Leadership Development in Academic Health Science Centers: Towards a Paradigm Shift.

PROBLEM: In an era of increasing complexity, leadership development is an urgent need for academic health science centers (AHSCs). The Association of American Medical Colleges (AAMC) and others have described the need for a focus on organizational leadership development and more rigorous evaluation of outcomes. Although the business literature notes the importance of evaluating institutional leadership culture, there is sparse conversation in the medical literature about this vital aspect of leadership development. Defining the leadership attributes that best align with and move an AHSC forward must serve as the foundational framework for strategic leadership development. APPROACH: In 2015, the Medical University of South Carolina (MUSC) began a systematic process to approach strategic leadership development for the organization. An interprofessional group completed an inventory of our leadership development programs and identified key drivers of a new institutional strategic plan. A strategic leadership advisory committee designed a series of leadership retreats to evaluate both individual and collective leadership development needs. OUTCOMES: Three key drivers were identified as critical attributes for the success of our institutional strategy. Four specific areas of focus for the growth of the institution's ideal leadership culture were identified, with specific action items or behaviors developed for our leaders to model. As a result of this foundational work, we have now launched the MUSC Leadership Institute. NEXT STEPS: Knowledge of our current leadership culture, key drivers of strategy and our desired collective leadership attributes are the basis for building our institutional leadership development strategy. This will be a longitudinal process that will start with senior leadership engagement, organizational restructuring, new programming and involve significant experimentation. Disciplined, thoughtful evaluation will be required to find the right model. In addition to individual transformation with leadership development, MUSC will measure specifically identified strategic outcomes and performance metrics for the institution.

A Focused Career Development Program for Women Faculty at an Academic Medical Center.

Background: Within free-standing academic medical centers, women continue to be underrepresented at upper faculty ranks and in leadership positions. A career development program (CDP) at the Medical University of South Carolina (MUSC) was implemented with the goal of improving the number of women in the upper ranks and in leadership positions. The CDP was initiated in 2013 as a 2-day program. Beginning in 2015, a half-day promotion-focused program was offered alternating with the 2-day program. Materials and Methods: The CDP has served ∼200 women from 2013 to 2017 and was evaluated for reaction and learning through postprogram surveys. Promotion success of ∼160 women who attended at least one of the programs through 2016 was assessed through an additional survey. Promotion information for ∼3000 faculty members during the same 2013-2016 period (post-CDP), as well as a 4-year time period before implementation of the CDP (pre-CDP), was collected using university-level personnel data. Results: The majority of CDP attendees (94%) indicated overall satisfaction with the program and would recommend the program to a colleague. Of the 137 CDP attendees still employed at MUSC in 2017, 50 had applied for promotion and 42 (84%) were successfully promoted. Among all the MUSC faculty, overall and rank-sepcific promotion rates for women and men were similar during the post-CDP time period and there was a significant increase in the promotion rate of women to Full Professor from pre-CDP to post-CDP time periods. Conclusions: CDP attendees were overwhelmingly satisfied with the program and were highly successful in being promoted. Since the overall university promotion rates of women and men were similar during the post-CDP time period and women are currently underrepresented at the upper faculty ranks, parity between men and women will likely not be achievable without additional programs to retain and/or recruit women in the upper ranks.

Improving Ethnocultural Empathy in Healthcare Students through a Targeted Intervention.

Students in training to become future healthcare providers must be trained not only how to provide quality care but also how to effectively communicate with patients, regardless of the patient's cultural background. Poor communication between provider and patient when racial or ethnic backgrounds differ between patient and provider is a relevant factor in suboptimal healthcare services to ethnic minorities. This pilot study was conducted to examine changes in the scores on the Scale of Ethnocultural Empathy (SEE)for first year nursing (n = 40) and dental students (n = 42)following an intervention. Participants completed an anonymous online survey that included the SEE, a validated measure of empathy toward people with racial and ethnic backgrounds different from one's own prior to the intervention (baseline), immediately following the intervention workshop (post-test) and one month following the workshop (follow-up). Results showed statistically significant increases from baseline to post-intervention on the SEE (p < .05), and these gains were maintained at follow-up. This study is the first to examine whether an intervention specifically designed to improve students' understanding of racial groups discordant from their own actually improves empathy and communication. Results from this pilot study support that controlled trials are warranted.

The value of a writing center at a medical university.

BACKGROUND: Students often enter graduate healthcare/biomedical schools with insufficient undergraduate instruction in effective writing, yet the ability to write well affects their career opportunities in health care and in scientific research. PURPOSE: The present study was conducted to determine the value and effectiveness of instruction by faculty with expertise in teaching writing at a writing center at an academic health science center. METHODS: Two separate sources of data were collected and analyzed. First, an anonymous campus-wide survey assessed students' satisfaction and utilization of the university's Writing Center. Second, a nonexperimental objective study was conducted comparing a subsample of students who used versus those who did not receive instruction at the Writing Center on quality of writing, as determined by an evaluator who was blind to students' utilization status. RESULTS: From the campus-wide survey, more than 90% of respondents who used the center (which was 26% of the student body) agreed that it was a valuable and effective resource. From the objective study of writing quality, students who used the Writing Center were twice as likely as students who did not to receive an A grade on the written assignment, and the blinded evaluator accurately estimated which students used the Writing Center based on the clarity of writing. CONCLUSIONS: The instruction at the Writing Center at our university is highly valued by students, and its value is further supported by objective evidence of efficacy. Such a center offers the opportunity to provide instruction that medical and other healthcare students increasingly need without requiring additions to existing curricula. By developing competency in writing, students prepare for scholarly pursuits, and through the process of writing, they engage critical thinking skills that can make them more attuned to narrative and more reflective and empathetic in the clinical setting.

Developing a program to promote stress resilience and self-care in first-year medical students.

BACKGROUND: Facilitating stress resilience in future physicians is an important role of medical educators and administrators. We developed an extracurricular program and pilot tested the program on first year medical students. METHODS: Presentations on topics related to mental health, help-seeking, and stress resilience were presented (one topic per session). Attendance was voluntary. Attendees were requested to complete anonymous evaluations following each presentation. Primary outcome variables were rates of agreement that the presentation (1) was interesting, (2) provided valuable information, and (3) provided information relevant for the student's future practice as a physician. RESULTS: Each of the seven topics was attended on average by approximately half of the student body. Evaluations were very positive that presentations were interesting and provided information useful to maintaining balance during medical school (all had ≥85% rates of agreement). Evaluations by students were variable (41%-88% rates of agreement) on whether each presented information relevant for future practice. CONCLUSIONS: The results support that first-year medical students value explicit guidance on ways to bolster stress resilience and self-care during medical school. It is important to clarify with each presentation how the information is relevant to their future practice as a physician.

Food cravings and the effects of left prefrontal repetitive transcranial magnetic stimulation using an improved sham condition.

This study examined whether a single session of repetitive transcranial magnetic stimulation (rTMS) of the left prefrontal cortex (PFC) would inhibit food cravings in healthy women who endorsed frequent food cravings. Ten participants viewed images of food and completed ratings for food cravings before and after receiving either real or sham rTMS over the left PFC (10 Hz, 100% resting motor threshold, 10 s-on, 20 s-off for 15 min; 3000 pulses). Sham-TMS was matched with real TMS with respect to perceived painfulness of the stimulation. Each participant received both real and sham rTMS in random order and were blind to the condition in a within-subject cross-over design. With an improved sham control condition, prefrontal rTMS inhibited food cravings no better than sham rTMS. The mild pain from the real and sham rTMS may distract or inhibit food craving, and the decreased craving may not be caused by the effect of rTMS itself. Further studies are needed to elucidate whether rTMS has any true effects on food craving and whether painful stimuli inhibit food or other cravings. A sham condition which matches the painfulness is important to understand the true effects of TMS on behaviors and diseases.

Core clerkship directors: their current resources and the rewards of the role.

PURPOSE: To conduct a national multidisciplinary investigation assessing core clinical clerkships and their directors, variances in resources from national guidelines, and the impact of the clerkship director role on faculty members' academic productivity, advancement, and satisfaction. METHOD: A multidisciplinary working group of the Alliance for Clinical Education (ACE), representing all seven core clinical disciplines, created and distributed a survey to clerkship directors at 125 U.S. MD-granting medical schools, in academic year 2006-2007. RESULTS: A total of 544 clerkship directors from Internal Medicine (96), Family Medicine (91), Psychiatry, (91), Pediatrics (79), Surgery (71), Neurology (60), and Obstetrics-Gynecology (56) responded, representing over 60% of U.S. core clinical clerkships. The clerkship directors were similar across disciplines in demographics and academic productivity, though clinical and clerkship activities varied. Departmental staff support for clerkships averaged 0.69 people, distinctly less than the ACE's 2003 guideline of a full-time coordinator in all disciplines' clerkships. Clerkship directors reported heavy clinical responsibilities, which, as in previous studies, were negatively related to academic productivity. However, many clerkship directors felt the role enhanced their academic advancement; a large majority felt it significantly enhanced their career satisfaction. CONCLUSIONS: The resources and rewards of the clerkship director role were similar across disciplines. Expectations of clerkship directors were considerable, including responsibility for clinical material and the learning environment. Resources for many fall short of those stated in the ACE guidelines, particularly regarding support staff. However, the findings indicate that the clerkship director role can have benefits for academic advancement and strongly enhances career satisfaction.

Clinical practice as natural laboratory for psychotherapy research: a guide to case-based time-series analysis.

Both researchers and practitioners need to know more about how laboratory treatment protocols translate to real-world practice settings and how clinical innovations can be systematically tested and communicated to a skeptical scientific community. The single-case time-series study is well suited to opening a productive discourse between practice and laboratory. The appeal of case-based time-series studies, with multiple observations both before and after treatment, is that they enrich our design palette by providing the discipline another way to expand its empirical reach to practice settings and its subject matter to the contingencies of individual change. This article is a user's guide to conducting empirically respectable case-based time-series studies in a clinical practice or laboratory setting.

Vagus nerve stimulation acutely alters food craving in adults with depression.

Vagus nerve stimulation (VNS) is now available as a treatment for epilepsy and treatment-resistant depression. The vagus nerve plays a central role in satiety and short-term regulation of food intake and research suggests a relationship between VNS and weight loss. The underlying mechanisms of this relationship are unknown. The purpose of the current study was to determine whether acute cervical VNS might temporarily alter food cravings. Thirty-three participants were recruited for three groups; depression VNS, depression non-VNS, and healthy controls. Participants viewed 22 computerized images of foods twice in one session and completed ratings for food cravings after each image. The VNS participants' devices were turned on for one viewing of an image and off for the other (randomized order). Participants were blind to VNS condition (on versus off). Acute VNS device activation was associated with a significant change in cravings-ratings for sweet foods. A significant proportion of variability in VNS-related changes in cravings was accounted for by patients' clinical VNS device settings, acute level of depression, and body mass. Further studies are warranted addressing how acute or chronic VNS might modify eating behavior and weight.

The computer-assisted cognitive/imagery system for use in the management of pain.

BACKGROUND: There is growing interest in computer-delivered psychological interventions for a number of clinical conditions, including pain. OBJECTIVES: This study tests the effectiveness of a new computer-delivered pain-management program using a laboratory pain paradigm. METHODS: One hundred twenty undergraduate students were randomly assigned to either the computerized pain-management group or the distraction control group. Subjects underwent a cold-pressor task and were asked to continuously rate their subjective pain experience. RESULTS: Women receiving the computerized pain management intervention were able to tolerate the cold-pressor task longer than those in the control group. No effect was found for men. Subjective pain ratings were consistently lower during the cold-pressor task for subjects in the computerized pain-management group regardless of sex. Subjects receiving the computerized intervention reported feeling more comfortable and relaxed than control subjects during the cold-pressor task. CONCLUSIONS: Findings indicate that further investigations of the program used in this study are warranted to determine its potential clinical utility and that of similar computerized interventions for pain.

Women's health competencies in the undergraduate psychiatry curriculum: past and future.

OBJECTIVE: To review the current psychiatry model clerkship objectives for their inclusion of women's health competencies and advise changes in light of recommendations of psychiatric educators and those developed at the Association of Professors of Gynecology and Obstetrics (APGO) Women's Health Education Retreat 2000. STUDY DESIGN: The clerkship objectives promulgated by the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) were reviewed for their relevance to women's health. ADMSEP members were surveyed at their 1997 annual meeting and again by means of their listserve in 2000 for opinions regarding inclusion of women's health topics in their curricula. RESULTS: The current objectives imply many women's health competencies. Those pertaining to abuse are particularly comprehensive. Survey data suggest that educators perceive that psychiatric aspects of reproductive functioning, violence, and trauma; gender differences in prevalence, presentation, and treatment of psychiatric disorders; and gender aspects of the doctor-patient relationship merit particular emphasis in the clerkship curriculum. CONCLUSIONS: Women's health competencies are broadly but implicitly represented in the psychiatry clerkship objectives as currently formulated. Revisions should encompass more explicit appreciation of gender differences and specific additional knowledge, skills, and attitudes.

Trauma screening in students attending a medical university.

Clinicians seldom assess trauma history in patients who seek treatment for psychological problems, yet trauma exposure is often related to psychological distress. Assessing trauma history can provide valuable information for treatment conceptualization and provision, although patients may not spontaneously share their histories because of embarrassment, avoidance, or other concerns. The authors compared 73 students at a southeastern US medical university who sought counseling and psychological services and completed intake paperwork without a trauma screen with 130 students whose intake procedures included trauma screening. They found that (a) patients who were specifically asked about trauma history were more likely to report such events, (b) previous physical assaults with a weapon were related to current psychological distress, and (c) physical assaults with or without a weapon were related to clinically significant psychological distress. These findings suggest that screening for lifetime trauma history should be a standard part of mental health screenings in similar medical university counseling centers.

Medical students' readiness to provide lifestyle counseling for overweight patients.

In order to assess medical students' readiness to engage in lifestyle counseling regarding nutrition, physical activity, and other health behaviors, the authors examined the knowledge, attitudes, and health behaviors of medical students. The authors analyzed questionnaire responses of 290 medical students in their first, second, or third year. Students were generally knowledgeable about cardiovascular disease risk factors, however they were less knowledgeable about body mass index (BMI) and specific nutrition and physical activity recommendations. Students were confident in the ability of physicians to change patients' health behaviors and had positive attitudes about providing lifestyle counseling. The upper-level students held significantly less positive attitudes than the first-year students. Almost half the sample reported regularly making unhealthy dietary choices. Only 23% of the sample met the public health guidelines for accumulating 30 min of moderate activity on at least 5 days a week. Third-year students engaged in significantly less activity than their underclassmen. Although medical students express positive attitudes toward providing lifestyle counseling, they require more instruction in the areas of weight screening, nutrition, and physical activity recommendations in order to be helpful to their patients. Because physicians who practice health behaviors are more likely to provide counseling, it would be beneficial to integrate an emphasis on student health into medical curricula.