A computerized faculty time-management system in an academic family medicine department.

The authors describe the development, implementation, and evaluation of a computerized faculty time-management system (FTMS) in the Department of Family Medicine at the University of North Carolina-Chapel Hill. The FTMS is presented as an integrated set of computerized spreadsheets used annually to allocate faculty time across all mission activities of the department. It was first implemented in 1996 and has been continuously developed since then. An iterative approach has been used to gain consensus among faculty about time resources needed for various tasks of all missions of the department. These time-resource assumptions are used in the computerized system. Faculty time is allocated annually by the department vice chair in negotiation with individual faculty, making sure that the activities planned do not exceed the work time each faculty member has available for the year. During this process, faculty preferences are balanced against department aggregate needs to meet mission commitments and obligations. The authors describe how the computerized FTMS is used for faculty time management and career development, department planning, budget planning, clinical scheduling, and mission cost accounting. They also describe barriers and potential abuses and the challenge of building an organizational culture willing to discuss faculty time openly and committed to developing a system perceived as fair and accurate. The spreadsheet file is available free from the authors for use in other departments.     

Effects of performance-based compensation and faculty track on the clinical activity, research portfolio, and teaching mission of a large academic department of medicine.

PURPOSE: Academic departments of medicine must compete effectively for extramural research support and access to patients while preserving their teaching mission. There is not much literature describing plausible mechanisms for ensuring success. The authors describe the design, implementation, and testing of a performance-based compensation plan in a department of medicine that is closely linked to the faculty appointment track. METHOD: Over a three-year period, the changes this plan effected in research portfolio, clinical enterprise, and faculty satisfaction as well as the teaching perceptions of students and housestaff were measured. RESULTS: The compound annual growth rate (CAGR) for clinical work grew 40% faster after plan implementation. Federal funding increased at a CAGR that was 170% greater than before. The department halved its award rankings at the National Institutes of Health and faculty satisfaction improved compared with the former method of compensation. Faculty who better understood the plan were more satisfied with the conversion. High measures of teaching quality were maintained by faculty with no apparent change in satisfaction among students or housestaff. CONCLUSIONS: This performance-based compensation plan with its emphasis on the objectives of career orientation and faculty track assignment strengthened the opportunity to grow both clinical productivity and the funded research portfolio.     

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 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.     

Implementing a comprehensive relative-value-based incentive plan in an academic family medicine department.

The authors describe the implementation and first three years (1997-1999) of a department-wide incentive plan of the Department of Family Medicine at the State University of New York at Buffalo School of Medicine and Biomedical Sciences. By using a consensus approach, a representative elected committee designed a clinical relative value unit (explained in detail) that could be translated to equally value and reward faculty efforts in patient care, education, and research and which allowed the department to avoid the imposition of a model that could have undervalued scholarship and teaching. By 1999, the plan's goal of eight patient-care-equivalent points per four-hour session had been exceeded for pure clinical care. Clearly, only a small financial incentive was necessary (in 1999, an incentive pool of 4% of providers' gross salary) to motivate the faculty to be more productive and to self-report their efforts. Long-term productivity for pure clinical care rose from 9.8 points per session in 1997 to 10.4 in 1999. Of the mean total of 3,980 points for the year 1999, the contribution from teaching was 1,146, or 29%, compared with 25% in 1997. For scholarship, the number of points was 775, or 20%, in 1999, compared with 11% in 1997. The authors describe modifications to the original plan (e.g., integration of quality measures) that the department's experience has fostered. Problems encountered included the lack of accurate and timely billing information from the associated teaching hospitals, the inherent problems of self-reported information, difficulties of gaining buy-in from the faculty, and inherent risks of a pay-for-performance approach. But the authors conclude that the plan is fulfilling its goal of effectively and fairly quantifying all areas of faculty effort, and is also helping the department to more effectively demonstrate clinical productivity in negotiations with teaching hospitals.     

A new faculty training model for countries developing academic family medicine programs

Medical schools in many countries wish to start academic programs in family medicine but do not have specifically trained faculty available. When the only medical school in Malta faced this situation, it agreed to try a new model for training potential faculty. This model was an intensive eight-month course for a selected group of ten experienced Maltese general practitioners to train in Malta with a visiting professor of family medicine. These adult learners were heavily involved in designing and contributing to an intensive course in family medicine and in teaching. Maltese teaching resources were used, and training occurred in the context of the society and health care system in which course members would ultimately teach. Subjective and objective measurements of course achievement were made. Results were compared with certification standards of the Canadian College of Family Physicians. This model merits consideration by other medical schools that wish to start academic programs in family medicine.     

The Cri$i$ in academic medicine

Many believe that academic medicine is failing to meet all of its responsibilities and is in crisis. We interviewed a number of distinguished academicians and, while they held different views, found agreement that academic medical centers in the USA have gradually changed during the past half century from small, cloistered, scholarly institutions to large, complex, corporate-style organizations. These changes were fueled by large contributions of funds for research and great research accomplishments. However, these institutions seem to have insatiable needs for more money, which refocuses institutional culture, making them behave more like business corporations. The result is very high tuitions, enormous student debt burdens, and pressure on young academicians to become self-supporting more quickly. Almost all non-compensated activities, especially teaching, suffer. Since clinical care pays an increasing portion of school operating revenue, those who teach and do research are under increasing pressure to provide more clinical care, to see more patients per unit of time and do more procedures, resulting in fatigue, less time for teaching and research, and less gratification for doctors and patients. Attention to community needs and providing help to academic medicine in less developed nations are very low priorities. Academic medicine appears on the surface to be vigorous and healthy but is at risk of imploding. The heads of academic centers, working together, must be charged to create plans to restore a healthy culture.     

Restructuring the inpatient practice of an academic internal medicine department.

The authors describe the process undertaken by the Department of Medicine at the Mayo Clinic in Rochester, Minnesota to improve inpatient care. The department systematically analyzed its inpatient practice and developed a set of hypotheses that challenged whether new inpatient models with greater physician commitment could improve the quality of care; patient, resident, and staff satisfaction; and financial performance. The new practice model they developed, which includes using more physicians whose time is dedicated to the hospital practice, has led to a more focused hospital experience for learners and has implications for all academic medical centers involved with primary care, subspecialty care, and hospital consultative services.     

Family medicine as a model of transition from academic medicine to academic health care: Estonia's experience

This paper presents the development of academic family medicine in an environment of traditional academic medicine at the Tartu University, Estonia. The introduction of university family medicine teachers to everyday practice and practitioners to academic teaching and research helps bridge the gap between theory and practice, and it shows changed approach to academic medicine.     

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.     

Academic approach to academic medicine

Scientific approach to academic medicine crisis would require research to provide evidence for the present state of academic medicine and future actions. The prerequisites for such a research would be clear definitions, appropriate indicators, and measuring instruments. The approach should be holistic, covering tripartite academic medicine activity: education, research, and health care.     

Nursing faculty academic incivility: perceptions of nursing students and faculty

Background

Incivility in nursing education can adversely affect the academic environment, the learning outcomes, and safety. Nursing faculty (NF) and nursing students (NS) contribute to the academic incivility. Little is known about the extent of NF academic incivility in the Middle East region. This study aimed at exploring the perceptions and extent of NF academic incivility in an undergraduate nursing program of a public university in Oman.

Methods

A cross sectional survey was used to collect data from 155 undergraduate NS and 40 NF about faculty academic incivility. Data was collected using the Incivility in Nursing Education Survey.

Results

The majority of NS and NF had similar perceptions about disruptive faculty behaviors. The incidence of faculty incivility was low (Mean?=?1.5). The disruptive behaviors with the highest incidence were arriving late for scheduled activities, leaving schedule activities early, cancelling scheduled activities without warning, ineffective teaching styles and methods, and subjective grading. The most common uncivil faculty behaviors reported by participants were general taunts or disrespect to other NF, challenges to other faculty knowledge or credibility, and general taunts or disrespect to NS.

Conclusion

The relatively low level of NF academic incivility could still affect the performance of some students, faculty, and program outcomes. Academic institutions need to ensure a policy of zero tolerance to all academic incivility, and regular monitoring and evaluation as part of the prevention strategies.

     

The role of DHEA in relation to problem solving and academic performance

Dehydroepiandrosterone (DHEA) has been correlated with lower susceptibility to anxiety and mood disturbance. Since coping styles have been shown to be a critical component of academic achievement, we aimed to assess the relationship between DHEA and coping mechanisms in college students. Participants were recruited and tested twice, one week apart. Cardiovascular measurements and saliva samples were taken for each participant. The behavioral task consisted of a set of anagrams of increasing difficulty (possible to impossible). American College Testing (ACT) scores, number of college courses failed and dropped along with current grade point average (GPA) were recorded. Results indicated that successfully coping with challenging tasks is a function of behavioral flexibility and physiological neuroprotection. When presented with challenging tasks, individuals who vary their behavioral response to fit the task's demands have the lowest probability of failing the task. The same individuals also have higher levels of resiliency hormones, demonstrated by a lower ratio of cortisol versus DHEA levels.     

The inevitable rise of mediocrity in academic medicine

The present analysis addresses the question of how it has been possible for academic medicine to grow and lose its creative productivity at the same time. A mathematical model is developed to simulate the mechanisms that govern growth of medical systems over time. Time-dependent growth of system size increases the occurrence of statistical deviations of all system parameters. Deviations are correlated with costs and creative output. As deviation-induced costs start to strain the system's tolerance, means become implemented to restrict deviation, which ultimately also reduces its creative output. To maintain growth combined with high levels of creative output, an academic medical system would need to continuously branch off and nurture smaller subsystems, which pursue their own set of goals relatively independently of the overall academic structure.