To Pay or Not to Pay Community Preceptors? That Is a Question .

Phenomenon: Pairing medical students with community-based preceptors has provided unique medical education advantages. However, due to an increase in the number of M.D.-granting medical schools and medical school class sizes, academic medical institutions have struggled to recruit community preceptors to teach their students. This task has been made more difficult due to rising pressures upon institutions and clinicians-for example, increased productivity demands, greater volume and oversight of electronic health record documentation, and competition for community preceptors from both D.O. and non-U.S.-based medical schools. Although academic institutions have historically relied largely on altruistic motives and intrinsic rewards to actively engage and retain community-based preceptors, alternative models have arisen, chiefly those in which community-based preceptors are explicitly compensated for teaching. Approach: To study this phenomenon, representatives of the Alliance for Clinical Education developed and deployed a 31-item survey accompanied with a subset of free text questions to the collective membership of its 8-member constituent organizations. Survey questions explored if community preceptors were compensated indirectly or directly and what types of compensation were provided, if any. There were 188 surveys analyzed, with an estimated response rate of 18.2%. Findings: Twenty-six percent of respondents indicated they compensate community preceptors directly and/or indirectly. Respondents discussed their motivations for payment (or nonpayment), mechanisms for paying, aspirations to pay, and expectations of the recipient. No statistically significant association was found when comparing responses of paid versus not paid by region. Free text responses provided additional insight regarding payment considerations, institutional competition, recruitment/retention, recognition, and education issues. Insights: Increasingly, medical schools are finding it necessary to provide funding for community preceptors in order to retain them. New creative forms of compensation to community preceptors may prove important in the future for this vital aspect of medical student education.

Does formal mentoring for faculty members matter? A survey of clinical faculty members.

BACKGROUND: Mentoring relationships, for all medical school faculty members, are an important component of lifelong development and education, yet an understanding of mentoring among medical school clinical faculty members is incomplete. This study examined associations between formal mentoring relationships and aspects of faculty members' engagement and satisfaction. It then explored the variability of these associations across subgroups of clinical faculty members to understand the status of mentoring and outcomes of mentoring relationships. The authors hypothesised that academic clinical faculty members currently in formal mentoring relationships experience enhanced employee engagement and satisfaction with their department and institution. METHODS: Medical school faculty members at 26 self-selected USA institutions participated in the 2011-2014 Faculty Forward Engagement Survey. Responses from clinical faculty members were analysed for relationships between mentoring status and perceptions of engagement by faculty members. RESULTS: Of the 11 953 clinical faculty respondents, almost one-third reported having a formal mentoring relationship (30%; 3529). Most mentored faculty indicated the relationship was important (86%; n = 3027), and over three-fourths were satisfied with their mentoring experience (77%; n = 2722). Mentored faculty members across ranks reported significantly higher levels of satisfaction and more positive perceptions of their roles in the organisation. Faculty members who were not receiving mentoring reported significantly less satisfaction with their workplace environment and lower overall satisfaction. CONCLUSIONS: Mentored clinical faculty members have significantly greater satisfaction with their department and institution. This multi-institutional study provides evidence that fostering mentoring opportunities may facilitate faculty members' satisfaction and engagement, which, in turn, may help medical schools retain high-quality faculty staff committed to the multidimensional academic mission.

Faculty development on professionalism and medical ethics: the design, development and implementation of Objective Structured Teaching Exercises (OSTEs).

BACKGROUND: As students are expected to develop competency in professionalism and medical ethics, faculty are also expected to facilitate medical students' learning and understanding of these areas. One of the main challenges to success in this domain has been uncertainty of whether or not faculty know the content and the methods to teach and assess these competencies. AIM: We used the Objective Structured Teaching Exercise (OSTE) format as a faculty development tool to train and evaluate faculty on how to teach professionalism and medical ethics to students in clinical settings. METHODS: The process for the design, development and implementation of OSTEs consisted of five phases: (1) performing a literature review and student needs assessment, (2) developing the OSTE cases and performance checklists, (3) recruiting and training of standardized students, (4) conducting a mock training session and (5) organizing faculty development workshops using OSTEs. RESULTS: Twenty clinical faculty members participated in one of three half-day OSTE workshops offered. Faculty confidence and attitudes about teaching professionalism increased significantly (p < 0.05) from before participating in the workshop to afterwards. CONCLUSIONS: Faculty feedback were positive stating that the OSTE scenarios were reflective of issues they generally encounter while teaching medical students, the information and skills they learned from the workshop are important to them as clinical educators, and that the information and skills will likely have an impact on the way they teach professionalism and ethics in the future.

New faculty orientation in North American medical schools.

BACKGROUND: Little is known about common elements or "best practices" of new faculty orientation (NFO) programs in medical schools. PURPOSE: The objective was to examine school-wide NFO programs in North American medical schools. METHODS: We reviewed the literature and conducted a web-based survey. Analyses included descriptive statistics and content analysis. RESULTS: We found little evidence of "best practices." Of the 106 responding schools (106/148=71.62%), 72 (67.9%) reported some type of school-wide NFO program. The typical program was organized by an Office of Faculty Affairs or Faculty Development, targeted broad goals, 4 to 8 hour long, offered early in the academic year, and used 2 or more presentation formats (e.g., oral, print). CONCLUSIONS: Based on the literature, this study appears to be the first comprehensive description of NFO programs in medical schools. Multiple types of NFO are needed to accommodate the diversity of faculty and faculty responsibilities. School-wide programs may serve best to develop institutional affiliation and collegiality.

Editors as Gatekeepers: One Medical Education Journal's Efforts to Resist Racism in Scholarly Publishing.

PURPOSE: Journals have begun to expand the racial diversity of editors as a first step to countering institutional racism. Given the power editors hold as gatekeepers, a diverse team helps ensure that minoritized scholars have equal opportunity to contribute. In 2021, Teaching and Learning in Medicine ( TLM ) created an editorial internship for racially minoritized individuals. This study examines the first 6 months of this program to better understand its creation and initial successes. METHOD: The authors employed critical collaborative autoethnography, a qualitative methodology, focusing on the underlying assumptions around power and hierarchy that are implicit in the design and implementation of the TLM internship. Participants included 13 TLM editorial board members (10 internship selection committee members, 3 mentors, 2 independent researchers), 3 external selection committee members, and 3 interns, with some holding multiple roles. Ten participants served as authors of this report. Data included archival emails, planning documents, and focus groups. The initial analysis explored what happened and how and was followed by a thematic analysis in which participants reflected on their responsibility for implementing an antiracist program. RESULTS: While the program developed interns' editorial skills, which they greatly valued, and diversified the TLM editorial board, it did not achieve the goal of fostering antiracism. Mentors focused on conducting joint peer reviews with interns, assuming that racial experiences can and should be separate from the editorial process, thus working within, rather than trying to change, the existing racist system. CONCLUSIONS: Given these findings, greater structural change is needed to disrupt the existing racist system. These experiences underscore the importance of recognizing the harmful impact a race-neutral lens can have on antiracist efforts. Moving forward, TLM will implement lessons learned ahead of offering the internship again with the goal of creating the transformative change intended with the creation of the program.

A "medical student practice profile" as the foundation for a case-based curriculum revision.

BACKGROUND: In 2001, the Keck School of Medicine of the University of Southern California initiated a major curriculum reform with fully integrated teaching of the basic sciences. DESCRIPTION: The new curriculum integrated a set of selected clinical cases called the student practice profile (SPP). The SPP cases were designed to (a) define the core target knowledge base and essential clinical experience of all graduating students, (b) to improve the relevance of basic science teaching, and (c) to serve as the overarching organizational structure for the 4-year curriculum. EVALUATION: Evaluation data demonstrated that implementation of the SPP project has been moderately successful and students have reported high exposure to the SPP cases and confidence in their ability to diagnose and manage problems. Improvement in teaching the basic sciences in a clinically relevant manner is suggested by a small continued improvement in USMLE scores since the SPP project was fully implemented. CONCLUSIONS: The SPP design represents a uniquely successful pathway to curriculum redesign.

Late-Career Expectations: A Survey of Full-Time Faculty Members Who Are 55 or Older at 14 U.S. Medical Schools.

PURPOSE: The average age of full-time faculty members at U.S. medical schools accredited by the Liaison Committee on Medical Education was 49.5 in 2017, yet the academic medicine community knows little about late-career faculty. The authors sought to characterize full-time faculty members 55 or older and assess their work-life expectations. METHOD: The authors conducted a survey (May-September 2017) of faculty 55+ at 14 U.S. medical schools. RESULTS: Of the 5,204 faculty members invited, 2,126 (40.8%) responded. The average age of respondents was 62.3, and among those responding to the relevant questions, most identified as male (1,425; 67.2%), white (1,841; 88.3%), and married/partnered (1,803; 85.5%). Fewer than half (915; 45.2%) indicated they had begun thinking about full-time retirement, estimating that they would do so at a mean age of 67.8 (standard deviation = 4.3). Half the respondents (1,004; 50.0%) would consider moving to part-time status. The top 3 personal factors likely to affect retirement decisions were health, postretirement plans, and spouse's/partner's plans. The top 3 professional factors were phased retirement or part-time options, changes in institutional leadership, and presence of a successor. Faculty indicated that they would, post retirement, be interested in ongoing work in teaching/education and research/scholarship and that they wanted health insurance, email, and part-time teaching opportunities. CONCLUSIONS: U.S. medical schools employ a rapidly aging workforce. These data indicate that neither faculty members nor institutions are prepared. Faculty affairs and develop ment leaders should champion efforts to engage with late-career faculty to prepare for this changing landscape.

Late-Career Faculty: A Survey of Faculty Affairs and Faculty Development Leaders of U.S. Medical Schools.

PURPOSE: Individuals 55 or older constitute 28.5% of the U.S. population but 32% of full-time faculty at U.S. medical schools accredited by the Liaison Committee on Medical Education (LCME). The academic medicine community knows little about the policies, programs, and resources for faculty in pre- and post-retirement stages. The authors sought to inventory the range of institutional resources for late-career faculty development and retirement planning in U.S. LCME-accredited medical schools. METHOD: The authors surveyed 138 medical school faculty affairs deans and leaders in May 2017 to ascertain (1) priorities around retirement, succession planning, and workforce development/support; (2) retirement policies; (3) late-career and retirement resources; and (4) perceived factors impacting faculty retirement. RESULTS: Of those invited, 84 (60.9%) responded to the survey, and of these, 44 (52.4%) disagreed or strongly disagreed that retirement planning and support was a top priority in their offices. Less than half (n = 35 [41.7%]) reported that their institution had a retirement policy. The 5 most common late-career and retirement-related resources offered were emeriti or honorific appointments, academic benefits for retirees, phased retirement, retirement counseling, and financial planning. More than half the respondents noted that the following factors impact faculty retirements: physician burnout (43/75 respondents [57.3%]), decreased grant funding (42/75 [56.0%]), and changes in productivity requirements (38/75 [50.7%]). CONCLUSIONS: These data highlight a distinct, startling gap between the needs of a fast-growing population of late-career faculty and the priorities of their institutions. Faculty affairs/faculty development offices must meet these growing needs.

Characteristics, satisfaction, and engagement of part-time faculty at U.S. medical schools.

PURPOSE: To describe the demographics of part-time faculty at U.S. medical schools and to examine their satisfaction with and perceptions of their workplace. METHOD: Faculty from 14 Liaison Committee on Medical Education-accredited U.S. medical schools participated in the 2011-2012 Faculty Forward Engagement Survey. The authors calculated descriptive statistics of part-time faculty respondents and used ANOVA and t test analyses to assess significant differences between and among demographic groups. RESULTS: The survey yielded an overall response rate of 62% (9,600/15,490). Of the part-time faculty respondents, most had appointments in clinical departments (634/674; 94%) and were female (415/674; 62%). Just over 80% (384/474) reported a full-time equivalent of 0.5 or higher. The majority of part-time faculty respondents reported satisfaction with their department and medical school as a place to work (372/496 [75%] and 325/492 [66%]); approximately half agreed that their institution had clear expectations for part-time faculty (210/456; 46%) and provided the resources they needed (232/457; 51%). Significant differences existed between part- and full-time faculty respondents regarding perceptions of growth opportunities and compensation and benefits, with part-time faculty respondents feeling less satisfied in these areas. CONCLUSIONS: As institutions work to improve the satisfaction of full-time faculty, they should do the same for part-time faculty. Understanding why faculty choose part-time work is important in encouraging the recruitment and retention of the most talented faculty. The findings of this study indicate multiple opportunities to improve the satisfaction and engagement of part-time faculty.

Evolution of faculty affairs and faculty development offices in U.S. medical schools: a 10-year follow-up survey.

PURPOSE: To determine how U.S. MD-granting medical schools manage, fund, and evaluate faculty affairs/development functions and to determine the evolution of these offices between 2000 and 2010. METHOD: In December 2010, the authors invited faculty affairs designees at 131 U.S. MD-granting medical schools to complete a questionnaire developed by the Association of American Medical Colleges Group on Faculty Affairs, based on a 2000 survey. Schools were asked about core functions, budget, staffing, and performance metrics. The authors analyzed the data using descriptive statistics. RESULTS: A total of 111 schools (84.7%) responded. Fifty percent of the offices were established since 2000. Seventy-eight percent reported their top core function as administrative support for appointments, promotions, and tenure, as in 2000. Faculty policies, appointments, databases, governance support, grievance proceedings, management issues, and annual trend analyses continued as major functions. All 11 core functions identified in 2000 remain predominantly provided by central offices of faculty affairs, except support of major leadership searches. Web site communication emerged as a new core function. Similar to 2000, several other offices were responsible for some faculty development functions. Office size and budget correlated positively with size of the faculty and age of the office (P < .05 for all). Thirty-five schools (31.5%) reported formally evaluating their faculty affairs office. CONCLUSIONS: The number of faculty affairs offices and their responsibilities have substantially increased since 2000. Most major core functions have not changed. These offices are now an established part of the central administration of most medical schools.

Predictors of workplace satisfaction for U.S. medical school faculty in an era of change and challenge.

PURPOSE: To examine the current state of satisfaction with the academic medicine workplace among U.S. medical school faculty and the workplace factors that have the greatest influence on global satisfaction. METHOD: The authors used data from the 2009 administration of a medical school faculty job satisfaction survey and used descriptive statistics and χ analyses to assess levels of overall satisfaction within faculty subgroups. Multiple regressions used the mean scores of the 18 survey dimensions and demographic variables to predict three global satisfaction measures. RESULTS: The survey was completed by 9,638 full-time faculty from 23 U.S. medical schools. Respondents were mostly satisfied on global satisfaction measures including satisfaction with their department (6,506/9,128; 71.3%) and medical school (5,796/9,124; 63.5%) and whether they would again choose to work at their medical school (5,968/8,506; 70.2%). The survey dimensions predicted global satisfaction well, with the final models explaining 51% to 67% of the variance in the dependent measures. Predictors across models include organization, governance, and transparency; focus of mission; recruitment and retention effectiveness; department relationships; workplace culture; and nature of work. CONCLUSIONS: Despite the relatively unpredictable environmental challenges facing medical schools today, leaders have opportunities to influence and improve the workplace satisfaction of their faculty. Examples of opportunities include fostering a culture characterized by open communication and occasions for faculty input, and remaining vigilant regarding factors contributing to faculty burnout. Understanding what drives faculty satisfaction is crucial for medical schools as they continue to seek excellence in all missions and recruit and retain high-quality faculty.