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The Culture of Academic Medicine: Faculty Perceptions of the Lack of Alignment Between Individual and Institutional Values

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Abstract

BACKGROUND

Energized, talented faculty are essential to achieving the missions of academic medical centers (AMCs) in education, research and health care. The alignment of individuals’ values with workplace experiences are linked to meaningfulness of work and productivity.

OBJECTIVE

To determine faculty values and their alignment with institutional values.

DESIGN

A qualitative hypothesis-generating interview study to understand the professional experiences of faculty and organizational approach in five AMCs that were nationally representative in regional and organizational characteristics. Analysis was inductive and data driven.

PARTICIPANTS

Using stratified, purposeful sampling, we interviewed 96 male and female faculty at different career stages (early career, plateaued, senior faculty and those who had left academic medicine) and diverse specialties (generalists, medical and surgical subspecialists, and research scientists).

APPROACH

Dominant themes that emerged from the data.

RESULTS

Faculty described values relating to excellence in clinical care, community service (including care for the underserved and disadvantaged), teaching, intellectual rigor/freedom and discovery, all values that mirror the stated missions of AMCs. However, many faculty also described behaviors that led them to conclude that their AMCs, in practice, undervalued excellence in clinical care, and their social and educational missions. Themes were seen across gender, career stage, race and discipline, except that female leaders appeared more likely than male leaders to identify incongruence of individual values and organizational practices.

CONCLUSIONS

In this study of five diverse medical schools, faculty values were well aligned with stated institutional missions; however, many perceived that institutional behaviors were not always aligned with individual faculty values.

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Acknowledgements

The authors gratefully acknowledge the critical funding support of the Josiah Macy, Jr. Foundation, Brandeis University Women’s Studies Research Center, and Wanda Jones and Anna Kindermann for leading the interagency agreement to provide supplemental support by the Office of Public Health and Science, Office on Women’s Health and Office on Minority Health; the National Institutes of Health, Office on Research on Women’s Health; the Agency for Healthcare Research and Quality; the Centers of Disease Control and Prevention and the Health Resources and Services Administration.

The authors thank Meg Lovejoy and Marianne MacPherson, who participated in data coding, and Kerri O’Connor for manuscript preparation. The authors are indebted to the medical faculty who generously shared their experiences in the interviews.

Conflict of Interest

None of the authors have any conflict of interest to disclose. The authors had access to all the study data, take responsibility for the accuracy of the analysis, and had authority over manuscript preparation and the decision to submit the manuscript for publication. The funders had no involvement in the design of the study, the collection of data, analysis and interpretation of the data, and the decision to approve publication of the finished manuscript. Dr. Pololi had full access to all of the data in this study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Specific contributions from each author

Pololi: conception, design, data collection, analysis and interpretation, drafting the article, final approval

Kern: interpretation, drafting the article, final approval

Carr: design, data collection, analysis and interpretation, drafting the article, final approval

Conrad: design, data collection, analysis and interpretation, drafting the article, final approval

Knight: design, data collection, analysis and interpretation, drafting the article, final approval

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Correspondence to Linda Pololi MBBS, MRCP.

Additional information

Prior Presentation: SGIM 32nd Annual Meeting, 2009: Plenary Research Presentation.

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Pololi, L., Kern, D.E., Carr, P. et al. The Culture of Academic Medicine: Faculty Perceptions of the Lack of Alignment Between Individual and Institutional Values. J GEN INTERN MED 24, 1289–1295 (2009). https://doi.org/10.1007/s11606-009-1131-5

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  • DOI: https://doi.org/10.1007/s11606-009-1131-5

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