Mind-Body Skills Course Changing the Culture of

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November/December 2008
www.acphysci.com
T H E S O U R C E F O R R E C RU I T M E N T A N D P RO F E S S I O N A L D E V E L O P M E N T
Students in Georgetown University School of Medicine’s Mind–Body Skills course
begin a session with a period of meditation.
Spotlight on Mind–Body Skills: A unique program blends
science and humanism by fostering student self-awareness and self-care.
See page 2
Career Watch: You’ve been offered a department chair;
do you know enough to take it? See page 4
Skipjack Project—Issues in Contemporary Medical
Education: What can we learn from TV medical shows? See page 7
The Five-Minute Mentor .................................................. 8
News & Views .................................................................... 9
Highlights from Academic Medicine .......................... 10
ACADEMIC CAREER OPPORTUNITIES.............. 13-27
®
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Academic Physician & Scientist
ACADEMIC PHYSICIAN & SCIENTIST:
The comprehensive source of professional
growth and development, recruitment, and
career enrichment information for all academic medicine faculty and administrators,
from entry to senior levels.
Spotlight On:
MIND-BODY
SKILLS
EDITORIAL ADVISORY BOARD
■
November/December 2008
Mind–Body Skills Course
Changing Culture of Medical
Education at Georgetown
BY AMY ROTHMAN SCHONFELD, PhD
David J. Bachrach, MBA, FACMPE/FACHE
The Physician Executive's Coach
Boulder, CO
Janet Bickel, MA
Career Development and Executive Coach
Faculty Career & Diversity Consultant
Falls Church, VA
Rosemary B. Duda, MD, MPH
Associate Professor of Surgery,
Harvard Medical School
Director, Center for Faculty Development,
Beth Israel Deaconess Medical Center
Boston, MA
R. Kevin Grigsby, DSW
Vice Dean for Faculty and
Administrative Affairs
Penn State College of Medicine
Hershey, PA
Susan R. Johnson, MD, MS
Associate Provost for Faculty
University of Iowa
Iowa City, IA
Page Morahan, PhD
Co-Director, ELAM
Drexel University College of Medicine
Philadelphia, PA
Michael L. Rainey, PhD
Associate Dean, Academic Advising, Retired
SUNY, Stony Brook School of Medicine
New York, NY
Susan R. Rosenthal, MD
Assistant Dean of Students
Clinical Professor of Pediatrics
Robert Wood Johnson Medical School
New Brunswick, NJ
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I
n the past decade there has been
increasing emphasis on developing initiatives to promote altruism and
humanism in medical students. One highly successful educational initiative at
Georgetown University School of Medicine
(GUSOM) teaches mind–body medicine
skills to blend science and humanism by
fostering student self-awareness and selfcare. The result is a palpable change in the
attitudes of both students and faculty
members who have participated, which is
having a ripple effect throughout the school.
“I believe the Mind–Body Skills program
is beginning to change the culture within
this medical school,” said Nancy Harazduk,
MEd, MSW, the director of the program.
“Students are becoming more passionate
about their medical careers, and they are
supporting each other rather than competing with each other. When I came here
seven years ago, there was so much anxiety
about being a medical student. Now, they
think, ‘I can do this.’ They have a sense of
the bigger picture, focusing not so much on
grades but on how to be better physicians.”
These accomplishments are especially
impressive in light of the challenges that
must be overcome in implementing such an
initiative, including carving time from the
rigorous science and clinical components of
the typical medical school curriculum and
the resistance of some traditionalists to alternative medical approaches. Mind–body
courses also require resources; in addition,
assessment of skills, such as self-awareness
and self-care, is not clear-cut.
So why is this initiative so successful,
with approximately 30% of the medical
school class choosing the first-year elective
and many opting to continue with the
course in their second and third years
despite their busy schedules? The answer
may lie in the “buy-in” of some of the key
opinion leaders of the school, who go
through the training sessions and in turn
become facilitators of the course and
champions of the concepts.
Development of the Program
In 2000, Aviad Haramati, PhD, a physiologist
and medical educator at GUSOM, brought
together a team of educators, researchers,
and clinicians to consider integrating aspects
of complementary and alternative medicine
(CAM) into the curriculum. A small grant
from the medical school led to a significant
educational curriculum grant from the
National Center for Complementary and
Alternative Medicine at the NIH in 2001, to
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November/December 2008
incorporate knowledge, skills, and attitudes
about CAM and integrative medicine into
the medical school curriculum. “We brought
acupuncture into anatomy and neuroscience,
biofeedback into physiology, and the science
of stress reduction into endocrinology,” he
said.
In addition, Dr. Haramati launched an
experiential component involving mind–
body medicine skills groups (as a pilot for
30 students) within the Human Physiology
course. After the pilot program, he surveyed
the students about the impact of the course.
He realized that students found the opportunity to learn stress management skills and to
engage in self-reflection and exercises that
foster self-awareness, in an environment that
was safe and nonjudgmental, to be truly
transformative. He subsequently changed the
focus of the project to include more faculty
development and train additional facilitators. The results have been profound. “We
want students to experience the mind–body
connection firsthand and understand more
about themselves,” he said.
Structure of the Course
The course, which meets two hours per week
for 11 weeks, is offered in the second semester of the first year in order to introduce
mind–body skills early in training, while students’ attitudes are still in the formative stages.
Six groups are conducted in parallel, each
containing 10 students and two facilitators.
Students who are friends are discouraged from joining the same group. “People
should be able to speak freely with no
constraints,” said Ms. Harazduk.
Each session follows a structured format.
An opening ritual, such as lighting a candle,
meditating, or ringing a chime, introduces
the session and allows students to shift
their focus from their hectic lives to
become present in the moment. After five
minutes, the check-in period begins, during
which all members—including facilitators—
share aspects of their daily experiences,
discuss any issues they have, and explore
any insights they have had about themselves. “Each person is allowed to say what
they feel without judgment or analysis,”
explained Ms. Harazduk. “The purpose of
the course is to create a safe place so students can learn about themselves, be open,
forthcoming, and authentic.” Another goal
is for students to learn how to practice
Mind–Body Skills students engage in
a drawing exercise to enhance their
self-exploration.
3
learn that the thoughts which intrude are
not the enemy, and they learn to accept the
thoughts and then bring their attention
back to their breath,” she said.
Concentration skills are also sharpened
through a walking meditation exercise,
during which students are asked to focus
on what they feel and experience as they
walk in a garden, noticing the environment,
even the process of taking each individual
step. In eating meditation, students may be
asked to focus on minute details—such as
the taste, smell, texture, and color of a
listening actively and generously. Complete
confidentiality about the discussions is a
priority.
After the 45-minute check-in, the
facilitators introduce a new mind–body
skill (which takes about 20 minutes) and
then the group has a chance to practice
the skill (which takes about 45 minutes).
Figure 1 lists some of the techniques
Continued on page 6
used.
For instance, different
types of meditation are
Figure 1. Mind–Body Medicine
taught, such as mindfulSkills Groups
ness meditation, explained
Ms. Harazduk, who was
Techniques
trained in mindfulness
meditation at the Omega
❖ Breathing (various)
Institute in Rhinebeck, NY,
❖ Meditation (mindfulness/awareness, concentrative)
and in guided imagery at
❖ Guided imagery (several types)
the Academy for Guided
❖ Biofeedback (autogenic training)
Imagery in Mill Valley, CA.
Students sit quietly or lie
❖ Art (emphasis on non-cognitive approaches)
on the floor in a dark❖ Music (used in meditation and imagery sessions)
ened room, and are asked
❖ Movement (shaking, dancing, exercise)
to focus on the present
❖ Writing (journals, dialogues, service commitment)
moment via concentrating
on their breathing. “Students
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CAREER
Watch
■
November/December 2008
You’ve Been Offered the Chair…But Do
You Know Enough to Take It?
B Y D AV I D J . B A C H R A C H
Y
ou’ve been offered the chair of a
department at a different medical
school and have been impressed
with the way the search process has been
handled over the past six months. You have
submitted a carefully thought out vision
statement for the department and the dean
has accepted it in principle. You now have
been asked to construct a comprehensive
statement of expectations and resource
needs. You have been invited to communicate with the school’s associate deans concerning any other information you feel you
may need before next month’s final visit.
The information you have received
throughout the search process has been
helpful and quite comprehensive, but you
are now wondering what questions you
haven’t asked, and what further information
you should have in order to make a firm
and final decision.
Most people undergo such a significant,
life-changing decision only a few times in
their careers, and although they may get
advice from others who have been through
the process, the best guidance may come
from those who negotiate these packages all
the time, even those who have done so from
the “other side of the table.” Here are some
things you can do to help you answer the
question, “Do I know enough to accept this
position?”
What Information Do I Need
to Make a Decision?
The Personal Package
Let’s get the personal part of the package out
of the way. Get information on competitive
salaries for chairs in your discipline. The
best source will be through your current
chair, the department administrator, or your
institution’s associate dean for faculty affairs
or administration and finance—if you are
comfortable revealing that you are in a
search. Otherwise, you may need to work
through a colleague at another institution
D
avid J. Bachrach has more than 35 years
of experience in academic medicine. For
the past 10 years he has been providing leadership coaching services to physicians in academic medical centers and teaching hospitals.
E-mail: [email protected]; phone: 303497-0844; Web site: www.PhysXCoach.com.
or ask your new institution to provide documentation. These individuals likely have
access to AAMC salary data and/or data collected by your discipline’s society of department chairs.
You should propose a salary either at or
above the AAMC’s 50th percentile, or determine whether the school has a practice of
compensating all its chairs at a given percentile level. Upward adjustments in high
housing cost areas, or access to housing/
mortgage support funds, may be discussed.
Many schools offer an incentive component
tied to the chair’s leadership performance,
although some either guarantee this in the
first year or add it to the compensation
package as a part of setting goals for year
two and beyond.
Basic benefit packages are probably not
negotiable, but some elements of the package may be discussed, including starting
date; relocation costs for family members,
household contents, automobiles, and office/
laboratory equipment; office/laboratory renovations; office/mobile equipment, such as
computers and cell phones; interim housing
and travel between acceptance and relocation dates; interim travel for up to one year
if your family doesn’t relocate at the same
time that you commence your new role; and
leadership coaching support for your first
year or two.
The Chair’s Leadership Package
You will undoubtedly get advice from
friends and colleagues concerning the negotiation process. There are often two things
told to people in your position at this time:
(1) Whatever you do, get it now and get it
in writing! And (2) More is better—and a lot
more is better still (sometime referred to as
“package envy”).
However, here are some things you really
need to know:
❖ The offer needs to be “sufficient”—not
necessarily large, but sufficient to get the
job done. Accordingly, it’s the program
description that you have put forward, the
timeline for its accomplishment, and the
measures of success that need to be
pinned down in writing, more so than the
precise resources you will receive—
although it is important to build and agree
on an inventory of resources, as described
below.
❖ You will not be able to anticipate everything you will need to be successful over
the next five to 10 years—no one can. As
such, it is more important that you, the
dean, and the senior staff in medical
administration agree in writing to the
principle that, within reason, resources
needed to be successful that are not committed to as a part of the offer will be
provided in good faith in the future, to
the degree that the institution can
respond at that time.
❖ It is important is that you and the dean
mutually agree to the following principle: “If I lead the department to a level of
performance equal to or greater than that
which has been described in your offer
and my acceptance, I will have access to
additional resources to take the department to the next level, as I will describe
in my rolling five-year vision statement
and action plan.” Most deans will welcome such a discussion, as it speaks to
your focus on accomplishment, and not
just a large package of resources for the
sake of bragging rights.
There is rarely as much information
available to you as you would like; you will
need to trust those with whom you have
been dealing and will depend on at your
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November/December 2008
new institution. Your confidence in the
commitments of others can be enhanced
by taking a number of simple steps. First,
plan your final visit to include one-on-one
visits with the chairs who are the “power
brokers” at the institution; include chairs
who have been recruited by the incumbent
dean in the past three years, as they can tell
you how well commitments are honored.
Further, meet with the search committee to
convey that you intend to call on them
once you arrive to assist with your transition. And third, at many institutions one or
more of the associate deans are involved in
developing and negotiating chair packages.
With so many contributors, I have witnessed various levels of clarity—and ambiguity—in offer letters. It is important that
if they do not do so, you should develop a
reference document that specifies commitments, and make it a part of the offer documentation.
Inventory of Current and
Incremental Resources
Most recruitment package negotiations are
built on a commitment to incremental
resources: “How much [positions/space for
various functions/dollars] will you add to
the department’s resource base as a part of
my recruitment?” In my judgment, the bestconstructed offer packages describe all
resources accessible to the new chair—those
that now exist and those that will be added
as a part of this commitment. Here is some
information to ask for as you prepare for
your visit:
❖ People: Ask for a list of all faculty, by
subdiscipline, rank, age (yes, you can ask
for this information), and any commentary on likely duration of tenure with the
institution. A discussion in advance of
your visit with the associate dean for faculty affairs regarding these data, and the
policies and practices followed by the
institution concerning adjustments in
faculty appointments, will let you know
how much flexibility you will have to
shape the department in the next few
years, and thus will provide additional
justification for how many new positions
(and core support) you will need to
request.
❖ Space: An inventory of all space in the
department (including annotations about
the condition of the space and its suit-
“Essential is a clear characterization of
the department five and 10 years hence
[and] a sense of trust with the dean and
senior staff that resources will be
sufficient to accomplish these goals.”
ability to support the programs you have
described) is essential before you start
talking about incremental space or large,
nonrecurring dollar allocations for
remodeling or new construction. A
department with grossly outdated space
will require a larger package for remodeling than one that has access to new,
well-designed space.
❖ Schedules of existing resources (separate
schedules for positions, space, equipment, and recurring and nonrecurring
funds) including what now exists, what
will be added, and when this will occur,
should be requested. This multidimensional matrix is complicated and will
likely have many footnotes explaining
complex relationships and referencing
institutional policies, procedures, practices, and principles.
With a draft of your spreadsheet in
hand, plan to visit with each one of the
individuals who will be responsible for
honoring these commitments. For example, the associate dean for research may
control research space; plan to go over the
commitment for new (or retained) research
space with him or her, walk the space with
this person and the school’s facilities expert
see if their assessment of current condition
is consonant with the intended use, and/or
whether the dollars allocated for upgrading
5
will get the job done (You might say, “I am
not interested, per se, in how much money
is in the package for this work; I care only
that it is sufficient to get the job done in
such a fashion and timeframe in which
I can recruit and retain faculty.”) You’ll want
to go through a similar exercise for office,
educational, and clinical space allocated to
the department for fulfillment of your
vision. Ideally, you will secure the “sign-off”
of each associate dean or hospital director
on your offer package for each area of
responsibility.
Finally, you need to ask about the culture
of the institution—not necessarily what
people say they want it to be, but rather
what it really is. Some institutions subscribe
to the credo, “Each tub on its own bottom,”
while others speak sincerely about collaboration. An institution that says “We reward
collaboration and cooperation with a greater
willingness to make funds available to those
who demonstrate better utilization of
resources by sharing expensive assets” gives
you greater flexibility for deploying committed assets. Knowing the culture will be a
factor in determining the level of specificity
with which you will need to be comfortable
when making your decision whether to
accept the offer.
Summary
Few candidates will have as much information, or as much time, as they would like to
make a commitment to their new position.
Accordingly, key factors need to be in place,
along with as many specifics as can be
agreed to in advance. Essential is a clear
characterization of the department five and
10 years hence; a sense of trust with the
dean and senior staff that resources will be
sufficient to accomplish these goals; an
understanding of the culture, as well as policies and practices, of the institution, with
the agreement that these are sufficient to
allow you to sculpt the department as needed; and, last, that those who have come
before you speak to the veracity and integrity of the people with whom you will deal, so
you will know that what they say is what
they mean, and what they do. ❖
For an expanded version of
this column, including additional
tips, visit the APS Web site at
www.acphysci.com.
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Mind–Body Skills
Continued from page 3
grape—so that the process of consuming
one grape could last for 20 minutes or more.
Students also learn to utilize guided
imagery techniques to reconnect the mind
with the body. Feeling state imagery helps
students relax by imagining a safe and
relaxing place (such as the beach), whereas end-state imagery encourages students
to imagine themselves successfully accomplishing something they are afraid of (such
as speaking in front of a large audience).
Biologically correct imagery is a technique
that can be incorporated into medical practice, which, for example, encourages a
patient to visualize cancer cells being
destroyed by chemotherapy.
Students also learn to utilize art, music,
movement, and writing as means for selfexploration. In an art exercise, students are
asked to draw pictures of themselves as they
see themselves that day, as they would
appear with their biggest problem, and as
they would like to look. Pictures drawn at the
beginning of the course are compared with
those drawn as the course is near completion.
After each exercise, participants are
asked, but not obligated, to process with
the group how the experience affected
them. Each session then ends with a closing ritual. “These sessions help me tune
out all the craziness of the outside world
and the stress that accompanies medical
school life. I love some of the imagery
exercises,” said third-year student Jaclyn
Winikoff. Ms. Winikoff became an advocate of the program in the first year of
medical school, and continues to meet
electively with a meditation group that grew
out of the program. “The group provides a
safe environment for us to reflect. It is a
fantastic forum—a haven,” she said.
Assessing the Impact
In order to assess the course, students were
asked to complete a number of survey
instruments, such as the Perceived Stress
Scale, the Mindful Awareness Attention
Scale and the Attitudinal Scale, before and
after the 11-week course. They were also
asked to answer six open-ended questions
that queried whether the course affected
their view of medicine, medical school, and
their relationship
with their classmates.
Quantitative
analysis of the survey instruments
indicated that after
the course, students
demonstrated a significant reduction
in perceived stress
and an increase in
their mindfulness,
said Dr. Haramati.
An increase in
concern for classmates’ welfare was
also apparent, suggesting an improvement
in empathy. A qualitative analysis of the
open-ended questions found that students
touched on five central themes as to how
the course benefited them: connections,
self-discovery, stress relief, learning skills,
and an enhanced awareness about issues
in medical education. (For details, see
Saunders PA et al. Medical Teacher 2007;
29:778–784.)
■
November/December 2008
Students in the Mind–Body Skills course
share a happy moment.
training to become a facilitator. Demonstrating
the importance of the program to medical
education at Georgetown, Ms. Harazduk,
the director of the mind–body program,
is now based in the dean of education’s
office.
Future Directions
Ripple Effects Through the
Georgetown Community
As of last spring, more than 700 people
have participated in a mind–body skills
course at Georgetown, said Dr. Haramati.
This includes 450 medical students, 100
nursing students, staff members, and graduate students in physiology. There are now
groups being formed for law students and
for faculty members.
A sign of how much these ideas and
skills have been embraced by the
Georgetown community is that many
high-profile faculty members, including
course and clerkship directors, have
taken the training to become facilitators.
“We have the director of pediatric oncology and the director of the neonatal intensive care unit participating. These people
have no spare time, but once they went
through the course and noticed the positive effect it had on their own lives, they
became enthusiastic backers and champions of the program,” said Dr. Haramati. He
noted that facilitators are excited to participate and are not paid for their efforts.
The dean of medical education, S. Ray
Mitchell, MD, recently went through
With an educational curriculum in place,
the focus is turning to research in
mind–body medicine. This is in part
spearheaded by the Consortium for
Academic Health Centers for Integrative
Medicine (www.imconsortium.org), a
group of 41 academic medical centers in
the United States and Canada. The group
is sponsoring a research conference on
integrative medicine, May 12–15, 2009 in
Minneapolis. Dr. Haramati also cited the
National Center for Complementary and
Alternative Medicine (NCCAM.nih.gov)
for providing funds to advance research in
the field.
Dr. Haramati spends considerable time
speaking about the mind–body skills
program at medical schools and conferences. “I see part of my mission as a scientist to talk about this,” he said. “The incorporation of approaches that foster selfawareness and improve stress management may stem the decline in student and
faculty empathy in medical school and
advance their professional development.
As one of my students said it best, ‘Know
thyself. Then you are in a better position
to help others.’” ❖
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THE
SKIPJACK PROJECT
Issues in Contemporary
Medical Education
Page 7
■
November/December 2008
7
While We Were Sleeping:
Encountering Grey’s Anatomy, House,
and Scrubs for the First Time
B Y F R E D E R I C J . H A F F E R T Y, P h D , A N D L Y U B A K O N O P A S E K , M D
I
t is virtually impossible to work with
medical students or residents and not
overhear them dissect the latest plot lines
and characters that inhabit today’s TV doctor
shows. Their fascination is nothing new. Generations of doctors-in-training have religiously tracked the interweavings of clinic, comedy, and drama depicted in programs such
as M*A*S*H (1972–1983) and St. Elsewhere
(1982–1988). Today’s students, awash with
cable and choice, can feast on new seasons
and reruns of ER (1994–), Scrubs (2001–),
House (2004–), and Grey’s Anatomy (2005–).
Although our students were functioning as
cultural insiders, many of their interjections
of plot and personage were lost to our appreciation (and possible enjoyment) because
neither of us had any experiential knowledge
about the programming, plots, and characters. It was as if these modern-day depictions
of medicine had invaded medical culture
while we were sleeping.
We decided to exorcise our ignorance, at
least partially, by watching the first episode
of three current shows (Grey’s Anatomy,
Scrubs, House). We thought we would use
our newly secured knowledge to say something pithy about medical training. Our first
plan was to take the ACGME competencies
and “score” each episode on how these
behavioral standards were reinforced or
undermined by the story lines of these
shows. This plan, however, quickly dissolved in the face of what quickly began to
capture our attention—which we had failed
to notice the first time around.
Yes, there were instances of “compassionate, appropriate, and effective” patient care,
and yes, there were scenes that the respective
directors obviously wanted us, as viewers, to
notice (who could miss the Grey’s Anatomy
depiction of “cutthroat” interns taking bets
and cheering on the failure of one of their
own during his first surgery?). But then there
were the myriad things that had escaped our
F
rederic J. Hafferty, PhD, is a Professor
in the Department of Behavioral Sciences
at University of Minnesota Medical School–
Duluth. E-mail: [email protected]. Lyuba
Konopasek, MD, is Co-Director of the
Pediatrics clerkship, Course Director of the
Medicine, Patients and Society course, and
Associate Professor of Pediatrics (Education)
at Weill Cornell Medical College in New
York. E-mail: [email protected].
attention until we began to compare notes.
Did you know, for example, that no one “in
medicine” washes his or her hands before
examining a patient? We didn’t—until we
were well into our discussions about each
program. Here we were, experienced medical educators exquisitely attuned to issues
of interpersonal communication, power and
hierarchies, professionalism, patient safety,
and quality-of-care issues, yet each (separately and together) had missed a number of
things that had “obviously” taken place
before our eyes.
The culprit, we decided, was our own
socialization. We were products of a life/
work world that had conditioned us to
attend to certain things while ignoring others. Again, this is nothing new. All social
groups can function over time because they
stand on a bedrock of practices that have
become so “taken for granted” that they are
invisible to insiders. Socialization, after all,
involves the transformation of things that
are strange, foreign, morally questionable,
or even repulsive to initiates into things that
are commonplace, routine, morally acceptable, and perhaps even desirable to insider–members. In short, becoming a doctor
means not only acquiring the physician’s
gaze, but also learning to “not see.”
So what did we fail to notice in these
three episodes? Here are some examples.
Grey’s Anatomy
Twice during this premiere episode, students
are manipulated by faculty to jump through
particular academic hoops in exchange for
access to some “forbidden fruits” (for firstday interns). The first time is when Christina
Yang inquires about who will be designated
the “most promising intern.” The reward
is to participate in the first surgery—something Yang is prepared to fight for. The
“honor,” however, goes to the most unlikely
intern (O’Malley). O’Malley, meanwhile, is
being set up for failure and humiliation.
Why? The reason, according to the attending
(Burke), is: “Terrorize one and the rest fall in
line.” Both of us noticed the manipulation,
but what we missed was the tainted nature of
the carrot itself (early access to an otherwise
off-limits procedure) and the “obvious” risk
to the patient.
The second manipulation came when a
second attending (Shepherd) asks the entire
assemblage of interns to help him solve a
diagnostic mystery with the promise,
“Whoever finds the answer rides with
me...you get to do what no intern gets to
do, scrub in and assist on an advanced procedure.” The interns are galvanized into
action. While we were quite attuned to the
spasms of competition generated among the
interns, we were so blinded by the nobility
of the overall goal (after all, there was a sympathetic patient’s life to be saved) that we
failed to notice (the first time around) the
totally inappropriate nature of the plum and
how easily faculty can sway student learning
by offering the “right” inducement.
House
Dr. Wilson, a colleague, persuades House
(who is not particularly interested in caring for patients) to take on the case of a
young woman by telling House that the
woman is Wilson’s cousin (a lie). House
Continued on page 9
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Academic Physician & Scientist
The Five-Minute
MENTOR
■
November/December 2008
The Five-Minute Mentor:
How Long Should a Search Take?
I
am the head of the search committee for a new department chair. The
associate dean who formed the
committee wants to put us on an accelerated schedule for finding a new chair,
as a number of reorganizations are set to
take effect in just a few months and the
dean wants all department chairs in
place by then. We have already engaged
a search firm to help us. Is this time
frame feasible?
Talk about the perfect makings for an
urban legend! I’ve heard of academic chair
searches that take two years to complete.
Thankfully, that’s not my frame of reference. Let’s use the case of a recent search
for a chair of surgery at the School of
Medicine at University of Mississippi
Medical Center (UMMC) in Jackson.
With an aggressive three-month completion timeline, I initially thought it was
an impossible feat, but I was up for the
challenge. To help expedite the process,
Daniel W. Jones, MD, Vice Chancellor
for Health Affairs, Dean of the School of
Medicine and Herbert G. Langford
Professor of Medicine, had assigned Martin
McMullan, MD, Senior Advisor for Clinical
Affairs, to be my internal partner on the
search. Here are several criteria we used.
Criterion 1: Partner Actively
Be an active partner with your clients; this
will considerably shorten the search time.
Identify an “internal expert,” who works
hand-in-hand with the search firm consultant to market the position.
My April 2007 site visit to UMMC
included meetings with the search committee and other key decision makers.
With the information I’d collected from
those one-on-one sessions, Dr. McMullan,
my internal consultant, and I came up with
a search strategy. Dr. McMullan already had
done research through his national surgical
society network to identify about 80 surgeons across the nation who had the credentials to fill the surgery chair at UMMC.
Criterion 2: Do Your Homework
Criterion 4: Stay on Target
Thorough research will enable you to create
a solid search strategy that pinpoints your
audience.
As a next step, Tyler & Company sent a
package to the workplaces of 51 potential
candidates. Materials included were a letter from me describing the opportunity; a
DVD featuring UMMC and the School
of Medicine; and other collaterals. Hallie
Banker, my Tyler & Company senior
researcher on the project, followed up
with phone calls and e-mails to each of
these individuals. During this sourcing
process, we received six additional names
of potential candidates, and we sent them
packages as well.
Always keep your presentation date in
mind.
From May through mid-June, UMMC
interviewed 10 candidates for a first interview on campus. By early July, the finalists
returned with their spouses (if applicable)
for additional meetings. After a search
committee meeting on July 12, the committee presented three top candidates to
the dean, and he made a decision less than
a week later. The appointment was
announced on July 23.
Criterion 3: Go the Extra Mile
Go the distance in the effort to recruit top
talent. Find what appeals to your audience
and deliver via expedited mail, e-mail, or
the old-fashioned phone call.
Through our coordinated effort, I was
able to present a long list of highly qualified candidates to the search committee
within a few weeks. The list presentation
was comprised of candidate CVs, plus a
summary sheet highlighting qualifying
experience and personal motivation to
pursue the opportunity, all of which was
gathered through phone interviews.
During the meeting, the search committee
selected candidates for me to personally
interview. I met with 11 candidates who
could meet the tight schedule, and
our team submitted complete dossiers to
the committee.
Criterion 5: Coordinate
Interviews Quickly
Coordinate your first and second interviews with the client quickly. Don’t lose
momentum.
From my perspective, this was an
amazing search. It epitomized the concept
of partnership between the search consultant and the client, and although it was a
lot of work, it was tremendously exciting
watching the search unfold from concept
to quality candidate recruitment to completion in record time.
Criterion 6: Roll Out
the Red Carpet
It is important to follow UMMC’s model of
rolling out the red carpet not only to the
candidate, but also to his or her spouse
when both come for a visit. Interviews are a
two-way street.
My goal for every search is to give the
client the “option to hire” from a slate
Continued on page 9
ATTENTION DEANS, DEPARTMENT CHAIRS,
AND DIVISION CHIEFS!
We want to hear about your own innovative residency programs, faculty
development initiatives, cutting-edge curricula, or any other unique features
of your school that you think would be of interest to our readers. Please contact APS Editor Deborah Wenger at [email protected].
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NEWS
&
Page 9
■
November/December 2008
9
Views
News & Views
Diversity in Schools Benefits
Medical Students
Medical students who attend racially and ethnically diverse medical schools say that the
experience makes them better able to care for
patients in different ethnic groups, according
to a study in the Journal of the American
Medical Association. Led by the UCLA Higher
Education Research Institute, the research—
using data supplied by the AAMC—is the
first to examine the link between medical
school diversity and educational benefits.
The Five-Minute Mentor…
Continued from page 8
of qualified individuals who are a cultural
fit for the organization. This “option”
becomes a reality when the search is well
run and done with the full engagement of
all interested parties. Although the
thought of selling/marketing the opportunity may seem crass, the “war for talent,”
as often referred to in major newspapers
and professional journals, is real.
Criterion 7: Good PR and
Marketing Are Key
Good public relations and effective marketing go a long way in not only establishing
the look, feel, and positioning of an organization (among other things), but also in
attracting talent.
So with these lucky seven criteria, I
have proved that accelerating an academic
search while not sacrificing quality is
possible.
—Patricia A. Hoffmeir
Senior Vice President
Tyler & Company
Chadds Ford, PA
For an expanded version of
this column, including additional
Q&A, visit the APS Web site at
www.acphysci.com.
The investigators looked at whether
the proportion of minority students
in a medical school made a difference in
three outcomes: whether students said
they felt prepared to care for diverse
patient populations; students’ attitudes
about access to health care; and whether
students were planning to care for
patients in areas that are traditionally
underserved by the current health care
system. The researchers found that white
students who attend racially diverse
Skipjack
Continued from page 7
relents. On first viewing, we picked up
on the lie, but accepted its underpinnings as a fact of medical culture: There
are limits to what you can do; you have
to triage your caring; and personal connections get you the best care. The second time around, we paused and asked:
Are these “facts” truly professional?
Should we not invest equally in every
patient? Can our patients trust us to do
our best every time? Can we trust our
colleagues not to manipulate us to try
“even harder”?
Scrubs
For the majority of this first episode, JD
is victimized and humiliated by his
supervising resident (Perry). In a final
scene, Perry forces JD to overcome his
fears and perform a risky but life-saving
procedure on a patient. “You can do it,
cut him or lose him,” we hear Perry bark
as the cardiac monitor slows toward flatline. JD is successful and the patient
recovers. Perry, for once, congratulates
JD, who beams and is now on his way to
becoming a competent doctor.
The first time we watched, we were
elated for JD. But what if JD had failed to
medical schools said they felt better
prepared than students at less diverse
schools to care for patients from racial
and ethnic groups other than their
own. They are also more likely to believe
that access to adequate health care is
a societal right rather than a privilege.
The authors found no association, however, between the diversity of a medical
school and whether white students
intended to care for patients in underserved areas.❖
insert the chest tube? The tacit message
is that doing is the best way to learn,
and that doing trumps patient safety.
Even as JD is optimistic as the episode
ends, we worry about what he has internalized about the primacy of patient
welfare and the importance of a safe
hospital culture.
What We Have Learned
Our take-home message is simple: Take
time to render problematic the obvious.
Much of what goes on around us in the
banality of everyday world of work is—
and should remain—innocuous. To
function otherwise is to be submerged
in the chaos of details. As medical educators, however, we need to be sensitive
to how easily our students embrace the
anesthesia of unremarkableness as they
quickly become overwhelmed by the
bedlam we have created in a fact-riddled
formal curriculum. However, improving
the training of future physicians should
never begin (and end) with curriculum
reform. It begins by challenging
that which we, as faculty, consider pedagogically beyond reproach or even
necessary in the quest to create ever-better physicians. It begins by questioning that which we consider “beyond
question.”❖
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■
November/December 2008
Highlights From
JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES
www.academicmedicine .org
What Are Schools’ Policies
Regarding Struggling Students?
Medical students struggle for a number of
reasons, both academic and personal.
Although struggling students are a minority among medical students, they present a
continuing concern for faculty. Sandra L.
Frellsen, MD, and colleagues surveyed a
national cohort of clerkship directors in an
effort to characterize the policies of US and
Canadian medical schools regarding struggling students during the core internal
medicine clerkship and fourth-year internal medicine rotations.
Respondents were asked about the percentage of students in the core clerkship
who received a less than passing grade, the
percentage who are identified as struggling,
the typical final-grade options for these students, how often the director used those
grades, and what remediation options were
available. They were also asked whether
they routinely shared (or should share)
information about struggling students with
other course and clerkship directors or
instructors, and whether the respondent’s
school had or should have a formal written
policy about sharing struggling students’
information.
Respondents said that between zero
and 15% of students each year were identified as struggling during the core internal
medical clerkship, and between zero and
11% of fourth-year students were tagged
as struggling. These students received a
variety of grades; however, 77% of respondents said that struggling students who
received unsatisfactory grades were always
presented to a medical school promotions
committee.
A majority of respondents (64%) felt
that they should share information about
struggling students with other clerkship
directors. Reasons for sharing information
included the need to provide a supportive
educational environment, the necessity of
identifying struggling students early, and
the importance of viewing medical education as a continuum and not focusing solely on a single clerkship. Those who did not
favor sharing information felt that doing so
might create bias or prejudice against students, and did not trust that clerkship
directors would use the information appropriately.
The authors conclude that there is a
need to accurately identify and remediate
struggling students, and advocate for the
development of national standards to promote grading uniformity, as well as the
development of effective remediation plans
for struggling students.
Frellsen SL, Baker EA, Papp KK, Durning SJ.
Medical school policies regarding struggling medical students during the internal
medicine clerkships: results of a national
survey. Acad Med 2008;83(9):876–881.
Point-Counterpoint on
‘Forward Feeding’ about
Students’ Progress
Several medical educators commented on
the article by Frellsen et al. (above). Lynn
Cleary, MD, opined that sharing information is the right thing to do, for the following reasons:
❖ The acquisition of knowledge and clinical skills is a longitudinal and cumulative process.
❖ Early identification of areas of concern
maximizes the time available to work on
improvements.
❖ Individual faculty may understate concerns and avoid submitting negative
evaluations.
❖ Struggling students may not be noticed
if information is not shared.
❖ A series of marginal performances is
reason for serious concern.
Dr. Cleary makes several recommendations for minimizing the risks to students
and communicating respectfully and professionally:
❖ Schools should have longitudinal, integrated, and shared assessment programs.
❖ A limited number of faculty should
participate in an information-sharing
committee.
❖ Students should participate in assessments that contribute to their cumulative performance profiles.
❖ Qualitative evaluations should describe
specific behaviors and issues.
Susan M. Cox, MD, disagrees. She feels
that information should not be shared
because of the likelihood of breaches of
confidentiality, the introduction of bias
and stigmatization, the creation of unfair
advantage, and other related legal issues.
She posits that there is no evidence of value
or proven benefit to forward feeding information that would justify the risks. In addition, the current litigious environment will
encourage students to file lawsuits against
schools, alleging that forward feeding led
to irreparable harm to their careers. She
believes that attention should be focused on
correcting the systemic difficulties inherent
in the current structure, and not on developing intrusive, costly, and risky arrangements
that, she states, have little or no proven value.
Finally, Louis Pangaro, MD, lists a number of questions that educators should ask
themselves in order to decide on their institutions’ policies about forward feeding:
1. Are there particular types of behaviors
that merit forward feeding so that patterns can be established and documented?
2. Is the history of a “first” problem in a
clinical course different for the professionalism domain than for cognitive
issues?
3. What preconditions are in the educational system and culture for consistent evaluation of students?
4. What is the empiric support for the
notion that a framework for educational goals can be used consistently?
5. Can clerkship directors be trained
to avoid bias coming from forward
feeding?
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November/December 2008
6. What evidence exists that forward
feeding has been successful in remediating struggling students’ problems?
Cleary L. ‘Forward feeding’ about students’
progress: the case for longitudinal, progressive, and shared assessment of medical students. Acad Med 2008;83(9): 800.
Cox SM. ‘Forward feeding’ about students’
progress: information on struggling medical students should not be shared among
clerkship directors or with students’ current teachers. Acad Med 2008;83(9):801.
Pangaro L. ‘Forward feeding’ about students’ progress: more information will
enable better policy. Acad Med 2008;83(9):
802–803.
Creating a New School
from the Old
The University of Colorado Health Sciences
Center (UCHSC) has undergone several
major changes over the past decade, not
the least of which is its name change to the
University of Colorado Denver. M. Roy
Wilson, MD, and Richard D. Krugman,
MD, describe the history and nature of
these changes.
The UCHSC was established in 1976.
As the school grew, it became clear that it
was unlikely to be able to expand in its current location, as it was surrounded entirely
by residential neighborhoods, whose citizens were concerned about parking and
congestion problems. A solution was found
when the Fitzsimons Army Medical Base in
Aurora, located about six miles from the
UCHSC campus, was closed. UCSHC was
granted 227 acres to build a new academic
health center at this location. Although several department heads initially objected to
the plan, feeling that it would drain
resources from the institution and hinder
the school’s research mission, faculty buyin was eventually achieved after faculty
realized that the new facilities would be
superior to the old ones, among other factors. By April 2008, 3.4 million square feet
of additional educational, clinical, and
research facilities had been completed.
As the new school was being built, the
University of Colorado leadership began to
consider the future of both the Aurora and
Denver campuses. A feasibility study was
done to determine whether the UCHSC
and the University of Colorado at Denver
should be combined into a single institution, with different missions but sharing a
common future. This consolidation was
accomplished in 2004; at first, the administrative units were combined, but the campuses continued to function as separate
entities with different cultures. The new
institution is named University of Colorado
Denver, branding the consolidated university as a single entity.
Wilson MR, Krugman RD. The changing
face of academic health centers: a path
forward for the University of Colorado
Denver. Acad Med 2008;83(9):855–860.
What Direction Should Internal
Medicine Training Take in the
21st Century?
Various voices have been heard regarding
the future of training in internal medicine.
Some say that internal medicine must
accommodate the increasing need for subspecialists. Others note that role differentiation should be acknowledged earlier in
the training process. Still others call for
increased attention to ambulatory training.
However, Thomas S. Huddle, MD, PhD,
and Gustavo R. Heudebert, MD, argue that
the traditional Oslerian model is the one
that should be followed, as it produces seasoned clinicians who possess a knowledge
of internal medicine that is both wide and
deep.
The increasing complexity of health
care delivery, along with increasing role
differentiation, threatens the viability of
the “consultant-generalist” ideal in medical
practice. Budgetary pressures make it
increasingly difficult to combine office and
hospital practice, leading to a division
between office-based and hospital-based
internists. The authors point out that the
multiple roles now played by internists
still require the kind of general competence provided by traditional training,
which involves familiarity with the broad
range of internal medicine illness and with
managing such illness in both inpatient
and outpatient settings. Calls for reform,
which imply that inpatient and outpatient
training should be conducted indepen-
11
dently of one another, are misguided, they
say, as the two are actually less separate
than they were previously.
The authors maintain that inpatient rotations should provide the core training in
diagnosing and treating disease in its most
demanding aspects; after they attain this
experience, trainees will be able to progress
to outpatient rotations and gain a supplementary view of the same diseases in their
less acute manifestations.
Huddle TS, Heudebert GR. Internal medicine training in the 21st century. Acad
Med 2008;83(10):910–915.
Experiential Learning of
Systems-Based Practice
In order to prepare for the systems-based,
interdisciplinary approach to health care
delivery that is the model for the 21st
century, residents must learn both sophisticated information technology and the
way in which various components of
the health care system interact with each
other. Arnold R. Eiser, MD, and Joanne
Connaughton-Storey, MD, report on a
two-week supervised experience developed at Mercy College Medical Center
in Philadelphia that permits first-year residents to experience the care provided by
other health care professionals.
The residents, under the supervision of
experts in the various disciplines, spend
clinical time in home nursing care, home
hospice care, pharmacy services, clinical
laboratory services, utilization management, and nutrition services. A component
in physical therapy is also planned.
After this experience, a substantial
majority of residents indicated that they
definitely had a better understanding of
available medical resources to optimize the
medical care of their clinical patients and
to better arrange for resources after the
patients are discharged. Almost all the residents felt that their overall knowledge of
nonphysician services within the health
care system increased to some extent.
Eiser AR, Connaughton-Storey J. Experiental
learning of systems-based practice: a
hands-on experience for first-year medical
residents. Acad Med 2008;83(10):916–923.
For the full text of these and other articles, visit the Academic Medicine Web site, www.academicmedicine.org
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Academic Physician & Scientist
❉ In the December issue of
www.academicmedicine .org
“Live Lecture Versus Video-Recorded Lecture:
Are Students Voting with Their Feet?”
In light of educators’ concerns that lecture attendance in medical school
has declined, doctoral candidate Scott Cardall and associates performed a
cross-sectional survey of first-and second-year medical students to assess
students’ perceptions, evaluations, and motivations concerning live lecture compared to accelerated, video-recorded lectures viewed online.
Respondents answered questions regarding, among other topics, their
lecture attendance; use of class and personal time; use of accelerated,
video-recorded lectures; and reasons for viewing video-recorded and live
lectures. Results showed that live attendance remains the predominant
method for viewing lectures; however, students find accelerated, videorecorded lectures equally or more valuable. Although educators may be
uncomfortable with the fundamental change in the learning process represented by video-recorded lecture use, students’ responses indicate their
decisions to attend lecture or view recorded lectures are motivated primarily by a desire to satisfy their professional goals.
Medical education is facing a convergence of
challenges that Mark Albanese, MA, PhD, and
colleagues characterize as the four horsemen of
the medical education apocalypse: teaching
patient shortages, teacher shortages, conflicting
systems, and financial problems. If medical education is to avoid a catastrophic decline, it will
need to take steps to reinvent itself and make
optimal use of all available resources. Curriculum
materials developed nationally, increased reliance
on simulation and standardized patient experiences, and adoption of quality control methods
such as competency-based education are suggested as ways to keep medical education vital in an
environment that is increasingly preoccupied
with fending off these challenges. The authors
offer several potential ways to maintain the vitality of medical education in the face of such overwhelming problems.
A Trusted Resource for the Medical
School and Teaching Hospital Community
V Highly ranked in its field
for 2007 with an impact
factor of 2.571
EDITOR-IN-CHIEF: Steven L. Kanter, MD
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Visit www.academicmedicine.org to subscribe,
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November/December 2008
“Perspective: CompetencyBased Medical Education:
A Defense Against the Four
Horsemen of the Medical
Education Apocalypse”
JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES
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“The Schism between
Medical and Public Health
Education: A Historical
Perspective”
The separation of “medicine” and “public
health” in academic institutions limits the
potential synergies that an integrated educational model could offer, say A.R. Ruis,
MA, and Robert N. Golden, MD. Today,
there is growing recognition of the considerable value afforded by the integration of medicine and public health education. Many schools have responded to a
national call for a renewed relationship
between medicine and public health by
increasing the availability of MD/MPH
programs and/or by incorporating one or
more public health courses into the basic
medical curriculum. A few schools have
created more substantial and innovative
changes. Review and consideration of the
history and politics of past efforts may
serve as a guide for the development of
successful new approaches to creating a
clinical workforce that incorporates the
principles of both clinical medicine and
public health.