Gender differences in appointments to pathology department interim chair positions and subsequent advancement to permanent chair positions.

Females are under-represented as departmental chairs in academic medical centers and identifying ways to increase their numbers in this position would be useful. A previous study of women chairs of pathology showed that 35% of permanent chairs had previously been interim chairs, suggesting that the interim position was a common pathway for women to advance to a permanent chair position. We sought to determine whether it might also be true for males and if not, possible reasons for the difference. Between January 2016 and June 2022, the Association of Pathology Chairs identified 50 people who had served as interim pathology department chairs. Males served as interim chairs more often than females (66% vs 34%), but, within this time frame, female interim chairs were more likely to become permanent chairs than males (47% of females compared to 27% of males). To better understand the difference in the rate of advancement from interim to permanent chair, we surveyed the 50 individuals who had served as interim chairs to explore gender differences in backgrounds, reasons for serving as interim chairs and reasons for seeking or not seeking the permanent chair position. No significant gender differences were found except that male interim chairs were older (59.2 years) than female interim chairs (50.4 years). This study affirms that serving as an interim chair is a common pathway for females to become permanent chairs, while it is less so for males, although the reasons for this difference could not be determined.

Communication during a global pandemic: The utility of a professional society listserv and journal.

The Association of Pathology Chairs listserv was studied in order to determine its utility in facilitating communication among pathology departments during the COVID-19 global pandemic. Between March 2020 and March 2022, there were 116 pandemic-related entries generated by 49 members that stimulated 395 responses from 109 members. Due to overlap between individuals providing listserv entries and those responding, there were 123 unique participants. The majority of entries (64%) as well as responses (64%) occurred during March and April 2020. The most common categorical theme (32% of entries and 39% of responses) related to COVID-19 testing protocols and procedures with the second most common theme being the proactive sharing of individual institutional experiences in coping with the pandemic (16% of entries and 11% of responses). Additional themes included remote pathologist sign-outs, use of alternative specimens for testing, supply chain issues, in-house preparation of viral transport media and swabs, autopsies on COVID-19 decedents, safety of the blood supply, disinfecting masks, Medicare payment for testing, and creation of a biorepository for specimens. Fifty-two (42%) of the 123 unique participants published 277 COVID-related papers during this time, and one third of COVID-19-related articles published during 2020 and 2021 in Academic Pathology, the official journal of the Association of Pathology Chairs, involved individuals who had contributed to the listserv either by generating entries or responding to them. These data suggest that professional society listservs and journals are effective vehicles for communication during crises by identifying issues, proposing solutions, and exporting this information into the literature.

Career transitions: Reflections of former chairs and academic health center leaders.

The 2022 Association of Pathology Chairs Annual Meeting included a live discussion session and a pre-meeting recorded panel webinar sponsored by the Senior Fellows Group (former chairs of academic departments of pathology who have remained active in the Association of Pathology Chairs). The presentation was focused on transition planning for academic health center leaders. Each of the discussion group panelists had served as a pathology department chair as well as in more senior leadership positions, and they provided perspectives based upon their personal experiences. It was noted that such positions are often "at will" appointments of indeterminate length and that those above department chair generally carry greater risks and less stability. Becoming "addicted" to a leadership position was not considered beneficial to the individual or to the institution served and makes transitioning more difficult. Ongoing organizational succession planning was deemed helpful to mitigate such addiction and facilitate personal transition planning. Modes of transitioning discussed included those planned (e.g., voluntary retirement, resignation, administrative advancement) and unplanned (e.g., being "fired"; unexpected personal, health, or family issues). Unplanned transitions were felt to be more difficult, while anticipating when it is time to go and planning for it provided greater personal fulfillment after transition. Many career options were identified after serving in a leadership position, including a return to teaching, research, and/or clinical service; writing; mentoring; becoming more active in professional organizations and boards; philanthropic work; and "reinventing oneself" by moving to another career entirely.

Generating Discretionary Income in an Academic Department of Pathology.

The 2021 Association of Pathology Chairs Annual Meeting included a chairs' session and a premeeting discussion-group webinar sponsored by the Senior Fellows Group (former chairs of academic departments of pathology who have remained active in the Association of Pathology Chairs) focused on generating discretionary income for departments. Discretionary income was defined as revenue that can be used by the department with few, if any, restrictions. Such income is particularly desirable given limitations on departmental budgets. Four discussion-group panelists presented the funds-flow model in their respective institutions and how they derived and used discretionary income. Discretionary income was obtained from both external sources (eg, philanthropy, indirect cost recovery, partnerships with outside entities, medical education courses, research laboratory agreements, clinical trials) and internal sources (eg, core facilities, institutional programmatic support, institutional incentive programs). Significant departmental variations were associated with differences in institutional financial structure and policies, revenue-generating capabilities of the department and individual faculty, practice plan policies, donor intentions, and geographic market forces. Most finances were dependent upon a robust funds-flow model. Uses of discretionary funds included salary support, recruitment expenses (including start-up packages), research equipment, space renovation, social events, support of academic programs, and travel. Panelists also discussed particular challenges of discretionary-fund generation and use during the coronavirus disease 2019 pandemic. Notably, each institution had its own unique methodology for generating discretionary income, and no obvious standard approach was identified. The 2 moderators emphasized the importance of identifying and understanding opportunities, issues, and institutional culture surrounding generation and use of discretionary funds.

The Relationship Between Medical School-Based Pathology Departments and Affiliated Forensic Pathology Training Sites.

Medical school-based pathology departments were surveyed in order to evaluate their relationship with sites providing forensic pathology training. Of 59 departments surveyed, 49 (83%) responded. Most (88%) respondents indicated that training occurs at an affiliated medical examiner/coroner office, and 78% indicated that the facility is 10 miles or less from the academic health center. The majority (61%) of respondents require 4 weeks of forensic pathology training for their residents while the others require none (3); 6, 8, or 12 weeks (2 each); and 16 weeks (3, with two having integrated forensic and medical autopsies). The majority (81%) send one resident at a time to the forensic pathology training site, and almost always (92%) the experience is dedicated to forensic pathology without mixing with other training. Two-thirds of respondents send between 1 and 5 residents per year for training. Prior autopsy experience is required by 79% of departments. Medical student rotations in forensic pathology are available to 86% of reporting departments. Almost 3 quarters of respondents indicated that a forensic pathology fellowship is available through the training site with 83% being funded by the training site. About half of departments indicated that they provide some financial support to the site. Of reporting departments, 71% indicated that they give faculty appointments to forensic pathologists at the training site, with 3 quarters being voluntary appointments. Affiliated forensic pathology training sites are a valuable asset although 6 respondents report offering such training either totally or partially within the pathology department itself.

Women in Academic Pathology: Pathways to Department Chair.

The Association of Pathology Chairs, an organization of American and Canadian academic pathology departments, has a record percent of women department chairs in its ranks (31%), although still not representative of the percent of women pathology faculty (43%). These women chairs were surveyed to determine what had impeded and what had facilitated their academic advancement before becoming chairs. The 2 most frequently identified impediments to their career advancement were heavy clinical loads and the lack of time, training, and/or funding to pursue research. Related to the second impediment, only one respondent became chair of a department which was in a top 25 National Institutes of Health-sponsored research medical school. Eighty-nine percent of respondents said that they had experienced gender bias during their careers in pathology, and 31% identified gender bias as an important impediment to advancement. The top facilitator of career advancement before becoming chairs was a supportive family. Strikingly, 98% of respondents have a spouse or partner, 75% have children, and 38% had children younger than 18 when becoming chairs. Additional top facilitators were opportunities to attend national meetings and opportunities to participate in leadership. Previous leadership experiences included directing a clinical service, a residency training program, and/or a medical student education program. These results suggest important ways to increase the success of women in academic pathology and increasing the percent of women department chairs, including supporting a family life and providing time, encouragement and resources for research, attending national meetings, and taking on departmental leadership positions.

Academic Pathology Departments and Associated Children's Hospitals: An Overview of the Relationship.

A survey of academic pathology departments was conducted in order to evaluate the relationship with their associated children's hospitals. Forty percent (88) of US children's hospitals were associated with academic pathology departments. Sixty percent of pathology department respondents indicated that their children's hospital was part of their academic health system. As a reflection of this, the majority (54%) of all respondents reported that their children's hospitals were physically located within the academic health care system itself. Accordingly, a vast number (94%) of academic departments reported that they performed the clinical services for those children's hospitals that were part of their academic health system. For those associated children's hospitals that were not part of the academic health system, 70% of respondents reported that the academic pathology department provided at least some clinical services for them. The number of pathologists in the children's hospital pathology departments that were not part of the academic health system ranged from 1 to 5 (41%), 6 to 10 (18%), and >10 (41%), with one-third having salaried faculty appointments in the academic pathology department. The chief of pathology in those children's hospital departments was part of the academic department leadership team in half of the cases. Although 86% of respondents reported that pathology residents rotate through the associated children's hospital, in only 26% of instances did the children's hospital provide resident support for the academic pathology department. The perceived strengths and weaknesses of the relationship between academic pathology departments and associated children's hospitals are discussed.

The Veterans Affairs Healthcare System and Academic Pathology Departments: Evaluation of the Relationship.

A survey was conducted to evaluate the relationship between Veterans Affairs Healthcare Systems and academic departments of pathology in their respective affiliated schools of medicine. Most (73%) of the responding academic departments were within 5 miles of their Veterans Affairs Healthcare Systems; 60% of Veterans Affairs Healthcare Systems supported 1 to 5 full-time pathologist positions at the Veterans Affairs Healthcare Systems while 70% provided 1 to 5 full-time resident positions; only 34% of academic departments had "without compensation" appointments at the Veterans Affairs Healthcare Systems while 20% had fee-based consulting appointments; 62% of academic departments granted academic appointments to full-time Veterans Affairs Healthcare Systems pathologists while few (26%) had split appointments between the academic department and the Veterans Affairs Healthcare Systems; only half of academic departments granted the same academic privileges to Veterans Affairs Healthcare Systems pathologists as they did to full-time university faculty; 60% of the Veterans Affairs Healthcare Systems pathologists were not involved in recruitment of medical school faculty while 58% of medical school faculty were not involved in recruitment of Veterans Affairs Healthcare Systems pathologists; most academic departments reported no research space at the Veterans Affairs Healthcare Systems (68%) and no Veterans Affairs Healthcare Systems research support (72%); only 23% of academic departments reported a sharing agreement that allows the Veterans Affairs Healthcare Systems to perform clinical work for the academic department while 36% reported an agreement that permits the academic department to perform clinical work for the Veterans Affairs Healthcare Systems; only 32% of academic departments indicated that the Veterans Affairs Healthcare Systems Chief of Pathology and Laboratory Medicine Service is a member of the academic department leadership team. All academic departments reported that the Veterans Affairs Healthcare Systems plays a significant role in education of medical students, residents, and fellows. Strengths and weaknesses of the Veterans Affairs Healthcare Systems/academic department relationships are identified.

Retaining the Value of Former Department Chairs: The Association of Pathology Chairs Experience.

Serving as a clinical department chair in an academic health center is an increasingly complex and difficult position. In 2014, the Association of Pathology Chairs engaged former chairs to assist its members by establishing an ad hoc committee of "Senior Fellows," which then became a permanent Senior Fellows Group. The Senior Fellows Group currently includes more than 50 former chairs, many of whom subsequently served as deans, medical center executives, and in other leadership roles. The primary mission of the Senior Fellows Group has been to provide advice, consultation, and mentoring to members of the Association of Pathology Chairs, especially new chairs and faculty interested in leadership roles. All new chairs are asked if they wish to select or be assigned a Senior Fellow advisor. Each Senior Fellow is listed on the Association of Pathology Chairs website with the areas of advice they are willing to provide, which include: "on-boarding" issues and opportunities facing a new chair; strategy (eg, departmental priorities, mission balance); administration (eg, financial, operational); institutional reviews of chairs/departments; interaction with institutional leaders (eg, other chairs, deans, hospital leadership); fundraising; faculty management (eg, recruitment, retention, annual evaluations, productivity, dismissal); and personal issues (eg, work-life balance, stepping down, retirement). The Senior Fellows Group also has participated actively in essentially all Association of Pathology Chairs programs, committees, fundraising, and projects. The organized structure and function of the Senior Fellows Group has been of significant value to the membership of the Association of Pathology Chairs, as well as to the participating former chairs, and may provide a model for other academic organizations to utilize this important resource.

Serving as a Temporary Pathology Chair: "Boon" or "Boondoggle"?

The 2019 Association of Pathology Chairs Annual Meeting included a discussion group sponsored by the Senior Fellows Group (former chairs of academic departments of pathology who have remained active in Association of Pathology Chairs) that was focused on serving as temporary pathology chair. Such positions include "acting chair" (service while the permanent chair is on leave or temporarily indisposed), "interim chair" (service after departure of the prior chair and before a new chair is appointed), "term-limited chair" (usually one nonrenewable term of less than 5 years), and "terminal chair" (permanent chair being asked to stay until a successor is appointed). Discussion group panelists represented each of these positions and included the perspective of 3 former deans about the rationale for making such appointments. The potential benefits and risks of serving in these roles were discussed. Issues addressed included acting as "caretaker manager" or "change-agent leader"; whether such service and experience would enhance or harm one's chances to become a permanent chair of that or another department; the effect of such service on academic productivity; the influence of department and institutional factors on the position; the range of authority provided, particularly in addressing significant problems affecting the department's future; and the impact of time served in these various positions. The "lame-duck" effect of prolonged service as "terminal chair" was also discussed. The observations and advice provided by the panelists and audience discussion are reported and may be useful for those considering service as temporary chair in pathology as well as other academic leadership positions.

Life After Being a Pathology Department Chair III: Reflections on the "Afterlife".

The Association of Pathology Chairs Senior Fellows Group provided reflections on activities that have kept them engaged and inspired after stepping down as chair. They offered advice to current chairs who were considering leaving their positions and also to individuals contemplating becoming pathology chairs. A majority (35/41) responded: 60% maintained teaching/mentoring activities; 43% engaged in hobbies; 40% took other administrative positions including deans, medical center chief executive officers, and residency program directors; 31% continued research; 28% wrote books; 20% performed community service; 14% led professional organizations; 14% developed specialized programs; 11% engaged in clinical service; and 11% performed entrepreneurial activities. Most individuals had several of these activities. One-third indicated that those considering becoming chair should be able to place faculty and department needs before their own. One-fourth emphasized the need to know why one wants to become chair, the need to develop clear goals, and the need to know what one wants to accomplish as chair before applying for and accepting the position. More than half (57%) indicated that before stepping down as chair, one should have a clear plan and/or professional goals that can be served by stepping down. Some even suggested that this be in place before applying for the chair. Almost two-thirds (63%) indicated they had no regrets stepping down as chair. These findings may be valuable to those contemplating stepping down from or stepping into any department chair position or other academic leadership role.

What Advice Current Pathology Chairs Seek From Former Chairs.

The 2018 Association of Pathology Chairs annual meeting included a panel discussion of Association of Pathology Chairs senior fellows (former chairs of academic departments of pathology who have remained active in Association of Pathology Chairs) about the type of advice that current (sitting) pathology chairs ask them. To inform the panel discussion, information was obtained from the senior fellows by e-mail and subsequent conference call. Of the 33 respondents, 24 (73%) had provided consultation advice (9, <5; 11, 5-10; 2, 10-20; and 2, >20). Most (>75%) of the consultations were provided face-to-face and outside the framework of Association of Pathology Chairs, with 70% of those seeking advice being well known by the consultant(s). Of the senior fellows providing advice, 71% had themselves sought consultation from former pathology chairs and 75% from nonpathology chairs. Modest correlation was found between the number of consultations senior fellows sought when they were chairs and the number of consultations they subsequently provided. The most frequent topics of consultation were strategic planning, balancing the missions, setting department priorities, recruitment of faculty and staff, conflict management, issues specific to new chairs, and resource (money/space) issues. Those who had provided such advice the longest and to the most people indicated that there was no significant change in the type of questions asked over time. Former department chairs can be a valuable source of counseling for current chairs, and organizations of department chairs should consider formalizing the use of these individuals as consultants to sitting chairs.

Life After Being a Pathology Department Chair II: Lessons Learned.

The 2016 Association of Pathology Chairs annual meeting featured a discussion group of Association of Pathology Chairs senior fellows (former chairs of academic departments of pathology who have remained active in Association of Pathology Chairs) that focused on how they decided to transition from the chair, how they prepared for such transition, and what they did after the transition. At the 2017 annual meeting, the senior fellows (encompassing 481 years of chair service) discussed lessons they learned from service as chair. These lessons included preparation for the chairship, what they would have done differently as chair, critical factors for success as chair, factors associated with failures, stress reduction techniques for themselves and for their faculty and staff, mechanisms for dealing with and avoiding problems, and the satisfaction they derived from their service as chair. It is reasonable to assume that these lessons may be representative of those learned by chairs of other specialties as well as by higher-level academic administrators such as deans, vice presidents, and chief executive officers. Although the environment for serving as a department chair has been changing dramatically, many of the lessons learned by former chairs are still valuable for current chairs of any length of tenure.

Life After Being a Pathology Department Chair: Issues and Opportunities.

Although there is a considerable literature on transition of faculty members to the position of department chair, there is a dearth of publications about transitioning from the chair to other activities including retirement. The Association of Pathology Chairs senior fellows (all of whom are former chairs of academic departments of pathology) made this topic a focus of discussion at the Association of Pathology Chairs 2016 Annual Meeting. Of the 33 senior fellows engaged in this discussion, following their time as chairs, a small majority (18) transitioned to other administrative posts within or outside the university, while the others either returned to the active faculty (7) or retired (8). The motivating factors and influences for transitioning from the chair were probed along with the processes used in executing the transition, such as the development of transition plans. The reasons for selecting the specific type of postchair activity were also investigated. There was extraordinary diversity in the type of post-chair activities pursued. To our knowledge, no other medical specialty has examined these issues, which may be potentially relevant for the career planning of active chairs.

Studies of the extraction of bilirubin from human amniotic fluid.

The recovery of unconjugated bilirubin from human amniotic fluid was studied using dichloromethane, chloroform/isopropanol (3:1 vol/vol), and chloroform/ methanol (3:1 vol/vol) extraction of human amniotic fluid that had been supplemented with bilirubin at various concentrations. Results were compared with those obtained with conventional chloroform extraction. Mean recoveries were found to be only 28% for chloroform and 25% for dichloromethane. When the polarity of chloroform was increased by the addition of an alcohol, the mean recovery increased to only 40% for chloroform/isopropanol and 38% for chloroform/ methanol. These results suggest that extraction methods for determination of amniotic fluid "delta OD(450)" (visible spectrophotometric absorbance [optical density] of bilirubin at 450 nm) tend to underestimate the result when compared with the nonextraction (direct-scan) method, on which the Liley Prognostication Chart is based. This finding should be clinically significant, particularly if extraction and direct-scan methods are used to monitor the condition of the same patient.

Studies of the inhibition of serum pseudocholinesterase activity in vitro by commonly used drugs.

We studied the effect of 17 commonly used drugs, including prescription and over-the-counter medications, on the activity of serum pseudocholinesterase (PCE) in vitro. Normal pooled human serum was incubated for 120 minutes at 37 degrees C with therapeutic serum concentrations of prescription and over-the-counter drugs, and the postincubation PCE activity was measured. Morphine, quinidine, and thioridazine depressed PCE activity by more than 5% while no or negligible effect was noted following incubation with acetaminophen, chlordiazepoxide, chlorpromazine, desipramine, doxepin, imipramine, methamphetamine, nortriptyline, phenobarbital, phenytoin, procainamide, salicylic acid, theophylline, and valproic acid. Depression of PCE activity can prolong the half-life of coadministered agents with metabolism mediated by PCE.

Valproic acid binding to human serum and human placenta in vitro.

The binding characteristics of the antiepileptic agent and teratogen valproic acid for human serum and human placenta were investigated utilizing equilibrium dialysis of the drugs in serum and in homogenates of whole placenta so that the transplacental transfer of the drug could be better defined. A low-capacity, high-affinity binder and a high-capacity, low-affinity binder for valproic acid were found in serum. However, there was only minimal, nonspecific binding of the drug to placenta. It appears that transplacental transfer of valproic acid is not mediated by binding to placenta. It is likely that such transfer occurs by passive diffusion, which may be facilitated by the lipophilicity of the drug and by development of a pH gradient across the placenta. These findings indicate that the placenta is not a depot for valproic acid.

The effect of lovastatin and thioridazine on the degradation of cocaine in human serum in vitro.

The effect of lovastatin and thioridazine on the degradation of cocaine in human serum was studied by incubating therapeutic and toxic concentrations of either drug with cocaine in human serum at 37 degrees C. Without these other drugs, cocaine concentrations decreased by an average of 88% in 120 minutes. Lovastatin at all concentrations studied showed a negligible effect on the degradation of cocaine in human serum and did not alter the pseudocholinesterase activity of the serum. In contrast, in the presence of a therapeutic concentration of thioridazine, cocaine concentrations decreased by only 71% during this period of time, and, with a toxic concentration of thioridazine, cocaine concentrations decreased by only 55%. Thioridazine suppressed the pseudocholinesterase activity of human serum by up to 19% during the 120-minute incubation period, and this effect was more pronounced at higher thioridazine concentrations. These findings suggest that thioridazine may prolong the serum half-life of cocaine by inhibiting the pseudocholinesterase-mediated catabolism of cocaine to ecgonine methyl ester. This may be important in cocaine users who are treated with phenothiazines and other structurally similar drugs. They also may be of interest in cocaine-abusing patients who are treated with phenothiazines for schizophrenic disorders.

The binding of acetaminophen, lidocaine, and valproic acid to human milk.

The binding of acetaminophen, lidocaine, and valproic acid to pooled normal mature human milk was studied in vitro by using equilibrium dialysis. Scatchard analysis revealed high-affinity, low-capacity binding for acetaminophen (Ka [affinity constant of association], 1.47 x 10(4) L/mol; Bo [concentration of binding sites], 9.01 x 10(-4) mol/L) and some minimal, nonspecific binding. Binding ranged up to 85%. For lidocaine, low-affinity, high-capacity binding was noted (Ka, 1.42 x 10(2) L/mol; Bo, 1.69 x 10(-2) mol/L). Binding ranged up to 72%. For valproic acid, only minimal, nonspecific binding was noted at low drug concentrations with binding ranging up to 64%. The binding of these drugs to milk might enhance their excretion and subsequent ingestion by infants who are breast-fed. In addition, the low pH of the milk (6.24) may cause "ion trapping" of acetaminophen (pKa, 9.5) and lidocaine (pKa, 7.9).

Gentamicin and tobramycin binding to human serum in vitro.

The binding of gentamicin and tobramycin to human serum was studied in vitro using equilibrium dialysis of pooled human serum supplemented to various concentrations of either drug. Only minimal and variable non-specific binding was noted for each drug: gentamicin, less than 15% and tobramycin, less than 30%. Conventional Scatchard analysis conducted over an array of drug concentrations failed to identify any specific binding proteins.