A mission-based reporting system applied to an academic pathology department

We report how data from the University of California (UC) Davis mission-based reporting system (MBR) can be used to define contributions for each division within a Department of Pathology based on faculty rank and series, and to evaluate whether these contributions are in alignment with the missions of the department and the goals of the school's leadership. MBR summary reports were generated for each division within the Department of Pathology; these reports illustrated the average contribution for each faculty rank and series in each of the following missions: investigative/creative work (research), teaching, clinical service, and administrative/community service. All divisions contributed equally to the teaching mission, averaging approximately 1/3 of a faculty member's time. Research was the primary mission for faculty in both the Research and the Clinical Pathology divisions, whereas clinical service was the primary mission for Anatomic Pathology. Both Anatomic Pathology and Clinical Pathology also played a large role in the administration/community service mission. These roles were appropriate based on the division's distribution of faculty in each of the faculty series. The average contribution to both the research and administrative/community service missions were larger for the Department of Pathology than it was for the school as a whole. The Department of Pathology's average contribution to both the teaching and clinical service missions was less than the school's average. We conclude that MBR data creates unique profiles for divisions and the department and enables interdepartmental comparisons that would not be possible by other means. Within the context of our school, the present analysis illustrates that the Department of Pathology is fulfilling the expectations of the school's leadership. In a more general sense, these profiles allow appropriate monitoring of the workforce, funds flow analysis, allocation of resources, and strategic planning in an academic medical center.     

A Brief History of the Bioengineering Institute of California and the UC System-wide Symposia

The plan to establish a Multicampus Research Unit (MRU) on Bioengineering in the University of California (UC) System started in August 1999. The cooperative efforts of the UC campuses led to the formal establishment of the Bioengineering Institute of California (BIC) in October 2003. Three years prior to the BIC establishment, the System-wide Annual Bioengineering Symposium was started at UC Davis. The Symposia were then hosted sequentially by UC Santa Barbara, UC Berkeley, UCSD, UC Santa Cruz, UC Irvine, UCSF, UCLA, and UC Riverside, with the completion of the first cycle of a decade in the newest campus of UC Merced in 2009. The second cycle began in 2010 with the Symposium returning again to UC Davis. Each campus hosted a wonderful Symposium, with the active participation of students and faculty from all campuses, with the motto of “Ten campuses united as one, learning and growing together.” These Symposia have contributed significantly to the collaborative research and training of students and young scientists in bioengineering, as well as fruitful interactions with industry and government agencies, which have provided strong support for these valuable meetings. The BIC will endeavor to further enhance these efforts by fostering research collaborations and joint education and training activities, with the ultimate goal of advancing bioengineering for the improvement of human health and wellbeing.     

Faculty renewal: modeling the impact of the end of mandatory retirement in the University of California medical schools

The Age Discrimination in Employment Act was amended in 1986 to remove age-determined mandatory retirement for nearly all employees. The present study was prompted by the concern that if medical school faculty failed to retire, there would be no positions available for new faculty. The author used 1984-85 data on both tenure-track and non-tenure-track faculty of the five medical schools of the University of California (UC) to make projections, over 20 years, of faculty age distributions and available positions, at several possible growth rates and delays in retirement age. Association of American Medical Colleges data on all U.S. medical school faculty in 1980 were used to show that the UC data were not exceptional. Acknowledging the various assumptions used in manipulating the data and the need to examine longitudinal data on faculty age, growth, turnover, and retirement to make more realistic projections, the author demonstrates that the impact of delaying retirement by several years would be minimal. Because of this conclusion and also the inevitable aging of the faculty resulting from the slowed growth of medical schools, academic institutions should pay more attention to maintaining the vitality and productivity of their individual faculty members, regardless of age.     

Implementing a mission-based reporting system at an academic health center: a method for mission enhancement.

PURPOSE: To describe the utility of school-wide use of mission-based reporting (MBR) for medical school deans and department chairs. METHOD: All faculty members in the University of California, Davis, School of Medicine reported their clinical, creative, teaching, and service activities for 2000-2001 to the MBR system. The authors report on school-wide and department MBR profiles, and profiles by rank and academic series. They validate MBR by comparing individual results with actual merit actions reviewed independently by the school's academic personnel committee. RESULTS: A total of 419 faculty members (85%) completed their MBR reports. The average faculty member spent considerably more than 50 hours per week fulfilling the missions of the school, and full professors and faculty members in academic series supported by state funds were the most productive in investigative and creative work. The teaching load was shared equally by all the academic ranks, although the clinician-scholars taught more than did faculty members in the other series. There was an inverse relationship between clinical load and academic rank, with the majority of the clinical work performed by junior faculty members. MBR results compared favorably with the merit review process, although MBR is not expected to replace the traditional peer review system. CONCLUSION: The creation of these graphic profiles and summaries is a valuable feature of MBR that would not have been possible without such quantitative data. The profiles allow monitoring to ensure that workload conforms to established objectives for individuals, departments, academic ranks and series. Finally, the authors discuss future directions for their MBR system.     

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.     

Blueprint for establishing an effective Postbaccalaureate medical school pre-entry program for educationally disadvantaged students.

The purpose of this article is to provide public and private medical schools with a pragmatic blueprint for the development and implementation of an effective medical school pre-entry program that increases the pool of students interested in returning to health care shortage areas. An ancillary benefit of this program is an increase in the number of underrepresented minority students to medical schools. The structure, experiences, and results of the University of California, Davis, School of Medicine's Postbaccalaureate Reapplicant Program are used as a case study to construct the blueprint for returning 85-90% of program participants to shortage areas while increasing minority student admissions. The UC Davis program has been in place since 1991 and post-program acceptance rates have varied from 57% to 100% with an overall acceptance rate of 90.4% through 1999-00. Of 115 participating students who had previously been rejected by medical schools, 104 were accepted to health professional programs: 95 students were accepted to major U.S. medical schools and nine were accepted to masters in public health programs, physician's assistant programs, and one international medical school. This success rate has been achieved through a combination of intense assistance in study skills and test-taking skills, academic course work, and academic and pre-professional counseling.     

Innovative mentoring programs to promote gender equity in academic medicine.

The authors describe the history, characteristics, and goals of four innovative programs, each in a medical school, that were established in 1998 to help faculty members of both sexes obtain mentors and thereby facilitate their career advancement. The programs were established as the result of an initiative by the Office on Women's Health (OWH) within the U.S. Department of Health and Human Services. Specifically, the OWH convened the National Task Force on Mentoring for Health Professionals, which determined that two principles are paramount to the success of any mentoring relationship or program: institutional commitment and institutional rewards and recognition to mentors. In accordance with the task force findings, the OWH created the National Centers of Leadership in Academic Medicine, one at each of four medical schools: MCP Hahnemann School of Medicine; the University of California, San Diego, School of Medicine; East Carolina University School of Medicine; and Meharry Medical College School of Medicine. The authors give highlights of each program's goals and progress, and note that, ideally, these programs will eventually serve as models for similar programs at other schools. Programs such as these foster the advancement of a diverse faculty, a more supportive academic environment, and the education of providers who are sensitive to the needs of all their patients, staff, and colleagues.     

A qualitative study of the experiences of one group of African Americans in pursuit of a career in academic medicine

Recent reports demonstrate that medical school enrollment of minority students has continuously declined over the past several years and underrepresented minorities (URMs) continue to account for a disproportionately low percentage (less than 4%) of full-time academic faculty at medical schools in the United States. This article reports on a qualitative research project to examine the sociocultural experiences that influenced one group of minority physicians pursuing an academic medical career. Nine African American faculty, one resident, and one fellow from a Southern medical school of 574 full-time clinical and basic faculty completed 25 open-ended questions on a structured, qualitative interview plus background demographics. These nine faculty represented 82% (N = 11) of the total number of African American clinical and basic scientist faculty on campus at the end of the 1999 academic year. The narrative interviews describe key decision points, environmental and economic influences, and cultural experiences that affected faculty career choices and illustrate the real-life experiences of current minority faculty and scientists. These narratives contain significant messages for addressing policy on school campuses to improve the opportunities and likelihood of increasing the proportion of minority physicians and scientists.     

Clinical academies: innovative school-health services partnerships to deliver clinical education.

During the past five years (2001-2006), the University of Bristol Medical School has developed and implemented a new model for delivering clinical education: the clinical academy. The principal features of the model are (1) having both in-Bristol and out-of-Bristol campuses for clinical education, (2) innovative partnerships with local health care providers, (3) local leadership of educational delivery, and (4) the recruitment and training of new cadres of clinical teachers.The seven clinical academies consist of two academies based in traditional acute-care teaching hospitals in the city of Bristol and five academies in the surrounding counties. The same Bristol curriculum is delivered in every clinical academy by locally recruited hospital specialists and family physicians. Each academy is led by an academy medical dean, who has local responsibility for program delivery, quality assurance, academic and personal support for students, and finances on behalf of the university.Medical students rotate between clinical academies every half academic year, alternately based in and outside of Bristol. They learn clinical medicine and develop clinical competence as apprentice members of a local multiprofessional learning community. The medical school now has enough high-quality clinical placements to accommodate increasing numbers of medical students whilst keeping a "human-scale" educational environment.Clinical academies are thus the key components of a decentralized system of curriculum delivery; they differ in concept and purpose from the new academies of medical educators in the United States that offer a centralized focus for the educational mission.     

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.     

Comparing problem-based learning with case-based learning: effects of a major curricular shift at two institutions.

PURPOSE: Problem-based learning (PBL) is now used at many medical schools to promote lifelong learning, open inquiry, teamwork, and critical thinking. PBL has not been compared with other forms of discussion-based small-group learning. Case-based learning (CBL) uses a guided inquiry method and provides more structure during small-group sessions. In this study, we compared faculty and medical students' perceptions of traditional PBL with CBL after a curricular shift at two institutions. METHOD: Over periods of three years, the medical schools at the University of California, Los Angeles (UCLA) and the University of California, Davis (UCD) changed first-, second-, and third-year Doctoring courses from PBL to CBL formats. Ten months after the shift (2001 at UCLA and 2004 at UCD), students and faculty who had participated in both curricula completed a 24-item questionnaire about their PBL and CBL perceptions and the perceived advantages of each format RESULTS: A total of 286 students (86%-97%) and 31 faculty (92%-100%) completed questionnaires. CBL was preferred by students (255; 89%) and faculty (26; 84%) across schools and learner levels.The few students preferring PBL (11%) felt it encouraged self-directed learning (26%) and valued its greater opportunities for participation (32%). From logistic regression, students preferred CBL because of fewer unfocused tangents (59%, odds ration [OR] 4.10, P = .01), less busy-work (80%, OR 3.97, P = .01), and more opportunities for clinical skills application (52%, OR 25.6, P = .002). CONCLUSIONS: Learners and faculty at two major academic medical centers overwhelmingly preferred CBL (guided inquiry) over PBL (open inquiry). Given the dense medical curriculum and need for efficient use of student and faculty time, CBL offers an alternative model to traditional PBL small-group teaching. This study could not assess which method produces better practicing physicians.     

Development of a teaching program in clinical medical ethics at the University of Chicago

The University of Chicago Pritzker School of Medicine has developed and evaluated an extensive teaching program in clinical ethics coordinated primarily through the Center for Clinical Medical Ethics. The program provides medical students with a foundation in medical ethics during the four years of medical school and augments the clinical ethics knowledge and teaching skills of the housestaff and clinical faculty at the University of Chicago. Together, medical student teaching and clinical faculty development have made clinical ethics an integral part of medical education at the University of Chicago. Through these efforts, the teaching program aims to incorporate clinical ethics considerations into medical decisions and in this way contribute to improving patient care. (A detailed overview of all clinical ethics instruction at the school is provided.)     

Preparing for change: the plan, the promise, and the parachute.

The University of California's (UC's) medical education programs are on the brink of change. In January 2007, the UC system completed a multiyear health sciences planning effort that is the most comprehensive undertaken in decades. For medical student education, the plan calls for an approximately one-third increase in enrollment across the system -- from approximately 650 current medical school graduates per year to a projected 920 graduates annually by the year 2020. During the same period, California's population is expected to increase in size and diversity in ways unmatched by any other state in the nation.The plan calls for development of new programs that will increase enrollment in unique and unprecedented ways. The first phase of this growth is under way and is planned to continue through a series of programs that seek to address the needs of California's medically underserved communities. Areas of focus include rural health and telemedicine (Davis); the Spanish-speaking Latino community (Irvine); diverse, disadvantaged communities (Los Angeles); health disparities and health equity (San Diego); and the urban underserved (San Francisco and Berkeley). In November 2006, UC medical schools received $200 million in bond funding to support this growth and to create new telemedicine programs to increase access to services provided by faculty physicians. In the coming years, UC medical schools will face demographic and budgetary challenges that will require perseverance, creativity, and certain leaps of faith. Public expectations are high.     

Mentorship through advisory colleges.

OBJECTIVE: Medical students face pressures ranging from the need to create a social network to learning vast amounts of scientific material. Students often feel isolated in this system and lack mentorship. In order to counteract feelings of bureaucratic anonymity and isolation, the University of California San Francisco has created an advisory college to foster the professional and personal growth and well being of students. DESCRIPTION: UCSF has developed a formal structure to advise medical students. A selection committee, chaired by the associate dean of student affairs, appointed five faculty mentors to head advisory colleges. These five colleges serve as the advising and well-being infrastructure for the students. Mentors were chosen from a balanced range of clinical disciplines, both primary and specialty. The disciplines are obstetrics-gynecology, otolaryngology/head and neck surgery, medicine, pediatrics, and psychiatry. The mentors have demonstrated excellence in advising and counseling of students. Mentors meet individually at the beginning of the academic year with incoming first-year and second-year students. They then have bimonthly meetings with eight to ten students within each college throughout the academic year. Curricula for these group sessions include well-being discussions and coping techniques, sessions on the hidden and informal curriculum of professionalism, and discussions on career choices and strategies. For third-year students, advisory college meetings are scheduled during intersessions, which are weeklong courses that occur between the eight-week clerkship blocks. Mentors are available throughout the year to meet with students on an as-needed basis, and advisory colleges may hold group social activities. The dean's office supports each mentor with 20% salary and provides administrative support for the group college activities. DISCUSSION: Historically, UCSF students feel they receive an excellent education and appropriate job opportunities, but they do not feel they receive adequate advising and mentoring. This may have as its root cause the financial, clinical, and research pressures placed upon a faculty who are also responsible for mentoring residents and fellows. The advisory colleges begin by providing an infrastructure for developing a relationship for the student with a single faculty member. The advisory college system is incorporated into the academic schedule rather than relying on ad-hoc activities from well-meaning but inconsistently available faculty. In the early part of medical school, the advisory college relationship concentrates on assimilation into the new environment and provides the student with advice pertaining to mastering academic material. The college also serves as a sounding board for problems that can then be relayed to course directors to improve the educational experience. For students encountering academic difficulty, the college advisor can provide discreet advice about tutoring resources and can direct the student to a separately staffed Student Well-being Program. As time progresses, the mentors can direct students to key people in different fields of interest such as program directors and keep the students on track to make career decisions in a timely manner. The college system can help transform an anonymous medical school experience into a supportive, rich environment.     

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.     

Women physicians in academic medicine: new insights from cohort studies

BACKGROUND: I conducted a study to determine whether women who graduate from medical schools are more or less likely than their male counterparts to pursue full-time careers in academic medicine and to advance to the senior ranks of medical school faculties. METHODS: The rates of advancement to the ranks of assistant, associate, and full professor for all U.S. medical school graduates from 1979 through 1993 and for all members of U.S. medical school faculties from 1979 through 1997 were studied. Cohorts were defined on the basis of the year of graduation from medical school, track (tenure or nontenure), and academic department. Within each cohort, the number of women who advanced to a senior rank was compared with the number that would be expected on the basis of parity between men and women, and 95 percent confidence intervals were calculated. RESULTS: Women were significantly more likely than men to pursue an academic career. During the study period, 634 more women became faculty members than expected. The numbers were higher in the older cohorts than in the younger cohorts. The numbers of women who advanced to the ranks of associate and full professor were significantly lower than the expected numbers. This was true for both tenure and nontenure tracks, even after adjustment for the department. A total of 334 fewer women advanced to associate professor than expected, and 44 fewer women advanced to full professor than expected. CONCLUSIONS: Disparities persist in the advancement of men and women on medical school faculties. However, the numbers of women physicians at all levels of academic medicine are increasing.     

Academic promotion at a medical school. Experience at Johns Hopkins University School of Medicine

We studied promotions at Johns Hopkins University School of Medicine to determine whether clinician-teachers are less likely to be promoted or are promoted later in life than researchers and whether those who are promoted have more articles published than those who are not promoted. Over a five-year period, 93 percent of candidates for the rank of associate professor and 79 percent of the candidates for the rank of professor were promoted. There were no significant differences between clinical and research faculty members in terms of the probability that they would be promoted or their age at promotion to either associate professor or professor. Despite these findings, the responses to a questionnaire indicated that former faculty members perceived clinician-teachers as less likely than researchers to be promoted. Those who were promoted had had about twice as many articles published in peer-reviewed journals as those who were not promoted. We recommend improved counseling of medical school faculty members and more extensive discussion of the criteria for promotion and the chances of academic success.     

Multigenerational challenges in academic medicine: UCDavis's responses.

Academic medicine is a unique work environment, one of the few where members of four different generations regularly interact and where multigenerational teams are key to fulfilling its missions, particularly education. This can lead to increased creativity, but also to intergenerational conflict, since each generation has different values and expectations. The authors describe multigenerational challenges confronted at the University of California, Davis, School of Medicine, and that school's responses to them. These challenges include issues related to work hours, workload, compensation, evaluation for advancement, recruitment and retention, and attendance at required meetings. Awareness of the different generational qualities and values allowed the school of medicine to identify the multigenerational origin of many of these ongoing issues and challenges and to plan appropriate solutions within the Office of Academic Affairs. These include policy changes related to work-life balance, utilizing multiple faculty tracks with different roles, allowing part-time faculty appointments, creating a variety of faculty development programs geared toward different generational needs (which utilize flexible modules, menus of options, and alternative technologies for presentation), defining appropriate reward and incentives through compensations plans, and creating peer-reviewed awards. The authors conclude that these efforts mitigate conflict, promote diversity, and allow multigenerational teams to function more effectively and creatively in education, research, and clinical care. Ongoing evaluation will further refine this approach.     

Administrative relationships between medical schools and community preceptors.

PURPOSE: To determine the current administrative relationships between medical schools and community preceptors, with special emphasis on arrangements for academic appointment, review, and promotion. METHOD: In 1999, administrative contacts at all 126 U.S. allopathic medical schools were mailed a ten-item questionnaire to elicit information concerning the current practices of the schools regarding community preceptors, who were defined as volunteer or part-time physician faculty, primarily practicing at non-university-owned facilities, who contribute to medical students' and/or residents' education in various specified ways. RESULTS: Responses were received from 71 (56%) of the schools; they were in general a representative sample of U.S. medical schools. The numbers of preceptors per school ranged from 40 to 3,500. Sixty-seven percent of reporting schools identified clinical departments as the main administrative interface with preceptors. Only three schools used a central office; none exclusively used a regionalized system. Forty-four schools (63.8%) reported using formal written criteria for all preceptor appointments. Sixty-six schools (93%) used consistent academic titling systems, with 83.3% using titles including the word "clinical." Thirty-three schools (47.8%) reported that their departments conducted regular preceptor reviews; an additional 28 reported reviews by some departments. Preceptors were eligible for promotion at 94.4% of the responding schools. At 46.8%, specific promotion criteria exist; four schools were developing such criteria. Preceptors' interest in academic promotion was perceived to be moderate or low. CONCLUSION: A substantial proportion of U.S. medical schools have taken action to recognize preceptors as a unique faculty group. The comments received indicate that this is an active area of development in faculty affairs policy.