A faculty-informed framework for responsible and equitable academic travel


 Introduction
 Academic medical faculty, who devote their lives to improving human health, are often frequent travelers. Given the significant contribution of transportation and travel activities to local and global environmental degradation, faculty must grapple with the impact of their work on patients and the public. During the COVID-19 pandemic, academicians were forced to develop innovative communication and business strategies, which also spawned new perspectives on the role of travel in academic life. We sought to learn more about these adaptations and perspectives, and to consider whether insights gained might inform a more deliberate and conscientious culture of academic travel.
 
 Materials and Methods
 We conducted faculty focus groups with participants from different academic levels and four different health graduate programs at an academic medical center, and inquired about motivations for and perspectives on past, present and future travel practices.
 
 Results
 Faculty provided extensive observations about their travel histories and how, in the middle of the COVID-19 pandemic, they were responding to abrupt challenges to their personal and professional responsibilities. They addressed the cognitive dissonance generated by flying frequently during a time of global warming, and they offered multiple recommendations for changes to the status quo.
 
 Conclusion
 Building on the rich qualitative data gathered during our focus groups, we propose a unique framework for academicians to advance the culture of travel in the 21st century. This framework proposes specific steps to mitigate planetary degradation and its associated inequities, and it suggests creative mechanisms for simultaneously enhancing the personal and professional quality of faculty life.



Introduction
Academic travel plays a central role in the advancement of medical knowledge and progress.Whether reviewing grant applications, speaking at meetings, conducting research in distant locations or traveling for job interviews, faculty and trainees have come to accept travel as a necessary and even routine element of a successful academic medical career, and institutions rely on their scholars to create and maintain their international reputations.
Recently, however, academicians have begun to weigh the impact of their travel activities on environmental degradation.Given their core mission to protect patients and the public, health professionals are particularly cognizant of the existential threat posed by global warming [1].
The COVID-19 pandemic, with its associated abrupt impact on business-as-usual, forced rapid changes to communication strategies, and presented a unique opportunity to re-examine and possibly reimagine the long-term goals and conduct of work-related travel activities.
In addition to forcing a halt to normal business travel, the timing of the pandemic has been propitious for several other reasons.First, academic medical centers have begun to recognize and respond to their own major role in the production of greenhouse gas (GHG) emissions and environmentally damaging medical waste [2−4].Second, the convergence of climate change, a pandemic and increasing recognition of health inequities and social injustices has motivated health professionals to amplify patient advocacy efforts [5,6].Third, in an unprecedented action, academic medicine's leadership has spoken in a unified voice by means of a joint editorial in 220 medical The Journal of Climate Change and Health journal homepage: www.elsevier.com/joclimjournals to describe the health emergency of climate change [7].The 2021−2022 academic years have therefore presented a rare opportunity for meaningful academic introspection and the development of an informed, evolved culture of academic travel.To that end we conducted focus groups with faculty members to learn about their past and present travel experiences, and to gain their insights about new paradigms for travel in the future.

Study design and recruitment
We conducted focus groups with faculty members at the University of California, San Francisco (UCSF) from July 2020 to August 2020, at a time of complete travel lockdown since March 2020.Participants were recruited using a purposeful sampling strategy with the goal of including faculty from across all four graduate health schools (Medicine, Nursing, Pharmacy, and Dentistry), in a variety of roles (including basic scientists, clinician educators, and public health experts), and from across the career trajectory (i.e.junior, mid-career and senior faculty).Potential participants were identified by two senior faculty in leadership roles, who recommended individuals for their diversity of backgrounds, experiences and opinions, and through a School of Nursing newsletter announcement.Email invitations were sent to identified and self-identified faculty inviting them to participate in a one-hour focus group.

Focus group guide
A semi-structured focus group guide was developed by all four authors in a collaborative process of development and revision.The process was guided by one of the authors (SA), who has expertise in qualitative methodology.The open-ended questions focused on faculty experiences and perspectives about academic travel in the past, the impact of the current travel lockdown and how faculty were envisioning changes to travel patterns in the future.Impacts of the COVID-19 pandemic on experiences with virtual meetings and conferences were also explored.

Data collection
Focus groups were conducted by Zoom and facilitated by medical students (SE and CB), who received training in and supervision of focus group facilitation from faculty (KG and SA).All focus groups were audio recorded with permission for recording and later analysis obtained from all participants.

Data analysis
The authors conducted thematic analysis using the constant comparison method, in which incidents in the data are compared with others and exemplary quotes are used as evidence to back propositions and themes [8].The analytic process took place in several stages.First, focus group recordings were reviewed by all authors, who wrote detailed notes summarizing key points made and capturing verbatim quotes.Next, the lead author (KG) reviewed and combined all authors' notes and verbatim quotes.Then, all researchers met repeatedly to discuss emerging findings, develop themes, and resolve differences in interpretation.Finally, the research team drew from the empirical findings to develop a normative framework that offers explicit guidance for shaping the future of academic travel.

Ethical considerations
The University of California, San Francisco's Human Research Protection Program certified the study as exempt from review (IRB 20 −31,391).

Results
Seventeen UCSF faculty members participated in four focus groups, including 8 junior and mid-career and 9 senior faculty (Table 1).Focus groups were divided by career level, with two groups for senior faculty and two for junior and mid-career faculty.Eleven of the participants were women and six were men.Faculty represented four health-professions schools (Medicine, Nursing, Pharmacy, and Dentistry) and participants included faculty who conduct research outside of the United States.
Below, we summarize findings and compare and contrast faculty experiences and perspectives related to academic travel.We frame these findings within a temporal framework (past, present and future) to illustrate the profound impact of the COVID-19 pandemic − not only on travel itself but also on how faculty think about the future of travel and how to ensure that it is conducted in a more deliberate and equitable manner.Tables 2-4 include additional verbatim quotes illustrating faculty experiences and perspectives across this temporal framework.

Pre-pandemic experiences
Reflecting on their general academic travel experiences before the pandemic, senior faculty valued the opportunity to establish long term relationships and productive collaborations with remote colleagues.They found themselves traveling more as they advanced through their careers, and collaborative decisions were facilitated by in-person meetings.One senior faculty member explained: "There is very little that I would identify in my academic career that was more satisfying than [the] opportunity to develop all those relationships with people who are different than me. .." Small perks of travel were noted, such as visiting new places as a side activity and avoiding the distractions of routine daily obligations.In contrast, some faculty noted significant disruptions to laboratory supervision, challenges with family schedules, and an extraordinary waste of resources and time engendered by traveling across the country for one short meeting, such as might be required by the National Institutes of Health (NIH).Hotel rooms were losing their appeal and a physiologic toll was noted over time, especially from sleep loss.Travel to both the east coast and Europe was perceived as particularly more taxing for west coast academics."Jet lag amplifies challenges with efficiency," said one senior faculty member.Although many were aware of or concerned about their carbon footprint from traveling, few faculty members reported altering their travel plans for environmental reasons.
Early and mid-level faculty expressed excitement about the opportunity to spread their wings and develop relationships with distant collaborators."Travel is absolutely essential for building those connections," said one participant.They perceived that travel was an important part of career advancement, though almost none had received clear directives about the relationship of travel to promotion, or the requirement of travel for leadership advancement within professional organizations.Rather, the pressure to travel was implicit, or "cultural," in the words of one participant.This led to the default action of traveling even when the potential benefit was unclear.For example, one junior/mid-career faculty member described the dubious value of presenting a poster at a distant conference: "That was a lot of work to just stand in front of a poster for half an hour and put that on my CV." Faculty identified the need for distant colleagues to write strong letters in support of promotion, and they expressed concern that such letters require meaningful in-person interactions.They described significant disruptions to home life, childcare and academic duties that accumulated during their absences.As a testament to the complex personal and professional motives driving academic travel, one young faculty member described taking her new baby to three meetings to prove that she could succeed in her academic work while being a new parent.

Intra-pandemic experiences
Based upon their experiences during the ongoing travel lockdown from March to August of 2020, senior faculty noted that the transition to virtual meetings was eased by having built collaborative relationships prior to the pandemic."We are senior and can be on a [virtual] call because we have established relationships," said one participant.On the other hand, the director of a large basic science laboratory

Table 4
Representative Faculty Focus Group Reflections on Academic Travel.

Thinking ahead to post-pandemic travel
Senior faculty Re-envisioning academic travel culture We need to look at this [travel culture] in a very systemic and systematic way.We are reviewed based on whether we've been invited to give talks.So how we are assessed as faculty has to change.It seems like it's more important than ever for the world to understand one another and to be connected, so how do you propose [we take care of] that human connection if we stop moving around?By [reducing costs] and interacting across distances there is a potential to really democratize [academic interactions] and to bring in people from lower and middle income countries. ... There is a real opportunity to democratize science. ..you could have platforms that [enable researchers and scientists to better clarify] their science for the end-users.We need to have everyone have equal access to these technologies.
[Travel] may be most important as a way to create opportunity for the less well established, the less well-known people.Professional organizations that host meetings could put together guidelines [for travel] that would be optimal for in-person encounters.

Maximizing the benefit of virtual meetings moving forward
The concept of hybrid meetings should be given more thought.On line [presentations]  perceived the lack of personal connection as a risk for hiring new team members.Overall, experiences with virtual meetings were mixed, with the impression that much work was needed to improve the quality of these interactions.One senior faculty member reported: "The NIH study section I was on worked really well [virtually].My experiences with conferences have been terrible, especially the poster sessions." On the positive side, colleagues who could not afford to travel were able to participate in conferences, and professional opportunities emerged that had been out of reach before the pandemic: "When I was asked to serve on an editorial board that would require me to travel to DC twice a year, I said no because I didn't want to add anything else to my plate.Now with everything being virtual, I am able to participate and I don't have to leave my family, and I don't have to feel like I am traveling again and destroying the planet." (senior faculty member) Overall, faculty expressed amazement that so much work could shift suddenly to the virtual realm.
Early and mid-level faculty highlighted improved access for some members of research teams with the switch to virtual meetings, although other team members lacked sufficient access to high-speed internet.Faculty found more time to write due to saved travel time, and they observed significant technological advancements in virtual conferencing.Global health researchers were impressed by how incountry staff assumed new responsibilities early in the pandemic, and they described evolving ideas about what constitutes "necessary" research travel.
In parallel to these positive experiences, there was a universal sense of screen fatigue, and it was challenging to focus on a virtual conference when patient care was being conducted on the same computer; one participant lamented, "Spending more hours on screens seems like torture."In light of newfound concerns about planetary and patient health and a transition to more virtual interactions, some young faculty were completely rethinking their career.

Thinking ahead to post-pandemic travel
There was general consensus among all participants that academic travel should not stop and that many of the benefits of travel still apply after the pandemic, but that much greater definition and guidance are needed to determine when travel is necessary."How we are assessed as faculty has to change," one participant said during a discussion about the need for advancement criteria that explicitly consider the planetary impact of academic travel.Senior faculty, for their part, highlighted the importance of travel for trainees in the course of job hunting, and the increased responsibilities of carrying national and international leadership roles.Senior faculty also identified the potential to democratize meetings: for example, expanding virtual attendance opportunities at professional gatherings to enable participation among those who cannot afford to travel.
Junior faculty were eager to define best travel practices for career advancement as those that enable the balancing of clinical and domestic obligations."If any good is coming out of this [the pandemic], it is certainly making our threshold of. ..necessary travel much, much higher," said one participant.Themes of planetary health, justice and gender equity were peppered throughout the conversations, along with related philosophical considerations.For example, junior faculty questioned whether we should redefine our concept of academic success, maybe "reboot" the system entirely (and how would that look?), or perhaps explore whether new academic travel habits could address multiple societal problems at once.The career advancement system, one participant explained "is in direct conflict with all of these conversations that we are having [about climate change, racism, and social justice]."Across all focus groups, there was an interest in "hybrid" meetings with both in-person and virtual options.Participants offered suggestions to make better use of virtual communication in ways that increase academic equity and decrease contributions to GHG emissions.They also expressed a desire for more information about the carbon footprint of different activities, for example, whether one international flight equates to two in-country trips.Overall, there was consensus that designing the future of academic travel should be a more thoughtful process than simply asking, "Could you have done this [meeting] with Zoom?"Moreover, we heard that changing the status quo requires leadership engagement at the institutional level, and more broadly: "It is hard for [the university] to engage in an isolated action, however noble, unless the system changes," said a senior faculty member.

Discussion
The COVID-19 pandemic placed the brakes on business as usual, and it continues to present a keen opportunity for health professionals to appraise their academic travel habits and routine activities in the context of planetary, societal and patient health.Our focus group findings indicate significant and growing awareness of the perils of climate change, a strong desire of faculty to take individual and collective measures that promote positive change, and to "first do no harm."Several major themes arose during these discussions.First, faculty acknowledged the benefits and joys of meaningful and productive relationships that arise from in-person interactions, but also emphasized the associated disruptions to work and home life.Faculty identified a straightforward strategy to decrease unnecessary travel and GHG emissions, which is to establish clear guidelines on the necessity of travel for advancement within schools, medical societies, and grant funding agencies.
Another common suggestion entailed providing faculty with useful information and voluntary tools to cultivate best decision-making, and to reward faculty for positive actions in sustainability and climate health activities.With the restrictions to in-person events imposed by the pandemic, faculty described effective methods of advancing virtual communications, which also serve to amplify the voices of colleagues who are unable to travel.Expanding on the theme of equity, we were struck by the strong feelings of several young colleagues that academic medicine must place issues of health equity, environmental justice and care of the most vulnerable front and center of any future conversations.
Drawing on the insights gleaned from our conversations with UCSF faculty, we have distilled the major themes and proposed opportunities for action into a normative framework with four main pillars, which collectively present an approach for transitioning academic medicine past the "more travel must be better" mentality.We call this framework the 21st Century Academic Travel Framework.

The 21st century academic travel framework
The four main pillars are:

Clarify guidance from leadership about the necessity of travel for career advancement
This was a common theme at all levels.Few faculty members had recalled receiving apprehensible directives from department leadership, medical societies or grant funding agencies, resulting in the default action of traveling when in doubt.Further direction and transparency could improve efficiency of travel while reducing expenses and ameliorating associated anxiety.Faculty suggested that the guidance threshold for "necessary" travel could be set much higher, which aligns with Wynes, et al., who in 2019 found that up to 10% of current air travel was completely avoidable in a sample of 705 faculty, and further found that amount of travel did not correlate with academic productivity [9].The elimination of unnecessary travel is a "low hanging fruit" solution that would immediately reduce academic medicine's collective GHG emissions.

Enable faculty to become stewards of their carbon footprints
Faculty expressed interest in acquiring greater understanding of their own carbon footprints and using tools that enable their best choices in supporting planetary and human health.Beyond air travel, reduction of harm might be characterized by methods of commuting to work or efficient use of energy in laboratories and offices [10].Given that teleconsultation appointments are increasingly recognized to spare GHG emissions, clinicians can contribute to patient and planetary health by refining recommendations regarding which patients are best served by virtual appointments [11,12,13].Academicians can also play a meaningful role in institutional reduction of GHG emissions and potentially enhance academic equity by utilizing virtual interviews for trainees [14,15].Our faculty participants also recommended institutional incentives, such as linking career advancement to positive actions in sustainability, health equity, and climate health activities.Although carbon offsets are recognized as a less than optimal mechanism to address global warming [16], faculty suggested ways (until superior solutions are available) that small charges for each flight could be applied to high quality local and remote adaptation and mitigation efforts.Some university models engage with third parties to assign offsets [17], and others seek to invest directly in climate projects involving their own institutions and communities [18,19].Among several ideas, participants generally supported the idea of direct reinvestments to incentivize ongoing health system efforts to reduce GHG emissions, to support climate and sustainability education efforts, and to partner with our community to reduce urban heat islands and air pollution [20].

Develop and support hybrid formats for meetings and conferences
Building on experience gained during the pandemic, faculty imagined new ways of conducting large and small meetings that accomplish multiple objectives, including the enhancement of equity in science by supporting participation of colleagues who cannot afford to travel, and decreasing overall GHG emissions.Early efforts at hybrid meetings have been reported [21].Faculty expressed confidence that at least some changes in virtual interactions made during the pandemic are here to stay.However, they also identified the need for more instruction and technical support to improve the quality of their engagement in electronic communications.Faculty suggested specific mechanisms of supporting each other in the development of related skills.

Advance solutions to excessive travel that can be adopted broadly by academic organizations
Travel is viewed as essential to build and maintain the reputations of schools and their faculty members, which encourages more travel rather than less.There is little incentive for leadership to discourage travel, and devotion to the greater good has not yet stimulated meaningful collective change.In view of the extraordinary call of 220 medical journals to take swift action in protecting the health of humanity [7] the academic medical community should respond in concert by pledging shared goals, cultivating innovative solutions, and incentivizing the development of tools to map, measure and compare institutional carbon footprints [22].Platforms already exist for the broader university systems to engage, and several academic colleagues have offered suggestions and taken steps to move forward [23,24,25].Our faculty stressed that we are all in this together, and we need bold leaders across academic medicine to step forward and establish an enlightened "new normal," which has the potential for significant positive health impacts immediately and for future generations.

Limitations
This study has several limitations.While our purposeful sampling strategy enabled us to speak with faculty from a range of professional backgrounds and at multiple career stages, faculty who were interested in the various personal, professional and planetary impacts of academic travel were probably more likely to participate.Thus, we may not have captured the full range of perspectives across the large faculty community at UCSF.Second, all participants are faculty at one academic medical campus with its own institutional culture and a longstanding commitment to addressing climate change, health inequities, and social injustices.Our findings may therefore not be fully transferable to other academic medical institutions.
Most of our faculty live within a relatively short distance of an international airport, which may influence travel behaviors compared to other institutions.Also, we did not gage changes of perception about travel activities unrelated to academic medicine.There are few studies for comparison, although Wang et al., noted in 2022 that the desire for exploration and leisure in a region of China continued to be strong motivators for travel in the community setting [26].These motivating factors were also identified by our participants, and may continue to influence their decision making.To the best of our knowledge, none of our participants conducted academic travel during the mandatory university lockdown in March to August 2020, though we did not specifically ask this question.Similarly, no one reported events that had been completely canceled, and our questions focused on the impact of rapid transition to virtual technology on already scheduled meetings.

Conclusion
To a profession that sees its mission as the promotion and protection of human health, it is not surprising that faculty recognize the expanding threats of climate change and wish to take personal and professional steps to tread with a lighter, more deliberate footprint.While the past culture of academic travel has had its advantages, the sudden changes brought by the COVID-19 pandemic and concomitant societal transformations have spawned new recognition of the urgent need for changes to our travel habits.
There is perhaps no group of individuals more capable of creating swift and meaningful change than academic medical faculty; the desire is there, as observed in our focus groups and as noted by Rissman, et al. [27].The question is whether we have the collective will to respond with the alacrity and courage demanded by our rapidly degrading planet.While medical institutions formulate their broader responses, this 21st Century Academic Travel Framework, which is based on recommendations from our faculty focus groups, can be applied quickly to decrease GHG emissions, engage faculty in crafting solutions that best fit their work environments, and still preserve the most compelling benefits of professional travel.

Funding
Drs. Gundling and Ackerman received no financial support for this project.Stephen Ettinger and Colin Baylen, medical students, received a Carbon Neutrality Initiative student fellowhip ($2000 each) from the University of California Office of the President (UCOP) in 2021.
UCOP had no input into the design, conduct, or reporting of this project, or the decision to approve publication of the finished manuscript.None of the authors have disclosures regarding conflicts of interest.
All four authors participated in the design and conduct of the faculty focus groups.Dr. Gundling drafted the manuscript, and the other three authors revised it critically for important intellectual content.Order of authorship was determined prior to manuscript preparation.

Table 1
Demographics of Faculty Participating in Focus Groups.

Table 2
Representative Faculty Focus Group Reflections on Academic Travel.Professional benefits of travel[Travel]is about building trust and relationships over time.Sometimes there is no substitution for face-to-face meetings.The hallway conversations and hors d'oeuvres at the end of the meeting are where connections are made.Our younger people become known and get engaged through travel.In translational science travel was key to fundraising and grant efforts.Travel helps with marketing one's own program and recruiting new fellows and laboratory staff.Professional and personal burdens of travel The physiologic toll of travel increases as you get older.It's hard to [make sure] things are functioning in the lab when I'm away.Junior and mid-level faculty Travel is obligatory for career advancement I'm strongly encouraged by my department to go to conferences in order to network and jumpstart my career.It's a cultural pressure [to travel].[For promotion you] have to have recommendations outside the university system so it's really a sense you have to network.At least 5 to 7 of my trips per year were to DC, and there was immense pressure [to attend in person]. . .for a one-hour presentation.Professional and personal burdens of travel Travel is really hard on the home life.I have severely cut back on the travel since [having] kids.Hotel ballroom chairs are just awful and my back always hurts.There is a lot about travel I really don't enjoy, and I love having remote conferences for that reason.Traveling to conferences has equity impacts on [those of us] who must limit our expenses.It's no fun asking colleagues to cover clinical duties when I am away.Some conferences are valuable, and some are more of just check the box travel.Topical themes grouped by authors following focus groups.Exact quotes used, except: [] Brackets indicate quote edited for clarity; . ..Ellipses indicate quote edited for brevity or clarity.

Table 3
Representative Faculty Focus Group Reflections on Academic Travel.Implications of the shift to virtual meetings Recently some [virtual] study sections [have] run pretty smoothly.Meetings are [no longer] restricted to those who can afford to travel.The lack of connection [normally made through in-person interviews] increases the risk [of hiring candidates who are not a good fit with a position].Remote meetings can be hard because you don't have the physical divide from work.Junior and mid-level faculty Implications of the shift to virtual meetings I didn't have to fly across the country for my international meeting, and I had increased access to people who wouldn't have been able to go otherwise.I've been able to write more because my brain isn't as harried.Conferences are getting really creative.The silver lining [of isolation during the pandemic] is that those of us on the US based team have learned to step back in a way that we probably should have from the beginning.[In the pandemic] I really saw what I could do without.[Some of our work involves] simulation, hands on training, clinical training and long-term mentorship, and of course that is completely not realistic [virtually].[I am] realizing how much of an industry exists around this kind of travel.On [virtual meetings] I am way less inspired as a human and a scientist.
Topical themes grouped by authors following focus groups.Exact quotes used, except: [] Brackets indicate quote edited for clarity.
really lends itself to being able to present visual data [such as complex data visualization, and displays of networks and heatmaps] in all sorts of new ways.[Initiating new projects] may become easier because you don't have the overhead associated with getting people together physically.Junior and mid-level faculty Re-envisioning academic travel culture We need to redefine what it means to be successful in advancing at [the university].We shouldn't make all meetings virtual, but we need to define which meetings could and should be virtual.Carbon offsets should be discussed with large professional organizations.COVID has [us rethinking how] we promote, connect and disseminate research and findings.Might [changing our travel policies] bring in more minority faculty?This is also a gender equality issue.[Improving the culture of travel] has to involve a shift of academic medicine more broadly.[We need to] apply pressure so that [we don't drift back to flying] for one-hour meetings.What are the ways to mitigate and consolidate?Topical themes grouped by authors following focus groups.Exact quotes used, except: [] Brackets indicate quote edited for clarity; . ..Ellipses indicate quote edited for brevity or clarity.