Abstract
Objective
The culture of academic medical institutions impacts trainee education, among many other faculty and patient outcomes. Disrespectful behavior by faculty is one of the most challenging and common problems that, left unattended, disrupts healthy work and learning environments. Conversely, a respectful environment facilitates learning, creates a sense of safety, and rewards professionalism. The authors developed surveys and an intervention in an effort to better understand and improve climate concerns among health sciences faculty at the University of California, San Diego (UCSD), a research-intense, public, academic medical center.
Methods
An online “climate survey” of all UC San Diego health sciences faculty was conducted in 2011–2012. A strategic campaign to address the behavioral issues identified in the initial survey was subsequently launched. In 2015, the climate was re-evaluated in order to assess the effectiveness of the intervention.
Results
A total of 478 faculty members (223 women, 235 men, 35 % of faculty) completed the baseline survey, reporting relatively low levels of observed sexual harassment (7 %). However, faculty reported concerning rates of other disruptive behaviors: derogatory comments (29 %), anger outbursts (25 %), and hostile communication (25 %). Women and mid-level faculty were more likely to report these behavioral concerns than men and junior or senior colleagues. Three years after an institutional strategy was initiated, 729 faculty members (50 % of the faculty) completed a follow-up survey. The 2015 survey results indicate significant improvement in numerous climate factors, including overall respectful behaviors, as well as behaviors related to gender.
Conclusions
In order to enhance a culture of respect in the learning environment, institutions can effectively engage academic leaders and faculty at all levels to address disruptive behavior and enhance positive climate factors.
This is a preview of subscription content, log in via an institution to check access.
References
Leape LL, Shore MF, Dienstag JL, Mayer RJ, Edgman-Levitan S, Meyer GS, et al. A culture of respect, part 1: the nature and causes of disrespectful behavior by physicians. Acad Med. 2012;87:845–52.
Hoff TJ, Pohl H, Bartfield J. Creating a learning environment to produce competent residents: the roles of culture and context. Acad Med. 2004;79:532–40.
Liaison Committee on Medical Education. Functions and structure of a medical school: standards for accreditation of medical education programs leading to the M.D. degree. (https://www.lcme.org/publications/functions.pdf). Accessed November 17, 2013.
Accreditation Council for Graduate Medical Education. Clinical Learning Environment Review (CLER) program. (https://www.acgme.org/acgmeweb/Portals/0/PDFs/CLER/CLER_Brochure.pdf). Accessed November 27, 2012.
Institute of Medicine. To err is human: building a safer health system. Washington, DC: National Academies Press; 2000.
Scheurer D, McKean S, Miller J, Wetterneck T. U.S. physician satisfaction: a systematic review. J Hosp Med. 2009;4:560–8.
Pololi L, Krupat E, Civian JT, Ash AS, Brennan RT. Why are a quarter of faculty considering leaving academic medicine? A study of their perceptions of institutional culture and intention to leave in 26 representative medical schools. Acad Med. 2012;87:859–69.
West CP, Huschka MM, Novotny PJ, Sloan JA, Kolars JC, Habermann TM, et al. Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. J Am Med Assoc. 2006;296:1071–8.
Dyrbye LN, Massie FS, Eacker A, Harper W, Power D, Durning SJ, et al. Relationship between burnout and professional conduct and attitudes among U.S. medical students: a multi-institutional study. J Am Med Assoc. 2010;304:1173–80.
Leape LL, Shore MF, Dienstag JL, Mayer RJ, Edgman-Levitan S, Meyer GS, et al. A culture of respect, part 2: creating a culture of respect. Acad Med. 2012;87:853–8.
Federation of State Medical Boards of the United States, Inc. Report of the Special Committee on Professional Conduct and Ethics. Dallas, TX: Federation of State Medical Boards; 2000.
Leape LL, Fromson JA. Problem doctors: is there a system-level solution? Ann Intern Med. 2006;144:107–15.
Federation of State Medical Boards of the United States, Inc. Policy on physician impairment. Euless, TX: Federation of State Medical Boards of the United States, Inc; 2011.
The Joint Commission Revisions to Standard LD 03.01.01. Leaders create and maintain a culture of safety and quality throughout the hospital. (http://www.jointcommission.org/assets/1/6/Pre-Pubs_LD.03.01.01_HAP.pdf). Accessed November 29, 2012.
Binder R, Friedli A, Fuentes-Afflick E. Preventing and managing unprofessionalism in medical school faculties. Acad Med. 2015;90(4):442–6.
Cottingham AH, Suchman AL, Litzelman DK, Frankel RM, Mossbarger DL, Williamson PR, et al. Enhancing the informal curriculum of a medical school: a case study in organizational culture change. J Gen Intern Med. 2008;23(6):715–22.
Acknowledgments
The authors designed the survey, analyzed the data, and led the institutional campaign. The authors are extremely grateful for the input of the vice chancellors of health sciences, deans of the school of medicine and pharmaceutical sciences, and the department chairs. Without their support, the efforts described in this manuscript would not have been possible.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Financial Disclosures
The authors have no financial disclosures.
Rights and permissions
About this article
Cite this article
Moutier, C., Wingard, D., Gudea, M. et al. The Culture of Academic Medicine: Faculty Behaviors Impacting the Learning Environment. Acad Psychiatry 40, 912–918 (2016). https://doi.org/10.1007/s40596-016-0582-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40596-016-0582-3