Medical School Deans Research Articles

The Medical School Dean: Leadership and Workforce Development

The author reviews the role of deans in US academic medical centers. The author describes the role of the dean of a medical school on the basis of his personal experience and key texts on the topic. Skills acquired earlier in an academic career are used across a much broader base in the role of dean, and the dean holds a time-honored and privileged position in academic medicine. Fundamental activities of the dean include communication, mentorship, recruitment, and retention. As with any leadership role, the position is not about the person, and a dean serves as a resource to a host of internal constituents and as an ambassador for the institution.

Anesthesia Scholarship, Research, and Publication

Anesthesia Scholarship, Research, and Publication

An Interview with Nancy Andrews

Nancy Andrews was drawn into the study of iron biology in the mid-1990s, just as the field was emerging from the doldrums. For decades, researchers had been frustrated by the lack of a molecular understanding of how proper iron concentrations are maintained in the body, but in 1996 a team of scientists discovered a defective gene in patients with iron overload, or hemochromatosis. As researchers raced to find out how the mutant gene caused the disease, Andrews set off on a different quest—to understand how iron enters and leaves cells in the first place. In 1997, she and colleagues identified the molecule responsible for transporting iron into cells. Over the following years, she would help crack the mystery of hemochromatosis and other issues in iron homeostasis, helping to usher in a golden age of iron biology. During that time she would assume a series of high-level administrative posts, earning a reputation as a passionate advocate for medical education and for women in medicine. In 2007, Andrews moved from Harvard Medical School, where she studied and worked for nearly 30 years, to become Dean of Duke Medical School. She is the only woman to be at the helm of a top 10 medical school, which earned her widespread media attention. She spoke to me first from her lab and then her office. You were surprised by the attention your appointment at Duke received. Why? I don't think I knew personally any women deans of medical schools but it seemed amazing that, in 2007, after women had been in academic medicine for some time, none of the top-ranking schools had a woman dean. You've said that part of the problem is the pipeline—many deans are former department chairs, in particular of internal medicine, and there are just not that many women in …

Review ofAlfalfa to Ivy: Memoir of a Harvard Medical School Dean

Review of<i>Alfalfa to Ivy: Memoir of a Harvard Medical School Dean</i>

The Pitfalls of Prestige and Dominance in Leadership Education

P hysicians in training need to appreciate that people end up in formal leadership positions for all sorts of reasons. Some are drafted without having sought such a post. Others have been thinking about it for a very long time—in some cases, virtually their whole lives. There are chairs of departments, deans of medical schools, and hospital CEOs who attained their positions simply because they were the best people for the job, and then there are others who have organized their lives around such objectives and put their names forward again and again in an effort to achieve them. Some are nearly desperate to be appointed to leadership and eagerly move from one institution to another to achieve their goal. This discussion concerns the latter group, people who have long sought out positions such as chair or dean or president. What animates them? In some cases, their passion for leadership does not grow out of a deep understanding of the organization’s challenges or a strong sense of calling to service, but rather a strong need for one of two things: prestige or dominance. Such people either see the desired leadership position as a clear ratification of their success or they want to increase their influence over other people by acquiring the formal authority of the person in charge. People whose leadership aspirations are motivated by a desire to appear successful often operate with a very conventional notion of success. They believe that success is measured not so much by the quality of a person’s ideas or work but rather by the titles on a resume or business card. They are not so interested in tackling the day-to-day challenges of the position as in using the position as a kind of trophy to prove that they have reached a particular career summit. For this very reason, they often become restless in whatever position

A New Day Dawns For Workforce Redesign

A New Day Dawns For Workforce Redesign

Tobacco Dependence Curricula in US Osteopathic Medical Schools: A Follow-up Study

Tobacco use is the leading preventable cause of illness and death in the United States. A 1998 survey of US osteopathic medical schools identified deficiencies in tobacco dependence curricula. To assess the current content and extent of tobacco dependence education and intervention skills in US osteopathic medical school curricula. An electronic survey. Osteopathic medical schools with students enrolled for the 2009-2010 academic year. Twenty-seven osteopathic medical school deans or their designated administrators. Reported instruction in 7 basic science and 6 clinical science content areas (elective or required) and hours of tobacco dependence education were assessed and compared with the 1998 data. The mean (standard deviation) number of content areas reported as covered in 2010 was 10.6 (2.3) (6.1 [1.2] basic science areas, 4.6 [1.3] clinical science areas). Seventeen of 27 respondents (63%) reported that smokeless tobacco content was covered at their school, and 9 of 27 (33%) reported that the stages of change counseling technique was covered. Compared with 1998, a significant increase was noted in the percentage of schools covering tobacco dependence (92.6% in 2010 compared with 57.9% in 1998, P=.0002). Reported hours of tobacco dependence instruction were also significantly higher in 2010 compared with those in 1998 (Fisher exact test, P<.05). No statistically significant changes were found in the proportion of schools covering all 13 content areas (15.7% vs 22.2%), the proportion covering motivational interviewing in detail (26.3% vs 33.3%), or the proportion requiring curricula on smokeless tobacco (57.9% vs 59.3%). Osteopathic medical school respondents reported more instruction on tobacco dependence in 2010 compared with those in 1998. However, some important basic science and clinical science content areas are not being adequately taught in US osteopathic medical schools.

"Raising the Bar" for Educational Science.

"Raising the Bar" for Educational Science.

How Competent Are Emergency Medicine Interns for Level 1 Milestones: Who Is Responsible?

The Next Accreditation System (NAS) of the Accreditation Council for Graduate Medical Education (ACGME) includes the implementation of developmental milestones for each specialty. The milestones include five progressively advancing skill levels, with Level 1 defining the skill level of a medical student graduate, and Level 5, that of an attending physician. The goal of this study was to query interns on how well they thought their medical school had prepared them to meet the proposed emergency medicine (EM) Level 1 milestones. In July 2012, an electronic survey was distributed to the interns of 13 EM residency programs, asking interns whether they were taught and assessed on the proposed Level 1 milestones. Of possible participants, 113 of 161 interns responded (70% response rate). The interns represented all four regions of the country. The interns responded that the rates of Level 1 milestones they had been taught ranged from 61% for ultrasound to 98% for performance of focused history and physical examination. A substantial number of interns (up to 39%) reported no instruction on milestones such as patient disposition, pain management, and vascular access. Graduating medical students were less commonly assessed than taught the milestones. Skills with technology, including "explain the role of the electronic health record and computerized physician order entry," were assessed for only 39% of interns, and knowledge (USMLE) and history and physical were assessed in nearly all interns. Disposition, ultrasound, multitasking, and wound management were assessed less than half of the time. Many entering EM interns may not have had either teaching or assessment on the knowledge, skills, and behaviors making up the Level 1 milestones expected for graduating medical students. Thus, there is a potential gap in the teaching and assessment of EM interns. Based on these findings, it is unclear who will be responsible (medical schools, EM clerkships, or residency programs) for ensuring that medical students entering residency have achieved Level 1 milestones.

A retrospective and prospective look at medical education in the United States: trends shaping anatomical sciences education

During the last decade of the 20th century and the first decade of the 21st century, curricular reform has been a popular theme. In fact, reform on the current scale has not occurred since the early 1900s, when Abraham Flexner released his landmark report 'Medical Education in the United States and Canada'. His report, suggesting major changes in how physicians were educated, became the norm and few changes occurred until the last quarter of the 20th century. During this period increased demands on medical school curriculums due to the explosion of knowledge in biomedical sciences and the pressure to add additional clinical experiences increased the momentum for curriculum reform. In 1984 an Association of American Medical Colleges (AAMC) report, 'Physicians for the Twenty-First Century: The Report of the Panel on the General Professional Education of the Physician (GPEP) and College Preparation for Medicine', discussed many items related to reforming medical education including the value of integration, increased use of active learning formats, more self-directed learning, improved communication skills and increased problem-solving activities. This was followed by a report released in 1993 entitled 'Educating Medical Students: Assessing Change in Medical Education - The Road to Implementation' (ACME-TRI), which identified educational problems by surveying medical school deans, suggested ways to deal with these issues and presented a plan of action. Recently, the Carnegie Foundation for the Advancement of Teaching released 'Education Physicians: A Call for Reform of Medical School and Residency' with additional suggestions. At this point the question that might be asked is - Where is all this going and how is it going to affect anatomy education?

Burnout and Distress Among Internal Medicine Program Directors: Results of A National Survey

Physician burnout and distress has been described in national studies of practicing physicians, internal medicine (IM) residents, IM clerkship directors, and medical school deans. However, no comparable national data exist for IM residency program directors. To assess burnout and distress among IM residency program directors, and to evaluate relationships of distress with personal and program characteristics and perceptions regarding implementation and consequences of Accreditation Council for Graduate Medical Education (ACGME) regulations. The 2010 Association of Program Directors in Internal Medicine (APDIM) Annual Survey, developed by the APDIM Survey Committee, was sent in August 2010 to the 377 program directors with APDIM membership, representing 99.0 % of the 381 United States categorical IM residency programs. The 2010 APDIM Annual Survey included validated items on well-being and distress, including questions addressing quality of life, satisfaction with work-life balance, and burnout. Questions addressing personal and program characteristics and perceptions regarding implementation and consequences of ACGME regulations were also included. Of 377 eligible program directors, 282 (74.8 %) completed surveys. Among respondents, 12.4 % and 28.8 % rated their quality of life and satisfaction with work-life balance negatively, respectively. Also, 27.0 % reported emotional exhaustion, 10.4 % reported depersonalization, and 28.7 % reported overall burnout. These rates were lower than those reported previously in national studies of medical students, IM residents, practicing physicians, IM clerkship directors, and medical school deans. Aspects of distress were more common among younger program directors, women, and those reporting greater weekly work hours. Work-home conflicts were common and associated with all domains of distress, especially if not resolved in a manner effectively balancing work and home responsibilities. Associations with program characteristics such as program size and American Board of Internal Medicine (ABIM) pass rates were not found apart from higher rates of depersonalization among directors of community-based programs (23.5 % vs. 8.6 %, p = 0.01). We did not observe any consistent associations between distress and perceptions of implementation and consequences of program regulations. The well-being of IM program directors across domains, including quality of life, satisfaction with work-life balance, and burnout, appears generally superior to that of medical trainees, practicing physicians, and other medical educators nationally. Additionally, it is reassuring that program directors' perceptions of their ability to respond to current regulatory requirements are not adversely associated with distress. However, the increased distress levels among younger program directors, women, and those at community-based training programs reported in this study are important concerns worthy of further study.

A different kind of loss: A tribute to Dr Clyde Hertzman (1953–2013)

Every now and then we experience a loss in our professional and work circles that somehow seems tougher and deeper than others, and so untimely it takes our breath away. And somehow the rituals of mourning that help us through the losses in our personal and family lives are not available to us in our work worlds. Much is being written about Dr Clyde Hertzman, our remarkable friend and colleague who died suddenly in February in the United Kingdom at the age of 59. Clyde’s current position was Director of the Human Early Learning Partnership (HELP) at the University of British Columbia (Vancouver, British Columbia). The reach of his work and ideas extended beyond academia to the grassroots of national and international audiences. There are multiple postings in online discussion boards, in local and national newspapers and in medical journals. ‘Google’ his name and pages of tribute entries return. Reflections have come from politicians, journalists, university and medical school deans and professors, leaders of professional organizations, advocacy groups and nongovernmental organizations – pretty well all the players, institutions and organizations in Canada, and beyond, who care about young children and who have shared Clyde’s journey and work on the human development agenda. So too has the Canadian Paediatric Society (CPS) posted its words of respect and tribute for the contributions Clyde has made internationally, nationally and locally. Most recently, he worked with our CPS Early Years Task Force to help develop our strategy, infusing his brilliance and enthusiasm for opportunities to make a better world for Canada’s children. He liberally shared his ideas, his contacts and his wisdom to help us craft the next steps in this long journey. He collaborated with the CPS Early Years Task Force just a week before his death and spent a morning in early December with us at HELP, where we brainstormed the options, the strategies and the direction. He had recently learned of, and shared in confidence, his Order of Canada appointment and, apart from being delighted at the recognition, was contemplating how to use this new platform to shine a brighter light on early child development. In November 2010, he was named CIHR’s Health Researcher of the Year, and he delivered a phenomenal lecture at Ottawa’s National Gallery. It was one of those magical nights with a bitter cold wind pounding at the windows, snow falling and an erudite crowd in attendance, including the Governor General and Clyde’s partner Marcy Cohen. Clyde was at the top of his game. His broad-reaching and convincing dissertation emphasized that the early years do matter and are a determinant of lifelong health and well-being. He brought the understanding of cellular biology to the story of a successful society, and created a buzz and excitement around his passion for measurement. Dr Clyde Hertzman Clyde introduced us to many new concepts, including biological embedding, emphasizing how the environmental experiences of early childhood in families and communities become hardwired into the brain. “Early in life, the environment talks to genes and the genes listen,” he wrote (1). Similarly, any of us who were lucky enough to experience Clyde through his teaching, his writings or his lectures have had our neuronal connections biologically and indelibly altered. His humility coupled with his vibrant curiosity made him very special to work with. Clyde has, in a most wonderful way, ‘gotten under our skin’. So the loss of Clyde feels like a tsunami for those of us working on the human development agenda – it’s a hole in our universe. And it will continue to manifest itself in the absence of his voice in the multiple conversations we shared, the silence from the podium and the empty chair at the panel table. The loss of his intellectual horsepower, his different, creative way of looking at and measuring the world, and his ability to take complexity and transform these complex ideas into brain butterscotch is immeasurable. We know that his impact will be felt by generations of children around the world forever. So this is the ‘now and then’ in our professional careers when, like William Wordsworth in Surprised by Joy, we instinctively turn at a moment of early childhood success to look for Clyde – for his leadership, wisdom and enthusiasm, then we realize he is no longer with us. We will repair, we will rebuild and refocus, but we will remember this different kind of loss.

Creating a Nobel Culture

In their Perspective “A golden era of Nobel laureates” (23 November 2012, p. [1033][1]), J. L. Goldstein and M. S. Brown call attention to nine physicians who trained at the National Institutes of Health (NIH) in fundamental research from 1964 to 1972 and were subsequently awarded Nobel Prizes. They speculated on factors responsible for this remarkable confluence, contrasting current research and medical education to their experiences. As dean of a research-intensive medical school who also trained at NIH, I offer some alternative perspectives. ![Figure][2] CREDIT: WIKIMEDIA COMMONS The NIH was a magical environment for biomedical research during the 1960s and 1970s. Many young physicians seeking academic careers—and some also wishing to avoid the military draft—spent time in NIH laboratories, some in combination with specialty training. The scientific environment was intoxicating, research resources seemed virtually unlimited, and scientific excellence was the highest value. Many experienced research success and now populate the leadership of biomedical research and academic medicine. Goldstein and Brown also raised important concerns. The first relates to the tension between basic and translational research. The authors point out that whereas many of their later discoveries had clinical impact, they were not conducting “translational research” while at NIH. Few would contest that important biological research need not be translational. Fundamental inquiry into molecular, cellular, and physiologic pathways is foundational to translational and clinical research. Nevertheless, many who launched research careers at NIH did research aimed at understanding disease. The NIH Clinical Center was a hotbed of bedside-to-bench research. Patients with rare and complex disorders stimulated basic investigations of molecular pathways with mentors in labs only a hallway away. We spend too much time today unproductively parsing the definitions and relative value of basic and translational research. All research should be assessed by one criterion: the novelty, importance, and impact of the insights generated. Less important are the motivation of the scientist (e.g., understanding molecules and cells versus understanding disease), whether research links to health, the model system used (e.g., single molecules, mice, or humans), and the department in which it is conducted. A second issue involves the status of research in medical education today. The authors state that while basic science was core to medical education in the 1960s, science is presented in an abbreviated manner today. I do not recognize this as an accurate description of science education in today's medical curricula, at least at research-intensive medical schools. Since the 1960s, the knowledge base within biomedical science has exploded, while important new areas such as health policy, global health, and biomedical ethics have emerged, requiring curricular choices. MD-Ph.D. programs train physician-scientists, and many schools now require scholarly projects of all students. The authors state that in the 1960s, the “best and the brightest” graduates were expected to pursue research careers. We delight when students pursue research, as many do today. We are also delighted when the “best and brightest” pursue clinical care and innovation, education, global health, and policy. Biomedical science is critical to the development of new treatments, but is one of several core missions of medical schools, as reflected in the diverse choices that medical students make. Goldstein and Brown are concerned that NIH has shifted focus from basic science and “curiosity-driven” research to translational research and “big science.” I have considerable sympathy for this view. Research into fundamental mechanisms is critical, and selectively diminished support for such research threatens the scientific enterprise and human health. The development of consortia and “big data” approaches arose from the hypothesis that they enabled discoveries otherwise impossible. Some, such as the human genome project, have fulfilled much if not all of their promise. With others, the jury is still out. The balance between individual curiosity-driven research into basic mechanisms and disease pathogenesis versus big science consortia will evolve, though it's virtually certain that both will be necessary. The nine Nobelists are products of an NIH program in which physician trainees were instilled with passion for fundamental research, and the opportunity for medical students and physicians to be exposed to and inspired by great science is as important now as it was then. But the many opportunities and challenges facing medicine and research today suggest that a more complex solution will be needed. The path forward will determine our success in both biologic discovery and in applying these discoveries to improve the health of the population. [1]: /lookup/doi/10.1126/science.1231699 [2]: pending:yes

Continuing to be somebody

Continuing to be somebody

Podiatric Medicine and Disaster Response

We surveyed the podiatric medicine professional and academic leadership concerning podiatric medicine professionals as disaster surge responders. All US podiatric medical school deans and state society presidents were mailed a self-administered structured questionnaire. The leaders were asked to complete the questionnaire and return it by mail; two repeated mailings were made. Descriptive statistics were produced, and differences between deans and society presidents were tested by the Fisher exact test. The response rate was 100% for the deans and 53% for the society presidents. All of the respondents agreed that podiatric physicians have skills applicable to catastrophe response, are ethically obligated to help, and should receive additional training in catastrophe response. Deans and society presidents agreed with the statements that podiatric physicians should provide basic first aid and place sutures, obtain medical histories, and assist with maintaining infection control. With one exception, all of the society presidents and deans agreed that with additional training, podiatric physicians could interpret radiographs, start intravenous lines, conduct mass casualty triage, manage a point of distribution, prescribe medications, and provide counseling to the worried well. There was variability in responses across the sources for training. These findings suggest that deliberations regarding academic competencies at the podiatric medical school level and continuing education should be conducted by the profession for a surge response role, including prevention, response, mitigation, and recovery activities. After coordination and integration with response agencies, podiatric medicine has a role in strengthening the nation's catastrophic event surge response.

Attitudes of medical school deans toward interprofessional education in Western Pacific Region countries

To examine the attitudes of medical school deans toward interprofessional education (IPE) and collaborative practice (CP), we conducted survey research in the Western Pacific Region. This regional survey was conducted as a collaborative research project with the World Health Organization. A survey was distributed to the medical school deans in Malaysia, the Philippines, Republic of Korea and Japan. Thirty-five surveys were returned from four countries. The survey demonstrated that many medical school deans have positive attitudes toward IPE and CP. However, respondents also reported that it is not easy to introduce interprofessional learning in their academic settings. It is suggested that collaboration between education systems and health systems is needed to introduce IPE in the academic setting. The possible role of international organizations is mentioned. This information helps to identify local efforts on which global health organizations and national governments can build.

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.

An emigration versus a globalization perspective of the Lebanese physician workforce: a qualitative study.

BackgroundLebanon is witnessing an increased emigration of physicians. The objective of this study was to understand the perceptions of Lebanese policymakers of this emigration, and elicit their proposals for future policies and strategies to deal with this emigration.MethodsWe conducted semi-structured individual interviews with the deans of Lebanon’s seven medical schools, the presidents of the two physicians professional associations, and governmental officials. We analyzed the results qualitatively.ResultsParticipants differed in the assessment of the extent and gravity of emigration. Lebanon has a surplus of physicians, driven largely by the over-production of graduates by a growing number of medical schools. Participants cited advantages and disadvantages of the emigration on the personal, financial, medical education system, healthcare system, and national levels. Proposed strategies included limiting the number of students entering medical schools, creating job opportunities for graduating students, and implementing quality standards. Most participants acknowledged the globalization of the Lebanese physician workforce, including exchanges with the Gulf region, exchanges with developed countries, and the involvement of North American medical education institutions in the region.ConclusionMany Lebanese policy makers, particularly deans of medical schools, perceive the emigration of the physician workforce as an opportunity in the context of the globalization of the profession.

A history of the International Pediatric Nephrology Association (IPNA)

Managing care of children of the world with kidney diseases requires balancing clinical aims, research findings and socio-economic goals within an international environment characterized by cultural and economic complexity and a large disparity in the availability, affordability and accessibility of renal care. Since 1974, the International Pediatric Nephrology Association (IPNA) has been trying to establish this balance, involving almost two generations of pediatric nephrologists. This report explores IPNA’s evolution and describes the founding generation of pioneers, the ratification of a constitution and the formulation of clinical aims as well as establishment of the journal of Pediatric Nephrology. This report also examines the highlights of the IPNA congresses and the training and teaching courses at each stage of development. It provides a brief history of the development of regional societies. The first 10 years of the IPNAwas the founding era, with small numbers of members, moderate research productivity and a tremendously efficient and friendly interaction between members that promoted communication among centers of the world. Achieving the goal of IPNA, namely, enhancing the treatment of children with kidney disease, wherever in the world they may need it, relied on three principal elements: a serviceable fund of knowledge, a cohort of engaged professionals and a broad geographical reach. A 20-year period of expansion followed, made possible by the rapid expansion of diagnostic and therapeutic facilities. With information technology reaching throughout the world in the last 10 years, IPNA embarked on teaching and training courses as well as on establishing fellowship programs for young practitioners in Africa, Asia and Latin America to assist their efforts to develop pediatric nephrology on their home ground. IPNA and IPNA associate organizations (AFPNA, ALANEPE, ANZPNA, ASPN, AsPNA, ESPN and JSPN) have reached a high level of international communication, cooperation and consensus to further the care of children with kidney diseases. The history manuscript completed in 2010 should be viewed as a beginning. The manuscript should not be seen as comprehensive but rather as a concise history aimed at capturing important events and spurring others in the Society to help compile even more of our past. IPNA leadership viewed as important the need to capture the wisdom of the founders of IPNA and to inform the IPNA membership of the driving vision and the path the organization has taken. We hope this beginning will serve as an impetus for the membership, now and in the future, to build on this history and to maintain a record of IPNA’s progress and accomplishments. The history can be viewed at http://www.ipna-online.org/ about/history/ A. Friedman (*) Medical School Dean’s Office, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA e-mail: alfried@umn.edu

A survey of Sub-Saharan African medical schools

BackgroundSub-Saharan Africa suffers a disproportionate share of the world's burden of disease while having some of the world's greatest health care workforce shortages. Doctors are an important component of any high functioning health care system. However, efforts to strengthen the doctor workforce in the region have been limited by a small number of medical schools with limited enrolments, international migration of graduates, poor geographic distribution of doctors, and insufficient data on medical schools. The goal of the Sub-Saharan African Medical Schools Study (SAMSS) is to increase the level of understanding and expand the baseline data on medical schools in the region.MethodsThe SAMSS survey is a descriptive survey study of Sub-Saharan African medical schools. The survey instrument included quantitative and qualitative questions focused on institutional characteristics, student profiles, curricula, post-graduate medical education, teaching staff, resources, barriers to capacity expansion, educational innovations, and external relationships with government and non-governmental organizations. Surveys were sent via e-mail to medical school deans or officials designated by the dean. Analysis is both descriptive and multivariable.ResultsSurveys were distributed to 146 medical schools in 40 of 48 Sub-Saharan African countries. One hundred and five responses were received (72% response rate). An additional 23 schools were identified after the close of the survey period. Fifty-eight respondents have been founded since 1990, including 22 private schools. Enrolments for medical schools range from 2 to 1800 and graduates range from 4 to 384. Seventy-three percent of respondents (n = 64) increased first year enrolments in the past five years. On average, 26% of respondents' graduates were reported to migrate out of the country within five years of graduation (n = 68). The most significant reported barriers to increasing the number of graduates, and improving quality, related to infrastructure and faculty limitations, respectively. Significant correlations were seen between schools implementing increased faculty salaries and bonuses, and lower percentage loss of faculty over the previous five years (P = 0.018); strengthened institutional research tools (P = 0.00015) and funded faculty research time (P = 0.045) and greater faculty involvement in research; and country compulsory service requirements (P = 0.039), a moderate number (1-5) of post-graduate medical education programs (P = 0.016) and francophone schools (P = 0.016) and greater rural general practice after graduation.ConclusionsThe results of the SAMSS survey increases the level of data and understanding of medical schools in Sub-Saharan Africa. This data serves as a baseline for future research, policies and investment in the health care workforce in the region which will be necessary for improving health.