Academic Medicine Departments Research Articles

Decision Making in an Academic Department of Medicine: The Role of a Management Control System

Academic Departments of Medicine have several challenges in managing resources, meeting academic goals and clinical demands. In this paper, we describe a management control system installed in 2014: the Strategic Plan, a Balanced Scorecard reflecting clinical research and educational performance, Annual feedback and review by Departmental and Divisional Chairs, and Improvement Plans.
 This system over 8 years resulted in a reduction in 30-day re-admissions of 14%, a decline in length of stay of 0.55 days, and reduced absolute in-hospital mortality of nearly 2%. Clinical revenue increased 42% from 2016 to 2022 largely due to increased ambulatory and procedural volumes. Teaching time and ratings were unaffected by the installation of this system. Return on investment for newly hired researchers and scientists was 67.5% with a 12.7% increase in peer-reviewed funding. We conclude that the Decision Management Control System was feasible to create and allowed capable monitoring of performance and informed decision-making. Major metrics improved after its implementation.

Infrastructure Features Associated With Increased Department Research Capacity.

Although researchers have identified factors associated with research capacity in academic medicine departments, less is known about how a department builds research capacity over time. The Association of Departments of Family Medicine's Research Capacity Scale (RCS) can be used by departments to self-categorize into five capacity levels. Our current study aimed to describe the distribution of infrastructure features and to evaluate how the addition of infrastructure features influences movement of a department along the RCS. An online survey was sent to US family medicine department chairs in August 2021. Survey questions asked chairs to categorize their department's research capacity in 2018 and 2021 and also about the presence of infrastructure resources and changes in these features across 6 years. The response rate was 54.2%. Departments identified substantial variation in research capacity. Most departments classified into the middle three levels. Departments in higher levels were more likely than those at lower levels to have any of the infrastructure resources in 2021. Department size, as measured by full time faculty, was highly associated with department level. From 2018 and 2021, 43% of responding departments climbed at least one level. Of these, more than half added three or more infrastructure features. Adding a PhD researcher was the feature most associated with increasing research capacity (P<.001). Most departments that increased their research capacity added multiple additional infrastructure features. For chairs of departments without a PhD researcher, this additional resource may be the most impactful investment to increase research capacity.

Robert (Bob) John Novak June 5, 1947 to August 4, 2022

Dr. Robert Novak (“Dr. Bob”), our dear friend and colleague, passed away on August 4, 2022, at the age of 75, in Tampa, Florida. Much can be said about his academic credentials and accomplishments from his long career. He was a respected professor with multiple appointments in several academic departments of medicine, microbiology, and public health. He served as a consultant and advisor for numerous national and international organizations, including the EPA, WHO, Chinese Academy of Sciences, US Fish and Wildlife Service, National Center for Supercomputing Applications, Illinois Governor's Office and Pollution Control Board, Vector Control Division of the Puerto Rico Department of Public Health, Ministry of Health of the US Virgin Islands, US Agency for International Development in Honduras, US Army Medical Virology Institute in Fort Detrick, Maryland, Pan American Health Organization Aedes aegypti biology and control, and Pueblo (Colorado) Board of Water Works. Bob was a world-renowned medical entomologist with his research focused on mosquito biology and control. He was also a member of many professional organizations among which the American Mosquito Control Association (AMCA) and the Society for Vector Ecology (SOVE) stood so dear to him that he seldom missed their annual meetings. For his service and dedication, Bob received several AMCA awards: Presidential Citation (1993), Memorial Lecture Award (1998), and Medal of Honor (2003), while he served as the AMCA President in 1996–1997. He also served as SOVE President in 2007 and received the society's Distinguished Service Award in 2013. While his many notable accomplishments and contributions can be addressed by others, to me and many others, he was known as Dr. Bob, or simply Bob. We all know how much he loved Colorado, second only to how much he loved his wife, Lorraine. His stories about his upbringing on a cattle ranch and how that influenced his decision to enter the field of public health are legendary. The funny thing is that he loved animals but found the connection between them and the bugs that fed on them to be fascinating. This happens to the vast majority of those of us working in medical and livestock entomology, so we all accepted his comments as par for the course, never odd.Bob was a great man. It's been said that you can gauge a person's greatness according to their degree of commitment, and this was certainly true of Bob. A person like Bob is great because he speaks directly to you and lives according to what he says, and when he treats you with affection and respect. A person is great when he does not think about only himself, when he behaves in a kind way, when he provides support, or when he supports others when they most need him. Bob always demonstrated what is most important between two people: friendship, companionship, affection, and respect. Bob was a giant. He was always interested in your life and looked for opportunities for your personal and professional growth, encouraging his students and colleagues to dream and explore areas outside the conventional box. This was especially true when it meant doing things everyone else thought were so farfetched and impossible, such as his project with the satellite imagery for mosquito surveillance and control.Bob never allowed himself to be governed by clichéd behaviors and cared little for how he looked in front of others. He abhorred being manipulated or handling people like a puppeteer. He dealt with most disappointments with grace and deference and shared his opinions clearly and with certainty. Bob was blunt and direct, but he always tried to understand the perspectives of others even when he didn't see things the same way they did. We all have at least one instance when his bluntness was clearly manifested, to be washed off later with a beer. He always placed himself in your position and judged you on what he expected from himself under that circumstance. In his personal life, Bob enjoyed fine and exotic dining. Very seldom can one witness a person enjoy the pleasure of a new dish the way he enjoyed fried crickets and sautéed scorpions at a roadside diner in Cambodia or a bowl of mystery porridge served in a crusty bowl as he did at a gourmet dinner in Eritrea close to the border with Sudan.Bob was a consummate field entomologist who could not be judged through centimeters, meters, or wealth. He was defined by his actions, honesty, and decency, and will be remembered as kind and respectful of the feelings and interests of others.Dr. Bob was a great man whose memory and joy for living will remain vibrant in the hearts of many. For his sensitivity and how he treated others, Dr. Bob was a giant.

Promoting scholarship in improvement science: A model for academic clinical departments.

Clinical departments at academic medical centers strive to deliver clinical care, provide education and training, support faculty development, and promote scholarship. These departments have experienced increasing demands to improve the quality, safety, and value of care delivery. However, many academic departments lack a sufficient number of clinical faculty members with expertise in improvement science to lead initiatives, teach, and generate scholarship. In this article, we describe the structure, activities, and early outcomes of a program within an academic department of medicine to promote scholarly improvement work. The Department of Medicine at the University of Vermont Medical Center launched a Quality Program with three primary goals: (a) improve care delivery, (b) provide education and training, and (c) promote scholarship in improvement science. The program serves as a resource center for students, trainees and faculty, offering education and training, analytic support, consultation in design and methodology, and project management. It strives to integrate education, research, and care delivery to learn, apply evidence and improve health care. Over the first 3 years of full implementation, the Quality Program supported an average of 123 projects annually, including prospective clinical quality improvement initiatives, retrospective assessment of clinical programs and practices, and curriculum development and evaluation. The projects have yielded a total of 127 scholarly products, defined as peer-reviewed publications and abstracts, posters, and oral presentations at local, regional, and national conferences. The Quality Program may serve as a practical model for promoting care delivery improvement, training, and scholarship in improvement science while advancing the goals of a learning health system at the level of an academic clinical department. Dedicated resources within such departments offer the potential to enhance care delivery while promoting academic success for faculty and trainees in improvement science.

Beyond the ratings: gender effects in written comments from clinical teaching assessments.

Assessment of clinical teachers by learners is problematic. Construct-irrelevant factors influence ratings, and women teachers often receive lower ratings than men. However, most studies focus only on numeric scores. Therefore, the authors analyzed written comments on 4032 teacher assessments, representing 282 women and 448 men teachers in one Department of Medicine, to explore for gender differences. NVivo was used to search for 61 evidence- and theoretically-based terms purported to reflect teaching excellence, which were analyzed using 2 × 2 chi-squared tests. The Linguistic Index and Word Count (LIWC) was used to categorize comment data, which were analyzed using linear regressions. The only significant difference in NVivo was that men were more likely than women to have the word "available" in a comment (OR 1.4, p < .05). A subset of LIWC variables showed significant gender differences, but all effects were modest. Men teachers had more positive emotion words written about them, while negative emotion words appeared equally. Significant differences occurred more often between the men and women residents who wrote the comments, rather than those attributed to the gender of the teachers. For example, women residents used more social and gender-related words (β 1.87, p < 0.001) and fewer words related to power or achievement (β -3.78, p < 0.001) than men residents. Profound gender differences were not found in teacher assessment comments in this large, diverse academic department of medicine, which differs from other studies. The authors explore possible reasons including differences in departmental culture and issues related to the methods used.

A survey of chairpersons of departments of medicine about the current and future roles of clinical genetics in internal medicine

Purpose: The response of academic Departments of Medicine (DOM), who train the bulk of future US internists, to the increasing importance of clinical genetics is not known.Methods: A survey was distributed to 153 DOM chairpersons assessing the current and future roles of clinical genetics as related to internal medicine.Results: Eighty-five (56%) surveys with complete data were returned. A minority of DOM currently employ geneticists; most genetics education and services are provided by nongeneticists; the general competency of internists to deliver genetic services is unclear.Conclusions: Academic DOM have limited faculty expertise in clinical genetics; this may impact the ability to integrate genetics into internal medicine practice and training.

CREATING AND IMPLEMENTING FACILITATED DIALOGS ON ANTIRACISM IN PSYCHIATRY, CHILD PSYCHIATRY, AND ACADEMIC MEDICINE

There is a significant and urgent need across psychiatry and other academic medicine departments to design, create, and execute effective dialogues on race, while examining unconscious bias and privilege. The overarching goal of facilitated dialogue is to create a safe space for faculty, staff, and trainees of different racial backgrounds to engage in meaningful dialogue that helps all develop an antiracist approach to their work and lives.

The impact of organizational culture on professional fulfillment and burnout in an academic department of medicine.

Physician wellness is vital to career satisfaction, provision of high quality patient care, and the successful education of the next generation of physicians. Despite this, the number of physicians experience symptoms of burnout is rising. To assess the impact of organizational culture on physicians' professional fulfillment and burnout, we surveyed full-time Department of Medicine members at the University of Toronto. A cross-sectional survey assessed: physician factors (age, gender, minority status, disability, desire to reduce clinical workload); workplace culture (efforts to create a collegial environment, respectful/civil interactions, confidence to address unprofessionalism without reprisal, witnessed and/or personally experienced unprofessionalism); professional fulfillment and burnout using the Stanford Professional Fulfillment Index. We used multivariable linear regression to examine the relationship of measures of workplace culture on professional fulfillment and burnout (scores 0-10), controlling for physician factors. Of 419 respondents (52.0% response rate), we included 400 with complete professional fulfillment and burnout data in analyses (60% ≤ age 50, 45% female). Mean scores for professional fulfillment and burnout were 6.7±1.9 and 2.8±1.9, respectively. Controlling for physician factors, professional fulfillment was associated with satisfaction with efforts to create a collegial environment (adjusted beta 0.45, 95% CI 0.21 to 0.70) and agreement that colleagues were respectful/civil (adjusted beta 0.85, 95% CI 0.53 to 1.17). Lower professional fulfillment was associated with higher burnout scores. Controlling for professional fulfillment and physician factors, lower confidence in taking action to address unprofessionalism (adjusted beta -0.22, 95% CI -0.40 to -0.03) was associated with burnout. Organizational culture and physician factors had an impact on professional fulfillment and burnout. Professional fulfillment partially mediated the relationship between organizational culture and burnout. Strategies that promote inclusion, respect and civility, and safe ways to report workplace unprofessionalism are needed in academic medicine.

Description of a Multi-faceted COVID-19 Pandemic Physician Workforce Plan at a Multi-site Academic Health System

BackgroundThe evolving COVID-19 pandemic has and continues to present a threat to health system capacity. Rapidly expanding an existing acute care physician workforce is critical to pandemic response planning in large urban academic health systems.InterventionThe Medical Emergency-Pandemic Operations Command (MEOC)—a multi-specialty team of physicians, operational leaders, and support staff within an academic Department of Medicine in Calgary, Canada—partnered with its provincial health system to rapidly develop a comprehensive, scalable pandemic physician workforce plan for non-ventilated inpatients with COVID-19 across multiple hospitals. The MEOC Pandemic Plan comprised seven components, each with unique structure and processes.MethodsIn this manuscript, we describe MEOC’s Pandemic Plan that was designed and implemented from March to May 2020 and re-escalated in October 2020. We report on the plan’s structure and process, early implementation outcomes, and unforeseen challenges. Data sources included MEOC documents, health system, public health, and physician engagement implementation data.Key ResultsFrom March 5 to October 26, 2020, 427 patients were admitted to COVID-19 units in Calgary hospitals. In the initial implementation period (March–May 2020), MEOC communications reached over 2500 physicians, leading to 1446 physicians volunteering to provide care on COVID-19 units. Of these, 234 physicians signed up for hospital shifts, and 227 physicians received in-person personal protective equipment simulation training. Ninety-three physicians were deployed on COVID-19 units at four large acute care hospitals. The resurgence of cases in September 2020 has prompted re-escalation including re-activation of COVID-19 units.ConclusionsMEOC leveraged an academic health system partnership to rapidly design, implement, and refine a comprehensive, scalable COVID-19 acute care physician workforce plan whose components are readily applicable across jurisdictions or healthcare crises. This description may guide other institutions responding to COVID-19 and future health emergencies.

Delivering Complex Care: Designing for Patients and Physicians

The management of high-utilizing patients is an area of active research with broad implications for the healthcare system. There are significant operational challenges to designing primary care models for these medically complex, high-needs patients. Although it is crucial to provide a high degree of continuity of care for this population, managing a cohort of these patients can lead to provider over-work and attrition. This may be magnified by the lack of training dedicated to addressing the unique care needs of these patients. While academic medical centers would seem well suited to care for individuals with multimorbidity needing intensive and specialized treatment, primary care providers in this setting need additional support to be clinically available for patients while pursuing scholarship and teaching. Formally recognizing intensive outpatient care as a specialty within internal medicine would help overcome some of these challenges. This would require a committed effort to high-level systems changes including a new focus on graduate medical education, the creation of division-level infrastructure within academic departments of medicine, and realistic levels of financial support to make this a viable career path.

Building Leadership Capacity for Mission Execution in a Large Academic Department of Medicine

Building Leadership Capacity for Mission Execution in a Large Academic Department of Medicine

A Perspective on the Baltimore Freddie Gray Riots: Turning Tragedy Into Civic Engagement and Culture Change in an Academic Department of Medicine.

The Johns Hopkins University School of Medicine Department of Medicine (DOM) sought ways of enhancing community engagement after the death of Freddie Gray and consequent unrest in Baltimore City. The DOM launched a five-part noon lecture series in May 2015-"Journeys in Medicine"-to facilitate discussion among DOM faculty, staff, trainees, and community residents regarding the city's unrest. This evolved into a department-wide civic engagement initiative in July 2016 to enhance employee and community engagement. The civic engagement committee is composed of two collaborative steering committees: Staff Engagement and Community Engagement. The DOM has sponsored and/or participated in programs to address major concerns raised during the Journeys in Medicine series-improving the strained relationship between police and the community, mentoring young people, involving more DOM employees in community activities, sharing research results with the community, and addressing cultural differences to enhance relationships and communication. To enhance staff engagement, a Nursing Diversity Council, complementing the Faculty Diversity Council, has been established. DOM faculty and staff have participated in and championed several disease-focused physical activity endeavors (e.g., walks) that, collectively, have raised over $40,000. Community service projects include supporting registration and screenings at a local health fair, a professional clothing drive, and DOM Days of Service. The Johns Hopkins University School of Medicine DOM is developing an administrator leadership program and continuing to participate in meaningful activities, leading to tangible outcomes designed to strengthen connections to the surrounding neighborhood and enhance engagement among all DOM employees.

The impact of active mentorship: results from a survey of faculty in the Department of Medicine at Massachusetts General Hospital

BackgroundTo assess mentorship experiences among the faculty of a large academic department of medicine and to examine how those experiences relate to academic advancement and job satisfaction.MethodsAmong faculty members in the Massachusetts General Hospital Department of Medicine, we assessed personal and professional characteristics as well as job satisfaction and examined their relationship with two mentorship dimensions: (1) currently have a mentor and (2) role as a mentor. We also developed a mentorship quality score and examined the relationship of each mentorship variable to academic advancement and job satisfaction.Results553/988 (56.0%) of eligible participants responded. 64.9% reported currently having a mentor, of whom 21.3% provided their mentor a low quality score; 66.6% reported serving as a mentor to others. Faculty with a current mentor had a 3.50-fold increased odds of serving as a mentor to others (OR 3.50, 95% CI 1.84–6.67, p < 0.001). Faculty who reported their mentorship as high quality had a decreased likelihood of being stalled in rank (OR 0.28, 95% CI: 0.10–0.78, p = 0.02) and an increased likelihood of high job satisfaction (OR 3.91, 95% CI 1.77–8.63, p < 0.001) compared with those who reported their mentorship of low quality; further, having a low mentorship score had a similar relationship to job satisfaction as not having a mentor.ConclusionsA majority of faculty survey respondents had mentorship, though not all of it of high caliber. Because quality mentorship significantly and substantially impacts both academic progress and job satisfaction, efforts devoted to improve the adoption and the quality of mentorship should be prioritized.

A systematic review of interventions to support the careers of women in academic medicine and other disciplines

ObjectiveTo summarise quantitative evaluations of interventions designed to support the careers of women in academia of any discipline.MethodA systematic search of English entries in PubMed, CINAHL and Google Scholar was...

A Department of Medicine Infrastructure for Patient Safety and Clinical Quality Improvement.

Payers, providers, and patients increasingly recognize the importance of quality and safety in health care. Academic Departments of Medicine can advance quality and safety given the large populations they serve and the broad spectrum of diseases they treat. However, there are only few detailed examples of how quality and safety can be organized. This article describes a practical model at The Johns Hopkins Hospital Department of Medicine and details its structure and operation within a large academic health system. It is based on a fractal model that integrates multiple smaller units similar in structure (composition of faculty/staff), process (use of similar tools), and approach (using a common framework to address issues). This organization stresses local, multidisciplinary leadership, facilitates horizontal connections for peer learning, and maintains vertical connections for broader accountability.

The effect of a monetary incentive for administrative assistants on the survey response rate: a randomized controlled trial.

BackgroundThere is sufficient evidence that monetary incentives are effective in increasing survey response rates in the general population as well as with physicians. The objective of this study was to assess the impact of a monetary incentive intended for administrative assistants on the survey response rate of physicians in leadership positions.MethodsThis was an ancillary study to a national survey of chairs of academic Departments of Medicine in the United States about measuring faculty productivity. We randomized survey participants to receive or not receive a $5 gift card enclosed in the survey package. The cover letter explained that the gift card was intended for the administrative assistants as a “thank you for their time.” We compared the response rates between the 2 study arms using the Chi-square test.ResultsOut of 152 participants to whom survey packages were mailed to, a total of 78 responses were received (51 % response rate). The response rates were 59 % in the incentive arm and 46 % in the no incentive arm. The relative effect of the incentive compared to no monetary incentive was borderline statistically significant (relative risk (RR) = 1.36, 95 % confidence interval (CI) 0.99 to 1.87; p = 0.055).ConclusionMonetary incentives intended for administrative assistants likely increase the response rate of physicians in leadership positions.

The Department of Medicine in 2030: A Look Ahead

The authors described the features of a hypothetical academic Department of Medicine in 2030 that would be most effective in improving the public health. Future departments of medicine will be compelled to respond to a projected shortage of physicians through augmented training strategies. The clinical programs will be more decentralized and responsive to patient preferences while demonstrating greater value. Departments will create adaptable, accountable structures in which clinicians working in interdisciplinary teams continuously improve processes and outcomes of care, and clinician and patient satisfaction. The restructuring of health care will afford exciting opportunities to align clinical and scholarly activities. The growing ability to link biological and clinical phenotypic information will lead to more effective and efficient clinical care. In view of the funding constraints and the remarkable opportunities for high-impact research, departmental research programs will become increasingly disciplined. Successful research programs will require durable investments in faculty career development, enabling infrastructure, interdisciplinary research teams, and diverse funding sources. The educational programs will demonstrate proficiency of trainees in the 6 current core competencies, as well as in additional areas critical to health care transformation. To improve organizational effectiveness, departments will create more nimble organizational structures led by individuals with diverse backgrounds. Chairs of departments of medicine will be expected to continuously expand their capacity to meet the evolving needs of their departments and institutions. Members of departments of medicine will be continuously fortified by the privilege and obligations of our profession while embracing the risks necessary to meet the extraordinary opportunities in 2030.

Analysis of research ethics board approval times in an academic department of medicine.

As part of an ongoing effort to better understand barriers to academic research, we reviewed and analyzed the process of research ethics applications, focusing on ethics approval time, within the Department of Medicine from 2006 to 2011. A total of 1,268 applications for approval to use human subjects in research were included in our analysis. Three variables, risk category (minimal vs. non-minimal risk), type of funding, and year of submission, were statistically significant for prediction of ethics approval time, with risk status being the most important of these. The covariate-adjusted mean time for approval for minimal risk studies (35.7 days) was less than half that of non-minimal risk protocols (76.5 days). Studies funded through a for-profit sponsor had significantly longer approval times than those funded through other means but were also predominantly (87%) non-minimal risk protocols. Further investigations of the reasons underlying the observed differences are needed to determine whether improved training for research ethics board (REB) members and/or greater dialogue with investigators may reduce the lengthy approval times associated with non-minimal risk protocols.

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

To address a dearth of mentoring and to avoid the pitfalls of dyadic mentoring, the authors implemented and evaluated a novel collaborative group peer mentoring program in a large academic department of medicine. The mentoring program aimed to facilitate faculty in their career planning, and targeted either early-career or midcareer faculty in 5 cohorts over 4 years, from 2010 to 2014. Each cohort of 9-12 faculty participated in a yearlong program with foundations in adult learning, relationship formation, mindfulness, and culture change. Participants convened for an entire day, once a month. Sessions incorporated facilitated stepwise and values-based career planning, skill development, and reflective practice. Early-career faculty participated in an integrated writing program and midcareer faculty in leadership development. Overall attendance of the 51 participants was 96%, and only 3 of 51 faculty who completed the program left the medical school during the 4 years. All faculty completed a written detailed structured academic development plan. Participants experienced an enhanced, inclusive, and appreciative culture; clarified their own career goals, values, strengths and priorities; enhanced their enthusiasm for collaboration; and developed skills. The program results highlight the need for faculty to personally experience the power of forming deep relationships with their peers for fostering successful career development and vitality. The outcomes of faculty humanity, vitality, professionalism, relationships, appreciation of diversity, and creativity are essential to the multiple missions of academic medicine.

Improving the Ambulatory Patient Experience Within an Academic Department of Medicine.

Academic departments of medicine (ADOM) can provide an important vehicle to drive the sharing and dissemination of best practices in clinical care delivery. With the increased focus on improving the patient experience, particularly in the ambulatory setting, ADOM also should lead efforts to cultivate improvements in this arena. To address this need, the study ADOM established a Patient Experience Working Group (PEWG) that brought together physician and nonphysician leaders, set improvement goals, and created a structure for sharing and learning. Since initiation, the PEWG has implemented more than 20 performance improvement initiatives, which have resulted in measured positive changes at both the local practice settings and department-wide. Striking the right balance between top-down governance, bottom-up innovation and ownership, and shared goal setting was a key to success. This model is one that could easily be adopted by other ADOM in their own efforts to improve the patient experience.