왜 1/4의 교수가 대학의학을 떠나려고 하는가?: 기관 문화와 이직 의도에 대한 연구(Acad Med, 2012)
Why Are a Quarter of Faculty Considering Leaving Academic Medicine? A Study of Their Perceptions of Institutional Culture and Intentions to Leave at 26 Representative U.S. Medical Schools
Linda H. Pololi, MD, Edward Krupat, PhD, Janet T. Civian, EdD, Arlene S. Ash, PhD, and Robert T. Brennan, EdD
의과대학 교수에 대한 여러 연구에서 불만족, 탈락, 탈진률, 연구에서의 비 윤리적 행위, 교수진의 노화 등이 보고되었습니다 .6 그렇더라도 교수진이 어떤 이유로 의과대학을 떠나거나 불만족하게 되는지에 대한 연구 결과는 거의 없습니다.
두 개의 단일 기관 연구에서 7,8 Cropsey7은 여성 및 Minority 교원의 감소가 전문성 발달 문제, 낮은 봉급 및 리더십에 대한 불만 (51 % 응답률)에 기인한다는 것을 발견했으며
Lowenstein은 교육이나 진료 우수성에 대한 reognition이 부족한 것, 가족과 직무 간 균형의 어려움 등이 떠날 의향 (38 % 응답률)과 관련이 있다고 했다.
Schindler 등 1)은 교사의 복지에 관한 4개 학교 연구에서 1985 년 조사의 결과와 비교하였을 때, 젊은 교수의 우울증과 불안증이 작업 만족도가 감소와 임상적으로 유의한 우울 증상과 관련되어있다고 하였다..
Several studies of faculty in academic medicine report high levels of dissatisfaction,1 attrition,2,3 burnout rates,4 unethical behavior in research,5 and an aging faculty.6 Even so, there is little published research on what predisposes faculty to leave academic medicine or the reasons for their dissatisfaction.
In two single-institution studies,7,8 Cropsey7 found that attrition of women and minority faculty was due to professional advancement issues, low salary, and chairman/ leadership discontent (51% response rate), and
Lowenstein8 found that lack of recognition for teaching and clinical excellence, and difficulty in balancing family–career responsibilities, were linked to the intent to leave (38% response rate).
Schindler et al,1 in an important four-school study of faculty well-being, documented high levels of depression andanxiety, especially in younger faculty, and, in comparison with findings of a 1985 study,9 found decreased work satisfaction and higher levels of clinically significant depressive symptoms in faculty.
최근 미국 의과 대학 (Association of American Medical Colleges)은 의과 대학 교수진이 보유율을 보고하고 만족도를 간략히 평가했습니다 (47.5 %의 응답률). Intent to leave는 진료활동과 질, 그리고 Workplace가 동료애를 키웠는 지와 상관 관계가 있었다.
A recent Association of American Medical Colleges (AAMC) analysis2 of clinical- only physician faculty in 23 self-selected medical schools reported retention ratesand briefly assessed satisfaction of this group of faculty (47.5% response rate). Correlates of intent to leave focused on the activity and quality of patient care and whether the workplace cultivated collegiality.
또한 1 명의 임상 교수를 대체하는 비용은 전공에 따라 155,000 달러에서 559,000 달러 사이이며, 그 외에도 아카데믹 건강 센터 (AHC)에 미치는 덜 tangible한 영향이 많다. 교수진 교체 비용은 한 AHC에서 연간 예산의 5 %를 차지합니다 .11
Additionally, the cost of replacing one clinical faculty member has been calculated as between $155,000 and $559,000, depending on discipline,10 plus the many less tangible effects on the academic health center (AHC). Faculty turnover costs account for 5% of the annual budget in one AHC.11
교수들은 직장 문화가 협동적이기보다는 경쟁적이었음에도 불구하고 직업에서 의미를 느끼고 지적으로 자극을 받았다. 교수들은 종종 동료들과 격리되고 연결이 끊어지는 느낌을 받았습니다. 14 많은 사람들은 자신의 가치관과 그들의 학교가 표방하는 가치에 alignment가 부족함을 느꼈다. 유색인종과 여성 교수에 대한 무의식적이고 의식적인 편향을 묘사했다.
We learned that faculty continued to find their work meaningful and intellectually stimulating, even though their workplace culture was competitive rather than collaborative and faculty often felt isolated and disconnected from their colleagues.14 Many perceived a lack of alignment between their own values and those exhibited by their schools.16,18 Both women and faculty of color described unconscious and conscious bias.19–21
Method
설문 도구 개발
Instrument development
The domains and items of our survey questions were derived in large part from themes identified in the C-Change qualitative studies14–18,20,21 in conjunction with an extensive search of the literature and reviews of relevant instruments.1,23–27 We created 74 items related to
advancement,
engagement,
relationships,
feelings about workplace,
diversity and equity,
leadership,
institutional values and practices, and
work–life integration.
표집
Sampling procedures
Selecting schools.
Schools were selected in a multistage process.
First, we included the 5 schools that were part of the consortium associated with the project from which this study derived. The 5 C-Change schools had been selected to vary among themselves in important ways and encompass a range of key attributes of medical schools (public/ private, region of the United States, National Institutes of Health [NIH] research intensive, or community care focused). The mean aggregate faculty demographics of these 5 schools matched those of all the 126 AAMC member schools at the time. Our survey was administered in these 5 schools as a pretest survey and very early in the school leaders’ participation in the C-Change Learning Action Network.
Then, with the assistance of the AAMC and using the AAMC roster of all its 126 member medical schools at that time, we constructed a stratified random sample of an additional 21 medical schools to ensure that the resulting 26 schools
(1) spanned all school types (including 1 small and 1 historically black school) and
(2) achieved a distribution similar to the overall proportion of AAMC member schools across eight strata defined by four geographic regions crossed with public/private status. Each dean was asked permission to approach faculty and to provide e-mail addresses. If consent was not granted, a school from the same stratum was randomly selected as a replacement. The same stratified random selection of faculty was used in all 26 schools.
Because the first 5 schools had not been selected at random, the data from these schools were systematically compared with those of the other 21. We found no significant differences in respondents’ perceptions on 11 of 12 scales created to measure dimensions of the culture (see Table 1). The exception was the relatedness/ inclusion scale, on which the 5-school faculty sample scored modestly higher; all demographic characteristics of the faculty were alike. We cannot name the participating schools because they were assured anonymity; however, the systematic random sampling of 21 of the 26 schools and the measured similarity of the 5 nonrandomly and 21 randomly selected schools gave us confidence that the sample 26 schools is reasonably representative of all U.S. medical schools.
Table 2 compares characteristics of the study schools with all AAMC member schools.
의과대학 내 교수 샘플링
Sampling faculty within schools.
The AAMC provided lists of full-time faculty at each school, including faculty demographic characteristics. For sampling, each faculty member was categorized by sex and chronological age: under 39 years old; 39 to 47 years; and 48 years and older. Faculty selection began with equal allocation stratified sampling to ensure adequate numbers of women in the respondent pool for analysis with a feasible total sample size. At each school, 25 faculty were randomly selected from each of 6 sex-by-age categories for a base sample of 150 per school. To ensure adequate numbers of faculty in 2 other groups of interest, we added faculty at each school to the 150 members sampled by sex and age.
Faculty who identified as underrepresented minorities in medicine (URMM) were one such group. We followed NIH definitions in coding the following as URMM:
- American Indian or Alaska Native,
- black or African American,
- Hispanic/Latino,
- Native Hawaiian, or
- other Pacific Islander.
At each school, we added URMM faculty to each age group, up to a maximum of 20 URMM faculty per group. When fewer than 20 URMM faculty were available in a category, faculty from the next-younger category were selected until the target was reached or the pool of URMM faculty was exhausted.
Female surgeons were another group of interest because of the particularly low representation of women in this specialty. To ensure their representation, additional female surgeons were selected until the pool was exhausted. By oversampling URMM faculty and female surgeons, we were able to maximize statistical power for testing comparative questions for these groups and to increase the precision for estimates in what might otherwise be sparse categories when examining characteristics within these groups such as faculty rank. Weights were employed to adjust for oversampling in survey analyses.
설문 시행
Survey administration
The stratified selection process and inclusion of additional URMM faculty and female surgeons resulted in a list of 4,578 sampled faculty.
Find work personally satisfying, proud to work at institution, feel energized by work, look forward to coming to work, feel burned out (RC§)
자기효능감
Self-Efficacy: confidence in ability to advance in career‡
Satisfied with career advancement, feel advancement as open to me as anyone else, feel confident in my ability to progress in career, feel confident I can overcome any professional barriers
기관의 서포트
Institutional Support: institutional commitment to faculty advancement‡
Institution actively encourages faculty retention, I feel part of a supportive community, institution seems committed to my success, institution facilitates professional development, I get help to advance career, I get constructive feedback, receive credit for work I do
관계성
Relatedness/Inclusion: faculty feelings of trust, inclusion, and connection‡
Faculty trusting and open, colleagues value my contributions, feel ignored/invisible (RC), hide what I think and feel (RC), feel isolated (RC), reluctant to express opinion/fear negative consequences (RC)
가치관의 부합
Values Alignment: alignment of faculty member’s personal values and observed institutional values‡
High faculty morale, administration only interested in me for revenue (RC), institution committed to serving the public, institution makes effort to involve me in decision making, institution’s actions well aligned with stated values and mission, institution puts own needs ahead of educational/clinical missions (RC), my values well aligned with school’s, institution rewards excellence in clinical care, institution does not value teaching (RC)
윤리/도덕적 스트레스
Ethical/Moral Distress: feeling ethical or moral distress and being adversely changed by the culture‡
Must be self-promoter to get ahead, working here is dehumanizing, culture discourages altruism, felt pressure to behave unethically, people need to be deceitful in order to succeed, have to be more aggressive than I like, others have taken credit for my work, have to compromise values to work here
리더십에 대한 열망
Leadership Aspirations: aspiring to be a leader in academic medicine‡
Being a leader in academic medicine important to me, want to be influential in making change happen at my institution
성 평등
Gender Equity: perceptions of equity for women
Harder for female faculty to get ahead than males (RC), institution actively supports women in achieving leadership, aware of instances of unfair treatment because of gender (RC), institution treats women and men equitably for promotion
소수인종 평등
URMM Equity: perceptions of equity for URMM faculty¶
Harder for minority faculty to get ahead than others (RC), institution actively supports minorities in achieving leadership, aware of instances of unfair treatment because of race or ethnicity (RC), institution treats minorities and nonminorities equitably for promotion, institution’s actions demonstrate that it values diversity
직장-삶 통합
Work–Life Integration: institutional support for managing work–life
Workplace is family friendly, able to take time for personal/family issues when needed, difficult to succeed without sacrificing personal/family commitments (RC), job allows me to maintain a reasonable balance in my life
다양성을 위한 기관의 노력
Institutional Change Efforts for Diversity: good-faith effort by institution to advance women and URMM faculty¶
(In past year) institution has made effort to recruit minority faculty, have women in positions of leadership, have minority faculty in positions of leadership
교수 서포트를 위한 기관의 변화노력
Institutional Change Efforts for Faculty Support: good-faith effort by institution to improve support for faculty
(In past year) institution has strengthened mentoring, attempted to humanize policies and practices, is responding to input from people like me, instituted family-friendly policies, invested in success of the faculty, open to change
Using the five-point scale described earlier (i.e., strongly disagree, somewhat disagree, neither agree nor disagree, somewhat agree, strongly agree), respondents were asked the extent to which they endorsed the following statement: “In the past 12 months, I have seriously considered leaving my current institution.” A second, analogously phrased item asked about “seriously considering leaving academic medicine.” Those responding with one of the “agree” categories were asked their reason for considering leaving. Responses to these items generated five discrete groups:
(1) stayers—those who had not seriously considered leaving,
(2) those considering leaving their school but not academic medicine because of dissatisfaction,
(3) those considering leaving academic medicine because of dissatisfaction, and
those considering leaving their school and/or academic medicine either
(4) to retire or
(5) for personal/family reasons.
독립변수
Independent variables
개인 수준
Several personal and professional demographic items were used as predictors:
sex;
URMM status;
age;
having a medical versus another terminal degree;
percent time devoted to research;
rank;
primary role of clinician, researcher, administrator, or educator; and
holding a leadership position.
설문 조사에서 확인한 특성
These characteristics were gathered from survey response data. Additional professional attributes included
receipt of mentoring (or not) and
whether their medical school (as opposed to their hospital) predominantly affected their job satisfaction.
학교 수준
School-level variables included
NIH award ranking and
(from the AAMC) sector (public versus private),
region,
school size, and
percentage of faculty who are women.
통계 분석
Analytic overview
We constructed weights based on sex, age, and URMM status of all faculty at the 126 AAMC member schools in 2008 to be able to generalize our findings to the national population of academic faculty. To address missing values in demographic data and scales representing dimensions of the culture, 10 multiply imputed data sets were estimated using IVEware 2002 (Survey Research Center, Institute for Social Research, University of Michigan).28 Under certain assumptions, multiple imputation yields unbiased point estimates and confidence intervals.29 IVEware uses chained equations in combination with a Markov chain Monte Carlo method.
To determine the conceptual structure underlying faculty responses, we subjected 46 items related to institutional culture to a factor analysis using SAS/STAT Version 8.2 for Windows, 2004 (SAS Institute, Cary, North Carolina).
First, we examined unrotated principal component loadings showing the linear consistency among all items, retaining items with unrotated factor loadings ≥ 0.40.30
Then, we used an equamax rotation to identify distinct factors, or subdimensions, of institutional culture.
We used these in conjunction with semantic review of the items to guide final scale development; an additional five scales were content derived.
Negatively stated individual questions were reverse coded, responses summed, and scores divided by the number of items in each scale. Cronbach α reliability coefficients were estimated to assess the internal consistency of each scale (see Table 1 for a complete list of scales and abbreviated items).
We used a two-level (individual and school) multinomial logit model31 to estimate predictors of membership in each leaver group using HLM 7 for Windows, 2011 (Scientific Software International, Inc., Lincolnwood, Illinois). Because these models are complex, in particular with regard to parallel equations for each of the four types of leaving intentions, and because some of the leaver groups were sparsely populated, the models were constructed by testing progressive blocks of variables as indicated in Table 3, starting with personal demographics, and by conducting joint significance tests to retain or drop each group of variables using the multiple general linear hypothesis testing available in HLM 7. Only significant variable blocks were retained. However, female and URMM were retained to test two-way interaction effects in a later model. Finally, a reduced model was created consisting only of variables that were significant predictors for at least one of the four outcome categories. The reduction alleviates multicollinearity concerns and improves the efficiency of the estimation.
In the model presented,
- odds ratios for the scale variables were interpreted for a one-unit change on the original Likert scale (e.g., from “3 = neither agree nor disagree” to “4 = somewhat agree”), and the
- odds ratio for age was interpreted for a one-decade change in age.
All continuous variables were centered on their grand means. All binary variables were coded 0/1, with the variable name representing the 1 value; for instance, the odds ratio associated with female represents the odds associated with being female versus being male.
결과
Results
응답자 특성
Among respondents with complete data, 1,142 (57%) were stayers. The remaining 852 (43%)—all “leavers”— were divided among
those considering leaving their school (but not academic medicine) because of dissatisfaction (273 [14%]),
those considering leaving academic medicine altogether because of dissatisfaction (421 [21%]),
those considering leaving their school and/or academic medicine for personal/family reasons (109 [5%]), and
potential retirees (49 [2%]).
Characteristics of the sample and descriptive statistics for faculty-level predictors are presented in Table 3.
학교 특성
Schools
were almost evenly split between public (14 [54%]) and private (12 [46%]) and
were similarly distributed by region in the universe of AAMC member schools: Northeast, 8 (31%); South, 8 (31%); Central, 6 (23%); and West, 4 (15%).
School faculty size ranged from about 200 to 1,600, with an average of 935;
NIH award ranks spanned nearly the entire range, with an average rank of 60.4.
Faculty at the 26 schools were 33% women (versus 32% across all schools nationally).
의과대학을 떠나려는 교수들과 관련된 요인
Scales associated with faculty staying versus considering leaving
The rotated solutions identified 8 factors, which were used to create 7 scales as identified in Table 1. The 5 additional content-derived scales and associated statistics for all 12 scales are also displayed in Table 1.
Intention to leave와 관련 없었던 요인들
For none of the leaver groups was there a significant association between intention to leave and
URMM status,
faculty rank,
percentage of time devoted to research,
holding a school leadership position,
whether their medical school (versus theirhospital) predominantly affected their job satisfaction,
school size,
sector (public versus private),
geographic region,
NIH award ranking, or
the percentage of faculty who are women.
Leaving을 예측하지 않은 스케일
Two scales failed to predict leaving:
성 평등 perceptions of gender equity and
다양성을 위한 기관변화 institutional change efforts for diversity.
Faculty considering leaving because of dissatisfaction
Faculty considering leaving because ofretirement or personal/family reasons
고찰
Discussion and Conclusions
우리의 연구는 교수진이 왜 자신들의 소속 기관이나 직업 자체를 떠날 정도로 불만족을 느끼는지를 조사했다..
Our study delves into why faculty feel so dissatisfied that they intend to leave either their own institutions or their careers in academic medicine.
불만족 요인
The central and concerning finding is that faculty dissatisfaction was saliently associated with
부정적 인식 faculty members’ negative perceptions and
비-관계적, 윤리적 문화에 의한 스트레스 distress about the non-relational and ethical culture of the workplace.
Intention to leave요인
Significant predictors of intention to leave included
취약함, 단절된 느낌 feeling vulnerable and unconnected to colleagues,
도덕적 스트레스 moral distress,
비윤리적인 문화 perceptions of the culture being at times unethical, and
Adversely changed하는 느낌 feelings of being adversely changed by the culture.
그 외
also predicted intention to leave.
낮은 자기효능감 Low self-efficacy and
낮은 참여 (low) sense of engagement and
자신의 가치와 기관의 가치 간 괴리 a lack of alignment of faculty members’ personal values with perceived institutional values
현저한 대조적으로,
학교 규모,
지역 또는 부문 (공공 대 민간)
...과 같은 객관적인 특성은 불만족이나 이직과 무관했다.
다음 사항들도 관련이 없었음.
교수자 구성원의 성별,
URMM 상태 또는
직업-삶 통합과 관련된 인식
유사하게, Lowenstein 등 8)은 학문적 의학을 떠나려는 의도에서 성별 차이를 발견하지 못했다.
In marked contrast, objective characteristics such as school size, region, or sector (public versus private) were not associated with dissatisfaction and considering leaving. None of the following either independently predicted, or moderated, dissatisfaction and considering leaving: the faculty member’s sex, URMM status, or perceptions associated with work–life integration (see List 1). Similarly, Lowenstein et al8 found no sex differencein intention to leave academic medicine.
관계성
Relationships and inclusion
비 관련성 - 고립되어 보이지 않는 느낌 - 은 떠나려는 의도와 관련이 있습니다. 이 발견은 연결성 부족과 낮은 자기 효능감을 특징으로 하는 사회적 환경이 내재적 동기 부여를 방해하고 개인의 타고난 심리적 요구를 저해한다는 심리적 이론의 교리에 부합한다 .33) medical training과 organizational healthcare outcome에 관계가 점점 중요하다고 인정되고 있지만, 동료 간의 관계에 관한 연구는 거의 없다 .35) 36) Lowenstein 등 8)은 응급 의학 교수진에서 "academic community로서의 인식 부족"과 관련이 있다고 밝혔다.
Unrelatedness—expressed as faculty feeling isolated and invisible—correlates with intent to leave. This finding accordswith the tenet of psychological theory that social environments characterized by a lack of connectedness and low self- efficacy hinder intrinsic motivation and thwart individual innate psychological needs.32 Although relationships are increasingly recognized as critical in shaping medical training33,34 and organizational health care outcomes,35 few studies exist on relationships among colleagues.35,36 In emergency medicine faculty, Lowenstein et al8 also showed that intention to leave was related to “departmental lack of a sense of academic community.”
쉰들러 (Schindler) 연구팀은 4 개의 의과 대학에서 남성과 여성 교수의 약 20 %가 우울증으로 임상 적으로 유의 한 증상을 나타내 었음은 물론 높은 불안의 등급을 얻었으며 젊은 교수진이 가장 많은 영향을 받았다. 이러한 문제는 응답자의 취약성, 동료와의 연결성 부족, 자기 효능감 및 참여감 저하에 기인할 수 있습니다.
Schindler and colleagues1 found clinically significant symptoms of depression among approximately 20% of both men and women faculty in four medical schools, as well as high anxiety ratings, with younger faculty being most affected. Such problems could be contributing to our respondents’
feelings of vulnerability,
being unconnected to colleagues, and
lower self-efficacy and
(low) sense of engagement.
윤리/도덕 스트레스
Faculty ethical/moral distress
우리의 연구 결과는 25 년 동안의 조직 정의 연구의 메타 분석과 일치합니다. 이 연구는 조직의 정의와 윤리적인 분위기에 대한 직원의 인식이 직무 만족도 증가, 리더십에 대한 신뢰, 성과 향상, 고용주에 대한 헌신 및 매출 감소와 관련되어 있음을 시사합니다 .12,13
Our findings are congruent with meta- analyses of 25 years of organizational justice research outside medicine. These studies suggest that employee perceptions of organizational justice and an ethical climate are related to
increased job satisfaction,
trust in leadership,
enhanced performance,
commitment to one’s employer, and
reduced turnover.12,13
윤리적 / 도덕적 어려움의 척도 (표 1 참조)는 지배적인 규범에 대한 반응 및 전문직업성의 부식 가능성과 조직의 이기주의 증가를 반영합니다. 조직은 직원의 윤리적 또는 비 윤리적 인 행동에 영향을 미치고 책임이 있다는 믿음이 증가하고 있습니다 .37,38
The scale of ethical/moral distress (see Table 1) reflects
reactions to the prevailing norms and
possible erosion of professionalism and
increased organizational self-interest.
There is a growing belief that organizations influence and are responsible for the ethical or unethical behaviors of their employees.37,38
조직의 정의에 대한 교수들의 인식은 의학에서 프로페셔널리즘의 문제에 중요한 역할을 합니다. 설문 조사에서 윤리적 / 도덕적 고통의 척도로는 "우리 기관 문화는 이타성을 낙담시킨다" "나는 여기에서 일하는 것이 비인간적 인 것으로 생각한다"(이 척도의 다른 항목은 표 1 참조) 도덕적 괴로움은 소속 기관 뿐만 아니라 대학의학을 완전히 떠나려는 의도와 더 밀접한 관계가 있었다. 교수들 사이의 이러한 부정적인 감정은 특히 그들에게 낙담하고 주요 직업 결정에 영향을 미칠 수 있습니다.
Faculty perceptions of organizational justice are pivotal to the critical issue of professionalism in medicine. The ethical/moral distress scale in the survey reported here included items such as “the culture of my institution discourages altruism” and “I find working here to be dehumanizing.” (See Table 1 for other items in this scale.) In that ethical/moral distress was more strongly related to intent to leave academic medicine entirely than intent to leave one’s own institution, these negative feelings among faculty must be particularly disheartening to them and may color major career decisions.
Intention to leave에 대한 효과 외에도, 교수진에 대한 detrimental한 문화는 의과대학생을 덜 이타주의적으로, 냉소적으로 만드는 잠재커리큘럼으로 작용한다..40,41 우리는 Inui42에 동의합니다. 공식교육과정에서 강조되는 도덕적, 인간적, 전문적 가치관을 교수 스스로 경험하지 못하면, 교육도 훼손될 수 있다.
In addition to effects on intention to leave, the detrimental culture for faculty members constitutes part of the hidden curriculum for medical students, who often become less altruistic and more cynical through the four years of medical school.40,41 We concur with Inui42 that
if faculty project that the moral, ethical, professional, and humane values articulated in the formal curriculum are not reinforced in their own experience as faculty (through the medium of the hidden or informal curriculum), the goals of educating and graduating competent, professional, and humanistic physicians may be undermined.
연령
Age of faculty members
AAMC 분석과 마찬가지로, 우리는 젊은 교수진이 불만족으로 인한 이직 의사를 더 많이 느낌을 발견했다. 교수개발은 개별 학교와 국가의 건강 관리를 위한 장기적인 투자이기 때문에 젊은 교수진의 손실은 특히 문제가됩니다. 이러한 turnover의 몇 가지 이점 중 하나는 신선한 아이디어와 에너지를 모집 할 수 있는 기회라는 점이다.
Similar to AAMC analyses,2 we found that younger faculty were more likely to consider leaving academic medicine for dissatisfaction than their older colleagues. Differential loss of young faculty is especially problematic because faculty development is a long-term investment for individual schools and for the nation’s health care. One of the few benefits of turnover is the opportunity to recruit fresh ideas and energy.
일과 삶의 균형
Work–life integration
남성과 여성 모두 일과 삶의 균형과는 상관 없었다.
Of note, our findings for both women and men did not associate work–personal life problems with dissatisfaction and leaving academic medicine.
강점과 약점
Study limitations and strengths
This study provides substantial detail to our previous understanding of faculty dissatisfaction and attrition.1,3,7,9,45,46 Because survey items were based on a hypothesis-generating qualitative analysis of prior faculty interviews, our survey included numerous non-customary questions and domains relating to relationships, values, ethical and moral climate, being changed by the culture, diversity, equity, and support/ advancement.
We hope that medical schools can use these findings to develop organizational structures that not only support intellectual endeavors but also support relationship formation among faculty, including those in leadership.47,48 The Relationship Centered Care Initiative has focused on this goal; for instance, Cottingham and colleagues42 gathered stories of positive relational patterns among faculty and used these to foster mindfulness and to enhance relational practices. Incorporating activities for faculty and leaders that encourage reflection on the meaningfulness of their work and core convictions could help address moral and ethical issues and help prevent faculty from feeling that they have been adversely changed in the culture.48 This core change in medical school culture could encourage trustworthy relationships and support the humanistic needs of health professionals. A supportive culture could also positively affect students and physicians in training and facilitate the inclusiveness and collaboration essential for creative research productivity and optimal patient care.
Although the beliefs and attitudes of faculty are fortunately aligned with the purported missions of academic medicine, our survey findings suggest that the culture of medical schools is a barrier to fulfilling these professed goals. We have some optimism that increased awareness of the issues discussed in this report will support ongoing efforts to positively change the culture for academic health professionals. It bodes well that the faculty we studied retained an awareness of a moral imperative and their own deeply held values, such that the negative aspects of their work environment did not obliterate their desire to act authentically and professionally in meeting the demands of their roles and responsibilities.
14 Pololi L, Conrad P, Knight S, Carr P. A study of the relational aspects of the culture of academic medicine. Acad Med. 2009;84: 106–114.
1 Schindler BA, Novack DH, Cohen DG, et al. The impact of the changing health care environment on the health and well-being of faculty at four medical schools. Acad Med. 2006;81:27–33.
Why are a quarter of faculty considering leaving academic medicine? A study of their perceptions of institutional culture and intentions to leave at 26 representative U.S. medical schools.
Author information
- 1
- National Initiative on Gender, Culture and Leadership in Medicine: C-Change, Brandeis University, 415 South St., Mailstop 079, Waltham, MA 02454-9110, USA. lpololi@brandeis.edu
Abstract
PURPOSE:
METHOD:
RESULTS:
CONCLUSIONS:
- PMID:
- 22622213
- DOI:
- 10.1097/ACM.0b013e3182582b18
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