Clinical Chairs Research Articles

Creating opportunities to engage with prospective historically marginalized trainees with clinical simulation

BackgroundRecruiting a diverse group of medical students, house officers, and faculty in medicine is challenging—particularly for predominantly white, midwest institutions that may not be racially or ethnically diverse. PurposeTo evaluate a novel clinical simulation program, SiMfest, for recruiting house officers from historically marginalized populations to our institution to demonstrate our leadership's commitment to high-quality education and recruitment of these students to enhance diversity in academic medicine. MethodsThe Office for Health Equity and Inclusion, institutional leadership, and clinical department chairs developed a novel and engaging series of clinical simulations, SiMfest, to engage the pipeline of historically marginalized trainees and demonstrate our leadership's commitment to high-quality education. SiMfest is a two-hour simulation session presented annually (2017–2019) by our institution at the Student National Medical Association Annual Medical Education Conference. ResultsOver 800 students participated in SiMfest sessions over three years. Of the 461 participants who completed a survey after participation, 301 identified as female, and 382 indicated a racial category considered as historically marginalized in medicine—91% of whom identified as African American or Black. Thirty percent (n = 125) of respondents identified as pre-medical (e.g., undergraduate, post-baccalaureate) students and 69% (n = 289) identified as current medical students. Over 80% of students would recommend SiMfest to others. Additionally, 73% (n = 87) of pre-medical and 54% (n = 143) of medical students reported exposure to a previously unknown specialty. Thirty-three department representatives reported their SiMfest experience revealed new information about historically marginalized applicants that they may not have engaged with through the traditional application process but would be more likely to engage with in future diversity, equity, and inclusion initiatives. ConclusionSiMfest harnessed our institution's high-quality training, personnel resources, and diversity, equity, and inclusion values to bring historically marginalized students in medicine and department leadership together to learn about one another and offer experiential learning. SiMfest may serve as a model for other institutions to draw on their strengths to develop innovative recruitment programs that promote the education and engagement of undergraduate and medical students from historically marginalized populations while simultaneously promoting diversity, equity, and inclusion culture change.

Diversity Trends by Sex and Underrepresented in Medicine Status Among US Radiation and Medical Oncology Faculty Over 5 Decades

It remains unclear how the historical exclusion of women and racial and ethnic minority groups from medical training, and therefore the oncologic subspecialties, has contributed to rates of faculty diversity among oncology departments over time. Oncologic faculty diversity is an important initiative to help improve care and address health disparities for an increasingly diverse US population with cancer. To report trends in academic faculty representation by sex and by race and ethnicity for radiation oncology (RO) and medical oncology (MO) departments and to describe comparisons with the general US population, medical students, RO and MO trainees, clinical department chairs, and faculty in other departments. This cross-sectional analysis used data from the Association of American Medical Colleges to analyze trends by sex and by race and ethnicity among full-time US faculty in RO and MO departments from 1970 through 2019. Data were analyzed between October 2020 and April 2021. Proportions of women and individuals from underrepresented in medicine (URM) racial and ethnic groups (Black, Hispanic, and Indigenous individuals) were calculated among RO and MO academic departments; trends were analyzed over 5 decades. These proportions were compared with cohorts already described. In addition, proportions of women and URM individuals were calculated by faculty rank among RO and MO departments. In 1970, there were 119 total faculty in RO (10 women [8.4%] and 2 URM [1.7%]) and 87 total faculty in MO (11 women [12.6%] and 7 URM [8.0%]). In 2019, there were 2115 total faculty in RO (615 women [29.1%] and 108 URM [5.1%]) and 819 total faculty in MO (312 women [38.1%] and 47 URM [5.7%]). Total faculty numbers increased over time in both RO and MO. Faculty representation of URM women proportionally increased by 0.1% per decade in both RO (95% CI, 0.005%-0.110%; P <. 001 for trend) and MO (95% CI, -0.03% to 0.16%; P = .06 for trend) compared with non-URM women faculty, which increased by 0.4% (95% CI, 0.25%-0.80%) per decade in RO and 0.7% (95% CI, 0.47%-0.87%) per decade in MO (P < .001 for trend for both). Faculty representation of URM men did not significantly change for RO (0.03% per decade [95% CI, -0.008% to 0.065%]; P = .09 for trend) or MO (0.003% per decade [95% CI, -0.13% to 0.14%]; P = .94 for trend). Representation of both women and URM individuals among both specialties was lower than their representation in the US population in both 2009 and 2019. Across all cohorts studied, RO faculty had the lowest URM representation in 2019 at 5.1%. At every rank in 2019, the number of total URM faculty represented among both MO and RO remained low (MO: instructor, 2 of 44 [5%]; assistant professor, 18 of 274 [7%]; associate professor, 13 of 177 [7%]; full professor, 13 of 276 [5%]; and RO: instructor, 9 of 147 [6%]; assistant professor, 57 of 927 [6%]; associate professor, 20 of 510 [4%]; full professor, 18 of 452 [4%]). This cross-sectional study suggests that RO and MO academic faculty have increased the representation of women over time, while URM representation has lagged. The URM trends over time need further investigation to inform strategies to improve URM representation in RO and MO.

Ophthalmology Departments Remain Among the Least Diverse Clinical Departments at United States Medical Schools

The current demographics of the ophthalmology workforce do not reflect the diverse United States population, which has implications for addressing health disparities. The demographics of ophthalmology department faculty may influence the recruitment of underrepresented students into the field. This study sought to determine how the racial and ethnic demographics of ophthalmology department faculty compare with those of other clinical departments at United States medical schools. Secondary data analysis of medical school faculty demographic data from the 2019 American Association of Medical Colleges (AAMC) Faculty Roster. Clinical faculty and department chairs at United States medical schools. We analyzed the racial and ethnic demographics of clinical department faculty and department chairpersons using data from the 2019 AAMC Faculty Roster. We calculated the proportion of underrepresented minority (URM) faculty in ophthalmology and in 17 other clinical departments. We analyzed these data for statistically significant differences between ophthalmology and other clinical departments. In addition, we compared the percentage of URM ophthalmology faculty with the proportion of URM persons among graduating United States medical students and in the United States population using data from the Medical School Graduation Questionnaire and the United States census, respectively. The proportion of URM persons, defined as Black, Hispanic or Latino, Native American, or Native Hawaiian or Pacific Islander among clinical faculty and department chairs. Ophthalmology faculty are less racially and ethnically diverse than graduating medical students and the general United States population. When compared with 17 other clinical departments, ophthalmology has the third-lowest proportion of URM faculty, with only radiology and orthopedic surgery having a smaller proportion of URM faculty. These differences were statistically significant in most departments (12 of 18). No statistically significant difference was found in the proportion of URM department chairs in ophthalmology compared with most other clinical departments, although the absolute number of URM chairs in ophthalmology is low at only 8 chairpersons. More work must be done to increase the recruitment of URM physicians into ophthalmology faculty positions to obtain parity with other clinical departments and with the diverse patient populations that physicians serve.

University of North Dakota School of Medicine and Health Sciences.

University of North Dakota School of Medicine and Health Sciences.

New York University Grossman School of Medicine.

New York University Grossman School of Medicine.

"It's a Little Different for Men"-Sponsorship and Gender in Academic Medicine: a Qualitative Study.

Women remain underrepresented in top leadership positions in academic medicine. In business settings, a person with power and influence actively supporting the career advancement of a junior person is referred to as a sponsor and sponsorship programs have been used to diversify leadership. Little is known about how sponsorship functions in academic medicine. To explore perceptions of sponsorship and its relationship to gender and career advancement in academic medicine. Qualitative study using semi-structured, one-on-one interviews with sponsors and protégés. Twelve sponsors (clinical department chairs) and 11 protégés (participants of a school of medicine executive leadership program [N = 23]) at the Johns Hopkins School of Medicine. All sponsors were men and all were professors, six of the 11 protégés were women, and four of the 23 participants were underrepresented minorities in medicine. We identified three themes: (1) people (how and who): women seek out and receive sponsorship differently; (2) process (faster and further): sponsorship provides an extra boost, especially for women; and (3) politics and culture (playing favorites and paying it forward): sponsorship and fairness. Informants acknowledge that sponsorship provides an extra boost for career advancement especially for women. Sponsors and protégés differ in their perceptions of how sponsorship happens. Informants describe gender differences in how sponsorship is experienced and specifically noted that women were less likely to actively seek out sponsorship and be identified as protégés compared to men. Informants describe a tension between sponsorship and core academic values such as transparency, fairness, and merit. Sponsorship is perceived to be critical to high-level advancement and is experienced differently by women. Increased understanding of how sponsorship works in academic medicine may empower individual faculty to utilize this professional relationship for career advancement and provide institutions with a strategy to diversify top leadership positions.

Assessment of Use, Specificity, and Readability of Written Clinical Informed Consent Forms for Patients With Cancer Undergoing Radiotherapy

Appropriate informed consent processes are crucial to preservation of patient autonomy and shared decision making. Although half of patients with cancer receive radiotherapy, it is unknown whether current consent practices are comprehensible for patients. To characterize use, specificity, and readability of clinical informed consent forms for radiotherapy, hypothesizing that forms would be higher than the recommended sixth- to eighth-grade readability level. This nationwide cross-sectional survey study and readability analysis was conducted from 2016 to 2018 and included 89 academic radiation oncology departments that were part of the 2016 Electronic Residency Application Service. Department leaders (clinical directors, chairs, and personal contacts of study authors) at academic radiation oncology departments were contacted via email. Readability levels were measured by 7 validated readability indices, including the Ford, Caylor, Sticht (FORCAST) index for nonnarrative texts. Difficult words were identified using The Living Word Vocabulary, which describes the readability grade levels of 40 000 common words. Of 89 departments, 67 (75%) responded to questions and 57 (64%) provided 113 forms for analysis. Departments providing forms did not differ substantially from others in terms of region, residency size, research output, rural vs urban location, or public vs private institution status. All departments obtained patient written informed consent before radiotherapy; 38 (57%) used body site-specific forms. Using the most conservative (low-score) estimate, mean form readability ranged from grade level 10.6 to 14.2. By 7 distinct indices, only 9 (8%) of 113 forms met the recommended eighth-grade readability level, and 4 (4%) forms met a sixth-grade level. Not a single form met either recommendation based on the FORCAST index. Forms used an average of 7.2 difficult words. Body site-specific forms had considerably better readability than general consent forms. This nationwide study of informed consent practices for cancer treatment with radiotherapy demonstrates that while all US academic radiotherapy departments use written consent forms, it is rare for templates to meet the recommended readability levels for patient materials. These data suggest the need for reevaluation and modification of the approach to radiotherapy consent, ideally with guidance and templates designed by national professional organizations.

What a medical school chair wants from the dean.

Economic pressure has led the evolution of the role of the medical school dean from a clinician educator to a health care system executive. In addition, other dynamic requirements also have likely led to changes in their leadership characteristics. The most important relationship a dean has is with the chairs, yet in the context of the dean’s changing role, little attention has been paid to this relationship. To frame this discussion, we asked medical school chairs what characteristics of a dean’s leadership were most beneficial. We distributed a 26-question survey to 885 clinical and basic science chairs at 41 medical schools. These chairs were confidentially surveyed on their views of six leadership areas: evaluation, barriers to productivity, communication, accountability, crisis management, and organizational values. Of the 491 chairs who responded (response rate =55%), 88% thought that their dean was effective at leading the organization, and 89% enjoyed working with their dean. Chairs indicated that the most important area of expertise of a dean is to define a strategic vision, and the most important value for a dean is integrity between words and deeds. Explaining the reasons behind decisions, providing good feedback, admitting errors, open discussion of complex or awkward topics, and skill in improving relations with the teaching hospital were judged as desirable attributes of a dean. Interestingly, only 23% of chairs want to be a dean in the future. Financial acumen was the least important skill a chair thought a dean should hold, which is in contrast to the skill set for which many deans are hired and evaluated. After reviewing the literature and analyzing these responses, we assert that medical school chairs want their dean to maintain more traditional leadership than that needed by a health care system executive, such as articulating a vision for the future and keeping their promises. Thus, there appears to be a mismatch between what medical school chairs perceive they need from their dean and how the success of a dean is evaluated.

One of Many Reasons Why Psychiatry Is Such a Fabulous Specialty

One of Many Reasons Why Psychiatry Is Such a Fabulous Specialty

The Impact of Survivorship Care Planning on Patients, General Practitioners, and Hospital-Based Staff.

In 2005, the Institute of Medicine recommended that all cancer patients receive a survivorship care plan (SCP). Despite widespread support, few centers have routinely implemented them. Understanding of their impact is limited. The aims of this study were to examine the impact of SCP delivery on patients and healthcare professionals at an Australian comprehensive cancer center and determine enablers and barriers to implementation. Six groups were surveyed: (1) patients who had received SCPs; (2) nurse coordinators using SCPs, (3) general practitioners (primary care, GPs) of patients who had received SCPs, (4) clinical service chairs, (5) heads of allied health, and (6) nurse coordinators not using SCPs (nonengaged nurse coordinators). Groups 1 to 3 completed written questionnaires. Groups 4 to 6 participated in semistructured interviews. Fifty patients, 7 nurse coordinators, 18 GPs, 7 clinical service chairs, 4 heads of allied health, and 8 nonengaged nurse coordinators participated. Eighty-seven percent of patients considered the SCP to be very or somewhat useful; 50% felt it helped them understand their cancer experience. All engaged nurse coordinators reported SCPs to be very or somewhat useful, and 86% believed SCPs improved communication with GPs. General practitioners felt SCPs were very or somewhat useful (67%) and wished to receive SCPs for future patients (83%). Organizational and clinical leadership, multidisciplinary engagement, resourcing, and timing of SCP delivery were considered critical enablers. Patients and healthcare professionals support the use of SCPs; however, they are resource intensive and require significant organizational support. Nurses are instrumental to SCP implementation. Attention to enablers and barriers is important for successful implementation.

Why Physician Leaders of Health Care Organizations Should Participate in Direct Patient Care.

Ideas and Opinions4 October 2016Why Physician Leaders of Health Care Organizations Should Participate in Direct Patient CareAllan S. Detsky, MD, PhD and Michael A. Gropper, MD, PhDAllan S. Detsky, MD, PhDFrom the Institute of Health Policy, Management, and Evaluation, University of Toronto, and Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada, and University of California, San Francisco, San Francisco, California.Search for more papers by this author and Michael A. Gropper, MD, PhDFrom the Institute of Health Policy, Management, and Evaluation, University of Toronto, and Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada, and University of California, San Francisco, San Francisco, California.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-0820 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Physicians assume a variety of leadership positions in health care. The most common ones are heads of clinical divisions, chiefs and chairs of clinical departments, and deans of medical schools. Some ultimately become chief executive officers of hospitals or health systems. Others lead national medical organizations like the American Board of Internal Medicine or the Royal College of Physicians and Surgeons of Canada. Physician leaders profoundly affect the way health care is delivered. They influence and sometimes determine working conditions; professional standards; training programs; research environments; payment schemes; certification requirements; and the quality, safety, and type of care that patients ...

Exploring Identity Dynamics from a Combined Social Exchange and Social Identity Perspective

ABSTRACTThe aim of this article is to explore identity dynamics of unit and department leaders in a healthcare setting using both social identity and social exchange theories. In particular, we developed a mediational moderated model in which supervisor trust indirectly influences identification with a subordinate level (i.e., the clinical unit) through its effect on identification with a superordinate level (i.e., the organization as a whole). Furthermore, we predicted and found that this relation is moderated by organizational tenure, contract breach, and the clinical-manager's role (heads of clinical units vs. chairs of departments). We tested our hypotheses with doctors of a large public hospital in northern Italy. A total of 370 doctors completed questionnaires measuring organizational and unit identification, supervisor trust, and contract breach. Results supported our hypotheses: supervisor trust was related to unit identification through its effect on organizational identification. As expected, this relation was stronger for more tenured department chairs, and for those doctors who perceived less contract breach.

Role of environmental cleanliness and decontamination in care homes.

While it is widely accepted that the environment has an important role in transmission of healthcare-associated infections, there has been a paucity of empirical investigation in this area to date, and the majority of published literature relates to acute settings. People living in care homes come into contact with a communally used environment and communally used equipment daily. Equipment may include hoists, hoist slings, clinical monitoring equipment, commodes and shower chairs. In care homes, primary responsibility for decontamination lies with the healthcare team, most of whom are not nurses. The challenge for nurses working in care homes is their accountability for the provision of safe and effective care.

Women chairs in academic medicine: engendering strategic intuition.

Because stereotypically masculine behaviors are required for effective leadership, examining female chairs' leadership in academic medicine can provide insight into the complex ways in which gender impacts on their leadership practices. The paper aims to discuss this issue. The author interviewed three female clinical chairs and compared the findings to interviews with 28 of their faculty. Grounded theory analysis of the subsequent text gathered comprehensive, systematic, and in-depth information about this case of interest at a US top-tier academic medical center. Four of five themes from the faculty were consistent with the chair's narrative with modifications: Prior Environment (Motivated by Excellence), Tough, Direct, Transparent (Developing Trust), Communal Actions (Creating Diversity of Opinion), and Building Power through Consensus (an "Artful Exercise") with an additional theme, the Significance (and Insignificance) of a Female Chair. While faculty members were acutely aware of the chair's gender, the chairs paradoxically vacillated between gender being a "non-issue" and noting that male chairs "don't do laundry." All three female chairs in this study independently and explicitly stated that gender was not a barrier, yet intuitively used successful strategies derived from the research literature. This study suggests that while their gender was highlighted by faculty, these women dismissed gender as a "non-issue." The duality of gender for these three female leaders was both minimized and subtly affirmed.

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Results of a research directed on studying of factors, impacting on a students� choice related to doctor�s profession, medical high educational institution and medical specialty during training in educational institution are presented in this paper. The factors having the greatest impact on medical specialty choice in students� subjective representation at a training phase before thesis have been ranged. It has been established that pedagogical technologies of medical specialty choice formation have to be implemented purposefully for vocational guidance process management in higher education institution, and also that subjective external factors, such as pedagogical competence of clinical chairs� academic staff in the pedagogical technologies area, training conditions on clinical chairs and teachers� attitude towards the professional choice problem have dominating impact on students� medical&#x0D; specialty choice at the present stage.

Organizational Culture in an Academic Health Center

Implementing cultural change and aligning organizational cultures could enhance innovation, quality, safety, and job satisfaction. The authors conducted this mixed-methods study to assess academic physician-scientists' perceptions of the current and preferred future organizational culture at a university medical school and its partner health system. In October 2010, the authors surveyed academic physicians and scientists jointly employed by the University of Oxford and its local, major partner health system. The survey included the U.S. Veterans Affairs Administration's 14-item Competing Values Framework instrument and two extra items prompting respondents to identify their substantive employer and to provide any additional open-ended comments. Of 436 academic physicians and scientists, 170 (39%) responded. Of these, 69 (41%) provided open-ended comments. Dominant hierarchical culture, moderate rational and team cultures, and underdeveloped entrepreneurial culture characterized the health system culture profile. The university profile was more balanced, with strong rational and entrepreneurial cultures, and moderate-to-strong hierarchical and team cultures. The preferred future culture (within five years) would emphasize team and entrepreneurial cultures and-to a lesser degree-rational culture, and would deemphasize hierarchical culture. Whereas the university and the health system currently have distinct organizational cultures, academic physicians and scientists would prefer the same type of culture across the two organizations so that both could more successfully pursue the shared mission of academic medicine. Further research should explore strengthening the validity and reliability of the organizational culture instrument for academic medicine and building an evidence base of effective culture change strategies and interventions.

Measuring academic productivity: don’t drop your ‘h’s!*

Measuring academic productivity: don’t drop your ‘h’s!*

Jonathan Reinarz, Health Care in Birmingham: The Birmingham Teaching Hospitals 1779–1939 (Woodbridge: Boydell Press, 2009), pp. xii + 276, £60.00, hardback, ISBN: 978-1-84383-506-6.

Jonathan Reinarz, Health Care in Birmingham: The Birmingham Teaching Hospitals 1779–1939 (Woodbridge: Boydell Press, 2009), pp. xii + 276, £60.00, hardback, ISBN: 978-1-84383-506-6. - Volume 55 Issue 3

Editor’s Choice

Journal of Advanced Nursing still publishes discussion papers as well as empirical research reports and review papers. A scholarly discussion paper on an important issue for nursing can make a real contribution to professional debate. What has gone wrong with clinical chairs in nursing? This is the question that Philip Darbyshire raises in his discussion paper (pp. 2592–2599) in this issue of JAN. Does Darbyshire provide convincing evidence and cogent argument to support his contention that things have gone wrong? The original idea of clinical (or joint) chairs in nursing was to provide positions, usually jointly supported by a university and a hospital or health service, that would ‘straddle the worlds of academia and clinical practice, developing research and scholarship, building research cultures in clinical areas and bridging the notorious theory-practice gap’ (p. 2593). Darbyshire tells us how, 15 years ago, he left Scotland—where I knew him as a PhD student – to take up a clinical chair in Australia, where there already were 20 or so such posts. Clinical chairs have been introduced in other countries, including the UK, and perhaps it is unsurprising that there have been problems in making these positions work satisfactorily in practice. Whether the situation is universally as dire as the picture Darbyshire paints is difficult to assess objectively. He is, however, absolutely right to draw attention to the impossibility of a clinical chair holder being expected to carry a full workload as a university professor and, in addition, to fulfil the demanding and varied expectations attached to a clinical professor’s role in practice. Likewise, that it is untenable to operate these senior posts on the basis of short term, untenured arrangements. No wonder, for these reasons, it might well be proving difficult to fill vacant or new clinical chair posts with suitably qualified candidates. Those with responsibility for these positions, on both sides – academe and service – really must resolve these issues. Darbyshire makes helpful suggestions at the end of his paper (p. 2598) with regard to selection, joint goal-setting, support, review and communication. His proposal that clinical professors should be left in peace to develop their role without the interference of ‘micromanagement’ is rather more controversial, however appealing is the notion of ‘intelligent accountability’ (p. 2598). But where I most disagree with Darbyshire’s analysis is his contention that the shared understandings and consensus between academe and service may be fragmenting (p. 2596). This relationship always will have inherent tension and divergence because the modus operandi, ethos, priorities and timelines are fundamentally different in universities and health services. There are, however, common goals that transcend these tensions, and what most powerfully binds academe and service together is the shared desire that nursing be a research-based profession. While this always has been a key driving force in academic nursing, it is now, I think, an equally well-understood goal in nursing service. At least in the UK, an unprecedented partnership between academe and service is now developing in order to introduce, at last, opportunities for nurses and midwives to pursue a clinical-academic career pathway, with appropriate training at each stage, and with proper employment contracts in and across the two sectors. The goal of this exciting development is to produce a new generation of research-active clinicians and research leaders for our profession. There is a unique opportunity, therefore, in this context, to create a new blueprint for the role of ‘clinical chair’. It needs to be a realistic role, realistically framed in the context of 21st century universities and health services, but with high aspirations as well. Poisoned chalice? Sad if it has come to that. But it need not be so. What do you think? Let’s continue this discussion in JAN Forum.

Joint or clinical chairs in nursing: from cup of plenty to poisoned chalice?

This paper presents a discussion of the current state of joint chair or clinical chair positions in nursing. Background. Joint chair positions in nursing or midwifery have been popular approaches to developing clinical research and to bridging the 'theory-practice gap'. Recent personal observations and commentaries in the literature suggest that the service-academy consensus that underpinned such positions may be crumbling. This paper is based on 13 years' experience of holding a joint chair position, an extensive review of the professional literature (up to and including 2009 sources), and conversations and discussions with many professorial and joint chair colleagues. Despite its demonstrated success, the joint chair position may be under threat from competing and unrealistic demands from partner organizations and from changing understandings of the essential role and nature of a professor. The situation may be exacerbated by appointing inexperienced or unsuitable applicants to such key posts. The joint chair position was a powerful initiative in nursing and midwifery with real potential. In the current climate, this potential is unlikely to be realized and nursing will be the poorer. If joint chair positions are still valued and seen as key roles in developing clinical research and university-service partnerships, then serious consideration needs to be given to the current state of position. I argue for a return to trust and what Onora O'Neill calls 'intelligent accountability' rather than the micromanagement that is so prevalent in both the health and academic industries.