Hierarchy as a barrier to advancement for women in academic medicine

Background: Research on barriers to professional advancement for women in academic medicine has not adequately considered the role of environmental factors and how the structure of organizations affects professional advancement and work experiences. This article examines the impact of the hierarchy, including both the organization's hierarchical structure and professionals' perceptions of this structure, in medical school organization on faculty members' experience and advancement in academic medicine. Methods: As part of an inductive qualitative study of faculty in five disparate U.S. medical schools, we interviewed 96 medical faculty at different career stages and in diverse specialties, using in-depth semistructured interviews, about their perceptions about and experiences in academic medicine. Data were coded and analysis was conducted in the grounded theory tradition. Results: Our respondents saw the hierarchy of chairs, based on the indeterminate tenure of department chairs, as a central characteristic of the structure of academic medicine. Many faculty saw this hierarchy as affecting inclusion, reducing transparency in decision making, and impeding advancement. Indeterminate chair terms lessen turnover and may create a bottleneck for advancement. Both men and women faculty perceived this hierarchy, but women saw it as more consequential. Conclusions: The hierarchical structure of academic medicine has a significant impact on faculty work experiences, including advancement, especially for women. We suggest that medical schools consider alternative models of leadership and managerial styles, including fixed terms for chairs with a greater emphasis on inclusion. This is a structural reform that could increase opportunities for advancement especially for women in academic medicine. © 2010 Copyright Mary Ann Liebert, Inc.

Irresponsible Lending?: A Case Study of a U.K. Credit Industry Reform Initiative

There are major concerns about the level of personal borrowing, particularly sourced from credit cards. This paper charts the progress of an initiative to create a Responsible Lending Index (RLI) for the credit industry. The RLI proposed to voluntarily benchmark lending standards and promote best practice within the credit industry by involving suppliers of credit, customer representatives and regulators. However, despite initial support from some banks, consumer bodies and the Chair of the Treasury Select Committee, it failed to gain sufficient support from financial institutions in its original format. The primary reasons for this were related to the complexity of building such a robust index and the banks trade body’s fear of exposing its members to public scrutiny. A revised alternative, the Responsible Lending Initiative, was proposed which took into account these concerns. However, the Association of Payment Clearing Service (APACS), the trade body of the credit industry, then effectively destroyed the proposal. This article describes an attempt to address the challenges in the credit card industry with the initiation of the RLI, reflected in stakeholder discourse and in the context of a wider concern expressed by the involved stakeholders in terms of the need for greater responsibility in the banking industry’s lending practices.

Contribution of primary motor cortex to compensatory balance reactions

Background: Rapid compensatory arm reactions represent important response strategies following an unexpected loss of balance. While it has been assumed that early corrective actions arise largely from sub-cortical networks, recent findings have prompted speculation about the potential role of cortical involvement. To test the idea that cortical motor regions are involved in early compensatory arm reactions, we used continuous theta burst stimulation (cTBS) to temporarily suppress the hand area of primary motor cortex (M1) in participants prior to evoking upper limb balance reactions in response to whole body perturbation. We hypothesized that following cTBS to the M1 hand area evoked EMG responses in the stimulated hand would be diminished. To isolate balance reactions to the upper limb participants were seated in an elevated tilt-chair while holding a stable handle with both hands. The chair was held vertical by a magnet and was triggered to fall backward unpredictably. To regain balance, participants used the handle to restore upright stability as quickly as possible with both hands. Muscle activity was recorded from proximal and distal muscles of both upper limbs.

Results: Our results revealed an impact of cTBS on the amplitude of the EMG responses in the stimulated hand muscles often manifest as inhibition in the stimulated hand. The change in EMG amplitude was specific to the target hand muscles and occasionally their homologous pairs on the non-stimulated hand with no consistent effects on the remaining more proximal arm muscles.

Conclusions: Present findings offer support for cortical contributions to the control of early compensatory arm reactions following whole-body perturbation.

Methodologies for the Development of the Management of Cough: CHEST Guideline and Expert Panel Report

BACKGROUND: This series of guidance documents on cough, which will be published over time, is a hybrid of two processes: (1) evidence-based guidelines and (2) trustworthy consensus statements based on a robust and transparent process.

METHODS: The CHEST Guidelines Oversight Committee selected a nonconflicted Panel Chair and jointly assembled an international panel of experts in each clinical area with few, if any, conflicts of interest. PICO (population, intervention, comparator, outcome)-based key questions and parameters of eligibility were developed for each clinical topic to inform the comprehensive literature search. Existing guidelines, systematic reviews, and primary studies were assessed for relevance and quality. Data elements were extracted into evidence tables and synthesized to provide summary statistics. These, in turn, are presented to support the evidence-based graded recommendations. A highly structured consensus-based Delphi approach was used to provide expert advice on all guidance statements. Transparency of process was documented.

RESULTS: Evidence-based guideline recommendations and consensus-based suggestions were carefully crafted to provide direction to health-care providers and investigators who treat and/or study patients with cough. Manuscripts and tables summarize the evidence in each clinical area supporting the recommendations and suggestions.

CONCLUSIONS: The resulting guidance statements are based on a rigorous methodology and transparency of process. Unless otherwise stated, the recommendations and suggestions meet the guidelines for trustworthiness developed by the Institute of Medicine and can be applied with confidence by physicians, nurses, other health-care providers, investigators, and patients.

maternal health as a human right’s issue.

In September 2010, just days before a crucial UN summit to review progress on the MDGs, chair of the RCM board for Northern Ireland Shona Hamilton participated in Amnesty International’s conference on poverty, health and human rights, held at Stormont. She provided great personal insight into the daily lives of women in some of the world’s poorest regions and the role midwives can play in addressing the disproportionate impact of poverty on women. She was accompanied by midwifery teaching fellow at Queen’s University Shirley Stronge who has experience of working in Malawi and Ethiopia.

Early warning systems: problems, pragmatics and potential

Symposium Chair: Dr Jennifer McGaughey

Title: Early Warning Systems: problems, pragmatics and potential

Early Warning Systems (EWS) provide a mechanism for staff to recognise, refer and manage deteriorating patients on general hospital wards. Implementation of EWS in practice has required considerable change in the delivery of critical care across hospitals. Drawing their experience of these changes the authors will demonstrate the problems and potential of using EWS to improve patient outcomes.

The first paper (Dr Jennifer McGaughey: Early Warning Systems: what works?) reviews the research evidence regarding the factors that support or constrain the implementation of Early Warning System (EWS) in practice. These findings explain those processes which impact on the successful achievement of patient outcomes. In order to improve detection and standardise practice National EWS have been implemented in the United Kingdom. The second paper (Catherine Plowright: The implementation of the National EWS in a District General Hospital) focuses on the process of implementing and auditing a National EWS. This process improvement is essential to contribute to future collaborative research and collection of robust datasets to improve patient safety as recommended by the Royal College of Physicians (RCP 2012). To successfully implement NEWS in practice requires strategic planning and staff education. The practical issues of training staff is discussed in the third paper. This paper (Collette Laws-Chapman: Simulation as a modality to embed the use of Early Warning Systems) focuses on using simulation and structured debrief to enhance learning in the early recognition and management of deteriorating patients. This session emphasises the importance of cognitive and social skills developed alongside practical skills in the simulated setting.

Call & response - Fall 2008

Call & Response is the newsletter of the South Carolina African American Heritage Commission, whose mission is to identify and promote the preservation of historic sites, structures, buildings, and culture of the African American experience in South Carolina. This is volume III, number 3 and includes a message from the chair, list of board members, preservation project profile, remembrance of Mr. Herbert Alexander DeCosta, Jr., news from the South Carolina Department of Archives and History, annual meeting information, and events calendar.

Call & response - Spring/Summer 2008

Call & Response is the newsletter of the South Carolina African American Heritage Commission, whose mission is to identify and promote the preservation of historic sites, structures, buildings, and culture of the African American experience in South Carolina. This is volume III, number 2 and includes a message from the chair, list of board members, preservation project profile, spotlight on Michael A. Allen, news from the South Carolina Department of Archives and History and events calendar.

Call & response - Winter 2008

Call & Response is the newsletter of the South Carolina African American Heritage Commission, whose mission is to identify and promote the preservation of historic sites, structures, buildings, and culture of the African American experience in South Carolina. This is volume III, number 1 and includes a message from the chair, list of board members, preservation project profile, news from the South Carolina Department of Archives and History and events calendar.

Call & response - Fall 2009

Call & Response is the newsletter of the South Carolina African American Heritage Commission, whose mission is to identify and promote the preservation of historic sites, structures, buildings, and culture of the African American experience in South Carolina. This is volume IV, number 3 and includes a message from the chair, list of board members, preservation project profile, African Americans during the Civil War, news from the South Carolina Department of Archives and History and events calendar.

Call & response - Spring/Summer 2009

Call & Response is the newsletter of the South Carolina African American Heritage Commission, whose mission is to identify and promote the preservation of historic sites, structures, buildings, and culture of the African American experience in South Carolina. This is volume IV, number 2 and includes a message from the chair, list of board members, preservation project profile, news from the South Carolina Department of Archives and History, annual meeting information, and events calendar.

Call & response - Winter 2009

Call & Response is the newsletter of the South Carolina African American Heritage Commission, whose mission is to identify and promote the preservation of historic sites, structures, buildings, and culture of the African American experience in South Carolina. This is volume IV, number 1 and includes a message from the chair, list of board members, preservation project profile, news from the South Carolina Department of Archives and History, and events calendar.

Call & response - Fall 2010

Call & Response is the newsletter of the South Carolina African American Heritage Commission, whose mission is to identify and promote the preservation of historic sites, structures, buildings, and culture of the African American experience in South Carolina. This is volume V, number 3 and includes a message from the chair, list of board members, preservation project profile, news from the South Carolina Department of Archives and History, annual meeting information, and events calendar.

Call & response - Spring/Summer 2010

Call & Response is the newsletter of the South Carolina African American Heritage Commission, whose mission is to identify and promote the preservation of historic sites, structures, buildings, and culture of the African American experience in South Carolina. This is volume V, number 2 and includes a message from the chair, list of board members, preservation project profile, news from the South Carolina Department of Archives and History and events calendar.