The Behavioral and Social Sciences: Contributions and Opportunities in Academic Medicine.

The Association of American Medical Colleges plays a leading role in supporting the expansion and evolution of academic medicine and medical science in North America, which are undergoing high-velocity change. Behavioral and social science concepts have great practical value when applied to the leadership practices and administrative structures that guide and support the rapid evolution of academic medicine and medical sciences. The authors are two behavioral and social science professionals who serve as academic administrators in academic medical centers. They outline their career development and describe the many ways activities have been shaped by their work with the Association of American Medical Colleges. Behavioral and social science professionals are encouraged to become change agents in the ongoing transformation of academic medicine.

Leadership in Academic Health Centers: Transactional and Transformational Leadership.

Leadership is a crucial component to the success of academic health science centers (AHCs) within the shifting U.S. healthcare environment. Leadership talent acquisition and development within AHCs is immature and approaches to leadership and its evolution will be inevitable to refine operations to accomplish the critical missions of clinical service delivery, the medical education continuum, and innovations toward discovery. To reach higher organizational outcomes in AHCs requires a reflection on what leadership approaches are in place and how they can better support these missions. Transactional leadership approaches are traditionally used in AHCs and this commentary suggests that movement toward a transformational approach is a performance improvement opportunity for AHC leaders. This commentary describes the transactional and transformational approaches, how they complement each other, and how to access the transformational approach. Drawing on behavioral sciences, suggestions are made on how a transactional leader can change her cognitions to align with the four dimensions of the transformational leadership approach.

Make the context work for you: faculty in a changing academic medicine landscape.

Academic medicine's landscape is dynamically adjusting. The changes are accelerating and these alterations are impacting both the faculty workforce as a whole and individual faculty members. This article reviews workforce and institutional changes within academic medicine and supports the need for faculty members to adapt to this changing landscape. Resources to maintain an understanding of these ongoing changes are reviewed. A faculty life-cycle model is proposed as a context for developing a personal action plan. Career management steps are suggested to facilitate career productivity and satisfaction. Finally, we propose that psychologists, being human behavior experts, are well positioned to contribute within the transformation of academic medicine.

Advancing Equity in Academic Medicine Through Holistic Review for Faculty Recruitment and Retention.

The Association of American Medical Colleges (AAMC) in 2007 developed the Holistic Review Framework for medical school admissions to increase mission-aligned student diversity. This approach balances an applicant's experiences, attributes, and metrics during the screening, interview, and selection processes. Faculty recruitment provides its own set of challenges, and there is persistent underrepresentation of certain racial and ethnic minority groups and women in faculty and leadership positions in U.S. academic health centers (AHCs). In 2019, the AAMC initiated a pilot program to adapt and implement the framework for use in faculty recruitment at AHCs. In this Invited Commentary, the authors describe the pilot implementation of the Holistic Review Framework for Faculty Recruitment and Retention and share lessons learned to date. Although the pilot proceeded during 2020, institutional implementation was impacted by the COVID-19 pandemic and racial justice movement. Pilot institutions encountered hiring freezes, reductions in funding, and restrictions on in-person meetings due to COVID-19 that resulted in both barriers and opportunities in implementing the framework. Renewed commitment to racial justice was associated with increased momentum and urgency for the implementation of faculty holistic review at the majority of pilot institutions. Common themes from the pilot leads' experiences included the importance of achieving "buy in," having a dedicated implementation team, and being explicit about core values. Other themes included the importance of adaptability and flexibility to meet the needs of different institutions and mission areas. The faculty holistic review framework has shown promise as an approach to advancing faculty diversity goals. The pilot institutions will continue to share best practices, track outcomes, implement quality improvement, and disseminate findings to assist other institutions and health care communities with their endeavors to recruit and retain diverse faculty.

Pretreatment cue reactivity predicts end-of-treatment smoking.

Although a substantial body of literature has established a relationship between cue reactivity and theoretically relevant addiction variables, the association with treatment process variables remains largely unexplored. In the current investigation, 62 smokers participated in a smoking cue reactivity study, and subsequently enrolled in a smoking cessation program. Hierarchical regressions revealed mean heart rate during the cue presentation phase of the laboratory-based assessment predicted final session smoking rate and expired CO level. Fagerström Tolerance Questionnaire score also predicted final session smoking rate. To the extent that rate reduction serves as an index of treatment progress, it may be of value in future cue reactivity research.

Race disparities in psychiatric rates in emergency departments.

Psychiatric diagnoses based on the International Classification of Diseases--Ninth Revision were examined in the medical discharge records of 33,000 emergency department (ED) patients to determine if (a) psychiatric disorders were underdiagnosed, (b) there were race and gender disparities in psychiatric rates, and (c) psychiatric rates varied as a function of type of injury (e.g., self vs. other-inflicted injuries) and medical diagnosis. The observed psychiatric rate of 5.27% was far below the national prevalence rate of 20%-28%. Both race groups were underdiagnosed, but the underdiagnosis was larger for African Americans. Younger patients had fewer psychiatric diagnoses than older patients. Men had more psychiatric diagnoses overall, whereas women had more mood and anxiety diagnoses. Self-injury patients had much higher psychiatric rates than the other injury groups. This psychiatric underdiagnosis contributes to needless emotional suffering, especially for minorities and the poor who rely on EDs for most of their health care.

Clinical inquiries. What interventions can help patients stop using chewing tobacco?

Nicotine replacement therapy (NRT), including gum and patches, decreases cravings and short-term abstinence rates, but does not improve long-term abstinence (strength of recommendation [SOR]: B, meta-analysis of small randomized controlled studies [RCT]). It is unclear if bupropion has an effect on cessation rates (SOR: B, small RCTs with conflicting results). Behavioral interventions increase abstinence rates for smokeless tobacco users (SOR: B, meta-analysis of small RCTs).

Smoking cessation research in primary care treatment centers: the SCRIPT-MS project.

Despite wide distribution of an evidence-based clinical practice guideline, the provision of treatment for tobacco use has been weak. The primary care setting is an ideal environment in which to implement the tobacco clinical practice guideline. It has been suggested that implementation of the guideline may be enhanced by adapting guideline recommendations into a stepped-care plus treatment-matching model; however, this model has yet to be tested. This article describes an ongoing investigation designed to evaluate (1) the feasibility of implementing this treatment model in a primary care environment, (2) efforts on identifying reasonable assessment methods, (3) primary care providers' use of assessment data, and (4) the relationships between predictors and outcomes under differing treatment "step" conditions in primary care settings. Six primary care clinics are participating in this study comparing usual care, brief clinical intervention, and enhanced clinical intervention conditions. The last of these conditions is hypothesized to produce the best and most cost-effective outcomes. Recruitment is expected to continue until January 2004, being 65% complete as of this writing. Follow-up contacts will continue until April 2005. Results should provide information that will contribute to the ongoing development of primary care-based tobacco intervention approaches.

A survey of tobacco-related knowledge, attitudes and behaviours of primary care providers in Mississippi.

RATIONALE: Relative to other regions in the USA, Mississippi has a high prevalence of tobacco use and tobacco-related disease. This study assessed the tobacco-related knowledge, attitudes and intervention behaviours of family doctors, dentists and nurse practitioners in the state of Mississippi. METHODS: The Provider Attitude Survey, an 85-item measure of tobacco-related knowledge, attitudes and intervention behaviours was mailed to all members of Mississippi's Family Medicine, Dentistry and Nurse Practitioner professional organizations (N=2043). RESULTS: Over one-third (n=802, 39.2%) of eligible providers responded. Just 24.3% had received training in tobacco cessation and 33.7% were aware of the Public Health Service clinical practice guideline. Over 90% indicated that it was their role to prevent tobacco use; felt rewarded when they helped patients quit; and were bothered and upset by the health effects of tobacco. Doctors assisted more patients than nurses or dentists. Doctors and nurses reported more self-efficacy, motivation and preparedness for treating tobacco use than dentists. Providers with training performed more interventions and reported more self-efficacy, preparedness and fewer barriers than those without training. Training was associated with greater increases in self-efficacy, preparedness and intervention behaviours for dentists than for the other groups. CONCLUSIONS: Despite a high prevalence of tobacco use and tobacco-related disease in Mississippi, primary care providers in Mississippi provide tobacco cessation interventions at an unacceptably low frequency relative to other regions. Training is likely to increase the frequency of intervention behaviours.

Wellness and Impairment Content in Schools of Medicine Curricula in the United States and Canada.

Medical students experience numerous stressors, ranging from academic demands to financial strain. These stressors contribute to medical students having a substantial incidence of psychological problems, substance abuse, and seeking of mental health treatment. Left untreated, these problems can result in dysfunctional habit development and subsequent professional impairment. Research has demonstrated the benefits of wellness-impairment educational programs in medical education, but it is unknown to what degree the topics of wellness and impairment are included in medical school curricula. To assess this, a 13-item survey instrument was sent to associate deans in 142 schools of allopathic medicine; 71 (50.0%) responded. The majority of respondents reported that physician impairment (95.8%) and wellness (77.5%) are addressed in their school of medicine curricula, although the degree to which these topics were included varied. Access to other health-promoting resources on campus was also assessed and is discussed. Results suggested that there is a disparity between primary and secondary prevention approaches on school of medicine campuses. Implications for curricula and directions for future research are discussed.

First-line pharmacotherapy for tobacco use and dependence.

First-line pharmacotherapies for tobacco use and dependence (namely, nicotine patch, nicotine gum, nicotine inhaler, nicotine nasal spray, and sustained-release bupropion) are safe and have been empirically determined to be efficacious and should always be considered part of a tobacco treatment intervention program unless contraindicated. Studies published subsequent to the literature synthesized in TTUD support previously determined efficacy of first-line pharmacologic medications for treatment of tobacco use and dependence. Further studies will be necessary to define clearly the efficacy and relative safety of combination treatments.