A comprehensive space management model for facilitating programmatic research.

In FY04, the authors developed and implemented models to manage existing and incremental research space, and to facilitate programmatic research, at the University of Arizona College of Medicine. Benchmarks were set for recovery of total sponsored research dollars and for facilities and administrative (F&A) dollars/net square foot (nsf) of space, based on college-wide metrics. Benchmarks were applied to units (departments, centers), rather than to individual faculty. Performance relative to the benchmark was assessed using three-year moving averages, and applied to existing blocks of space. Space was recaptured or allocated, in all cases to programmatic themes, using uniform policies. F&A revenues were returned on the basis of performance relative to a benchmark. During the first two years after implementation of the model (FY05 and FY06), and for the 24 units occupying research space, median total sponsored research revenue/nsf increased from $393.96 to $474.46 (20.4%), and median F&A revenue/nsf increased from $57.42 to $91.86 (60.0%). These large increases in median values are driven primarily from redistribution and recapturing of space. Recruiting policies for unit heads were developed to facilitate joint hires among units. In combination, these policies created a comprehensive space management model for facilitating programmatic research. Although challenges remain in implementing the programmatic recruitment strategy, and selected modifications to the original policy were introduced later (e.g., research space for newly recruited junior faculty is now exempted from calculations for three years), overall, the models have created a climate of transparency that is now accepted and that allows efficient and equitable management of research space.     

Sponsored-research funding by newly recruited assistant professors: can it be modeled as a sequential series of uncertain events?

PURPOSE: Recruitment of junior faculty with an investigative focus is essential to regenerate and expand the research mission of academic health centers. Predicting funding profiles for junior faculty is limited by variability in the timing, magnitude, and duration of projected research grant funding. The author demonstrated the validity of Monte Carlo simulation to predict sponsored-research revenues by newly recruited faculty. METHOD: Demographic characteristics and funding profiles were determined for assistant professors recruited to Yale University School of Medicine in four separate fiscal years (1992-93, 1993-94, 1996-97, 1997-98). These data were applied to develop and assess the simulation model. RESULTS: Only when assistant professors were subcategorized by type of research was it possible to accurately predict recovery of both direct research costs and facilities and administrative costs. Simulations illustrated both the high degree of variability among individual faculty and also the advantage of a prediction tool that displays the range and probability of all possible outcomes. CONCLUSION: Sponsored-research funding by newly recruited assistant professors can be modeled as a sequential series of uncertain events and used to predict consequences of imminent changes in federal funding for biomedical research.     

Criteria of the "educators' pyramid" fulfilled by medical school faculty promoted on a teaching pathway.

PURPOSE: To compare the results of academic promotion to associate professor and professor via the teaching pathway at the Wake Forest University School of Medicine (WFUSM) with the criteria of the "educators' pyramid" of Sachdeva et al. METHOD: Data on all candidates promoted to associate professor and professor in the academic years 1995-2000 at WFUSM were collected from candidates' portfolios and compared with the criteria for educator (level three) and master educator (level four) from a modified version of the educators' pyramid. RESULTS: Of 186 faculty promoted, 38 were on the teaching pathway. Everyone promoted on the pathway fulfilled all teacher and master teacher criteria. All educator criteria were found among the associate professors, and all but one of the master educator criteria were found among professors. More than 75% of associate professors demonstrated "sustained participation in significant amounts of effective teaching in more than one modality" and "service as a medical student clerkship, course, or residency director." Less than 30% demonstrated "service as assistant dean of education or student affairs" or "service as the chair of departmental education committees." Most associate professors had not regularly participated in national education meetings. For professors, more than 50% demonstrated "achievement of leadership positions in national organizations, committees, and medical school education"; "recognition as a national leader in specialty education"; and "mentorship of other faculty members locally and nationally." Less than 30% demonstrated "pursuit of further training in education through workshops, faculty development programs, or educational fellowship programs" or "development and implementation of nationally-recognized (in education) innovative curricula or teaching programs." No one promoted to professor on the teaching pathway had made what was considered to be a landmark contribution to educational research and development. CONCLUSION: The findings suggest that the educators' pyramid is generalizable to medical faculty being promoted on a teaching pathway at WFUSM. Documentation of achievement in teaching criteria is essential and faculty should be encouraged to maintain records of accomplishment before becoming candidates for promotion.     

Gender differences in academic advancement: patterns, causes, and potential solutions in one US College of Medicine.

PURPOSE: The influx of women into academic medicine has not been accompanied by equality for male and female faculty. Women earn less than men in comparable positions, progress more slowly through academic ranks, and have not attained important leadership roles. This study tested hypotheses about why gender disparities exist in salary, rank, track, leadership, and perceptions of campus climate at one academic center, the University of Arizona College of Medicine, Tucson. METHOD: Salary, rank, and track data were obtained from institutional databases for the 1999-2000 fiscal year. A structured, online questionnaire was made available to 418 faculty members to collect information about their goals, attitudes, and experiences. RESULTS: A total of 198 faculty members completed the questionnaire. The data showed significant gender differences in faculty salaries, ranks, tracks, leadership positions, resources, and perceptions of academic climate. On average, women earned US dollars 12777 or 11% less than men, after adjusting for rank, track, degree, specialty, years in rank, and administrative positions (p <.0003). Of female faculty, 62% were assistant professors (49% of women were non-tenure-eligible assistant professors), while 55% of male faculty were promoted and tenured. Almost a third of women reported being discriminated against, compared with only 5% of men (p <.00001). CONCLUSION: Substantial gender differences in the rewards and opportunities of academic medicine remain, that can not be attributed to differences in productivity or commitment between women and men.     

Empowering junior faculty: Penn State's faculty development and mentoring program.

Empowerment of faculty is essential for academic success. The Junior Faculty Development Program (JFDP), sponsored by the Office of Professional Development of the Penn State College of Medicine, was established in 2003 with the goal of promoting the development and advancement of junior faculty so they can achieve success in their academic careers. The program consists of two components: a curriculum in research, education, clinical practice, and career development, and an individual project completed under the guidance of a senior faculty mentor. The curriculum provides faculty with knowledge, skills, and resources. Mentoring provides relationships and support. Together, these elements combine to empower junior faculty to better manage their careers.The effectiveness of the program has been demonstrated by several measures: participants evaluated the program highly, demonstrated increases in their perceptions of their own abilities, and completed tasks important to the advancement of their careers. Participants stated they were better prepared to advance their academic careers and that the individual projects would contribute to their career advancement.On the basis of this experience, the authors suggest that faculty development programs should empower faculty so that they can more effectively chart a successful career in academic medicine. This report describes an empowerment model, and the design, implementation, and evaluation of the Junior Faculty Development Program in 2003-04 and 2004-05. The authors offer this program as a model for the benefit of other institutions and for one of their most valuable assets: junior faculty.     

Mentoring program for minority faculty at the University of Pennsylvania School of Medicine.

Research indicates that having a faculty mentor and being part of an active network of peers are critical ingredients of successful academic medicine careers. Minority physicians, however, often do not have mentors, and the problem is greatest for minority groups underrepresented in medicine. The University of Pennsylvania School of Medicine in 1994-1996 undertook to learn the extent of mentoring programs in its departments and divisions and to compare the experiences of underrepresented-minority faculty and others. The results were used to establish a system for mentoring and networking support for minority faculty members. Examining the reports of division and department heads on their formal mentoring programs, it was clear that these leaders considered a mentor essential for career development, but many reported having no systematic plan for mentors for junior faculty. In looking at the reported experiences of minority and non-minority assistant professors (matched for promotion track, department, appointment date, and, where possible, gender), it was found that approximately half of either group did not have mentors. As a result of this information, the school established a faculty development program to meet the faculty members' demonstrated needs: annual career development meetings with new minority faculty; assistance in identifying and assigning mentors; assistance in developing research skills; and monitoring of the retention of minority faculty. As experience with the program produces additional insights into the needs of minority faculty--and particularly of junior faculty--the program will be adjusted and expanded to meet these identified needs.     

Phoenix rises, with Tucson's help: establishing the first four-year allopathic program in the nation's fifth largest city.

The authors describe the expansion of The University of Arizona College of Medicine from Tucson, Arizona, into Phoenix. They explain how the new Phoenix program, in partnership with Arizona State University, is one college of medicine for the state of Arizona, governed by a single accreditation by the Liaison Committee for Medical Education (LCME). The authors present 21 lessons to be considered early in a medical school expansion process: clearly establish responsibility, authority, and accountability; define activities under university purview and those that require broader engagement; delineate college-wide versus campus-specific functions; clearly define the intent of the new initiative; get frequent input from the LCME; use LCME input to ensure a student focus; be cautious in using consultants; use respected local "brokers"; create a single locus for input and concerns; educate constituencies about medical school requirements; engage leadership to create linkages across sites; encourage communication between leaders in both sites; discriminate between shared and distinctive local curriculum elements; consider the effort and experience required to develop a full curriculum versus those required to develop specific local curricular areas; create simple, transparent admission processes; define faculty profiles for the new program; ensure sufficient resources for core faculty; budget based on national metrics; create core mission-based principles to frame discussions and decisions; segregate clinical affiliation discussions from curriculum and recruitment of basic science faculty; and ensure sufficient land. Although these observations are most relevant to institutions planning expansions of already accredited programs, they derive from principles and practical considerations with wider applicability.     

The metrics process: Baylor's development of a "report card" for faculty and departments.

In 1996, Baylor College of Medicine began the first year of its "metrics process," collecting, analyzing, and reporting data on the performance of each individual faculty member and each department in achieving the school's missions of education, patient care, research, service, and finance. This article is a report of the first two years of the process, with updates about the 1999 process, future plans, and lessons learned. The primary goal of the metrics process is to provide meaningful data to assess and improve the performance of faculty and departments across all missions. The authors (1) indicate the categories chosen, within each mission of the school, for measuring faculty time and effort (e.g., patient care, with or without learners) and state the measures chosen (e.g., percentage of time); (2) describe the development of questionnaires in 1996 and 1997 to acquire data from faculty, in the chosen categories and measures, about the time and effort they spent; and (3) report highlights of the resulting departmental data that were gathered in 1997. Among the key categories and units of measure chosen for measuring faculty (and departmental) time and effort are research grant dollars (total and per research full-time equivalent, or FTE); basic research grant dollars per square foot of laboratory space; percentage of faculty who spend at least 50% of their time in research who are National Institutes of Health principal investigators; numbers of inpatient and outpatient visits per evaluation and management FTE; total relative value units (RVUs) per patient-care FTE; patient-care income/RVU and expense/RVU for total faculty and support staff; percentage of faculty with at least one leadership position in a state or national organization; and income in excess of expense, by mission (e.g., patient care). Results of comparing data from the first two years of the metrics process demonstrate marked improvements in performance for most research measures (i.e., items of measurement agreed upon for the metrics process). The process is continually being redeveloped; the ultimate challenge is to place the objective measurements in a context where less objective qualities (e.g., innovation) also figure importantly in the evaluation and fostering of excellence. The metrics process is providing important management data, encouraging significant discussions among faculty and chairs about performance and accountability, and aiding greatly in departmental goal-setting and ultimately in determining the overall performance of the school.     

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.     

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.     

The integrative family medicine program: an innovation in residency education.

The Integrative Family Medicine (IFM) Program is a four-year combined family medicine residency program and integrative medicine fellowship. It was created in 2003 to address the needs of four constituencies: patients who desire care from well trained integrative physicians, physicians who seek such training, the health care system which lacks a conventional integrative medicine training route, and educational leaders in family medicine who are seeking new strategies to reverse the declining interest in family medicine amongst U.S. graduates. The program was designed jointly by the University of Arizona Program in Integrative Medicine (PIM) and family medicine residency programs at Beth Israel/Albert Einstein College of Medicine (AECOM), Maine Medical Center, Middlesex Hospital, Oregon Health & Science University, and the Universities of Arizona and Wisconsin. One or two residents from each of these institutions may apply, and when selected, commit to extending their training by a fourth year. They complete their family medicine residencies at their home sites, enroll in the distributed learning associate fellowship at PIM, and are mentored by local faculty members who have training in integrative medicine. To date three classes totaling twenty residents have entered the program. Evaluation is performed jointly: PIM evaluates the residents during residential weeks and through online modules and residency faculty members perform direct observation of care and review treatment plans. Preliminary data suggest that the program enhances interest amongst graduating medical students in family medicine training. The Accreditation Council of Graduate Medical Education Family Medicine residency review committee has awarded the pilot experimental status.     

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.     

The relation of faculty academic activity to financing sources in a department of medicine

Academic medical departments confront important changes in funding sources and consequent pressure to change faculty activities. Valid information has often been lacking concerning the existing relations of faculty activity to funding sources. We examined those relations in the Stanford Department of Medicine through a combination of randomized observations of faculty and faculty self-reports over a period of one year. For an average 62-hour workweek, there was approximate consonance between types of activities and sources of salary support. Sensitivity analyses indicated that even sizable errors in self-reports would not have changed the outcomes substantially. Over 60 per cent of the activity involved "joint products," representing two or more categories of activity. There was wide variation in activities and fund sources between divisions. Per full-time faculty equivalent, research generated far more income than the most lucrative specialty practice; thus, at least in this type of department, attempts to compensate for lost research revenue by intensifying clinical practice will probably fail and undermine present research activities. The method of analysis used here may be useful in improving prospective planning by departments and by larger medical-policy bodies, particularly in the public sector.     

Baylor's program to attract minority students and others to science and medicine

To attract minority students and others to careers in medical practice and biomedical research and to prepare them for such careers, Baylor College of Medicine conducts a variety of summer enrichment programs and other programs to improve how science is presented to students in their preprofessional years from elementary grades through college. These efforts aim to increase the number of competitive candidates for medical school, particularly those from minority groups underrepresented in medicine. They entail close collaboration between the Baylor administration and faculty from Texas public schools and two-year and four-year colleges and universities. The authors discuss the rationale for these programs and comment about the need for institutional commitments of faculty and financial support. They note that these programs are an investment in the future and that longitudinal assessment is needed to determine their ultimate success.     

Aging of medical school faculty and the end of mandatory retirement.

In anticipation of the end of mandatory retirement for tenured professors in 1994 (mandatory retirement ended for other academics in 1986), the author analyzed the demographics of medical school faculty, using 25 years of data taken in mid-1989 from the Faculty Roster of the Association of American Medical Colleges. The annual growth rate of the number of full-time faculty dropped from well over 10% before 1972 to about 1.5% after 1982, while the mean age of the faculty increased from under 42 years to over 45 in 1988. Retirement patterns changed little after the minimum mandatory retirement age was raised in 1982 from 65 to 70 (for tenured professors). Only about 2.5% of all faculty separations in 1984-1987 occurred at or after age 70, and only 5.5% did even in the tenure tracks of the 20 largest private medical schools. Since such a small proportion of openings is created each year by mandatory retirement, uncapping will have little effect on the age or turnover of medical faculty.     

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.     

Mentoring for women and underrepresented minority faculty and students: experience at two institutions of higher education

Women and minority faculty and students are seriously underrepresented in university and academic healthcare institutions. The role of mentoring has been identified as one of the significant factors in addressing this underrepresentation. We have described the mentoring efforts at two institutions of higher learning in assisting women and minority students and faculty in being accomplished in their academic pursuits. One-hundred-thirty students and >50 women and minority faculty have participated in the mentoring programs described. The number of participants has increased dramatically over the years and continues to evolve positively. These programs appear to be quite successful in the short term. Further evaluation of measurable outcomes will be necessary to fully determine their true impact. The mentoring models for women and underrepresented minority faculty and students at Creighton University Health Sciences Schools and Wake Forest University School of Medicine will serve as a guide for other Health Sciences Schools.     

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.     

Improving the retention of underrepresented minority faculty in academic medicine

BACKGROUND: Although several studies have outlined the need for and benefits of diversity in academia, the number of underrepresented minority (URM) faculty in academic health centers remains low, and minority faculty are primarily concentrated at the rank of assistant professor. In order to increase the diversity of the faculty of the University of California, San Diego (UCSD) School of Medicine, the UCSD National Center for Leadership in Academic Medicine, in collaboration with the UCSD Hispanic Center of Excellence, implemented a junior faculty development program designed in part to overcome the differential disadvantage of minority faculty and to increase the academic success rate of all faculty. METHODS: Junior faculty received counseling in career and research objectives; assistance with academic file preparation, introduction to the institutional culture; workshops on pedagogy and grant writing; and instrumental, proactive mentoring by senior faculty. RESULTS: After implementation of the program, the retention rate of URM junior faculty in the school of medicine increased from 58% to 80% and retention in academic medicine increased from 75% to 90%. CONCLUSION: A junior faculty development program that integrates professional skill development and focused academic career advising with instrumental mentoring is associated with an increase in the retention of URM faculty in a school of medicine.     

A program of management training for residents

To help prepare residents in preventive medicine and occupational medicine for their future management roles, the University of Arizona College of Medicine incorporated administrative training into many aspects of its residency programs, beginning in 1983. Training focuses on seven skill areas seen as needed to meet the management demands of the physicians' future specialties. The authors discuss the career choices of University of Arizona graduates and advocate long-term administrative training for all specialties.