Academic Health Center Faculty Research Articles

KATP Channels Function in the Peripheral and Central Nervous Systems in a Mouse Model of Type 2 Diabetes

Over 50% of individuals with type 2 diabetes eventually develop diabetic neuropathy. There is a need for increased knowledge in how diabetes affects structural and molecular changes in the nervous system, and how current diabetes interventions affect the progression of chronic pain. Loss of KATP channel activity or function could cause nerve fiber hypersensitivity and consequently increased pain sensitivity due to neuron depolarization. Diabetic neuropathy was induced in male and female C57Bl6 mice over a total of 16 weeks by feeding the animals a high-fat diet (HFD) or corresponding control diet (12330 and 12328, Research Diets Inc., New Brunswick, NJ) for over 16 weeks. Mice on the HFD for at longer than 8 weeks have significantly lower mechanical thresholds and compared to control diet mice. Decreased expression of KATP channel subunits in the spinal cord, and dorsal root ganglia were correlated with decreased mechanical paw withdrawal thresholds. Mice fed a HFD also have decreased analgesia to systemic morphine (0-20 mg/kg, s.c.), which is exacerbated after systemic treatment with glyburide or nateglinide for four weeks, (KATP channel antagonist, glyburide or nateglinide, 50 mg/kg/day, IP or vehicle, 5% DMSO + 0.5% Tween). Upregulation of KATP channels using a viral vector strategy increased paw withdrawal thresholds to systemic morphine. Diabetes affects many adults including those with prediabetes and new-onset diabetes. It is clear that novel biomarkers and pharmaceutical targets are needed in order to (1) confront the demand for new treatments that better manage and (2) identify patients that may develop diabetic neuropathy. Further investigation of KATP channel expression and function during chronic pain syndromes, including diabetic neuropathy, may help to find sufficient treatment options for patients. This work was supported through a University of Minnesota Academic Health Center Faculty Development Grant to AHK and MLG. Funding also provided by the NIH: K01 DA042902, R01 DA051876, and UL1TR002494 (AHK).

Faculty leadership development: A case study of a synergistic approach

Introduction Ongoing leadership development is essential for academic health center faculty members to respond to increasing environmental complexity. At the George Washington University School of Medicine and Health Sciences, an 8-month program, based on Conger’s leadership development approach emphasizing conceptual understanding, skill building, feedback and personal growth was offered to mid-level faculty charged with developing educational programs, clinical services, and/or research initiatives. We studied how specific learning methods catering to different learning approaches contributed to improving leadership competencies. Methods Session and program evaluations, participant interviews, mentor surveys, and supervisor interviews were used for data collection. Themes were identified through open coding with use of constant comparative methods to help find patterns in the data. Results Readings and classroom modules provided a broadened, holistic understanding of leadership; role plays and action plans helped participants apply and practice leadership skills; self-assessments and feedback from peers and mentors provided specifics for focusing development efforts; and personal growth exercises provided opportunities to reflect and consider fresh perspectives. Anchoring learning methods around a real-time project led to improved leadership competencies and personal confidence as reported by participants, supervisors and mentors. Conclusion A faculty leadership development program that integrates understanding, skill building, feedback and personal growth and connects multiple learning methods can provide the synergy to facilitate behavior change and organizational growth.

Open Office Space: The Wave of the Future for Academic Health Centers?

Facing space constraints similar to those experienced by many urban campuses, the University of California, San Francisco (UCSF) looked to innovative office workplace design to curb growing facilities expenditures. Mission Hall, a new office building primarily for desktop and clinical researchers and staff, was designed as an activity-based workplace (ABW), a type of open-space design. ABW was simultaneously being proposed as the template for future UCSF desktop research workspaces. ABWs can be less costly to construct than other designs, and their mix of shared and open workspaces is intended to improve efficiency and interaction. Evaluations of ABWs in corporate settings have yielded mixed results. Examples of ABW buildings for faculty in academic health centers (AHCs) are rare.The Mission Hall experience provided a unique opportunity to understand the impact of an ABW design on faculty satisfaction, work effectiveness, well-being, and engagement. In a 2016 survey of faculty, 1 year after occupancy, respondents reported adverse changes in all 4 areas. The most common complaints involved noise exposure and lack of visual and auditory privacy. In response to these issues, faculty reported working at home or elsewhere more frequently, making collaboration more difficult. In 2018, UCSF retrofitted the building to create some private offices and adjusted its overall program to balance private office and open workspaces in future projects.Lessons drawn from this experience can inform workplace solutions at other AHCs. Most critical are the needs to assess functional requirements of work and align design, change management, and technologies to support those requirements.

A Systematic Review of Development Programs Designed to Address Leadership in Academic Health Center Faculty.

To describe Academic Health Center (AHC) faculty leadership development program characteristics and categorize leadership topics into thematic areas suggesting competency domains to guide programmatic curricular development. A systematic literature review was conducted (PubMed/MEDLINE, Scopus, Cumulative Index of Nursing and Allied Health Literature [CINAHL], and Journal Storage [JSTOR databases]). Eligible studies described programs with leadership development intent for faculty in AHCs. Information was extracted using a structured data form and process. Six hundred ninety citations were screened; 25 publications describing 22 unique programs were eligible. The majority (73%) were institutionally based; mean class size was 18.5 (SD ± 10.2, range 4.5-48); and mean in-person time commitment was 110 hours (SD ± 101.2, range 16-416), commonly occurring in regular intervals over months to years (n = 10, 45%). Six programs provided per participant costs (mean $7,400, range $1000-$21,000). Didactic teaching was the primary instructional method (99.5%); a majority (68%) included project work. Fourteen thematic content areas were derived from 264 abstracted topics. The majority or near majority incorporated content regarding leadership skills, organizational strategy and alignment, management, self-assessment, and finance/budget. Institutions and faculty invest significantly in leadership development programs, addressing perceived needs and with perceived benefit for both. The prevalence of common curricular content indicates that AHCs deem important faculty development in leadership, business, and self-assessment skills.

From Contemplation to Action: Mechanisms of Change in the Mentoring Academy

Mentoring is fundamental to the professional development of research scientists in academic health centers (AHC). Qualified mentors can support the development of competencies considered most significant in training research scientists. Yet AHC faculty may have little preparation in and knowledge of how to mentor. Emerging AHC mentor academies provide educational environments whereby faculty can learn the art and practice of mentoring. However, little is known about their effectiveness. Using the Transtheoretical Change Model (TTM), this study explored how 23 mentors used newly learned information to change their communication styles and develop shared expectations with mentees. Based on an inductive analysis of 46 reflective writing assignments, the results showed that the mentor academy enabled progress through the stages of contemplation and preparation, however, mentors rarely implemented new knowledge to make changes in their approach to mentoring. The authors suggest instructional strategies that will promote actionable change and accountability for implementation.

Aligning Education With Health Care Transformation: Identifying a Shared Mental Model of "New" Faculty Competencies for Academic Faculty.

To develop a potential competency framework for faculty development programs aligned with the needs of faculty in academic health centers (AHCs). In 2014 and 2015, the authors interviewed 23 health system leaders and analyzed transcripts using constant comparative analysis and thematic analysis. They coded competencies and curricular concepts into subcategories. Lead investigators reviewed drafts of the categorization themes and subthemes related to gaps in faculty knowledge and skills, collapsed and combined competency domains, and resolved disagreements via discussion. Through analysis, the authors identified four themes. The first was core functional competencies and curricular domains for conceptual learning, including patient-centered care, health care processes, clinical informatics, population and public health, policy and payment, value-based care, and health system improvement. The second was the need for foundational competency domains, including systems thinking, change agency/management, teaming, and leadership. The third theme was paradigm shifts in how academic faculty should approach health care, categorized into four areas: delivery, transformation, provider characteristics and skills, and education. The fourth theme was the need for faculty to be aware of challenges in the culture of AHCs as an influential context for change. This broad competency framework for faculty development programs expands existing curricula by including a comprehensive scope of health systems science content and skills. AHC leaders can use these results to better align faculty education with the real-time needs of their health systems. Future work should focus on optimal prioritization and methods for teaching.

Procedural Competence Among Faculty in Academic Health Centers: Challenges and Future Directions.

Increasingly, faculty are taking on more direct responsibilities in patient care because of reductions in resident work hours, increasing admissions, and an endless push for efficiency. Furthermore, the rise of different career tracks in academia (i.e., patient care, research, education, or administration) and a drive for efficiency and subspecialization have placed additional strains on academic health centers. Combined, these factors have led to faculty increasingly being placed in the position of supervising bedside procedures that they may have not performed in years or with tools they have never trained with at all. Despite these challenges, procedural retraining for faculty remains nonstandardized across most academic health centers. The resulting lack of procedural competence among faculty creates a number of challenges for the different parties involved.In this Perspective, the authors discuss the nature of the current problem of faculty procedural competence and the challenges it poses for faculty and academic health centers, medicolegal ramifications, and the challenges it poses to the faculty-trainee relationship. The authors then suggest several strategies to delineate and resolve this problem. To delineate the problem, they suggest single-center surveys to address the current paucity of data. To resolve the problem, they suggest the consideration of some modest, low-cost interventions such as having backup systems in place for procedure supervision (e.g., procedural service teams or interventional radiologists) and providing faculty with opportunities to retrain.

"Fair Play": A Videogame Designed to Address Implicit Race Bias Through Active Perspective Taking.

Having diverse faculty in academic health centers will help diversify the healthcare workforce and reduce health disparities. Implicit race bias is one factor that contributes to the underrepresentation of Black faculty. We designed the videogame "Fair Play" in which players assume the role of a Black graduate student named Jamal Davis. As Jamal, players experience subtle race bias while completing "quests" to obtain a science degree. We hypothesized that participants randomly assigned to play the game would have greater empathy for Jamal and lower implicit race bias than participants randomized to read narrative text describing Jamal's experience. University of Wisconsin-Madison graduate students were recruited via e-mail and randomly assigned to play "Fair Play" or read narrative text through an online link. Upon completion, participants took an Implicit Association Test to measure implicit bias and answered survey questions assessing empathy toward Jamal and awareness of bias. As hypothesized, gameplayers showed the least implicit bias but only when they also showed high empathy for Jamal (P=0.013). Gameplayers did not show greater empathy than text readers, and women in the text condition reported the greatest empathy for Jamal (P=0.008). However, high empathy only predicted lower levels of implicit bias among those who actively took Jamal's perspective through gameplay (P=0.014). A videogame in which players experience subtle race bias as a Black graduate student has the potential to reduce implicit bias, possibly because of a game's ability to foster empathy through active perspective taking.

Facilitating Research Faculty Participation in CBPR: Development of a Model Based on Key Informant Interviews

Community-based participatory research (CBPR) may enhance the translational research process; however, this would require increased institutional capacity for community engaged research. In this paper, we fi rst present results of key informant interviews with academic health center faculty regarding facilitators to faculty participation in CBPR partnerships and then propose a model arising from these results describing how increased capacity may be achieved. Participants were 13 key informant faculty of varying levels of expertise in CBPR at a large university academic health center. Interviews were recorded and transcribed. A thematic content analysis of each interview was conducted by research team members. Facilitators reported by faculty representing fi ve health science schools were grouped into fi ve thematic areas: (1) researcher personal attributes including an innate orientation toward working with community, (2) positive attitudes toward collaboration, (3) a partnership-building skill set, (4) community partners who are ready and eager to collaborate, and (5) supportive institutional policies and procedures. We propose a model describing the relationship between personal attributes, learned/environmental factors, and community facilitators that may be utilized to promote increased institutional capacity for CBPR and thus increase the likelihood of the successful translation of research findings into community settings.

Do Physicians Referred for Competency Evaluations Have Underlying Cognitive Problems?

Research suggests that there are concerns about the neuropsychological functioning of physicians who undergo physician competency evaluation. Academic health center faculty often participate in the evaluation and remediation of these physicians. The purpose of this study was to compare the cognitive abilities between a group of physicians referred for competency evaluations and a control group. Using the MicroCog, a computerized neuropsychological screen originally designed for physicians, the authors compared the cognitive performance of 267 physicians referred for competency evaluations with a control group of 68 recruited physicians. Physicians referred for competency evaluations took the MicroCog as a part of their evaluation at CPEP, the national Center for Personalized Education for Physicians, from January 1997 to January 2004. The control group comprised practicing physicians whose competency was not in question. Compared with the control group, the competency evaluation group had a greater proportion of physicians with scores suggesting possible cognitive impairment and performed significantly lower on scores of processing speed, processing accuracy, and cognitive proficiency. The control group of physicians performed significantly better than the age- and education-corrected normative sample. Because there were significant neuropsychological differences between physicians referred for competency evaluations and physicians whose competency was not in question, it is important that neuropsychological screening be included as part of physicians' competency evaluations.

Establishing Policies for the Relationship Between Industry and Clinicians: Lessons Learned From Two Academic Health Centers

The relationship between faculty in academic health centers (AHCs) and commercial entities is critically important to improving the public health, yet it may be prone to conflicts of interest that adversely affect medical education, research, and clinical care. The Association of American Medical Colleges has recently recommended that medical schools and AHCs develop policies that better manage and occasionally prohibit interactions between academic medicine and industry. Because the development of more stringent policies is complex and potentially contentious, the author reports the lessons learned from developing new policies for the interactions between faculty and industry related to medical education and clinical care at Yale School of Medicine and Boston University School of Medicine/Boston Medical Center. The content of the policies was strongly influenced by the tenets of medical professionalism. Faculty support for new policies was strong, an iterative and inclusive process of formulation was critical, compromises in content were necessary, and the views of faculty concerning industry relationships were complex. After implementation of the new policies, the departmental food-related expenses increased, the loss of gifts was not appreciably missed, the faculty assumed more responsibility for educating trainees on the evaluation of new products, a central repository for receiving and evaluating grants from industry was useful, enforcement of the policies has been a lingering challenge, and the new policies generated positive publicity. Several recommendations are proposed. Creating these policies affirmed the importance of an inclusive process, open communication, support of institutional leadership, and focus on professional values.

Glenn Lowell Brudvig, 1931–2007

Glenn Lowell Brudvig, 1931–2007

Recognizing the Value of Community Involvement by AHC Faculty: A Case Study

Physicians seek connections to their communities. Some health care and academic leaders believe that facilitating the creation of more such community connections is one way to reverse the trend of waning social and political legitimacy for the U.S. medical profession. For academic health centers (AHCs), such connections can maintain local and state support crucial to their long-term success. Multiple barriers exist to such involvement, especially for physicians in AHCs, where work done beyond direct patient care, administration, and research rarely contributes to the tenure and promotion process. The authors present a case study to show how one department in an AHC, beginning in the late 1990s, has been overcoming these barriers to incorporate the scholarship of community engagement into its mission and structure. The case study incorporates theoretical underpinnings to crystallize the following lessons that the department has learned so far: (1) If academic departments wish community service to be a central part of their mission, they need ways to institutionalize community engagement within organizational structures. (2) Community engagement can be scholarly. (3) If faculty members are to be recognized for their service activities, measures are necessary to determine what constitutes "excellence" and "scholarship" in community service. (4) Scholarship of community engagement goes beyond performing service activities in the community.

A Strategy for Allocating Central Funds to Support New Faculty Recruitment

Requests for central funding for recruiting new faculty in academic health centers (AHCs) typically exceed available resources. The administration's prioritization of the requests, therefore, involves implicit or explicit predictions of the value of the potential faculty member to the institution. Optimal management dictates that the value of the recruit be assessed both on the extent to which they contribute to the organization's mission and on their capacity to generate revenues. The first premise of this article is that faculty recruits can be considered as "projects," and their potential value to the organization can be estimated in this context. The second premise is that the best way to determine a project's financial worth is by determining the net present value of each potential faculty recruit. The author models the combination of these premises and demonstrates that the approach allows for the more systematic prioritization of resource allocation for faculty recruitment in AHCs.

Using utility theory to optimize a salary incentive plan for grant-funded faculty.

Few salary incentive plans for academic health center faculty funded primarily by research grants exist, and hence the optimal structure for such plans is uncertain. The author examined the impact of incentives and the optimal structure for a salary incentive plan for a group of research faculty at the Yale University School of Medicine (Yale). A three-part instrument was delivered to a convenience sample of 40 faculty to determine the impact of their risk aversion on two salary plans. Utility theory was used to quantify their preferences for the Expense Model (salary bonuses are paid from direct costs of the research award) and the No Expense Model (salary increases are funded from another source). Outcomes were projected for both models over a range of funding probabilities. In all, 27 faculty responded. On average, Yale faculty had risk-averse (and therefore unfavorable) attitudes towards the Expense Model, with substantial variability in response depending on rank. In contrast, Yale faculty had more homogeneous risk seeking (and therefore favorable) responses to the No Expense Model. Cost recoveries were greatest for the No Expense Model. Utility modeling demonstrated that the optimal incentive payment for the Expense Model is substantially greater than for the No Expense Model, and increases as the probability of obtaining funding with diligent effort declines. For purposes of both equity and efficacy, the No Expense Model appears preferable to the Expense Model. Modeling can be used to determine optimal incentive-plans and bonus-payment magnitudes for research faculty.

Changes in Academic Productivity: Implications for Clinical Laboratory Research and Development

A recent report from the Council of Scientific Affairs of the American Medical Association indicated that the introduction of managed healthcare had a substantially negative influence on the academic productivity of clinical faculty in academic health centers (1). Consistent with this finding is the observed change in the number of scientific abstracts presented during the Annual Meeting of the AACC (2). As can be seen, over the last 4 years there has been a substantial 30% decrease in the number of abstracts received and accepted from all sources, including academia and industry (Fig. 1⇓ , A and B). This decline does not correlate to a change in the abstract rejection rate, which has remained relatively constant (∼20%) since 1992 (Fig. 1C⇓ ). Figure 1. Indicators of AACC academic productivity from 1992 through 1999. Comparison of abstract volume ( A and B ) and abstract acceptance rate ( C ) for the AACC annual meetings with student participation ( D ), COMACC-approved clinical chemistry training programs …

Market forces and unsponsored research in academic health centers.

Increased competitive pressures on academic health centers may result in reduced discretionary funds from patient care revenues to support the performance of unsponsored research, including institutionally funded and faculty-supported activities. To measure the amount and distribution of unsponsored research activities and their outcomes. Survey conducted in academic year 1996-1997 of 2336 research faculty in 117 medical schools. Responses were weighted to provide national estimates. Institutionally funded research as a proportion of total direct costs of research was compared across stages of market competition. Logistic regression was used to assess the relationship of performing unsponsored research to faculty characteristics and market stage. Overall, 43% of faculty received institutional funding for research. Young faculty were more likely than others to receive institutional support (adjusted odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.9; P = .004). The amount of institutional support as a proportion of total funding was more than twice as high in less competitive markets (6.1%) compared with the most competitive markets (2.5%; P = .05). Most faculty (55%) performed faculty-supported research. Clinical researchers (OR, 1.6; 95% CI, 1.1-2.3), principal investigators (OR, 4.3; 95% CI, 2.8-7.0), faculty with high levels of research effort (OR, 6.2; 95% CI, 4.0-9.5) or institutional funding (OR, 1.9; 95% CI, 1.4-2.6), and faculty in the most competitive markets (OR, 1.9; 95% CI, 1.4-2.5) were more likely than others to conduct faculty-supported research. When undertaken by clinical researchers, these activities were supported by clinical income, extra hours worked, and discretionary funds, and often led to publications (76%) or grant awards (51%). Many academic health center faculty receive institutional support to conduct their research or fund the research themselves. Market pressures may be affecting the level of institutional funding available to faculty.

Cultures in conflict: a challenge to faculty of academic health centers.

Academic health centers (AHCs) are experiencing turmoil in all three of their traditional missions of teaching, research, and patient care. The authors examine origins of universities and medical education to place in historical context the stresses affecting AHCs at the end of the 20th century. They describe the cultures of the university to suggest strategies for successful adaptation to these stresses. Clashes of values and norms of the cultures within universities and AHCs can hinder effective adaptation to external change. Administrators, researchers, teachers, and clinicians can have strongly conflicting perspectives. For example, business skill is of increasing importance to the survival of the clinical enterprise, but not typically valued by faculty members. University faculty have often considered accountability as antithetical to academic freedom, and, until recently, accountability was not strongly demanded of AHCs. The authors conclude that AHC faculty must transcend the outdated view that the roles of the scholar, scientist, and healer are in opposition to those of the leader and manager. If AHCs are to survive and prosper through their current cultural transition, their faculty must understand all these roles as part of their intellectual and organizational responsibility.

Academic health centers and health care reform.

There is increasing support for the proposition that academic health centers have a duty to accept broad responsibility for the health of their communities. The Health of the Public program has proposed that centers become directly involved in the social-political process as advocates for reform of the health care system. Such engagement raises important issues about the roles and responsibilities of centers and their faculties. To address these issues, the authors draw upon the available literature and their experiences in recent health care reform efforts in Minnesota and Vermont in which academic health center faculty participated. The authors discuss (1) the problematic balance between academic objectivity and social advocacy that faculty must attempt when they engage in the health care reform process; (2) the management of the sometimes divergent interests of academic health centers, some of their faculty, and society (including giving faculty permission to engage in reform efforts and developing a tacit understanding that distinguishes faculty positions on reform issues from the center's position on such issues); and (3) the challenge for centers to develop infrastructure support for health reform activities. The authors maintain that academic health centers' participation in the process of health care reform helps them fulfill the trust of the public that they are obligated to and ultimately depend on.

The Scholarly Productivity of Medical Technology Faculty Compared With Other Academic Health Center Faculty

The Scholarly Productivity of Medical Technology Faculty Compared With Other Academic Health Center Faculty