Academic Medicine Community Research Articles

Neuro and Psychomotor Therapist of Developmental Age Professional in Italy: An Anomaly or an Opportunity?

The aim of this work is to explore the distinct role of the Neuro and Psychomotor Therapist of Developmental Age (TNPEE) within the Italian health care system, examining challenges in recognizing and comparing this profession with international counterparts, particularly physiotherapists and occupational therapists. The historical evolution and educational framework, integrated into the Italian university model, provide a foundation for TNPEE's competencies in rehabilitation and habilitation. The TNPEE operates within the bio-psycho-social model, addressing the developmental age range with a holistic approach. Despite its unique contributions, TNPEE faces challenges internationally because of its exclusive presence in Italy. Unlike other health care professions, TNPEE lacks a standardized international equivalent, complicating professional comparisons and mobility. This anomaly hinders the global recognition and integration of TNPEE professionals, posing a challenge to the academic medicine community in terms of standardizing and promoting interdisciplinary collaboration. This communication concludes by proposing mechanisms to facilitate TNPEE's recognition and integration into international health care frameworks. By addressing these challenges, the work contributes to the broader discourse on the cultural context in shaping effective therapeutic interventions, highlighting the need for an inclusive approach to health care education and practice worldwide.

Advances in gynecologic simulation: implementation, validity, and new resources.

Simulation plays an integral role in gynecological surgical training that will continue and grow in the future. It aims to supplement surgical training as residents are experiencing decreased surgical volumes. It has also been recognized as a means for assessing a trainee's capabilities to the point of being incorporated into the board certification process. This review will highlight the recent updates in research and resources available for gynecologic surgery simulation. The literature reviewed demonstrated that, across the board, participants in simulation find it beneficial. A variety of low-fidelity and high-fidelity models, virtual reality programs, and artificial intelligence technology have been developed recently. As the field advances, researchers have started to investigate methods to increased engagement and provide feedback without the need for direct observation, the logical next step considerations to maximize the impact and availability of simulation. Gynecologic surgery training programs must stay abreast of the wide variety of simulation training available. Efforts should continue to be made to investigate the impact of simulation patient outcomes. The academic medicine community has a responsibility to ensure high-quality simulation is available to all surgical trainees to avoid disparities between low-resource and high-resource programs.

Examining trends in emergency medicine journals' publications about racism.

In recent years, the academic medicine community has produced numerous statements and calls to action condemning racism. Though health equity work examining health disparities has expanded, few studies specifically name racism as an operational construct. As emergency departments serve a high proportion of patients with social and economic disadvantage rooted in structural racism, it is critically important that racism be a focus of our academic discourse. This study examines the frequency at which four prominent emergency medicine journals, Annals of Emergency Medicine, Academic Emergency Medicine, the American Journal of Emergency Medicine, and the Western Journal of Emergency Medicine, publish on health disparities and racism. This is a descriptive analysis measuring the frequency of publications on health disparities and racism in U.S.-based emergency medicine journals from 2014 to 2021. The search strategies for the concepts of "racism" and "health disparities" used a combination of MeSH and keywords. These search strategies were developed based on prior literature and the MEDLINE/PubMed Health Disparities and Minority Health Search Strategy. Articles identified through the PubMed search were then reviewed by two authors for final inclusion. Since 2014, a total of 6248 articles were published by the four emergency medicine journals over the 8-year study period. Of those, 82 research papers that focused on health disparities were identified and only 16 that focused on racism. Most emergency medicine publications on racism and health disparities were in 2021. Our findings suggest that the national discourse on racism and calls to action within emergency medicine were followed by an increase in publications on health disparities and racism. Continued investigation is needed to evaluate these trends moving forward.

Systems-Based Practice 20 Years On: Navigating the System for Better Care.

Systems-based practice (SBP) was introduced as 1 of 6 core competencies in 1999 because of its recognized importance in the quality and safety of health care provided to patients. Nearly 25 years later, faculty and learners continue to struggle with understanding and implementing this essential competency, thus hindering the medical education community's ability to most effectively teach and learn this important competency.Milestones were first introduced in 2013 as one effort to support implementation of the general competencies. However, each specialty developed its milestones independently, leading to substantial heterogeneity in the narrative descriptions of competencies including SBP. The process to create Milestones 2.0, and more specifically, the Harmonized Milestones, took this experience into account and endeavored to create a shared language for SBP across all specialties and subspecialties. The 3 subcompetencies in SBP are now patient safety and quality improvement, systems-navigation for patient-centered care (coordination of care, transitions of care, local population health), and physician's role in health care systems (components of the system, costs and resources, transitions to practice). Milestones 2.0 are also now supported by new supplemental guides that provide specific real-world examples to help learners and faculty put SBP into the context of the complex health care environment.While substantially more resources and tools are now available to aid faculty and to serve as a guide for residents and fellows, much work to effectively implement SBP remains. This commentary will explore the evolutionary history of SBP, the challenges facing implementation, and suggestions for how programs can use the new milestone resources for SBP. The academic medicine community must work together to advance this competency as an essential part of professional development.

Gender disparity trends in genitourinary oncology academic publishing over the past 3 decades: A bibliometric analysis

To examine gender disparities in genitourinary (GU) oncology academic publishing over the past three decades. We performed a bibliometric analysis of eight academic journals featuring GU oncology research articles: Journal of Clinical Oncology, Cancer, European Journal of Cancer, European Urology, Journal of Urology, BJU International, Prostate Cancer and Prostatic Diseases, and Urologic Oncology: Seminars and Original Investigations. After selecting four time points (1990, 2000, 2010, 2020), we recorded the gender of the first and senior authors and investigated their association with independent variables including publication year, research field, and geographic continent. Results were expressed as odds ratios (ORs) and 95% confidence intervals (CIs). A total of 14,786 articles were included in our analyses. Females comprised 25.7% of first and 18.1% of senior authors. Compared to 1990, there was a trend of progressively higher female first author (OR 1.47 [95% CI 1.27-1.69] in 2000; 2.28 [95% CI 2.00-2.59] in 2010; 3.10 [95% CI 2.71-3.55] in 2020) and senior author positions (OR 1.23 [95% CI 1.05-1.45] in 2000; 1.67 [95% CI 1.45-1.93] in 2010; 2.55 [95% CI 2.20-2.96] in 2020). Compared to GU oncology, non-GU oncology articles were more likely to have female first (OR 2.61, 95% CI 2.38-2.86) or senior authors (OR 2.61, 95% CI 2.35-2.91). Articles from Asia (OR 0.45, 95% CI 0.38-0.51), Africa (OR 0.45, 95% CI 0.22-0.91), and international collaborations (OR 0.62, 95% CI 0.50-0.76) had a lower proportion of female first authors compared to North America. First authors were significantly more likely to be female when senior authors were also female (OR 2.45, 95% CI 2.23-2.69). Despite the bridging trend demonstrated, GU oncology remains a male-predominant discipline. Female leadership and mentorship are pivotal in achieving gender parity in the academic medicine community.

The Impact of Virtual Interviews on the Resident Candidate: A Before-and-After Comparison.

A significant impact of the COVID-19 pandemic on family medicine residency recruitment has been a requested transition to virtual interviewing by the Association of American Medical Colleges and the academic family medicine community. This has led to creative and adaptive approaches to virtual interviewing with little previous knowledge, experience, or processes. This work describes the impact of transitioning to virtual recruitment on applicants' reported experiences and factors influencing decision-making with family medicine at a large research university. We made a comparison of 2 years of in-person interview day surveys with 2 years of virtual interview surveys following transition to virtual recruitment. We tested differences between in-person and virtual interviews for significance using χ2 tests. There were significant differences in factors influencing a candidate's decision to apply. Candidates who participated in virtual interviews were more interested in urban training settings, a community setting, and obstetrical training compared with the in-person interview cohort. Nearly 50% of virtual candidates reported preferring virtual interviews in the future. There were no significant differences in how candidates rated their experience of the interview process and they indicated adequate contact with resident personnel despite a transition to virtual interviews. The transition to virtual recruitment has been well received by candidates, as indicated by the high positive ratings of the cohorts. The transition has not resulted in a negative impact on the recruitment experience or the ability to meet with resident leadership.

How Academic Medicine Can Amplify Truth Amid the Noise of Misinformation, Inaccuracies, and Lies.

Inaccurate statements and lies from public figures and political and government leaders have the power to exacerbate dangerous upheavals in our political, health care, and social environments. The widespread misinformation, inaccuracies, and lies about the COVID-19 pandemic (about the origin of the virus, the severity of illness, vaccination, and "cures," to name a few) illustrate the potentially disastrous consequences of false information. Academic medicine must recognize the dangers of such lies and inaccuracies, particularly those related to health, and must understand their sources in traditional and social media and how and why many in the public accept them. Academic health professionals have a unique responsibility to promote and defend the truth in medicine and science, help the public to understand the sources of inaccurate scientific information, and find ways to debunk falsehoods spread by politicians and media outlets. Inaccurate information and lies have threatened the health of the population, the function of health systems, and the training of the future health workforce. They must be combatted by truth telling through scholarly work, clinical activities, and educating health professions trainees at all levels. Academic medicine's institutions should also consider joining the communities they serve and their medical specialty organizations to engage in political advocacy whenever possible. Health professions journals have an important role in highlighting and clarifying important topics and sustaining conversations on them within the academic medicine community. Across all its missions and activities, academic medicine must do its best to combat today's poisonous misinformation, inaccuracies, and lies, and to enter the larger social and political struggles that will determine the health of society and the future.

The development, implementation, and evaluation of a medical student peer teaching training curriculum during a high-fidelity prehospital trauma simulation.

While peer teaching has been found to be an effective technique during simulation, no peer teaching training curriculum (PTTC) has been developed for simulation-based learning. The objective of this study, therefore, was to develop, implement, and evaluate a PTTC during a high-fidelity trauma simulation. When developing the PTTC, we combined several validated learning models for teaching and learning procedural skills. We then implemented it over 6 days in two phases: instructional (learning how to teach) and experiential (practicing teaching). Our research team conducted a qualitative evaluation to evaluate the effectiveness of the PTTC. We analyzed written self-reflections from 20 second-year medical students who completed the PTTC. Using an iterative inductive approach to data analysis, our research team first individually coded the reflection papers. We then met to define and categorize the codes into themes. Finally, we compared these themes to the PTTC's objectives to evaluate the curriculum's effectiveness. The following themes emerged from the data: 1) learning through teaching; 2) self-actualization as an educator; and 3) role of physician as leader, advocate, and educator. The students described how the peer teaching experience improved their own procedural knowledge and skills. They also reported an increase in their leadership and communication skills as they effectively provided guidance and feedback to their peers, which led to their self-actualization as an educator. This self-actualization inspired the peer teachers' professional identity formation as leaders and educators in medicine. Based on these themes, we found our PTTC to be an effective curricular design. Our results reinforce previously described benefits to both peer teachers and learners in regard to medical knowledge and skills acquisition and furthers the academic emergency medicine community's understanding of how students' involvement as peer teachers in simulation-based education impacts their professional development.

Retention and Career Success of Faculty: The Case for Building a Sense of Belonging to the Academic Medicine Community

As attrition in the healthcare workforce rises, factors that positively impact retention, engagement, work satisfaction, and vitality for faculty in Colleges of Medicine are of critical importance. One important factor that is less often discussed is the need to develop a sense of belonging and connectedness to the institutional community. Underrepresented minority faculty particularly feel the benefit of feeling like they belong. Recommendations for enhancing faculty connectedness to a community in support of developing a sense of belonging to that community are offered.

Moving Forward Through the Pandemic With Strength, Resilience, and Adaptation in Academic Medicine.

Moving Forward Through the Pandemic With Strength, Resilience, and Adaptation in Academic Medicine.

Student-Led Efforts to Advance Anti-Racist Medical Education.

Over the past decade, medical schools across the United States have increasingly dedicated resources to advancing racial and social justice, such as by supporting diversity and inclusion efforts and by incorporating social medicine into the traditional medical curricula. While these changes are promising, the academic medicine community must apply an anti-racist lens to every aspect of medical education to equip trainees to recognize and address structural inequities. Notably, organizing and scholarly work led by medical students has been critical in advancing anti-racist curricula. In this article, the authors illustrate how student activism has reshaped medical education by highlighting examples of student-led efforts to advance anti-racist curricula at Harvard Medical School (HMS) and at the University of California, San Francisco (UCSF) School of Medicine. HMS students collaborated with faculty to address aspects of existing clinical practice that perpetuate racism, such as the racial correction factor in determining kidney function. They also responded to the existing curricula by noting missed opportunities to discuss structural racism, and they planned supplemental sessions to address these gaps. At UCSF, students identified specific avenues to improve the rigor of social medicine courses and developed new curricula to equip students with skills to confront and work to dismantle racism. The authors describe how HMS students, in an effort to improve the learning environment, developed a workshop to assist students in navigating microaggressions and discrimination in the clinical setting. At UCSF, students partnered with faculty and administration to advocate pass/fail grading for clerkships after university data revealed racial disparities in students' clerkship assessments. In reviewing these examples of students' advocacy to improve their own curricula and learning environments, the authors aim to provide support for students and faculty pursuing anti-racist curricular changes at their own institutions.

Learning From the Past and Working in the Present to Create an Antiracist Future for Academic Medicine.

Learning From the Past and Working in the Present to Create an Antiracist Future for Academic Medicine.

Tweeting from the Bench: Twitter and the Physician-Scientist Benefits and Challenges.

Purpose of ReviewSocial media platforms such as Twitter are increasingly utilized to interact, collaborate, and exchange information within the academic medicine community. However, as Twitter begins to become formally incorporated into professional meetings, educational activities, and even the consideration of academic promotion, it is critical to better understand both the benefits and challenges posed by this platform.Recent FindingsTwitter use is rising amongst healthcare providers nationally and internationally, including in the field of hematology and oncology. Participation on Twitter at national conferences such as the annual meetings of American Society of Hematology (ASH) and American Society of Clinical Oncology (ASCO) has steadily increased over recent years. Tweeting can be used advantageously to cultivate opportunities for networking or collaboration, promote one’s research and increase access to other’s research, and provide efficient means of learning and educating. However, given the novelty of this platform and little formal training on its use, concerns regarding patient privacy, professionalism, and equity must be considered.SummaryThese new technologies present unique opportunities for career development, networking, research advancement, and efficient learning. From “tweet ups” to Twitter journal clubs, physician-scientists are quickly learning how to capitalize on the opportunities that this medium offers. Yet caution must be exercised to ensure that the information exchanged is valid and true, that professionalism is maintained, that patient privacy is protected, and that this platform does not reinforce preexisting structural inequalities.

Academics in Absentia: An Opportunity to Rethink Conferences in the Age of Coronavirus Cancellations.

The COVID-19 pandemic has caused major disruptions to the academic medicine community, including the cancellation of most medical and health professions conferences. In this Perspective, the authors examine both the short- and longer-term implications of these cancellations, including the effects on the professional development and advancement of junior faculty and learners. While the COVID-19 pandemic is new in 2020, impediments to conference attendance and participation are not. Cost, personal responsibilities at home, and clinical duties have always restricted attendance. The authors argue that the unprecedented hardships of this pandemic present a unique opportunity to reimagine how conferences can be conducted and to rethink what it means to be part of an academic community. While there are challenges with this digital transformation of academia, there are also undeniable opportunities: online abstracts and recorded presentations enable wider viewership, virtual sessions permit wider participation and greater interactivity, and the elimination of travel facilitates more diverse expert panel participation. The authors conclude with proposals for how conference organizers and participants can expand access by leveraging available distance learning technology and other virtual tools, both during the COVID-19 pandemic and beyond.

Lessons to Learn From Hahnemann University Hospital's Closure.

Despite the number of hospital closures over the past decade, the June 2019 announcement of the closing of Hahnemann University Hospital (HUH) in downtown Philadelphia has greatly impacted the academic medicine community. Several factors contributed to the collapse of the hospital; however, the operational approach throughout the period leading up to and during the hospital's closing left faculty, students, and especially residents with many questions as they scrambled to determine how to continue their careers. This Invited Commentary examines factors that contributed to the crisis following the hospital's closure, such as the influence of HUH's ownership history and the complicated landscape of graduate medical education, and discusses the lessons that can be learned from this cataclysmic event. Above all, the academic medicine community must consider lessons learned from HUH's closure and make a firm commitment to preserve and protect the educational mission of our institutions.

Late-Career Expectations: A Survey of Full-Time Faculty Members Who Are 55 or Older at 14 U.S. Medical Schools.

The average age of full-time faculty members at U.S. medical schools accredited by the Liaison Committee on Medical Education was 49.5 in 2017, yet the academic medicine community knows little about late-career faculty. The authors sought to characterize full-time faculty members 55 or older and assess their work-life expectations. The authors conducted a survey (May-September 2017) of faculty 55+ at 14 U.S. medical schools. Of the 5,204 faculty members invited, 2,126 (40.8%) responded. The average age of respondents was 62.3, and among those responding to the relevant questions, most identified as male (1,425; 67.2%), white (1,841; 88.3%), and married/partnered (1,803; 85.5%). Fewer than half (915; 45.2%) indicated they had begun thinking about full-time retirement, estimating that they would do so at a mean age of 67.8 (standard deviation = 4.3). Half the respondents (1,004; 50.0%) would consider moving to part-time status. The top 3 personal factors likely to affect retirement decisions were health, postretirement plans, and spouse's/partner's plans. The top 3 professional factors were phased retirement or part-time options, changes in institutional leadership, and presence of a successor. Faculty indicated that they would, post retirement, be interested in ongoing work in teaching/education and research/scholarship and that they wanted health insurance, email, and part-time teaching opportunities. U.S. medical schools employ a rapidly aging workforce. These data indicate that neither faculty members nor institutions are prepared. Faculty affairs and develop ment leaders should champion efforts to engage with late-career faculty to prepare for this changing landscape.

Late-Career Faculty: A Survey of Faculty Affairs and Faculty Development Leaders of U.S. Medical Schools.

Individuals 55 or older constitute 28.5% of the U.S. population but 32% of full-time faculty at U.S. medical schools accredited by the Liaison Committee on Medical Education (LCME). The academic medicine community knows little about the policies, programs, and resources for faculty in pre- and post-retirement stages. The authors sought to inventory the range of institutional resources for late-career faculty development and retirement planning in U.S. LCME-accredited medical schools. The authors surveyed 138 medical school faculty affairs deans and leaders in May 2017 to ascertain (1) priorities around retirement, succession planning, and workforce development/support; (2) retirement policies; (3) late-career and retirement resources; and (4) perceived factors impacting faculty retirement. Of those invited, 84 (60.9%) responded to the survey, and of these, 44 (52.4%) disagreed or strongly disagreed that retirement planning and support was a top priority in their offices. Less than half (n = 35 [41.7%]) reported that their institution had a retirement policy. The 5 most common late-career and retirement-related resources offered were emeriti or honorific appointments, academic benefits for retirees, phased retirement, retirement counseling, and financial planning. More than half the respondents noted that the following factors impact faculty retirements: physician burnout (43/75 respondents [57.3%]), decreased grant funding (42/75 [56.0%]), and changes in productivity requirements (38/75 [50.7%]). These data highlight a distinct, startling gap between the needs of a fast-growing population of late-career faculty and the priorities of their institutions. Faculty affairs/faculty development offices must meet these growing needs.

Late-Career Faculty: Individual and Institutional Perspectives

The demographic shift toward older populations of physicians is well documented across much of the globe. As a result, it is becoming imperative that academic organizations generate research to inform understanding of both individual and institutional needs relating to these faculty members. The 2 reports by Skarupski and colleagues in this issue of Academic Medicine build on the research that is available, expose some new areas for consideration, and raise new lines of inquiry for researchers interested in studying late-career faculty and faculty transitions. The author of this Invited Commentary aims to situate Skarupski and colleagues' findings relative to what the academic medicine community knows-and does not know-about late-career faculty members, the institutions that employ these faculty, and the complex relationships therewith. Specifically, the author explores the following: the demographics of those considering retirement; the connection between identity and retirement decisions; the alignment between institutional and faculty member needs; institution preparedness; mentoring; and theoretical constructs and areas for inquiry that may inform future investigations.

Energizing the Conversation: How to Identify and Overcome Gender Inequalities in Academic Medicine

Abstract Gender inequality exists in advanced faculty and leadership positions at academic medical centers; however, despite growing awareness, how to best approach and rectify the issue is unknown. To energize the conversation on gender inequality at one academic medical center, chairs and women faculty were surveyed to identify barriers faced by women navigating their careers. A symposium with short talks to increase awareness, a panel with University leaders to discuss issues and successful strategies to overcome gaps, and focus groups to delve further into key areas that underlie inequity through an active café style format were planned and implemented. This multifaceted approach resulted in a wealth of knowledge. The symposium and panel highlighted important relevant issues and offered personal strategies for successful career advancement, while the focus group discussions further identified barriers and inspired ongoing efforts across departments and novel approaches to overcome three key issues (work-life integration, deliberate promotion of mentor/sponsor relationships, and overcoming unconscious bias) identified through the initial surveys. Compiled data were then disseminated to participants and University leaders to enhance awareness of available programs and prompt action in critical areas lacking support. Overall, the approach indicated that securing support from leaders and the academic community alike are pertinent to emphasize actions needed to overcome issues affecting women in academic medicine. Moreover, bringing leaders and faculty together for an informational session and brainstorming appears to energize the conversation. Such efforts can ultimately instill change and establish an inclusive environment where all members of the academic medicine community can thrive.

A Seat at the Table: Strategic Engagement in Service Activities for Early-Career Faculty From Underrepresented Groups in the Academy.

Many academic institutions strive to promote more diverse and inclusive campuses for faculty, staff, and students. As part of this effort, these institutions seek to include individuals from historically underrepresented groups (URGs)-such as women, people from racial/ethnic minority populations, persons with disabilities-on committees and in other service activities. However, given the low number of faculty members from URGs at many institutions, these faculty members tend to receive more requests to provide service to the institution or department (e.g., serving on committees, mentoring) than their counterparts from majority groups. Faculty members from URGs, especially early-career faculty, thus risk becoming overburdened with providing service at the expense of working on other scholarly activities required for promotion and tenure (i.e., conducting research, publishing). Although many scholars and others have written about this "minority tax" and its implications for early-career faculty from underrepresented racial/ethnic minority groups, fewer have published about how this tax extends beyond racial/ethnic minorities to women and persons with disabilities. Further, the literature provides scant practical advice on how to avoid overburdening early-career faculty from URGs. Here, a group of multidisciplinary early- and mid-career faculty members from URGs seek to provide their peers from URGs with practical strategies for both evaluating the appropriateness of service requests and declining those that are not a good fit. The authors also provide institutional leaders with actionable recommendations to prevent early-career faculty from URGs from becoming overburdened with service.