Motivating factors for academic physicians within departments of medicine

OBJECTIVE: To understand what motivates academic physicians at a time when physician dissatisfaction is prevalent. SUBJECTS AND METHODS: Of a cohort of 480 physician faculty members (identified from the Association of American Medical Colleges faculty roster) hired at the assistant professor level, 183 were monitored prospectively for a characterization of their success in achieving promotion. In mid-2001, follow-up data were collected about the factors that physicians described as motivating in their work. We conducted this study to understand the differences in motivators between clinician-educators and cliniclan-investigators and between male and female physicians, as well as to validate a previously used instrument developed to assess motivation and occupational values. RESULTS: Of 183 physicians monitored, 144 (79%) responded to an interim follow-up questionnaire. Factor analysis revealed that physicians' occupational motivators could be grouped statistically into 3 factors: self-expression, helping others, and extrinsic rewards. Compared with clinician-educators, clinician-investigators were more motivated in their current work by having the ability to express themselves (composite factor score, 4.30 vs 3.84; P<.001). Clinician-investigators also rated 4 of the 6 items within the factor of self-expression as being significantly stronger motivators for them than did the clinician-educators. Compared with male physicians, female physicians Indicated they were more motivated by helping others (composite factor score, 4.18 vs 3.89; P=.03). CONCLUSIONS: Factors that motivate physicians appear to be different for clinician-investigators and clinician-educators as well as for male and female physicians. Understanding the inspiration for physicians may help medical leadership to better motivate and relate to their physician workforce.     

Clinical activities of an academic pediatric pharmacy team

BACKGROUND: Pharmacy school faculty, residents, and students have been shown to positively impact patient care in multiple settings. However, their potential role in the care of pediatric patients has not been described. OBJECTIVE: To document the contribution of pharmacy school faculty, residents, and students to the optimization of medical care for pediatric patients. METHODS: All clinical interventions performed by faculty, residents, and students for pediatric patients seen from January through December 2002 were recorded and analyzed. The interventions were concurrently recorded using a handheld and desktop computer-based documentation system, the Pharmacist's Electronic Database for Interventions, developed by the pediatric practice team. Practice sites included general pediatrics, pediatric intensive care, neonatal intensive care, and ambulatory clinics. RESULTS: Four faculty members, 5 residents, and 44 students collected intervention data. A total of 4605 interventions were performed for 3978 patients. The most common interventions performed were drug therapy change, pharmacokinetic monitoring, drug information, and medication histories/patient education. Drug added and drug deleted were the most frequent interventions performed in the drug therapy change category. The most common indications for which interventions were made were infectious (39.6%) and respiratory (23.3%) diseases. A total of 223 adverse drug events or medication errors were prevented or detected during the study period. Errors in dosing (overdose or underdose) were the most commonly encountered adverse events. CONCLUSIONS: Pharmacy school faculty, residents, and students perform numerous clinical activities that play a significant role in the multidisciplinary care of pediatric patients.     

Nurses in academic departments of general practice and primary care

In 1997, the authors conducted a survey of registered nurses working in the academic departments of general practice and primary care in UK and Irish medical schools. The survey aimed to determine the number, demographic and professional profile of nurses employed in these academic departments, including their employment status and their views on their clinical work and professional development. The majority of nurses were professionally experienced, had higher degrees, worked in a research capacity, and were likely to have short-term contracts. Contrary to professional perceptions, the majority of nurses stated that clinical work is important to their current job and expressed a need for research support and recognition of their autonomy as healthcare professionals.     

Factors influencing satisfaction and anticipated turnover for nurses in an academic medical center

OBJECTIVES: The purpose of this study was to examine the relationships between work satisfaction, stress, age, cohesion, work schedule, and anticipated turnover in an academic medical center. BACKGROUND DATA: Nurse turnover is a costly problem that will continue as healthcare faces the impending nursing shortage, a new generation of nurses enter the workforce, and incentives provided to nurses to work for institutions increase. A variety of factors influence the retention of nurses in adult care settings, including work satisfaction, group cohesion, job stress, and work schedule. In general, previous research has documented positive relationships between work satisfaction, group cohesion, strong leadership, and retention rates and a negative relationship between stress, work schedule, and retention. In addition, age and experience in nursing are related to job satisfaction. METHODS: This study used a cross-sectional survey design in which nurses from 12 units in a 908-bed university hospital in the Southeast completed questionnaires on one occasion. The following factors were measured using self-report questionnaires: nurse perception of job stress, work satisfaction, group cohesion, and anticipated turnover. RESULTS: The more job stress, the lower group cohesion, the lower work satisfaction, and the higher the anticipated turnover. The higher the work satisfaction, the higher group cohesion and the lower anticipated turnover. The more stable the work schedule, the less work-related stress, the lower anticipated turnover, the higher group cohesion, and the higher work satisfaction. Job Stress, work satisfaction, group cohesion, and weekend overtime were all predictors of anticipated turnover. There are differences in the factors predicting anticipated turnover for different age groups. CONCLUSIONS: As healthcare institutions face a nursing shortage and a new generation of nurses enter the workforce, consideration of the factors that influence turnover is essential to creating a working environment that retains the nurse.     

Improved care of acute exacerbation of chronic obstructive pulmonary disease in two academic emergency departments

Background

Although several chronic obstructive pulmonary disease (COPD) practice guidelines have been published, there is sparse data on the actual emergency department (ED) management of acute exacerbation of COPD (AECOPD).

Aims

Our objectives were to examine concordance of ED care of AECOPD in older patients with guideline recommendations and to evaluate whether concordance has improved over time in two academic EDs.

Methods

Data were obtained from two cohort studies on AECOPD performed in two academic EDs during two different time periods, 2000 and 2005–2006. Both studies included ED patients, aged 55 and older, who presented with AECOPD, and cases were confirmed by emergency physicians. Data on ED management and disposition were obtained from chart review for both cohorts.

Results

The analysis included 272 patients: 72 in the 2000 database and 200 in the 2005–2006 database. The mean age of the patients was 72 years; 50% were women and 80% white. In 2005–2006, overall concordance with guideline recommendations was high (for chest radiography, pulse oximetry, bronchodilators, all ≥?90%), except for arterial blood gas testing (7% among the admitted) and discharge medication with systemic corticosteroids (42%). Compared to the 2000 data, the use of systemic corticosteroids in the ED improved from 53 to 77% [absolute improvement: 24%, 95% confidence interval (CI): 11–37%], and the use of antibiotics among the patients with respiratory infection symptoms improved from 56 to 78% (absolute improvement: 22%, 95% CI: 6–38%).

Conclusions

Overall concordance with guideline-recommended care for AECOPD was high in two academic EDs, and some emergency treatments have improved over time.     

Faculty development: What academic primary care physicians need to know and what they want to know

Background: Recruiting and retaining junior faculty is key to the success of academic medicine, particularly in the primary care disciplines.

Purpose: This study integrated principles of adult education and instructional design to identify and prioritize clinical and nonclinical training needs to guide faculty development planning for primary care internal medicine physicians.

Methods: A questionnaire was administered. Paired t tests were used to examine differences between faculty's current and desired levels of expertise in 5 nonclinical domains. Content analysis was used to examine responses about clinical skills.

Results: Paired t tests indicated current levels of competence lower, p < .001, than desired levels in all nonclinical domains. Content analysis surfaced clinical procedures with high frequency. Clinical skills were chosen by faculty as their training priority.

Conclusions: Desire for state‐of‐art clinical skills needed by academic primary care physicians may overshadow their desire to learn nonclinical career‐advancement skills. To succeed over time, the challenge of effective faculty development is to integrate both areas.     

Innovations in academic and practice partnerships: new collaborations within existing models

New models in academic institutions that engage practice experts accelerate innovative thinking, productivity, and quality. A successful model in a southwest university college of nursing and health innovation is presented. In this article, the authors provide experiences specific to identifying needs, developing partnerships, integrating experts into the college, and challenges in sustaining partnerships and their potential for transforming the academic and service relationship in the age of reform.     

Incorporating Peer Assessments within a Clinical Practicum Course: Insights from a Clinical Faculty Initiative

IntroductionPeer assessments have been used within health professional programs to provide some degree of judgment of professional behavior and to facilitate feedback among peers. In an attempt to further support the clinical learning of our students, the clinical education team at the Odette Cancer Centre initiated a pilot to introduce peer assessments as a part of strategies for learning and engagement within laboratory sessions. The aim of our work was to retrospectively review peer assessments completed during these sessions in an attempt to identify professional behaviors, both positive and negative, and subsequently correlate the assessments with observed behaviors noted, both formally and anecdotally, within clinical faculty assessments. Further to this, our team attempted to explore student perceptions on the impact of peer assessments to their own learning.MethodsStudents in the final year of a 3-year undergraduate medical radiation sciences program were asked to assess their peers during laboratory sessions using a modified version of an assessment tool previously known to the students, the Assessment of Readiness for Clinical tool. Students (N = 14) were required to evaluate each of their peers who participated in the same session and provide supporting comments for their rating. For each student, responses from peer assessors were anonymized and collated. Comments and numerical ratings on the peer assessments were compared. The student assessments were subsequently compared with similar measures extracted from faculty assessments. Students also participated in a debriefing session to provide feedback regarding the integration of these assessments within the learning sessions and the potential impact they had on their own professional behaviors.ResultsThe majority of students rated their peers in all criteria at a score of 2 (performed or surpassed expectations). There was some correlation between numerical ratings and comments written in the assessments. Comments on peer assessments were in concordance with observations extracted from previous assessments by clinical faculty and teachers for 71% of the students. Students expressed a favorable attitude toward the use of the peer assessments but did not find the numerical ratings useful and instead valued supporting constructive comments that cited specific examples for improvement.ConclusionsPeer assessments were found to be of some benefit to the learning of our students, particularly the anecdotal supporting comments that accompanied the ratings. However, their use must be accompanied by formalized training and guidelines to teachers and learners as well as a careful consideration of the tool chosen to ensure the most purposeful impact on behavior change.