Division Leaders Research Articles

Quality improvement project to reduce inpatient chemotherapy usage on a solid tumor oncology service.

333 Background: Inpatient chemotherapy is not routinely recommended for patients with solid tumors as administration is associated with increased length of stay (LOS), higher healthcare costs, and higher morbidity; and chemotherapy administration within 14 days of death is considered poor quality care. However, inpatient chemotherapy may sometimes be indicated for toxicity monitoring or due to barriers that limit prompt delivery of medications with clinically meaningful benefit. To ensure judicious use of inpatient chemotherapy we are undertaking iterative Plan, Do, Study, Act (PDSA) cycles involving education and policy initiatives on a solid tumor oncology service at an urban, academic medical center. Methods: PDSA cycles followed standard methodology. The initial goal was to reduce inappropriate inpatient chemotherapy use, which was expected to correspond with a 25% overall reduction. The initial intervention consisted of two main components: 1) division-wide education about the indications for inpatient chemotherapy, and 2) formation of a committee to review all chemotherapy requests for adult inpatients with solid tumors. The committee consists of clinicians within division leadership, including the division chief and representatives from operations, quality and safety, and ethics. Requests are sent from inpatient teams to the committee, who review each case for factors supporting inpatient treatment such as patient stability/performance status, clinically meaningful benefit, and practical barriers to outpatient administration. To evaluate the impact of the intervention, data were extracted from the electronic medical record for all patients admitted to the service for the 8.5 months before (12/1/22-8/15/23) and after (8/16/23-4/30/24) the initiation of the first PDSA cycle. Results: At baseline, prior to PDSA cycle 1, there were 930 admissions (n=606 patients), and 111 (11.9%, n=82 patients) received inpatient chemotherapy. During PDSA cycle 1 there were 889 admissions (n=557 patients), and 57 (6.4%, n=35 patients) received inpatient chemotherapy (p<0.001). There was no significant change in the proportion of patients receiving chemotherapy within 14 days or 30 days of death pre-PDSA cycle and post, 7.5% vs. 6.6% within 14 days of death (p>0.9), and 13.1% vs. 11.5% within 30 days of death (p>0.9). Overall, mean LOS for all admissions decreased from 11.1 days to 8.8 days (p<0.001). Conclusions: Preliminary results of this quality improvement initiative using iterative PDSA cycles to optimize inpatient chemotherapy use suggest a benefit. After the first PDSA cycle, there was a 46.3% decrease in the proportion of admissions receiving inpatient chemotherapy, and an overall decrease in LOS. Future PDSA cycles are aimed at limiting end-of-life chemotherapy and streamlining the transition from inpatient to outpatient chemotherapy to reduce delays and improve the patient experience.

Hiring in the Pediatric Hospital Medicine Board Certification Era: PHM Leader Perspectives.

The designation of pediatric hospital medicine (PHM) as a board-certified (BC) subspecialty has led to uncertainty about the importance of PHM board certification in hiring pediatric hospitalists and ambiguity in counseling trainees interested in PHM careers about the decision to pursue fellowship. We sought to determine the importance of PHM board eligibility or certification in hiring practices. We conducted an online, cross-sectional, survey-based study of individuals who self-identified as PHM division leadership utilizing the PHM Division Director Listserv and participant recruitment at a national meeting. A total of 86 responses were received. A total of 64% (30/47) of university-setting hospitals, 77% (17/28) of community hospitals, and 100% (11/11) of combined settings reported that they will hire applicants who are not board-eligible (BE) or BC (P = .83). Of the hospitals who will be hiring non-BE hospitalists, 50% of university settings, 77% of community settings, and 55% of combined settings plan to give equal consideration to both BE and non-BE applicants (P = .21). A total of 57% (21/37) of programs with a PHM fellowship felt that fellowship training was an important or very important consideration in hiring, compared with 27% (13/49) of programs without a PHM fellowship (P = .04). Programs with a PHM fellowship were significantly more likely to believe that fellowship training is an important consideration in hiring hospitalists. PHM board certification and fellowship training are perceived as more important by university-based programs, although all settings will consider hiring applicants who are not BC or BE.

Effectiveness of a Brief Point of Care Ultrasound Course at a National Nephrology Conference.

The rising demand for point of care ultrasound (POCUS) instruction during nephrology fellowship has been limited due to a shortage of trained faculty and courses designed specifically for nephrologists. A hands-on POCUS pre-course was organized during the April 2023 National Kidney Foundation (NKF) Spring Clinical Meeting to address this challenge. The course consisted of pre-recorded lectures and a 4-hour hands-on workshop guided by multidisciplinary POCUS experts. The anonymous post-course survey received responses from 25 out of 39 participants, yielding a 64.1% response rate. On a scale of 0-10, confidence levels for acquiring kidney images rose from 2.6 + 2.3 (mean + SD) pre-workshop to 7.8 + 1.5 post-workshop (p<0.001). Similarly, a remarkable improvement in confidence for acquiring lung and cardiac images was seen as scores increased from 1.8 + 2.4 to 7.7 + 1.5 (p<0.001) and from 1.5 + 2.2 to 7.2 + 1.3 (p<0.001), respectively. Additionally, respondents reported a substantial improvement in their confidence to interpret kidney, lung, and cardiac POCUS images, with scores increasing from 4.5 + 2.2 to 7.7 + 1.1 (p<0.001), 2.3 + 2.4 to 7.6 + 1.5 (p<0.001), and 2 + 2 to 7.3 + 1.5 (p<0.001), respectively. Barriers to implementing POCUS use at institutions included a perceived lack of trained faculty, limited protected time for faculty, and insufficient support from division leadership. The NKF POCUS pre-course successfully improved participants' confidence in acquiring and interpreting basic POCUS images.

Gender diversity at academic conferences—the case of the International Communication Association

Abstract Gender diversity and the lack of women in leadership in academia have been issues of academic interest for decades. However, little is known about gender diversity at academic conferences as an essential aspect of academia. We investigated 86,719 contributions to International Communication Association (ICA) conferences over the past 18 years with regard to female and male authorship and how it changed following the introduction of childcare, during the global pandemic, and under female division leadership. Lastly, we analyzed divisions/interest groups, authors’ gender, and national affiliation. We found that the proportion of female authors is high in all conference years and is representative of ICA membership. We found differences in how women and men are represented across divisions, countries of author affiliation, based on the availability of childcare, and during the global pandemic. We discuss implications at societal, organizational, and individual levels.

The Quest for Improving Sickle Cell Care: Creating High-Level Quality Improvement Goals with a Care Process Team

Background: A Care Process Team (CPT) is an interdisciplinary team focused on improvement effort across systems or a population cohort with high degree of variation in care, high volume, high cost, or institutional priority. The Texas Children's Hospital Quality &amp; Safety Department has implemented CPTs for several disease populations including, asthma, diabetes, and pain management. In 2021, the sickle cell CPT (SCCPT) was launched in partnership with the Texas Children's Cancer and Hematology Center. An early step in developing a CPT is delineating goals via a balanced scorecard, a comprehensive framework that translates the team's strategic objectives into a coherent set of performance measures. After establishing priority quality metrics, the SCCPT sought to establish an operational structure and to define and implement specific quality improvement (QI) initiatives to improve outcomes. Methods: The SCCPT assembled a multi-disciplinary expert panel which included providers, nurses, division leadership, data architects, analysts, and quality specialists. After a systematic review of the literature identified metrics with best practice evidence, a modified-Delphi process was used to rank quality metrics according to standards set forth by the National Quality Forum. High-priority metrics were organized into a balanced scorecard. Goals were developed based on Institute of Healthcare QI methodology. A QlikView® dashboard was created to abstract patient data from the electronic medical record. Results: The expert panel met 7 times between January to October 2021. The systematic review found 26 quality measures for SCD and subsequently panel review expanded the list to 34 measures. Expert consensus was reached and 5 metrics were selected for the final SCCPT balanced scorecard. The SCCPT initiated routine meetings in January 2022. Three goals and SMART aims were prioritized from balanced scorecard metrics relating to stroke screenings, disease-modifying drug education and prescriptions, and assignment of a primary Hematology team. Baseline data revealed that 60% of eligible children with SCD had obtained a transcranial Doppler ultrasound within the last 15 months. Hydroxyurea was prescribed to 70% of patients with Hb SS or S/beta-0-thalassemia disease. Primary Hematologist and nurse coordinator teams were assigned to 50% and 23%, respectively. To design and implement QI projects, two teams were created: one focused on prevention-related metrics and the other on treatment-related metrics. Discussion: The successful launch of the SCCPT involved the convening a team of multi-disciplinary members, creation of a balanced scorecard, prioritizing goals, and analyzing baseline data to set SMART aims related to improving SCD care. Two operational teams were created and have proceeded to design and implement QI projects related to SMART aims.

Strategi Universitas Muhammadiyah Buton dalam Meningkatkan Minat Calon Mahasiswa Baru

As time progresses, the competition in the higher education sector, both public and private, to attract students is becoming increasingly fierce. They are becoming more aggressive in carrying out specific exercises to compete for the attention of incoming students. With the widening competition among universities, Muhammadiyah Buton University (UM Buton) must play a crucial role in overseeing and disseminating information about the university to the general public. This way, it can increase the interest of potential new students to join and study at the university. In the intense competition in developed countries, universities must continue to compete in providing information to the general public. The exploration technique used in this examination is subjective methodology. Subjective methodology is an exploratory approach that emphasizes understanding and clarification from top to bottom regarding the social uniqueness that occurs, whether related to significance, experiences, or emotional translation of exam participants. The search results indicate that the Advertising methodology of Muhammadiyah Buton University in increasing the interest of potential new students exists in several stages. The idea conveyed is that with the presence of advertising in the hierarchy design of Muhammadiyah Buton University under the overall division leadership, it is hoped that it can transition to other departments, thus making advertising have a reasonable construction.

27 EDI Practices Amongst Academic Leaders at a Tertiary Paediatric Centre

Abstract Background Our university’s strategic approach to Equity, Diversity and Inclusion (EDI) includes institutional capacity and commitment. Embedded within this pillar is the establishment of “systems, structures and policies that sustain EDI commitments through leadership, governance and accountability”. 1.Objectives: To ascertain baseline EDI practices of Division Leaders and the Department Executive Team 2.To identify prioritized training/learning needs early in the tenure of the inaugural Associate Chair, EDI Design/Methods An anonymized, 10 question electronic survey was distributed to division leads and executive team members with the Department of Paediatrics. Results An electronic survey was distributed to 22 people and 14 responded (64% response rate). Only 21% of leaders included a land acknowledgement at the beginning of their division, portfolio, or committee meetings. Reasons for not doing so included: • Meetings are informal or have few people • Worried about tokenism/checking a box • Had not thought to do so 29% of leaders have a standing “EDI matters” agenda item for their division, portfolio, or committee meetings. Reasons for not doing so included: • Attempting to incorporate EDI principles into work • Addressing EDI items as they occur • Unsure how to engage in meaningful action • Had not thought to do so The majority of leaders who responded, 79%, completed bias education and/or training. All the respondents want more, or specific, EDI training for their division(s) or portfolio(s). Racism was identified as the #1 equity issue urgently impacting divisions or teams. Other priority areas identified included: 2SLGBTQIA+, gender equity, Indigenous reconciliation, and employment bias. Other themes that were raised included: • Equitable healthcare access • Representation at decision-making tables • Gender bias impact on career and work opportunities • Bias in the workplace • Becoming an antiracist organization • Engaging everyone in antiracist work • Systemically embedding EDI principles • Equitable opportunities and support for all employees That 36% of department leaders did not respond to our brief EDI survey may need to be explored further. Conclusion Most leaders are not routinely doing land acknowledgments or incorporating EDI into agendas as a standing item. All expressed a desire for more EDI training. Survey responses informed priorities for the first term of the Inaugural Associate Chair, EDI. An EDI-focused Grand Rounds Series and an EDI SharePoint site were created. Leaders are encouraged to make EDI awareness integral to daily tasks from initial recruitment. Our Anti-Racism Coalition’s version of the Power Flower (Figure 1) was shared to enhance awareness of various power differentials at play.

Development, Implementation, and Assessment of a Quality, Research, Education, and Wellness (QREW) Professional Development Lecture Series for Radiology Faculty

Professional development is important to academic radiologists. We developed, implemented, and assessed an internal professional development lecture series focusing on the non-interpretative themes of Quality, Research, Education, and Wellness (QREW). The faculty of a 29-member abdominal radiology division at an academic hospital were invited to deliver 1-hour virtual lectures on noninterpretative topics to division colleagues. Topics were curated by division leadership based on the perceived needs of faculty. Anonymous feedback was collected from attendees for quality improvement purposes and analyzed using descriptive statistics and Fisher's exact test. Over 17 months, 13 QREW lectures were delivered. In total, 91 feedback forms were completed by faculty (mean 7 forms, range 2-12 per session). Of these, 57 responses (63%) were by those <7 years post training ("junior faculty"), 34 responses (37%) by those ≥ 7 years from training ("senior faculty"). Most respondents reported low levels of prior instruction (80/90, 89%) and personal knowledge (49/91, 54%) on topics. Compared to senior faculty, a greater proportion of junior faculty reported less prior instruction (73% vs 98%, P < 0.001) and less personal knowledge (32% vs 65%, P < 0.01). Most respondents agreed or strongly agreed that the topics were important to their clinical practice (87/90, 97%), professional development (86/90, 96%), and personal well-being (82/91, 90%). Faculty identified the QREW program as a major contributor to their professional development. A noninterpretative professional development lecture series delivered by radiology faculty in a virtual, interactive format is feasible and effective, particularly for junior faculty.

EXPLORING THE ROLES OF SCHOOL HEADS IN THE IMPLEMENTATION OF READING PROGRAMS

The study dealt with the exploration of the roles of school heads in the implementation of reading programs of the Department of Education. A qualitative research design was used to analyze the data gathered from the interview of school heads and school reading coordinators. Purposive sampling was used to identify the respondents. This study sought to answer the perception of school heads in their roles in the implementation of DepEd reading programs as well as their teachers perceptions in their roles. The findings from the research provide principals and division leaders with a collection of best practices on strategies for the implementation of a successful reading program. It revealed that in the implementation, principals gave regular technical assistance, mentoring, and coaching to provide resources. They lead in the planning and implementation of reading activities empowering and motivating teachers, partners, and learners. Implications for school leaders and principals are shared as well as suggestions for future research. KEYWORDS: Comprehension, Implementation, Reading , Perception

Evaluating the gender of vascular surgery residency program directors in the United States

ObjectiveWomen in vascular surgery, especially those in leadership positions, are historically sparse but have the potential to make significant contributions to diversifying the future cohort of vascular surgeons. We aimed to analyze the current demographics of integrated vascular surgery residency (0+5) and fellowship (5+2) program directors (PDs) in the United States. MethodsA cross-sectional study of all active Accreditation Council for Graduate Medical Education-accredited 0+5 and 5+2 programs was performed. Program and PD data were obtained in February 2023 using publicly accessible sources. Program accreditation date, affiliation type, female faculty, and female trainees were collected. PD data included medical degree, training pathway, country of training, gender (male vs female), current age, appointment age, duration between training and appointment, research output, and H-index. ResultsSeventy-four 0+5 programs and 117 5+2 programs were included. Most programs were university-affiliated (164/191; 86%). Seventy-six percent (146/191) of PDs were identified as male, with the remaining 24% female. The mean age was 52 ± 7 years, and the age at PD appointment was 46 ± 7 years. The time between training completion and PD appointment was 11 ± 7 years, and the mean term length was 4 ± 3.5 years. Female PDs were younger overall (49 ± 6 vs 53 ± 7 years; P = .04) and at age of appointment (41 ± 5 vs 48 ± 7 years; P = .03). There was a trend of female PDs having longer term lengths compared with male PDs (6 ± 4 vs 4 ± 3 years; P = .08). Forty percent of residents were female, and 26% of full-time faculty were female. 5+2 female PDs were in programs with more female faculty (P = .001). Female department leaders had double the number of female PDs compared with male department leaders. Male PDs had a higher mean number of publications and Hirsch index compared with female PDs. However, these differences were not statistically significant when adjusting for age and age at position appointment. ConclusionsMost 0+5 and 5+2 PDs were men, and the overwhelming majority of department or division leaders in vascular surgery were male. Although the majority of PDs were male, female PDs were appointed earlier in their career. The current state of diversity in vascular surgery leadership has improved over the past decade; however, there still needs to be more female vascular surgeons, especially in leadership positions. Continuing institutional and societal efforts to recruit female trainees and promote women to leadership is essential to improve the diversification of vascular surgeons.

Initiation and Implementation of Infusional Chemotherapy As a Base Regimen for Increased Risk Lymphoid Malignancy in an Inner-City Academic Institution

Our institution is a 695-bed facility that serves an inner-city population and the surrounding area which together are largely urban and have withstood longstanding obstacles to care including food insecurity, absence of reliable transportation, lack of insurance coverage, and poor health literacy. Such barriers have historically served to limit for many patients, routine outpatient visits, weekly, or even nadir lab work as well as outpatient-based cancer therapy. Institutional barriers include limited nursing resources. Given these challenges, with a change in divisional leadership and the establishment of a new fellowship in hematology/oncology, a simplified and streamlined approach to managing and treating high-risk lymphoid malignancies was planned. Infusional chemotherapy has been shown to have activity in a variety of lymphoid cancers (Wilson, 1993; Dobashi, 1998; Cassaday, 2018). To address inconsistent patient follow-up, a program was instituted, utilizing a dedicated Registered Nurse coordinator making routine proactive phone and electronic check-ins to ascertain patient status; a distinct, direct phone number to call to report symptoms; electronic medical record access for communication; dedicated physician/physician assistant availability; and treatment planning assigned to a single, designated faculty physician with fellow support. Additionally, planned treatment needed inpatient administration, no routine dose alterations, no requirement for patient self-medication, and scheduled single-dose growth factor support. With this in mind, we have utilized an infusional chemotherapy regimen of Hydroxydaunorubicin (Adriamycin) (10 mg/m2), OncovinR (Vincristine) (0.4 mg/m2), and Etoposide (50 mg/m2) by continuous infusion daily for 4 days with Prednisolone 125 mg IV daily for 5 days, and Cyclophosphamide 750 mg/m2 IV on day 5. Peg-filgastrim 6 mg subcutaneously was given following completion of therapy. Cycles were repeated every 21 days. Additions of Rituximab and TKI varied by individual malignancy type. Pt characteristics: 7 males/6 females, median age-45 (range: 19-75), median ECOG status-2, B symptoms-8, LDH elevation-9, no prior therapy-7, disease types: diffuse large B-cell lymphoma-4, large cell unclassifiable, intermediate between DLBCL and classical Hodgkin-2, plasmablastic lymphoma-1, primary effusion lymphoma-1, Burkitt lymphoma-1, lymphoblastic lymphoma-1, acute lymphoblastic leukemia-3.Median number of cycles received = 6 (range: 1-8).Six have had complete responses and four partial responses. One patient with acute lymphoblastic leukemia has undergone transplant and is free of leukemia at 19.9+ months. The median duration of complete response has not been reached at > 6 months. Median survival is ongoing at 11.5+ months. There have been no treatment-related deaths. Three patients required dose modification of Vincristine related to transient paresthesia. There have been no hospitalizations related to toxicity. This systematic approach including an infusional chemotherapy regimen may produce positive downstream effects such as consistency with nursing, a deeper understanding of side effects by nurses and mid-level providers and a predictable patient flow to improve the patient experience and ultimately outcomes. Given the resource constraints experienced at our institution, and potentially other urban teaching institutions, this approach may prove helpful in terms of patient compliance, satisfaction with care, and outcomes.

Psychological services: A wonderful journey.

When we started our journey in 2006, with our original editorial team of Associate Editors Sheila Brandt, Leon Green, Jill Oliveira-Berry, and Morgan Sammons, Gary VandenBos served as managing editor. From the very beginning, we decided that Psychological Services was to be the division's journal and that we would craft its content to address the interests and needs of the membership, who primarily serve in public service, interdisciplinary systems. We wanted to increase the participation of psychologists in nonacademic settings in the editorial process, especially women and ethnic minorities. Throughout our tenure, we reached out to the division's leadership (especially its past presidents) for their thoughtful input. They would know the division's interests. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

An Analysis of Academic Background and Research Activity Among Pediatric Orthopaedic Surgery Division Chiefs and Fellowship Program Directors

Background: Pediatric orthopedics has seen a large increase in the number of practicing surgeons. As a field that is concentrated at tertiary referral centers, research productivity can be a critical component of academic advancement for pediatric orthopedics. Little has been published on the academic profiles of pediatric orthopedic leaders, and therefore, this study sought to highlight the demographics of these individuals. Methods: Pediatric orthopedic division chiefs and fellowship program directors (PD) were identified for all Pediatric Orthopedic Society of North America (POSNA) accredited fellowship programs in the 2020-21 application cycle. A combination of organizational and public websites was used to compile the academic profiles of these leaders, including demographic variables and research productivity. Division chiefs and PDs were then compared, as were leaders when stratified by fellowship size. Results: A total of 46 POSNA-accredited fellowships were identified. As 12 surgeons held dual roles as division chief and PD, 46 division leaders and 34 PDs formed the groups for comparison. Division chiefs had greater median years-in-practice (24.0 vs 13.0, p&lt;0.001), PubMed publications (56.0 vs 27.0, p=0.037), and more frequently were appointed as “Professor” (54.3% vs 23.5%, p=0.013) compared to fellowship PDs. Leaders working at programs with &gt;1 spot/year were more likely to have completed fellowship at their home program (40.0% vs 8.0%, p=0.001) and had higher research productivity across all metrics (all p&lt;0.002) than leaders at programs with 1 position/year. Female representation among division chiefs and fellowship PDs was 10.9% and 14.7%, respectively. Conclusions: When compared to fellowship PDs, pediatric division chiefs had higher research productivity and academic appointments. Division leaders at larger programs additionally had higher research output and more commonly trained at their current institution. Female representation among pediatric orthopedic leaders was higher than the field of orthopedics at large, but lagged behind reported POSNA membership.

The Disparity Morbidity and Mortality Conference: A Mechanism to Identify and Remedy Health Care Inequity.

The Disparity Morbidity and Mortality Conference: A Mechanism to Identify and Remedy Health Care Inequity.

Assessment is a leadership process: The multilevel assessment process

AbstractThis article provides a new conceptual model for student affairs assessment that describes the unique and intersectional contributions of student affairs educators, departmental leadership, and divisional leadership with the assessment process.

591 Transition to an Advanced Practice Provider led burn service: process and lessons learned

IntroductionBurn is not a required rotation for general surgery residency training. Additionally, mandates on resident work hours have created a deficiency in resident support for many burn programs across the country. Subsequently, the need to transition to an Advanced Practice Provider (APP) service was identified. At our institution, a medium volume (~250 admissions/year) burn center, we created an APP service and evaluated the evolution and lessons learned during the transition.MethodsTimeline of recruitment of APPs was reviewed along with the recruitment process, onboarding process and orientation process. Exit interviews were conducted with all APPs who resigned to delineate strengths and weakness of the APP program. Functionality of the institution’s APP recruiter, manager and Lead Burn APP (LAPP) were reviewed as well.ResultsBetween 2014 and 2021 the daytime burn APP service expanded from two to six APPs and the Night House Officer (NHO) APP service was created and expanded to four APPs. Based on thorough review of the APP program, key changes were made including improvements in team communication, daily nurse-driven rounds, the 90-day focused professional performance evaluation (FPPE), enhanced and structured education, and critical care exposure.The need for a LAPP was identified and designated in 2019. The LAPP is responsible for making an equitable schedule, execution of new APP orientation, organizing the 90 day FPPE and ongoing professional performance evaluation (OPPE), monthly APP peer review and APP meetings, coordinating OR coverage, and functioning as an APP advocate at division leadership. The LAPP enacted changes to the existing hiring/onboarding process as described below.All APPs are now recruited through an APP recruiter who discusses the hospital contract and salary as well as organizes the logistics of the interview, formalizes the offer, and aids with the transition to credentialing. All new APPs are given a hospital onboarding checklist, that includes hospital orientation, APP boot camp, simulation and electronic health record training classes. In addition they are given a clinical orientation checklist, which includes BLS/ABLS/ACLS/ATLS certification, exposure to various phases of patient care, tracking of quantitative patient care metrics, participation in monthly burn APP peer review and burn triage simulation. There are subtle differences with the NHO APP clinical checklist. After 90 days of employment a new employee FPPE is held with the LAPP and burn director. This allows for direction of areas to focus on, comprehensive feedback, and discussion about increasing autonomy.ConclusionsThrough a focused process, APPs can play an integral role in the daily functioning of a burn center. We believe that a similar effective and financially sound model can be created for similar sized units.

Letter to the Editor Regarding “Bibliometric Analysis of Publications from 2011–2020 in 6 Major Neurosurgical Journals (Part 1): Geographic, Demographic, and Article Type Trends”

Women have historically been underrepresented in academic medicine, particularly in surgical subspecialties. This study investigated potential associations between gender and promoting practices in academic neurosurgery.Faculty data, including time from residency, professorship, specialty, and h-index, were obtained from websites of the institutions listed in the American Association of Neurological Surgeons Neurosurgical Residency Training Program Directory. Demographics, training, and appointments were compared between male and female neurosurgeons. Predictors of professorship, chair, directorship, and division leadership were identified using multivariable models.The study examined 1629 faculty members. Women were more likely to be assistant professors (P < 0.0001), while men were more likely to be full professors (P < 0.0001), hold chair positions (P = 0.007), lead subspecialty divisions (P = 0.008), and have a higher Scopus h-index (P < 0.0001). In a multivariable analysis, years from training (P < 0.001), fellowship (P = 0.009), h-index (P < 0.001), and chair/program director/division leadership position (P < 0.001) were significant positive predictors of full professorship. Holding additional advanced degrees (P = 0.010), leading a subspecialty division (P = 0.005), and having a higher h-index (P = 0.002) positively predicted chair position. However, when accounting for all other factors, gender was not a significant predictor of full professorship, division leadership, chair, or program directorship.While significantly more men hold leadership positions in U.S. academic institutions, after controlling for contributing variables, there did not appear to be an association between gender and full professorship, division leadership, chair, or program directorship in academic neurosurgery. While the field still has significant work to do to achieve gender equity, these results may serve as encouragement to women who are looking to advance their careers in academic neurosurgery.

Successful recruitment and retention of academic physicians: hiring for longevity, productivity, and leadership in hospital medicine

ABSTRACT Background Considerable resources are expended by hospitals to recruit and retain physicians that will be successful. Healthcare managers lack data to guide these decisions. In that vacuum, suppositions regarding what attributes contribute to physician success predominate. Objectives To evaluate the relationship between candidate factors known at the time of hiring and subsequent longevity and success of physicians in an academic division of hospital internal medicine. Research Design A retrospective review of all physicians hired in an academic hospital internal medicine division. Measures of longevity, research productivity, academic promotion and division leadership roles were compared to personal and professional characteristics at the time of hiring. Success was quantified in those four domains and associations explored for between success and hiring factors. Results Female physicians had greater longevity at the institution. Physicians from the hospital region were no more likely to stay long-term as compared to those from other regions. United States medical graduates were more likely to attain leadership positions than international graduates. There was an inverse relationship between research productivity and administrative leadership. Conclusions Factors commonly sought by academic healthcare institutions were not associated with long term success in academic hospital medicine. Less research productivity was associated with greater divisional leadership involvement, suggesting that scholarship and administrative leadership may represent separate tracks for physicians at academic institutions.

Gender Equity of Promoting Practices in Academic Neurosurgery in the United States

Women have historically been underrepresented in academic medicine, particularly in surgical subspecialties. This study investigated potential associations between gender and promoting practices in academic neurosurgery. Faculty data, including time from residency, professorship, specialty, and h-index, were obtained from websites of the institutions listed in the American Association of Neurological Surgeons Neurosurgical Residency Training Program Directory. Demographics, training, and appointments were compared between male and female neurosurgeons. Predictors of professorship, chair, directorship, and division leadership were identified using multivariable models. The study examined 1629 faculty members. Women were more likely to be assistant professors (P < 0.0001), while men were more likely to be full professors (P < 0.0001), hold chair positions (P= 0.007), lead subspecialty divisions (P= 0.008), and have a higher Scopus h-index (P < 0.0001). In a multivariable analysis, years from training (P < 0.001), fellowship (P= 0.009), h-index (P < 0.001), and chair/program director/division leadership position (P < 0.001) were significant positive predictors of full professorship. Holding additional advanced degrees (P= 0.010), leading a subspecialty division (P= 0.005), and having a higher h-index (P= 0.002) positively predicted chair position. However, when accounting for all other factors, gender was not a significant predictor of full professorship, division leadership, chair, or program directorship. While significantly more men hold leadership positions in U.S. academic institutions, after controlling for contributing variables, there did not appear to be an association between gender and full professorship, division leadership, chair, or program directorship in academic neurosurgery. While the field still has significant work to do to achieve gender equity, these results may serve as encouragement to women who are looking to advance their careers in academic neurosurgery.

Hematology Patient Explorer - an Informatics Infrastructure and Web Application Empowering Clinicians and Researchers to Use Electronic Health Record Information to Identify Clinical Cohorts of Interest

Introduction: The widespread adoption of electronic health records (EHR) in the US (Adler-Milstein and Jha 2017) presents an opportunity to transform healthcare into rapidly learning health organizations and systems (Etheredge 2007; Abernethy et al. 2010) that use routinely collected clinical data in the course of care to generate evidence, address information disparities in patients underrepresented in clinical trials, such as those who are older, belong to ethnic minorities, or are in medically underserved areas, and continuously improve the quality of care delivered.(Rivera et al. 2019; Penberthy, Rivera, and Ward 2019) Unfortunately, this potential remains largely unrealized due to deficiencies in EHR interoperability (Holmgren, Patel, and Adler-Milstein 2017) and usability.(Dunn Lopez et al. 2021) EHR information remains largely unstructured due to the nature of the patient-clinician interaction and current user interfaces where structured data entry is burdensome.(Khairat et al. 2019) At the University of Utah Huntsman Cancer Institute division of Hematology, clinicians as well as clinical and translational researchers often need detailed information on patients seen at the cancer center to plan and conduct research and evaluate and improve the quality of care delivered. Previous efforts to address these needs relied on a clinical data science and health informatics staff working with clinicians to identify patient cohorts of interest. As part of an effort to improve the efficiency of this service, decrease the latency in information provision, and serve a larger number of clinicians and researchers, we designed and implemented a highly usable, scalable, health information technology solution that allows clinicians and researchers to identify, in near real time, cohorts of interest, based on patient and disease characteristics.Methods: Common information needs at the division were assessed by identifying key stakeholders, including division leadership, clinicians, researchers, and health informatics leadership and staff. A team was formed to include overlapping expertise in Hematology, clinical informatics and data science, and prior experience in extraction of clinical information from EHR data warehouses to generate evidence on patient practices and outcomes. Information sources and architectures were evaluated on their comprehensiveness, validity, extensibility, and ability to integrate multiple data sources. A modern web-based interface was designed to mirror the steps clinicians and clinical researchers frequently used to identify cohorts of interest, provide guidance for these users, and generate population level and patient level information. Usability testing included rounds of initial internal testing, followed by a round of closed beta testing.Results: A data lake architecture was implemented to ingest, harmonize and stage information from various data sources, including the Enterprise Data Warehouse, Tumor Registry, and other data silos. Data cleaning and harmonization was done using Python. A web application using ‘Dash’ was implemented with four steps split into four consecutive panes. The first two focused on cohort identification using diagnosis (first pane), and patient and disease characteristics (pane 2). Users first input keywords that allow them to identify diagnoses of interest based on ICDO-3 codes. Users can select multiple codes at this stage. In the next step, users can filter down their cohort based on patient and disease characteristics, such as sex, age, year of initial diagnosis, grade and stage of disease, and others. Once all desired refinements to the pilot cohort are made, users move on to the third tab, which displays customizable population level information, such as number of diagnoses by year, sex, or age. Finally, the fourth tab presents individual level data such as Patient Medical Record Numbers, age, or ICDO-3 diagnosis descriptions. Based on this output, users can return to the initial selection criteria and adjust them. Users are able to download or export selection criteria and query results for future work.Conclusion: We describe the process, roles, and informatics infrastructure and tools to implement a web interface that allows clinicians and researchers to leverage EHR information to identify cohorts of patients for research and quality improvement. Further research will focus on tool usability and scope. DisclosuresDeininger: Sangamo: Consultancy, Membership on an entity's Board of Directors or advisory committees; Fusion Pharma, Medscape, DisperSol: Consultancy; Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Part of a Study Management Committee, Research Funding; SPARC, DisperSol, Leukemia & Lymphoma Society: Research Funding; Novartis: Consultancy, Research Funding; Incyte: Consultancy, Honoraria, Research Funding; Blueprint Medicines Corporation: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Part of a Study Management Committee, Research Funding.