Competing Risks Analysis of Promotion and Attrition in Academic Medicine: A National Study of U.S. Medical School Graduates.
Competing Risks Analysis of Promotion and Attrition in Academic Medicine: A National Study of U.S. Medical School Graduates.
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DOI：
10.1097/acm.0000000000002441
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发表时间：
2019-03
期刊：
影响因子：
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通讯作者：
Andriole DA
中科院分区：
文献类型：
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作者：
Jeffe DB;Yan Y;Andriole DA
使用竞争风险方法来确定与美国 LCME 认证医学院新任命的全职讲师或助理教授的晋升和流失相关的变量。对 1997-2004 历年美国医学博士授予医学院毕业生的全国样本进行跟踪，这些毕业生在 2000 年 1 月 1 日至 2012 年 12 月 31 日期间获得了最初的全职讲师或助理教授任命，并进行了跟踪至 2013 年 12 月 31 日。调整后的比例次分布风险比 (aSHR) 衡量了人口、教育和制度变量对晋升和人员流失的影响。最终研究样本包括 27,219 名全职讲师（n = 10,470）和助理教授（n = 16,749）。在所有模型（整个样本和按初始排名分层的样本）中，在毕业时报告所有其他（相对于全职教师）职业意向且代表性不足的少数族裔（相对于白人）教师，其晋升的 aSHR 较低，而人员流失的 aSHR 较高，而研究密集型（相对于非研究密集型）医学院毕业生、没有终身教职的学校的教师以及受过指导的 K 获奖者，晋升的 aSHR 较高，而人员流失的 aSHR 较高。 aSHR 的自然损耗。在所有模型中，毕业时债务超过 100,000 美元（与无债务相比）的教员的 aSHR 自然流失率更高。在讲师中，女性的 aSHR 流失率低于男性，但在助理教授中，女性的 aSHR 流失率更高。这项研究增加了关于最初被任命为全职讲师的学术医学教师的职业轨迹的新知识。医学院期间和之后的职业发展干预和研究指导以及债务减免计划可以帮助增加学术医学教师的保留和晋升。
Competing risk methodology was used to identify variables associated with promotion and attrition of newly appointed full-time instructors or assistant professors in U.S. LCME-accredited medical schools. A national sample of U.S. MD-granting medical school graduates in calendar years 1997–2004, who received initial full-time instructor or assistant professor appointments from January 1, 2000 through December 31, 2012, was followed through December 31, 2013. Adjusted proportional subdistribution hazard ratios (aSHRs) measured the effects of demographic, educational, and institutional variables on promotion and attrition. The final study sample included 27,219 full-time instructors (n = 10,470) and assistant professors (n = 16,749). In all models (entire sample and those stratified by initial rank), faculty who reported all other (vs full-time faculty) career intentions at graduation and were underrepresented racial/ethnic minority (vs white) faculty had lower aSHRs for promotion and greater aSHRs for attrition, whereas research-intensive (vs non-research-intensive) medical school graduates, faculty at schools without a tenure track, and mentored K awardees had greater aSHRs for promotion and lower aSHRs for attrition. In all models, faculty with ≥ $100,000 (vs no) debt at graduation had greater aSHRs for attrition. Among instructors, women had lower aSHRs for attrition than men, but among assistant professors, women had greater aSHRs for attrition. This study adds new knowledge about career trajectories of academic medicine faculty initially appointed as full-time instructors. Career development interventions and research mentoring during and after medical school and debt reduction programs could help increase academic medicine faculty retention and promotion.