 has increased occupational demands, work-life conflicts, and decreased well-being in veterinary academia. Institutional-level interventions are discussed and recommended to aid individual and institutional well-being.

Midcareer Medical School Research Faculty Perspectives on Vitality and Professionalism During the COVID-19 Pandemic

Importance

As medical faculty have central roles during the COVID-19 pandemic, it is important to study the pandemic's association with the vitality and careers of medical school faculty.

Objective

To examine how the COVID-19 pandemic affected midcareer research faculty in academic medicine.

Design, Setting, and Participants

This qualitative study included medical school faculty who participated in the C-Change Mentoring and Leadership Institute. All US medical school faculty recipients of recent National Institutes of Health (NIH) RO1, RO1-equivalent, and K awards were invited to apply to the institute. The 99 applicants who met inclusion criteria were stratified by degree (MD or MD/PhD vs PhD), gender, and race/ethnicity. Enrollment was offered to applicants randomly selected for 40 spots, demographically balanced by sex, underrepresented in medicine minority (URMM) status, and degree. In April 2020, an inquiry was emailed to faculty enrolled in the institute requesting responses to questions about meaning in work, career choice, and values. A qualitative analysis of narrative data responses, using grounded theory, was undertaken to determine key themes. This study is part of a NIH-funded randomized trial to test the efficacy of a group peer mentoring course for midcareer faculty and study the course's mechanisms of action.

Main Outcomes and Measures

Key themes in data.

Results

Of 40 enrolled participants, 39 responded to the inquiry, for a response rate of 97%. The analytic sample included 39 faculty members; 19 (47%) were women, 20 (53%) identified as URMM, and 20 (53%) had an MD or MD with PhD vs 19 (47%) with PhD degrees. Key themes in the data that emerged describing faculty lived experience of the pandemic included increased meaningfulness of work; professionalism and moral responsibility; enhanced relationships with colleagues; reassertion of career choice; disrupted research; impact on clinical work; attention to health disparities, social justice and advocacy; increased family responsibilities; psychological stress; and focus on leadership.

Conclusions and Relevance

During the pandemic, diverse PhD and physician investigators reported increased meaningfulness in work and professionalism and enhanced relationships, all intrinsic motivators associated with vitality. Working during the pandemic appears to have produced intrinsic rewards positively associated with vitality, in addition to adverse mental health effects. These findings have implications for combatting burnout and retaining investigators in the future.

Adapting Teaching to the Clinical Setting

Adapting teaching to the clinical setting is most successful when the teacher and trainee are able to work alongside of each other allowing the cognitive apprenticeship model to be embraced. Six tools of experiential learning as components of this framework are described including scaffolding, modeling, coaching/supervision, articulation, reflection, and exploration. These tools provide useful guidance for supervisors to teach in clinical settings. Inherent in this process is the concept of validation of the trainees and includes the importance of supervisors cultivating nonjudgmental acceptance of themselves. Optimal teaching and learning in the clinical environment requires investment of time and resources.

The "Medical Education Roadshow:" Delivering Faculty Development to Busy Clinician Educators When They Least Expect It

INTRODUCTION

Designing impactful faculty development for busy clinicians is challenging. Many may not recognize their impact on the learning environment or prioritize their development as educators. Our objective was to evaluate the feasibility and acceptability of a faculty development approach, the "Medical Education Roadshow," which delivered succinct, actionable faculty development at regularly scheduled, departmental clinical business meetings.

METHODS

Between October 2018 and October 2019, we conducted six 15-minute "roadshows" for the Obstetrics and Gynecology faculty at one academic medical center. Each roadshow addressed a foundational education topic in an interactive manner with an emphasis on one take-away skill in teaching behavior. We utilized a simple, anonymous evaluation tool to obtain participant feedback and analyzed quantitative data descriptively and qualitative data thematically.

RESULTS

A total of 174 of 265 evaluations were returned (65.6% response rate). Participants indicated that the roadshows helped them think about teaching more effectively and offered one or more practical daily practice tips. Qualitative findings coalesced into two themes. First, participants identified multiple intended practice changes, including using more effective teaching strategies, being more deliberate about feedback, and modeling exemplary professional behavior. Second, participants recommended multiple improvement opportunities and future topics.

DISCUSSION

Busy clinical faculty were highly receptive to opportunities to improve as educators through the "roadshow" approach.

Racial/Ethnic Differences in Burnout: a Systematic Review

BACKGROUND

Awareness of burnout and its implications within the medical field has been growing. However, an understanding of the prevalence and consequences of burnout among underrepresented minority (URM), specifically underrepresented minority in medicine (UiM) populations, is not readily available.

OBJECTIVE

To examine literature investigating burnout among UiM compared to non-UiM, with particular attention to which measures of burnout are currently being used for which racial/ethnic groups.

METHODS

The authors identified peer-reviewed articles, published in English through systematic examination using PubMed, PsycINFO, Countway Discovery Medicine, and Web of Science databases. Studies meeting the inclusion criteria were summarized and study quality was assessed.

RESULTS

Sixteen studies assessing racial/ethnic differences in burnout were eligible for inclusion. Nearly all studies were cross-sectional (n = 15) in design and conducted among populations in North America (n = 15). Most studies examined burnout among medical students or physicians and used the Maslach Burnout Inventory. Differences in burnout among UiM and non-UiM are inconclusive, although several studies have nuanced findings.

CONCLUSION

Increased focus on burnout measurement, conceptualization, and mitigation among UiM populations may be useful in improving recruitment, retention, and thriving.

How Full Is Your Tank? A Qualitative Exploration of Faculty Volunteerism in a National Professional Development Program

OBJECTIVE

Professional development programs (PDPs) within academic professional organizations rely on faculty volunteers, but little is known about the volunteering process and experience. Our aim was to gain insights into the initial decision to volunteer, the experience of volunteering and the decision to re-volunteer or not (ie, remain or leave as a volunteer). The study setting was a PDP of the Academic Pediatric Association, the Educational Scholars Program.

METHODS

In 2014, 13 Educational Scholars Program faculty members participated in semistructured phone interviews. The authors performed a general inductive analysis of the data, inductively created codes, and analyzed coded data for emergent themes that led to the creation of a model for recruiting and sustaining volunteers.

RESULTS

Four themes related to the initial volunteer decision and the decision to re-volunteer or not (self-interest and altruism, reputation of the program, relevant skill set, and doability), and 4 themes related to the experience of volunteering (emotional impact, career advancement and professional recognition, professional growth, and doability) emerged. The relationship among the themes led to the creation of a model of volunteering, involving a metaphorical volunteerism "tank" that is full when faculty initially volunteer and subsequently fills or empties as a result of dynamic interplay between the themes for each individual.

CONCLUSIONS

Leaders of PDPs may find our model of volunteering beneficial for enhancing the emotional and tangible benefits and minimizing the logistical issues of volunteering. This information should contribute to success in recruiting and retaining the volunteers who are essential for developing and sustaining PDPs.

The American Society for Clinical Pathology's Job Satisfaction, Well-Being, and Burnout Survey of Laboratory Professionals

OBJECTIVES

To examine job satisfaction, well-being, job stress, and burnout among laboratory professionals.

METHODS

The study utilized a cross-sectional survey design. The survey was administered online via the American Society for Clinical Pathology's survey tool, to elicit information about job satisfaction, well-being, job stress, and burnout among medical laboratory professionals.

RESULTS

Although this survey shows high job satisfaction among respondents, overall job-related stress is high and burnout is prevalent. The majority of the respondents rated their work-life balance as "fair." The main contributing factors to job stress, burnout, and work-life balance are quantity of workload and understaffing.

CONCLUSIONS

Based on the results of this survey, creating targeted interventions may help improve the quality of well-being programs for laboratory professionals. A comprehensive wellness program developed at the institutional, local, and national levels may improve morale and alleviate the recruitment and retention challenges faced by medical laboratory professionals.

Us, Too. Sexual Harassment Within Academic Medicine in the United States

PURPOSE

We report on the extent of sexual harassment among residents and examine its relationship to specialty and program year and effects.

METHODS

Using the C-Change Resident Survey, we surveyed residents in 34 internal medicine, pediatrics, and general surgery programs in 14 academic medical centers (AMCs). A total of 1708 residents completed the survey (70% response-rate); 51% (n = 879) were women. Respondents reported unwanted sexual comments, attention, or advances by a superior or colleagues within the last 2 years. Measures of vitality and ethical or moral distress were included in the surveys.

RESULTS

Rates of sexual harassment reported by women differed across the 34 programs, with an interquartile range of 0%-11%. Residents in pediatrics had the lowest frequencies of sexual harassment (mean 2%, 95% confidence interval [CI] 0%, 4%). Residents in internal medicine had higher rates of sexual harassment (mean 7%, 95% CI 1%, 25%). Residents in surgery had the highest rates (mean 12%, 95% CI 2%, 33%). Sexual harassment was associated with lower levels of vitality and higher ethical or moral distress (both, P <0.05).

CONCLUSIONS

Sexual harassment is more common for women residents in Internal Medicine and Surgery programs. The adverse effects of sexual harassment on female residents detracts from an institution's professional workforce.

Women's leadership in academic medicine: a systematic review of extent, condition and interventions

OBJECTIVES

Because culture reflects leadership, the making of diverse and inclusive medical schools begins with diversity among leaders. The inclusion of women leaders remains elusive, warranting a systematic exploration of scholarship in this area. We ask: (1) What is the extent of women's leadership in academic medicine? (2) What factors influence women's leadership? (3) What is the impact of leadership development programmes?

DESIGN

Systematic review.

DATA SOURCES

A systematic search of six online databases (OvidMEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library and ERIC) from the earliest date available to April 2018 was conducted. Bridging searches were conducted from April 2018 until October 2019. ELIGIBILITY CRITERIA: (1) Peer-reviewed; (2) English; (3) Quantitative studies (prospective and retrospective cohort, cross-sectional and preintervention/postintervention); evaluating (4) The extent of women's leadership at departmental, college and graduate programme levels; (5) Factors influencing women's leadership; (6) Leadership development programmes. Quantitative studies that explored women's leadership in journal editorial boards and professional societies and qualitative study designs were excluded.

DATA EXTRACTION AND SYNTHESIS

Two reviewers screened retrieved data of abstracts and full-texts for eligibility, assessment and extracted study-level data independently. The included studies were objectively appraised using the Medical Education Research Quality Study Instrument with an inter-rater reliability of (κ=0.93).

RESULTS

Of 4024 records retrieved, 40 studies met the inclusion criteria. The extent of women's leadership was determined through gender distribution of leadership positions. Women's leadership emergence was hindered by institutional requirements such as research productivity and educational credentials, while women's enactment of leadership was hindered by lack of policy implementation. Leadership development programmes had a positive influence on women's individual enactment of leadership and on medical schools' cultures.

CONCLUSIONS

Scholarship on women's leadership inadvertently produced institute-centric rather than women-centric research. More robust contextualised scholarship is needed to provide practical-recommendations; drawing on existing conceptual frameworks and using more rigorous research methods.

Knowing Your Personal Brand: What Academics Can Learn From Marketing 101

Academic departments are increasingly borrowing from the business world as they encourage faculty members to consider their personal mission, vision, and values statements in crafting their plans for engagement and advancement. Business organizations have long known that although doing the work necessary to refine these internal guideposts is important, failing to understand what consumers actually perceive about their product is detrimental. In the business world, perception is reality, and understanding the external shorthand of what consumers perceive-that is, the brand-is essential. Academic clinicians have a brand whether they take ownership of it or not. A faculty member's brand is both what their work (academic products) and how they do their work say about them to those who encounter it. In this Perspective, the authors explore the brand framework informed by marketing literature, and they outline a four-step process for faculty members to identify their own personal brands. The authors share how knowing one's academic brand can (1) help faculty members approach projects and other responsibilities through the lens of building or detracting from that brand, (2) provide a framework for determining how faculty members might best work within their institutions, and (3) help faculty members better understand and advocate their own engagement and advancement. The authors also share a paradigm for finding one's brand sweet spot at the intersection of passion, skill, and institutional need, and they propose how working outside of this sweet spot is a setup for failure.

Attending Physicians' Perspectives of Resident Academic Half Day

Phenomenon: Academic health centers face significant challenges trying to improve medical education while meeting patient care needs. In response to problems with traditional forms of didactic education, many residency programs have transitioned to Academic Half Day (AHD), a curricular model in which learning is condensed into half-day blocks. In this model, trainees have protected educational time free from clinical responsibilities. However, an understanding of the impact on attending physicians and patient care when residents depart clinical sites for learning activities has not been well described. We sought to explore attending physicians' perspectives when residents depart clinical sites to attend AHD. Approach: We performed a qualitative study with a grounded theory approach using individual semistructured interviews (December 2016-April 2017) of attending physicians who worked at inpatient and emergency department clinical sites from which residents departed to attend AHD. We used the constant comparative method, generating codes using an iterative approach and continuing sampling until saturation was reached. Major themes were identified and disagreements were resolved by consensus. Findings: Fifteen attending physicians from 6 clinical services were interviewed. Data analysis yielded 5 themes: emotional strain of workload, technology and systems challenges, patient safety and care concerns, disrupted resident learning, and the challenge to optimize resident education. Attending physicians, already working on busy services, felt frustrated and perceived having an increased workload when residents departed for AHD. They were concerned about safely entering orders in the electronic health record, impeded patient workflow, and further disruption of resident schedules already disrupted by duty hour restrictions and continuity clinic. Attending physicians described the importance of experiential learning from caring for patients and from structured didactic learning; however, the optimal balance was uncertain. Insights: We found that attending physicians experienced significant emotional strain, faced technological challenges, and were concerned about impeded workflow and patient safety when residents departed clinical sites for AHD. This is likely to be true whenever residents are pulled out of the clinical setting for any reason. Educators need to partner with hospital administrators to provide appropriate support for attending physicians when residents leave clinical sites, evaluate the effectiveness of different educational models, and determine how structured learning activities fit into the overall curriculum.

Perspectives on Healthcare Provider Well-Being: Looking Back, Moving Forward

Recognizing the impact of healthcare professional (HCP) burnout has led to vigorous interest from organizations and individuals regarding how to most effectively promote HCP well-being. The present paper reviews the literature on HCP well-being and describes factors that impact well-being at various levels (i.e., system, institution, program, interpersonal, and individual). We propose that change must occur at all levels to have the greatest impact. Further, we highlight opportunities to advance research on HCP well-being (e.g., being more inclusive regarding study populations and designing longitudinal intervention studies).

The Prevalence of Faculty Physician Burnout in Military Graduate Medical Education Training Programs: A Cross-Sectional Study of Academic Physicians in the United States Department of Defense

Introduction

In military populations, physician burnout has potential to adversely affect medical readiness to deploy in support of joint operations. Burnout among Graduate Medical Education (GME) faculty may further threaten the welfare of the medical force given the central role these officers have in training and developing junior physicians. The primary aim of this investigation was to estimate the prevalence of burnout among faculty physicians in United States (US) Army, Navy, and Air Force GME programs.

Materials and Methods

We conducted a cross-sectional study of faculty physicians at US military GME training programs between January 2018 and July 2018. Through direct coordination with Designated Institutional Officials, we administered the Maslach Burnout Inventory Health Services Survey (MBI-HSS) via online web link to faculty physicians listed in Accreditation Data System at each sponsoring institution. In addition to the MBI-HSS, we collected demographic data and queried physicians about common occupational stressors in order to assist institutional leaders with identifying at-risk physicians and developing future interventions to address burnout.

Results

Sixteen of 21 institutions that currently sponsor military GME programs agreed to distribute the MBI-HSS survey to core faculty. We received completed assessments from 622 of the 1,769 (35.1%) reported physician core faculty at these institutions. Of the 622 physician respondents, 162 demonstrated high levels of emotional exhaustion and depersonalization for an estimated 26% prevalence of burnout. We identified only one independent risk factor for burnout: increasing numbers of deployments (OR 1.38, 95% CI 1.07–1.77). Physicians in our cohort who reported a desire to stay beyond their initial active duty service obligation were less likely to be classified with burnout (OR 0.45, 95% CI 0.26–0.77). The most common drivers of occupational distress were cumbersome bureaucratic tasks, insufficient administrative support, and overemphasis on productivity metrics.

Conclusions

We estimate that 26% of physician faculty in military GME programs are experiencing burnout. No specialty, branch of service, or specific demographic was immune to burnout in our sample. Institutional leaders in the MHS should take action to address physician burnout and consider using our prevalence estimate to assess effectiveness of future interventions.

Resident Vitality in 34 Programs at 14 Academic Health Systems: Insights for Educating Physicians and Surgeons for the Future

OBJECTIVE

To clarify our understanding of how the culture of residency training influences the well-being of residents, this study reports on the vitality of residents at 34 programs across the United States and identifies characteristics of the programs, institutions and residents that are associated with high resident vitality.

DESIGN

In 2014 to 2015, residents nationally were surveyed using the validated C - Change Resident Survey. The survey assessed residents' vitality and 12 other dimensions that characterize residents' perspectives of the culture of the residency training programs: Self-efficacy, Institutional/program support, Relationships/inclusion/trust, Values alignment, Ethical/moral distress, Respect, Leadership aspirations, Mentoring, Work-life integration, Gender equity, Racial/ethnic minority equity, and self-assessed Competencies. Multilevel models were used to assess vitality within and across programs, and examine predictors including resident, program, and institution characteristics.

PARTICIPANTS

Two thousand four hundred and fifty-two residents from 11 General Surgery, 12 Internal Medicine, and 11 Pediatrics programs at 14 U.S. academic health systems.

RESULTS

One thousand seven hundred and eight residents responded (70% response rate). The mean Vitality score was 3.6 (range 1-5, where values of 4-5 represent high Vitality). There was wide variation among the 34 programs in the percent of residents who had high Vitality scores, ranging from 17% to 71%. However, the average Vitality scores within specialty (Surgery, Medicine, and Pediatrics) were not significantly different. The strongest predictors of Vitality were Work-life integration, Relationships/inclusion/trust, Institutional/program support, Res?>pect, Values alignment, and Ethical/moral distress, which together accounted for 50% of vitality variance. Individual demographics accounted for just 3% of variance.

CONCLUSIONS

Vitality is an essential component of resident well-being, and within each specialty there are programs that have excelled in promoting a culture of high vitality. Our findings suggest that we should test interventions to enhance resident vitality by focusing greater attention on providing institutional support, aligning individual and institutional values, integrating work and personal life, and facilitating relationships, inclusiveness and trust.

Restoring Faculty Vitality in Academic Medicine When Burnout Threatens

Increasing rates of burnout-with accompanying stress and lack of engagement-among faculty, residents, students, and practicing physicians have caused alarm in academic medicine. Central to the debate among academic medicine's stakeholders are oft-competing issues of social accountability; cost containment; effectiveness of academic medicine's institutions; faculty recruitment, retention, and satisfaction; increasing expectations for faculty; and mission-based productivity.The authors propose that understanding and fostering what contributes to faculty and institutional vitality is central to preventing burnout during times of change. They first look at faculty vitality and how it is threatened by burnout, to provide a framework for a greater understanding of faculty well-being. Then they draw on higher education literature to determine how vitality is defined in academic settings and what factors affect faculty vitality within the context of academic medicine. Next, they propose a model to explain and examine faculty vitality in academic medicine, followed by a discussion of the need for a greater understanding of faculty vitality. Finally, the authors offer conclusions and propose future directions to promote faculty vitality.The authors encourage institutional decision makers and other stakeholders to focus particular attention on the evolving expectations for faculty, the risk of extensive faculty burnout, and the opportunity to reduce burnout by improving the vitality and resilience of these talented and crucial contributors. Faculty vitality, as defined by the institution, has a critical role in ensuring future institutional successes and the capacity for faculty to thrive in a complex health care economy.

Assessing the Culture of Residency Using the C - Change Resident Survey: Validity Evidence in 34 U.S. Residency Programs

BACKGROUND

A practical instrument is needed to reliably measure the clinical learning environment and professionalism for residents.

OBJECTIVE

To develop and present evidence of validity of an instrument to assess the culture of residency programs and the clinical learning environment.

DESIGN

During 2014-2015, we surveyed residents using the C - Change Resident Survey to assess residents' perceptions of the culture in their programs.

PARTICIPANTS

Residents in all years of training in 34 programs in internal medicine, pediatrics, and general surgery in 14 geographically diverse public and private academic health systems.

MAIN MEASURES

The C - Change Resident Survey assessed residents' perceptions of 13 dimensions of the culture: Vitality, Self-Efficacy, Institutional Support, Relationships/Inclusion, Values Alignment, Ethical/Moral Distress, Respect, Mentoring, Work-Life Integration, Gender Equity, Racial/Ethnic Minority Equity, and self-assessed Competencies. We measured the internal reliability of each of the 13 dimensions and evaluated response process, content validity, and construct-related evidence validity by assessing relationships predicted by our conceptual model and prior research. We also assessed whether the measurements were sensitive to differences in specialty and across institutions.

KEY RESULTS

A total of 1708 residents completed the survey [internal medicine: n = 956, pediatrics: n = 411, general surgery: n = 311 (51% women; 16% underrepresented in medicine minority)], with a response rate of 70% (range across programs, 51-87%). Internal consistency of each dimension was high (Cronbach α: 0.73-0.90). The instrument was able to detect significant differences in the learning environment across programs and sites. Evidence of validity was supported by a good response process and the demonstration of several relationships predicted by our conceptual model.

CONCLUSIONS

The C - Change Resident Survey assesses the clinical learning environment for residents, and we encourage further study of validity in different contexts. Results could be used to facilitate and monitor improvements in the clinical learning environment and resident well-being.

Assessing the Learning Environment for Medical Students: An Evaluation of a Novel Survey Instrument in Four Medical Schools

OBJECTIVE

A practical, reliable, and valid instrument is needed to measure the impact of the learning environment on medical students' well-being and educational experience and to meet medical school accreditation requirements.

METHODS

From 2012 to 2015, medical students were surveyed at the end of their first, second, and third year of studies at four medical schools. The survey assessed students' perceptions of the following nine dimensions of the school culture: vitality, self-efficacy, institutional support, relationships/inclusion, values alignment, ethical/moral distress, work-life integration, gender equity, and ethnic minority equity. The internal reliability of each of the nine dimensions was measured. Construct validity was evaluated by assessing relationships predicted by our conceptual model and prior research. Assessment was made of whether the measurements were sensitive to differences over time and across institutions.

RESULTS

Six hundred and eighty-six students completed the survey (49 % women; 9 % underrepresented minorities), with a response rate of 89 % (range over the student cohorts 72-100 %). Internal consistency of each dimension was high (Cronbach's α 0.71-0.86). The instrument was able to detect significant differences in the learning environment across institutions and over time. Construct validity was supported by demonstrating several relationships predicted by our conceptual model.

CONCLUSIONS

The C-Change Medical Student Survey is a practical, reliable, and valid instrument for assessing the learning environment of medical students. Because it is sensitive to changes over time and differences across institution, results could potentially be used to facilitate and monitor improvements in the learning environment of medical students.

Accreditation Council for Graduate Medical Education Core Competencies at a Community Teaching Hospital: Is There a Gap in Awareness?

CONTEXT

Reports evaluating faculty knowledge of the Accreditation Council for Graduate Medical Education (ACGME) core competencies in community hospitals without a dedicated residency program are uncommon.

OBJECTIVE

Faculty evaluation regarding knowledge of ACGME core competencies before a residency program is started.

DESIGN

Physicians at the Kaiser Permanente Fontana Medical Center (N = 480) were surveyed for their knowledge of ACGME core competencies before starting new residency programs.

MAIN OUTCOME MEASURES

Knowledge of ACGME core competencies.

RESULTS

Fifty percent of physicians responded to the survey, and 172 (71%) of respondents were involved in teaching residents. Of physicians who taught residents and had complete responses (N = 164), 65 (39.7%) were unsure of their knowledge of the core competencies. However, most stated that they provided direct teaching to residents related to the knowledge, skills, and attitudes stated in each of the 6 competencies as follows: medical knowledge (96.3%), patient care (95.7%), professionalism (90.7%), interpersonal and communication skills (86.3%), practice-based learning (85.9%), and system-based practice (79.6%). Physician specialty, years in practice (1-10 vs > 10), and number of rotations taught per year (1-6 vs 7-12) were not associated with knowledge of the competencies (p > 0.05); however, full-time faculty (teaching 10-12 rotations per year) were more likely to provide competency-based teaching.

CONCLUSION

Objective assessment of faculty awareness of ACGME core competencies is essential when starting a residency program. Discrepancy between knowledge of the competencies and acclaimed provision of competency-based teaching emphasizes the need for standardized teaching methods that incorporate the values of these competencies.

How the distinctive cultures of osteopathic and allopathic medical schools affect the careers, perceptions, and institutional efforts of their anatomy faculties: A qualitative case study of two schools

Anatomy faculties are integral to basic science instruction in medical schools, particularly given the preponderance of anatomic instruction in the preclinical curriculum. Recent years have witnessed major curricular restructuring and other emerging national trends that pose significant challenges to anatomists. An examination of anatomy faculty perceptions at two philosophically distinct medical schools within this shifting climate provides an indicator of how different institutional characteristics may impact anatomy instruction and other faculty responsibilities. Semistructured interviews of anatomy faculty from a large, well-established allopathic medical school (Indiana University School of Medicine) and a small, new osteopathic medical school (Marian University College of Osteopathic Medicine) were explored using qualitative thematic analysis. Four overarching themes were identified: (1) Institutional philosophies, such as affiliation with osteopathic versus allopathic medicine, have minimal impact on how the anatomical sciences are taught. (2) Differences in anatomy faculty experiences at these two institutions are largely driven by the institution's size and history. There is a disparity between institutions in the relative importance of teaching and research, but an ability to do research is important for both faculties. (3) Anatomy instruction and research agendas are driven by personal philosophies and interests rather than institutional philosophy. (4) Autonomy is highly valued by anatomists at both institutions. All the participants share a devotion to educating future physicians. In fact, this study identified more similarities than differences in these two faculties. Finally, we argue that shared educational resources and research collaborations can improve anatomy education and faculty development at both institutions. Anat Sci Educ 9: 255-264. © 2015 American Association of Anatomists.

A Novel Measure of "Good" Mentoring: Testing Its Reliability and Validity in Four Academic Health Centers

INTRODUCTION

Despite the well-recognized benefits of mentoring in academic medicine, there is a lack of clarity regarding what constitutes effective mentoring. We developed a tool to assess mentoring activities experienced by faculty and evaluated evidence for its validity.

METHODS

The National Initiative on Gender, Culture, and Leadership in Medicine-"C-Change"-previously developed the C-Change Faculty Survey to assess the culture of academic medicine. After intensive review, we added six items representing six components of mentoring to the survey-receiving help with career and personal goals, learning skills, sponsorship, and resources. We tested the items in four academic health centers during 2013 to 2014. We estimated reliability of the new items and tested the correlation of the new items with a mentoring composite variable representing faculty mentoring experiences as positive, neutral, or inadequate and with other C-Change dimensions of culture.

RESULTS

Among the 1520 responding faculty (response rate 61-63%), there was a positive association between each of the six mentoring activities and satisfaction with both the amount and quality of mentoring received. There was no difference by sex. Cronbach α coefficients ranged from 0.89 to 0.95 across subgroups of faculty (by sex, race, and principal roles). The mentoring responses were associated most closely with dimensions of Institutional Support (r = 0.58, P < .001), Institutional Change Efforts for Faculty Support (r = 0.52, P < .001), Values Alignment (r = 0.58, P < .001), Self-efficacy (r = 0.43; P < .001), and Relationships/Inclusion/Trust (r = 0.41; P < .001).

DISCUSSION

Data demonstrated that the Mentoring scale is a valid instrument to assess mentoring. Survey results could facilitate mentoring program development and evaluation.

Group Peer Mentoring: An Answer to the Faculty Mentoring Problem? A Successful Program at a Large Academic Department of Medicine

INTRODUCTION

To address a dearth of mentoring and to avoid the pitfalls of dyadic mentoring, the authors implemented and evaluated a novel collaborative group peer mentoring program in a large academic department of medicine.

METHODS

The mentoring program aimed to facilitate faculty in their career planning, and targeted either early-career or midcareer faculty in 5 cohorts over 4 years, from 2010 to 2014. Each cohort of 9-12 faculty participated in a yearlong program with foundations in adult learning, relationship formation, mindfulness, and culture change. Participants convened for an entire day, once a month. Sessions incorporated facilitated stepwise and values-based career planning, skill development, and reflective practice. Early-career faculty participated in an integrated writing program and midcareer faculty in leadership development.

RESULTS

Overall attendance of the 51 participants was 96%, and only 3 of 51 faculty who completed the program left the medical school during the 4 years. All faculty completed a written detailed structured academic development plan. Participants experienced an enhanced, inclusive, and appreciative culture; clarified their own career goals, values, strengths and priorities; enhanced their enthusiasm for collaboration; and developed skills.

DISCUSSION

The program results highlight the need for faculty to personally experience the power of forming deep relationships with their peers for fostering successful career development and vitality. The outcomes of faculty humanity, vitality, professionalism, relationships, appreciation of diversity, and creativity are essential to the multiple missions of academic medicine.

Mentoring Faculty: A US National Survey of Its Adequacy and Linkage to Culture in Academic Health Centers

INTRODUCTION

The aims of this study were to (1) describe the quantity and quality of mentoring faculty in US academic health centers (AHCs), (2) measure associations between mentoring and 12 dimensions that reflect the culture of AHCs, and (3) assess whether mentoring predicts seriously contemplating leaving one's institution.

METHODS

During 2007-2009, our National Initiative on Gender, Culture and Leadership in Medicine (C - Change) conducted a cross-sectional study of faculty from 26 representative AHCs in the United States using the 74-item C - Change Faculty Survey to assess relationships of faculty characteristics and various aspects of the institutional culture (52% response rate). Among the 2178 eligible respondents (assistant, associate, and full professors), we classified their mentoring experience as either inadequate, neutral, or positive.

RESULTS

In this national sample, 43% of the 2178 respondents had inadequate mentoring; only 30% had a positive assessment of mentoring. There was no statistical difference by sex, minority status, or rank. Inadequate mentoring was most strongly associated with less institutional support, lower self-efficacy in career advancement, and lower scores on the trust/relationship/inclusion scale. The percent of faculty who had seriously considered leaving their institution was highest among those who had inadequate mentoring (58%), compared to those who were neutral (28%) or had positive mentoring (14%) (all paired comparisons, p < .001).

DISCUSSION

In a national survey of faculty of US AHCs, mentoring was frequently inadequate and this was associated with faculty contemplating leaving their institutions. Positive mentoring, although less prevalent, was associated with many other positive dimensions of AHCs.