MCAT Optional?

July 29th, 2010 by pcahn

McGill University in Montreal will no longer require Canadian applicants to its medical school to take the MCAT. The admissions committee hopes the move will increase the number of Francophone students in its program. Applicants from outside Canada will still be required to submit MCAT scores.

Although McGill has no objection to standardized testing (and indeed tried to arrange for a translated test), the move fits into a trend of test-optional undergraduate institutions. Bates College eliminated the SAT for applicants 25 years ago and has seen no drop in student quality. By some measures, applicants are more qualified.

With the push for learner-centered medical education and the empathetic physicians, it seems contradictory that medical schools would still rely heavily on a multiple-choice test for admissions decisions.

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Reviewing the Performance Review

July 28th, 2010 by pcahn

UCLA professor of management Samuel Culbert has become a one-person army battling the annual performance review. The first salvo came in a Wall Street Journal op-ed in 2008.

In it, he argued that the reviews enact power plays between a boss and subordinate. They intimidate and subvert without having any impact on pay. Culbert has now expanded his diatribe into a book.

Instead of performance reviews, he recommends performance previews. These conversations would be more balanced and focused on what resources a worker needs to complete his or her tasks.

Culbert is thinking of for-profit institutions when he talks about performance reviews, but such corporate ideas have found a place in academia. In the Department of Medicine, section chiefs this month will be sitting down with faculty for their annual reviews. In the best cases, supervisors will use the opportunity to project ahead more than to dwell on the past.

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Incompetent Colleagues

July 27th, 2010 by pcahn

A study in the July 14, 2010 issue of the Journal of the American Medical Association reports on the findings of a survey of nearly 2,000 physicians around the country. The authors, from Massachusetts General Hospital, asked how many of the respondents knew of a colleague who was impaired or incompetent to perform work. The low proportion who said yes (17%) was encouraging, but the proportion who informed the authorities (69%) was also low.

The upshot of the study points to a gap between the recognition of improper behavior and the mechanisms for how to combat it. Those who did not report their bungling colleagues mostly cited reasons like they thought someone else was taking care of the problem or that a formal complaint would have no effect.

Perhaps even more upsetting--though less commented on--was the finding that only 64% of all respondents felt a professional obligation to report impaired or incompetent colleagues. For the integrity of the profession and the benefit of patients, every physician must feel responsible for helping their colleagues. Leadership should ensure that such reports will be taken seriously, investigated, and acted on.

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Hiring for Diversity

July 26th, 2010 by pcahn

After a year in which no faculty searches occurred, University of California San Diego leaders have authorized 33 new faculty searches for the coming year. Of the 33 searches, 12 have been designated for scholars who enhance the university's commitment to diversity. In addition, they established a pool of funding to hire seven more scholars during the year who promote diversity.

On the surface, it's heartening that a public university is hiring again and has devoted so many resources to making an inclusive work environment. It's also wise to reserve some funds for target of opportunity hires to take advantage of hiring circumstances throughout the year.

At the same time, UCSD--as any university--must approach diversity from a holistic perspective. What strategies do they have in place to identify promising candidates? What is their plan for retaining them? How do they see diversity fitting into the larger academic mission of the university? The press release is too brief to go into this detail, but it's important that the gesture not be a superficial one simply to boost numbers.

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Workplace Violence

July 23rd, 2010 by pcahn

Massachusetts enacted a new law that increases the penalties for assaulting a nurse on the job. Nurses face the same level of risk for workplace violence as police officers and prison guards. EMTs already enjoyed protection against assaults. This law now extends those rules to nurses.

The statistics of abuse horrify. Fifty percent of emergency room nurses reported being punched in the previous two years. In all the news coverage, however, the reports never address who is inflicting the violence. I suppose we are to understand that unruly patients are to blame. Isn't it also possible that the perpetrators could be other health service workers?

BU's Medical School has an Appropriate Treatment in Medicine initiative that tracks abuse against medical students. From what I understand, the most frequent culprits are older residents who mistreat younger students. It's conceivable that nurses face physical abuse from their co-workers. The new law can only hope to have a deterrent effect. In reality, it might still require the nurse to report a supervisor or physician for punishment.

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False Claims

July 22nd, 2010 by pcahn

Dr. Anil Potti seemed to fit the definition of a successful medical school faculty member. An Associate Professor of Medicine at Duke, he had received over $1 million in funding for his research on lung cancer tumors. He was an active presence on campus and appeared in press releases.

Then it emerged that Dr. Potti had lied about one seemingly small part of his resume. On different applications for grants he claimed to have been a Rhodes Scholar from Australia. Though he later dropped that claim from his CV, it appears he misrepresented his qualifications on federal grant applications. Duke has placed Dr. Potti on leave, and the NIH may review his funding.

It seems trivial that a single honor could have tipped the balance in favor his grant application. And it is unclear if there were any flaws in the clinical trials he had been funded for. Yet, maintaining the integrity of the research enterprise is crucial. In a competitive academic environment, it can be tempting to exaggerate credentials. Dr. Potti did not receive his training at prestigious universities, but how you perform your role matters more than how people perceive your background.

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Conflicts of Interest

July 21st, 2010 by pcahn

The Boston Globe published a story today about new rules at Harvard limiting medical faculty involvement with the health care industry. Pressure from the U.S. Senate and an embarrassing episode with a child psychologist who failed to disclose over a million dollars in drug company funding motivated the change.

Boston University has its own guidelines for interactions between clinicians and industry, which aims to avoid the same appearance of impropriety. The Globe article does not mention how Harvard will enforce the new rules. BU relies on department chairs to report violations of the policy, but that assumes department chairs have detailed knowledge of faculty activities.

I understand the difficulties of navigating industry influence in medicine. Particularly where physicians in academic institutions may accept lower pay than private practice, supplementing with drug company food and honoraria presents an attractive trade off. In applying for Continuing Medical Education credit for the faculty development seminar series, I learned that all the speakers must sign disclosure forms and all the evaluations must include a question about perceived conflicts of interest. The CME forms provides some accountability, but how will departments monitor the less visible ties between faculty and industry?

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Residency Plagiarism

July 20th, 2010 by pcahn

Ever since the Internet became the predominant source of information for students, new concerns about plagiarism have arisen. Certainly academic dishonesty existed before, but now a sneaky student does not even have to take the time to copy purloined passages by hand. It's just a cut and a paste away.

The New York Times reported on this trend recently. Now the Annals of Internal Medicine have published a study called "Plagiarism in Residency Application Essays." The authors analyzed application essays for the five largest residency programs at Brigham and Women's Hospital using the Turnitin application. They found that 5% of the essays registered as plagiarized.

In general, international students and students with lesser qualifications were more likely to plagiarize, but the study found instances of top students plagiarizing, too. I tend to think that part of the blame lies with the assignment. A personal narrative is such a vague prompt. Applicants don't intend to be dishonest, but they have little guidance for what kind of essay is appropriate. In this case, it seems safe to borrow from a supposedly trusted source. This is not to excuse their actions, but it does suggest that the application process could be tailored to elicit more original responses.

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Scheduling technology

July 19th, 2010 by pcahn

Between the Mentoring Task Force, the Faculty Development and Diversity Committee, the Awards Committee, focus groups, journal clubs, and working groups, it seems like I spend a significant chunk of time scheduling meetings. Everyone is so busy that finding that golden hour when all the participants are available can be impossible.

So far, my technological solution has been to use Doodle. The free version allows users to set up several potential meeting days and times and then generates a link to a grid. All the invited attendees can add their availability by checking boxes. Doodle tallies up the yeses, and highlights the slot that most people can attend.

I recently heard about an alternative called Tungle.me. The website works in much the same way, but with far more powerful features. It allows you to link to Facebook and Twitter profiles and to sync with Outlook or iCalendar features to automatically avoid conflicts. Of course, to get those robust options, users have to sign up and download an application that connects to their calendar software. That may be more work than I can expect busy academics to perform.

Ideally, Outlook would incorporate these features and mesh seamlessly with the Department's room scheduler. Until then, I'll probably stick with Doodle.

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The Mommy Track

July 16th, 2010 by pcahn

As academic departments look to achieve gender balance in their faculty, the competing demands of scholarship and parenting become more acute. A study released by the Association of American University Professors (and nicely summarized in the the Washington Post) provides more evidence that female academics are feeling overwhelmed.

It's not news that the building years of a faculty member's career overlaps exactly with a woman's childbearing window. The burden of establishing a research agenda while raising a family puts women in "survival mode." What struck me about the study was that professors who become fathers at the same age experience a positive effect. They do not miss opportunities for career advancement or suffer from the perception that parenting detracts from their professional work.

The message for universities seems to be accommodation. Make timelines for advancement more flexible. Allow options to take leave without penalty. As much as structural changes are needed, attitudes about working mothers need to change as well.

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