Archive for October, 2010

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Electronic Error

Friday, October 29th, 2010

Electronic medical records hold the promise of managing the flow of data more efficiently. When a doctor orders a test, the computerized system will automatically flag any abnormal results for follow-up.

Yet, a study at the Houston VA Medical Center showed that one-third of over 1,000 electronic alerts over a three-month period went unacknowledged. Of those cases, 45 (or 4% of all abnormal results) did not receive any follow-up at all.

In an interview with the Wall Street Journal, the study’s author suggested that physicians may be suffering from information overload. Electronic medical records can send physicians up to 50 alerts and reminders each day, making it difficult to distinguish the crucial data from the less urgent.

This electronic bombardment may be exacerbated in an academic medical center, where faculty also receive regular e-mail blasts about university events and research opportunities. Some past faculty development seminars have offered tips for managing the flow of information. Based on recent response to a seminar about conducting an efficient clinical visit, we will revisit how to maximize use of electronic medical records in the spring.

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Posted in Faculty development | 8 Comments »

Are Men the New Minority?

Monday, October 25th, 2010

According to this graph of Canadian medical school enrollment, men outnumbered women by three to one in 1970. Women finally reached parity in 1995. By 2005, women made up nearly 60% of students in Canadian medical schools. At one, McMaster, women constituted over 76% of the incoming class of 2002.

McMaster eventually determined that the imbalance was not healthy and decided to offer a kind of affirmative action for male applicants. By reducing the emphasis on GPA and broadening the criteria for admission, they were able to offer spots to more male students.

I think of this disparity, too, in the faculty development events we organize. Participation in seminars and mentoring programs is overwhelmingly female. This could reflect the preponderance of women at the lower ranks of the faculty, the target audience for many of our activities. Or it could be that women are more sympathetic to the kind of professional education that we offer.

Of course, even to worry about having too many women is unfair because no one seemed to mind when men dominated medical campuses. But we do have an interest in producing both male and female doctors and scientists and making everyone feel welcome at our events.

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The NIH Bubble

Friday, October 22nd, 2010

One feature of a medical campus that has struck me as different from an arts and sciences campus is the casual way that research faculty get hired. No strategic plan or educational mission determines the ideal number of faculty each section should have. Rather, Principal Investigators hire on new faculty to assist with their labs. Then, if the researcher cannot establish independent funding or the PI loses a grant, that faculty member is let go.

A commentary in the Chronicle of Higher Education explains why this pattern has developed. After supplying start-up costs and some initial salary, universities can then funnel researchers into the NIH system. NIH grants, the primary source of funding for biomedical research, covers faculty salaries and provides overhead to the university. In this way, medical campuses have incentive to keep hiring more faculty, hope they obtain extramural funding, and then drop them if they don't.

The same commentary also argues that this system is unsustainable. More and more investigators are entering the system, but the overall NIH budget has been flat since 2003. The crisis can already be seen in the number of applications for training grants, which tripled from 1997 to 2007 while success rates nearly halved.

One solution would be to require universities to support their own faculty, as the National Science Foundation already does. This would put a natural limit on the number of investigators on medical campuses, but it would give each of them enhanced stability and confidence to pursue research that matters, not just research that pays the bills.

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What’s the “C”?

Thursday, October 21st, 2010

We know what the initials  BU stand for. And we know what BMC stands for. But what about BUMC?

Look at this sign from outside the main entrance to the medical school. At the top, it welcomes visitors to "Boston University Medical Center." At the bottom, the logo states "Boston University Medical Campus."

Segal 005

This is not the only discrepancy. The website calls it the Boston University Medical Campus, but signs on buildings--including a large one overlooking Route 93--proclaims this the Boston University Medical Center.

I noticed when I was using the library to access a journal, the subscription was registered to Boston University Medical Center. The side of the mail truck say the same thing. But the letterhead and official communications call it the Boston University Medical Campus.

It may seem like a trivial distinction, but disagreement about the name of an institution can make it harder for its members to feel loyal. Boston Medical Center has a consistent name, logo, and even a slogan. Whether people believe it or not, they can recognize it and identify with it. BUMC could use similar branding.

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Posted in Faculty development | 18 Comments »

Medical School Enrollment Up

Wednesday, October 20th, 2010

The Association of American Medical Colleges has been pushing to expand the number of doctors trained across the United States. They have been encouraged new schools to open and existing schools to expand the number of available seats. The goal is to enroll 21,000 first-year students by 2015.

This year's total, 18,665, represents a 1.5% increase over last year, and a step toward achieving the organization's goal. It helped that overall applications also increased by a little more than 1%, to 42,742. (For those of you doing the math, it's a nearly 44% acceptance rate).

The larger pool of incoming students also reflects greater racial and ethnic diversity. Hispanic males, in particular, increased 17% over last year. All minority groups except Native Americans and Pacific Islanders registered a rise in first-year enrollments.

Sadly, these gains were accompanied by a homogeneity of socio-economic backgrounds. Eighty percent of applicants over the last 10 years have come from the top two income quintiles. It's important to have a medical profession that reflects the ethnic diversity of the population, but it's just as crucial to train doctors from working class and poor families.

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Version Control

Tuesday, October 19th, 2010

With documents like CVs that get regularly updated, it can be a challenge to locate the most recent version. This became apparent after a round of grant reviews when some applicants submitted CVs that left off publications. It's also apparent in my hard drive's folders, where I have a dozen copies of certain drafts each labeled with a different date at the end.

For tech geeks, there are several options using specialized software that helps tame the proliferation of versions. But for folks who want a simple, elegant solution, I suggest Dropbox.

Once you install this free download on your different computers, it creates a kind of shared drive where you can store files. When you make changes in your CV on one computer and sync in to Dropbox, it automatically overwrites the previous draft and makes the latest version available on all your computers.

Another neat feature is it assigns a URL to your documents, so you can send them easily to collaborators for commenting. It comes with 2GB free storage, then charges for more space. The free amount is more than enough to detangle the mess of CV versions. No matter whether you remember to add that talk or paper on your home or work computer, it's all harmonized and updated.

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E-mail Etiquette

Friday, October 15th, 2010

A dean at the University of Missouri has apologized for accidentally broadcasting his response to a student's e-mail to the entire graduate student listserv. It seems that the student's original message to the dean was copied to the graduate student distribution list, but because the sender did not have permission, only the dean received the e-mail. When the dean went to respond, however, he hit "Reply All." The dean does have permission to distribute messages to the listserv, and a private message became public.

The gaffe recalls another e-mail mishap where a history department sent a message to all the candidates who had applied for a job opening there. Rather than hide the recipients' names in the BCC line, the chair made visible all the applicants--including some who did not want their current employers to know they were looking for new jobs.

It's easy to see how slip-ups happen. We use e-mail so freely and fleetly that we neglect to edit our messages before we send them out. One solution is to schedule when messages go out.  For instance, in Outlook, after composing a message, click the button that says "Options." It will show a box of choices. Under "Delivery Options," you can select the time you want the message to go out. By choosing a time later in the day, you buy yourself a chance to reflect on the e-mail and make changes. You can also use this method to send messages at odd hours, making your colleagues think you're working when they're sleeping.

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Posted in Faculty development | 1 Comment »

Training Opportunities

Wednesday, October 13th, 2010

The next deadline to apply for faculty development grants is Friday, October 15. While reading books and listening to CDs can help inspire productive changes in work habits, there's something powerful about attending an in-person training.

I've collected a list of possible training opportunities for faculty in academic medicine. Some target clinicians, others researchers, but they all are premised on the belief that live, in-person workshops provide lasting benefits.

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Posted in Faculty development | 4 Comments »

Faculty Hiring

Tuesday, October 12th, 2010

Like a lot of regional universities, Christopher Newport University in Newport News, VA is looking to boost its academic profile. So many institutions of higher education have made promises of future excellence that a new category has emerged: Wannabe U.

What distinguishes Christopher Newport University is how it's opted to go about improving quality. A new set of guidelines under consideration would require departments to hire only faculty members with undergraduate and graduate degrees from schools ranked highly by the U.S. News and World Report survey.

This takes the prestige sweepstakes to an absurd level. Faculty in each discipline are best equipped to judge the qualifications of a job candidate. They know that some low-ranked institutions have outstanding training programs in certain areas. Also, they can recognize an outstanding candidate who for personal reasons decided to study at a less well-known institution.

We're all guilty of matching the prestige of the institution to the trainees it produces. It's an easy shorthand, but no substitute for rigorous evaluation.

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Choose Your Own Teaching Adventure

Monday, October 11th, 2010

Several on-line resources exist for dealing with tricky teaching situations. I've collected several of them here. Sometimes the tip sheets suffice to guide you through a problem, but other times, they can be too general.

I learned about a new website from Carnegie Mellon's Enhancing Education initiative that brings some specificity to on-line teaching advice. The multi-step Solving a Teaching Problem works like a choose-your-own-adventure book. You start by identifying the category of problem you're facing. Next you identify possible reasons for the problem. Finally, the site provides possible strategies.

For instance, I chose the problem: Students can't apply the material. As a reason, I selected, they are unable to synthesize knowledge. The site offered several solutions that include "provide stepping stones to complexity" and talking to students about the process of learning. It's not a prescriptive site, but one that provides a range of options.

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Posted in Faculty development | 141 Comments »

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