The Teaching Formula

July 15th, 2010 by pcahn

Researchers at the University of Hertfordshire have analyzed submissions to the annual Tutor of the Year award. By counting how many times the nominations mentioned a specific trait, they were able to rank the elements in an educator most valued by students.

Not surprisingly, the most common quality in a nominee was “great teaching.” Thirty percent of the nominations mentioned that. More revealing was the least mentioned item: feedback and assessment. Just four percent of students cited that as a reason to recognize their instructors. Also highly ranked: positive outlook, influential, and edutaining.

It is not too helpful for an educator looking to improve her skills to know that students want “great teaching.” But the lack of interest in feedback seems to go against many current pedagogical trends. Is this a case where the patient does not know what is good for him? I would be curious to see a longitudinal study that follows up on the students at intervals after the class is over. With time, do they come to appreciate different qualities about an instructor?

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Job Satisfaction

July 14th, 2010 by pcahn

The Collaborative on Academic Careers in Higher Education has released results from a survey of tenure-track faculty at research universities. What's novel about these findings is that they document significant differences in job satisfaction between male and female professors. In particular, women in social science disciplines reported significantly greater job satisfaction than their male counterparts.

Inside Higher Ed breaks down the categories in which female academics felt less satisfied. Some of these relate to the tenure process, but many others are relevant to an institution like BUMC: teaching obligations, family-friendly policies, funding expectations. That women in the social sciences, departments that tend to have a more even gender distribution, felt less satisfied indicates that achieving parity in hiring is only a start.

In fact, I wonder if the higher concentration of women in those departments makes it easier to share information and become aware of inequities. This points to the need to keep faculty development programs in mind for mid-career professors as well as new hires.

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Going Gray

July 13th, 2010 by pcahn

In 1993, 43% of Stanford's faculty was over 50 years old. By 2008, the proportion had reached 53%. At the same time, the cohort of faculty under age 45 has fallen to just 33%. As the San Jose Mercury News reports, it's getting difficult to convince professors to retire.

Of course, many older faculty members continue to be productive scholars and teachers. All that experience counts for something. Nor are universities allowed to impose a mandatory retirement age. Still, the longevity of faculty members prevents new hiring, ties up office space, and limits the introduction of new perspectives. So, Stanford has unveiled an incentive plan to encourage retirements.

Not all institutions can be as generous, but we can develop robust emeriti programs that promise faculty continued access to the intellectual and social life of the university. Even without tenure, academic jobs promise long-lived satisfaction. If professors knew they could continue pursuing the projects they love and remain part of the department while in retirement, perhaps they would take advantage of the plan.

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A Century After Flexner

July 12th, 2010 by pcahn

Abraham Flexner was not a physician, but his report, Medical education in the United States and Canada: a report to the Carnegie Foundation for the Advancement of Teaching changed the way medical students learned. It professionalized training and standardized teaching practices.

One hundred years later, the Carnegie Foundation has released another report. Educating Physicians: A Call for Reform of Medical School and Residency calls anew for a close look at medical training. Since Flexner's original recommendations, the field of health care has changed dramatically, though the way new M.D.s are taught has not.

The authors found several weaknesses in the current system:

  • Inflexible, excessively long training
  • Overly focused on inpatient clinical experience
  • Poor connections between formal knowledge and experiential learning
  • Inadequate opportunities to work with patients over time

At Boston University, a group of medical educators has formed a journal club to respond to the critiques in the new report. The state of graduate medical education has improved since 1910, but the centennial provides a symbolic opportunity to update the curriculum.

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Clinical Faculty Satisfaction

July 9th, 2010 by pcahn

The Association of American Medical Colleges released a new report last week. Clinical Faculty Satisfaction with the Academic Medicine Workplace presents findings from a survey of 6,000 clinical faculty at 23 medical schools. Boston University was not part of the sample.

The headline result is that two-thirds of faculty are satisfied or very satisfied with their jobs. The fine print is that satisfaction varies greatly by specialty. The happiest folks in the hospital are the dermatologists, and the least happy are the anesthesiologist. Significantly, faculty in general internal medicine are much more likely to be satisfied with work than faculty in medicine subspecialties.

While the survey cannot reveal the reasons behind these differences, it can point to a strong correlation between job satisfaction and retention. This gives us motivation to conduct further research on what makes a clinical faculty member feel supported. The findings will help reduce turnover at academic medical centers.

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Enduring Questions

July 8th, 2010 by pcahn

The National Endowment for the Humanities has announced a new grant program. Winning faculty will receive $25,000 to design a new course that addresses an "enduring question." Examples include: "Are there human universals?" "What is the relationship between humans and the natural world?"

Although the grants are limited to undergraduate courses, they offer a compelling framework for approaching graduate medical education. Too often we begin teaching--whether in a classroom or at the bedside--with the idea of covering material. That is, we treat interactions with students as an opportunity to convey information.

The problem with the "brain dump" is that students may not comprehend or retain much of the material. Starting with the end goal ensures that the teacher is engaging students' critical thinking skills and not just their memorization skills. A powerful end goal is one of the overarching questions of the discipline.

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Living Longer

July 2nd, 2010 by pcahn

Department of Medicine researchers and their collaborators published a paper in Science this week. Using participants in the New England Centenarian Study, they identified 150 single nucleotide polymorphisms, or, less technically, parts of the genome, associated with long life.

As with most science stories picked up in the media, the details are less dramatic than the headlines. Senior author Thomas Perls explained to the Boston Globe that the findings do not portend a genetic test for longevity. Environmental factors play an even larger part in health.

Still, with UC Berkeley asking freshman to submit to a DNA test, the paper arrives at a time when people in the United States are curious about what our genes reveal.

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Disclosing Compensation

July 1st, 2010 by pcahn

All nonprofit universities must file Form 990 with the IRS each year. This form discloses the financial health of the organization including its assets, lobbying activities, and fundraising practices. Tucked away in Schedule J, the university must also reveal the salaries of the leaders and its five highest-compensated employees.

BU made its form available on the web, an admirable act of transparency. Page 61 lists the salaries, deferred compensation, and nontaxable benefits of 15 key employees. Seven of them are affiliated with the medical campus.

The highest paid active employee on the BU payroll is Dr. Jeffrey Spiegel, Chief of Facial Plastic and Reconstructive Surgery, who earned $1,282,130. From his website, it looks like Dr. Spiegel is an active researcher and clinician who offers everything from brow lifts to facial feminization. Timothy Foster, an orthopedic surgeon, earned $1,072,930--nearly $30,000 more than the university president.

The procedures these surgeons perform clearly generate sufficient revenue to justify their salaries. In some cases, they may be accepting a pay cut to work in an academic medical center. There's no reason to suspect a scandal. To the contrary, if all employees' salaries were made publicly available, it would clear up rumors and provide a clear guide to what the institution values.

For reports from other universities and hospitals, consult GuideStar.

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Foreign Medical Schools

June 30th, 2010 by pcahn

The Government Accountability Office released a report this week on the role of federal student loans in supporting foreign medical schools. Like the recent Congressional hearings on for-profit undergraduate education, foreign medical schools claim billions of dollars in federal aid from students with little evidence about return on the investment.

One of the GAO's findings, as reported in Inside Higher Ed is that 97% of U.S. medical school graduates pass the Step 1 licensure exam on the first try, but only 64% of foreign medical school graduates do. If foreign medical schools, some of the largest of which are for-profit, receive taxpayer money, then they should produce competent doctors.

At the same time, foreign medical schools help meet the need for physicians in this country. And no doubt many of their graduates are outstanding doctors. The larger issue may be the high cost of medical education at home and abroad, which requires students to go deeply in debt to pursue their dreams.

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Residents’ Hours

June 29th, 2010 by pcahn

My doctor friends always joke not to get sick around the first of July. That's when the new class of interns, those recent medical school graduates, arrive at the hospital. They're not only less experienced, but they're also subject to harsh work routines. As fatigue increases, so does the likelihood of medical error.

Under proposed new guidelines, interns would be limited to 16-hour shifts (down from 30 hours at a stretch) and receive more supervision. The accreditation agency would also increase monitoring and penalties for programs that fail to adhere to the new rules.

Seems sensible enough, but there are arguments on both sides. Some say 16-hour stretches are still to long to ensure sound judgment. Others fear that shortening work shifts will lead to more disruptions in patient care.

My sense is that one goal of residency is to initiate M.D.s into being a doctor, so to make the rite of passage more effective, there must be a period of disorientation and suspension of normal rules. To prove themselves ready, many residents will want to work longer hours. The key change seems to be not in the number of hours worked, but in the amount of supervision offered. That will help guarantee satisfactory patient outcomes.

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