Assessing the Learning Environment for Medical Students: An Evaluation of a Novel Survey Instrument in Four Medical Schools.

OBJECTIVE: A practical, reliable, and valid instrument is needed to measure the impact of the learning environment on medical students' well-being and educational experience and to meet medical school accreditation requirements. METHODS: From 2012 to 2015, medical students were surveyed at the end of their first, second, and third year of studies at four medical schools. The survey assessed students' perceptions of the following nine dimensions of the school culture: vitality, self-efficacy, institutional support, relationships/inclusion, values alignment, ethical/moral distress, work-life integration, gender equity, and ethnic minority equity. The internal reliability of each of the nine dimensions was measured. Construct validity was evaluated by assessing relationships predicted by our conceptual model and prior research. Assessment was made of whether the measurements were sensitive to differences over time and across institutions. RESULTS: Six hundred and eighty-six students completed the survey (49 % women; 9 % underrepresented minorities), with a response rate of 89 % (range over the student cohorts 72-100 %). Internal consistency of each dimension was high (Cronbach's α 0.71-0.86). The instrument was able to detect significant differences in the learning environment across institutions and over time. Construct validity was supported by demonstrating several relationships predicted by our conceptual model. CONCLUSIONS: The C-Change Medical Student Survey is a practical, reliable, and valid instrument for assessing the learning environment of medical students. Because it is sensitive to changes over time and differences across institution, results could potentially be used to facilitate and monitor improvements in the learning environment of medical students.

Mentoring Faculty: A US National Survey of Its Adequacy and Linkage to Culture in Academic Health Centers.

INTRODUCTION: The aims of this study were to (1) describe the quantity and quality of mentoring faculty in US academic health centers (AHCs), (2) measure associations between mentoring and 12 dimensions that reflect the culture of AHCs, and (3) assess whether mentoring predicts seriously contemplating leaving one's institution. METHODS: During 2007-2009, our National Initiative on Gender, Culture and Leadership in Medicine (C - Change) conducted a cross-sectional study of faculty from 26 representative AHCs in the United States using the 74-item C - Change Faculty Survey to assess relationships of faculty characteristics and various aspects of the institutional culture (52% response rate). Among the 2178 eligible respondents (assistant, associate, and full professors), we classified their mentoring experience as either inadequate, neutral, or positive. RESULTS: In this national sample, 43% of the 2178 respondents had inadequate mentoring; only 30% had a positive assessment of mentoring. There was no statistical difference by sex, minority status, or rank. Inadequate mentoring was most strongly associated with less institutional support, lower self-efficacy in career advancement, and lower scores on the trust/relationship/inclusion scale. The percent of faculty who had seriously considered leaving their institution was highest among those who had inadequate mentoring (58%), compared to those who were neutral (28%) or had positive mentoring (14%) (all paired comparisons, p < .001). DISCUSSION: In a national survey of faculty of US AHCs, mentoring was frequently inadequate and this was associated with faculty contemplating leaving their institutions. Positive mentoring, although less prevalent, was associated with many other positive dimensions of AHCs.

Faculty Vitality-Surviving the Challenges Facing Academic Health Centers: A National Survey of Medical Faculty.

PURPOSE: Faculty with high vitality are essential to the missions of academic health centers (AHCs). Because little is known about how to measure or enhance faculty vitality, the authors assessed current faculty vitality and identified its predictors. METHOD: In a stratified random sample of 26 nationally representative U.S. AHCs, the authors surveyed 4,578 full-time faculty during 2007-2009. The validated survey measured detailed faculty perceptions of their professional experiences and organizational culture. Vitality was measured with a previously evaluated five-item scale. RESULTS: Of the faculty invited, 2,381 (52%) responded, with 2,218 eligible for analysis. Respondents included 512 (23%) underrepresented in medicine minority (URMM) faculty and 1,172 (53%) women. In a multivariable model including individual- and AHC-level factors, the strongest predictors of vitality were faculty members' perceptions of four dimensions of AHC culture: Relationships/inclusion, Values alignment, Work-life integration, and Institutional support (all P < .001). Weaker predictors were faculty age, institution type (public/private), and the AHC's National Institutes of Health funding rank (all P ≤ .03). Half of the respondents scored high on vitality, whereas 25% had low, or suboptimal, scores. Holding perceptions of culture constant, neither female nor URMM faculty had vitality scores that were different on average from male or nonminority faculty. CONCLUSIONS: A large percentage of faculty lack the vitality essential to meeting the AHC missions of discovery, education, and patient care. Enhancing faculty vitality, and AHC resilience, requires more attention to strengthening relationships, improving the misalignment between faculty and institutional values, and improving work-life integration.

Future focus for professional development.

Professional development has evolved from individually focused sabbaticals and professional leaves to institutionally focused programs with an interest in developing faculty members' ability to teach in various environments as well as to succeed in the many endeavors they undertake. We address various issues related to professional development in the medical school arena. Professional development in medical school takes place in a context where faculty are stretched to engage in research and service not only for their own sake but also to financially support their institutions. This obligates professional developers to acknowledge and address the environments in which teaching faculty work, and to use approaches to professional development that honor the time and efforts of teaching faculty. These approaches may be brief interventions that make use of principles of education, and may include online offerings. Professional development will be most effective when professional developers acknowledge that most faculty members aspire to excellence in teaching, but they do so in an environment that pushes them to address competing concerns. Offering professional development opportunities that fit within the workplace environment, take little time, and build upon faculty's existing knowledge will assist in enhancing faculty success.

Introducing INSPIRE, a scholarly component in undergraduate medical education.

Individualized learning is a fundamental tenet of the Carnegie Foundation's new recommendations for physician training. A primary goal of Mount Sinai School of Medicine's new curriculum is to train self-directed physicians who have mastered lifelong learning skills. The Individual Scholarly Project and Independent Research Experience (INSPIRE) was created to enable fourth-year students to conduct mentored, independent scholarly projects to develop critical thinking skills and intellectual independence. Four students were accepted into the 2008 12-week pilot. Two did clinical research, 1 conducted medical education research, and 1 continued a basic science project. INSPIRE featured weekly sessions in which students shared their progress, heard about the careers of physician-scientists, and participated in presentation skills workshops. Mentors gave feedback using a form based on the program goals. Anonymous evaluations showed that all participants believed their goals were successfully fulfilled, that the likelihood of including research in their careers increased, and that they felt more skilled at writing abstracts and presenting their work orally. Students agreed that INSPIRE was a valuable opportunity for acquiring in-depth knowledge on a topic and building research and presentation skills. Helping students shape an individualized scholarly experience may help to produce doctors who are self-directed, are personally fulfilled, are able to serve society with diverse expertise, and have the tools to become leaders in their fields.