National Initiative on Gender, Culture and Leadership in Medicine: C-Change

C-Change Faculty Survey

A validated instrument measuring dimensions of the existing institutional culture often used to address the professional and personal development of faculty in academic medical centers. The survey provides an assessment framework for inclusive excellence.

Development of the C-Change Surveys

The National Initiative on Gender, Culture and Leadership in Medicine, known as C-Change (for culture change) and housed at Brandeis University, is dedicated to improving the culture of academic medicine through research and action. Our objective is to promote an inclusive, affirming, relational, energizing and productive working environment for all medical school faculty and trainees, at the same time increasing the diversity of leadership in academic medicine.

In an initial phase, C-Change conducted in-depth interviews with male and female faculty in five academic medical centers in order to document the culture and issues affecting faculty productivity and well-being. Those qualitative interview data served as basis for the construction of an extensive quantitative survey instrument, the C-Change Faculty Survey,© which systematically explores and documents the experiences of medical school faculty and the organizational culture in their academic medical centers.

In a second phase, randomly selected faculty in each of a stratified random sample of 26 U.S. medical schools were studied using our Survey. This large, nationally representative dataset of faculty responses serves as a rigorously analytic resource to investigate important topics, such as the vitality and retention of academic faculty.^1-7 Survey findings in individual institutions provide a solid foundation for developing activities to support both an enhanced working environment and set of values in academic medicine. Our national normative C-Change Survey data allow medical schools to compare themselves with other similar institutions. Recent C-Change research⁴ identifies dimensions of the culture as measured by the survey that predict faculty intention to leave due to dissatisfaction.

The C-Change Faculty Survey is available for use in the health sciences and other disciplines⁷ wishing to understand and improve their culture and existing practices in order to create a more productive, inclusive, diverse, and humanistic environment where all individuals can thrive. The survey allows detailed exploration of the foundations of the development of human capital (e.g., trust, relationships, perception of opportunity, professionalism, respect, mentoring, equity, and the learning environment) as well as the waste of such human capital (e.g., disconnection, causes of dissatisfaction, burnout, harassment, discrimination and desire to leave academia).

The survey also pays particular attention to cultural awareness, including the extent to which faculty value diversity, their anti-sexism and anti-racism skills, and their change agency for equity. When used in parallel, the Student, Resident and Faculty Surveys provide credible and powerful tools for institutional improvements and for research. Survey findings can address accreditation requirements.

The validated C-Change Faculty Survey has been used by institutions across the country and internationally and by the NIH in studies, including the NIH FIRST Program.

Content of the C-Change Faculty Survey

The C-Change Faculty Survey assesses medical faculty perceptions of their organizational culture and professional experiences including: extent of vitality, trust, professionalism, feelings of being valued and belonging, inclusion, respect, race, ethnicity, and gender, equity, mentoring, valuing diversity, anti-sexism and anti-racism skills, change agency for equity, and other constructs related to the organizational culture for faculty. It also collects data on faculty roles (e.g., percent time spent in research, education, administration, clinical time) and faculty perception of their school’s support for career development, mentoring and work-life integration. It assesses burnout and faculty commitment to their institution, as well as intention to leave academia.

Discrete scales with demonstrated statistical reliability summarize C-Change data along important dimensions of the culture, to allow comparison of sub-populations and investigate outcomes of interest.

An example of the C-Change Faculty Survey in use: University of Miami Miller School of Medicine

Administration of the C-Change Faculty Survey and Confidentiality

The C-Change Faculty Survey is fielded electronically and takes about 15 minutes to complete. The survey is hosted on a secure external website and administered by the C-Change team at Brandeis University to ensure confidentiality of responses and help achieve a high response rate. Data are provided to schools in aggregate form only to protect the anonymity of respondents. Most of the time, we accomplish at least a 70% response rate because of the trust in our confidentiality procedures and record.

C-Change works closely with medical schools to understand any unique needs they might have in survey adaptation or fielding, and administers the survey. C-Change works in collaboration with each institution to develop a strong communications plan to enable a high response rate. Depending on the size and analytic needs of the institution, C-Change can recommend and develop a sampling plan or field the survey to the full census of the faculty, as appropriate.

Analysis and Reporting of Study Findings

C-Change provides customized reports that include the scales representing dimensions of the culture and other analytic variables of interest, and prepares data tables with frequencies for all survey variables. Respondent data is analyzed by demographic group (e.g., gender, race and ethnicity, rank and career stage). Our collected national faculty data are also provided as comparison to help identify similarities and differences with the study institution.

Fee Structure

Budgeting for the C-Change surveys depends on study specifics, such as the size of the study population, analysis of sub-populations, research design or tailoring the survey to institutional needs. The C-Change research team has developed a streamlined process to manage survey data collection, analysis and reporting.

Customization for Different Populations

The survey can also be used effectively for faculty in a variety of health sciences disciplines and higher education, and for staff.

Data – Action Cycles

Assisting institutions to collect and use their faculty survey data effectively and constructively are central elements of the services provided.

Selected Publications Regarding the C-Change Faculty Survey

• Pololi LH, Evans AT, Brimhall-Vargas M, Civian JT, Cooper LA, Gibbs BK, Ninteau K, Vasiliou V, Brennan RT. Randomized controlled trial of a group peer mentoring model for a U.S. academic medicine research faculty. Journal of Clinical and Translational Science. 2023;7(1)e174.
• Pololi LH, Evans AT, Civian JT, Cooper LA, Ninteau K, Dagher RK, Gibbs BK, Bloom-Feshbach K, Brennan RT. Are researchers in academic medicine flourishing? A survey of midcareer Ph.D. and physician investigators. Journal of Clinical and Translational Science. 2023:1-25. 
• Pololi LH, Evans AT, Civian JT, Gibbs BK, Coplit LD, Gillum LH, Brennan RT. Faculty vitality — surviving the challenges facing academic health centers: a national survey of medical faculty. Academic Medicine. 2015;90:930-936.
• Pololi LH, Evans AT, Gibbs BK, Krupat E, Brennan RT, Civian JT. The experience of minority faculty who are underrepresented in medicine, at 26 representative U.S. medical schools. Academic Medicine. 2013;88:1308-1314.
• Pololi LH, Civian JT, Brennan RT, Dotollo AL, Krupat E. Experiencing the culture of academic medicine: gender matters, a national study. Journal of General Internal Medicine. 2013;28:201-207.
• 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.
• Pololi LH, Evans AT, Civian JT, Vasiliou V, Gibbs BK, Coplit LD, Gillum LH, Brennan RT. Mentoring faculty: A U.S. national survey of its adequacy and linkage to culture in academic health centers. J. Continuing Education in the Health Professions. 2015;35:176-184.
• Pololi L, Evans A, Civian J, Gibbs B, Gillum L, Brennan R. A novel measure of "good" mentoring: Testing its reliability and validity in four academic health centers. J Continuing Education in the Health Professions. 2016; 36(4):263-268.
• Ovseiko PV, Pololi LH, Edmunds LD, Civian JT, Daly M, Buchan AM. Creating a more supportive and inclusive university culture: a mixed-methods interdisciplinary comparative analysis of medical and social sciences at the University of Oxford. Interdisciplinary Science Reviews. 2019. doi: 10.1080/03080188.2019.1603880
• Ovseiko PV, Greenhalgh T, Adam P, Grant J, Hinrichs-Krapels S, Graham KE, Valentine PA, Sued O, Boukhris OF, Al Olaqi NM, Al Rahbi IS, Dowd AM, Bice S, Heiden TL, Fischer MD, Dopson S, Norton R, Pollitt A, Wooding S, Balling GV, Jakobsen U, Kuhlmann E, Klinge I, Pololi LH, Jagsi R, Smith HL, Etzkowitz H, Neilsen MW, Carrion C, Solans-Domènech M, Vizcaino E, Naing L, Cheok QHN, Eckelmann B, Simuyemba MC, Msiska T, Declich G, Edmunds LD, Kiparoglou V, Buchan AMJ, Williamson C, Lord GM, Channon KM, Surender R, Buchan AM. A global call for action to include gender in research impact assessment. Health Res Policy Syst. 2016;14:50.
• Ovseiko PV, Gossec L, Andreoli L, Kiltz U, van Mens L, Hassan N, van der Leeden M, Siddle, HJ Alunno HJA, McInnes I, Damjanov NS, Apparailly F, Ospelt C, van der Horst-Bruinsma I, Nikiphorou E, Druce KL, Szekanecz Z, Sepriano A, Avcin T, Bertsias G, Schett G, Keenan A, Pololi LH, Coates LC. Gender equity in academic rheumatology and how to advance it: A cross-sectional study to inform a EULAR task force. In press