Commentary: Interim leadership of academic departments at U.S. medical schools.

Medical schools and teaching hospitals are experiencing more frequent turnover of department chairs. Loss of a department chair creates instability in the department and may have a negative effect on the organization at large. Interim leadership of academic departments is common, and interim chairs are expected to immediately demonstrate skills and leadership abilities. However, little is known about how persons are prepared to assume the interim chair role. Newer competencies for effective leadership include an understanding of the business of medicine, interpersonal and communication skills, the ability to deal with conflict and solve adaptive challenges, and the ability to build and work on teams. Medical schools and teaching hospitals need assistance to meet the unique training and support needs of persons serving as interim leaders. For example, the Association of American Medical Colleges and individual chair societies can develop programs to allow current chairs to reflect on their present positions and plan for the future. Formal leadership training, mentorship opportunities, and conscientious succession planning are good first steps in preparing to meet the needs of academic departments during transitions in leadership. Also, interim leadership experience may be useful as a means for "opening the door" to underrepresented persons, including women, and increasing the diversity of the leadership team.

Patients' request for and emergency physicians' prescription of antimicrobial prophylaxis for anthrax during the 2001 bioterrorism-related outbreak.

BACKGROUND: Inappropriate use of antibiotics by individuals worried about biological agent exposures during bioterrorism events is an important public health concern. However, little is documented about the extent to which individuals with self-identified risk of anthrax exposure approached physicians for antimicrobial prophylaxis during the 2001 bioterrorism attacks in the United States. METHODS: We conducted a telephone survey of randomly selected members of the Pennsylvania Chapter of the American College of Emergency Physicians to assess patients' request for and emergency physicians' prescription of antimicrobial agents during the 2001 anthrax attacks. RESULTS: Ninety-seven physicians completed the survey. Sixty-four (66%) respondents had received requests from patients for anthrax prophylaxis; 16 (25%) of these physicians prescribed antibiotics to a total of 23 patients. Ten physicians prescribed ciprofloxacin while 8 physicians prescribed doxycycline. CONCLUSION: During the 2001 bioterrorist attacks, the majority of the emergency physicians we surveyed encountered patients who requested anthrax prophylaxis. Public fears may lead to a high demand for antibiotic prophylaxis during bioterrorism events. Elucidation of the relationship between public health response to outbreaks and outcomes would yield insights to ease burden on frontline clinicians and guide strategies to control inappropriate antibiotic allocation during bioterrorist events.

Factors that influence doctors' participation in clinical research.

BACKGROUND: Although clinical investigators are regarded as an endangered species, no systematic investigation of the factors that influence doctor participation in clinical research has previously been performed. AIM: The objective of this study was to evaluate the influences of selected aspects of medical education, specialty selection and practice type upon current involvement in clinical research. METHODS: Data were obtained by a mail survey of 428 graduates from the 1985-95 classes of the Penn State College of Medicine. RESULTS: Among the 34% (n = 145) of doctors who were currently participating in clinical research, there was a higher rate of participation among those in medical and surgical specialties versus those in primary care or hospital-based specialties. Of those participating in clinical research, 46% (n = 65) had sought external funds for their research, and 82% (n = 51) of that group had been awarded funds. Those who had been awarded funds as the percentage of their time involved in clinical research increased were more likely to report that research carried out in medical school had positively influenced their current involvement in clinical research (P = 0.004). The gender distribution among both this latter funded group and the larger group of 145 who were participating in clinical research was 72% men and 28% women, whereas the gender distribution among all respondents was 60% men and 40% women. The 283 individuals who were not participating in clinical research cited financial, family, career plan and practice philosophy as reasons for not doing so. CONCLUSION: The authors conclude that participation in medical research as a medical student may be under-recognised as a determinant of future involvement in clinical research and that the gender disparity of young doctors entering clinical research must be addressed.