Department Chairs Research Articles

Evolving Patient-Centred Therapies for Metastatic NSCLC

The metastatic non-small cell lung cancer (mNSCLC) treatment landscape has vastly expanded over the past two decades as a result of advancements in biomarker testing. However, unmet needs remain both in terms of treatment options for some patient groups, and patient support throughout the treatment journey. In this symposium, Jarushka Naidoo, Consultant Medical Oncologist, Beaumont RCSI Cancer Centre, Dublin, Ireland; Terri Conneran, KRAS Kickers, Charlotte, North Carolina, USA; Luis Paz-Ares, Chair of the Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; and Alexander Drilon, Chief of Early Drug Development and Thoracic Oncology, Memorial Sloan Kettering Cancer Center, New York, USA, focused on patient-centric approaches to mNSCLC treatment, starting with a patient and patient advocacy group perspective on what patients want from their care team during their treatment journey. The panel also discussed both immuno-oncology (I-O) monotherapy and combination therapy, including dual I-O therapies for patients with programmed death-ligand 1 (PD-L1) tumour expression <1%, as well as the treatment landscape for KRASG12C-mutated mNSCLC, and ongoing trials of KRAS-targeted agents. In addition, the latest data on tyrosine kinase inhibitors (TKI) for patients with alterations in ROS1 and NTRK genes were discussed, focusing on next-generation TKIs. Finally, the panel discussed patient cases, taking into account specific considerations and how to best approach treatment decisions.

Collaborative Preclinical/Clinical Efforts Aimed at Strengthening a Neurology Residency Program: Challenges, Activities and Outcomes

AbstractRecent trends in medical education have included efforts to better integrate traditionally preclinical content with subject matter included in the clinical years of the curriculum. The participation of clinical faculty in preclinical courses is well established; however, involvement of biomedical science faculty in resident education is less common. We describe here a project in which a basic science faculty member participated in a neurology residency program to address specific basic science knowledge weaknesses identified by the neurology department chair. We address issues and challenges associated with planning and implementation. Benefits to both the residents and the biomedical scientist are described.

Welfare of pet primates for sale in the United States

Welfare of pet primates for sale in the United States Dr. Melissa Seaboch, Professor and Department Chair at Salt Lake Community College, charts the welfare of pet primates for sale in the United States. Despite their unsuitability as pets, there are thousands, if not tens of thousands, of pet primates in the United States (1), and the U.S. ranks third out of 171 countries in the ease of purchasing a pet primate online. (2) Though the pet primate trade is robust, there are few federal regulations addressing the care of companion animals or pets. The Animal Welfare Act (AWA), often considered the minimum acceptable standard for animal care and use, governs the care of animals in multiple settings, including research labs, zoos, and commercial breeding facilities. PACT (Preventing Animal Cruelty and Torture) prevents the most egregious forms of animal cruelty, and the Lacey Act addresses interstate transportation and illegal wildlife trafficking. (3) None of these regulations address the care or welfare of pet primates.

Sentiment analysis of letters of recommendation for a U.S. pain medicine fellowship from 2020 to 2023.

Letters of recommendation (LORs) are an important part of pain medicine fellowship applications that may be subject to implicit bias by the letter's author. This study evaluated letters of recommendation for applications to pain medicine fellowships in the United States to characterize biases and differences among applicants over four application cycles. This was a retrospective single-site cohort study. De-identified LORs were collected from 2020 to 2023 from one institution. The Valence Aware Dictionary and sEntiment Reasoner (VADER) natural language processing package scored positive LOR sentiment. In addition, the deep learning tool, Empath, scored LORs for 15 sentiments. Wilcoxon rank-sum and one-way ANOVA tests compared scores between applicant demographics: gender, race, medical school type, residency specialty, and chief resident status, as well as letter writers' academic position. Nine hundred and sixty-four applications were studied over four application cycles. Program directors wrote fewer words (p = 0.020) and less positively (p < 0.001) compared to department chairs and letter writers with neither position. Department chairs wrote with less "negative emotion" compared to both program directors and writers with neither position (p < 0.001). Anesthesiologist applicants received more letters highlighting "achievement" (p < 0.001) while PM&R applicants submitted letters with less "negative emotion" (p < 0.001) compared to other specialties. Chief residents' letters scored higher in "leader" sentiment (p < 0.001) and lower in "negative emotion" (p < 0.001). Linguistic content did not favor certain genders or races over others. However, disparities in LORs do exist depending on an applicant's specialty and chief resident status, as well as the academic status of the letter writer.

Exploring Impact and Variability of Research Productivity Among Academic Orthopaedic Leaders.

Assessing scholarly contributions in academic orthopaedic surgery remains challenging, despite the importance of publication productivity in evaluating academic leaders. The Hirsch (h)-index and its derivative, the m-index, offer objective measures to compare and evaluate publication productivity. The primary aims of this study were to compare h- and m-indices of department chairs and residency program directors of orthopaedic training programs in the United States and assess the association between h-index and program rank. A publicly available Doximity report was used to identify and rank orthopaedic surgery residency programs in the United States. Internet-based searches of institution-specific websites were performed to confirm current department chairs and residency program directors as of January 2024. H-index data were collected from a publicly available database known as Scopus. The m-index was calculated as the quotient of h-index and years in practice. Gender and years in practice were obtained through available biographies on institution-specific websites. Department chairs had significantly higher h- and m-indices at both the career and 5-year time intervals compared with program directors. Upon subgroup analysis, department chairs and program directors at top-10 ranked programs had significantly higher h- and m-indices compared with the entire population of department chairs and program directors. Linear regression analyses demonstrated a direct linear association between department chair/program director h- and m-indices and program rank. Publication productivity was higher for department chairs than residency program directors. Orthopaedic leaders at top-10 institutions had higher publication productivity compared with those at institutions outside of the top 10, per Doximity rankings. Finally, there is substantial variation in publication productivity of orthopaedic surgeons in leadership roles at academic institutions in the United States. This study highlights the publication productivity of orthopaedic surgery department chairs and residency program directors and describes the linear association between publication productivity of academic orthopaedic leaders and program rank. This information can be utilized by those interested in learning more about the publication productivity among academic orthopaedic surgeons across different institutions and can assist those who are involved in the hiring and promotion process at these academic institutions.

You Can't Be What You Can't See: The Progression of Women in Otolaryngology-Head and Neck Surgery.

Objective: To examine trends in the gender composition of residents and faculty in Otolaryngology-Head and Neck Surgery residency programs in the United States and to investigate the correlation between women's representation in leadership positions and the proportion of women faculty and residents. Methods: A literature review was first performed to analyze trends in the gender composition of residents and faculty in Otolaryngology-Head and Neck Surgery (OHNS) residency programs. Current residency programs were then identified using the Electronic Residency Application Service 2023 Participating Specialties and Programs website. The following data was collected from each program website: gender of associated medical school dean, gender of department chair, gender of residency program director, and total number and gender of fellowship directors, faculty, and residents. Wilcoxon rank sum test and Fischer's exact test were used to analyze relationships between the number of women in leadership positions and the proportion of women faculty and residents. Results: An increase in the number of women chairs, residency program directors, residents, and faculty over the past decade is documented across published literature. One hundred twenty-three current academic residency programs were identified. Women accounted for 42%, 30%, 27%, and 8% of current residents, residency program directors, faculty, and department chairs, respectively. Department chair gender was significantly correlated with number of women faculty (P = .01). Any women in a leadership position were correlated with a statistically significant increase in median percent of women faculty (P = .006). Conclusion: Further understanding of how the mentorship of women promotes gender equity is necessary to promote gender diversity in OHNS.

Assessing Academic Preferential Hiring Practices in Highly Ranked Otolaryngology Departments.

Objective: To assess whether preferential hiring practices, particularly self-hiring, are present in academic otolaryngology departments. Setting: A list of academic Otolaryngology-Head and Neck Surgery (O-HNS) departments ranked #1-40 was generated from the Doximity 2021 rankings. The educational background and training information of clinical faculty members and departmental leadership was extracted from each department's online directories. Methods: Descriptive statistics were used to examine inter/intradepartmental relationships and affiliations of included clinical faculty and departmental leadership based on current employment and medical training sites. A "prior affiliation ratio" was calculated to assess the degree of self-hiring and account for multiple possible prior affiliations (medical school, residency, and fellowship) by dividing all prior self-hired affiliations of faculty by the total number of faculty at each department. Results: A total of 1344 clinical faculty were identified, and 596 (44.35%) had at least 1 prior affiliation with their department. The overall prior affiliation ratio was 0.6, and 7 departments had a value >0.8, with the highest being 1.27 (>1.0 indicating multiple prior affiliations per individual such as both residency and fellowship). A network map of departments #1-10 showed heavy intradepartmental faculty recruitment with 24% of faculty having completed a #1-10 residency, 24% a #11-20 residency, 13% a #21-30 residency, and 11% a #31-40 residency. Totaling this data, 76% of faculty at departments ranked #1-10 had completed training at a program ranked #1-40. Furthermore, our data shows high rates of self-hiring among departmental leadership, (40% of Departmental Chairs and 62.5% of Program Directors) though rates are not significantly higher than self-hiring among faculty overall. Conclusion: The top 40 ranked O-HNS departments have high rates of self-hiring, relying on prestige of training programs and prior affiliation in hiring decisions. The effect on departmental productivity and training is unclear.

The Israeli anesthesiology workforce crisis: a reassessment survey

BackgroundAnesthesiologists provide crucial anesthesiology services in the operating room and non-operating room locations. Combined with an aging and growing Israeli population, there is an increasing demand for anesthesiology services. A previous study performed in 2005 showed that most anesthesiologists are immigrant physicians with few Israeli medical school graduates. Since then, physician immigration decreased, many have retired and demand for anesthesia services has increased while insufficient numbers of new anesthesiologists were trained, leading to a shortage, limiting surgeries and other procedures in many hospitals. The present study examined the composition of the Israeli anesthesiology workforce in 2021and compared it to the 2005 workforce.MethodsA cross-sectional survey of demographic and professional information about each Israeli hospital anesthesiologists was solicited from 34 anesthesiology department chairs responsible for 36 Israeli acute care hospitals.ResultsThere are 1313 anesthesiologists in the 36 hospitals, resulting in a ratio of 14.2 anesthesiologists per 100,000 population. 22.6% of anesthesiologists will reach retirement age over the next ten years. The proportion of female anesthesiologists was 28.7%. While Israeli medical school graduates increased to 18.1% from 12.2% in 2005, non-Israeli citizens and non-permanent residents comprised 8.5% of the workforce.ConclusionsDespite growth in the ratio of anesthesiologists per population, a workforce shortage is expected to worsen over the next ten years due to retirements, shortened call hours, and the Yatziv reform which bans graduates of certain overseas medical schools from obtaining Israeli Medical Licenses. The current workforce has compensated for the existing shortage of anesthesiologists by enlisting non-Israeli trainees from overseas. Yet, it is crucial to maintain and enlarge the local Israeli workforce to forestall a worsening shortage.

The Role of Department Chair through the Lenses of Family Systems Theory and Family Strengths Perspective

As middle managers in higher education, department chairs play a critical role in the university structure while operating in an ambiguous location between faculty and senior administration. This paper will take a closer look at the role of department chair, how chairs are selected and prepared for the position, what the job entails, qualities of an effective chair, and challenges within the position. Then, after brief descriptions of family systems theory and family strengths perspective, the benefit of each as a useful lens for enacting the position of department chair will be explored. Sample applications of each will be provided.

Being an Advocate, Not an Adversary, as a Department Chair: Modeling Teamwork, Minimizing Toxicity

Being an Advocate, Not an Adversary, as a Department Chair: Modeling Teamwork, Minimizing Toxicity

Strategies and Barriers for Diversity, Equity, Inclusion, and Antiracism Work in Family Medicine Departments: A CERA Study.

Medical schools and family medicine organizations have been working on advancing diversity, equity, inclusion, and antiracism (DEIA). Black, Indigenous, and People of Color (BIPOC) faculty members are disproportionately expected to lead DEIA initiatives, negatively affecting academic promotion and well-being. Our study aimed to describe the existing DEIA initiatives, strategies, and barriers to implementing support for DEIA work, as well as the implications of addressing the minority tax in US and Canadian family medicine departments. We used data collected as a part of the 2023 Council of Academic Family Medicine Educational Research Alliance (CERA) study. The survey was delivered to 227 department chairs across the United States and Canada. The survey response rate was 50.2% (114/227). Sixty-two percent of the respondents strongly agreed that advancing DEIA was important, and 55.4% reported having a DEIA leader, with 75.4% of those positions reportedly held by BIPOC faculty. Lack of funding was identified as the most significant barrier (26.2%), followed by lack of faculty expertise (18.7%). Department chairs who strongly agreed that DEIA work was important were significantly more likely to report having a DEIA committee, mentorship for BIPOC faculty, and a holistic review for faculty recruitment than those who did not strongly agree. Though most department chairs perceived advancing DEIA work as important, appropriate compensation and institutional support are often lacking. Further study is needed to explore ways in which departments can enhance their institutional support for DEIA initiatives.

Sex, Race, and Ethnicity of Faculty and Department Chairs in Orthopaedic Surgery and Comparable Fields: 2015 to 2022.

The field of orthopaedic surgery has disproportionately low numbers of women and underrepresented in medicine (URM) groups. Although the representation of women and URM in orthopaedics has increased over the past several years, the growth has not kept up with other surgical specialties. This is a retrospective review of data presented by the Association of American Medical Colleges (AAMC) regarding US medical school faculty and department chair makeup in 2018 to 2022 and 2015 data from the AAMC Group on Women in Medicine and Sciences reports. Data regarding the sex and race/ethnicity of faculty and department chairs in orthopaedic surgery, a comparable surgical specialty (otolaryngology), surgery, and all medical fields were assessed. Otolaryngology was chosen as a comparable specialty because orthopaedic surgery and otolaryngology are the only two surgical specialties classified within the AAMC faculty report, separate from any medical counterpart. Among orthopaedic surgery, otolaryngology, surgery, and all clinical sciences, the representation of women and individuals from URM groups increased between 2015 and 2022. During this time, orthopaedic surgery had the lowest growth rate of the four groups in female faculty (+0.63%/year), URM faculty (+0.32%/year), and URM department chairs (+0.11%/year). However, orthopaedic surgery did have an increase in female department chairs (0.96%/year to 7% in 2022), similar to increases seen in surgery and all clinical sciences. The increase in representation in female and URM faculty and department chairs in orthopaedic surgery lags behind comparable fields and medicine as a whole. In addition, orthopaedic surgery had the lowest representation of female and URM faculty in 2015 and 2022. Improving the representation of female and URM orthopaedic faculty and department chairs is critical because this may encourage more diverse medical students to consider pursuing a career in the field.

Best-Practice Strategies for Faculty Evaluations: A Focus on Pharmacy Departments or Divisions with Both Tenure and Nontenure-Track Faculty Members

There are unique challenges associated with the evaluation of faculty in pharmacy departments or divisions that have a mix of nontenure-track and tenure-track faculty members. Such evaluations are intended to provide feedback on performance and personal growth but have the potential to demotivate faculty and add to existing stress if improperly performed. The purpose of this commentary is to suggest best practices for department chairs involved in performing evaluations of faculty in pharmacy departments or divisions that have a mix of nontenure-track and tenure-track faculty members. The paper is intended to help ensure these evaluations not only capture the quality and quantity of each faculty member’s full range of activities and responsibilities but also are conducted in a supportive and constructive fashion. This commentary is targeted at new department chairs, new faculty members unfamiliar with academic evaluation processes, and departments contemplating changes in their existing evaluation procedures.

Does Teacher Professional Development Improve Student Learning? Evidence from Leading Educators’ Fellowship Model

Teachers are the most important school-specific factor in student learning. Yet, little evidence exists linking teacher professional development programs and the strategies or activities that comprise them to student achievement. In this paper, we examine a fellowship model for professional development designed and implemented by Leading Educators, a national nonprofit organization that aims to bridge research and practice to improve instructional quality and accelerate learning across school systems. During the 2015–2016 and 2016–2017 school years, Leading Educators conducted its fellowship program for two cohorts of instructional leaders, such as department chairs, mentor teachers, instructional coaches, and assistant principals, to provide these educators ongoing, collaborative, job-embedded professional development and to improve student achievement. Relying on quasi-experimental methods, we find that a school’s participation in the fellowship program significantly increased student proficiency rates in English language arts and math on state achievement exams. The positive impact was concentrated in the first cohort and in just one of three regions, and approximately 80% of treated schools were charters. Student achievement benefited from a more sustained duration of participation in the fellowship program, varied depending on the share of a school’s educators who participated in the fellowship and differed based on whether fellows independently selected into the program or were appointed to participate by their school leaders. Taken together, findings from this paper should inform professional learning organizations, schools, and policymakers on the design, implementation, and impact of educator professional development.

The National Organization of Nurse Practitioner Faculties Leadership Mentoring Program: Ten years of positive outcomes

BackgroundNursing leadership programs can have a positive impact on organizations and communities. Health equity in nursing requires leaders who parallel the population demographics. PurposeThis work evaluated the National Organization of Nurse Practitioner Faculties Leadership Mentoring Program (LMP) 10 years from its inception. Lessons learned from this evaluation can inform leadership initiatives in nursing and other health professions. MethodThis cross-sectional evaluation applied the Context, Inputs, Process, and Products model to gauge effectiveness of the LMP. All 48 participants were invited to participate. ResultsThirty-two survey respondents, a 67 % response rate, demonstrated a 767 % increase in extramural scholarship collaborations and promotion to associate and full professor at 43 % and 90 %, respectively. Academic leadership positions to department chair, assistant/associate dean, and dean increased 200 %, 167 %, and 100 %, respectively. Seventy-seven percent of program participants are engaged on boards and committees at local, state, national, and international levels. These roles significantly impact legislative, policy, advocacy, and regulatory efforts, signifying the LMP's influence on broader societal and professional domains. ConclusionIdentifying clear program outcomes and metrics for leadership program evaluation can advance diversity, equity, and inclusion efforts. Sustainable funding models for leadership development will have a high return on investment for health professions.

Ivory tower in MD/PhD programmes: sticky floor, broken ladder and glass ceiling

ObjectiveAchieving gender equity in academic medicine is not only a matter of social justice but also necessary in promoting an innovative and productive academic community. The purpose of this study...

“Does an Additional Advanced Degree Influence Career Trajectory as a Shoulder and Elbow Surgeon?”

BackgroundAs orthopedic surgery becomes increasingly competitive, orthopedic surgeons are now pursuing advanced degrees more frequently to enhance their resumes or gain additional expertise. The specific impact of this additional training and education on a surgeon’s career trajectory is not well defined. The purpose of this study was to understand the impact of an advanced degree on the academic career of orthopedic shoulder and elbow surgeons. MethodsOrthopedic shoulder and elbow fellowship-trained surgeons were identified using the directory listed on the American Shoulder and Elbow Surgeons website. Demographics, education, and current professional roles were obtained. Research productivity was obtained using SCOPUS and Google Scholar. Advanced degrees were defined as those additional to the primary medical degree (Doctor of Medicine [MD] or Doctor of Osteopathic Medicine [DO]). Outcome measures collected included timing of advanced degree obtainment, current academic and leadership roles, leadership on journal editorial boards, and research productivity. Statistical analysis was performed using the chi-square test and Mann-Whitney U test to determine the association of advanced degrees on outcome measures. ResultsIn total, 893 orthopedic shoulder and elbow surgeons were identified, of whom 129 had advanced degrees. Most common advanced degrees included Master of Science (MS/MSc; 43%), Master of Business Administration (MBA; 23%), and Doctor of Philosophy (PhD; 13%). The most common period of degree obtainment was before medical school (35%) with the least common times being after medical school/before residency (0.9%) and between residency and fellowship training (0.9%). Surgeons who held advanced degrees demonstrated greater research productivity, with a higher h-index (p < 0.001), a greater number of citations (p < 0.001), and more publications (p < 0.001). Of the 523 shoulder and elbow surgeons who worked at an academic institution, those holding advanced degrees were more likely to serve as orthopedic department chair (p < 0.001) and serve an editorial board position (< 0.001). ConclusionThis study found that having an advanced degree as an orthopedic shoulder and elbow surgeon was linked to higher research impact and productivity and an increased likelihood of becoming a department chair and holding an editorial position. These significant findings can help future trainees and department leadership in understanding the importance and impact of additional training on career trajectories for academic faculty.

Pushing Past the Paywall: Accessing Open Peer-Reviewed Research

Effective teaching and special education programming should be informed by scientific research published in peer-reviewed journals. However, many peer-reviewed articles, including how-to articles based on research findings in practitioner-focused journals, are not freely accessible to instructional coaches, department chairs, special education administrators, special education teachers, families of students with disabilities, and other interested individuals, creating a significant obstacle to informing practice with research findings. Fortunately, the number of peer-reviewed articles that are openly accessible on the internet is growing. In this article, we describe types of peer-reviewed articles, discuss different types of open-access publishing, and provide a six-step approach for accessing open-access publications.

STEM department chairs’ perspectives on navigating teaching culture to influence instructional change: a four-frames model analysis

Academic departments have been highlighted as key targets to sustainably transform the learning environments of postsecondary science, technology, engineering, and mathematics (STEM) courses in the United States. Despite STEM department chairs playing a critical role in shaping their unit, few studies have characterized how chairs view the teaching culture within their department and how cultural features influence instructional change. This study addressed this gap by applying the four-frames model for organizational change to analyze interviews conducted with 14 STEM department chairs at one research-intensive institution in the United States. The department chairs identified several challenges to supporting and advancing teaching culture. These challenges were mostly related to the structures and symbols frames and included an institutional emphasis on research over teaching, inadequate methods to evaluate effective teaching, and weak teaching feedback mechanisms available to faculty. The chairs also described how they leverage their power to affect people and thereby influence the teaching culture. For example, they strategically position teaching as an important aspect of the departmental culture during hiring processes and elevate certain groups of faculty who have demonstrated interest and efficacy in teaching. This study contributes to the literature by providing a rich description of the teaching culture in STEM departments at a research-intensive institution from the perspective of department chairs. This unique focus on department chairs helps identify opportunities for instructional reforms that are grounded in the reality of the departmental environment and provides a framework for considering how change might occur in STEM departments at research-intensive institutions. The opportunities identified emphasize the importance for department chairs to consider and leverage all four frames to enact instructional change.

Experiences With Unionization Among General Surgery Resident Physicians, Faculty, and Staff

Labor unions are a mechanism for employee advocacy, but their role in surgery resident wellness is poorly characterized. To understand experiences with unionization among general surgery residents and residency program faculty and staff. This exploratory qualitative study included data from the Surgical Education Culture Optimization Through Targeted Interventions Based on National Comparative Data (SECOND) trial. In the exploratory phase of the SECOND trial (from March 6, 2019, to March 12, 2020), semistructured interviews about wellness were conducted with residents, faculty (attending physicians), and staff (program administrators) at 15 general surgery residency programs. Unionization was identified as an emergent theme in the interviews. Data analysis was performed from March 2019 to May 2023. The main outcome was resident and faculty experience with resident labor unions. In the qualitative analysis, lexical searches of interview transcripts identified content regarding resident labor unions. A codebook was developed inductively. Transcripts were coded by dyads, using a constant comparative approach, with differences reconciled by consensus. A total of 22 interview transcripts were identified with relevant content. Of these, 19 were individual interviews conducted with residents (n = 10), faculty (n = 4), administrative staff (n = 1), a program director (n = 1), a department chair (n = 1), and designated institutional officials (n = 2), and 3 were from resident focus groups. Residents from all postgraduate year levels, including professional development (ie, research) years, were represented. Interviewees discussed resident unions at 2 programs (1 recently unionized and 1 with a decades-long history). Interviewees described the lack of voice and the lack of agency as drivers of unionization ("Residents…are trying to take control of their well-being"). Increased salary stipends and/or housing stipends were the most concretely identified union benefits. Unanticipated consequences of unionization were described by both residents and faculty, including (1) irrelevance of union-negotiated benefits to surgical residents, (2) paradoxical losses of surgery department-provided benefits, and (3) framing of resident-faculty relationships as adversarial. Union executives were noted to be nonphysician administrators whose participation in discussions about clinical education progression may increase the time and effort to remediate a resident and/or reduce educators' will to meaningfully intervene. Active surgical resident participation within the union allows for an understanding of surgical trainees' unique needs and reduced conflict. In this qualitative study, unionization was a mechanism for resident voice and agency; the desire to unionize likely highlighted the lack of other such mechanisms in the training environment. However, these findings suggest that unionization may have had unintended consequences on benefits, flexibility, and teaching. Effective advocacy, whether within or outside the context of a union, was facilitated by participation from surgical residents. Future research should expand on this exploratory study by including a greater number of institutions and investigating the evolution of themes over time.