On the first day of my internship some 30 years ago, I and my fellow newly-minted physicians dutifully attended an orientation session. After receiving a nametag, keys, and various other paraphernalia that afforded us access to departmental offices, mail cubbies, and call rooms, a chief resident spoke to us. He said that we were to be in the hospital every day and that there was no excuse that he could imagine that could keep us from being there. He reified his point with an example. On any given day, he said, we would either not be sick enough to miss work—so we should be in the hospital—or we would be so sick that we should be admitted to the hospital. Either way, he reiterated, we should be in the hospital. Every day. Period.
This part of the culture of medicine—that to be a good doctor, one must live at the “working” end of the continuum of work–life balance—has been around for some time. However, in recent years it has been questioned by many in academic medicine; such questioning reflects one aspect of how we are beginning to reconceptualize professional effort in new ways.
In this issue of the journal, Brown et al.1 report the results of a phenomenological study of work–life balance. They used in-depth, individual, semistructured interviews with academic surgeons of both sexes to explore how these individuals sought balance between competing personal and professional priorities. One interesting finding was that the process of achieving work–life balance required adaptive, dynamic responses rather than static approaches.
Additional aspects of faculty professional effort also are explored by several other articles this month; they add to the growing body of literature on this topic. Milner et al.2 describe several approaches to identify faculty competencies and explore ways to organize and categorize such competencies. In another article, Srinivasan et al.3 focus specifically on competencies for medical educators.
Page et al.4 conducted a cross-sectional survey to examine the characteristics of diversity programs at U.S. medical schools and how these characteristics relate to increased faculty diversity. Their findings highlight the key roles of the environment and of the minority medical student pipeline. Bickel and Rosenthal5 examine barriers to developing effective mentoring relationships. They offer valuable recommendations to “communicating across differences” so that mentoring can achieve its fullest potential.
And finally, Schor et al.6 used the time-honored principle of anticipatory guidance—so useful in pediatrics to promote health and prevent disease—to develop programs for their own faculty targeted at key periods of transition and change across the professional lifespan. These authors stress that faculty development must continue to evolve from its “informal, top-down” traditions to a more formal system based on the principle of anticipatory guidance and tailored to the appropriate period of career progression. (See my August 2011 editorial7 for more discussion on the topic of career progression.)
Over the past few years, Academic Medicine has received an increasing number of submissions on the broad range of topics related to the professional efforts of faculty at academic health centers. Obviously, this reflects a growing interest in the importance of this aspect of academic medicine. You can access key published articles and commentaries on these topics by visiting www.academicmedicine.org. Click on “Collections,” and then click on “Faculty Affairs” or “Faculty Development.”
And, of course, the journal continues to be interested in additional scholarly articles that advance our understanding of the professional efforts of medical faculty, including, but not limited to, the changing nature of these efforts (e.g., the decline of the so-called “triple threat” faculty member), how faculty effort is judged to be effective (along with threats and barriers to being effective), how faculty members balance professional efforts with personal life, the physician– scientist as an endangered species, promotion and tenure issues, and how all of these factors change over the course of a faculty member's professional lifespan.
Steven L. Kanter, MD
1 Brown JB, Fluit M, Lent B, Herbert C. Seeking balance: The complexity of choice-making among academic surgeons. Acad Med. 2011;86:1288–1292.
2 Milner RJ, Gusic ME, Thorndyke L. Perspective: Toward a competency framework for faculty. Acad Med. 2011;86:1204–1210.
3 Srinivasan M, Li S-T T, Meyers FJ, Pratt DD, et al. “Teaching as a competency”: Competencies for medical educators. Acad Med. 2011;86:1211–1220.
4 Page KR, Castillo-Page L, Wright SM. Faculty diversity programs in U.S. medical schools and characteristics associated with higher faculty diversity. Acad Med. 2011;86:1221–1228.
5 Bickel J, Rosenthal SL. Difficult issues in mentoring: Recommendations on making the “undiscussable” discussable. Acad Med. 2011;86:1229–1234.
6 Schor NF, Guillet R, McAnarney ER. Anticipatory guidance as a principle of faculty development: Managing transition and change. Acad Med. 2011;86:1235–1240.
7 Kanter SL. Faculty career progression. Acad Med 2011;86:919.