D.B. Jeffe is professor of medicine, Washington University School of Medicine, St. Louis, Missouri; ORCID: http://orcid.org/0000-0002-7642-3777. Y. Yan is professor of surgery and biostatistics, Washington University School of Medicine, St. Louis, Missouri; ORCID: http://orcid.org/0000-0002-5917-1475. D.A. Andriole was associate professor of surgery and assistant dean for medical education, Washington University School of Medicine, St. Louis, Missouri, at the time of this work. She is now senior director of medical education research, Association of American Medical Colleges, Washington, DC; ORCID: http://orcid.org/0000-0001-8902-1227.
Acad Med. 2019 Feb;94(2):227-236. doi: 10.1097/ACM.0000000000002441.
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.
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 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.
采用竞争风险方法，确定与美国医学博士授予医学院新任命全职讲师或助理教授晋升和离职相关的变量。
对 1997-2004 年美国医学博士授予医学院毕业生进行全国性抽样，这些毕业生在 2000 年 1 月 1 日至 2012 年 12 月 31 日期间首次获得全职讲师或助理教授的任命，并随访至 2013 年 12 月 31 日。调整后的比例亚分布风险比（aSHR）衡量了人口统计学、教育和机构变量对晋升和离职的影响。
最终研究样本包括 27219 名全职讲师（n=10470）和助理教授（n=16749）。在所有模型（整个样本和按初始职级分层）中，与全职教员相比，毕业时报告其他（非全职教员）职业意向的教员以及代表性不足的少数族裔（非白种人）教员晋升的 aSHR 较低，离职的 aSHR 较高，而研究密集型（非研究密集型）医学院毕业生、无终身教职轨制学校的教员和获得 K 奖的教员晋升的 aSHR 较高，离职的 aSHR 较低。在所有模型中，毕业时有≥100000 美元（有）债务的教员离职的 aSHR 较高。在讲师中，女性离职的 aSHR 低于男性，但在助理教授中，女性离职的 aSHR 高于男性。
本研究增加了关于最初被任命为全职讲师的学术医学教师职业轨迹的新知识。在医学院期间和之后以及减少债务的职业发展干预和研究指导可能有助于增加学术医学教师的保留和晋升。
