Medical School Deans Research Articles

Leadership in Academic Medicine: Capabilities and Conditions for Organizational Success

Leadership in Academic Medicine: Capabilities and Conditions for Organizational Success

Accès du public aux informations sur les prestations et la qualité des soins dans les établissements publics de santé

For the past eight years, the Ministry of Health has released information about the services and quality of care in public hospitals, in response to the increasing concern about hospital performance expressed by patient associations. The press publishes hospital ratings based on this information. This survey asked hospital administrators about their views of communication on this topic. This survey, conducted from 7 October through 20 November 2004, sent a two-page open questionnaire to a variety of hospital executive personnel - medical directors, chief administrators, medical school deans, and public information officers - to determine their views on this subject. The response rate was 34%. Without contesting either the legitimacy of the expectation for information or the transparency owed to patients, health professionals expressed the need to know in advance the "rules of the game" and the methodology of the rating techniques to be used. Most reported few changes in their professional behavior due to these publications, the methodology and criteria of which they contested. They suggested changes including different criteria and indicators for the rating, the ability to contest the conclusions drawn from the PMSI data, and the need for preliminary work to define criteria by working groups composed of physicians, other professionals, and even those outside the health field. On the other hand, only half were willing to participate in such a working group. These hospital managers see a need for specialists in the analysis of hospital data, who can clarify the meaning of the statistics and improve the public's understanding of them, now shaped by the mass media's failure to provide meaningful analysis.

Burnout and Psychological Stress among Deans of Colleges of Medicine: A National Study

Psychological burnout may inhibit the ability of deans of colleges of medicine to effectively lead their organizations during periods of rapid change. The objective of this study was measure the prevalence and intensity of the psychological components of burnout and their correlates among deans of U.S. colleges of medicine. To do so, questionnaires that burnout, job stressors, personal support systems and job satisfaction were sent to deans of all U. S. colleges of medicine, and selected deans of nursing schools, and other academic health center leaders. Medical school deans exhibited a high prevalence of depersonalization (42.9% of respondents), emotional exhaustion (25.4%), and reduced personal accomplishment (27.0%). High levels of these subdomains and of overall burnout intensity significantly correlated with high levels of personal, job, and environmental stress; low levels of support or coping resources; high prevalence of physical and behavioral symptoms; and reduced job satisfaction. Deans of colleges of medicine frequently exhibit characteristics of burnout that may impede effective leadership. These characteristics are likely to intensify unless specific interventions are devised and implemented.

Financial and Organizational Turmoil in the Academic Health Center: Is It a Crisis or an Opportunity for Medical Education?

Received September 29, 2005; revised November 16, 2005; accepted December 2, 2005. Dr. Kirch is Senior Vice President for Health Affairs, Dean of the College ofMedicine, and Chief ExecutiveOfficer of the Milton S. Hershey Medical Center, Hershey, Pennsylvania. Dr. Kirch is also Professor Psychiatry at The Pennsylvania State University. Address correspondence to Dr. Kirch, 500 University Drive, H162, Hershey, PA 17033; dkirch@psu.edu (E-mail). Copyright 2006 Academic Psychiatry. The degree of turmoil existing in academic health centers (AHCs) has been a matter of extensive discussion and debate over the last decade (1, 2). This commentary offers the perspective of the author, who has served as a medical school dean and academic health system chief executive over the last 12 years. Although representing an individual perspective, an attempt is made to rely on known data regarding the structure and function of AHCs as well as principles for organizational change. Within the AHC community, individual faculty members express views ranging from longing for times that seemed “easier” to feeling that they are in the midst of a full-blown crisis. When asked to identify the cause of this sense of turmoil, more often than not, financial instability is cited as the key driver. There is no doubt that some challenging fiscal forces are at work (3). In the aftermath of managed care and legislative efforts to create balanced budgets, revenues from both private and public payers for healthcare services have been significantly restricted. The effect on teaching hospitals and practice plans has been profound. Another factor is that direct public appropriations to medical schools have had their growth slowed or in some cases have been significantly decreased. In addition, as the “hard landing” following a 5-year doubling of the budget for the National Institutes of Health has occurred, competition for research funding has become even more intense. Finally, with concern mounting regarding medical student debt, increased scrutiny has been placed on tuition levels (4). Perception and Reality

No Method, Thus Madness?

If you ask most medical school deans if they have a course, program, or center doing bioethics, they will enthusiastically assure you that they do. And their enthusiasm for bioethics grows exponentially in proportion to their interest in showing that they are doing something about managing research ethics issues at their institutions. The same can be said about the entire biomedical research establishment--from private companies to independent research centers to professional organizations--bioethics is on the masthead, the organizational chart, and the agenda of the annual meeting. Not to worry--medicine's got ethics. It is certainly fine to feature bioethics as a topic area. But there is mounting that perhaps bioethics is not all or even primarily what the doctor should be ordering just now. Some of the problems now ailing require admitting that what has befallen and the health sciences is an epistemological crisis as much as a moral one. Now this may seem an odd claim since it is hard, or rather, completely impossible, to avoid the phrase medicine in the august halls of academic medical centers in the United States, Europe, Australia, and New Zealand these days. There are journals, resource centers, toolkits, web sites, and more publications than anyone interested in evidence-based could possibly ever read. So how could it be that a field that is embracing at every turn, teaching about outcomes, drilling the need for verifiable data into the heads of the next generation, and extolling the virtue of at every conference, meeting, seminar, and water-cooler, possibly be in the midst of an epistemological crisis? Where is the evidence? Contemporary is sailing on very rocky seas these days. It is being buffeted by ever-rising costs, doubts about its efficacy, and intrusions on its turf from competitors that range from optometrists, psychologists, chiropractors, midwives, and nurse-anesthetists to the friendly folks at the herb and vitamin store. Recently, there seems to be real uncertainty on the part of medicine's leaders about what to say in the face of a continuing stream of fraud and misconduct. The editors of the Lancet, Science, Nature, and the New England Journal of Medicine--the key guardians of the gates--face a stream of questions about how they plan to secure the gates following the shenanigans of the South Korean researcher who lied about producing stem cells from cloned human embryos and a Norwegian cancer researcher who fabricated findings about ways smokers could reduce their risk of acquiring oral cancer, and their tortured agonizing is painful to watch. Far from having an answer to the question of what distinguishes as a mode of healing and a field capable of minimizing fraud, the leaders of the medical professional cling to the phrase medicine as if intoning the word evidence will act as a talisman to keep all the troubles at bay. But the fervency of the embrace of evidence-based reflects a deeper and much more serious problem among the stewards of medical knowledge--a crisis of faith in the methods, processes, and checks and balances that have, at least since the nineteenth century, been the infrastructure that has permitted to make the transition from an art to a science. Consider the response to the recent battle over what to do about fetal pain. In the August 24, 2005, Journal of the American Medical Association, an article claimed that a review of all the available published medical showed that fetuses do not feel pain until they are at least seven months old. The JAMA article appeared at a time when efforts are underway in Congress and state legislatures to use the topic of fetal pain as a way to discourage women from seeking elective abortions. The JAMA article contended that there is no medical showing that fetuses can feel pain at twenty weeks. …

John Collins Warren: Master Educator and Pioneer Surgeon of Ether Fame

John Collins Warren (1778–1856) represented the apex of surgery and medicine of the first half of nineteenth century Boston. Educated at Harvard College where he obtained a Bachelor of Arts in 1797, he contemplated the idea of a business career prior to setting sail for a traditional medical education at Europe's finest universities. From 1799 to 1802, he attended prestigious medical and surgical lectures in London, Edinburgh, and Paris. Warren received an honorary MD from Scotland's St. Andrews University in 1802. He then returned to Boston and joined his father's practice.In 1815, he followed his accomplished father as the Hersey Professor of Anatomy and Surgery at Harvard Medical School. He held this position with great distinction until 1847 when he retired as professor emeritus. From 1816 to 1819 he served as Harvard Medical School dean and received an honorary medical degree at the end of his term.John Collins Warren had numerous surgical accomplishments during his illustrious career. Clinically, he was active and varied in his practice, operating on strangulated hernias, tumors, and cataracts, in addition to performing vascular surgery and amputations. He published many articles and books of widespread circulation. Professor Warren also performed the first reported case of ether anesthesia administered by William T. Morton on October 16, 1846.Outside the operating theatre, Doctor Warren and his colleagues were revered for founding the Massachusetts General Hospital in 1821, and years before, in 1812, Warren and his associates established the New England Journal of Medicine and Surgery. In light of his varied contributions, John Collins Warren is remembered as a dedicated and innovative surgeon, as well as a committed medical educator, able administrator and effective leader.

Sexual Harassment in Academic Medicine: Persistence, Non-Reporting, and Institutional Response

Sexual harassment occurs with regularity during medical training, and it remains largely unreported. This study is one institution’s attempt to understand how third and fourth-year medical students perceive and experience sexual harassment, what they believe about reporting sexual harassment, and how they believe it might be eradicated from the educational environment. We used a qualitative research method for our investigation, which would generate more specific language to use in a larger empirical study involving larger numbers of our students. We conducted five focus groups with 24 students, which yielded five categories of response obtained through a close, line-byline reading of transcribed audiotapes. In addition, we offer four recommendations to medical education researchers, deans of medical schools, and medical school accrediting bodies that may reduce the incidence of sexual harassment of medical students. While we do not make the case that the observations, explanations, and recommendations of these 24 students reflect the opinions of all medical students here or elsewhere, we do propose that they are a snapshot of one medical school’s gender climate and offer a valuable foundation for further inquiry.

Physician-Advocate: Deciding What To Fight for and When

Q. What led you to become active in advocacy for causes in medicine and pediatrics? You have had a complicated relationship with the federal government: you worked for the government at the National Institutes of Health, interacted with it both as the dean of a major medical school and in an advisory capacity in the Institute for Medicine, and now as director of the California Stem Cell Initiative. Can you tell me a little bit about these experiences and how they have shaped your thinking about your role as a physician and now a public figure?

Burnout in Academic Chairs of Otolaryngology: Head and Neck Surgery

Burnout can be characterized by a low degree of personal accomplishment and a high degree of emotional exhaustion and depersonalization using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). With increasing demands and constraints placed on academic department chairs, the risk of developing burnout may be increasing. The prevalence of burnout in chairs of academic departments of otolaryngology and the factors associated with it have not been previously described. The purpose of this study was to determine the prevalence of burnout in otolaryngology chairs and to identify the factors that are associated with burnout development. Understanding these elements can lead to improved prevention, recognition, and treatment of professional burnout. A cross-sectional questionnaire-based study of 120 academic chairs of otolaryngology in the United States was performed. A confidential questionnaire was mailed to U.S. otolaryngology chairs. The questionnaire consisted of six parts assessing the following elements: 1) demographic information, 2) professional stressors, 3) personal and professional life satisfaction, 4) a self efficacy survey, 5) a spousal support survey, and 6) the MBI-HSS. Statistical analyses were performed using Pearson correlation and analysis of variance, and burnout data were compared with previously reported data from other department chairs and physicians. Questionnaires were returned from 107 department chairs for a response rate of 89%. Chairs were on average 56 years of age, serving as chair for a mean of 11 years. Average work week was 68 hours and did not vary significantly with increasing duration as chair. Sixty-six percent of time was spent delivering patient care, 8% in research, and 26% performing administrative duties. MBI-HSS scores demonstrate 3% of chairs experiencing high burnout, 81% of chairs with moderate burnout, and 16% of chairs with low burnout. On average, chairs have low depersonalization scores, low-moderate emotional exhaustion scores, and low-moderate personal accomplishment scores. High emotional exhaustion or depersonalization was correlated with low self-efficacy, low spousal support, disputes with the dean, department budget deficits, working nights and weekends, Medicare audits, loss of key faculty, and being a malpractice defendant. High personal accomplishment was correlated with increased time spent performing administrative duties. When compared with other physician specialties, otolaryngology chairs demonstrate less sense of emotional exhaustion and depersonalization but also slightly less sense of personal accomplishment. Duration as chair, age, and hours worked per week were not associated with increased burnout. Most otolaryngology chairs experience moderate levels of burnout. The biggest risk factors for burnout include low self-efficacy, low spousal support, disputes with the medical school dean, department budget deficits, and nights/weekends worked. These findings may help department chairs identify and prevent burnout and may help in developing programs to minimize burnout in our field's academic leaders.

Educational Programs in US Medical Schools, 2004-2005

The educational environment affects the outcomes of medical education, including the characteristics and distribution of medical school graduates. To report the status of variables related to medical education that represent areas that recently have been in flux or have potential impact on health care delivery. Descriptive survey study comparing selected results of the Liaison Committee on Medical Education Annual Medical School Questionnaire between 2004-2005 and 1994-1995. The questionnaire was sent to the deans of all 125 LCME-accredited medical schools. Response rate was 100% in both years. Overall trends between 1994-1995 and 2004-2005 in the size and composition of the medical school faculty, the numbers of medical school applicants and students, requirements for passage of the US Medical Licensing Examination, medical student work hours, the use of computers in the educational program, the geographic pipeline from entry to medical school to entry to graduate medical education, and the educational background of medical school deans. The number of full-time faculty members increased from 90 016 in 1994-1995 to 119 025 in 2004-2005 (a 32% increase) while the number of medical students remained constant at about 67 000. In 2004-2005, 11% of medical school deans held MD and PhD degrees, 6% held MD and MBA degrees, 4% held MD and MPH degrees, and 2% held an MD and another degree (such as JD). In 2004-2005, 68% of all first-year medical students were residents of the state in which the medical school is located and a mean of 43% of 2005 graduates remained in the same state as the medical school for graduate medical education; results were similar in 1995. In 2004-2005, 58 schools (46%) required students to have their own computers and 35 (28%) to have their own personal digital assistants. In 2004-2005, night call was less common in the family medicine, internal medicine, pediatrics, and psychiatry clerkships compared with 1994-1995. Although most students remain in their home state for medical school, most students leave the medical school state for residency. Factors external to the medical school, such as funding mechanisms and regulations from the public and private sectors, may be having an impact on faculty size and composition, and on the geographic pipeline of students into medical school and residency training.

Developing rheumatology in the Asia‐Pacific region: it starts with our medical students

At the end of one of my general medical ward rounds last week, I asked my students if they had any questions. The response was almost instantaneous, but not related to the general cases that we had just seen. They wanted extra rheumatology teaching sessions from me. Asked why they needed these sessions, the unanimous reply was ‘rheumatology is difficult’ and ‘I do not know how to properly evaluate a rheumatic disease patient’. This was not the first time my students had asked for extra teaching sessions or commented on how difficult rheumatology was. The possible reasons are manifold. It could be a true reflection of just how difficult rheumatology is for undergraduate students, or that students at my university have extra hunger for knowledge, or my teaching has been substandard. I am glad to read from Dr Geoffrey McColl's article ‘A survey of the musculoskeletal curricula of medical schools in the Asia-Pacific region’1 in this issue that the more probable answer is we allocate too little time in musculoskeletal system teaching. Of the 44 medical schools, out of the 130 approached, who responded to Dr McColl's questionnaire, the average total number of hours of musculoskeletal teaching represented approximately 2% of the total student contact hours only. Although the author stated that this figure was not dissimilar to that from the Canadian medical school average, personally, I feel this is a significant inadequacy considering musculoskeletal disorders are expected to account for approximately 25% of all chronic physical disabilities in developed countries 20 years from now. There is a more urgent need for Asia-Pacific countries to train doctors to manage patients with musculoskeletal complaints because we have fewer rheumatologists, orthopedic surgeons and family physicians per capita compared with Western countries, while our population is ageing at the same, if not greater, rate as the rest of the world. This has to start at the undergraduate level. It is widely believed among medical educationalists that knowledge acquired in the few years spent at a medical school as a student shapes the subject's learning in medicine, as well as his/her future approach to patients. A basic understanding of how to clinically evaluate a person who presents with a musculoskeletal complaint, the patho-etiology of common rheumatic disorders, and the principles of management of these syndromes is essential. Explosion in the understanding of the immunopathology of many chronic rheumatic disorders such as rheumatoid arthritis, ankylosing spondylitis and systemic lupus erythematosus means that close coordination with immunology teaching is desirable. As Dr McColl rightly points out, metabolic bone disorders are going to be a major burden of many health authorities in the next 1–2 decades, thus more emphasis in this area is important. The biochemist, endocrinologist, rheumatologist and orthopedic surgeon need to be brought together to formulate an appropriate teaching program. But how can this be done? First, medical school deans and those who are responsible for running the undergraduate medical curriculum need to be convinced of the potential impact musculoskeletal disorders have on our society. Studies on the cost of arthritis on both local and regional levels are to be encouraged. Second, a structure for the development of a musculoskeletal curriculum needs to be developed. The Bone & Joint Decade has taken this initiative, and the structure suggested by Woolf et al.2 are to be recommended with adaptations to suit local needs. APLAR may have a role here by encouraging the COPCORD Standing Committee to coordinate regional and local cost studies, as well as reinforcing medical schools in this region regarding the importance of a comprehensive undergraduate musculoskeletal curriculum. I commend Dr McColl for conducting the survey. It is an important reminder to us all that while we applaud how efficacious the many novel biologic drugs are in the treatment of common chronic rheumatic disorders, they are of no use if the patients are not being identified, and that musculoskeletal disease awareness starts at an elementary level. Finally, did I find out from my students if my teaching had been substandard? I dared not ask them. However, the Faculty Teaching Medal that was awarded to me 2 years ago did reassure me that I might not be that bad after all!

La acreditación de la formación médica continuada y la mejora de la calidad. Situación actual en España y en el ámbito internacional

The main goal of Continuing Medical Education (CME) accreditation is to improve the supply of CME. Therefore, CME accreditation can decisively contribute to healthcare quality assurance through maintaining and improving physicians’ competence. The accreditation system of the Catalan Council for CME was implemented in 1997 and that of the Spanish Commission of Continuing Education in 1998. Since then, most of the Autonomous Regions of Spain have created their own Commissions and currently 9 of them are accrediting CE events. The Spanish Accreditation Council for CME (SACCME) was created in 2003 and its members include the Spanish Medical Association, the Spanish Federation of Medical and Scientific Societies, the Spanish Council of Medical Specialties, and the Spanish Assembly of Deans of Medical Schools. The most widely recognized international CME accreditation systems are the Accreditation Council for CME of the United States, which provides institutional accreditation, and the American Medical Association's accreditation system for CME events. The situation in Europe is highly variable. In the last few years the European Accreditation Council for CME (EACCME) has been implemented by the Union Européenne des Médecins Spécialistes (UEMS), with the aim of making it the reference system for EU countries. The Spanish Medical Association has signed an agreement with the UEMS for the mutual recognition of CME credits awarded by the SACCME and EACCME.

Research Centers and Institutes in U.S. Medical Schools: A Descriptive Analysis

Research centers and institutes are a common mechanism to organize and facilitate biomedical research at medical schools and universities. The authors report the results of a study on the size, scope, and range of activities of 604 research centers and institutes at research-intensive U.S. medical schools and their parent universities. Centers and institutes with primary missions of patient care, education, or outreach were not included. The findings indicate that, in addition to research, centers and institutes are involved in a range of activities, including education, service, and technology transfer. The centers and institutes the authors studied were more interdisciplinary than those included in previous studies on this topic. Most research centers and institutes did not have authority comparable to academic departments. Only 22% of centers directly appointed faculty members, and most center directors reported to a medical school dean or a department chair. A small group of centers and institutes ("power centers"), however, reported to a university president or provost, and may have considerable power and influence in academic decision making and resource allocation. Two main types of centers and institutes emerge from this research. The first type, which includes the vast of majority of centers, is modest in its scope and marginal in its influence. The second type--with greater amounts of funding, larger staffs, and direct access to institutional decisionmakers--may have a more significant role in the organization and governance of the medical school and university and in the ways that researchers interact within and across academic divisions.

The polity of academic medicine: A critical analysis of autocratic governance

How should academic radiology departments be governed? This question has rarely been directly addressed in the radiology literature. The dominant model of administration in present-day academic departments differs from that typically seen in private group practices. Whereas private group practices tend to follow a democratic model whereby key decisions must be supported by a majority of the partners, in academic institutions, medical school deans and department chairs generally possess great latitude in strategic and operational decision making. This article considers arguments for and against "top-down" governance in academia. The rationale supporting this form of governance is weak, and the best evidence from the fields of management and organizational behavior suggests it may in fact be detrimental.

The new Australian medical schools: daring to be different

This is an extraordinary opportunity and very exciting, say the Deans of the new medical schools.

Personal health promotion at US medical schools: a quantitative study and qualitative description of deans' and students' perceptions

BackgroundPrior literature has shown that physicians with healthy personal habits are more likely to encourage patients to adopt similar habits. However, despite the possibility that promoting medical student health might therefore efficiently improve patient outcomes, no one has studied whether such promotion happens in medical school. We therefore wished to describe both typical and outstanding personal health promotion environments experienced by students in U.S. medical schools.MethodsWe collected information through four different modalities: a literature review, written surveys of medical school deans and students, student and dean focus groups, and site visits at and interviews with medical schools with reportedly outstanding student health promotion programs.ResultsWe found strong correlations between deans' and students' perceptions of their schools' health promotion environments, including consistent support of the idea of schools' encouraging healthy student behaviors, with less consistent follow-through by schools on this concept. Though students seemed to have thought little about the relationships between their own personal and clinical health promotion practices, deans felt strongly that faculty members should model healthy behaviors.ConclusionsDeans' support of the relationship between physicians' personal and clinical health practices, and concern about their institutions' acting on this relationship augurs well for the role of student health promotion in the future of medical education. Deans seem to understand their students' health environment, and believe it could and should be improved; if this is acted on, it could create important positive changes in medical education and in disease prevention.

The Views of U.S. Medical School Deans Toward Academic Primary Care

To understand the views of U.S. medical school deans about their primary care faculties. In 2000, the authors mailed a questionnaire containing 43 multipart items to deans of 130 U.S. allopathic medical schools. The questionnaire assessed the deans' attitudes about and evaluation of primary care at their school and their school's efforts to strengthen it. Deans were asked to compare family medicine, general internal medicine, and general pediatrics with nonprimary care clinical departments at their schools. Of the 83 (64%) deans who responded, 82% reported their school had departments or divisions of family medicine, general internal medicine, and general pediatrics. Deans rated general internal medicine and general pediatrics higher than nonprimary care faculty on clinical expertise and productivity (p < .001) and family medicine equivalent to nonprimary care faculty. Deans rated all three primary care faculties superior to nonprimary care faculty for teaching skills (p < .001) and programs (p < .05), but lower than nonprimary care disciplines for research productivity (p < .01) and revenues (p < .001). They rated family medicine and general pediatrics lower for research skills (p < .001), but 73% of deans stated research was equally important for primary care and nonprimary care departments. Deans considered overall financial resources to be equivalent for primary care and nonprimary care departments, but 77% of deans felt primary care departments or divisions needed financial support from the medical school to survive. Most deans attempted to strengthen primary care by changing the curriculum to promote primary care and by providing financial support. Deans ranked primary care faculty high on clinical and teaching measures. Although they considered research to be an important activity for primary care faculty, they evaluated it low relative to nonprimary care departments.

Research Training in Psychiatry Residency: Strategies for Reform

Research Training in Psychiatry Residency: Strategies for Reform

Research Training in Psychiatry Residency: Strategies for Reform

Research Training in Psychiatry Residency: Strategies for Reform

Educational programs in US medical schools, 2003-2004.

US medical schools continue to change their organizational structures, staffing patterns, and educational programs. To review the status of US medical school educational programs in the 2003-2004 academic year, compared with 1993-1994. The Liaison Committee on Medical Education (LCME) Annual Medical School Questionnaire for 2003-2004 and the Association of American Medical Colleges Directory of American Medical Education for the years 1983-1984, 1993-1994, and 2003-2004. The number of full-time faculty members in the 126 LCME-accredited medical schools increased from 90 975 in 1993-1994 to 114 549 in 2003-2004 (+26%), whereas the number of enrolled students remained essentially unchanged (66 453 in 1993-1994 and 67 166 in 2003-2004). In 2003-2004, 48% of medical school deans held another title at the medical center or university level, such as vice president for health affairs. There are 94 medical schools that have a comprehensive clinical examination using the standardized patient/objective structured clinical examination format; 59 schools require students to pass this examination for graduation. As of spring 2004, 58 schools will require students in the class of 2005 to pass the new US Medical Licensing Examination Step 2 Clinical Skills examination. The role of the medical school dean has expanded over time and is associated with the creation of a discrete administrative structure for the educational program. The number of full-time medical school faculty continues to increase, whereas the number of enrolled students remains steady. Considerable variability exists among medical schools in their use of standardized clinical evaluations.