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A Facilitated Peer Mentoring Program for Junior Faculty to Promote Professional Development and Peer Networking

Fleming, Geoffrey M. MD; Simmons, Jill H. MD; Xu, Meng MS; Gesell, Sabina B. PhD; Brown, Rebekah F. MD; Cutrer, William B. MD, MEd; Gigante, Joseph MD; Cooper, William O. MD, MPH

Author Information
doi: 10.1097/ACM.0000000000000705

Abstract

The future success of academic medicine relies heavily on the recruitment, development, and retention of faculty.1–4 Integral to the advancement and productivity of these faculty members is their ability to generate a career vision, map a path to success, and align their activities with their career goals. Although some skills may be acquired in a workshop or classroom setting, experience and individual guidance through the process is essential to achieve the most robust outcome.

Experiential guidance via mentorship is important to early career development and results in improved job satisfaction and retention.5–9 Despite the critical need for mentorship, a survey of junior faculty revealed that “less than half … felt adequately mentored”; however, those who were mentored spent significantly more time pursuing “scholarly activity.”10 Faculty on the clinician–educator track are less likely to have a mentor than colleagues on the physician–scientist track, and if a faculty member’s scholarship efforts are not supported by extramural funding sources, she or he may not be encouraged to seek a mentoring relationship.11 Numerous publications have described effective faculty development programs, which place mentorship in a central role and which may more significantly affect women’s career advancement than men’s.4,11–22 Although the mentoring relationship has traditionally followed the dyad model of one senior mentor and one junior mentee, newer models include a peer mentoring network.23,24 Although many faculty development programs have focused on scholarly publication as the sole outcome of interest,12,14,17,25 others have included reported satisfaction, confidence, and empowerment.15,18,19,26 The purpose of our study was to explore the design, implementation, and efficacy of a faculty development program designed both to provide a skill development curriculum and mentorship experience to improve early career advancement skills for junior faculty and to create a peer mentoring network.

Method

Program design and implementation

In the fall of 2010, the Department of Pediatrics at Vanderbilt University School of Medicine identified areas for improvement through a small-group needs assessment of the department faculty. A steering committee of junior faculty members, with guidance from senior faculty members, refined the needs assessment data with feedback from focus groups, which were conducted using a modified Delphi process to prioritize and categorize current faculty development efforts and areas of need. They identified two specific themes from the focus group discussions: the need for both mentorship and a curriculum that taught the basic skills necessary for advancement and promotion in academic medicine.

On the basis of what was learned during this needs assessment process, the steering committee developed a new small-group-based faculty development program. The curriculum covered the following topics: creating a professional portfolio; goal development and preparing for the annual faculty review; mentorship; aligning goals and activities; negotiation; defining scholarly activity; time management; navigating a departmental political landscape; and manager and leader attributes.27 For each topic, a steering committee member created a handout for program participants as well as a condensed synopsis to guide the facilitators to maximize consistency while ensuring minimal impact on their workload.

In February 2011, the steering committee presented the program design to the department leadership and requested material support for the implementation process, including office assistant support for program administration. No salary support for participants or facilitators was requested.

Small-group facilitators were nominated and agreed on by members of the steering committee based on their reputation for dedication to faculty development as well as on demonstrable career success. Participation in the program was voluntary and open to all junior faculty in the Department of Pediatrics. Initial recruitment for participants began in September 2011 (Enrollment-1) using a combination of e-mail and presentations at faculty meetings. In September 2012 (Enrollment-2), an additional enrollment period opened during which faculty could join or opt out of the program. To ensure the random distribution of junior faculty to each small group, participants were blinded to the identity of the facilitators when they selected a small-group time slot based on the predetermined availability of the facilitators. Small groups included 8 to 10 junior faculty members per senior facilitator.

The program began in October 2011; small groups met once a month for 1.5 hours. They did not meet from June to August of each year. At the first meeting of each small group, ground rules for creating a safe environment were established. These ground rules included having participants and facilitators sign a confidentiality agreement that conversations were not to be shared outside the group. Each session began with a check-in question designed by the steering committee to start the process of sharing and discussing that session’s topic. The facilitator led the discussion with participants typically sharing experiences and issues related to the topic. The facilitator guide emphasized the major elements to be included in the discussion but allowed for a spontaneous dialogue by the group.

In June 2012, the steering committee conducted an interim program evaluation; they surveyed participants who had attended more than three of the eight sessions and interviewed those who had attended fewer than three sessions. They also solicited feedback from the facilitators. On the basis of this feedback, the steering committee implemented three changes to the program: a second enrollment period was added in September 2012, new curricular elements were implemented, and a new small group with a physician–scientist track-specific focus was created.

Data collection

This study was approved by the institutional review board of Vanderbilt University School of Medicine, initially with consent obtained for study participation and then modified to include that all participant data would be reviewed in an exempt and deidentified fashion. Junior faculty received no compensation for participation in the program or study.

The steering committee used a modified Delphi technique to create a REDCap28 survey (see Supplemental Digital Appendix 1 at https://links.lww.com/ACADMED/A273). All participants were sent a link to the survey at the start of the program in October 2011 (Survey-1) and again in May 2013 (Survey-2). Nonrespondents were sent three reminders each time.

Demographic data included academic rank at the start of the program, years since last graduate medical education (GME) training at the start of the program, year joined faculty, gender, full-time status, academic track, and attendance in small-group sessions. Participants were asked to use a 100-point visual analogue scale using a sliding indicator to rate their confidence in their ability to problem solve in the domains of professional development and scholarship. They also were asked to rate their confidence in their ability to write career goals and align their activities with those goals. However, data were not collected regarding the specific academic activities or career goals that participants pursued. Next, participants were asked to estimate the percentage of nonclinical time they spent pursuing their written career goals as well as to report the number of their activities that were related or unrelated to those goals categorized into five groups (0, 1–2, 3–4, 5–6, > 6). Finally, to capture network ties, participants were asked to list the people within the department to whom they felt the most connected as well as those they viewed as resources for problem solving in the domains of scholarship and professional development.

The steering committee also collected departmental outcomes data, including faculty retention rates and selection to the Vanderbilt Academy for Excellence in Teaching.

Statistical analysis

Statistical analysis was performed using R Core Team (Vienna, Austria). Descriptive statistics were calculated for all variables of interest. Continuous variables were summarized using mean (standard deviation) and median (interquartile range [IQR]). Categorical variables were summarized using frequency (percentage).

Univariate analysis was performed on the variables of interest to compare self-reported knowledge, skills, and attitudes (KSA) scores between the two surveys for the total cohort. To accommodate for any discontinuity between enrollment and the two survey time points, data for the total cohort from the two surveys were compared using two sample Wilcoxon rank-sum tests. For the subset of the cohort that completed both surveys, the changes of scores in each area were calculated and a Wilcoxon signed rank test was used to assess for significant changes between the two time points.

Multivariable analysis was performed on the variables of interest to find the factors significantly associated with the change in self-reported KSA scores. Linear regression models were used to identify items/variables that were statistically associated with the change in scores for continuous outcomes, adjusting for covariables (proper transformation was performed to meet the normal assumption) for those participants who responded to both surveys and whose data were linked in the subset cohort. For ordinal outcome variables, proportional odds models were fitted. The items/variables in the models were gender, academic rank at the start of the program, and years since last GME training at the start of the program. Linear mixed models with random intercepts using all data were also fitted for the missing data from participants who only completed one survey to assess for the effect of the curriculum after adjusting for gender, current academic rank, and years since last GME training. A cumulative link mixed model with random effect was used for ordinal outcome variables.

Descriptive statistics regarding network ties between participants, including academic rank and number of incoming and outgoing ties, were calculated using UCINET (Analytic Technologies; Lexington, Kentucky), and the network was visualized using NetDraw.29

Results

Demographic data

Eighty-two (45%) of the 184 junior faculty members (instructors or assistant professors) in the department were enrolled in the program in October 2011 (Enrollment-1). They were divided into 10 small groups. In September 2012 (Enrollment-2), 62 (76%) members of the original cohort remained enrolled, 20 opted out, and 22 new faculty were added, for a total of 84 faculty at Enrollment-2. Thus, 104 unique individuals were enrolled in the program during the study period (Enrollment-1 + Enrollment-2). The demographics of the total cohort are reported in Table 1. Of the 104 total participants, 69 (66%) were female, 100 (96%) were full-time, 82 (79%) were assistant professors, and 75 (72%) were on the clinician–educator academic track. Participants reported a median of five years since their last GME training. Among participants enrolled at the time of each survey, 48 (59%) completed Survey-1 and 43 (51%) completed Survey-2, with 27 (44% of the participants enrolled at both time points) completing both (see Figure 1). Of all participants, median (IQR) attendance for all possible sessions was 42% (18%, 60%), which represents approximately 650 hours of faculty development provided over 18 months using 192 hours of facilitator time. Facilitators were all at the rank of associate professor or professor, and 3 of the 10 were female.

T1-32
Table 1:
Demographic Characteristics of Participants in a Facilitated Peer Mentoring Program in the Department of Pediatrics at Vanderbilt University School of Medicine, 2011–2013
F1-32
Figure 1:
Vanderbilt University School of Medicine Department of Pediatrics peer mentoring program time line, 2011–2013, and number of participants at enrollment and at two survey time points.

Participant outcome data

In univariate analysis, the median scores from Survey-1 differed from those from Survey-2 in the domains of professional development and scholarship for the entire cohort. Median scores increased from Survey-1 (range 63–67) to Survey-2 (range 71–79) in both participants’ current KSA as well as their ability to identify resources for problem solving in these domains (P < .05) (see Table 2). Among the subset of participants who completed both surveys, univariate analysis demonstrated a significant change from pre to post participation only in the professional development domain (see Table 2). In linear regression analysis, current academic rank and years since last GME training did not have a significant effect on the model in either domain; however, gender had an effect in the domain of professional development. Female faculty demonstrated a median score change of 22 points (100-point scale) more than male faculty (P < .05). In a mixed-model analysis in which all three confounder variables were held constant, significant changes in self-reported KSA in both the domains of scholarship (coefficient estimates 8.83 and 10.56) and professional development (coefficient estimates 10.98 and 13.46) were noted (P < .05).

T2-32
Table 2:
Self-Reported Knowledge, Skills, and Attitudes in the Domains of Professional Development and Scholarship of Junior Faculty Participants in a Facilitated Peer Mentoring Program in the Department of Pediatrics at Vanderbilt University School of Medicine, 2011 and 2013

For both the total cohort as well as the subset completing both surveys, participants reported an increased ability to write career goals as well as align activities and goals (see Table 3). They reported an increase in the percentage of nonclinical time they spent pursuing goal-related activities at Survey-2 compared with Survey-1 from a median (IQR) 53% (25%, 79%) to 76% (64%, 86%) in the entire cohort and from 51% (30%, 75%) to 75% (30%, 82%) in the subset completing both surveys. Finally, participants reported an increase in the number of nonclinical activities related to their career goals post participation (P = .01) that was not associated with a concomitant decrease in the number of unrelated activities (P = .49). At Survey-1, 71% (34/48) of participants reported having one to two or three to four academic activities related to their career goals, and at Survey-2, 67% (29/43) reported having three to four or five to six such activities. No specific data were collected to characterize the exact nature of these activities.

T3-32
Table 3:
Self-Reported Knowledge, Skills, and Attitudes in Creating Goals and Aligning Activities of Junior Faculty Participants in a Facilitated Peer Mentoring Program in the Department of Pediatrics at Vanderbilt University School of Medicine, 2011 and 2013

At Survey-1, 36 participants listed the faculty members to whom they felt most connected, resulting in 210 ties between 160 nodes, which yielded one large component and five small components with 4 or fewer nodes (see Figure 2, Panel A). At Survey-2, 275 ties between 162 nodes were captured, representing a single interconnected network structure (see Figure 2, Panel B). A small number of participants (4 from Survey-1, 5 from Survey-2) reported the most outward connections ranging from 10 to 15 each. Of the individuals with the highest density of connections, 4 were junior faculty and 4 were senior faculty. The junior and senior faculty representing these nodes had 4 to 6 incoming connections each and served as central cohesive bridging nodes within the network. The junior faculty identified in these network positions were members of the steering committee, and the senior faculty represented core leadership within the department. Thus, the formation of high-degree nodes likely represented emerging and existing leadership within the department.

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Figure 2:
Self-reported interconnectedness of junior faculty participants in a peer mentoring program at Vanderbilt University School of Medicine Department of Pediatrics at Survey-1 (Panel A) and Survey-2 (Panel B) time points by academic rank. Individual faculty members are depicted as squares with arrows demonstrating incoming and outgoing connections to other faculty members.

Departmental data demonstrate that faculty retention during the study period increased from 92% (217/237) at the start of the study to 95% (246/260) at its completion. During the study period, 12 members of the Department of Pediatrics faculty were selected for admission to the Vanderbilt Academy for Excellence in Teaching compared with 3 members in the prior two calendar years.

Program evaluation data

In June 2012, the steering committee conducted an interim program evaluation to identify areas for improvement. The results led to midstudy alterations. Notably, nearly all participating facilitators wished to remain in their position, citing their positive and impactful role in junior faculty development. Of those who left, one moved institutions and another developed new leadership responsibilities necessitating his departure from the position. Junior faculty participants evaluated each individual session, including the effectiveness of the facilitator. They expressed no concerns regarding the quality of the group facilitation and described the facilitators as effective. The facilitators reported that the curriculum guides were helpful and limited their preparation time, thus enhancing their participation in the program. Additionally, they reported that the opening check-in period during each session provided an ideal opportunity to problem solve as a group and that a great deal of the overall conversation came from the participants rather than the facilitator. The only substantial change requested by the facilitators was the ability to choose the upcoming curricular topic from the list rather than to have to adhere to a predetermined schedule; they felt that this change would allow them to better meet the needs of the group.

Participants who attended less than three sessions predominantly cited changes in their clinical duty schedule or personal issues as barriers to their attendance rather than the structure or focus of the program. However, a small subset of participants from the physician–scientist track felt strongly that the lack of a track-specific group was a barrier to their attendance. The majority of participants who attended more than three sessions (47/55; 85%) indicated that they would participate in the program again during the subsequent academic year; 24% (13/55) indicated that they would change their meeting time, and only 1 participant requested to change his or her small-group assignment. An analysis of the qualitative feedback collected from the interim program evaluation was done by two of the authors (W.B.C., J.G.). It revealed five themes for the steering committee to consider: (1) excessive time for check-in, (2) the value of small-group problem solving, (3) the effects of low attendance on small-group discussions, (4) the need for new curricular elements, and (5) managing difficult personalities.

Discussion

We have described a peer mentoring program for junior faculty that is facilitated by senior faculty, which aims to provide the resources for career advancement. We also have summarized self-reported outcomes, including junior faculty members’ skills, satisfaction, and interconnectedness. The program was designed to impart knowledge and support skill development in the domains of professional development and scholarship by improving participants’ ability to write career goals, align their current activities with those goals, and increase the number of and amount of time spent on goal-related activities. Our program resulted in a significant improvement in participants’ self-reported abilities, with female faculty reporting greater improvement than male faculty. At the same time, it increased the interconnectedness of faculty in the department across academic ranks.

Clinician–educator faculty in particular, like many of the participants in our study, are at risk for not receiving adequate mentorship and for not acquiring in a timely fashion the skills necessary to design and document those activities that foster a path to promotion.10,30 Our findings provide an important distinction from many development programs described in the literature, which focus on manuscript preparation or scholarly writing as the desired outcome or which have no specific outcome measure beyond global satisfaction scores. Although publication is an essential component for advancement, the development of career goals and active alignment of activities with these goals is a significant initial step in faculty development. The curriculum in our peer mentoring program focused on this process, beginning with an understanding of the paths to promotion and the scholarly activities that contribute to one’s progression on a chosen track, followed by the creation of career goals and the alignment of these goals with both current activities and promotion standards. Our program also was associated with an increase in faculty retention and selection to the institution’s Academy for Excellence in Teaching. Further study will be required to demonstrate more objective measurements of academic achievement, such as a quicker time to promotion and increased publication rates for participating faculty. Longitudinal tracking of participants is planned to strengthen and confirm the value of our program for participants and the department.

Even with the ability to align career goals and activities, a lack of mentorship may significantly limit the academic progress of faculty and may contribute to a high rate of attrition.13,21,31 Although mentorship is often viewed as a dyad with a senior mentor and a junior mentee, multiple models exist, including a peer network.23,24 The goal of our program was not to supplant the traditional dyad model of mentorship but instead to create an additional peer network of support while encouraging each faculty participant to seek a specific mentor.

Female faculty in academic medicine face substantial barriers to career development and promotion, including a lack of mentorship, yet they demonstrate increased scholarly achievement when they participate in career development programs.13,14 The significant improvement in self-reported KSA among female faculty participants in our program may have been driven solely by their skill development; however, this improvement also may have been affected by a reduction in their feelings of isolation as they increased their sense of interconnectedness, empowerment, and connection to the greater academic community, as Seritan and colleagues15 demonstrated in their study of peer mentoring.

Data from the interconnectivity maps demonstrate the potential of our program to increase the cohesiveness of a department with both junior and senior faculty acting as bridging nodes. Although no control group was evaluated for interconnectivity, identified faculty connections were not limited to those participating in the program. Although we do not have specific data connecting the improved KSA scores to the increase in interconnectivity, we have assumed an association based on the temporal nature of the changes. The benefits of the increased interconnectedness that arise in a peer network have been described previously, both specific outcomes, including increased scholarly productivity,15,25 and more general outcomes, including improved support, collaboration, and resource access across the workplace.24

The central role of the target audience in the creation of our program, through the work of the steering committee as well as the extensive needs assessment period, likely contributed to its success and utility. Senior faculty oversight during the development process led to efforts that targeted the needs of the participants while maintaining focus on the needs and resources of the department, thus making it a viable and sustainable program. Rather than relying on a one-size-fits-all model, pairing the needs of faculty and the institution with available resources and desired outcomes will determine the best model for faculty development and mentoring programs.26,32

This study has limitations to consider in interpreting our findings. First, the outcomes are not objective measures of KSA but are self-reported scores that risk inaccurate self-assessment. Second, the survey was created using a modified Delphi technique and expert opinion; however, we have no validity or reliability data for this primary outcome measurement tool. Third, although an overall curriculum plan was developed for each session, we did not control for heterogeneity in delivery and implementation between groups, and the experience of each participant may have varied, affecting the results. Finally, the short-term duration of the study required us to use surrogate outcomes, such as self-reported abilities, rather than real-world outcomes like the achievement of academic milestones and time-appropriate promotion.

Despite these limitations, this study documents the success of a faculty development program in improving self-reported KSA in the domains of professional development and scholarship. The specific skills acquired by the faculty participants include an improved ability to write career goals using standards for promotion as a guide as well as to align nonclinical activities with these goals. The effect was amplified among female faculty and persisted when controlling for possible confounder variables, such as academic rank or time since last GME training. These benefits to junior faculty were realized with a minimal financial commitment and were feasible within a large academic department. At the time of this article’s publication, our program remains in full effect with the ongoing enrollment of new faculty participants and 8 to 10 small groups meeting each month. Further study will focus on additional outcomes, such as rate and timeliness of promotion as well as improvement in the quality of the department’s scholarly work.

Acknowledgments: The Hazinski Society for Junior Faculty Development was named in honor of Dr. Thomas Hazinski, a faculty member of the Department of Pediatrics at Vanderbilt University School of Medicine, whose career was dedicated to the development of junior faculty. The authors also acknowledge the support of Dr. Steven Webber, the James C. Overall Professor of Pediatrics and Chairman of the Department, Vanderbilt University School of Medicine, in the sustained implementation of this program.

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