Reasons for faculty departures from an academic medical center: a survey and comparison across faculty lines

Leaders' Perspectives on Resources for Academic Success: Defining Clinical Effort, Academic Time, and Faculty Support

INTRODUCTION

For academic promotion, clinical faculty are expected to excel in clinical care, teaching, and scholarship. Ensuring adequate protected time and resources to engage in scholarly work in the face of competing clinical responsibilities is critical. The authors examined academic leaders' perspectives across affiliate hospitals of a large medical school regarding the definition of clinical full-time effort and academic time, best practices to enable academic success, and barriers to faculty advancement.

METHODS

Open-ended, semistructured, individual interviews were conducted with a purposive sample of clinical department and division heads. Interview data were examined to illuminate the range and commonalities in practices and to identify successful approaches.

RESULTS

Interviews were conducted with 17 academic leaders across 6 affiliate hospitals. There was considerable variability in clinical full-time effort definition. "Academic time," more accurately characterized as "nonclinical time," was typically 1 day a week for nonshift specialties and mostly used for administrative work or completing clinical documentation. Certain departments were more explicit in designating and protecting time for academic pursuits; some had invested resources in intensive programs for academic advancement with built-in expectations for accountability. The impact of documentation burden was considerable in certain departments.

DISCUSSION AND CONCLUSION

Marked variability exists in time allocations for clinical and academic work, as well as in resources for academic success. This supports the potential value of establishing standards for defining and protecting academic time, motivating clinical faculty to engage in academic work, and building accountability expectations. Sharing best practices and setting standards may enhance academic advancement. Strategies to reduce documentation burden may enhance wellness.

Predictors of Job Satisfaction and Association with Psychological Distress Among Academic Medicine Faculty in Kazakhstan

BACKGROUND

The growing concern for the faculty's well-being is allied with the emotionally demanding nature of teaching, which has an adverse effect on physical and mental health. There is abundant evidence that academic medicine faculty are subjected to high rates of dissatisfaction, distress, burnout, and turnover among medical educators. This study is dedicated to the exploration of the association between job satisfaction and psychological distress among academic medicine faculty in Kazakhstan.

METHODS

The observational cross-sectional study was conducted among medical educators in Kazakhstan between 1 October and 25 December. The survey was completed by 715 representatives of academic medicine staff. The sample size was calculated by Epi Info Sample Size Calculator, version 7.0. Multinomial logistic regression analysis using the forced entry procedure was applied to identify the factors associated with job satisfaction.

RESULTS

The prevalence of job satisfaction, depression, anxiety, and stress was 19.2%, 40.6%, 41.3%, and 53%, respectively. Three variables were significantly associated with job satisfaction: having a partner (AOR=0.79; 95% CI 0.38-1.659), having work experience of 5-10 years (AOR=0.32; 95% CI 0.14-0.74), and holding a Ph.D. degree (AOR=0.40; 95% CI 0.18-0.91). Job satisfaction was significantly associated with depression (p=0.005) and stress (p<0.001).

CONCLUSIONS

Compared to previous research in this area, our findings reported a higher prevalence of psychological distress and dissatisfaction. Potential reason for higher rates of dissatisfaction may be the global disruption due to COVID-19 pandemic.

Virtual Academic Asynchronous Mentoring (VAAM) for Faculty Physicians: An Innovative Mentorship

INTRODUCTION

Successful mentorship programs in academic medicine correlate with increased achievement in scholarly activities, leadership, and academic advancement for faculty members, as well as reduced burnout. Despite these benefits, the traditional mentorship model may be underutilized due to challenges of time constraints and alignment in goals. Furthermore, women and underrepresented in medicine (UriM) physicians are less likely to have mentorship, perpetuating the gap in the diversity of academic faculty in leadership and career advancement. To address this, we created an innovative mentorship model for busy academic faculty physicians using a virtual academic asynchronous mentoring video platform.  Methods: A series of videos were created by interviewing 10 identified mentors (four male, six female) from various medical specialties at a national academic institution. The mentors included nine physician faculty with the academic rank of Associate Professor or full Professor and one Research Administrator. Key learning points shared by mentors included topics on academic advancement, mentorship development, leadership development, and research resources.

RESULTS

Between March 2020 and September 2023, the Virtual Academic Asynchronous Mentoring (VAAM) Video Series garnered 182 unique viewers, received 2,107 visits, and accumulated 1,871 total minutes of viewing time. All viewers were surveyed, with an 11% survey response rate received. Fifty-two percent of survey respondents reported that the video content was excellent and 43% reported very good. Seventy-six percent of respondents thought the video series had the potential to enhance their professional development and academic productivity.

CONCLUSION

The VAAM Video Platform offers a novel approach to academic mentoring for faculty physicians which eliminates limitations of traditional mentorship models in a convenient and cost-effective way. VAAM offers an egalitarian starting point for all junior faculty who have not yet established a mentoring relationship to seek information and resources on academic advancement and career development.

Gender and retention patterns among U.S. faculty

Women remain underrepresented among faculty in nearly all academic fields. Using a census of 245,270 tenure-track and tenured professors at United States-based PhD-granting departments, we show that women leave academia overall at higher rates than men at every career age, in large part because of strongly gendered attrition at lower-prestige institutions, in non-STEM fields, and among tenured faculty. A large-scale survey of the same faculty indicates that the reasons faculty leave are gendered, even for institutions, fields, and career ages in which retention rates are not. Women are more likely than men to feel pushed from their jobs and less likely to feel pulled toward better opportunities, and women leave or consider leaving because of workplace climate more often than work-life balance. These results quantify the systemic nature of gendered faculty retention; contextualize its relationship with career age, institutional prestige, and field; and highlight the importance of understanding the gendered reasons for attrition rather than focusing on rates alone.

Workforce Attrition Among Male and Female Physicians Working in US Academic Hospitals, 2014-2019

Importance

Retaining female physicians in the academic health care workforce is necessary to serve the needs of sociodemographically diverse patient populations.

Objective

To investigate differences in rates of leaving academia between male and female physicians.

Design, Setting, and Participants

This cohort study used Care Compare data from the Centers for Medicare & Medicaid Services for all physicians who billed Medicare from teaching hospitals from March 2014 to December 2019, excluding physicians who retired during the study period. Data were analyzed from November 11, 2021, to May 24, 2022.

Exposure

Physician gender.

Main Outcome and Measures

The primary outcome was leaving academia, which was defined as not billing Medicare from a teaching hospital for more than 1 year. Multivariable logistic regression was conducted adjusting for physician characteristics and region of the country.

Results

There were 294 963 physicians analyzed (69.5% male). The overall attrition rate from academia was 34.2% after 5 years (38.3% for female physicians and 32.4% for male physicians). Female physicians had higher attrition rates than their male counterparts across every career stage (time since medical school graduation: <15 years, 40.5% vs 34.8%; 15-29 years, 36.4% vs 30.3%; ≥30 years, 38.5% vs 33.3%). On adjusted analysis, female physicians were more likely to leave academia than were their male counterparts (odds ratio, 1.25; 95% CI, 1.23-1.28).

Conclusions and Relevance

In this cohort study, female physicians were more likely to leave academia than were male physicians at all career stages. The findings suggest that diversity, equity, and inclusion efforts should address attrition issues in addition to recruiting more female physicians into academic medicine.

An Investigation of Organizational Correlates of Distress in Non-Clinician Biomedical Researchers in the United States

Purpose

Challenges ushered by the COVID-19 pandemic led to an increased focus on the mental well-being of the healthcare workforce. Despite the important contribution non-clinician biomedical researchers make to the mission of academic medical centers, the well-being of this unique population remains understudied in the United States. The purpose of this study was to examine the individual and organizational correlates of distress among non-clinician biomedical researchers.

Methods

A survey was delivered to employees of a large academic medical center in the southeastern United States, including non-clinician biomedical researchers. Participants were asked to assess their own well-being using the validated Well-Being Index (WBI) tool, resilience, work and nonwork-related stressors and demographic descriptors. Descriptive statistics and bivariate analyses were conducted, and binary logistic regression was used to examine predictors of increased odds of overall distress.

Results

Nearly 44% of surveyed non-clinician biomedical researchers met the threshold for high distress which indicates an increased risk of suicidal ideation, turnover intention, and burnout. The major correlates of distress were at the organizational level, including perceived organizational support (OR 0.79, 95% CI 0.70-0.90), heavy workload and long hours (OR 3.25, 95% CI 1.53-6.88), inability or lack of support to take time off (OR 2.80, 95% CI 1.03-7.66) and conflict with supervisor (OR 5.03, 95% CI 1.13-22.1). While lower individual resilience (OR 0.69, 95% CI 0.54-0.88) was statistically significantly associated with greater distress, it accounted for less than 10% of the overall variance when controlling for other work-related factors.

Conclusion

These findings suggest that developing organizational interventions that address institutional support for non-clinician biomedical researchers within academic medical centers represents an important opportunity to reduce distress within this population. While emphasizing individual resiliency as an important in the pursuit of well-being, it is also the responsibility of the organization to create and foster an environment in which employees can access their own resilience.

A National Survey of Job Satisfaction and Workload Among Emergency Medicine (EM) Residency Faculty

INTRODUCTION

 Faculty workload, and its relation to job satisfaction, has not been well studied in Emergency Medicine (EM).  Methods: A cross-sectional survey was conducted among EM physician faculty at 49 residency programs across the United States. We collected information on clinical and non-clinical (education, administration, and research) workload, demographics, and EM department characteristics, as well as job satisfaction measured using the Global Job Satisfaction (GJS) scale. Comparisons were made using Wilcox signed rank tests. Multivariable associations with job satisfaction were assessed in a regression model.

RESULTS

 Of 1,791 surveys sent, 265 were completed. The quantity of contracted clinical and non-clinical hours was lower than the actual clinical (difference (95% confidence interval (CI)): 2.7 (1.5-4.1)) and non-clinical hours (6.0 (3.8-8.8)) worked. Respondents preferred a distribution of 50% clinical work. However, the actual percentage was 62% (difference (95% CI): 14.4% (10.8%-17.6%)). Identifying as core faculty and required logging of non-clinical hours were associated with improved job satisfaction while increased percentage of time spent in the clinical and administrative domains were associated with significant declines.

CONCLUSIONS

 The estimated actual work performed by EM physician faculty is greater than contracted and misaligned with their preferred type of work, the latter of which is associated with decreased job satisfaction. Improved job satisfaction and faculty retention might be achieved by increasing the percentage of time devoted to education and research, by increasing the core faculty contingent and by implementing tracking of non-clinical efforts.

Submit It Again! Learning From Rejected Manuscripts

Rejection of manuscripts by academic journals can be devastating for the early-career family medicine faculty members. Taking experience from teaching early-career underrepresented in medicine faculty members writing and scholarship skills, we identify and explain five lessons to be learned from rejected manuscripts. The five lessons are: (1) rejections teach journal scope, (2) rejections teach process, (3) rejection should lead to resubmission, (4) rejections reflect writing effort, and (5) rejections happen to papers, not authors. Early-career family medicine faculty can use these lessons for reassurance and to adapt behaviors to remain in the scholarship arena.

Faculty retirements will likely exacerbate the anatomy educator shortage

Medical education has reported a shortage of anatomy educators since the 1960s. While the faculty pipeline has recently been explored, insights into retirement intentions, a key driver of faculty turnover, have yet to be investigated. With the mean age of anatomists rising, knowledge of retirement intentions among current educators is essential to understanding the anatomy educator shortage. This study explored the retirement intentions of current anatomy educators and their likely effects on the workforce. Surveys were distributed to department heads and the American Association for Anatomy (AAA) membership to inquire about job postings from 2018-2020 and retirement intentions, respectively. Department heads sought to fill open positions due to faculty retirements (36%, 15 of 42), faculty relocations/sabbaticals/new responsibilities (31%), and brand new positions (24%). The retirement intentions survey revealed that 61% (23 of 38) of faculty '55 and older' intend to retire within five years. Based on the extrapolation of AAA membership data, estimates suggest that almost twice as many anatomy faculty could retire per year (n = 40) over the next five years compared to the estimated number of annual PhD graduates (n = 22) likely to enter the workforce. Factors driving retirement intentions were overwhelmingly age and finances, followed by job satisfaction and family. The creation of new anatomy educator positions to address increased student enrollments and new health sciences programs is likely to place even greater strain on workforce demands.

Attributes of excellent clinician teachers and barriers to recognizing and rewarding clinician teachers' performances and achievements: a narrative review

BACKGROUND

Over the last 31 years, there have been several institutional efforts to better recognize and reward clinician teachers. However, the perception of inadequate recognition and rewards by clinician teachers for their clinical teaching performance and achievements remains. The objective of this narrative review is two-fold: deepen understanding of the attributes of excellent clinician teachers considered for recognition and reward decisions and identify the barriers clinician teachers face in receiving recognition and rewards.

METHODS

We searched OVID Medline, Embase, Education Source and Web of Science to identify relevant papers published between 1990 and 2020. After screening for eligibility, we conducted a content analysis of the findings from 43 relevant papers to identify key trends and issues in the literature.

RESULTS

We found the majority of relevant papers from the US context, a paucity of relevant papers from the Canadian context, and a declining international focus on the attributes of excellent clinician teachers and barriers to the recognition and rewarding of clinician teachers since 2010. 'Provides feedback', 'excellent communication skills', 'good supervision', and 'organizational skills' were common cognitive attributes considered for recognition and rewards. 'Stimulates', 'passionate and enthusiastic', and 'creates supportive environment', were common non-cognitive attributes considered for recognition and rewards. The devaluation of teaching, unclear criteria, and unreliable metrics were the main barriers to the recognition and rewarding of clinician teachers.

CONCLUSIONS

The findings of our narrative review highlight a need for local empirical research on recognition and reward issues to better inform local, context-specific reforms to policies and practices.

Changing gender gap and practice patterns in reproductive endocrinology and infertility subspecialists in the United States: a Society for Reproductive Endocrinology and Infertility report

OBJECTIVE

To identify changes in current practice patterns, salaries, and satisfaction by gender and by years in practice among board-certified reproductive endocrinology and infertility (REI) subspecialists in the United States.

DESIGN

Cross-sectional web-based survey including 37 questions conducted by the Society for Reproductive Endocrinology and Infertility.

SETTING

Not applicable.

PATIENT(S)

None.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

The primary outcome measures were total compensation and practice patterns compared by gender and the type of practice. The secondary outcomes included demographics, the number of in vitro fertilization cycles, surgeries performed, and the morale of survey respondents.

RESULT(S)

There were 370 respondents (48.4% women and 51.4% men). Compared with a similar survey conducted 6 years earlier, a 27% increase in the number of female respondents was observed in this survey. There was a marginally significant trend toward lower compensation for female than male REI subspecialists (17% lower, $472,807 vs. $571,969). The gap was seen for responders with ≥10 years' experience, which is also when there was the largest gap between private and academic practice (mean $820,997 vs, $391,600). Most (77%) felt positively about the current state of the reproductive endocrinology field, and >90% would choose the subspecialty again.

CONCLUSION(S)

There has been a substantial increase in the number of recent female REI subspecialists showing less disparity in compensation, and the gap appears to be closing. There is an increasing gap in compensation between private and academic practices with ≥5 years of experience. Reproductive endocrinology and infertility remains a high morale specialty.

Systems to support scholarly social media: a qualitative exploration of enablers and barriers to new scholarship in academic medicine

INTRODUCTION

As academia begins to incorporate modern communication technologies into its scholarly structures, there are both enablers and barriers which foster academics' uptake of these innovations. Those who are early adopters of academic social media - whether it be for education, research-related networking, or knowledge translation - may therefore be best positioned to highlight both enablers and barriers within their work environments.

METHODS

The authors conducted a constructivist grounded theory study to discern what prominent practitioners of academic social media (e.g. Twitter) have encountered in their careers. Participants were recruited via a snowball sampling technique and invited to participate in semi-structured interviews. Three investigators engaged in constant comparative analysis of incoming transcripts. To enhance rigour, we conducted an audit of the analysis and a participant member check.

RESULTS

Seventeen emerging influencers in the field of academic social media were recruited. After axial coding, the 30 enablers and 21 barriers to academic social media use were mapped to three spheres of influence: personal, institutional, and virtual. The investigators propose a framework that organizes these enablers and barriers around a tipping point where sustainability becomes possible.

CONCLUSIONS

Multiple enablers and barriers were described to influence social media users within academic medicine. By organizing these facets into a personal, institutional, and virtual framework along a spectrum, we can begin to understand the underlying structures that potentiate the academic ecosystems in which social media and similar innovations may flourish.

Guiding Academic Clinician Educators at Research-Intensive Institutions: a Framework for Chairs, Chiefs, and Mentors

Department chairs and division chiefs at research-intensive academic medical centers often find mentoring clinician educators challenging. These faculty constitute the majority of academic physicians. Supporting excellent clinician educators is key to ensuring high-quality patient care and developing tomorrow's physicians. Little has been written for leaders on strategies to advance academic clinician educators' career success. We present a framework to guide chairs, chiefs, and mentors seeking to address clinician educator retention and satisfaction in academic medical centers.

The Distinguished Teaching Society at the Johns Hopkins University School of Medicine: A Student-Led Initiative to Recognize Clinical Educators

PROBLEM

Some focus on recognizing excellence in clinical teaching has been lost with the increasing emphasis placed on clinical efficiency and value. Clinical teaching awards and academies of educators aim to address this problem. In 2015, medical student leaders at the Johns Hopkins University School of Medicine created the Distinguished Teaching Society (DTS), a student-driven program to recognize the best clinical educators.

APPROACH

Medical students designed a comprehensive scoring rubric focusing on 3 domains: feedback and evaluation, role model behavior, and teaching process. A student committee solicits student nominations providing narratives endorsing faculty or house staff for potential inclusion in the DTS. Using the rubric, student judges score each deidentified narrative nomination, as well as an application from finalists and comments about finalists submitted by the student body. Inductees are recognized at an annual ceremony.

OUTCOMES

From academic years 2015-2016 to 2018-2019, students nominated 254 unique candidates, and 82 nominees (32%) were inducted into the DTS. The majority of inductees were faculty and male. In 2017-2018 and 2018-2019, nearly half of inductees were female, and less than 10% of inductees self-reported as underrepresented in medicine and/or LGBTQ+. The Department of Internal Medicine had the greatest departmental representation. There were no statistically significant differences in the proportional representation within the nomination and inductee cohorts by gender, rank, and department. Several process changes were made in response to student feedback and to increase nominee and inductee diversity.

NEXT STEPS

Next steps include adding a diversity and inclusion chair to the student committee and collecting survey data on student and DTS inductee opinions on how to improve learner-teacher engagement and the clinical learning environment. Future activities may include educational workshops, panel discussions, mentorship programs, and networking events. Other medical schools may find value in considering similar structures.

An analysis of the challenges in recruiting clinical teachers in Iranian medical universities: A qualitative analysis

BACKGROUND

Employing appropriate and deserving staff is goal of human resource management (HRM). A group of staff at medical science universities are clinical teachers. Considering the position and importance of these peoples, this study addresses the challenges of recruiting clinical teachers.

MATERIALS AND METHODS

This is a qualitative study of the conventional content analysis done in Isfahan medical university in 2018. The participants were selected through intensity sampling of purposive sampling method, and data were obtained through semi-structured interviews conducted to survey 23 experts and clinical faculty members concerning the challenges involved in employing clinical teachers. Data were analyzed using conventional content analysis method and OneNote 2013.

RESULTS

Two main categories and ten subcategories were classified as follows: HRM inadequacy in educational departments with six subscales such as indefiniteness of the workforce status for HR managers, reluctance of educational departments to increase human resources, nonproportionality of the teacher-student ratio, recruitment of faculty based on the needs in the treatment sector, weakness of the infrastructure to use nonfaculty teachers, and reduced public interest in employment as a faculty and weakness of the selection process with four subscales based on data analysis such as undesirable manner of selection, recruitment based on the score given by the national board of medical examiners, purpose-based calls to recruit predefined individuals, and personal and emotional issues, rather than managerial standards, governing cooperation with teachers.

CONCLUSION

Recruitment process is part of HRM tasks. Employment system in a medical sciences university must be considered to improve the clinical faculty recruitment. HRM inadequacy in educational departments and weakness of the selection process are challenges that affect the employment system. According to these findings, it is necessary to review the regulations and tasks of HRM in medical sciences universities.

Implementation and Assessment of a Visiting Scholar Exchange Program in Pediatric Anesthesiology to Promote Junior Faculty and Fellow Professional Development

BACKGROUND

Junior faculty in academic medicine often struggle with establishing their careers, resulting in low promotion and high attrition rates. Fellows also grapple with the decision to pursue careers in academic medicine. We report on the implementation and evaluation of a novel faculty and fellows exchange program that promotes career development.

METHODS

In 2017, the University of California San Francisco created a reciprocal faculty exchange program called the Visiting Scholars in Pediatric Anesthesia Program (ViSiPAP). ViSiPAP expanded to involve 17 institutions across the United States. Fellows from 3 of the institutions were paired with faculty mentors to create Fellow/Faculty ViSiPAP. An initial postparticipation survey was sent after each exchange, and a follow-up survey in 2020 assessed ViSiPAP's impact.

RESULTS

Fifty-three faculty participated in ViSiPAP and gave 66 presentations, and 20 fellows from 3 institutions gave 20 presentations. The initial postparticipation survey response rate was 88%, and the follow-up survey response rate was 74%. Survey responses indicated that ViSiPAP enhanced fellow and faculty well-being, improved didactic conferences, and provided opportunities for networking and collaborating. The follow-up survey indicated that participation in ViSiPAP led to 45 online academic publications, 39 additional invited presentations, and 8 authorships in peer-reviewed academic journals.

CONCLUSIONS

ViSiPAP is a successful professional development program for both fellows and junior faculty in pediatric anesthesia. Our program successfully introduced the participants into the pediatric anesthesia community and jumpstarted academic careers. Participation in ViSiPAP led to increased scholarly output and assisted with faculty promotion. This combined fellow/faculty exchange program is a novel approach to professional development and is broadly applicable to other disciplines in academic medicine.

Organizational behavior among academic medical school faculty

The study of organizational behavior in an academic medical school setting has many variables for consideration, including fragmentation, responsibilities, professionalism, burnout, and gender. In this Commentary, the author highlights some major factors affecting osteopathic physicians who practice in an academic setting, to bring to the attention of the medical community some of the inherent problems with modern academic medical education structure.

Mentoring New and Early-Stage Investigators and Underrepresented Minority Faculty for Research Success in Health-Related Fields: An Integrative Literature Review (2010-2020)

Mentoring to develop research skills is an important strategy for facilitating faculty success. The purpose of this study was to conduct an integrative literature review to examine the barriers and facilitators to mentoring in health-related research, particularly for three categories: new investigators (NI), early-stage investigators (ESI) and underrepresented minority faculty (UMF). PsychINFO, CINAHL and PubMed were searched for papers published in English from 2010 to 2020, and 46 papers were reviewed. Most papers recommended having multiple mentors and many recommended assessing baseline research skills. Barriers and facilitators were both individual and institutional. Individual barriers mentioned most frequently were a lack of time and finding work-life balance. UMF mentioned barriers related to bias, discrimination and isolation. Institutional barriers included lack of mentors, lack of access to resources, and heavy teaching and service loads. UMF experienced institutional barriers such as devaluation of experience or expertise. Individual facilitators were subdivided and included writing and synthesis as technical skills, networking and collaborating as interpersonal skills, and accountability, leadership, time management, and resilience/grit as personal skills. Institutional facilitators included access to mentoring, professional development opportunities, and workload assigned to research. Advocacy for diversity and cultural humility were included as unique interpersonal and institutional facilitators for UMF. Several overlapping and unique barriers and facilitators to mentoring for research success for NI, ESI and UMF in the health-related disciplines are presented.

Clinician-Educator Training and Its Impact on Career Success: a Mixed Methods Study

BACKGROUND

Clinician-educator (CE) careers in academic medicine are heterogeneous. Expectations for CEs have grown, along with a need to better prepare CEs for these roles.

OBJECTIVE

To assess whether advanced education training is associated with productivity and success.

DESIGN

We used a sequential mixed methods approach, collecting quantitative survey data and qualitative focus groups data. We developed a three-tiered categorization of advanced training to reflect intensity by program type.

PARTICIPANTS

We surveyed CEs in the Society of General Internal Medicine (SGIM) and conducted two focus groups at an SGIM annual meeting.

MAIN MEASURES

Primary outcomes were academic productivity (manuscripts, presentations, etc.) and leadership role attainment. Secondary analysis examined the interactive effect of gender and training intensity on these outcomes.

KEY RESULTS

A total of 198 completed the survey (response rate 53%). Compared with medium- or low-intensity training, high-intensity training was associated with a greater likelihood of publishing ≥ 3 first- or senior-author manuscripts (adjusted OR 2.6; CI 0.8-8.6; p = 0.002), teaching ≥ 3 lectures/workshops at the regional/national/international level (adjusted OR 5.7; CI 1.5-21.3; p = 0.001), and having ≥ 3 regional/national committee memberships (adjusted OR 3.4; CI 1.0-11.7; p = 0.04). Among participants in the "no training" and "high-intensity training" categories, men were more likely to have ≥ 3 publications (OR 4.87 and 3.17, respectively), while women in the high intensity category had a likelihood similar to men with no training (OR 4.81 vs. OR 4.87). Participants felt the value of advanced training exists not only in content but also in networking opportunities that programs provide.

CONCLUSIONS

While opinions were divided as to whether advanced training is necessary to position oneself for education roles, it is associated with greater academic productivity and reduced gender disparity in the publication domain. Institutions should consider providing opportunities for CEs to pursue advanced education training.

Program Director Retention and Attrition Rates in International Graduate Medical Education

BACKGROUND

Program directors (PDs) are integral to the education of the next generation of physicians. Yet, administrative burdens, substantial patient care responsibilities, and lack of protected time for teaching may contribute to work-life imbalance and physician burnout, leading to high rates of attrition. Data on international residency program leadership turnover are lacking.

OBJECTIVE

This study aimed to quantify PD turnover in Accreditation Council for Graduate Medical Education-International (ACGME-I) accredited programs in Singapore, United Arab Emirates (UAE), and Qatar, and to compare to US PD attrition rates.

METHODS

Data on PD turnover in international programs was extracted from the ACGME-I Accreditation Data System for academic years 2010-2011 through 2018-2019 for Singapore and 2013-2014 through 2018-2019 for UAE and Qatar. Rates of PD turnover were calculated by country and by ACGME-I medical-, surgical-, and hospital-based specialty groupings and compared using χ² test. Annual US PD turnover data was extracted from the ACGME's Data Resource Book.

RESULTS

Seventy programs met inclusion criteria. International PD attrition was high, with 56 programs (80%) changing PDs since program inception, and 16 programs (29%) having 2 or more PD turnovers. There was no significant difference between PD turnover rates in hospital (83%), medical (79%), or surgical (78%) specialties. International PD attrition rates varied from 7% to 20% annually and were comparable to PD turnover in US programs (range 12%-15%).

CONCLUSIONS

High PD turnover rates in newly accredited international residency programs were noted, although annual attrition rates were comparable to US residency programs.

Scholarly productivity of faculty in primary care roles related to tenure versus non-tenure tracks

BACKGROUND

Increasing the number of primary care physicians is critical to overcoming the shortage of healthcare providers. Primary care physicians are increasingly called upon to address not only medical concerns but also behavioral health needs and social determinants of health which requires ongoing research and innovation. This paper evaluated scholarly productivity of faculty in tenure versus non-tenure tracks in primary care roles, defined as family medicine, internal medicine, internal medicine/pediatrics and pediatrics.

METHODS

The study included physician faculty in the clinical departments of Brody School of Medicine serving between the 2014-2015 and 2018-2019 academic years. Department, track, and rank at the beginning of each academic year (e.g., 2014-2015) were correlated with having any publications in the following calendar year (e.g., 2015), as determined from a search of the Scopus database.

RESULTS

A total of 1620 observations and 542 unique faculty were included in the analysis. As of 2018-2019, 19% percent of primary care faculty were either tenured or on tenure track, as compared to 41% of faculty in other departments (p < 0.001). Primary care departments were also disproportionately staffed by junior faculty (60% as compared to 48% in other departments; p = 0.087). The proportion of faculty with any publications was significantly higher for faculty on the tenure track compared to those not on the tenure track (34% vs. 14%, p < 0.001).

CONCLUSIONS

Academic productivity was lower among non-tenure-track physician faculty, as measured by publication in peer-reviewed journals. This was exacerbated among faculty in primary care departments, who were also more likely to hold non-tenure-track appointments. The loss of tenure-track positions disproportionately impacts scholarly activity in primary care and may be limiting progress in care-oriented research. Findings suggest that providing non-tenure faculty the time and resources to be involved in research, in addition to their clinical work, as well as access to research collaborators and mentors can promote scholarly activity among this group.

A Qualitative Evaluation of a Clinical Faculty Mentorship Program Using a Realist Evaluation Approach

OBJECTIVE

Clinically focused faculty (full-time clinical faculty and clinician educators) comprise an increasing proportion of academic faculty, yet they underutilize mentorship nationally. The aims of this study were to test and refine a program theory for an institutional mentorship program for junior clinically focused faculty and to understand the facilitators and barriers of sustained participation.

METHODS

We conducted a qualitative study using a realist evaluation approach. Between July and December 2017, we performed in-depth semistructured interviews of 2 participant groups from a junior faculty mentorship program at our institution: 1) those who attended more than two thirds of the program sessions; and 2) those who only attended 1 session. We used inductive thematic analysis to identify key context and program mechanisms that led to meaningful outcomes for faculty mentorship.

RESULTS

We interviewed 23 junior faculty representing 15 pediatric specialties. We identified 4 contextual themes (past personal experience, current competing priorities, institutional culture, and gaps in support and resources), 3 mechanisms (connecting with faculty, sharing ideas and strategies, and self-reflecting), and 3 outcomes (sense of community, acquired tools and skills, and broadened perspectives), which we organized into a programmatic theory representing the program's impact on participants. Themes that emerged were consistent between both groups.

CONCLUSIONS

A mentorship program that provided junior faculty with opportunities to connect, share ideas and strategies, and self-reflect led to improvement in meaningful outcomes for clinically focused faculty. Our program theory provides a basis for institutions seeking to build a mentorship program targeted towards this increasing proportion of junior faculty.

A preliminary model for faculty workload for a highly integrated curriculum delivered by team-based learning

INTRODUCTION

We detail the process of developing a workload calculation model (WCM) for a highly integrated curriculum delivered by team-based learning, rationale for workload multipliers, and preliminary results of our effort to implement the WCM.

METHODS

Our WCM includes teaching, service, and scholarship, with a time buffer. The WCM utilizes multipliers for most work activities (teaching and service). For other activities, a fixed number of hours per year was used. The WCM was set up using Microsoft Excel. The development of the WCM was an iterative process in collaboration with the school's Faculty Affairs Committee, each department, and then individually with all faculty members.

RESULTS

The WCM had three sections. A section each for teaching and service workload calculations and a dashboard section to summarize workload calculations per department that added in time for scholarship and a buffer calculation (to allow flexibility for faculty). Teaching included classroom, experiential, and academic advising, all of which had unique multipliers. Service included committee work at all levels and student organization advising. A fourth section for time spent at individual faculty practice sites. Calculations were kept consistent between departments for most activities.

CONCLUSION

We developed a novel WCM to accommodate all of the major areas of workload for faculty at a private institution. The unique approach to building it included representing teaching in a highly integrated curriculum delivered via team-based learning and creating a buffer category to allow for workload individualization. The WCM is actively used in our school to proactively manage workload.

A survey of retaining faculty at a new medical school: opportunities, challenges and solutions

BACKGROUND

At well-established academic university settings, retaining faculty remains a pressing challenge due to competing market forces, decreasing institutional support, and changing personal expectations. There is a paucity of information about the difficulties faced by new medical schools to maintain their academic workforce. The objective of this study was to determine the challenges facing the faculty at a newly developed medical school.

METHODS

Twelve founding faculty were surveyed anonymously by a 32-item questionnaire. Their responses were independently analyzed by three researchers.

RESULTS

The views of the faculty were categorized into in four inter-related themes: personal, support, institutional, and environmental. The constant sources of satisfaction among faculty were higher academic rank (75%), harmonious inter-collegial relationships (74%), healthy pecuniary rewards (58%), better professional growth (58%) along with greater autonomy, administrative independence, minimum groupism and excellent team work. Poor opportunities for promotion (68%), reduced support for scholarly activities (67%) and unsatisfactory support from the administration (55%) were detrimental to retaining faculty.

CONCLUSION

By addressing specific issues facing its staff, every new medical school will not only manage to retain its academic faculty but also be able to attract well qualified academic staff from established medical institutions worldwide.