Carole J. Bland

Determinants of primary care specialty choice: a non-statistical meta-analysis of the literature

This paper analyzes and synthesizes the literature on primary care specialty choice from 1987 through 1993. To improve the validity and usefulness of the conclusions drawn from the literature, the authors developed a model of medical student specialty choice to guide the synthesis, and used only high-quality research (a final total of 73 articles). They found that students predominantly enter medical school with a preference for primary care careers, but that this preference diminishes over time (particularly over the clinical clerkship years). Student characteristics associated with primary care career choice are: being female, older, and married; having a broad undergraduate background; having non-physician parents; having relatively low income expectations; being interested in diverse patients and health problems; and having less interest in prestige, high technology, and surgery. Other traits, such as value orientation, personality, or life situation, yet to be reliably measured, may actually be responsible for some of these associations. Two curricular experiences are associated with increases in the numbers of students choosing primary care: required family practice clerkships and longitudinal primary care experiences. Overall, the number of required weeks in family practice shows the strongest association. Students are influenced by the cultures of the institutions in which they train, and an important factor in this influence is the relative representation of academically credible, full-time primary care faculty within each institutions governance and everyday operation. In turn, the institutional culture and faculty composition are largely determined by each schools mission and funding sources–explaining, perhaps, the strong and consistent association frequently found between public schools and a greater output of primary care physicians. Factors that do not influence primary care specialty choice include early exposure to family practice faculty or to family practitioners in their own clinics, having a high family medicine faculty-to-student ratio, and student debt level, unless exceptionally high. Also, students view a lack of understanding of the specialties as a major impediment to their career decisions, and it appears they acquire distorted images of the primary care specialties as they learn within major academic settings. Strikingly few schools produce a majority of primary care graduates who enter family practice, general internal medicine, or general practice residencies or who actually practice as generalists. Even specially designed tracks seldom produce more than 60% primary care graduates. Twelve recommendations for strategies to increase the proportion of primary care physicians are provided.

Curricular Change in Medical Schools: How to Succeed

Societys changing needs, advancing knowledge, and innovations in education require constant changes of medical school curricula. But successful curricular change occurs only through the dedicated efforts of effective change agents. This study systematically searched and synthesized the literature on educational curricular change (at all levels of instruction), as well as organizational change, to provide guidance for those who direct curricular change initiatives in medical schools. The focus was on the process of planning, implementing, and institutionalizing curricular change efforts; thus, only those articles that dealt with examining the change process and articulating the factors that promote or inhibit change efforts were included. In spite of the highly diverse literature reviewed, a consistent set of characteristics emerged as being associated with successful curricular change. The frequent reappearance of the same characteristics in the varied fields and settings suggests they are robust contributors to successful change. Specifically, the characteristics are in the areas of the organizations mission and goals, history of change in the organization, politics (internal networking, resource allocation, relationship with the external environment), organizational structure, need for change, scope and complexity of the innovation, cooperative climate, participation by the organizations members, communication, human resource development (training, incorporating new members, reward structure), evaluation, performance dip (i.e., the temporary decrease in an organizations performance as a new program is implemented), and leadership. These characteristics are discussed in detail and related specifically to curricular change in medical school settings.

Characteristics of a productive research environment: literature review

What environmental factors stimulate and maintain research productivity? To answer this question, the authors conducted an extensive review of articles and books on research productivity published from the mid-1960s through 1990. This review revealed that a consistent set of 12 characteristics was found in research-conducive environments: (1) clear goals that serve a coordinating function, (2) research emphasis, (3) distinctive culture, (4) positive group climate, (5) assertive participative governance, (6) decentralized organization, (7) frequent communication, (8) accessible resources, particularly human, (9) sufficient size, age, and diversity of the research group, (10) appropriate rewards, (11) concentration on recruitment and selection, and (12) leadership with research expertise and skill in both initiating appropriate organizational structure and using participatory management practices. Some of these characteristics are not surprising, although some findings were unexpected, such as that participative governance correlated consistently with research productivity. The differential impact of each of these 12 characteristics is unclear. It is clear, however, that the leader has a disproportionate impact through his or her influence on all of the other characteristics. Yet, an overarching feature of these characteristics is their interdependency. These factors do not operate in research groups as isolated characteristics. Rather, they are like fine threads of a whole fabric: individual, yet when interwoven, providing a strong, supportive, and stimulating backdrop for the researcher. The authors conclude that while at a distance the productive research enterprise looks like a highly robust entity, upon closer inspection it is revealed to be a delicate structure highly dependent on the existence and effective working of numerous individual, organizational, and leadership characteristics.

A theoretical, practical, predictive model of faculty and department research productivity.

Purpose Although numerous characteristics impact faculty research productivity, and although researchers have suggested comprehensive theoretical models to explain the relationship between these characteristics and levels of faculty research productivity, few studies have assessed these models. This study tests the ability of the Bland et al. (2002) model—based on individual, institutional, and leadership variables influencing faculty research productivity—to explain individual and group (department) research productivity within the context of a large medical school. Method This study used data from a University of Minnesota Medical School—Twin Cities vitality survey conducted in 2000 that had a response rate of 76% (n = 465 faculty). A statistical software package was used to conduct t tests, logistic regressions, and multiple regressions on these data. Results The validity of faculty, department, and leadership characteristics identified in the Bland et al. (2002) model were confirmed as necessary for high levels of research productivity. Faculty productivity was influenced more by individual and institutional characteristics; group productivity was more affected by institutional and leadership characteristics. Conclusion The characteristics and groupings (individual, institutional, and leadership) in the Bland et al. (2002) model predict faculty research productivity. Research productivity is influenced by the interaction of the three broad groupings, and it is the dynamic interplay of individual and institutional characteristics, supplemented with effective leadership, that determines the productivity of individuals and departments.

Characteristics of the successful researcher and implications for faculty development

To understand better the role of faculty development in training family medicine researchers, the authors examined in a comprehensive literature review the characteristics of productive researchers, their training, and their work environment. Areas reviewed were faculty development and evaluation, career development, professional socialization, organizational development, and faculty vitality in higher education, medicine, and corporate research and development. Findings reveal that, besides prerequisite knowledge and skills in a research area, successful researchers have academic values and attitudes derived from specific socialization experiences. They also receive meaningful support from their organization, mentors, and peers.

The Impact of Appointment Type on the Productivity and Commitment of Full-Time Faculty in Research and Doctoral Institutions

A paradigm shift in the use of faculty appointment types is occurring in academia. Using National Study of Postsecondary Faculty data, this study examines the influence of appointment type on faculty productivity—research and education—and commitment at Research and Doctoral institutions. All full-time faculty and a subset based on experience comprised the samples.

Organizational climate and family life: how these factors affect the status of women faculty at one medical school.

Purpose To compare men and women faculty’s family situations and perceptions of organizational climate. Method In 2005, the authors sent an electronic survey to full-time faculty at the University of Minnesota Medical School to assess their perceptions of professional relationships, mentoring, obstacles to satisfaction, policies, circumstances that contribute to departure, gender equality, family situations, and work life. Results Of 615 faculty, 354 (57%) responded. Women and men were equally productive and worked similar total hours. Women were less likely to have partners/spouses, were more likely to have partners/spouses who were employed, and devoted more time to household tasks. Compared with men, women reported more experience with obstacles to career success and satisfaction and with circumstances that contribute to departure. More women than men perceived that they were expected to represent the perspective of their gender, that they were constantly under scrutiny by colleagues, that they worked harder than colleagues worked in order to be perceived as legitimate, and that there were “unwritten rules” and bias against women. Few faculty reported overt discrimination; however, more women than men perceived gender discrimination in promotion, salary, space/resources, access to administrative staff, and graduate student/fellow assignment. Conclusions Work–life and family–life factors served as obstacles to satisfaction and retention of the women faculty studied. Many of these factors reflect challenges attributable to subtle gender bias and the intersection of work and family life. The authors provide examples showing that medical schools can implement policy changes that support faculty who must balance work and family responsibilities. Identification and elimination of gender bias in areas such as promotion, salary, and resource allocation is essential.

Professional Networks: The Influence of Colleagues on the Academic Success of Faculty

Background Successful higher education faculty, those who get promoted and tenured, who get recognized for contributions, who produce more and significant research, frequently consult colleagues. This article summarizes what is known about colleague relationships with the hope of stimulating further research to extend current conclusions to medical school faculty. Method In the spring of 1992, a systematic literature review was conducted using database searches and author review of 137 selected books and articles using a standard protocol; preference was given to articles that were data-oriented, used quality designs, and related directly to the topic. Results Forty-seven “best” sources, published between 1963 and 1991, were included in the review of (1) types and configurations of colleague relationships, (2) forming and maintaining colleague relationships, (3) colleague effects on faculty success, (4) functions of colleague relationships, (5) changes in colleague relationships over a career, and (6) effects on methods, size, and configuration of colleague relationships. Conclusion Among the conclusions reached are that (1) there are a variety of types or configurations of colleague relationships, all with different functions and effects on faculty performance; (2) dyadic conceptions of colleague relationships are insufficient to explain the functions of colleague relationships; and (3) the most important source for developing colleague relationships is professional associations, while the least important source is ones own institution.ABSTRACTBackgroundAlthough national figures for medical student withdrawal and extended leave have long been reported, similar data have not been available for residents in training.MethodData for this study came from the American Medical Association survey of the 1991–92 residency year, in which pr

A systematic approach to conducting a non-statistical meta-analysis of research literature

Literature analyses and syntheses are becoming increasingly important as a means of periodically bringing coherence to a research area, contributing new knowledge revealed by integrating single studies, and quickly informing scientists of the state of the field. As a result, there is a need for approaches that can provide replicable, reliable, and trustworthy results. Over the last decade many researchers have begun using the statistical meta-analysis approach to integrate studies. However, the single studies conducted in many areas are not of the type amenable to statistical meta-analysis but are more appropriate for non-statistical analysis and synthesis. The present paper describes (1) a rigorous approach to conducting a non-statistical meta-analysis of research literature and (2) an example of how this approach was applied to the literature of determinants of primary care specialty choice published between 1987 and 1993. This approach includes model development, literature retrieval, literature coding, rating references for quality, annotating high-quality references, and synthesizing only the subset of the literature found of sufficient quality to be considered. Also, the basic results of each included study are reported in the synthesis so that readers have before them all the “data points” used in the synthesis. Thus, readers can draw their own interpretations without having to re-collect the data, just as they would be able to do in any single study that presents original data as well as conclusions and discussion.

Faculty development in the health professions: Conclusions and recommendations

This report summarizes recent literature reviews and resource books on faculty development in the health professions and describes findings from articles not previously reviewed. Nine conclusions about faculty development in the health professions are drawn: (1) the concept of faculty development is evolving and expanding; (2) research skills are becoming a major focus of faculty development; (3) teaching skills are still a prominent aspect of faculty development; (4) fellowships are being used effectively to recruit and train new faculty; (5) the institutional environment has become a focus of faculty development; (6) faculty evaluation is an effective approach to faculty development; (7) the efficacy of faculty development needs better research documentation; (8) model curricula have been developed for different types of faculty; and (9) comprehensive faculty development centers are gaining in popularity. A set of recommendations based on the conclusions drawn is offered for those planning faculty development interventions.