Impact of UK academic foundation programmes on aspirations to pursue a career in academia

Medical Education 2010: 44: 996–1005 Objectives This study aimed to determine the role played by academic foundation programmes in influencing junior doctors’ desire to pursue a career in academic medicine. Methods We conducted an online questionnaire‐based study of doctors who were enrolled on or had completed academic foundation programmes in the UK. There were 92 respondents (44 men, 48 women). Of these, 32 (35%) possessed a higher degree and 73 (79%) had undertaken a 4‐month academic placement during Foundation Year 2. Outcomes were measured using Likert scale‐based ordinal response data. Results From a cohort of 115 academic foundation trainees directly contacted, 46 replies were obtained (40% response rate). A further 46 responses were obtained via indirect notification through local programme directors. From the combined responses, the majority (77%) wished to pursue a career in academia at the end of the academic Foundation Year (acFY) programme. Feeling well informed about academic careers (odds ratio [OR] 16.9, p = 0.005) and possessing a higher degree (OR 31.1, p = 0.013) were independently associated with an increased desire to continue in academia. Concern about reduced clinical experience whilst in academic training dissuaded from continuing in academia (OR 0.15, p = 0.026). Many respondents expressed concerns about autonomy, the organisation of the programme and the quantity and quality of academic teaching received. However, choice of work carried out during the academic block was the only variable independently associated with increasing the desire of respondents to pursue a career in academia following their experiences in the acFY programme (OR 6.3, p = 0.007). Conclusions The results support the provision of well‐organised academic training programmes that assist junior clinical academics in achieving clinical competencies whilst providing protected academic time, information about further academic training pathways and autonomy in their choice of academic work.     

A qualitative study of work-life choices in academic internal medicine

The high attrition rate of female physicians pursuing an academic medicine research career has not been examined in the context of career development theory. We explored how internal medicine residents and faculty experience their work within the context of their broader life domain in order to identify strategies for facilitating career advancement. Semi-structured interviews were conducted with a purposeful sample of 18 residents and 34 faculty members representing male and female physicians at different career stages. Using thematic analysis, three themes emerged: (1) the love of being a physician (“Raison d’être”), (2) family obligations (“2nd Shift”), and (3) balancing work demands with non-work life (“Negotiating Academic Medicine”). Female researchers and educators reported more strategies for multiple role planning and management than female practitioners. Interventions aimed at enhancing academic internists’ planning and self-efficacy for multiple role management should be investigated as a potential means for increasing participation and facilitate advancement.     

They Just Respect You for Who You Are: Contributors to Educator Positive Youth Development Promotion for Somali,Latino, and Hmong Students

Youth from immigrant communities may experience barriers to connecting with schools and teachers, potentially undermining academic achievement and healthy youth development. This qualitative study aimed to understand how educators serving Somali, Latino, and Hmong (SLH) youth can best promote educator–student connectedness and positive youth development, by exploring the perspectives of teachers, youth workers, and SLH youth, using a community based participatory research approach. We conducted four focus groups with teachers, 18 key informant interviews with adults working with SLH youth, and nine focus groups with SLH middle and high school students. Four themes emerged regarding facilitators to educators promoting positive youth development in schools: (1) an authoritative teaching approach where teachers hold high expectations for student behavior and achievement, (2) building trusting educator–student relationships, (3) conveying respect for students as individuals, and (4) a school infrastructure characterized by a supportive and inclusive environment. Findings suggest a set of skills and educator–student interactions that may promote positive youth development and increase student-educator connectedness for SLH youth in public schools.     

Becoming an academic doctor: perceptions of scholarly careers

Objectives  Despite a recognised need to prepare future faculty members, little research has been conducted on how best to accomplish this task, especially among learners and faculty members within research-intensive medical schools.
Methods  We interviewed 40 medical students, residents and faculty members from a single institution in the USA and asked questions about which careers the school does and should prepare individuals for, and the strengths of the institution for doing so. Interviews were conducted in person at a location chosen by the participant. All interviews were transcribed and coded using qualitative methods and software. The coding and themes were reviewed and discussed among members of the research team and verified by external reviewers.
Results  We identified five themes related to becoming an academic doctor: early exposure to research; role models and mentoring; career pathways; interplay of personal and social factors, and career support for junior faculty members.
Conclusions  Results suggest that opportunities should be structured within undergraduate and graduate medical education to stimulate interest in careers as academic doctors and to aid junior faculty members to act as role models who can encourage learners to pursue careers in academic medicine.     

Prioritizing research needs based on a systematic evidence review: a pilot process for engaging stakeholders

Background/context Systematic evidence reviews (SERs) identify knowledge gaps in the literature, a logical starting place for prioritizing future research. Varied methods have been used to elicit diverse stakeholders’ input in such prioritization. Objective To pilot a simple, easily replicable process for simultaneously soliciting consumer, clinician and researcher input in the identification of research priorities, based on the results of the 2009 SER on screening adults for depression in primary care. Methods We recruited 20 clinicians, clinic staff, researchers and patient advocates to participate in a half‐day event in October 2009. We presented SER research methods and the results of the 2009 SER. Participants took part in focus groups, organized by profession; broad themes from these groups were then prioritized in a formal exercise. The focus group content was also subsequently analysed for specific themes. Results Focus group themes generally reacted to the evidence presented; few were articulated as research questions. Themes included the need for resources to respond to positive depression screens, the impact of depression screening on delivery systems, concerns that screening tools do not address comorbid or situational causes of depression and a perceived ‘disconnect’ between screening and treatment. The two highest‐priority themes were the system effects of screening for depression and whether depression screening effectively leads to improved treatment. Conclusion We successfully piloted a simple, half‐day, easily replicable multi‐stakeholder engagement process based on the results of a recent SER. We recommend a number of potential improvements in future endeavours to replicate this process.     

What makes a quality occupational therapy practice placement? Students’ and practice educators’ perspectives

Background/aim: Practice placement experiences are crucial to enable students to integrate theory with practice, demonstrate professional and interpersonal skills and build confidence in their practice skills. This study addressed practice educators’ and students’ perspectives regarding quality practice placement experiences. Method: In total 29 students, 41 practice educators and eight practice education staff members across three Queensland universities participated in focus groups or individual interviews (N = 78) focusing on their views about quality learning experiences on placements. Results: Key themes described university preparation and processes, a welcoming learning environment, detailed orientation and clear expectations, graded program of learning experiences, quality modelling and practice, consistent approach and expectations, quality feedback, open and honest relationships and supervisor experience and skills. These findings were consistent with research previously undertaken in Australia and Canada that had investigated either student or practice educator perspectives. Conclusions: This article synthesises the perspectives of these stakeholder groups and has led to the development of quality indicators across the phases of placement establishment, preparation, maintenance and review. Although having sufficient placements can be challenging for university programmes, ensuring that the experiences provided are of high quality is also important and requires significant attention by university academics and practice education staff, practice educators, managers and practice organisations alike.     

Academic training schemes reviewed: implications for the future development of our researchers and educators

CONTEXT: There is an international crisis in academic medicine: numbers of academics are low; there is a split between teaching and research, and career progression is poorly defined. In the UK, academic career pathways have recently been reformed, but there is little readily accessible information on what a high-quality academic training scheme might comprise. METHODS: I conducted a wide review of medical and bio-psychosocial databases, coupled with a search of the grey literature. RESULTS: The review suggests both widespread support for training in research and dissatisfaction with training schemes. Insufficient training time is a major issue. High-quality supervision is crucial, with clear goals and expectations for research fellows. Structured training seems to be helpful, as is financial, administrative and statistical support. However, the vast majority of studies give a broad overview or opinion, or report the superficial results of questionnaire surveys. The focus is on research training; teaching is ignored. CONCLUSIONS: Although there appears to be broad agreement on a number of issues, the literature lacks sufficient depth, and little is known about factors that contribute to effective academic training schemes. Schemes must be studied in depth to determine what makes them successful, in order to ensure the future of teaching and research.     

Making progress in the ethical treatment of medical trainees

There is an inherent conflict within clinician educators as we balance the roles of healthcare provider to patients in need of care with that of educator of learners in need of teaching. In this essay we use Beauchamp and Childress’ principles of biomedical ethics as a framework to compare the relationship that clinician educators have with their patients and their learners, and suggest that while we typically apply ethical principles when addressing the needs of our patients, these principles are frequently lacking in our interactions with learners. This dichotomy reflects a person-by-situation interaction that may be partly explained by the expectations of the regulatory bodies that define how clinicians should interact with patients and how educators should interact with learners. The result is that we may fall short in applying respect for autonomy, beneficence/nonmaleficence, and justice when addressing the needs of our learners. Fortunately there are ways in which we can incorporate these ethical principles into our interactions with learners while still adhering to accreditation standards and institutional policy. These include flipped classrooms and simulated learning experiences, incorporating aspects of instructional design that have been shown to improve learning outcomes, providing additional resources to learners with greater needs, and organizing training curricula around entrustable professional activities. Although the consistent application of ethical principles with all learners during all learning experiences is likely unachievable, we can, and should, move towards more ethical treatment of our learners.     

How Does Context Relate to Nutrition Promotion and Mealtime Practice in Early Care and Education Settings? A Qualitative Exploration

Background

Early childhood educators have the potential to influence children’s dietary outcomes through daily interactions. However, existing research suggests that educator practices are often suboptimal. Previous research has often focused on individual characteristics that affect practices. There is less study of contextual influences of practices of early childhood educators.

Why people apply to medical school: implications for widening participation activities

OBJECTIVES: This research aims to identify the influences contributing to students' decisions to study medicine and to apply the findings to the design and targeting of outreach activities aimed at widening participation. METHODS: Semi-structured interviews were carried out with 15 medical students at a UK medical school. Framework analysis was used to identify themes and subthemes and findings relating to becoming a doctor were analysed further in the context of a theory of career decision making. RESULTS: Five themes and subthemes were identified. We report the results for the 3 main aspects relating to becoming a doctor from the theme School to Medical School Transition: early motivation; inhibitory factors, and facilitating factors. Many students spoke about having always wanted to study medicine. Early exposure to the possibility of being a doctor allowed the idea to flourish and motivated students to achieve high academic goals. Inhibitory factors included discouragement from application by teachers on the grounds of not being 'doctor material'. Factors which facilitated access to medicine included the support of family members, particularly mothers, and other close friends, and having positive role models. CONCLUSIONS: Our analysis provides evidence of important factors in career decision making for medicine which can be used to inform widening participation interventions in 3 areas, namely, those of school support, home support and raising aspirations.     

Research productivity of allied health faculty in academic health centers

As colleges of allied health become a more integral part of the academic community, faculty will increasingly be expected to contribute to the research mission of their respective institutions. The purpose of this study was to identify characteristics associated with research productivity of allied health faculty. A survey was mailed to 1444 full-time faculty members in 50 academic health centers nationwide, representing 10 of the most prevalent allied health fields. Research productivity was defined as the total number of publications produced by a faculty member over his/her academic career. Data from 579 respondents (40%) were analyzed. Results of the regression analysis showed that 44% of the variance in total publications was explained by an earned doctorate, hours spent in research, and salary. As a group, the study results showed that allied health faculty were not prolific researchers and did not publish extensively. Although faculty distributed their time among teaching, research, service, consulting, and practice, the greater percentage of faculty time was spent in teaching and service.     

Primary Care Clinicians’ Perspectives on Management of Skin and Soft Tissue Infections: An Iowa Research Network Study

An estimated 95,000 people developed methicillin‐resistant Staphylococcus aureus (MRSA) infections during 2005 of which 14% were community‐associated and 85% were hospital or other health setting associated, and 19,000 Americans died from these infections that year. Purpose: To explore health care providers’ perspectives on management of skin and soft tissue infections to gain a better understanding of the problems faced by busy providers in primary care settings. Methods: Focus group meetings were held at 9 family physician offices in the Iowa Research Network. Seventy‐eight clinicians including physicians, nurses, nurse practitioners, and house officers attended. Meeting audiotapes were transcribed and coded by 3 investigators, and a MRSA‐management taxonomy was developed. Findings: The main themes that emerged from the focus groups included epidemiology, diagnosis, treatment, management, prevention, special populations, and public relations. The incidence of MRSA infections was perceived to have increased over the past decade. However, diagnosis and treatment protocols for physicians in the outpatient setting have lagged behind, and no well‐accepted diagnostic or treatment algorithms were used by physicians attending the focus groups. Conclusion: The clinicians in this study noted considerable confusion and inconsistency in the management of skin and soft tissue infections, particularly those due to MRSA.     

An expanded model of faculty vitality in academic medicine

Many faculty in today’s academic medical centers face high levels of stress and low career satisfaction. Understanding faculty vitality is critically important for the health of our academic medical centers, yet the concept is ill-defined and lacking a comprehensive model. Expanding on previous research that examines vital faculty in higher education broadly and in academic medical centers specifically, this study proposes an expanded model of the unique factors that contribute to faculty vitality in academic medicine. We developed an online survey on the basis of a conceptual model (N?=?564) and used linear regression to investigate the fit of the model. We examined the relationships of two predictor variables measuring Primary Unit Climate and Leadership and Career and Life Management with an overall Faculty Vitality index comprised of three measures: Professional Engagement, Career Satisfaction, and Productivity. The findings revealed significant predictive relationships between Primary Unit Climate and Leadership, Career and Life Management, and Faculty Vitality. The overall model accounted for 59% of the variance in the overall Faculty Vitality Index. The results provide new insights into the developing model of faculty vitality and inform initiatives to support faculty in academic medical centers. Given the immense challenges faced by faculty, now more than ever do we need reliable evidence regarding what sustains faculty vitality.     

Arts-based learning in medical education: the students' perspective

Medical Education 2011: 45 : 1090–1100 Context Arts subjects are often included in medical school curricula to facilitate the exploration of non‐scientific elements of medicine, such as communication, social, political, emotional and spiritual issues. However, little research has reported on students’ experience of arts teaching. Performing Medicine is a programme created by the Clod Ensemble theatre company in collaboration with Barts and The London School of Medicine and Dentistry, and the Department of Drama at Queen Mary University, London. Professional artists run a range of workshops exploring issues relating to health care and work to develop students’ professional skills in self‐presentation, observation, communication, self‐care and their understanding of difference. This article presents an analysis of student‐written material about Performing Medicine. Methods A dataset of written student materials (reflections and feedback), drawn from three academic years (2006–2009), was analysed using the qualitative methods of thematic analysis and word frequency analysis. Results Five prevalent themes were identified: (i) Acting like a doctor; (ii) Developing broader awareness of others; (iii) The self in focus; (iv) The art of communication, and (v) A place for arts‐based teaching within the medical curriculum. The corpus linguistic analysis confirmed and elaborated on the five themes found in the thematic analysis. Conclusions Students generally felt that arts teaching made a valuable contribution to the medical curriculum. Many felt the training would reduce ‘performance anxiety’ in situations such as examinations, presentations and new placements. Group work developed camaraderie and students enjoyed the opportunity to learn new skills through creative writing, theatre and movement sessions. Some sessions developed students' ability to engage with and relate to people from very different backgrounds than their own.     

Reflections of a mid-career clinician educator--fanning the flames for teaching

Family medicine educators today face vast challenges. Clinical demands and the lack of specific revenue streams for our educational mission are among the many threats to the commitment of our faculty to keep education in its rightful place of honor and value within our academic institutions. To preserve our historic and critical mission, it is imperative that we find ways to rekindle the passion that called many of us to a teaching career path.     

Definitions of research by occupational therapy clinicians: An exploratory study

The primary aim of this exploratory study was to explore how occupational therapy clinicians define ‘research’ in conceptual and operational terms. The secondary aim of this study was to identify observable and measurable indicators of research which could be used in structured instruments for further study of clinician research involvement. An opportunistic sample of 26 clinicians participated. A self report, open-ended question survey was used to explore clinician perspectives. Content analysis of data revealed a wide range of categories describing and explaining definitions of research, the way in which these definitions were formulated, and other factors associated with the term research such as the role of researcher, issues personally affecting clinicians and aspects of the environment. Recommendations for further research are made.     

Career satisfaction and professional accomplishments

Medical Education 2010: 44 : 969–976 Context Research on doctor career satisfaction has often focused on factors such as income, specialty, gender, work hours, autonomy, patient load, lifestyle preferences, work environment, and insurance regulations. Other educational, personal and professional factors have not received sufficient empirical attention. Objective This study was designed to test the following five hypotheses that doctors’ career satisfaction is associated with: (i) Higher satisfaction with their undergraduate medical education; (ii) Greater academic and clinical competence; (iii) More involvement in teaching and research activities; (iv) Higher orientation toward lifelong learning; and (v) Increased professional accomplishments. Methods A survey was mailed in 2006 to a national sample of 5349 doctors in the United States who graduated from Jefferson Medical College between 1975 and 2000; 3170 (59%) returned completed surveys. Based on responses to a career satisfaction question, doctors were classified into three groups: Highly satisfied (top third, n = 1078); moderately satisfied (middle third, n = 1031); and least satisfied (bottom third, n = 1061). These groups were compared on a number of variables. Results All five research hypotheses were confirmed. Additionally, no significant association was observed between career satisfaction, age, years in practice, gender, or ethnicity; however, career satisfaction was associated with doctors’ specialties. Conclusions The findings suggest that factors such as satisfaction with medical education, medical school class rank, assessments of clinical competence, teaching, and research activities, orientation toward lifelong learning, and professional accomplishments should be considered for a more comprehensive understanding of doctors’ career satisfaction.