Joan Y. Reede

Screening for Psychosocial Dysfunction in Inner-City Children: Further Validation of the Pediatric Symptom Checklist

A sample of 123 6- to 12-year-old outpatients at an inner-city pediatric clinic was screened for psychosocial dysfunction using the Pediatric Symptom Checklist (PSC), a brief parent-completed questionnaire. The prevalence of positive screening scores on the PSC was 22%, significantly higher than the rate found in lower middle to upper middle-class samples. Comparing PSC case classifications with comprehensive assessments made by clinicians, overall agreement was 92% (kappa = 0.82; sensitivity = 88%; specificity = 100%); a comparison with several other measures provided additional support for the validity of the PSC. The PSCs reliability over time was also acceptable. These findings provide preliminary evidence that the PSC is as valid and reliable for screening children from economically disadvantaged and minority backgrounds as it is for middle and upper middle-class populations.

Screening for Psychosocial Dysfunction In Pediatric Practice A Naturalistic Study of the Pediatric Symptom Checklist

This study examined the routine implementation of the Pediatric Symptom Checklist (PSC), a brief questionnaire which screens for psychosocial dysfunction in school-aged children in an outpatient pediatric practice. Results indicated that the PSC was well-accepted by parents and adequately tolerated by busy clinic staff. When the PSC was included as part of the standard procedure for well-child visits, the referral rate for psychosocial problems due to positive PSC scores rose to 12% from the clinic baseline referral rate of 1.5%, a significant increase (P<.01). Half of the children who screened positive on the PSC had not been previously identified by their pediatricians as having psychosocial problems, and more than half had never received any psychological treatment. When implementation of the PSC was discontinued, the referral rate fell to 2%, a rate similar to baseline. The findings suggest that it is possible to incorporate the PSC into routine pediatric practice and that the PSC can help pediatricians identify and better serve children experiencing psychosocial difficulties. The study also suggests that further work is needed to understand the barriers to ongoing implementation.

Predictors of success in medicine.

Many different variables have been used in an attempt to predict performance in medical school, residency, and practice. The extensive literature on this subject has been reviewed and evaluated. Admission to medical school should not be based solely on grade point average and Medical College Admission Test scores because these offer no measure of extremely important noncognitive attributes. Although performance in the preclinical years is predicted by the grade point average and Medical College Admission Test scores, no such correlation exists for achievements in the clinical years, for postgraduate training, or as physicians. Thus, even though underrepresented minority applicants to medical school tend to have lower grade point averages and Medical College Admission Test scores than majority applicants, ultimate success in postgraduate training and as practicing physicians is equivalent to that attained by majority students.

Variability in Women Faculty’s Preferences Regarding Mentor Similarity: A Multi-institution Study in Academic Medicine

Purpose To investigate which mentor-similarity characteristics women faculty in academic medicine rate most important and to determine whether this importance differs among women faculty on the basis of current and prior mentoring, demographic and personal factors, and career factors. Method Cross-sectional survey data from 3,100 women faculty at 13 purposively sampled U.S. medical schools were collected in 2012. The preferences of participants regarding the importance of mentor similarity in terms of race/ethnicity, gender, personal and career interests, and department and institution were studied. Analysis entailed chi-square tests and multivariable ordered logistic models. Results Overall, respondents ranked having a mentor in the same department and institution as most important. Same department and institution were less important for those without a current mentor and for senior faculty, and were more important for Asian faculty. Same career and personal interests were less important for older faculty and more important for those with a doctorate only. Same gender was more important for black faculty, faculty at the rank of instructor, and those without current mentoring. Overall, same race/ethnicity was rated least important; however, it was more important for racial–ethnic minorities, U.S.-born faculty, and those who had never had a mentor. Conclusions Mentor preferences, as indicated by level of importance assigned to types of mentor similarity, varied among women faculty. To advance effective mentoring, characterized by good mentor–mentee fit, the authors provide recommendations on matching strategies to be used in academic medicine when considering the diverse mentor preferences of women faculty.

Considering context in academic medicine: differences in demographic and professional characteristics and in research productivity and advancement metrics across seven clinical departments.

Purpose To understand the disciplinary contexts in which faculty work, the authors examined demographics, professional characteristics, research productivity, and advancement across seven clinical departments at Harvard Medical School (HMS) and nationally. Method HMS analyses included faculty from seven clinical departments—anesthesiology, medicine, neurology, pediatrics, psychiatry, radiology, and surgery—in May 2011 (N = 7,304). National analyses included faculty at 141 U.S. medical schools in the same seven departments as of December 31, 2011 (N = 91,414). The authors used chi-square and Wilcoxon Mann–Whitney tests to compare departmental characteristics. Results Heterogeneity in demographics, professional characteristics, and advancement across departments was observed in HMS and national data. At HMS, psychiatry had the highest percentage of underrepresented minority faculty at 6.6% (75/1,139). In anesthesiology, 24.2% (128/530) of faculty were Asian, whereas in psychiatry only 7.9% (90/1,139) were (P < .0001). Female faculty were the majority in pediatrics and psychiatry, whereas in surgery 26.3% (172/654) of the faculty were female (P < .0001). At HMS, surgery, radiology, and neurology had the shortest median times to promotion and the highest median number of publications, H-index, and second-degree centrality. Neurology also had the highest percentage of faculty who had been principal investigators on a National Institutes of Health–funded grant. Conclusions There were differences in demographics, professional characteristics, and advancement across clinical departments at HMS and nationally. The context in which faculty work, of which department is a proxy, should be accounted for in research on faculty career outcomes and diversity inclusion in academic medicine.

Historically Black Medical Schools: Addressing the Minority Health Professional Pipeline and the Public Mission of Care For Vulnerable Populations

Substantial changes in not only access to care, cost, and quality of care, but also health professions education are needed to ensure effective national healthcare reform. Since the actionable determinants of health such as personal beliefs and behaviors, socioeconomic factors, and the environment disproportionately affect the poor (and often racial/ethnic minorities), many have suggested that focusing efforts on this population will both directly and indirectly improve the overall health of the nation. Key to the success of such strategies are the ongoing efforts by historically black medical schools (HBMSs) as well as other minority serving medical and health professional schools, who produce a disproportionate percentage of the high-quality and diverse health professionals that are dedicated to maintaining the health of an increasingly diverse nation. Despite their public mission, HBMSs receive limited public support threatening their ability to not only meet the increasing minority health workforce needs but to even sustain their existing contributions. Substantial changes in health education policy and funding are needed to ensure HBMSs as well as other minority-serving medical and health professional schools can continue to produce the diverse, high-quality health professional workforce necessary to maintain the health of an increasingly diverse nation. We explore several model initiatives including focused partnerships with legislative and business leaders that are urgently needed to ensure the ability of HBMSs to maintain their legacy of providing compassionate, quality care to the communities in greatest need.

Rationale and Design of the Women and Inclusion in Academic Medicine Study

BACKGROUND AND OBJECTIVE Women of color (WOC) (African American, Hispanic, Native American/Alaskan Native, and Asian American) faculty remain disproportionately underrepresented among medical school faculty and especially at senior ranks compared with White female faculty. The barriers or facilitators to the career advancement of WOC are poorly understood. The Women and Inclusion in Academic Medicine (WIAM) study was developed to characterize individual, institutional and sociocultural factors that influence the entry, progression and persistence, and advancement of women faculty in academic medical careers with a focus on WOC. METHODS Using a purposive sample of 13 academic medical institutions, we collected qualitative interview data from 21 WOC junior faculty and quantitative data from 3,127 (38.9% of 8,053 eligible women) respondents via an online survey. To gather institutional data, we used an online survey and conducted 23 key administrative informant interviews from the 13 institutions. Grounded theory methodology will be used to analyze qualitative data. Multivariable analysis including hierarchical linear modeling will be used to investigate outcomes, such as the inclusiveness of organizational gender climate and women facultys intent to stay. CONCLUSION We describe the design, methods, rationale and limitations of one of the largest and most comprehensive studies of women faculty in academic medicine with a focus on WOC. This study will enhance our understanding of challenges that face women, and, especially WOC, faculty in academic medicine and will provide solutions at both the individual and institutional levels.

Minority faculty development programs at US medical schools.

A national study conducted by Dr Guevara and colleagues1 did not find an association between targeted faculty development programs and greater representation, recruitment, or promotion of underrepresented minority faculty at US allopathic medical schools over a 10-year period. However, this finding should be placed in context. Comparing schools of medicine is difficult, considering the complexity of factors that influence such organizations. The composition of the local community and mission of the institution may influence faculty demographics, which are dimensions not considered in the authors’ model. Two important additional factors that should be incorporated are institutional structure and program quality. Faculty composition may differ in a medical school that is part of an integrated health system, in which the entire organization is administered under 1 umbrella, from in an institution that is only affiliated with a teaching hospital. A faculty development program in an affiliated model may have less effect on faculty demographics than a program in an integrated model.