The National Initiative on Gender, Culture and Leadership in Medicine, known as C - Change (for culture change), was founded in 2006 and is housed at Brandeis University.
Even with the altruistic motives of most medical faculty and the noble missions of academic medicine, the present culture in medical schools is felt by many faculty to be lonely, unwelcoming of differences, and more competitive and critical than collaborative or supportive.1-7 Many faculty perceive discrepancies between stated mission and institutional behaviors.8-9 The culture discourages humanistic orientations, and those who seek professional rewards learn that the preferred route is through competition and self-promotion rather than collaboration. This culture contributes to high rates of faculty dissatisfaction, burnout and depression.10-13 In turn, dissatisfaction is associated with high levels of turnover and attrition.9,14-16 Also, there is a lack of diversity at all levels of leadership in medical schools.17-19 Despite calls for culture change in academic medical centers,20-27 few interventions to facilitate culture change in medical schools have been reported or evaluated.28
There appears to be a mismatch between the prevailing organizational approach and culture in academic medicine and its vital faculty workforce. It is increasingly clear that addressing these serious issues requires dedicated and innovative efforts and a renewed focus on the culture of academic medicine. C - Change is dedicated to improving the culture of academic medicine through research and action.
The initial C - Change research studies and 2006 to 2010 Learning Action Network were generously funded by the Josiah Macy, Jr. Foundation. The Office of Public Health and Science Offices on Women's Health and Minority Health, the NIH Office of Research on Women's Health, the Agency for Healthcare Research and Quality, the Health Resources and Services Administration, the Centers for Disease Control and Prevention, and Brandeis University Women's Studies Research Center provided supplemental collaborative support.
1. Pololi L, Conrad P, Knight S, Carr P. A study of the relational aspects of the culture of academic medicine. Academic Medicine. 2009;84:106-114.
2. Conrad P, Carr P, Knight S, Renfrew MR, Dunn M, Pololi L. Hierarchy as a barrier to advancement for women in academic medicine. J Women’s Health. 2010;19(4):799-805.
3. Pololi L, Kern DE, Carr P, Conrad P, Knight S. The culture of academic medicine: Faculty perceptions of the lack of alignment between individual and institutional values. J. Gen. Intern. Med. 2009;24(12):1289-95.
4. Pololi L, Kern DE, Carr P, Conrad P. Authors’ Reply: Faculty values. J. Gen. Intern. Med. 2010;25(7):647.
5. Pololi L, Cooper LA, Carr P. Race, disadvantage and faculty experiences in U.S. Academic Medicine. J. Gen. Intern. Med. 2010;25:1363-9.
6. Pololi LH, Jones S.J. Women faculty: an analysis of their experiences in academic medicine and their coping strategies. Gender Medicine. 2010;7:438-450.
7. Pololi LH, Civian JT, Brennan RT, Dotollo AL, Krupat E. Experiencing the culture of academic medicine: Gender matters, a national study. J. Gen. Intern. Med. 2013;28:201-7.
8. Carr P, Pololi L, Knight S, Conrad P. Collaboration in academic medicine: reflections on gender and advancement. Academic Medicine. 2009;84(10):1447-1453.
9. Levine RB, Lin F, Kern DE, Wright SM, Carrese J. Stories from early-career women physicians who have left academic medicine: a qualitative study at a single institution. Academic Medicine. 2011;752-758.
10. Schindler BA, Novack DH, Cohen DG, et al. The impact of the changing health care environment on the health and well-bring of faculty at four medical schools. Academic Medicine. 2006;81-27-33.
11. Shanafelt T, Sloan J, Haberman T. The well-being of physicians. American J Medicine. 2003; 114:513-9
12. Linn LS, Yager J, Cope D, Leake B. Health status, job satisfaction, job stress, and life satisfaction among academic and clinical faculty. JAMA. 1985;254:2775-2782.
13. Bunton SA, Corrice AM, Pollart SM, Novielli KD, Williams VN, Morrison LA, Mylona E, Fox S. Predictors of workplace satisfaction for U.S. medical school faculty in an era of change and challenge. Academic Medicine. 2012;87:574-581.
14. Alexander H, Land J. The long-term retention and attrition of U.S. medical schools. AAMC Analysis in Brief. June 2008;8;1-2.
15. Pololi, LH, Krupat E, Civian JT, Ash AS, Brennan RT. Why are a quarter of faculty considering leaving academic medicine? A study of their perceptions of institutional culture and intention to leave in 26 representative medical schools. Academic Medicine. 2012;87:859-869.
16. Corrice AM, Fox S, Bunton SA. Retention of full-time clinical M.D. faculty at US medical schools. AAMC Analysis in Brief. February 2011;11:1-2.
17. Beyond Bias and Barriers: Fulfilling the Potential of Women in Academic Science and Engineering. National Academies of Sciences, National Academy of Engineers and Institute of Medicine. National Academies Press. 2006.
18. Association of American Medical Colleges (AAMC). Faculty roster. http://www.aamc.org/data/facultyroster. Accessed October 16, 2012.
19. Striving Toward Excellence: Faculty Diversity in Medical Education. Association of American Medical Colleges (AAMC) Diversity Policy and Programs. AAMC. 2009
20. Smedley BD, Butler AS, Bristow LR. In the Nation’s Compelling Interest: Ensuring Diversity in the Health Care Workforce, Institute of Medicine, National Academies of Sciences Press. 2004, pp. 23-54.
21. Kirch DG. AAMC President’s Address 2007: Culture and the Courage to Change. Available at: http://www.aamc.org/newsroom/pressrel/2007/2007presidentsaddress.pdf.
22. Haizlip J, May N, Schorling J, Williams A, Plews-Ogan M. The Negativity Bias, Medical Education, and the Culture of Academic Medicine: Why Culture Change is Hard. Academic Medicine. 2012;87: 1206-1209
23. Leape LL, Shore MF, Dienstag JL, Mayer RJ, Edgman-Levitan S, Meyer GS, Healy GB. A culture of respect, part 1: the nature and causes of disrespectful behavior by physicians. Academic Medicine. 2012;87:845-852.
24. Leape LL, Shore MF, Dienstag JL, Mayer RJ, Edgman-Levitan S, Meyer GS, Healy GB. A Culture of respect, part 2: creating a culture of respect. Academic Medicine. 2012;87:853-858.
25. Powell D, Scott JL, Rosenblatt M, Roth PB, Pololi L. Commentary: A call for culture change in academic medicine. Academic Medicine. 2010;84:586-587.
26. Pololi LH. Changing the Culture of Academic Medicine. Perspectives of Women Faculty. Hanover, NH: Dartmouth College Press; 2010.
27. Pololi LH. A prescription for diversifying medical faculties. Chronicle of Higher Education. September 24, 2010. B32-34
28. Cottingham AH, Suchman AL, Litzelman DK, et al. Enhancing the informal curriculum of a medical school: a case study in organizational culture change. J Gen Intern Med. 2008;23:715-722.
C - Change Practices and Services
Linda Pololi, MBBS, MRCP
Senior Scientist and Resident Scholar
Director, National Initiative on Gender, Culture and Leadership
in Medicine: C - Change
415 South Street, Mail Stop 079
Waltham, MA 02454