Job turnover and its correlates among residency program directors in internal medicine: a three-year cohort study

Job characteristics that enrich clinician-educators' career: a theory-informed exploratory survey

Clinician educators (CEs) play a vital role in helping academic institutions achieve the missions of patient care, education and research. The driving forces that motivate pediatric CEs in professional growth and personal satisfaction remain unexplored. An exploratory survey research to investigate the job characteristics and factors that motivate CEs to pursue professional growth with personal satisfaction. Using the Job Characteristics Model (JCM) as a framework, we developed a 22-item survey comprised of the JCM derived Job Diagnostic Survey, Global Job Satisfaction scales and demographics. We collected data from January 2020 to March 2020 from self-identified pediatric CEs (with and without educational leadership roles) through a survey recruitment service. Given no data on total number of CEs in the survey pool, response rate was unknown. Job characteristics in the core job dimensions of meaningfulness, autonomy, and performance feedback, as well as, the derived Motivating Potential Score (MPS), were analyzed using descriptive statistics and regression models. From 201 respondents, including 55 education leaders, >70% were satisfied with patient care, teaching, and mentoring while <40% were satisfied with administrative and scholarly activities. Meaningfulness (in some areas), autonomy (patient care/teaching), and internal feedback (all areas) had significant effects on job satisfaction. In regression analysis, skill variety, feedback, and years of experience were associated with higher job satisfaction, and the MPS was a predictor of total job satisfaction. The JCM can be utilized to understand CE's motivations and needs within their workplace and guide professional development via job enrichment efforts.

Who Is Shaping the Future of Academic Urology? A Descriptive Analysis of Residency Program Directors

OBJECTIVE

To characterize the demographics, educational background, and scholarly characteristics of current urology residency program directors (PDs).

METHODS

Urology programs were identified by the listing on the "Accredited US Urology Programs" section of American Urological Association website as of October 2021. Demographics and academic data were collected via publicly available department website and Google search engine. Metrics obtained included years of service as PD from time of appointment, sex, medical school/residency/fellowship, all-time H-index, dual degrees obtained, and professorial ranking.

RESULTS

One hundred and forty-seven accredited urological residencies were reviewed; every PD was included. The majority were male (78%) and fellowship trained (68%). Women represented only 22% of PDs. The median active time served as PD, as of 11/2021, was 4years (IQR: 2-7). Forty (28%) were faculty at the same program they completed their residency. The median all-time H-index was 12 (IQR: 7-19; range 1-61). Twelve PDs also served as chair of their department.

CONCLUSION

The vast majority of PDs are male, fellowship trained, and have served for less than 5years. Future studies are necessary to follow the trends of representation in leaders of urology residency programs.

Satisfaction and attrition in Canadian surgical training program leadership: a survey of program directors

BACKGROUND

Surgical program directors (PDs) play an integral role in the well-being and success of postgraduate trainees. Although studies about medical specialties have documented factors contributing to PD burnout, early attrition rates and contributory factors among surgical PDs have not yet been described. We aimed to evaluate Canadian surgical PD satisfaction, stressors in the role and areas institutions could target to improve PD support.

METHODS

We administered a cross-sectional survey of postgraduate Canadian surgical PDs from all Royal College of Physicians and Surgeons of Canada accredited surgical specialties. Domains we assessed included PD demographics and compensation, availability of administrative support, satisfaction with the PD role and factors contributing to PD challenges and burnout.

RESULTS

Sixty percent of eligible surgical PDs (81 out of 134) from all 12 surgical specialties responded to the survey. We found significant heterogeneity in PD tenure, compensation models and available administrative support. All respondents reported exceeding their weekly protected time for the PD position, and 66% received less than 0.8 full-time equivalent of administrative support. One-third of respondents were satisfied with overall compensation, whereas 43% were unhappy with compensatory models. Most respondents (70%) enjoyed many aspects of the PD role, including relationships with trainees and shaping the education of future surgeons. Significant stressors included insufficient administrative support, complexities in resident remediation and inadequate compensation, which contributed to 37% of PDs having considered leaving the post prematurely.

INTERPRETATION

Most surgical PDs enjoyed the role. However, intersecting factors such as disproportionate time demands, lack of administrative support and inadequate compensation for the role contributed to significant stress and risk of early attrition.

Practical tips for navigating a program director transition

Residency and fellowship program directors profoundly impact trainees, institutions, and patient safety. Yet, there is concern for rapid attrition in the role. The average program director tenure is only 4-7 years, and that timeline is likely a result of burnout or opportunities for career advancement. Program director transitions must be carefully executed to ensure minimal disruption to the program. Transitions benefit from clear communication with trainees and other stakeholders, well-planned successions or searches for a replacement, and clearly delineated expectations and responsibilities of the outgoing program director. In this Practical Tips, four former residency program directors offer a roadmap for a successful program director transition, with specific recommendations to guide critical decisions and steps in the process. Themes emphasized include readiness for a transition, communication strategies, alignment of program mission and search efforts, and anticipatory support to ensure the success of the new director.

"We've Really Built Something": Why Family Medicine Program Directors Stay in Their Positions-A Qualitative Study

BACKGROUND

Program directors (PDs) are essential to more than 12 000 residency and fellowship programs accredited in the United States. Short PD tenure may affect overall program quality. Reasons why PDs leave the position are multifactorial, and little is known about the reasons why PDs stay in the position.

OBJECTIVE

The authors explored factors related to retention and why family medicine PDs have stayed in their positions long term.

METHODS

This was a qualitative study of PDs in their roles for 12 or more years drawn from a national sample of family medicine residency PDs. Interviews with semi-structured and structured questions about long-term PD experience were conducted in October and November 2020. Multiple cycles of comparative coding and code network analysis produced constructs describing reasons why some PDs stay in the position long term.

RESULTS

Among 17 respondents with a mean tenure of 17.4 years, 3 interrelated constructs consistently emerged that supported PDs: developing the program, support systems, and job rewards. Program development reinforces internal and external support systems and enhances experiencing rewards of the job. Strong support systems enable further program development and job rewards.

CONCLUSIONS

Family medicine residency PDs who have been in the role 12 or more years continuously work to develop the program, benefit from strong internal and external support systems, and describe many important rewards of the position that help sustain them in the role.

International Residency Program Directors on Implementing Educational Transformation: A Qualitative Study of Their Experiences and Strategies for Overcoming Challenges

BACKGROUND

Residency program directors (PDs) need to navigate diverse roles and responsibilities as clinical teachers, administrators, and drivers of educational improvement. Little is known about the experience of PDs leading transformation of international residency programs.

OBJECTIVE

We explored the lived experiences of international residency PDs and developed an understanding of how PDs manage educational program transformation.

METHODS

Using a phenomenological approach, semi-structured interviews were conducted with current and former PDs involved in the transformation to competency-based medical education in the first international settings to be accredited by the Accreditation Council for Graduate Medical Education-International (ACGME-I). Thirty-three interviews with PDs from Qatar, Singapore, and the United Arab Emirates were conducted from September 2018 to July 2019, audio-recorded, and transcribed. Data were independently coded by 2 researchers. A thematic analysis was conducted and patterns that reflected coping and managing educational reform were identified.

RESULTS

PDs described distinctive patterns of navigating the educational transformation. Five themes emerged: PDs (1) embraced continuous learning and self-development; (2) managed change in the context of their local settings; (3) anticipated problems and built support networks to effectively problem-solve; (4) maintained relationships with stakeholders for meaningful and constructive interactions; and (5) focused on intrinsic qualities that helped them navigate challenges.

CONCLUSIONS

International PDs were presented with significant challenges in implementing educational transformation but coped successfully through distinctive patterns and methods.

Diagnostic Radiology Residency Program Director Workforce in the United States: A Descriptive Analysis

PURPOSE

To investigate and describe the demographics, academic background, and scholarly activity of Diagnostic Radiology (DR) residency program directors in the United States.

METHODS

A list of all DR residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and corresponding program directors (PD) was obtained from ACGME website. Information about each PD was obtained from publicly available sources including program websites, Healthgrades and Doximity. Demographic and academic data including age, sex, educational background, subspecialty, tenure, interval between residency completion and appointment as PD, terms served, additional degrees, academic rank, prior leadership positions and metrics of scholarly activity were recorded. Nonparametric statistics including Mann-Whitney U and Kruskal-Wallis tests were applied to compare differences between groups. Results are considered statistically significant at p < 0.05.

RESULTS

A total of 197 PDs were included in the study of which 139 (70.6%) were male. Average age of PDs was 47.56 years (SD 8.29, median 45, range 35-77). There was no significant difference in median age of male vs female PDs (45 vs 44.5, p = 0.655). Majority of PDs attended American medical schools (181/197, 91.9%), and 16/197 attended international medical schools. Nine PDs received DO degrees (9/197, 4.6%). Academic rank was available for 137 PDs, of which 4 (2.9%) were instructors, 63 (46.0%) were assistant professors, 47 (34.3%) were associate professors and 23 (16.8%) were professors. Fellowship information was available for 183 PDs, of which the most common subspecialties were neuroradiology (24.5%), musculoskeletal radiology (15.8%), abdominal radiology (10.3%), and interventional radiology (9.8%). Female PDs had a significantly higher median publications (13.5 vs 6.0, p = 0.003), median citations (133 vs 37, p = 0.19) and median h-index compared to male PDs (6 ± 3, p = 0.005).

CONCLUSION

Radiology PDs are mostly males who graduated from US allopathic medical schools. Female PDs had significantly higher scholarly metrics compared to male PDs. Twenty three percent PDs were appointed in the last 1 year.

Roles, Responsibilities, and Needs of Institutional GME Leaders: A Multinational Characterization of Designated Institutional Officials

BACKGROUND

Since 2012, several academic centers in the Middle East have attained accreditation by the Accreditation Council for Graduate Medical Education International (ACGME-I). An emerging group of GME leaders have assumed the role of designated institutional official (DIO), leading their institutions to accreditation. Despite these DIOs' key positions in driving GME reform, there is a lack of published studies on the roles, responsibilities, and needs of DIOs in international settings.

OBJECTIVE

We examined the characteristics, roles, responsibilities, and needs of DIOs in the Middle East.

METHODS

A questionnaire was electronically distributed from December 2018 to February 2019 to all current and former DIOs in ACGME-I accredited institutions in the Middle East.

RESULTS

Of 16 surveys sent, 11 (69%) were returned. All DIOs were physicians; the majority were women less than 55 years of age, and assumed the role of DIO in the past decade. Most DIOs felt prepared for the position and well supported by their institution and their program directors. All reported having additional roles beyond the DIO position. Most identified the most challenging aspect of their role related to GME budgets, training for their responsibilities, sharing best practices and documents such as DIO job descriptions and other key documents, and DIO training.

CONCLUSIONS

ACGME-I accreditation is a critical driver of efforts to define the DIO role. DIOs in the Middle East share common perceptions, experiences, and needs. Further research should identify professional development needs in an increasingly diverse international worldwide DIO community.

Satisfaction, Salaries, and Sustainability: Results of a National Survey of Pediatric Program Directors

OBJECTIVE

Describe the career and work environment of pediatric program directors (PDs) and associated factors, including salary disparities and long-term career plans.

METHODS

A national, anonymous, electronic survey was sent to all categorical residency PD members of the Association of Pediatric Program Directors. Surveys assessed PD demographics, characteristics of the residency program and PD positions (including salary), and measures of satisfaction. Chi-square and Fisher's exact tests were used to analyze results.

RESULTS

A total of 149 PDs (74%) responded. Significantly more men earned $250,000 or more annually (26.9% vs 6.1% of women), and gender remained a significant independent predictor of salary after controlling for age, academic rank, and subspecialty. Satisfaction was high for most measures, although 20% or more reported low satisfaction with pay (38.9%), administrative workload (32.1%), managing accreditation and expectations of the Accreditation Council for Graduate Medical Education (31.9%), resources (27.9%), work/life balance (24.1%), and being valued by administration (20.0%). Only 34.3% saw the PD position as an end goal, and 29.5% stated they would be in their current position in 5 years. Satisfaction with the PD career, with faculty relationships, with resident performance, and with administrative workload was associated with plans to remain.

CONCLUSIONS

Most pediatric program directors did not view the position of PD as their long-term career goal, and many identified administrative duties and work/life balance as contributing to significant dissatisfaction. Without changes to address these issues, PD turnover may be high, with potential negative implications for the success of training programs.

Pediatric Program Leadership's Contribution Toward Resident Wellness

BACKGROUND

Residency program leaders are required to support resident well-being, but often they do not receive training in how to do so.

OBJECTIVE

To determine frequency in which program leadership provides support for resident well-being, comfort in supporting resident well-being, and factors associated with need for additional training in supporting resident well-being.

METHODS

National cross-sectional web-based survey in June 2015 of pediatric program directors, associate program directors, and coordinators about their experiences supporting resident well-being. Univariate and bivariate descriptive statistics compared responses between groups. Generalized linear modeling, adjusting for program region, size, program leadership role, and number of years in role determined factors associated with need for additional training.

RESULTS

The response rate was 39.3% (322/820). Most respondents strongly agreed that supporting resident well-being is an important part of their role, but few reported supporting resident well-being as part of their job description. Most reported supporting residents' clinical, personal, and health issues at least annually, and in some cases weekly, with 72% spending >10%of their time on resident well-being. Most program leaders desired more training. After adjusting for level of comfort in dealing with resident well-being issues, program leaders more frequently exposed to resident well-being issues were more likely to desire additional training (P < .02).

CONCLUSIONS

Program leaders spend a significant amount of time supporting resident well-being. Although they think that supporting resident well-being is an important part of their job, opportunities exist for developing program leaders through including resident wellness on job descriptions and training program leaders how to support resident well-being.

The Changing Landscape of Surgical Education: What are Residency Education Teams and do we Need Them?

OBJECTIVES

This study aims to understand how general surgery training programs constitute their residency education team (RET), how they define the roles of RET members, and how they measure success of the team. It fundamentally asks the question, "What is a RET and do we need one?"

DESIGN AND PARTICIPANTS

Program directors, associate program directors, educators, program coordinators, and chief residents from Accreditation Council for Graduate Medical Education (ACGME) general surgery training programs were asked to anonymously complete a survey categorized into 3 sections: (1) roles and responsibilities, (2) views of his/her RET and team members, and (3) general views about RETs. All respondents provided their opinions on the importance of a RET for administering and leading a surgical residency, whom the ideal members would be, and the main outcomes of a high-functioning RET.

RESULTS

Respondents (n = 167) included 59 (35.3%) program directors, 16 (9.6%) associate program directors, 8 (4.8%) educators, 67 (40.1%) program coordinators, and 6 (3.6%) chief residents. Overall, 84.4% of respondents were a part of a RET, defined as 2 or more individuals who are responsible and accountable for oversight and conduct of the residency training program. RET respondents expressed statistically significantly and higher importance for a RET (p < 0.0001) than their non-RET counterparts.

CONCLUSIONS

This study provides a snapshot of how some associated with general surgery residencies view and value RETs. The results of this survey are preliminary and suggest a need for educators within surgery programs and ambiguity about the role of associate program director. It also suggests that a closer look at role responsibilities may be of value, especially in view of the changing landscape of surgical education. Overall, most respondents felt that a RET was important to the main outcomes of a successful residency program.

Stress and Burnout Among Residency Program Directors in United States Radiation Oncology Programs

PURPOSE

To evaluate stressors among radiation oncology residency program directors (PDs) and determine the prevalence and indicators of burnout.

METHODS AND MATERIALS

An anonymous, online, cross-sectional survey was offered to PDs of US radiation oncology programs in the fall of 2014. Survey content examined individual and program demographics, perceptions surrounding the role of PD, and commonly encountered stressors. Burnout was assessed using the validated Maslach Burnout Inventory-Human Services Survey.

RESULTS

In total, 47 of 88 PDs (53%) responded to the survey. Although 78% of respondents reported feeling "satisfied" or "highly satisfied" with their current role, 85% planned to remain as PD for <5 years. The most commonly cited stressors were satisfying Accreditation Council for Graduate Medical Education/Residency Review Committee requirements (47%), administrative duties (30%) and resident morale (28%). Three-quarters of respondents were satisfied that they became PDs. Overall, 11% of respondents met criteria for low burnout, 83% for moderate burnout, and 6% for high burnout. Not having served as a PD at a prior institution correlated with high depersonalization (OR 6.75, P=.04) and overall burnout (odds ratio [OR], 15.6; P=.04). Having more years on faculty prior to becoming PD correlated with less emotional exhaustion (OR, 0.44, P=.05) and depersonalization (OR, 0.20, P=.04). Finally, having dedicated time for PD duties correlated with less emotional exhaustion (OR, 0.27, P=.04).

CONCLUSIONS

Moderate levels of burnout are common in U.S. radiation oncology PDs with regulatory stressors being common. Despite this, many PDs are fulfilled with their role. Longitudinal studies assessing dynamic external factors and their influence on PD burnout would be beneficial.

Gender differences in salary of internal medicine residency directors: a national survey

OBJECTIVES

Whether salary disparities exist between men and women in medical education leadership roles is not known. The study objective was to determine whether salary disparities exist between male and female Internal Medicine residency program directors, and if so, to identify factors associated with the disparities and explore historical trends.

METHODS

The annual Association of Program Directors in Internal Medicine (APDIM) survey in August 2012 included items to assess the salary and demographic characteristics of program directors, which were merged with publically available program data. To assess historical trends, we used similarly obtained survey data from 2008 to 2011. The study included program directors of 370 APDIM member programs, representing 95.6% of the 387 accredited Internal Medicine training programs in the United States and Puerto Rico. Of the 370 APDIM member programs, 241 (65.1%) completed the survey, of whom 169 (70.1%) were men and 72 (29.9%) were women. Program directors' total annual salary, measured in $25,000 increments, ranged from $75,000 or less to more than $400,000. Historical trends of mode salary by gender from 2008 to 2012 were assessed.

RESULTS

The mode salary was $200,000 to 225,000 for men and $175,000 to $200,000 for women (P = .0005). After controlling for academic rank, career in general internal medicine, and program director age, the distribution of salary remained different by gender (P = .004). Historical trends show that the difference in mode salary has persisted since 2008.

CONCLUSIONS

Leaders in academic medical centers, residency and fellowship directors, and all faculty in medical education need to be aware that salary disparities cited decades ago persist in this sample of medical educators. Closing the gender gap will require continued advocacy for measuring and reporting salary gaps, and changing the culture of academic medical centers.

Burnout and distress among internal medicine program directors: results of a national survey

BACKGROUND

Physician burnout and distress has been described in national studies of practicing physicians, internal medicine (IM) residents, IM clerkship directors, and medical school deans. However, no comparable national data exist for IM residency program directors.

OBJECTIVE

To assess burnout and distress among IM residency program directors, and to evaluate relationships of distress with personal and program characteristics and perceptions regarding implementation and consequences of Accreditation Council for Graduate Medical Education (ACGME) regulations.

DESIGN AND PARTICIPANTS

The 2010 Association of Program Directors in Internal Medicine (APDIM) Annual Survey, developed by the APDIM Survey Committee, was sent in August 2010 to the 377 program directors with APDIM membership, representing 99.0 % of the 381 United States categorical IM residency programs.

MAIN MEASURES

The 2010 APDIM Annual Survey included validated items on well-being and distress, including questions addressing quality of life, satisfaction with work-life balance, and burnout. Questions addressing personal and program characteristics and perceptions regarding implementation and consequences of ACGME regulations were also included.

KEY RESULTS

Of 377 eligible program directors, 282 (74.8 %) completed surveys. Among respondents, 12.4 % and 28.8 % rated their quality of life and satisfaction with work-life balance negatively, respectively. Also, 27.0 % reported emotional exhaustion, 10.4 % reported depersonalization, and 28.7 % reported overall burnout. These rates were lower than those reported previously in national studies of medical students, IM residents, practicing physicians, IM clerkship directors, and medical school deans. Aspects of distress were more common among younger program directors, women, and those reporting greater weekly work hours. Work-home conflicts were common and associated with all domains of distress, especially if not resolved in a manner effectively balancing work and home responsibilities. Associations with program characteristics such as program size and American Board of Internal Medicine (ABIM) pass rates were not found apart from higher rates of depersonalization among directors of community-based programs (23.5 % vs. 8.6 %, p = 0.01). We did not observe any consistent associations between distress and perceptions of implementation and consequences of program regulations.

CONCLUSIONS

The well-being of IM program directors across domains, including quality of life, satisfaction with work-life balance, and burnout, appears generally superior to that of medical trainees, practicing physicians, and other medical educators nationally. Additionally, it is reassuring that program directors' perceptions of their ability to respond to current regulatory requirements are not adversely associated with distress. However, the increased distress levels among younger program directors, women, and those at community-based training programs reported in this study are important concerns worthy of further study.

Barriers to Implementing the ACGME Outcome Project: A Systematic Review of Program Director Surveys

INTRODUCTION

The Accreditation Council for Graduate Medical Education (ACGME) introduced the Outcome Project in July 2001 to improve the quality of resident education through competency-based learning. The purpose of this systematic review is to determine and explore the perceptions of program directors regarding challenges to implementing the ACGME Outcome Project.

METHODS

We used the PubMed and Web of Science databases and bibliographies for English-language articles published between January 1, 2001, and February 17, 2012. Studies were included if they described program directors' opinions on (1) barriers encountered when attempting to implement ACGME competency-based education, and (2) assessment methods that each residency program was using to implement competency-based education. Articles meeting the inclusion criteria were screened by 2 researchers. The grading criterion was created by the authors and used to assess the quality of each study.

RESULTS

The survey-based data reported the opinions of 1076 program directors. Barriers that were encountered include: (1) lack of time; (2) lack of faculty support; (3) resistance of residents to the Outcome Project; (4) insufficient funding; (5) perceived low priority for the Outcome Project; (6) inadequate salary incentive; and (7) inadequate knowledge of the competencies. Of the 6 competencies, those pertaining to patient care and medical knowledge received the most responses from program directors and were given highest priority.

CONCLUSIONS

The reviewed literature revealed that time and financial constraints were the most important barriers encountered when implementing the ACGME Outcome Project.

The activities and responsibilities of the vice chair for education in U.S. and Canadian departments of medicine

PURPOSE

A profile of the activities and responsibilities of vice chairs for education is notably absent from the medical education literature. The authors sought to determine the demographics, roles and responsibilities, and major priorities and challenges faced by vice chairs for education.

METHOD

In 2010, the authors sent a confidential, Web-based survey to all 82 identified department of medicine vice chairs for education in the United States and Canada. The authors inquired about demographics, roles, expectations of and for their position, opinions on the responsibilities outlined for their position, metrics used to evaluate their success, top priorities, and job descriptions. Analysis included creating descriptive statistics and categorizing the qualitative comments.

RESULTS

Fifty-nine vice chairs for education (72%) responded. At the time of appointment, only 6 (10%) were given a job description, and only 17 (28%) had a defined job description and metrics used to evaluate their success. Only 20 (33%) had any formal budget management training, and 23 (38%) controlled an education budget. Five themes emerged regarding the responsibilities and goals of the vice chair for education: oversee educational programs; possess educational expertise; promote educational scholarship; serve in leadership activities; and, disturbingly, respondents found expectations to be vague and ill defined.

CONCLUSIONS

Vice chairs for education are departmental leaders. The authors' findings and recommendations can serve as a beginning for defining educational directions and resources, building consensus, and designing an appropriate educational infrastructure for departments of medicine.

Why are a quarter of faculty considering leaving academic medicine? A study of their perceptions of institutional culture and intentions to leave at 26 representative U.S. medical schools

PURPOSE

Vital, productive faculty are critical to academic medicine, yet studies indicate high dissatisfaction and attrition. The authors sought to identify key personal and cultural factors associated with intentions to leave one's institution and/or academic medicine.

METHOD

From 2007 through early 2009, the authors surveyed a stratified random sample of 4,578 full-time faculty from 26 representative U.S. medical schools. The survey asked about advancement, engagement, relationships, diversity and equity, leadership, institutional values and practices, and work-life integration. A two-level, multinomial logit model was used to predict leaving intentions.

RESULTS

A total of 2,381 faculty responded (52%); 1,994 provided complete data for analysis. Of these, 1,062 (53%) were female and 475 (24%) were underrepresented minorities in medicine. Faculty valued their work, but 273 (14%) had seriously considered leaving their own institution during the prior year and 421 (21%) had considered leaving academic medicine altogether because of dissatisfaction; an additional 109 (5%) cited personal/family issues and 49 (2%) retirement as reasons to leave. Negative perceptions of the culture-unrelatedness, feeling moral distress at work, and lack of engagement-were associated with leaving for dissatisfaction. Other significant predictors were perceptions of values incongruence, low institutional support, and low self-efficacy. Institutional characteristics and personal variables (e.g., gender) were not predictive.

CONCLUSIONS

Findings suggest that academic medicine does not support relatedness and a moral culture for many faculty. If these issues are not addressed, academic health centers may find themselves with dissatisfied faculty looking to go elsewhere.

Results from a transitional-year program director survey: identifying crucial issues and concerns

BACKGROUND

Transitional Year (TY) programs meet an important need by preparing residents for specialties that accept individuals after an initial preparatory year. To our knowledge, no surveys to date have been conducted to identify attributes of TY programs and concerns of TY program directors.

PURPOSE

The purpose of this study was to review TY program characteristics and identify critical issues and concerns of TY program directors (TYPDs).

METHODS

A web-based, 22-question survey was sent to all 114 TYPDs of programs accredited by the Accreditation Council for Graduate Medical Education between January and April 2011. The survey included open-formatted and closed-formatted questions addressing program and institution demographics, program director time, administrative support, satisfaction, and future plans.

RESULTS

The survey response rate was 86%. The median age of TY programs was 28 years, with few new programs. More than 80% of TY programs were conducted at community hospitals and university-affiliated community hospitals. Of the responding TYPDs, 17% had served less than 2 years, and 32% had served 10 years or more. Common sponsoring TY programs included internal medicine (88%), general surgery (42%), family medicine (25%), emergency medicine (24%), and pediatrics (18%). Overall, TYPDs were satisfied with their positions. They expressed concerns about inadequate time to complete duties, salary support, and administrative duties assigned to program coordinators. Forty-nine percent of TYPDs reported they planned to leave the position within the next 5 years.

CONCLUSIONS

Our survey provides useful information to assist institutions and the graduate medical education community in meeting the needs of TYPDs and strengthening TY programs.

Use of a standardized patient exercise to assess core competencies during fellowship training

BACKGROUND

The Accreditation Council for Graduate Medical Education requires fellows in many specialties to demonstrate attainment of 6 core competencies, yet relatively few validated assessment tools currently exist. We present our initial experience with the design and implementation of a standardized patient (SP) exercise during gastroenterology fellowship that facilitates appraisal of all core clinical competencies.

METHODS

Fellows evaluated an SP trained to portray an individual referred for evaluation of abnormal liver tests. The encounters were independently graded by the SP and a faculty preceptor for patient care, professionalism, and interpersonal and communication skills using quantitative checklist tools. Trainees' consultation notes were scored using predefined key elements (medical knowledge) and subjected to a coding audit (systems-based practice). Practice-based learning and improvement was addressed via verbal feedback from the SP and self-assessment of the videotaped encounter.

RESULTS

Six trainees completed the exercise. Second-year fellows received significantly higher scores in medical knowledge (55.0 ± 4.2 [standard deviation], P  =  .05) and patient care skills (19.5 ± 0.7, P  =  .04) by a faculty evaluator as compared with first-year trainees (46.2 ± 2.3 and 14.7 ± 1.5, respectively). Scores correlated by Spearman rank (0.82, P  =  .03) with the results of the Gastroenterology Training Examination. Ratings of the fellows by the SP did not differ by level of training, nor did they correlate with faculty scores. Fellows viewed the exercise favorably, with most indicating they would alter their practice based on the experience.

CONCLUSIONS

An SP exercise is an efficient and effective tool for assessing core clinical competencies during fellowship training.

Quality of life during orthopaedic training and academic practice. Part 1: orthopaedic surgery residents and faculty

BACKGROUND

A pilot study of two academic training programs revealed concerning levels of resident burnout and psychological dysfunction. The purpose of the present study was to determine the quality of life of orthopaedic residents and faculty on a national scale and to identify risk factors for decompensation.

METHODS

Three hundred and eighty-four orthopaedic residents and 264 full-time orthopaedic faculty members completed a voluntary, anonymous survey consisting of three validated instruments (the Maslach Burnout Inventory, the General Health Questionnaire-12, and the Revised Dyadic Adjustment Scale) and question sets assessing demographic information, relationship issues, stress reactions/management, and work/life balance.

RESULTS

High levels of burnout were seen in 56% of the residents and 28% of the faculty members. Burnout risk was greatest among second-postgraduate-year residents and residents in training programs with six or more residents per postgraduate year. Sixteen percent of residents and 19% of faculty members reported symptoms of psychological distress. Sleep deprivation was common among the residents and correlated positively with every distress measure. Faculty reported greater levels of stress but greater satisfaction with work and work/life balance. A number of factors, such as making time for hobbies and limiting alcohol use, correlated with decreased dysfunction for both residents and faculty.

CONCLUSIONS

Despite reporting high levels of job satisfaction, orthopaedic residents and faculty are at risk for burnout and distress. Identification of protective factors and risk factors may provide guidance to improve the quality of life of academic orthopaedic surgeons in training and beyond.

What predicts residency accreditation cycle length? Results of a national survey

PURPOSE

To determine whether residency program baseline characteristics, program director characteristics, and the date of the most recent Accrediation Council for Graduate Medical Education (ACGME) site visit would affect program accreditation cycle length.

METHOD

A survey asked about cycle length as well as program and program director characteristics. The survey was sent to all 391 accredited internal medicine residency programs registered with the Association of Program Directors in Internal Medicine in March 2005. Bivariate and multivariate regressions were performed to find factors independently associated with cycle length.

RESULTS

The mean cycle length was 3.8 years among respondents (70% response rate). Program characteristics associated with longer cycle length included having a higher three-year American Board of Internal Medicine (ABIM) board pass rate. Program characteristics associated with shorter cycle length included being reviewed by the Residency Review Committee in Internal Medicine (RRC-IM) shortly after the July 2003 ACGME program requirement changes, being a university-based program, and having a large percentage of voluntary teaching faculty. Program director characteristics associated with longer cycle length included time spent in clinic. Other program and program director characteristics had no effect on cycle length.

CONCLUSIONS

Several program and program director characteristics are associated with RRC-IM cycle length. Programs should be wary of the dates of their Residency Review Committee site visits in relation to ACGME programmatic rule changes. The percentage of voluntary faculty at each program, the ABIM board pass rate, and the amount of time the program director spends in clinic also affect a program's cycle length.

Viewpoint: enhancing the professional fulfillment of physicians

Academic medical centers (AMCs) devote countless hours to studying the diagnosis and treatment of disease, yet little or no time to determining the factors that enhance or detract from physicians' professional fulfillment. This is unfortunate because physicians' degree of professional engagement, the quality of care they provide, and their tendency to burn out all depend on the fulfillment they find in work.Indeed, if AMCs are to thrive, it is vital to understand and promote the professional fulfillment of physicians. This article reviews the sources of professional fulfillment among physicians and outlines ways to enhance it within physicians' organizations.

Mental health and psychiatry training in primary care residency programs. Part II. What skills and diagnoses are taught, how adequate, and what affects training directors' satisfaction?

OBJECTIVE

The purpose of this study is to describe the psychiatric skills and diagnostic categories taught in primary care training programs, their adequacy, the perceived needs and desires for curriculum enhancement and the factors affecting training directors' satisfaction.

METHOD

All 1365 directors of accredited residency training programs in Internal Medicine (IM), Family Practice (FP), Obstetrics and Gynecology (Ob/Gyn), Pediatrics (Peds) and psychiatry received a 16-item anonymous questionnaire about psychiatry training in their program. Responses to the questionnaire to items concerning the skills and diagnostic categories taught, assessment of adequacy of teaching and desires for curriculum enhancement for specific skills and diagnostic categories were analyzed. The factors affecting training directors' satisfaction were explored.

RESULTS

Interviewing skills were taught by a majority of all training programs and were considered adequate by 81% of FP and 54% of IM programs, in contrast to less than a majority of Ob/Gyn and Peds programs (P<.001). A majority provided diagnostic interviewing and counseling training, but only FP considered it adequate. A majority taught psychopharmacology and various psychiatric diagnoses, but only in FP did a majority consider them adequate. Both Peds and FP programs teach child psychiatry; significantly, more Peds compared to FP consider their training to be adequate. A vast majority of IM, Ob/Gyn and Peds programs, and 50% of FP programs desired more training in interviewing techniques and diagnostic interview. A majority of all programs desired more counseling and psychopharmacology training and more training in disorders of childhood and adolescence. The overall satisfaction rate for psychiatric training across specialties was 46% (n=657). Sixty-four percent of FP programs were satisfied compared to 31% of non-FP programs. Satisfaction was associated with increased amount of psychiatric training, diversity of training formats, venues, faculty and settings, the amount of contribution to teaching by psychiatry departments and the presence of current teaching in interviewing skills. There were specialty-specific differences in factors associated with satisfaction. In general, a smaller size of residency program was associated with satisfaction except in IM, where larger size was associated with satisfaction. Satisfaction was associated with the opinion that primary care physician should be ready and willing to treat more psychiatric conditions.

CONCLUSION

Most primary care training programs currently offer training in most psychiatric skills and disorders, but a majority of training directors are dissatisfied with their psychiatry training. There is a difference in the estimation of adequacy concerning training between FP, which consistently rates their teaching to be adequate, and all other primary care programs, which consider their teaching inadequate. This difference may be partly due to actual differences in amount and diversity of training as well as differences in the threshold for satisfaction. A vast majority of primary care training programs desire more training in almost all aspects of psychiatry, and there may be specialty-specific needs and areas of curriculum enhancement. To enhance satisfaction, we should improve the quality as well as the quantity of training, as well as the diversity in training formats, venues and faculty.

Electives in Complementary Medicine: Are We Preaching to the Choir?

CONTEXT

Many medical schools offer electives on complementary medicine, but little is known about the characteristics of students who sign up for such electives compared with those who do not.

OBJECTIVE

Compare enrollees to nonenrollees in an elective course on therapeutic touch and healing touch (TTHT).

DESIGN

Cross-sectional survey.

SETTING

Wake Forest University School of Medicine, second-year course on medicine as a profession.

SUBJECTS

Second-year medical students who returned surveys: 22 who signed up for an elective on TTHT and 58 who did not.

INSTRUMENT

Anonymous surveys included questions about demographics, attitudes, practices, and the Maslach Burnout Inventory (MBI).

RESULTS

Those who signed up for the elective were more likely to be women (73% for TTHT vs 33% for others, P < .01). Nearly all students thought that being centered and compassionate were very important. Students who signed up for TTHT were less likely to report feeling confident in being able to be centered when it was quiet (41% vs 64%, respectively, very confident, P < .04) and less confident in their ability to demonstrate nonverbal comforting behaviors (9% vs 43%, respectively, very confident, P = .02). Only 18% of elective vs 66% of others reported being centered during patient encounters (P < .001). The TTHT students and their classmates reported comparable levels of burnout.

CONCLUSIONS

Elective students were no more likely than classmates to believe that it is very important to be centered and to extend compassion toward patients; they reported being less confident and practicing these skills less often than their classmates. Burnout was not less common among those in the elective. Electives may not be "preaching to the choir." Future studies need to determine whether training enhances confidence and skills and whether it protects against developing burnout.

Teaching the teachers: national survey of faculty development in departments of medicine of U.S. teaching hospitals

OBJECTIVE

To determine the prevalence, topics, methods, and intensity of ongoing faculty development (FD) in teaching skills.

DESIGN

Mailed survey.

PARTICIPANTS

Two hundred and seventy-seven of the 386 (72%) U.S. teaching hospitals with internal medicine residency programs.

MEASUREMENTS

Prevalence and characteristics of ongoing FD.

RESULTS

One hundred and eight teaching hospitals (39%) reported ongoing FD. Hospitals with a primary medical school affiliation (university hospitals) were more likely to have ongoing FD than non-university hospitals. For non-university hospitals, funding from the Health Resources Services Administration and >50 house staff were associated with ongoing FD. For university hospitals, >100 department of medicine faculty was associated. Ongoing programs included a mean of 10.4 topics (standard deviation, 5.4). Most offered half-day workshops (80%), but 22% offered > or =1-month programs. Evaluations were predominantly limited to postcourse evaluations forms. Only 14% of the hospitals with ongoing FD (5% of all hospitals) had "advanced" programs, defined as offering > or =10 topics, lasting >2 days, and using > or =3 experiential teaching methods. These were significantly more likely to be university hospitals and to offer salary support and/or protected time to their FD instructors. Generalists and hospital-based faculty were more likely to receive training than subspecialist and community-based faculty. Factors facilitating participation in FD activities were supervisor attitudes, FD expertise, and institutional culture.

CONCLUSIONS

A minority of U.S. teaching hospitals offer ongoing faculty development in teaching skills. Continued progress will likely require increased institutional commitment, improved evaluations, and adequate resources, particularly FD instructors and funding.

Job satisfaction among program directors in obstetrics and gynecology: A national portrait

OBJECTIVES

The purpose of this study was to determine job satisfaction among program directors in obstetrics and gynecology with the use of a validated tool and to identify specific sources of dissatisfaction that might lead to job change.

STUDY DESIGN

The program director satisfaction and a global job satisfaction survey were sent to all program directors in the United States. Motivators for seeking a job change were assessed. The chi(2) test, Kruskal-Wallis test, correlation analysis, and multiple linear regression were used.

RESULTS

Seventy percent of 254 surveys were completed. Global job satisfaction (minimum, 4; maximum, 16) was 11.9+/-2.9; mean program director satisfaction score was 135+/-25.8 (minimum, 54; maximum, 200). Job satisfaction was highest in chairs, full professors, those whose age was >50 years, and those with >5 years of experience (P=.02) and in facets that were related to work with residents, colleagues, and patients. Dissatisfaction was highest with regard to salary, promotion opportunities, and resources. Forty-six percent of those who responded were considering a job change in 3 years; the most common reason for a job change that was cited was administrative hassles.

CONCLUSION

Although job satisfaction is high among program directors, administrative hassles may lead to high rate of rapid turnover.

Does being a clerkship director benefit academic career advancement: results of a national survey

BACKGROUND

Changes in academic medicine have left clerkship directors (CDs) anxious about their career pathway, because clerkship administrative efforts may detract from other activities.

PURPOSE

The Clerkship Directors in Internal Medicine (CDIM) asked members about benefits of being a CD or CDIM membership toward career development.

METHODS

Responses were on 1-5 Likert scales with 5 (strongly agree). Background and demographic issues were analyzed for associations with the career benefits statements.

RESULTS

The response rate was 75% (n = 92). Mean agreement with CD benefit was 4.2 (SD = 0.82) and CDIM membership 3.8 (SD = 0.95). Eighty-one percent and 58% of CDs agreed with the respective statements. Significant predictors of CD benefit were CD and coordinator salary support, years as CD, and receiving a university teaching award. Structured discussions of expectations strongly predicted perceiving CDIM benefit.

CONCLUSIONS

Most CDs agreed that their CD role and CDIM benefited their careers. Salary support and clearly defining expectations may increase the likelihood of perceiving benefit.