Graduate Medical Education Leadership Research Articles

When Taking Pay off the Table: A Qualitative Study of Gender Equity for Academic Leaders in the US Military.

Although gender inequity persists globally in academic leadership positions, the United States Military has equitable pay and, in academic pediatrics, has equitable gender representation in leadership positions. To better understand how the US Military framework affects physician leaders, pediatricians were interviewed to illuminate the factors that facilitated their success and what barriers they faced in their career. In 2022, following institutional review board approval, semi-structured interviews were conducted with 13 total participants (69% female, 31% male) serving as general pediatricians or pediatric subspecialists in the US Military. These pediatricians were in leadership positions of military academic medicine across seven graduate medical education (GME) sites. The interviews examined the leaders' perceptions of facilitators and barriers to their success. The authors analyzed the interviews using Acker's theory of gendered organizations as a theoretical framework, which explains embedded gender roles within work environments. Drawing on the theory of gendered organizations, the authors identified that participants described several facilitators to their success, including the availability of mentorship/sponsorship, inclusive leadership, and early and persistent exposure to women leaders in GME training and beyond. Because medicine's ideal worker was normed around the traditional roles of men, men observed and women experienced barriers to leadership success around issues related to childbearing, maternity leave, and microaggressions. This study revealed that equitability for pediatric GME leadership in the military heavily relied on structures and support created by former leaders and mentors. Isolating these structures within a unique context of military academic medicine can illuminate physicians' experiences to address barriers and better support equitable leadership roles in both military and civilian academic medicine.

Exploring Competency-Based Medical Education Through the Lens of the UME-GME Transition: A Qualitative Study.

Competency-based medical education (CBME) represents a shift to a paradigm with shared definitions, explicit outcomes, and assessments of competence. The groundwork has been laid to ensure all learners achieve the desired outcomes along the medical education continuum using the principles of CBME. However, this continuum spans the major transition from undergraduate medical education (UME) to graduate medical education (GME) that is also evolving. This study explores the experiences of medical educators working to use CBME assessments in the context of the UME-GME transition and their perspectives on the existing challenges. This study used a constructivist-oriented qualitative methodology. In-depth, semistructured interviews of UME and GME leaders in CBME were performed between February 2019 and January 2020 via Zoom. When possible, each interviewee was interviewed by 2 team members, one with UME and one with GME experience, which allowed follow-up questions to be pursued that reflected the perspectives of both UME and GME educators more fully. A multistep iterative process of thematic analysis was used to analyze the transcripts and identify patterns across interviews. The 9 interviewees represented a broad swath of UME and GME leadership positions, though most had an internal medicine training background. Analysis identified 4 overarching themes: mistrust (a trust chasm exists between UME and GME); misaligned goals (the residency selection process is antithetical to CBME); inadequate communication (communication regarding competence is infrequent, often unidirectional, and lacks a shared language); and inflexible timeframes (current training timeframes do not account for individual learners' competency trajectories). Despite the mutual desire and commitment to move to CBME across the continuum, mistrust, misaligned goals, inadequate communication, and inflexible timeframes confound such efforts of individual schools and programs. If current efforts to improve the UME-GME transition address the themes identified, educators may be more successful implementing CBME along the continuum.

The phenotype of pathology residency program directors

Pathology residency programs vary greatly across the United States. To the authors’ knowledge, little is formally known about the “phenotype” or career pathways of pathology residency program directors (PDs). PDs, former PDs (FPDs), and associate PDs (APDs) were surveyed, aiming to address whether or not dominant phenotypes or pathways to graduate medical education leadership exist. Several trends emerged including: 76% Whites, 70% females, 15% MD/PhDs, and more junior faculty (33% being <5 years in practice, another 24% being in practice <10 years, and 41% assistant professors at time of first PD/APD appointment). Anatomic and clinical pathology-certified individuals represented 79%. Sixty-two percent of respondents were on a nontenure employment track, with only 18% indicating tenure track. For subspecialty focus, cytopathology (25%), transfusion medicine (16%), and hematopathology (14%) represented the most common subspecialties practiced. A majority (65%) had served as a chief resident during residency, and most (61%) of PDs had served as APDs first. Most (60%) had not served as fellowship director. Most (65%) had not participated in any education leadership training, with 27% having participated in certificate programs or other educational professional development. Thematic analysis of perceived key criterion in selection for the role was passion for education, demeanor, emotional intelligence, and willingness to serve the department. This information may influence training or experience pursued by individuals aspiring to pathology graduate medical education leadership, inform chairs on qualities to look for, and supplement future educational sessions of the Association of Pathology Chairs Program Directors Council.

The Influence of Anti-LGBTQIA+ Legislation on Graduate Medical Education

The Influence of Anti-LGBTQIA+ Legislation on Graduate Medical Education

Perceptions of Gender Stereotypes among Women Residents in Surgical and Nonsurgical Specialties.

The objective of this study was to determine whether and to what degree residents experience stereotype perception by gender and specialty type (surgical vs nonsurgical). A cross-sectional survey was sent to resident physicians across all specialties at a single academic institution in February 2021. The survey items asked whether participants believe residents, faculty, and the public expect men or women to be better physicians on a numerical scale from 1 to 7. A χ2 test compared the calculated mean and standard error for each survey item. This study took place at Washington University School of Medicine in St. Louis, Missouri, a large academic tertiary care center. A total of 411 (46% of total) residents participated; 13 were excluded because of nonbinary gender or missing demographic information, for a final sample of 398. Participants perceived all three groups to expect men to be better physicians than women. Regression analysis showed a significant effect of gender on stereotype perception, with women reporting stronger stereotype perceptions than men. There were no significant differences in stereotype perceptions by specialty type. Women resident physicians in both surgical and nonsurgical fields reported higher levels of gender stereotype perception compared with men, making it imperative that graduate medical education leadership support changes to the current learning environment.

Education Research: Diversity in Neurology Graduate Medical Education Leadership

Background and Objectives To describe the current landscape of gender and racial diversity among adult neurology residency and fellowship program directors (PDs). Diversity in medicine affects the quality of care provided to a diverse patient population. There are efforts in nearly every field of medicine to increase the diversity of the physician workforce. While there has been improvement in some of the known disparities in medicine such as gender disparities, these disparities have persisted in more senior academic positions in medicine. Methods A data set was generated by the Association of American Medical Colleges for the purpose of this study using a variety of sources. The data included deidentified, person-level variables, including self-reported gender, race, or ethnicity, and the type of program for all PDs of Accreditation Council for Graduate Medical Education–accredited residencies and fellowships. This retrospective descriptive survey study sought to (1) describe the current gender and race climate of neurology PDs and (2) identify groups that may be disproportionally underrepresented in these positions compared with those in other specialties and levels of medical training. Descriptive statistics and tests of nonrandom association were performed to address the objectives. Results We found that 56.7% of residency PDs and 58% of fellowship PDs are male. The male to female ratio of PDs was similar to current neurology residents who are 53.4% male. There were significantly more female medical students (51.5%) compared with all other categories of academic rank other than neurology residency PDs (41.1%). Only 4.3% of residency PDs were Black and only 3.7% were Hispanic. There were no Black fellowship PDs, and 5.1% were Hispanic. There were significantly more non-White medical students and trainees compared with each PD group. The breakdown of gender and ethnic diversity of neurology PDs was similar to that of PDs from all residencies and fellowships. Discussion While there are many barriers to achieving diversity in medicine, program leadership in graduate medical education may be one of them. This report describes the current landscape of diversity among PDs of residency and fellowship programs in the United States. This study shows one snapshot in time, which can be used as a baseline during this era of change.

AIMS: Increasing Diversity in Graduate Medical Education Leadership.

Graduate medical education (GME) leadership needs more diverse representation. Specialty medical education associations have a responsibility to support the development of the next generation of underrepresented in medicine (UIM) GME leaders. In our continued commitment to become an anti-racist organization,1 the Association of Pediatric Program Directors (APPD), in collaboration with the APPD UIM in Pediatric GME Learning Community, created the Advancing Inclusiveness in Medical Education Scholars (AIMS) Program in 2019 to address this gap.AIMS is a 12-month program that provides professional development and mentorship to UIM pediatric residents (AIM scholars) with the objective of exposing them to careers in medical education and mentorship earlier in their training with the goal of increasing the diversity of pediatric medical education leadership.Pediatric residents are eligible to apply if they meet the following criteria: postgraduate year (PGY)-2 categorical or PGY-3 in a combined pediatrics program, UIM as defined by the Association of American Medical Colleges, able to attend the national APPD conference, and demonstrating an interest in medical education leadership.The AIMS Program has been developed using the conceptual framework of self-determination theory, which posits that competence, relatedness, and autonomy lead to internal motivation. The program consists of:Scholars participate in a half-day of programming before our national conference that includes: a welcome from APPD Board, an overview of careers in medical education, a meet the educator panel, speed mentoring (topics: mentorship, wellness/minority tax, career branding, medical education scholarship), and 1:1 meetings with their mentors. The scholars then participate in the regular conference educational content to engage with the broader APPD community and end each day debriefing with their cohort and program leadership.Scholars are paired with UIM mentors who have an educational leadership position at a different institution and engage in peer mentoring, faculty mentoring, and inclusion in the UIM in Pediatric GME Learning Community.Scholars have been deliberately provided opportunities and sponsored to participate in various national committees and academic scholarship within the APPD that aligns with their interests (eg, have served on the Confronting Racism Action Team, Workforce Initiative, Curriculum Reform).Our first 2 cohorts consisted of 28 total scholars out of 71 applicants (2020 cohort: 30 applicants, 12 selected; 2021 cohort: 41 applicants, 16 selected). Scholars included 25 (89%) categorical residents, 22 (79%) female, 21 (75%) Black/African American, 8 (29%) Hispanic/Latino, and 8 (29%) first-generation college graduates. For each cohort, we ensured that there was representation across the United States from training programs in all APPD regions.Twenty-four scholars (86%) have completed a voluntary anonymous program survey. For overall quality of the program, on a 5-point scale (poor to excellent), 21 (88%) rated it excellent and 3 (13%) very good. All scholars (100%) either strongly agreed or agreed that the AIMS programming and attending the APPD conference were helpful in: (1) career development, (2) networking, and (3) feeling like they belong in educational leadership. For the future, we plan to continue program evaluation and track longitudinal career outcomes.As we continue to scale the program, the APPD has committed to fund 16 scholars per year for the next 3 years, and we continue to seek additional sustainable funding through key stakeholders. AIMS leadership comes from the established UIM in Pediatric GME Learning Community, which further supports its sustainability. Due to the COVID-19 pandemic, the first 2 cohorts have participated virtually, which has reduced costs and increased accessibility.The AIMS Program represents a feasible and adaptable framework that specialty medical education associations can utilize to build programs that provide career development, mentorship, and a sense of community for UIM trainees interested in careers in medical education leadership.

The Diversity of Graduate Medical Education Leadership in Neurology (P18-13.003)

The Diversity of Graduate Medical Education Leadership in Neurology (P18-13.003)

AAIM Recommendations to Improve Learner Transitions

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Outcomes From a Novel Graduate Medical Education Leadership Program in Advancing Diversity, Equity, and Inclusion.

Academic medicine needs more diverse leadership from racial/ethnic minorities, women, people with disabilities, and LGBTQIA+ physicians. Longitudinal structural support programs that bring together underrepresented in medicine (UiM) and non-UiM trainees are one approach to build leadership and scholarship capacity in diversity, equity, and inclusion (DEI). To describe the creation, satisfaction with, and feasibility of a Leadership Education in Advancing Diversity (LEAD) Program and evaluate scholars' changes in self-efficacy, intended and actual behavior change, and outputs in leadership and DEI scholarship. In 2017, we created the LEAD Program, a 10-month longitudinal, single institution program that provides residents and fellows ("scholars") across graduate medical education (GME) with leadership training and mentorship in creating DEI-focused scholarship. In the first 3 cohorts (2017-2020), we assessed scholars' self-efficacy, actual and planned behavior change, and program satisfaction using IRB-approved, de-identified retrospective pre-/post-surveys. We measured scholarship as the number of workshops presented and publications developed by the LEAD scholars. We used descriptive statistics and paired 2-tailed t tests to analyze the data. Seventy-five trainees completed LEAD; 99% (74 of 75) completed the retrospective pre-/post-surveys. There was statistically significant improvement in scholars' self-efficacy for all learning objectives. All trainees thought LEAD should continue. LEAD scholars have created workshops and presented at local, regional, and national conferences, as well published their findings. Scholars identified the greatest benefits as mentorship, developing friendships with UiM and ally peers outside of their subspecialty, and confidence in public speaking. LEAD is an innovative, feasible GME-wide model to improve resident and fellow self-efficacy and behaviors in DEI scholarship and leadership.

A 12-Year North American Longitudinal Study of Gender Equity and Equality in Gastroenterology

A 12-Year North American Longitudinal Study of Gender Equity and Equality in Gastroenterology

Engaging Housestaff as Informatics Collaborators: Educational and Operational Opportunities.

In academic hospitals, housestaff (interns, residents, and fellows) are a core user group of clinical information technology (IT) systems, yet are often relegated to being recipients of change, rather than active partners in system improvement. These information systems are an integral part of health care delivery and formal efforts to involve and educate housestaff are nascent. This article develops a sustainable forum for effective engagement of housestaff in hospital informatics initiatives and creates opportunities for professional development. A housestaff-led IT council was created within an academic medical center and integrated with informatics and graduate medical education leadership. The Council was designed to provide a venue for hands-on clinical informatics educational experiences to housestaff across all specialties. In the first year, five housestaff co-chairs and 50 members were recruited. More than 15 projects were completed with substantial improvements made to clinical systems impacting more than 1,300 housestaff and with touchpoints to nearly 3,000 staff members. Council leadership was integrally involved in hospital governance committees and became the go-to source for housestaff input on informatics efforts. Positive experiences informed members' career development toward informatics roles. Key lessons learned in building for success are discussed. The council model has effectively engaged housestaff as learners, local champions, and key informatics collaborators, with positive impact for the participating members and the institution. Requiring few resources for implementation, the model should be replicable at other institutions.

Graduate Medical Education Enhancement and the Consolidated Appropriations Act, 2021.

Graduate Medical Education Enhancement and the Consolidated Appropriations Act, 2021.

Creation of a Student-Run Medical Education Podcast: Tutorial.

BackgroundPodcasting has become a popular medium for medical education content. Educators and trainees of all levels are turning to podcasts for high-quality, asynchronous content. Although numerous medical education podcasts have emerged in recent years, few student-run podcasts exist. Student-run podcasts are a novel approach to supporting medical students. Near-peer mentoring has been shown to promote medical students’ personal and professional identity formation. Student-run podcasts offer a new medium for delivering near-peer advice to medical students in an enduring and accessible manner.ObjectiveThis paper describes the creation of the UnsCripted Medicine Podcast—a student-run medical education podcast produced at the University of Cincinnati College of Medicine.MethodsThe planning and preparatory phases spanned 6 months. Defining a target audience and establishing a podcast mission were key first steps. Efforts were directed toward securing funding; obtaining necessary equipment; and navigating the technical considerations of recording, editing, and publishing a podcast. In order to ensure that high professionalism standards were met, key partnerships were created with faculty from the College of Medicine.ResultsThe UnsCripted Medicine Podcast published 53 episodes in its first 2 years. The number of episodes released per month ranges from 0 to 5, with a mean of 2.0 episodes. The podcast has a Twitter account with 217 followers. The number of listeners who subscribed to the podcast via Apple Podcasts grew to 86 in the first year and then to 218 in the second year. The show has an average rating of 4.8 (out of 5) on Apple Podcasts, which is based on 24 ratings. The podcast has hosted 70 unique guests, including medical students, resident physicians, attending physicians, nurses, physicians’ family members, graduate medical education leadership, and educators.ConclusionsMedical student–run podcasts are a novel approach to supporting medical students and fostering professional identity formation. Podcasts are widely available and convenient for listeners. Additionally, podcast creators can publish content with lower barriers of entry compared to those of other forms of published content. Medical schools should consider supporting student podcast initiatives to allow for near-peer mentoring, augment the community, facilitate professional identity formation, and prepare the rising physician workforce for the technological frontier of medical education and practice.

Abstract No. 179 Interventional radiology trainee perspectives on clinical training paradigm and trends on future job perception

Abstract No. 179 Interventional radiology trainee perspectives on clinical training paradigm and trends on future job perception

Peek at the glass ceiling: gender distribution of leadership among emergency medicine residency programs

BackgroundA gender gap in faculty rank at academic institutions exists; however, data among graduate medical education (GME) programmes are limited. There is a need to assess gender disparities in GME...

On Blast: A Framework for Monitoring and Responding to Online Comments About Your Graduate Medical Education Program.

On Blast: A Framework for Monitoring and Responding to Online Comments About Your Graduate Medical Education Program.

Creating a COVID-19 Action Plan for GME Programs.

Creating a COVID-19 Action Plan for GME Programs.

A cross-sectional study of United States family medicine residency programme director burnout: implications for mitigation efforts and future research.

Academic physician burnout is concerning. Too little is known about factors associated with residency programme director burnout. Continued uncertainty risks adverse outcomes including graduate medical education leadership turnover and negative impact on recruiting and retaining under-represented minority residency programme directors. This study assessed symptoms of burnout (emotional exhaustion, depersonalization) and depression along with evidence-based individual and environmental risk factors in a U.S. sample of family medicine residency programme directors. The omnibus 2018 Council of Academic Family Medicine Education Research Alliance survey was used to contact programme directors at all Accreditation Council for Graduate Medical Education accredited U.S. family medicine residency programmes via email. Descriptive data included programme director and programme characteristics, Areas of Worklife (workload, values and control), loneliness (lack companionship, feel left out and feel isolated), burnout (emotional exhaustion, depersonalization) and depressive symptoms. Chi-square tests contrasted descriptive variables with burnout and depressive symptoms. Logistic regression (LR) modelled associations between significant descriptive variables and burnout and depressive symptoms. The survey response rate was 45.2% (268/590). Programme directors reported: emotional exhaustion (25.0%), depersonalization (10.3%) and depressive symptoms (25.3%). LR models found significant associations with emotional exhaustion (Workload: lacking time and other work-related resources); lack of companionship, depersonalization (North West Central residency region; Workload and lack of companionship) and depressive symptoms (Black/African American ethnicity). One-quarter of U.S. programme directors report burnout or depressive symptoms. Future research should consider associated variables as possible intervention targets to reduce programme director distress and turnover.

Nimble, Together: A Training Program's Response to the COVID-19 Pandemic.

Nimble, Together: A Training Program's Response to the COVID-19 Pandemic.