Brownfield, Erica MD; Clyburn, Benjamin MD; Santen, Sally MD, PhD; Heudebert, Gustavo MD; Hemmer, Paul A. MD, MPH
Within academic medical departments, the chair’s office is responsible for managing the three missions of patient care, education, and research. To more effectively manage the educational mission, many department chairs have created a position of vice chair for education, to parallel the importance given to the research mission. With increased regulatory monitoring of undergraduate and graduate medical education, expanding educational administrative loads within departments of medicine, and increasing time demands on chairs of medicine, it should come as no surprise that such positions are becoming more commonplace. Nevertheless, the prevalence and penetration of the position of vice chair for education within departments of medicine—the academic department within medical schools that typically has the broadest scope of educational responsibility—is unknown beyond informal, collegial sharing of such information.
Although there are clear expectations for residency program and clerkship directors as outlined by regulatory bodies and position statements,1–3 a profile of the activities and responsibilities of vice chairs for education, to include a common understanding of the job description, is notably absent. With the increasing prevalence of this role and the potential for vice chairs for education to help shape the future of medical education, we sought to learn about this group and determine who they are, the roles and responsibilities they fulfill, and the major priorities and challenges they face in their role as vice chairs for education.
In 2010, we designed a survey instrument for vice chairs for education that was initially informed by the existing literature addressing demographics, roles, and expectations of and for clerkship directors.1 We also included open-ended questions with a free-text response field that sought opinions of vice chairs for education on the goals and responsibilities outlined for their position, the metrics used to evaluate their success, their top three priorities, and their top three goals. If they had a job description, we asked them to provide that.
To find the pool of potential participants in our survey, we sent an e-mail to all 132 current chairs of departments of medicine in the United States and Canada at that time, inquiring whether or not the department had a designated vice chair for education and, if so, to provide contact information for that individual. Contact information for department of medicine chairs was obtained from the Association of Professors of Medicine (APM) database via the Alliance for Academic Internal Medicine (AAIM). The responses identified 82 vice chairs for education, 44 departments of medicine without a vice chair for education position, and 6 department chairs who did not respond. In the summer of 2010, we sent the final survey instrument to vice chairs for education using e-mail addresses provided by department chairs. The survey instrument was administered using Survey Monkey (Palo Alto, California). Responses were not linked to respondents’ names.
We analyzed the responses using both qualitative and quantitative approaches, as described in the next section. Our study was determined to be exempt by the Emory University institutional review board.
The surveys sent to the 82 vice chairs for education were completed by 59 respondents (72%). Their demographic data are noted in Table 1.
In terms of specialty, 30 (51%) vice chairs for education were general internists, and the others were a mix of other internal medicine subspecialties. A significant number of vice chairs for education also served in other leadership roles, such as residency program director, dean, or fellowship program director. Nine vice chairs had additional higher education degrees, such as masters in public health (2) and masters in medical education (2).
Respondents indicated that the position of vice chair for education had been established in their respective departments for a mean of 9 years (SD = 6; range = 6 months to 25 years) and that they personally had been in the position for a mean of 6.7 years (SD = 5; range = 6 months to 17 years). The size of the faculty represented by the departments of medicine with vice chairs for education was 271 (SD = 223; range = 35–1,400). Nearly all respondents, 58 (98%), described their departments of medicine as academic based.
Respondents reported spending approximately 35% of their professional time on administrative-related activities and less than 25% of their time on clinical activities; 20 (34%) spent less than 20% of their time on education-related activities. None of the vice chairs spent more than 30% of their time on research-related activities. Responses on administrative support for the position of vice chair for education were varied and often qualified by remarks of overlap of support for dual roles that respondents play in their departments, making it difficult to calculate a meaningful percentage of administrative support specifically devoted to the vice chair position.
The total annual salary for 2009–2010 that vice chairs for education reported varied, but 11 (19%) earned over $250,000, and 29 (49%) earned between $200,000 and $250,000.
In terms of preparation for the role of vice chair for education, only 6 (10%) were given an initial job description, and only 20 (33%) had any formal training in budget management. Even after serving the role for a mean of almost seven years, only 17 (28%) of the vice chairs for education currently had a defined job description and metrics used to evaluate their success, and only 23 (38%) controlled an education budget.
Responsibilities and goals of vice chairs for education: Five themes
To analyze qualitative responses, two of us (E.B., P.A.H.) independently reviewed the free-text responses to each open-ended question about responsibilities, goals, and metrics and developed preliminary themes. All five of us met to review the themes, discussed and resolved differences, and then applied the final coding themes to the responses. There were five themes that emerged; these themes and examples are summarized below.
Oversee educational programs of the department. Examples of how vice chairs oversee educational programs include creating and monitoring education metrics; evaluating programs; accreditation; procuring and/or managing resources; overseeing program leadership and staff; scheduling; creating initiatives for programs; and ensuring successful graduates. Representative comments include “Oversee medical school and residency training and educational programs, including curriculum, testing, trainee and teacher evaluations,” “Educating staff regarding program elements and curriculum,” and “Monitor and evaluate the education delivered by the department.”
Possess educational expertise. In this theme, respondents indicated that they had responsibility for, and were expected to develop, their own educational expertise and that of others. They cited serving as advocates and resources to others, championing the educational mission, and playing a role in faculty development of educators. Representative comments include “Provide opportunities for and to promote faculty development,” “Advocate on behalf of education mission leaders when appropriate,” and “Carry the banner for education as playing an equal role to clinical [care] and research—the three legs of excellence.”
Promote educational scholarship. The responding vice chairs for education believed that they were responsible for promoting educational scholarship within their departments. This includes not only leading by example and through their own personal development and achievement but also by promoting scholarship and academic advancement among members of the department. Illustrative comments include “Create a positive environment for educational creativity and innovation,” “Improve education-related scholarship,” and “Encourage scholarship in education.”
Serve in leadership activities within the department. Vice chairs for education commented that they are expected to serve in leadership activities within the department and school of medicine, commensurate with their position in the chair’s office. Examples of these activities include chairing and serving on education committees; serving as a liaison or advisor to the chair, school of medicine, and training sites; helping with trainee and faculty recruitment; writing letters of recommendation; overseeing patient care models; and evaluating performances of administrative and faculty involved in educational programs. Illustrative comments include “Serve on medical school committees for preclinical and clinical education,” “Increase the number of our medical school graduates choosing a career in internal medicine,” and “Interface with our clinical care sites and site leadership regarding education in the department.”
Found expectations to be vague and ill defined. This theme was included because many who responded to the survey simply stated that the scope and type of responsibilities were not well defined. Illustrative comments include “Uncertain beyond representing the chair and department on any educational matters,” “Vague,” “Any problem that has anything to do with a learner ends up in my lap,” and “Basically do scut-work for the chair.”
Defined metrics of success for role as vice chair for education. In response to the open-ended question “Are metrics of success defined for your role as vice chair for education?” the most common answers included accreditation status, residency Match results (a “good” match), national examination scores of trainees, recruitment of faculty, research productivity, and academic promotion of junior faculty. Less-often-mentioned metrics included “innovation,” teaching awards, teaching contribution, learner satisfaction, and other measures of trainee “performance.”
Top three goals. When asked about their personal top three most important goals as vice chairs for education, common themes were oversight and management of educational programs, meeting and exceeding accreditation standards, and providing quality educational programs. Other goals include being an advocate and a resource for others, providing faculty development, obtaining and managing resources for education, serving as a liaison to the chair, and advancing educational scholarship. Comments include “Create educational models that can serve as national examples,” “Ensure appropriate balance for all educational programs in the context of the other missions of the department,” and “Maintain highest-quality educational programs.”
Further refining expectations of and for the vice chair: Feedback from national workshop participants
The preliminary results of the survey data were later presented as an AAIM joint workshop session during the 2010 Academic Internal Medicine Week. The goal of the workshop was to further delineate and discuss expectations of and for vice chairs for education and to begin to better define metrics for the role. Twenty-four vice chairs for education participated in the joint workshop. Several general expectations of and for vice chairs for education emerged from this group discussion and presentation of preliminary survey results. These are summarized in List 1. Consensus agreement reached during this workshop on expectations of and for vice chairs for education helped form our recommendations outlined in the next section.
Despite what seemed to be an increasing prevalence of vice chairs for education in departments of medicine, the characteristics of those who serve in this role and their responsibilities have not been previously described. In the present study, we found that, as a group, they were senior academic faculty members (the majority at the rank of professor) who had been in their positions for several years (an average of nine years), not unlike other academic leaders such as clerkship directors, program directors, and chairs.4–8 Furthermore, they were often simultaneously serving in key educational leadership roles (such as residency program director, clerkship director, or a dean’s office position) and were deeply involved in educational management within their respective institutions. It seems clear that the vice chairs are prominent and respected educational leaders, academically accomplished, and committed to the educational mission of the department and institution.
However, we found that a substantial percentage (44 [33%]) of departments of medicine did not have such a position at the time of our study, although what seems to be the relative newness of this position would suggest that this percentage will continue to decline with time (although we did not determine how long the position of vice chair for education had been present in the department, only the mean duration of the current incumbent). Nevertheless, the advent of this position within academic departments speaks to the increasing complexity of managing educational programs both at the undergraduate and graduate medical education levels. The position of vice chair ensures a level of oversight and management that may be necessary to help course, clerkship, and program directors meet their accreditation requirements while maintaining a more strategic outlook for the educational mission.
In outlining their goals and responsibilities, vice chairs described several common and not-unexpected themes: oversee educational programs of the department, possess educational expertise, promote educational scholarship, and serve as leaders of educational activities within the department. These are responsibilities that would be commensurate with the role and position and that should be expected of the vice chair as a member of the chair’s office. Given the senior rank and experience of the respondents in our survey, this is likely the reason these individuals were chosen for their positions.
However, we were concerned to uncover some degree of uncertainty about the responsibilities and expectations among the respondents. In particular, job descriptions were lacking for some, expectations were not clear or clearly understood, and some noted that the position was a “catch-all” for any and all issues related to education. Although this situation might reflect that the position of vice chair for education is relatively new (and it should be acknowledged that common expectations for the clerkship director were not described until the end of the 20th century),2 a lack of clear expectations and outlining of responsibility has created a degree of uncertainty among the vice chairs that is not desirable and could lead to a lack of direction or accomplishment. Coming to a common understanding of the position of vice chair for education is important and necessary at this time.
A first step toward this understanding was made possible by the findings of our survey. In addition, as stated earlier, we discussed those findings with 24 vice chairs at the 2010 AAIM joint workshop. From that discussion, we sought to begin a conversation about the expectations of and for the vice chair for education, and some metrics to define success. Although the resulting statements of expectations (see List 1) are preliminary, they are rooted in the survey results and the discussion among vice chairs at the workshop, and they draw from established expectations for other core academic program leaders such as clerkship directors and residency or fellowship directors. Although the list is likely incomplete (e.g., the discussion did not incorporate the time requirements to accomplish expectations, as is present in other expectations documents), it is an important first step in further defining expectations. Additionally, it provides the first such information about the vice chair role. This can and should inform discussions across disciplines to reach common definitions, expectations, and understanding. In List 2, we have summarized some points that can serve for now as guidance to other vice chairs for education.
In a time when considerable attention is being paid to health care leadership,9–11 there has been little to nothing written about the leadership role or development of vice chairs for education in departments of medicine. As the health care environment becomes increasingly more complex, it is imperative that we create clear job descriptions with measurable outcome metrics and promote leadership development, not only for vice chairs for education but also for other vice chairs. Vice chairs for education occupy a pivotal position in academic health centers and, thus, have the unique opportunity (and responsibility) to be influential in defining educational directions, negotiating for resources, building consensus, and designing an appropriate educational infrastructure if given defined responsibilities and resources needed to maximize their role and if given opportunities for training in executive management. Furthermore, vice chairs for education, working with other vice chairs for education, research, clinical affairs, and faculty development, both within and outside medicine departments, will be more likely to achieve success through shared collaboration and mutual respect of all missions being served by academic medicine.
Our study has several limitations. It is a national survey of vice chairs for education in departments of medicine, and, therefore, we do not know whether vice chairs for education in other disciplines would identify the same responsibilities, goals, expectations, and metrics. The themes emerging from the responses to the open-ended questions about goals, responsibilities, and metrics were similar enough that we suspect some respondents may have conflated these three areas and/or that we did not clearly differentiate the three in our questions. Although the response rate was sufficient for a survey of this type, nonresponder bias remains a possibility.
Our study is the first of its kind to describe who vice chairs for education are, what roles they play, and what priorities they have in their position. We suggest that further development of common expectations could productively occur through the formation of a vice chair for education interest group within existing organizations such as the APM, or across academic organizations such as the Alliance for Clinical Education or the Association of American Medical Colleges.
Acknowledgments: The authors wish to thank all of the vice chairs for education who participated in the discussion of this topic during the 2010 Alliance for Academic Internal Medicine Joint Workshop, and the Alliance for Academic Internal Medicine staff, particularly Ms. Janet Stiles, for their assistance with identifying contact information for internal medicine department chairs.
Other disclosures: None.
Ethical approval: Ethical approval was granted by the Emory University institutional review board.
Previous presentations: The results of the survey were discussed at the 2010 Alliance for Academic Internal Medicine Joint Workshop in San Antonio, Texas.
Disclaimer: The views expressed in this report are those of the authors and do not represent the official views of the United States Air Force, the Department of Defense, or other federal agencies.