By Chance or by Design: the Organizational Identification of Academic Directors in Academic Medical Centers in the U.S.

Abstract

Academic medical centers (AMCs) are complex, bureaucratic organizations with multiple, interconnected missions and constituencies. What happens in the classroom affects the operating room and lab. Clinical medical school faculty who become clerkship or course directors (called “academic directors” or ADs) often do so because they are gifted educators. They value education, and are responsible for developing faculty, as well as managing curriculum and assessment. These complex roles often lack clear position descriptions and expectations. However, they may face economic pressures to spend more time in clinical duties at the expense of their education responsibilities. This can create conflicts in organizational identification and values, as well as an unclear path to tenure, promotion, and rewards. This study uses eight in-depth interviews with ADs from four similar institutions to understand how they manage the multiple values and priorities of their roles. Three interrelated concepts were investigated: how faculty become ADs; how they make sense of their roles and values in relationship to those of the institution; and how the structure of AMCs shapes the roles and values of ADs. A thematic analysis revealed connections among faculty socialization, organizational identification, and organizational values. Findings from this study indicate that ADs are critical to the education mission and can be powerful in shaping the institution. The diverse responsibilities of ADs may create isolation and mean that their paths to promotion are ambiguous or tenuous. Results of the study can be used to shape policies and faculty development efforts for ADs, leading to a clearer reward system and sense of purpose. Understanding ADs experiences more deeply benefits both faculty vi and institutions. For faculty, the benefit is more role clarity and individual agency. For AMCs, the benefit is information on how to better meet ADs’ needs, thus improving the efficacy of medical education.