Rebecca A. Harrison

A time for change: an exploration of attitudes toward part-time work in academia among women internists and their division chiefs.

Background Increasing numbers of clinicians desire part-time work, and many will opt out of academic medicine if the barriers to part-time work are too great. Method Purposeful sampling was used to investigate the experiences of part-time academic physicians and their division leaders to understand (1) how each identified the negative and positive consequences of part-time work, and (2) how each conceptualize part-time work. In 2004, the authors interviewed the Society of General Medicine Horn Scholars Program applicants and their division chiefs from the 2001 and 2004 award cycles and performed a qualitative analysis of the one- to two-hour audiotaped interviews. Results Seven out of nine eligible applicants and six of seven division chiefs participated. All applicants were female junior faculty clinician educators in academic internal medicine from seven institutions. All division chiefs were male full-time faculty members. Both applicants and division chiefs identified multiple specific negative and positive consequences of part-time work. Analysis of interviews suggested that both groups tended to frame part-time work as a decision to “work less” or to “work differently.” Self-reflection and articulation of values helped some faculty determine where they derive the greatest happiness and fulfillment personally and professionally. Conclusions As more academics seek work–life balance and consider part-time work as a tool to achieve that balance, academic medicine will be challenged to develop creative models for integrating successful part-time physicians, or it will lose that segment of the workforce. This study’s findings suggest that one such model may require that physicians and their leaders reconceptualize work altogether.

Medical student evaluation of the quality of hospitalist and nonhospitalist teaching faculty on inpatient medicine rotations.

Purpose To evaluate the impact of academic hospitalists on third-year medical students during inpatient medicine rotations. Method The authors conducted a retrospective quantitative assessment of medical student evaluations of hospitalist and nonhospitalist Department of Medicine faculty at Oregon Health & Science University, for the 1998–00 academic years. Using a nine-point Likert-type scale, students evaluated the faculty on the following characteristics: communication of rotation goals, establishing a favorable learning climate, use of educational time, teaching style, evaluation and feedback, contributions to the student’s growth and development, and overall effectiveness as a clinical teacher. Results A total of 138 students rotated on the university wards during the study period; 100 with hospitalists, and 38 with nonhospitalists. Of these students, 99 (71.7%) returned evaluations. The hospitalists received higher numeric evaluations for all individual attending characteristics. Significance was achieved comparing communication of goals (p = .011), effectiveness as a clinical teacher (p = .016), and for the combined analysis of all parameters (p < .001). Despite lack of achieving statistical significance, there was a trend toward hospitalists being more likely to contribute to the medical student’s perception of growth and development during the period evaluated (p = .065). Conclusions In addition to performing the responsibilities required of full-time hospital-based physicians, hospitalists were able to provide at least as positive an educational experience as did highly rated nonhospitalist teaching faculty and in some areas performed better. A hospitalist model can be an effective method of delivering inpatient education to medical students.

Career Satisfaction and Burnout in Academic Hospital Medicine

T he number of hospitalists in academic medical centers has grown rapidly, producing a field with few senior members, potentially impeding the academic success and career sustainability of academic hospitalists, not to mention contributing to burnout. However, little is known about career promotion, job satisfaction, stress, and rates of burnout in academic hospital medicine or how these factors affect scholarly success and productivity.

Teaching Internal Medicine Residents in the New Era: Inpatient Attending with Duty-Hour Regulations

AbstractBACKGROUND: Little is known about the impact of resident duty-hour regulations on the inpatient teaching experience. OBJECTIVE: Provide descriptive information on the effect of resident duty-hour regulations on attendings and the educational environment. DESIGN: Qualitative analysis of attending focus groups and e-mail survey of residents in Internal Medicine. PARTICIPANTS: Inpatient attending physicians at 2 academic centers and residents at the affiliated university-based Internal Medicine residency program in Portland, OR. RESULTS: Seventy-two percent of eligible attendings participated in 2 focus groups. Three themes were generated: increased clinical role, altered time management, and altered teaching. Attending physicians report performing more clinical work, teaching less, using more focused teaching methods, and experiencing an increased perception of intensity. Forty percent of eligible residents completed our e-mail survey. We organized residents data using the same 3 themes as attending physician data. Residents observed attending physicians performing increased clinical work, being more time aware, delivering more focused teaching, and having less time to teach. Participants noted changes in autonomy and professionalism. Strategies to enhance teaching effectiveness in the new environment were described. CONCLUSION: Duty-hour regulations have increased attending clinical responsibility and decreased teaching time in 1 residency program, leading to the perception of a more intense attending experience. Duty-hour regulations encourage educators to determine what is critical to preserve in the educational experiences of learners and challenge us to reexamine autonomy and professionalism in training.

Bushido and medical professionalism in Japan.

Medical professionalism has become a core topic in medical education. As it has been considered mostly from a Western perspective, there is a need to examine how the same or similar concepts are reflected in a wider range of cultural contexts. To gain insights into medical professionalism concepts in Japanese culture, the authors compare the tenets of a frequently referenced Western guide to professionalism (the physician charter proposed by the American Board of Internal Medicine Foundation, American College of Physicians Foundation, and the European Federation of Internal Medicine) with the concepts of Bushido, a Japanese code of personal conduct originating from the ancient samurai warriors. The authors also present survey evidence about how a group of present-day Japanese doctors view the values of Bushido. Cultural scholars have demonstrated Bushido’s continuing influence on Japanese people today. The authors explain the seven main virtues of Bushido (e.g., rectitude), describe the similarities and differences between Bushido and the physician charter, and speculate on factors that may account for the differences, including the influence of religion, how much the group versus the individual is emphasized in a culture, and what emphasis is given to virtue-based versus duty-based ethics. The authors suggest that for those who are teaching and practicing in Japan today, Bushido’s virtues are applicable when considering medical professionalism and merit further study. They urge that there be a richer discussion, from the viewpoints of different cultures, on the meaning of professionalism in today’s health care practice.

A good career choice for women: Female medical students' mentoring experiences: A multi-institutional qualitative study

Purpose The career decisions, practice patterns, and approach to patient care of current female students, who make up close to 50% of medical school classes, will have a profound impact on the profession. This study explores the role gender plays in the mentoring experiences of female medical students. Method In 2011, the authors conducted focus groups with 48 third- and fourth-year female medical students at four U.S. medical schools. Using a template organizing style, they derived themes in an iterative process to explore female medical students’ mentoring relationships and the impact of gender on those relationships. Results The authors identified four major themes: (1) Optimal mentoring relationships are highly relational. Students emphasized shared values, trust, and a personal connection in describing ideal mentoring relationships. (2) Relational mentoring is more important than gender concordance. Students identified a desire for access to female mentors but stated that when a mentor and mentee developed a personal connection, the gender of the mentor was less important. (3) Gender-based assumptions and stereotypes affect mentoring relationships. Students described gender-based assumptions and expectations for themselves and their mentors. (4) Gender-based power dynamics influence students’ thinking about mentoring. Students stated that they were concerned about how their mentors might perceive their professional decisions because of their gender, which influenced what they disclosed to male mentors and mentors in positions of power. Conclusions Gender appears to play a role in female medical students’ expectations and experience with mentoring relationships and may influence their decision making around career planning.

Professional Characteristics and Job Satisfaction Among SGIM Members: A Comparison of Part-time and Full-time Physician Members

BACKGROUNDAs more physicians work part-time (PT), the faculty, institutions, and organizations that represent them should understand the factors that motivate and satisfy these physicians.OBJECTIVECompare factors associated with job satisfaction among PT and full-time (FT) academic physicians.DESIGNCross-sectional survey.PARTICIPANTSMembers of the Society of General Internal Medicine (SGIM), a national, academic Internal Medicine organization.RESULTSFifty percent (1,396 of 2,772) of SGIM members responded, 11% work PT. Compared to FT, PT physicians were more often female (85% vs 38%, p < .001), clinicians (Cs) or clinician–educators (CEs) (84% vs 56%, p < .001), and of a lower rank (77% vs 61%, p = .001). Job satisfaction was similar between PT and FT Cs and CEs. For PT Cs and CEs, record of publication (11% vs 21%, p = .04) and local and national recognition (24% vs 36%, p = .03) were less important to overall job satisfaction compared to FT Cs and CEs. In multivariate analysis, academic rank (odds ratio [OR] = 7.18, 95%CI = 1.40–36.50) was associated with higher satisfaction among PT Cs and CEs.CONCLUSIONSPT and FT C and CE SGIM members report similar satisfaction, but different factors contribute to satisfaction. Knowing what motivates and satisfies PT physicians may allow medical centers to retain faculty and create positions to help them to fulfill their potential.

Survey of US academic hospitalist leaders about mentorship and academic activities in hospitalist groups

BACKGROUND Few data describe the structure, activities, and goals of academic hospital medicine groups. METHODS We carried out a cross sectional email survey of academic hospitalist leaders. Our survey asked about group resources, services, recruitment and growth, as well as mentoring of faculty, future priorities, and general impressions of group stability. RESULTS A total of 57 of 142 (40%) potential hospitalist leaders responded to our email survey. Hospitalist groups were generally young (<5 years old). Hospitalist group leaders worried about adequate mentorship and burnout while placing a high priority on avoiding physician turnover. However, most groups also placed a high priority on expanding nonclinical activities (teaching, research, etc.). Leaders felt financially and philosophically unsupported, a sentiment which seemed to stem from being viewed primarily as a clinical rather than an academic service. CONCLUSION Academic hospital medicine groups have an acute need for mentoring and career development programs. These programs should target both individual hospitalists and their leaders while also helping to enhance scholarly work.

Survey of overnight academic hospitalist supervision of trainees

In 2003, Accreditation Council for Graduate Medical Education (ACGME) announced the first in a series of guidelines related to the residency training. The most recent recommendations include explicit recommendations regarding the provision of on-site clinical supervision for trainees of internal medicine. To meet these standards, many internal medicine residency programs turned to hospitalist programs to fill that need. However, much is unknown about the current relationships between hospitalist and residency programs, specifically with regard to supervisory roles and supervision policies. We aimed to describe how academic hospitalists currently supervise housestaff during the on-call, or overnight, period and hospitalist program leader their perceptions of how these new policies would impact trainee-hospitalist interactions.

Evolving trends in balancing work and family for future academic physicians: a role for personal stories

Overlapping trends in medicine include, (1) an increasing number of women entering medicine, (2) a growing number of generation X physicians, (3) the implementation of duty hour regulations, and (4) a diversifying workforce which have all contributed to the need for mentoring learners and young faculty in the area of balancing work and family. In pace with the increasing complexity of their lives and practices, women trainees and young physicians are seeking creative solutions to the challenges of simultaneous work and parenting. As teachers and mentors in academic medicine, it is our calling to share our own personal stories about personal and professional balance to help attract, retain, and anchor the next generation of physicians and identify policies in need of change.