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Teach Your Physicians Well

October 19, 2009

A new Brandeis study reveals that academic medical centers, the nation’s classrooms for doctors and researchers, don’t always practice the values they preach

As the national conversation about healthcare reform engages millions of Americans, a new Brandeis study sheds light on the values of medical faculty who train the nation’s physicians and lead in health care and research in the U.S. The study, published this week in the Journal of General Internal Medicine, shows that faculty values regarding clinical care, education, community service and research correlate well with the stated missions of their institutions, but that in some instances, the institutions fall short of “practicing what they preach.”

The first of its kind to assess the alignment between institutional practices and individual faculty values, the study involved conducting and evaluating in-depth interviews with 96 faculty members, mostly physicians, at five diverse U.S. academic medical centers. In the interviews, the researchers asked faculty about their professional experiences and aspirations. Faculty prioritized caring for the underserved, teaching, intellectual rigor, and freedom of discovery in research.

“If academic medical centers are to achieve their missions in education, research and patient care, they must have energized, engaged and diverse talented faculty,” said lead author Dr. Linda Pololi, a senior scientist at the Women’s Studies Research Center at Brandeis.

“Our study revealed that while the stated missions of academic medical centers aligned well with faculty values, many physicians, in practice, believed that their institutions undervalued excellence in clinical care, as well as in their social justice and educational missions,” said Pololi, who directs the National Initiative on Gender, Culture and Leadership in Medicine: C – Change at Brandeis. The current study is being undertaken by C – Change, which addresses the need to realize the full potential of women, under-represented minority and generalist faculty members in U.S. academic medicine.

In the study, ethnically diverse male and female, senior and junior, faculty were asked a variety of questions, including these: “When have you felt most successful in your work?” “What do you see as valued at your institution?” “How do your personal values align or conflict with what you experience in academic medicine?”

In the area of clinical care, for example, some physicians criticized their institutions for not living up to their stated missions. As one study participant who left academic medicine explained, “I truly believe in health care for everybody, that it’s a basic human right, and that it’s our goal to organize resources in our society to make sure that that can happen, and that does not happen in academic medicine.”

But the study also reported comments like this one about working in academic medicine: “I had my own lab, there was an unbelievably driving passion to answer questions in a way that I would be adding to the information that would make children’s lives better.”

Pololi said that this study, and related ones using the same data, are helping to shift the national discourse on academic medicine, where women and members of under-represented minority groups have had a very difficult time achieving leadership positions, and where the dominant culture is hierarchical, competitively individualistic and corporate.

The overall goal of the C – Change initiative is to use rigorous research to bring about culture change within academic medical centers so that all faculty, including women and under-represented minority members, have equal opportunities and are able to contribute fully.

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