Reasons for Optimism About Academic Medicine's Actions Against Climate Change.

Since the first mention of climate change in Academic Medicine in 2009, the pace of the climate crisis has accelerated, its impacts on every facet of planetary health have grown more severe, and the urgency for humans to act has become more dire. Medical schools, teaching hospitals and health systems, universities, affiliated organizations, and the millions of people who traverse the halls of these institutions as leaders, physicians, scientists, educators, learners, patients and families, and community members have an obligation to respond. In this commentary, the authors describe 3 reasons they are optimistic that academic medicine will continue to act against climate change. First, the mission of academic medicine, inherently aligned with climate action, propels teaching hospitals and health systems to address climate change to improve the health of patients, families, and communities. Second, younger generations of learners, faculty, and staff who populate the workforce increasingly desire, and often demand, to work at institutions that are aligned with their personal values for climate action. Third, broader forces are pushing academic medicine forward in action against climate change. Economic factors will continue to reduce the cost and increase the return on investment of climate-smart facilities, purchased goods and services, fuel, transportation, food systems, and waste management. The authors are optimistic but not complacent. Current levels of climate action in academic medicine are not nearly enough. Faculty, staff, learners, leaders, patients and families, and community partners can and must apply a "climate lens" to everything they do: weave climate solutions into education, patient care, research, community collaborations, operations, and supply chain and facility management; integrate climate actions into strategic thinking, planning, and doing; address health inequities and climate injustice; and leverage their trusted voices to press for climate action and climate justice in the health sector and in society.

Population Health at the Academic Health Center: An Interactive, Multipart, Case-Based Session for Executives, Faculty, and Administrators.

INTRODUCTION: Academic health centers (AHCs) play critical roles in population health by providing health care, conducting population health research, and providing population health training and education. This publication describes an interactive, multipart, case-based session targeted at AHC executives, faculty, and administrators about population health initiatives at AHCs and how the AHC structure can be leveraged to promote population health. METHODS: This 90-minute virtual session was conducted during the Association of Academic Health Centers' 2020 annual meeting. The session opened with 5-minute, Ignite-style presentations showcasing population health innovations. Next, in small groups, participants discussed a case introducing a fictional AHC charged with assisting its local government's population health efforts. Participants self-selected into one of four small groups (analytics, education and training, community engagement, and implementation) and were provided additional case content and tailored prompts. In the large group, participants debriefed their discussions. Participants completed a postsession survey. RESULTS: Forty-six individuals from 31 AHCs participated. Eighteen participants completed the survey. Sixteen respondents (89%) agreed the session was valuable and provided ideas for implementation at their AHC. Fifteen participants (83%) indicated that they planned to follow up with their colleagues regarding how to leverage the AHC structure to improve population health. DISCUSSION: This session provides an interactive forum to discuss population health in the context of an AHC and examine how its structure can facilitate population health. While offered at a conference, the session can also be implemented at a single AHC to foster local understanding of population health and inform future initiatives.

Characteristics of Faculty at Risk of Leaving Their Medical Schools: An Analysis of the StandPoint™ Faculty Engagement Survey.

PURPOSE: This study seeks to identify the characteristics and attitudes of faculty in US medical colleges who are at risk of leaving their institution. METHODS: This research leverages data from the AAMC StandPoint Faculty Engagement Survey administered to 37,779 faculty representing 36 institutions participating during 2013-2016. Univariate and multivariable robust logistic regression models were used to assess predictors of the intent to leave based on the question: "Do you plan to leave this medical school in the next 1-2 years?". RESULTS: Thirty percent (n=5559/18,475) of faculty responded that they were considering leaving their institution. Thirty-one percent of female faculty vs 29% of male faculty expressed an intent to leave. At-risk faculty were likely to be at junior faculty rank and at their institutions for 6-15 years vs other time periods (OR=1.16; p≤0.001). Having an administrative title (OR=0.72; p≤0.001) and receiving formal mentorship (OR=0.65; p≤0.001) were protective. Finally, faculty answering "disagree" or "strongly disagree" to any one of these StandPoint Survey questions were at > 6 fold risk of expressing an intent to leave: 1) I am satisfied with my opportunities for professional development, 2) I feel appreciated by my supervisor, 3) My day-to-day activities give me a sense of accomplishment. CONCLUSION: Faculty expressing an intent to leave their institution have an identifiable profile. Top concerns of at-risk faculty relate to supervisory relationships and growth opportunities rather than compensation or governance. Institutional leaders should consider these factors in the development of a proactive strategy to retain talented faculty.

What a medical school chair wants from the dean.

Economic pressure has led the evolution of the role of the medical school dean from a clinician educator to a health care system executive. In addition, other dynamic requirements also have likely led to changes in their leadership characteristics. The most important relationship a dean has is with the chairs, yet in the context of the dean's changing role, little attention has been paid to this relationship. To frame this discussion, we asked medical school chairs what characteristics of a dean's leadership were most beneficial. We distributed a 26-question survey to 885 clinical and basic science chairs at 41 medical schools. These chairs were confidentially surveyed on their views of six leadership areas: evaluation, barriers to productivity, communication, accountability, crisis management, and organizational values. Of the 491 chairs who responded (response rate =55%), 88% thought that their dean was effective at leading the organization, and 89% enjoyed working with their dean. Chairs indicated that the most important area of expertise of a dean is to define a strategic vision, and the most important value for a dean is integrity between words and deeds. Explaining the reasons behind decisions, providing good feedback, admitting errors, open discussion of complex or awkward topics, and skill in improving relations with the teaching hospital were judged as desirable attributes of a dean. Interestingly, only 23% of chairs want to be a dean in the future. Financial acumen was the least important skill a chair thought a dean should hold, which is in contrast to the skill set for which many deans are hired and evaluated. After reviewing the literature and analyzing these responses, we assert that medical school chairs want their dean to maintain more traditional leadership than that needed by a health care system executive, such as articulating a vision for the future and keeping their promises. Thus, there appears to be a mismatch between what medical school chairs perceive they need from their dean and how the success of a dean is evaluated.

Learning about new anesthetics using a model driven, full human simulator.

OBJECTIVE: New pharmacological agents are introduced into medical practice at an ever-increasing pace. Teaching how to use new medications in the clinical setting presents educational challenges and puts patients at risk. METHODS: Patients and clinical settings in which remifentanil might provide clinical advantages over existing anesthetics were identified. A simulator curriculum was developed to demonstrate the use of remifentanil in the sample cases. The simulation was designed to highlight the clinical advantages and potential side effects of remifentanil. A screen displaying the concentrations of remifentanil in plasma and in the hypothetical effector site was developed. A simulator was modified (addition of an infusion pump and a pharmacokinetic screen display) and transported to several cities in the U.S.A. An instructor guided small groups of anesthesiologists and anesthetists through a structured program that enabled participants to observe drug effects in simulated patients. RESULTS: There were 836 participants in the remifentanil program, which was offered in 58 cities in the U.S.A. Surveys were completed by 574 anesthesiologists. There was a significant difference in comfort level for using remifentanil after the session compared to before (Chi-square, p < 0.001.) The statement: "Clinical simulation experience is a means to learn about new agents like remifentanil" was rated as "excellent" by 81% and as "good" by 19% of participants. No participant found the experience to be "not useful." CONCLUSIONS: Patient simulation is a novel method of introducing new drugs to the medical community and is perceived by anesthesia providers as a valuable addition to available teaching methods.