PhD faculty in clinical departments of U.S. medical schools, 1981-1999: their widening presence and roles in research.

PURPOSE: To analyze the growth, research activities, and academic status of PhD faculty in U. S. medical school clinical departments between 1981 and 1999. METHOD: Full-time U.S. medical school faculty who had PhDs and appointments in clinical departments in 1981 and 1999 and junior PhD faculty who became assistant professors between 1981 and 1990 were selected from the Faculty Roster System of the Association of American Medical Colleges. Their research activities and academic statuses were compared with those of MD or MD/PhD faculty in clinical departments or PhD faculty in basic science departments in the same years. RESULTS: The number of PhD faculty in clinical departments now exceeds the number of PhD faculty in basic science departments. PhD faculty in clinical departments come from diverse research backgrounds, contribute substantially to the research intensity of their institutions, and are more likely than their counterparts in basic science departments to become involved in research involving human participants or human tissues. PhD faculty in clinical departments are less likely than their counterparts in basic science departments, but are as likely as physicians in clinical departments, to be rewarded with academic promotion. They are less likely than their physician colleagues to be promoted in research-intensive departments such as departments of medicine and at top 20 research-intensive schools. CONCLUSIONS: The burgeoning career opportunities for PhD faculty in clinical departments should be reflected in the course work, mentorship, and potential thesis topics of PhD training programs. In lieu of tenure, research-intensive medical schools should develop alternative career tracks providing somewhat greater job stability for these faculty.     

A study to examine whether the basic sciences are appropriately organized to meet the future needs of medical education

There is a growing divergence between the content of research activities in the basic sciences and that of the traditional preclinical courses for medical students. A 1977 study at the University of Pennsylvania School of Medicine (Penn) examined the organization of the school's basic sciences, including surveying the research interests and departmental affiliations of 101 basic science faculty at Penn and interviewing the basic science departments chairmen there and at five other research-intensive schools of medicine. The findings demonstrated overlapping interests among basic science investigators, significant blurring of departmental boundaries, and a divergence between the faculty members' research interests and the disciplines represented by the departments in which these faculty held appointments. A second study a decade later documented that this divergence had increased. This paper also addresses the mounting concern among medical educators in response to these kinds of developments, the effect of such developments on medical education, and issues concerning the teaching of basic sciences, course content, the responsibility of schools of medicine for effecting change, and a possible model for basic science instruction.     

The reorganization of basic science departments in U.S. medical schools, 1980-1999.

The evolution of biomedical science and technology over the last 50 years has made biomedical research inherently interdisciplinary. Such changes have led observers to speculate about the ways in which traditional basic science departments in U.S. medical schools are being changed or consolidated. The authors describe their findings from a study that constructed a 20-year longitudinal database (1980-1999) to examine how basic science departments have been reorganized at U.S. medical schools. The data reveal that, in fact, there were fewer basic science departments in the traditional disciplines of anatomy, biochemistry, microbiology, pharmacology, and physiology in 1999 than in 1980. But as biomedical science has developed in an interdisciplinary manner, new basic science departments have been added. The most frequent type of change, however, has been in the renaming of existing departments. Overall, there were more, not fewer, basic science departments and more, not fewer, faculty members in these departments. These changes, taken together with the growth of interdisciplinary research centers and institutes and changing patterns of biomedical PhD training, affect both teaching and research in academic medicine. First, basic scientists are becoming increasingly dissociated from the traditional disciplines around which medical students' education is often organized. Second, the organization of biomedical research is in a state of transition that is responding to advances in scientific knowledge, technology, and targets of opportunity.     

Research centers and institutes in U.S. medical schools: a descriptive analysis.

Research centers and institutes are a common mechanism to organize and facilitate biomedical research at medical schools and universities. The authors report the results of a study on the size, scope, and range of activities of 604 research centers and institutes at research-intensive U.S. medical schools and their parent universities. Centers and institutes with primary missions of patient care, education, or outreach were not included. The findings indicate that, in addition to research, centers and institutes are involved in a range of activities, including education, service, and technology transfer. The centers and institutes the authors studied were more interdisciplinary than those included in previous studies on this topic. Most research centers and institutes did not have authority comparable to academic departments. Only 22% of centers directly appointed faculty members, and most center directors reported to a medical school dean or a department chair. A small group of centers and institutes ("power centers"), however, reported to a university president or provost, and may have considerable power and influence in academic decision making and resource allocation. Two main types of centers and institutes emerge from this research. The first type, which includes the vast of majority of centers, is modest in its scope and marginal in its influence. The second type--with greater amounts of funding, larger staffs, and direct access to institutional decisionmakers--may have a more significant role in the organization and governance of the medical school and university and in the ways that researchers interact within and across academic divisions.     

Academic ranks and medical schools of underrepresented minority faculty in family medicine departments.

PURPOSE: To examine academic rankings and educational backgrounds of underrepresented minority (URM) family medicine faculty and compare their academic ranks with national trends. The authors also determined the extent to which international and historically black educational institutions contributed URM faculty to family medicine. METHOD: In 1999 questionnaires were sent to 129 family medicine departments asking for academic ranks and educational institutions attended by their URM faculty. Comparisons were made between URM faculty's academic ranks and all family medicine faculty, medical school minority faculty, and medical school faculty. RESULTS: A total of 80% of URM faculty were assistant professors or instructors, and 4.4% were professors. URM family medicine faculty had significantly lower rankings compared with medical school minority faculty and all family medicine faculty. URM family medicine faculty at historically black medical schools were more likely to have received their degrees from historically black undergraduate institutions and medical schools than were URM family medicine faculty at non-historically-black medical schools. CONCLUSIONS: URM family medicine faculty appear to experience a double disadvantage: being minority and working for family medicine departments. Their academic ranks remain far below those of both minority medical school faculty and family medicine faculty, a discouraging finding considering the current shortage of URM faculty in family medicine departments. Historically black medical schools cannot address the shortage alone, so non-historically-black medical schools need to both recruit URM faculty and follow up with appropriate mentoring of those faculty.     

Specialty choices, compensation, and career satisfaction of underrepresented minority faculty in academic medicine.

PURPOSE: Despite efforts to increase the numbers of underrepresented minorities (URMs), only 3.9% of medical school faculty are URMs. The authors compared the specialty choices, compensation, and career satisfaction of minority faculty with those of their majority counterparts to determine whether there were differences that might affect the recruitment and retention of minority faculty. METHOD: In 1995, the authors mailed a self-administered survey to a stratified random sample of 3,013 eligible full-time salaried faculty in 24 randomly selected medical schools. Those schools, which had at least 200 faculty, did not include the Puerto Rican or historically black medical schools. RESULTS: Of the eligible faculty surveyed, 1,807 (60%) responded; 1,463 were majority faculty, 195 were URM faculty, and 149 were other-minority faculty. Similar proportions of the three groups were in the primary care specialties. Only 11% of the URM respondents were in basic science departments. There was no significant difference in adjusted mean compensation between majority, URM, and other-minority faculty. However, URM faculty were significantly less satisfied with their careers (adjusted scores: 60 versus > 65; p = .001) and more often considered leaving academic medicine within five years (58% versus < 45%). CONCLUSION: Given the demographic changes of the U.S. population, these issues should be addressed by deans and department heads in order to enhance recruitment and facilitate retention of URM faculty in academic medicine.     

Increasing departmental and college-wide faculty development opportunities through a teaching scholars program.

The University of Iowa Teaching Scholars Program was initiated in 1999 at the University of Iowa Carver College of Medicine (CCOM) with the overall goal of promoting leadership in faculty development related to teaching skills. Specific goals of this program are (1) to promote the development of a cadre of faculty members who have the skills to implement faculty development within their departments and the CCOM; (2) to increase departmental involvement in faculty development efforts; (3) to increase resources available for dissemination of college-wide faculty development efforts; and (4) to acknowledge the extra effort faculty put into developing their skills and knowledge in medical education and in providing continuing education to their faculty colleagues. All clinical and basic science departments in the CCOM are given the opportunity to have a faculty member participate in the program. Unlike other programs reported in the literature, competitive decisions for program participation are made at the departmental level. The three-year program combines monthly meetings and other activities to train faculty to provide faculty development in teaching skills. Each scholar develops and implements a project to address departmental faculty development needs as well as needs of other departments in the CCOM. To date (2006), 50 faculty members from 19 different departments have participated in the program with an average of 12 scholars per class. The program has resulted in a substantial increase in departmental and college-wide faculty development programming and has had a positive impact on individual scholars' teaching skills and leadership roles.     

Comparing research activities of women and men faculty in departments of internal medicine

The findings from a questionnaire prepared by the Association of Professors of Medicine and the Association of American Medical Colleges were published in two reports in 1986 and 1987. These reports assessed the research activities of full-time members of departments of internal medicine in 1982 and 1983. The purpose of the present study was to analyze the data of the earlier reports in order to compare the research activities of women and men who were full-time faculty in departments of medicine during the time period originally surveyed. More than half of the faculty women who responded (52%) were less than 40 years old, compared with 23% of the faculty men. Sixty-seven percent of the women held the rank of instructor or assistant professor, in contrast to 40% of the men holding these ranks. Although the faculty of both genders reported generally the same proportions of time devoted to research, the women researchers with M.D. degrees had significantly less National Institutes of Health (NIH) grant support than did their counterparts who were men. Since this difference may have been a function of age, the authors compared NIH grant support of the faculty men and women with M.D. degrees who were 40-59 years old. Even in this older group, significantly fewer of the faculty women had NIH grant support than did the men (16% versus 30%). Furthermore, the percentage of designated laboratory space was significantly lower among the faculty women, regardless of degree (M.D., M.D./Ph.D., or Ph.D.). Further investigation is warranted to monitor the progress of women attempting to develop their research careers and to assess their overall clinical teaching and administrative roles in departments of medicine.     

A conceptual model for faculty development in academic medicine: the underrepresented minority faculty experience

In May 2010, the Association of American Medical Colleges reported that nonwhite professors have a lower promotion rate than white professors. A cohort of 30 underrepresented minority (URM) junior faculty who participated in a structured faculty development program at a public, research-intensive, academic medical center were followed in a 10-year longitudinal study. This paper reports on the career status of 12 of the 30 URM faculty who were eligible for promotion during this period. Ninety-two percent (11/12) of URM faculty eligible for promotion were promoted to associate professor. When asked what factors contributed to their success, these URM faculty identified access and support of senior faculty mentors, peer networking, professional skill development, and knowledge of institutional culture. A faculty development program that addresses these components can promote the success of URM faculty in academic medicine.     

Forces affecting community involvement of AHCs: perspectives of institutional and faculty leaders.

PURPOSE: To understand the external and internal factors that either facilitated or were barriers to an academic health center's (AHC's) involvement in community-based education, research, and clinical care; community service; and community or economic development activities. METHOD: Eight AHCs in the United States were selected by objective criteria for their significant community involvement. Chief executive officers, vice chancellors, deans, and the individuals responsible for community-based education, research, and community service responded to written surveys. Responses were subjected to quantitative and qualitative analyses. RESULTS: The overall response rate was 79% (n = 91). Public perception, an increased focus on a population health perspective, and an increased call for AHCs to be accountable to local and statewide constituents were cited as the most significant external factors contributing to an AHC's community involvement. Institutional leadership, familiarity with community-based organizations, institutional climate, faculty and student interest, and institutional structures were cited as the most significant internal facilitators of community involvement. Fiscal concerns, competition for community-based training sites, lack of collaboration across health professions schools, and inadequate faculty roles and rewards were viewed as the most significant barriers to community involvement. All respondents reported that their AHCs' orientations towards community service, and community-based teaching, research, and clinical care would increase in the next five years. CONCLUSION: Development of a strategic plan may increase the effectiveness of an institution's community involvement. Central to this plan should be a restructuring of faculty roles and reward polices and an increase in faculty release time to promote community involvement. The importance of involving the community in the planning and implementation of community-campus partnerships should not be underestimated.     

Behavioral medicine in Hungary: past,present, and future

During the socialist period before 1989, training in behavioral medicine and behavioral science was not a priority in Hungary's medical schools despite the nation's long tradition of psychosomatic and behavioral medicine. In this article, the authors review the development of behavioral medicine and behavioral science in Hungarian medical schools and outline some of the problems and future challenges these departments face. The resistance of faculty members has influenced the acceptance of behavioral medicine and behavioral science courses, attitudes toward the acceptance of departments of behavioral science, and evaluations of the staff's scientific research. Although research is emphasized in these departments of behavioral medicine, closer integration of teaching, research, and health policy is necessary. The primary message of this approach is that modern physicians should see beyond molecular substances and perceive humans from a total biopsychosocial perspective.     

The views of U.S. medical school deans toward academic primary care.

PURPOSE: To understand the views of U.S. medical school deans about their primary care faculties. METHOD: In 2000, the authors mailed a questionnaire containing 43 multipart items to deans of 130 U.S. allopathic medical schools. The questionnaire assessed the deans' attitudes about and evaluation of primary care at their school and their school's efforts to strengthen it. Deans were asked to compare family medicine, general internal medicine, and general pediatrics with nonprimary care clinical departments at their schools. RESULTS: Of the 83 (64%) deans who responded, 82% reported their school had departments or divisions of family medicine, general internal medicine, and general pediatrics. Deans rated general internal medicine and general pediatrics higher than nonprimary care faculty on clinical expertise and productivity (p < .001) and family medicine equivalent to nonprimary care faculty. Deans rated all three primary care faculties superior to nonprimary care faculty for teaching skills (p < .001) and programs (p < .05), but lower than nonprimary care disciplines for research productivity (p < .01) and revenues (p < .001). They rated family medicine and general pediatrics lower for research skills (p < .001), but 73% of deans stated research was equally important for primary care and nonprimary care departments. Deans considered overall financial resources to be equivalent for primary care and nonprimary care departments, but 77% of deans felt primary care departments or divisions needed financial support from the medical school to survive. Most deans attempted to strengthen primary care by changing the curriculum to promote primary care and by providing financial support. CONCLUSIONS: Deans ranked primary care faculty high on clinical and teaching measures. Although they considered research to be an important activity for primary care faculty, they evaluated it low relative to nonprimary care departments.     

The Center for Clinical Epidemiology and Biostatistics of the Perelman School of Medicine at the University of Pennsylvania: an organizational model for clinical research in a school of medicine

A new model for the conduct of clinical research was established at the University of Pennsylvania (Penn) School of Medicine, now the Perelman School of Medicine, through the development of the interdepartmental Center for Clinical Epidemiology and Biostatistics in 1993 and the basic science Department of Biostatistics and Epidemiology in 1994. The authors describe the development and evolution of these novel structures.Five key objectives were achieved with these structures' creation: (1) Clinical faculty have the opportunity to be identified as both clinicians and epidemiologists, (2) nonclinical faculty have an academic "home," (3) clinical trainees are now educated in population medicine, which promotes its incorporation into their clinical practice, (4) population medicine and clinical medicine have become fully integrated, and (5) better epidemiologic research is conducted, informed by clinical insights.Today's center is the primary home for epidemiology and biostatistics at Penn, linking epidemiology, biostatistics, clinical medicine, and the health sciences. The center's core faculty manage their own research programs, conduct primary research in epidemiology and biostatistics, serve as members of collaborative research teams, manage cores and service centers that support research projects, and lead graduate training programs in epidemiology and biostatistics. The department provides an academic home and structure for faculty, provides primary research in epidemiology and biostatistics, supports the center's mission, and provides training in biostatistics. This organizational approach has wide applicability across schools of medicine in the United States and abroad and has been a model for many.     

Tenure in transition: trends in basic science faculty appointment policies at U.S. medical schools.

This article-based on a 2002 survey of 125 U.S. allopathic medical schools, reviews of institutional policy documents, and interviews with medical school leaders-explores and analyzes three trends in appointment and tenure policies for basic science faculty at U.S. medical schools. First, the percentage of full-time, nontenure track basic science faculty has increased, from 12% in 1980 to 20% in 2000. More dramatically, by the late 1990s, the percentage of new basic science faculty hired on a nontenure track surpassed the percentage hired on a traditional tenure-track line. This development stems from the tendency of some schools to appoint faculty to nontenure-eligible "research scientists" faculty tracks, to hire junior faculty on 100% grant funding, and to allow nontenure-track faculty to switch to the tenure track as their research career progresses. The second trend is an alteration to the tenure financial guarantee. Historically, at most medical schools, it was assumed that tenure guaranteed total institutional salary for basic scientists. Schools have begun to redefine that commitment to less than full salary to protect against financial vulnerabilities and to provide a means to reduce faculty salaries, if warranted. The third trend is increased flexibility to pretenure policies. Schools have lengthened probationary periods, revised up-or-out provisions, instituted stopping-the-tenure-clock policies and less-than-full-time appointments, and permitted faculty to switch between the tenure and nontenure tracks. These policy modifications recognize the increased professional and personal demands on faculty time.     

Behavioral Medicine in Hungary: Past,Present, and Future

Abstract

During the socialist period before 1989, training in behavioral medicine and behavioral science was not a priority in Hungary's medical schools despite the nation's long tradition of psychosomatic and behavioral medicine. In this article, the authors review the development of behavioral medicine and behavioral science in Hungarian medical schools and outline some of the problems and future challenges these departments face. The resistance of faculty members has influenced the acceptance of behavioral medicine and behavioral science courses, attitudes toward the acceptance of departments of behavioral science, and evaluations of the staff's scientific research. Although research is emphasized in these departments of behavioral medicine, closer integration of teaching, research, and health policy is necessary. The primary message of this approach is that modern physicians should see beyond molecular substances and perceive humans from a total biopsychosocial perspective.     

Results of an academic promotion and career path survey of faculty at the Johns Hopkins University School of Medicine.

PURPOSE: Clinician-educator faculty are increasing in numbers in academic medical centers, but their academic advancement is slower than that of research faculty. The authors sought to quantify the magnitude of this difference in career advancement and to explore the characteristics of faculty that might explain the difference. METHOD: In 1999, a questionnaire was administered to all MD faculty at the rank of instructor and above (259) in the Department of Medicine at the Johns Hopkins University School of Medicine. RESULTS: A total of 180 (69%) faculty returned questionnaires. Of these, 178 identified with one of four career paths: basic researcher (46), clinical researcher (69), academic clinician (38), or teacher-clinician (25). Career path did not differ by age, gender, rank, years on faculty, hours worked per week, family responsibility, or global work satisfaction. After adjusting for age, gender, time at rank, and work satisfaction, the odds of being at a higher rank were 85% less for academic clinicians (odds ratio,.15; 95% confidence interval, 0.06-0.40) and 69% less for teacher-clinicians (odds ratio,.31; 95% confidence interval, 0.11-0.88) than for basic researchers. Clinical researchers did not differ from basic researchers in the likelihood of being at higher rank. Similarly, compared with basic research faculty, the adjusted odds of being more satisfied with progress towards academic promotion were 92% lower for academic clinicians and 87% lower for teacher-clinicians. CONCLUSIONS: Clinician-educator faculty were less likely to be at higher rank at this institution than were faculty in research paths. Differences in rank may be explained by lower rank at hire for faculty in these career paths, time available for scholarly activities, or other resources available to support scholarship. Retaining clinician-educators will require further exploration of barriers to promotion inherent to these career paths and methods of modifying these barriers.     

Medical faculty development: a modern-day odyssey

Academic medical centers (AMCs) are pillars of the community; they provide health care, create jobs, educate biomedical professionals, and engage in research and innovation. To sustain their impact on human health, AMCs must improve the professional satisfaction of their faculty. Here, we describe ways to enhance recruitment, retention, creativity, and productivity of health science faculty.