A system-wide health sciences faculty mentor training program is associated with improved effective mentoring and institutional climate.

Introduction: Mentorship is critical for faculty success, satisfaction, and engagement. However, many faculty, particularly underrepresented racial/ethnic (UR) faculty, lack access to high-quality mentoring. In an effort to improve mentoring for all faculty, we developed and implemented a formally structured faculty mentor training program (FMTP) across UC San Diego Health Sciences, which included institutional support, mentorship training, and department/division mentorship programs. Methods: FMTP impact was evaluated using three primary outcome variables: mentoring quality, mentoring behaviors, and institutional climate. Participants' self-assessed mentoring competencies were measured using validated instruments. Results: A total of 391 (23%) of Health Sciences faculty participated in FMTP. Participation rate was higher for women than men (30% versus 17%) and highest for UR faculty (39%). FMTP was implemented in 16 of 19 departments. Self-reported mentoring improved for FMTP participants with mentoring quality (p = 0.009) and meeting mentees' expectations (p = 0.01) continuing to improve for up to 2 years after training. However, participants were unsure if they were meeting UR mentees' expectations. FMTP participants were significantly more satisfied with mentoring quality (p < 0.001) compared to non-participants, with the greatest increase in satisfaction reported by UR faculty (38-61%). UR faculty reported improved overall morale (51-61%) and a perception that the environment was supportive for UR faculty (48-70%). Conclusion: The implementation of a system-wide formal structured FMTP was associated with improved faculty satisfaction, quality of mentoring, and institutional climate, especially for UR faculty.

Faculty Equity, Diversity, Culture and Climate Change in Academic Medicine: A Longitudinal Study.

There is a national call for academic medicine to use evidence-based initiatives to improve its culture and climate. The authors report data-driven policy and programmatic interventions that were associated with increased faculty diversity, equity, respectful behavior and improved faculty climate, at UC San Diego Health Sciences. METHODS: Based on demographic and survey data, interventions were designed to improve the climate between 2005 and 2015. Interventions included routine measuring and dissemination of demographic data, changes and dissemination of policy and procedures, and new and improved faculty development programming. Impact was measured using demographic data over time, salary equity studies, and school-wide climate surveys in 2005, 2011, and 2015. Specific outcomes included measures of diversity, salary equity, behavior, and climate. RESULTS: Over the ten-year period, the proportion of women increased from 16% to 23% of tenure/tenure-track faculty and 31%-40% of all faculty. Underrepresented minority faculty increased from less than 1%-7% of tenure/tenure-track faculty and from 5% to 8% of all faculty. While women continued to be paid less than men, the adjusted difference dropped from 23% to 12%. Reports of inappropriate behavior by faculty decreased significantly, while satisfaction and knowledge about institutional mentoring and resources improved. CONCLUSION: Multiple interventions including new faculty development programs, changes in policy, and measuring demographics/climate supported diverse faculty recruitment, enhanced a culture of respect and improved faculty morale. Cultural changes in policy, periodic faculty data collection with dissemination, and increased faculty development, improve the climate in academic medicine.

The Culture of Academic Medicine: Faculty Behaviors Impacting the Learning Environment.

OBJECTIVE: The culture of academic medical institutions impacts trainee education, among many other faculty and patient outcomes. Disrespectful behavior by faculty is one of the most challenging and common problems that, left unattended, disrupts healthy work and learning environments. Conversely, a respectful environment facilitates learning, creates a sense of safety, and rewards professionalism. The authors developed surveys and an intervention in an effort to better understand and improve climate concerns among health sciences faculty at the University of California, San Diego (UCSD), a research-intense, public, academic medical center. METHODS: An online "climate survey" of all UC San Diego health sciences faculty was conducted in 2011-2012. A strategic campaign to address the behavioral issues identified in the initial survey was subsequently launched. In 2015, the climate was re-evaluated in order to assess the effectiveness of the intervention. RESULTS: A total of 478 faculty members (223 women, 235 men, 35 % of faculty) completed the baseline survey, reporting relatively low levels of observed sexual harassment (7 %). However, faculty reported concerning rates of other disruptive behaviors: derogatory comments (29 %), anger outbursts (25 %), and hostile communication (25 %). Women and mid-level faculty were more likely to report these behavioral concerns than men and junior or senior colleagues. Three years after an institutional strategy was initiated, 729 faculty members (50 % of the faculty) completed a follow-up survey. The 2015 survey results indicate significant improvement in numerous climate factors, including overall respectful behaviors, as well as behaviors related to gender. CONCLUSIONS: In order to enhance a culture of respect in the learning environment, institutions can effectively engage academic leaders and faculty at all levels to address disruptive behavior and enhance positive climate factors.

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.

Measuring faculty retention and success in academic medicine.

PURPOSE: To develop and demonstrate the usefulness of quantitative methods for assessing retention and academic success of junior faculty in academic medicine. METHOD: The authors created matched sets of participants and nonparticipants in a junior faculty development program based on hire date and academic series for newly hired assistant professors at the University of California, San Diego (UCSD), School of Medicine between 1988 and 2005. They used Kaplan-Meier and Cox proportional hazards survival analyses to characterize the influence of covariates, including gender, ethnicity, and program participation, on retention. They also developed a new method for quantifying academic success based on several measures including (1) leadership and professional activities, (2) honors and awards, (3) research grants, (4) teaching and mentoring/advising activities, and (5) publications. The authors then used these measures to compare matched pairs of participating and nonparticipating faculty who were subsequently promoted and remained at UCSD. RESULTS: Compared with matched nonparticipants, the retention of junior faculty who participated in the faculty development program was significantly higher. Among those who were promoted and remained at UCSD, the academic success of faculty development participants was consistently greater than that of matched nonparticipants. This difference reached statistical significance for leadership and professional activities. CONCLUSIONS: Using better quantitative methods for evaluating retention and academic success will improve understanding and research in these areas. In this study, use of such methods indicated that organized junior faculty development programs have positive effects on faculty retention and may facilitate success in academic medicine.

A conceptual model for faculty development in academic medicine: the underrepresented minority faculty experience.

In May 2010, the Association of American Medical Colleges reported that nonwhite professors have a lower promotion rate than white professors. A cohort of 30 underrepresented minority (URM) junior faculty who participated in a structured faculty development program at a public, research-intensive, academic medical center were followed in a 10-year longitudinal study. This paper reports on the career status of 12 of the 30 URM faculty who were eligible for promotion during this period. Ninety-two percent (11/12) of URM faculty eligible for promotion were promoted to associate professor. When asked what factors contributed to their success, these URM faculty identified access and support of senior faculty mentors, peer networking, professional skill development, and knowledge of institutional culture. A faculty development program that addresses these components can promote the success of URM faculty in academic medicine.

Increasing the capacity of health sciences to address health disparities.

In order to create a cohort of investigators who are engaged in health disparities research, scholarship, and practice, and to increase the amount of funding in the university that is invested in research focused on reducing health disparities, the San Diego EXPORT Center implemented 2 major initiatives: (1) the support of underrepresented minority (URM) junior faculty development and (2) the funding for pilot research grants in health disparities. This paper describes the activities employed by the center and summarizes the outcomes of these two initiatives. Ninety-five percent (18 of 19) URM junior faculty completed the faculty development program, and 83.3% (15 of 18) of the completers are advancing in their academic careers at University of California San Diego (UCSD) and are teaching, working with populations at risk and/or conducting research in health disparities. EXPORT awarded 7 investigators a total of $429186 to conduct pilot research, and 71.4% (5/7) have now obtained $4.7 million in independent extramural funding. The San Diego EXPORT Center has increased the research capacity, strengthened the infrastructure for health disparities research, and created a cohort of successful URM junior faculty who are advancing in their academic careers. These investigators are already changing the climate at UCSD by their leadership activities, research focus, peer-networking, and mentoring of students.

Translating operational research to the medical community: using "guiding measurements" to improve the quality of healthcare delivery.

Despite the ubiquity problems with pay-for-performance and other quality improvement initiatives, there is little in the way of objective evidence that these efforts have improved the quality of care. In part, it may be because the measurements selected are used to "grade" instead of guide improvement efforts. We propose using operational research methods that include how to develop "guiding measurements" to improve care. We show that use of this type of guiding measurements can lead to improved patient understanding, throughput, and satisfaction in a pediatric nephrology ambulatory care clinic, and may have wider applications across the continuum of care.

Overlapping presentation of fungal tubulointerstitial nephritis in an immunosuppressed pediatric patient.

With the expanding use of immunosuppressive therapies and broad-spectrum antibiotics, Candida species has become an increasingly important cause of infections, particularly in the presence of anti-tumor necrosis factor-alpha therapy. We report the case of a 17-year-old female with ulcerative colitis who developed oliguric renal failure following immunosuppressive and nephrotoxic therapy. Although urine cultures and urinary tract imaging were negative in the face of fungemia, renal biopsy was the key to establishing the diagnosis of fungal tubulo-interstitial nephritis as the primary reversible cause of the renal failure.

Retention of junior faculty in academic medicine at the University of California, San Diego.

PURPOSE: To measure overall retention of junior faculty and evaluate the effects of a junior faculty development program on the retention of junior faculty at one institution. METHOD: Quantitative survival analysis techniques were used to characterize retention of all new assistant professors hired at the University of California, San Diego (UCSD) School of Medicine for 18 years between July 1988 and December 2005, and the influence on retention of a junior faculty development program established in 1998. Data available included initial hire date, gender, ethnicity, participation in the faculty development program, and date of separation from UCSD. Actuarial Kaplan-Meier survival and Cox proportional hazard analyses were used to characterize retention and the influence of covariates up to the end of the probationary period, eight years after initial hire date. RESULTS: For the 839 new assistant professors, participation in the faculty development program and being hired after July 1997 had significant effects on retention. After adjusting for hire date, gender, and ethnicity, faculty participating in the faculty development program were 67% more likely to remain at UCSD at the end of their probationary period compared with nonparticipating faculty. CONCLUSIONS: Faculty development programs for junior faculty in academic medicine can have positive effects on faculty retention and may facilitate success in academic medicine.

Chronic kidney disease in the VACTERL association: clinical course and outcome.

Approximately 60% of VACTERL (vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula with atresia, renal defects/radial limb dysplasia) patients have renal anomalies that can be associated with chronic kidney disease (CKD). With improved medical care, a large proportion of these patients survive into adulthood. Longitudinal follow-up data regarding the management of kidney disease in these children is lacking. Twelve VACTERL patients with CKD stage 2-5 and 12 age-matched controls with similar urologic anomalies and CKD [mean follow-up period 15.0 +/- 1.4 (SE) and 11.9 +/- 2.1 years, respectively] were identified in a single center. Eight VACTERL patients progressed to end-stage renal disease (ESRD) compared to four controls (66.7 vs. 33.3%, respectively). Six VACTERL patients were dialyzed pre-transplant. Of the four patients on peritoneal dialysis (PD), three had to be switched to hemodialysis due to complications, whereas two of the three controls on PD did not experience significant problems. Seven VACTERL patients underwent renal transplantation compared to four controls. Mean creatinine clearance 2 years post-transplant was 65.8 +/- 6.3 in VACTERL patients vs. 87.8 +/- 7.1 ml/min per 1.73 m(2) in controls (p = 0.03). VACTERL patients had a significantly lower mean height standard deviation score than the controls (-2.34 +/- 0.41 vs. -1.27 +/- 0.24, respectively; p < 0.05). Based on these results, VACTERL patients with CKD develop ESRD more frequently, experience more complications with dialysis, may have a poorer transplant outcome, and have more severe growth failure than controls.

Career experiences and perceptions of underrepresented minority medical school faculty.

BACKGROUND: Although studies have outlined the benefit of diversity in academic medicine, the number of underrepresented minority (URM) faculty remains low. In 1998, University of California, San Diego (UCSD) School of Medicine with the Hispanic Center of Excellence began a formalized proactive faculty development program. Over the past 10 years, recruitment and retention of URM junior faculty have increased. We undertook a study to explore factors associated with this improvement. METHODS: Semistructured interviews were conducted with 18 out of 26 URM and 12 out of 26 randomly chosen non-URM assistant and associate faculty members throughout 2005. Interview content, based on a conceptual framework from Joanne Moody, included career path, knowledge and experience with faculty development programs and perceived faculty standing. RESULTS: URM faculty were more likely than majority faculty (44% vs. 8%, p = 0.04) to mention the importance of a role model in choosing their career path. URM faculty participated in faculty development programs at a higher rate than majority faculty (78% vs. 17%, p < 0.001), were more likely to find out about programs through personal contact (94% vs. 42%, p = 0.001) and reported more personal contacts prior to participation (78% vs. 33%, p = 0.02). URM faculty were older, graduated earlier and were more likely hired into a staff position prior to faculty appointment (61% vs. 17%, p = 0.02). CONCLUSIONS: Academic medical centers may find competitive URM candidates in staff positions and alternative faculty tracks within their institution. Informing URM faculty often and personally about opportunities for faculty development may increase their participation in career development programs and improve retention.

Engaging Latino residents to build a healthier community in mid-city San Diego.

Faculty and staff from the University of California, San Diego Academic Center of Excellence on Youth Violence Prevention partnered with a local collaborative, the Mid-City Community Advocacy Network, to build the capacity of the community to identify quality of life issues and advocate for change. In an effort to train and mobilize community residents effectively in the skills needed to engage in advocacy and systems change, the traditional delivery model of community engagement (surveys, focus groups, large and small forums, health fairs, and street fairs) was replaced with culturally specific, active engagement strategies. Engaging diverse communities in Mid-City (Latino, Somali, and Vietnamese) required an approach that included hiring bilingual, bicultural staff recruited from those communities, hosting meetings in residents' homes, and providing extensive leadership training and support for residents. This community resident leadership initiative, piloted in the Latino community of mid-city San Diego, was successful in engaging resident participation in the process. This paper outlines the lessons learned from this initiative.

Incorporating the experiences of youth with traumatic injury into the training of health professionals.

Youth violence and related injury continue to be a serious public health problem and are identified as a major priority on the national health care agenda. Despite recommendations by numerous professional organizations to enhance healthcare professionals' roles in youth violence prevention efforts, there has been little documentation of effective training. To address this gap, the University of California, San Diego Department of Pediatrics (UCSD) partnered with San Diego-based Sharp HealthCare's Institute for Injury & Violence Prevention Think First San Diego in a novel program. As part of a panel that highlighted violence as a public health problem and a physician's responsibility in youth violence prevention, youth disabled by violence told fourth year medical students about opportunities for direct intervention in the lives of victims and perpetrators. The personal stories these young people tell of the effect of violence on individuals is a valuable training tool and a powerful way of humanizing the situation. Their participation also highlights physicians' opportunities for intervention and responsibility in directly addressing adolescents at risk.

Ethnic differences and treatment trajectories in chronic kidney disease.

Little is known about barriers to care experienced by Latino children with chronic kidney disease (CKD). We conducted a qualitative study with children with CKD and their families to elucidate conceptions about disease process, expression, and treatment; perceived access to care barriers; and potential for treatment non-adherence. Semi-structured interviews were conducted with 42 individuals from 28 family units treated for CKD in San Diego, California. Transcripts were analyzed by coding consensus, co-occurrence, and comparison. Latino patients cited pre-diagnosis barriers in accessing primary and subspecialty care not mentioned by non-Latino Whites. Whites described a pro-active style of interacting with the health care system not mentioned by Latinos. There were no differences apparent in reports of medication adherence, but both groups emphasized the importance of extended social networks in adhering to treatment regimens. Families' perspectives provide valuable information that can serve future studies and interventions for improving care for children with CKD.

Should we measure the individual or the system? Operational factors affecting compliance with treatment.

Chronic kidney disease requires a complex array of treatment interventions, including dietary and fluid restriction, medications, and self-monitoring of blood pressure. Patient well-being is directly linked to adhering to physician recommendations and treatment schedules. While considerable efforts have been directed to understanding the contribution of patient characteristics, burden of treatment, and patient-provider relations, little study has been conducted on the "system" requirements that support good patient-provider communication. This study examines how operational characteristics occurring at the time of an encounter affect the likelihood a patient will "hear" provider recommendations.

Youth violence prevention comes of age: research, training and future directions.

Youth violence is recognized as a major public health problem in the United States and the world. Over the past ten years, progress has been made in documenting the factors that contribute to violent behavior. Emerging research is deepening our understanding of the individual and societal influences that contribute to and protect against youth violence. However, much work still remains to be done in this field, both in examining potential causes and in designing effective intervention strategies. This chapter highlights specific dimensions of youth violence prevention selected by the authors because these dimensions are the focus of public attention, are emerging as critical issues in the study of youth violence, or have a unique place in the current political and social context. We focus on the developmental pathways to violence, factors that mediate and moderate youth violence, the role of culture and media in youth violence, school-based violence such as school shootings and bullying, and the training of health care professionals.

Evaluation of residency training in the delivery of culturally effective care.

OBJECTIVE: To augment resident training in the delivery of culturally effective care in order to improve clinician capacity to effectively care for patients from diverse backgrounds. METHODS: Residents from the Naval Medical Center San Diego and the University of California San Diego participated in experiential learning and service activities. Programme evaluation assessed aspects of the delivery of culturally effective care in community settings. A community-based participatory approach to engaging residents in the delivery of culturally effective care and evaluation of the effectiveness of this approach are described. RESULTS: A significant pre-post rotation increase was noted in residents' self-perceived ability to identify culture-related issues that may impact on the patient's view of illness (P<0.001) and ability to address a culture-related issue (P<0.001). Community evaluations rated residents positively on behaviours that reflected communication skills and professionalism, but less positively on knowledge about communities. CONCLUSIONS: The authors conclude that resident exposure to the block rotation curriculum contributes to improved knowledge of the skills necessary to provide culturally effective care in diverse community settings.

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.