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Competing Risks Analysis of Promotion and Attrition in Academic Medicine: A National Study of U.S. Medical School Graduates.

ABSTRACT: PURPOSE: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. MD-granting medical schools. METHOD: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. RESULTS: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 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. CONCLUSIONS: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.

SUBMITTER: Jeffe DB

PROVIDER: S-EPMC6351173 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Competing Risks Analysis of Promotion and Attrition in Academic Medicine: A National Study of U.S. Medical School Graduates.

Jeffe Donna B DB Yan Yan Y Andriole Dorothy A DA

Academic medicine : journal of the Association of American Medical Colleges 20190201 2

<h4>Purpose</h4>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. MD-granting medical schools.<h4>Method</h4>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 prop ...[more]

PMID: 30188371

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Project description:BackgroundA major challenge of prospective cohort studies is attrition in follow-up surveys. This study investigated attrition in a prospective cohort comprised of medical graduates in China. We described status of attrition, identified participants with higher possibility of attrition, and examined if attrition affect the estimation of the key outcome measures.MethodsThe cohort study recruited 3,620 new medical graduates from four medical universities in central and western China between 2015 and 2019. Online follow-up surveys were conducted on an annual basis. Follow-up status was defined as complete (meaning that the participant completed all the follow-up surveys) and incomplete, while incomplete follow-up was further divided into 'always-out', 'rejoin' and 'other'. Multivariable logistic and linear regressions were used to examine factors predicting attrition and the influence on the outcome measures of career development.Results2364 (65.3%) participants completed all follow-up surveys. For those with incomplete follow-up, 520 (14.4%) were 'always-out', 276 (7.6%) rejoined in the 2020 survey. Willingness to participate in residency training (OR=0.80, 95%CI[0.66 - 0.98]) and willingness to provide sensitive information in the baseline survey predicted a lower rate of attrition (providing scores for university entrance exam OR=0.82, 95%CI[0.69 - 0.97]]; providing contact information (OR=0.46, 95%CI[0.32 - 0.66]); providing household income (OR=0.60, 95%CI[0.43 - 0.84]). Participants with compulsory rural service (OR=1.52, 95%CI[1.05 - 2.19]) and those providing university entrance scores (OR=1.64, 95%CI[1.15-2.33)) were more likely to rejoin in the follow-up survey. These factors associated with follow-up status did not have significant impact on key outcome measures of career development.ConclusionsGraduates who were unwilling to participate in residency training or not providing sensitive information should be targeted early in the cohort study to reduce attrition. More information about the study should be provided to those graduates early to facilitate their understanding of the meaning in participation. On the contrary, medical graduates with compulsory rural service and those who provided university entrance scores were more likely to rejoin in the cohort. The research team should invest more effort in contacting those graduates and returned them to the cohort.

Dataset Information

Competing Risks Analysis of Promotion and Attrition in Academic Medicine: A National Study of U.S. Medical School Graduates.

Publications

Competing Risks Analysis of Promotion and Attrition in Academic Medicine: A National Study of U.S. Medical School Graduates.

Similar Datasets

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