Commitment to inclusion: The importance of collaboration in gender equity work.

Despite decades of faculty professional development programs created to prepare women for leadership, gender inequities persist in salary, promotion, and leadership roles. Indeed, men still earn more than women, are more likely than women to hold the rank of professor, and hold the vast majority of positions of power in academic medicine. Institutions demonstrate commitment to their faculty's growth by investing resources, including creating faculty development programs. These programs are essential to help prepare women to lead and navigate the highly matrixed, complex systems of academic medicine. However, data still show that women persistently lag behind men in their career advancement and salary. Clearly, training women to adapt to existing structures and norms alone is not sufficient. To effectively generate organizational change, leaders with power and resources must commit to gender equity. This article describes several efforts by the Office of Faculty in the Johns Hopkins University School of Medicine to broaden inclusivity in collaborative work for gender equity. The authors are women and men leaders in the Office of Faculty, which is within the Johns Hopkins University School of Medicine dean's office and includes Women in Science and Medicine. Here, we discuss potential methods to advance gender equity using inclusivity based on our institutional experience and on the findings of other studies. Ongoing data collection to evaluate programmatic outcomes in the Johns Hopkins University School of Medicine will be reported in the future.

Identifying Gender Disparities and Barriers to Measuring the Status of Female Faculty: The Experience of a Large School of Medicine.

Background: Women in academic medicine are not attaining parity with men in several domains. This issue is not only one of fairness; some funding agencies are requesting data on gender benchmarking. However, most published reports on gender disparities have not included examination of trends or actionable recommendations to address them. Materials and Methods: The Dean of the Johns Hopkins University School of Medicine charged the Committee on the Status of Women (CSW) with conducting a comprehensive review of gender equity. In 2014, the CSW identified key domains important for academic success and created a sustainable framework to monitor trends by gender. Utilizing data from multiple key sources, the CSW measured differences in the domains of academic promotion, leadership, and satisfaction. Results: Gender differences were present in each domain. Data were not centralized and not readily available for most domains. The CSW recommended strategies to address gender disparities and created a set of measurable recommendations to monitor progress. The recommendations include requiring detailed descriptions of departmental organizational leadership charts; diverse compositions of both search committees and applicant pools; increased proportion of female faculty in top-tier leadership positions; and transparent departmental promotions criteria and processes. Conclusions: To maintain progress, we recommend that data be readily and easily accessible from a central institutional registry rather than come from multiple sources, that data be analyzed on a regular basis, and that results be shared across the institution to ensure transparency and accountability.

The impact of working part-time on measures of academic productivity among general internists.

BACKGROUND: There is increased interest in part-time (PT) positions at academic medical centers (AMCs). Faculty and institutional leaders may have concerns about the potential for academic advancement among PT faculty. Our objective was to determine the impact of working PT on measures of academic productivity. METHODS: A cross-sectional survey was mailed to PT and full-time (FT) physicians in U.S. divisions of general internal medicine. Outcome measures included publications and funding. We used multivariate analysis to identify factors associated with academic productivity. RESULTS: The response rate was 63% (176 of 279); 91% of respondents were women (160 of 176). Compared with FT faculty, PT faculty were more often clinicians (Cs) or clinician-educators (CEs) (78% vs. 96%, p < 0.001), were less likely to be fellowship trained (44% vs. 23%, p < 0.001), and reported less academic support, including administrative assistance (84% vs. 67%, p = 0.008), mentoring (71% vs. 54%, p = 0.02), and research support (43% vs. 25%, p = 0.01). PT faculty spent a greater percentage of their time in patient care (55% vs. 45%, p = 0.01) and teaching (32% vs. 23%, p = 0.01) and less time in research activities (5% vs. 15%, p = 0.01) compared with FT faculty. Among Cs and CEs, FT faculty reported more publications (median 2, interquartile range [IQR 5] vs. median 0, IQR 1, p < 0.001) and funding (odds ratio [OR] 2.85, 95% confidence internal [CI] 1.36-5.98). Multivariate analyses showed that fellowship training, mentors, academic support, and number of total years worked were associated with publications and acquisition of funding. There were no associations between working PT and publications or funding. CONCLUSIONS: PT faculty report fewer publications and grants. This may be related to insufficient training and academic support. AMCs wanting to facilitate the success of their PT faculty may need to expand the support available to them.

Association between funding and quality of published medical education research.

CONTEXT: Methodological shortcomings in medical education research are often attributed to insufficient funding, yet an association between funding and study quality has not been established. OBJECTIVES: To develop and evaluate an instrument for measuring the quality of education research studies and to assess the relationship between funding and study quality. DESIGN, SETTING, AND PARTICIPANTS: Internal consistency, interrater and intrarater reliability, and criterion validity were determined for a 10-item medical education research study quality instrument (MERSQI). This was applied to 210 medical education research studies published in 13 peer-reviewed journals between September 1, 2002, and December 31, 2003. The amount of funding obtained per study and the publication record of the first author were determined by survey. MAIN OUTCOME MEASURES: Study quality as measured by the MERSQI (potential maximum total score, 18; maximum domain score, 3), amount of funding per study, and previous publications by the first author. RESULTS: The mean MERSQI score was 9.95 (SD, 2.34; range, 5-16). Mean domain scores were highest for data analysis (2.58) and lowest for validity (0.69). Intraclass correlation coefficient ranges for interrater and intrarater reliability were 0.72 to 0.98 and 0.78 to 0.998, respectively. Total MERSQI scores were associated with expert quality ratings (Spearman rho, 0.73; 95% confidence interval [CI], 0.56-0.84; P < .001), 3-year citation rate (0.8 increase in score per 10 citations; 95% CI, 0.03-1.30; P = .003), and journal impact factor (1.0 increase in score per 6-unit increase in impact factor; 95% CI, 0.34-1.56; P = .003). In multivariate analysis, MERSQI scores were independently associated with study funding of $20 000 or more (0.95 increase in score; 95% CI, 0.22-1.86; P = .045) and previous medical education publications by the first author (1.07 increase in score per 20 publications; 95% CI, 0.15-2.23; P = .047). CONCLUSION: The quality of published medical education research is associated with study funding.

Facing the malpractice crisis: academic physicians' willingness to accept quick fix solutions.

BACKGROUND: We sought to determine the willingness of academic physicians to accept strategies to contain institutional malpractice costs. METHODS: We surveyed all 270 Department of Medicine physicians at a large academic center. Respondents were asked about their knowledge regarding malpractice premiums, willingness to reduce patient-care activities and accept decreases in compensation. RESULTS: The response rate was 80%. Respondents estimated the annual increase in malpractice premiums from 2004 to 2005 to be 29%. The true increase was 28% (P = 0.55). Almost all opposed eliminating patient care (95%) or providing patient care every other year at double effort and withdrawing from patient care on alternate years (97%). Seventy percent would limit their clinical procedures. Most physicians opposed salary reduction (97%) or decreases in fringe benefits (99%). CONCLUSIONS: Few academic physicians are willing to limit patient care or accept decreases in compensation to recoup institutional malpractice costs.

Factors associated with citation of internal medicine residency programs for lack of scholarly activity.

BACKGROUND: The Accreditation Council for Graduate Medical Education requires that residents demonstrate scholarly activity prior to completion of training. PURPOSE: To determine which factors are associated with program citation for failure to comply with the Residency Review Committee (RRC) scholarly activity requirement for internal medicine residencies. METHODS: All 391 internal medicine residency program directors were surveyed in March 2002. Data were collected on program characteristics and factors (research curriculum, research director, faculty mentors, protected time for research, funding, and presence of a mandatory research requirement) that have been associated with successful resident research. Multiple logistic regression analysis identified factors associated with citation. RESULTS: The response rate was 78%. Ten percent of respondents report having been cited for lack of demonstration of scholarly activity. Factors that reduced the odds of citation were being a university-based program, odds ratio (OR) 0.13, 95% confidence interval (CI) 0.03-0.54, p = .005; having a greater number of residents, OR 0.95, 95% CI 0.93-0.98, p = .001; and having funding to support resident scholarship, OR 0.39, 95% CI 0.17-0.91, p = .03. Using multiple logistic regression analysis, having designated funding for resident scholarship was the only factor independently associated with a decreased odds of citation, OR 0.27, 95% CI 0.10-0.72, p = .009. CONCLUSIONS: To improve compliance with the RRC requirement for scholarly activity and avoid citation, residency programs may wish to consider devoting more resources, particularly money, to support resident scholarly activity.

Costs and funding for published medical education research.

CONTEXT: The Institute of Medicine has called for increased rigor of education research and funding to support educational innovation. However, funding for medical education research is scarce. The costs of conducting studies in medical education and how such research is currently funded have not been systematically evaluated. OBJECTIVES: To determine how medical education research studies that were recently published were funded and to approximate the costs of conducting these studies. DESIGN, SETTING, AND PARTICIPANTS: We conducted a cross-sectional survey of first authors of medical education studies published from September 1, 2002, to December 31, 2003. Original medical education research studies conducted at US institutions and published in 13 prominent peer-reviewed journals were included. MAIN OUTCOME MEASURES: For each study we measured duration, percentage of the authors' total work commitment ("percentage effort") devoted to the study, resources used and their costs, attainment of funding, and the first author's estimated cost of conducting the study. The cost of each study was calculated by multiplying the percentage effort of each author for the duration of the study by the national median salary for each author, according to specialty and academic rank, and then adding the costs of resources used. RESULTS: Responses were received from authors of 243 (84%) of 290 identified medical education studies. The median calculated cost of conducting the 243 studies was 24,471 dollars (interquartile range [IQR], 11,531 dollars-63 808 dollars). The median authors' estimate of study cost was 10,000 dollars (IQR, 4000 dollars-25 000 dollars). Some funding was obtained for 72 (29.6%) of the studies. Of studies that were funded, the median amount of funding was 15,000 dollars (IQR, 5000 dollars-66,500 dollars). The median calculated cost of funded studies was 37,315 dollars (IQR, 18,731 dollars-82,393 dollars). Private foundation grants were the most common funding source (n = 30 [41.7%]). Factors independently associated with attaining funding were training in grant writing (odds ratio, 2.05; 95% confidence interval, 1.11-3.79) and number of medical education studies published by the first author (odds ratio, 2.4; 95% confidence interval, 1.24-4.63). CONCLUSIONS: The majority of published medical education research is not formally funded, and the studies that do receive support are substantially underfunded. To realize the Institute of Medicine's directive and to improve the quality of medical research, policy reform that increases funding for medical education scholarship will likely be required.