New online-first articles are available from Academic Medicine! The authors of one study demonstrated that 39% of medical students at one university had an anti-obesity bias and less than 25% were aware of their bias. In another study, the authors assessed the needs and effectiveness of department chairs in academic medicine. Additional published ahead-of-print articles, which will appear in the July issue, address lecture attendance, budgeting in times of fiscal constraint, and other important topics. Keep reading for more details.

Perspectives

A Humble Task: Restoring Virtue in an Age of Conflicted Interests 
DuBois and colleagues propose strategies to minimize the influence of self-serving biases when making medical business ethics decisions and decisions involving conflicting interests.

Articles

An Adaptive Approach to Facilitating Research Productivity in a Primary Care Clinical Department 
When challenged to increase research productivity, Weber-Main and colleagues, part of a family medicine department, used a multifaceted “grow your own” approach to build and maintain research capacity over a ten-year period.

Allocating Limited Resources in a Time of Fiscal Constraints: A Priority Setting Case Study from Dalhousie University Faculty of Medicine  
Mitton and colleagues describe the development and implementation of an explicit, transparent, criteria-based priority setting process for resource reallocation, during which they used a program budgeting and marginal analysis framework.

Aligning Clinical Compensation with Clinical Productivity: Design and Implementation of the Financial Value Unit (FVU) System in an Academic Department of Internal Medicine 
Stites and colleagues present a new metric that analyzes clinical compensation compared to clinical productivity, for divisions and individuals, as a transparent means for decreasing compensation variability and increasing compensation equity.

Applying Organizational Science to Health Care: A Framework for Collaborative Practice
Dow and colleagues review team process, leadership and followership, locus and formality of leadership, and dynamic delegation and identify competencies to aid in developing curricula to improve collaborative practice.

Research Reports

Understanding the Needs of Department Chairs in Academic Medicine  
Departmental chairs within faculties of medicine fill complex, emotionally burdensome roles. Lieff and colleagues found that their effectiveness is enhanced by transitional processes and supports, development, and mentoring. 

The Use and Misuse of Prescription Stimulants as “Cognitive Enhancers” by Students at One Academic Health Sciences Center 
Bossaer and colleagues found that a majority of respondents have used stimulants for enhanced energy or academic performance, according to this 2011 study. Quality of patient care and academic ethics may be compromised.

The Impact of Lecture Attendance and Other Variables on How Medical Students Evaluate Faculty in a Preclinical Program 
Martin and colleagues found that students’ attendance at lecture, year, and class grade, as well as lecturer degree, affect students’ evaluation of lecturers.

Are Medical Students Aware of Their Anti-Obesity Bias? 
Miller and colleagues sought to determine the prevalence of weight-related biases among medical students and whether they were aware of their biases.

Eleven-Year Outcomes from an Integrated Residency Program to Train Research Psychiatrists
Tsai and colleagues describe the development process for a research resident training program, including its organizational structure, eligibility criteria, and core program elements, and report 11 years of outcomes data.

Development of a Team Performance Scale to Assess Undergraduate Health Professionals 
Sigalet and colleagues found that when simulation is used in acute illness management training, the KidSIM Team Performance Scale provides reliable and valid score interpretation of undergraduates’ team process.

A Multisite, Multistakeholder Validation for the Accreditation Council for Graduate Medical Education Competencies 
Using Cultural Consensus Analysis methodology, Smith and colleagues assessed the validity of the ACGME competencies across eight clinical settings and five groups: patients, nurses, residents, faculty members, and administrators.

The Mentoring Competency Assessment: Validation of a New Instrument to Evaluate Skills of Research Mentors 
Fleming and colleagues present findings demonstrating that the MCA has reliability and validity and provide preliminary norms derived from a national sample of research mentors and mentees.

Enhancing Undergraduate Public Health Education through Public Health Interest Groups
Jang and colleagues found that with consistent funding, national networking opportunities, and a common operating structure, public health interest groups have been able to increase public health awareness amongst medical students. 

Using Patients’ Narratives to Reveal Gender Stereotypes among Medical Students
Medical students have culturally shared stereotypes about gender. To prevent this, Andersson and colleagues found that medical curricula must explicitly address the impact of gender stereotypes and their possible consequences.

Reviews

Evidence-Based Medicine Training in Undergraduate Medical Education: A Review and Critique of the Literature Published 2006–2011
Maggio and colleagues identify a need for broader evidence-based medicine training and encourage educators designing interventions to consider trends including online learning, interprofessional education, and electronic health records.

Mentoring Programs for Physicians in Academic Medicine: A Systematic Review
Through a review of the literature, Kashiwagi and colleagues identified key program elements that could contribute to successful physician mentoring, including mentor training, mentor-mentee contracts, and protected time. 

Advancing Faculty Development in Medical Education: A Systematic Review
Leslie and colleagues concluded that research should employ more rigorous evaluation methods, explore the role of interprofessional teams, and address how different organizational factors shape the success of faculty development programs.

First, why targeted professional development for department chairs?

• Department chairs are an under-served group
• They have a lot of responsibility with ambiguous authority

Why a blended learning course?

• Blended learning courses offer opportunities for sustained reflection
• They are able to connect people who are geographically distant

Class Logistics:

• The course began with one face-to-face (F2F) all-day session to allow participants to get to know each other
• There were 5 synchronous sessions, 90 minutes long
• For asynchronous work, Haiku was the platform used

Course topics included:

• Rules and Responsibilities of Department Chairs
• Managing Up/ Managing Down
• Current and Future Trends in Learning & Teaching
• Supervision, Evaluation, & Assessment
• Planning Professional Development
• Hiring Talent
• Critical Conversations

Some rewards of using a blended learning model included:

• Opportunity to spend time with other department chairs
• Flexible with respect to individual teachers’ time demands
• The first F2F session was good at setting the tone and expectations
• Able to have sustained professional development over time
• Experts were brought in from all over the country to lead the synchronous sessions
• There is value in being part of a cohort
• New networks of department chairs within disciplines were established

Some challenges:

• Time was a factor. Many participants had trouble finding the necessary time to devote to the course.
• Using Blackboard’s Collaborate application wasn’t easy for some
• Putting your thoughts out online to people you aren’t familiar with
• Learning the technology
• There were inconsistent numbers of participants at different sessions

Based on their experience, the next iteration of this professional development will incorporate these things:

Start:

• Have clear expectations at the beginning
• Provide better technology training
• More community building at the F2F session
• More small group work

Stop:

• Shorten the length to 2 – 4 months
• Less lecture in the synchronous sessions
• Are the synchronous sessions necessary?

Continue:

• The initial F2F meeting
• Provide cutting-edge experts to present their work
• Breakout groups
• Encourage team-building among department chairs within the the same school

To All New English Department Chairs,

First of all, thank you for taking on such an important, demanding job. You will make decisions that impact the literacy of every student in your school. You are the buffer between the teachers in your department and your administration. You set the tone for how your department members will relate to one another. Your work is valuable. Again, thank you.

I was a department chair for six years and supervised 28 energetic professionals with strong personalities. When we had positions to fill, I worked with our principal to bring in the best new teachers we could find, and I’m proud of how those hires have turned out. Having a place on the leadership team of the school I care about was gratifying as I had a voice and vote on some meaningful decisions. I made some mistakes along the way, no doubt about it, but I tried to not repeat them. When the ground shifted in my professional environment and personal life and I was no longer able to make the same kinds of contributions, I left the department chair position and began focusing my energies in other productive ways with no regrets.

I learned a few lessons during my time as an English department chair, and I’d like to offer them here for those entering this position.

1. Keep family first. Keep your home and family life at the center of your life. You will need time away from a demanding position. Do things that have nothing to do with school. Keep pictures of your loved ones on your desk. This is important.

2. Know your goals. You applied for this position for a reason (or reasons). Clarify those reasons for yourself and then articulate them to yourself in the form of goals. You can share them or not, but those goals will be a lighthouse to you when the fog sets in. Others may set some goals for you too. Those are less important than your personal goals.

3. Turn philosophy into action. Again, articulate to yourself what you believe about education, schools, and learning. Then look for ways to put that philosophy into action through the decisions you make. If you believe certain things, you can build the schedule to reflect them to a certain extent. You can also put people in positions that will be most likely to bring about the positive results of your philosophy. If you don’t know what you believe, your decision-making can be haphazard. You won’t be able to do this 100%, but the more solidly you know what you believe, the more you can shape things. Look beyond the walls of your school for the big picture. Your PLN should include a lot of people who don’t work in the same school and district as you.

4. “What’s best for students?” When this simple question is at the heart of your decisions, you’ll be right almost always. Your new position puts you around grown-ups more and more, and around students less and less. That makes it easier to forget why we show up every day. We may love our colleagues, but we’re here for the students.

5. Hire the best people. Don’t compromise. Hire as early as possible. Throw hissy fits until you get what you want. Your hires may be around for decades and affect thousands of students. This is the most important thing you do. Don’t trade an excellent English candidate in order to satisfy some other extra-curricular need. People will try to influence you on hiring by recommending their friends, former students, cousins, friends of friends, and people they meet at parties. Many times these people are simply fulfilling social obligations and not wholeheartedly advocating for the people they’re recommending. Listen to those recommendations, but the final decision needs to be yours, and it needs to be based on #4 above. When a new hire is not working out, don’t get too far ahead of or too far behind your principal in making the decision about whether to re-hire. Releasing a teacher is difficult for you, the released teacher, and the entire department, but remember #4 above.

6. Invest in productivity more than entropy. You know who the productive, innovative people are. You also know who the people are who are resistant to innovation for no reason other than being vested in entropy. Trying to change that isn’t worth your finite energy. Look for ways to help the productive innovators be even more productive and innovative. (Sometimes this means getting out of their way.)

7. See what you can do about providing relevant professional development. Teachers need to continue to learn and grow, but adults need autonomy. Too much professional development is based on a top-down model. That is doomed to failure and can create morale problems. Empower your department members to clarify their own intellectual interests and encourage them to pursue those interests creatively.

8. When parents call you, insist that they talk to the teacher first. If they don’t get satisfaction, then they can call you back. You need to be the next line of involvement, not the first line of involvement. Listen to them, but don’t take any action unless and until the parents and teachers have directly communicated. Most problems are resolved at that level. If they’re not resolved, then you are needed.

9. Conduct independent verification of facts. Just because someone says something doesn’t mean it’s true, even if the person saying it believes it to be true. Find out for yourself with your own two eyes.

10. Call ‘em like you see ‘em. Inauthenticy will bite you in the butt. You have to be the same person in the department office as you are in meetings with muckety-mucks.

For everyone stepping into a department leadership role, including our own department’s new chair–a colleague I respect, admire, and trust—I wish you satisfaction and luck, and I hope these suggestions are helpful to you.

bies (CC BY-NC-SA 2.0)

Shortly after Marissa Mayer’s appointment this week as CEO of Yahoo, news of her pregnancy opened a new chapter in the work-life debate. Today, we offer context with perspectives on gender roles, women in leadership, and work-family balance. We hope you’ll find this selection interesting and useful.

Gary N. Powell of the University of Connecticut and Jeffrey H. Greenhaus of Drexel University published “Sex, Gender, and Decisions at the Family → Work Interface” in the July 2010 issue of the Journal of Management:

We explore whether sex differences in work-domain decisions can be explained by family-domain factors and whether the effect of family-domain factors on work decisions is different for women and men. We believe that answers to these questions can provide important insights into the role of sex in the interplay between family and work lives.

Athena Perrakis and Cynthia Martinez, both of the University of San Diego, published “In Pursuit of Sustainable Leadership: How Female Chairs With Children Negotiate Personal and Professional Roles” in the May 2012 issue of Advances in Developing Human Resources.

The lived experiences of the women in this study indicate complex tensions between personal and professional roles. Childcare and home responsibilities were the primary factors that complicated or derailed efforts to achieve work–life balance.

Frank L. Giancola, HR researcher and writer, published “Can the Work–Life Movement Regain Its Balance?” in the September/October 2011 issue of Compensation & Benefits Review. See also our five-part series on work-life balance.

The work–life discipline of human resources (HR) management has been in a period of transformation for the past decade. This fact may have eluded many people in the business world, since the key reasons behind the transformation and the new direction are not widely known outside work–life circles.

Are you interested in receiving email alerts whenever a new article or issue becomes available online? Then click here!

Anna J. Small Roseboro, NBCT

The opening days of school can be overwhelming, even for a veteran English Department Chair, mentor, or student-teacher supervisor. Inevitably, you’ll have new administration goals for the year that must be implemented and clarified for returning teachers. There are the inherent problems of adjusting classroom assignments, the frustrations of locating missing textbooks, the tedium of following up on equipment repair requests, and the scheduling of essential meetings with new or novice teachers.

Many English language arts leaders also teach classes themselves and are absorbed with the demands any classroom teacher faces at the start of a new school year. Consequently, during these first decisive days, even the most conscientious department chair may postpone the one-on-one meetings with the new or novice teachers until a week or two into the term. As an English department chair, I am often asked by beginning teachers to quickly tell them what they need to know to get a good start in their first year of full-time teaching. The answer is usually, “No, I can’t tell you quickly. But, here are a few things you can be doing now and some ideas to think about. We can meet in a week or so and talk more then.” By that time, those teachers already may be feeling swamped and discouraged.

To help prevent this demoralizing experience, I want to share some of the responses and advice I’ve learned to offer these new and novice teachers. While the comments probably relate to most secondary English language arts teachers, I’ve directed them to those who also may be teaching in the middle school because their issues can differ from high school teachers. For ease in reading, I’ve organized my remarks around the journalism format of Who? What? When? Where? Why? and How?

 Who Will I Be Teaching, Really?

 One of the more important tasks of teachers is to get to know their students quickly. You see, teaching is more than dispensing information. Teaching is cyclical; it is not complete until learning takes place. So during the first few days of school, successful teachers use a variety of strategies to discover what students already know and are able to do, and then adapting their lessons for a wide range of students (Tchudi & Tchudi, 1999). The sooner teachers know their students—not just their names—the sooner real teaching and learning begin.

 Teachers, especially new ones, seldom have much say about whom they will teach, and the students who walk into the room arrive with varying degrees of commitment to learning. More than once I was assigned to teach three different grades requiring as many different preparations. I learned quickly that the more skillful you become at getting to know your students and assessing their specific needs, the more students you will reach and teach successfully.

 The primary challenges in teaching adolescents are the physical, emotional, and social issues that can overwhelm them in uneven waves from day to day and that distract them from learning (Caught in the Middle, 1987). Emotionally, with the hormone changes, both the girls and the boys can be manically mischievous one day and dismally depressed the next—from belle of the ball to ostracized pariah, from big man on campus to bait for the bully. Still, we must teach them.

In addition to these unavoidable issues, you may be working among a cultural population very new to you. It will be important for you to remain open to what you can learn from them that will help you make the understanding and application of the English language arts relevant to them and create a classroom environment that nurtures and respects them while building on their prior knowledge and experience. And with different cultures come different languages (see Shafer, 2001) and code switching (where students alternate from one form of English to another; see Wheeler & Swords, 2006). In any case, one key to a successful school year is your getting to know the students you teach and adapting what you learn from and about them to what you know about effective English language arts instruction.

 What Must I Teach?

 It’s more than reading and writing. If you’ll take a look at the English language arts standards published by your school, district, or state, you’ll find that they include both content skills and habits of mind. We ELA teachers are charged with presenting lessons in which students experience— read, talk about, write about—an array of literature, both print and non-print, fiction and nonfiction (Standards, 1996 ), and use a variety of resources: technology and library. With the new Common Core Standards that many states are adopting, the challenge heightens even for veteran educators(Common Core, 2010).  Ultimately, our common goal is to help our students expand their understanding of themselves and other, learn to appreciate how reading and writing, speaking and listening, viewing and representing visually can make them independent and productive members of society (Jackson and Davis, 2000), and to use technology skillfully and responsibly. Of course, we’re also expected to assess student learning and report these observations in a variety of formats to a variety of people—parents, other teachers, counselors, etc. A big task, but a manageable one.

 When in the School Year?

 Students in the middle and high school grades are expected to learn to read increasingly more demanding literature in a variety of genres and to write for a wider range of purposes and audiences (Parents’Guide, 2006). Your task is to determine what the students know already and then to move them along as efficiently as possible through the curriculum you’re given. But how do you use preparation and class time to achieve these goals? When should certain skills be taught?

 First, do your best to understand what you’re expected to achieve by the end of the school year, and then work backwards (Wiggins and Mc-Tighe, 2005). What kinds of lessons will allow you to meet your requirements? What literature and modes of writing must you teach? What resources are available to you? Which professionals in your school setting are available to assist you? You’ll want to block out the semester and then subdivide these blocks into units and lessons. Be sure to take into consideration the school calendar—assemblies, concerts, sports events, holidays, and vacations will impact the time you’ll have available to teach. Keep in mind that the time before and after these events will drain emotional energy from your students. Athletes and their fans may be totally consumed with thoughts of “the big game” or the post-season chances, so you, the skillful teacher, will plan class activities that make the most of your time with each class; some days, that will mean designing lessons that use physical activity to channel pent-up energy, while other days will focus on more cerebral activity.

 Where Will I Be Teaching?

 Believe it or not, the physical space in which you teach and how you organize it will have an impact on how well you teach . . . and feel. Few new teachers have much choice about the room to which they are assigned, but you can make the space work for you.

 If you will be sharing space, get to know your “roommates” and talk about access to desks, storage, and display space; determine which resources you’ll be sharing and which you must supply yourself. For instance, if those using the room are teaching the same grades or courses, you may be able to coordinate units so you can leave in the classroom those resources and supplies you share. When I’ve shared rooms, my colleagues and I usually split the bulletin board space, often designating a common space to post general notices we both want in view all the time. Reutzel and Cooter (2003) say, “classroom displays are intended to immerse students . . . in an environment of interesting and functional print” (p. 89). Surprisingly, we found that both the older and younger students enjoyed seeing what the others were doing. The older ones would reflect on what they’d done in earlier grades, and younger students would project to the future when they would have those more sophisticated assignments. Colleagues would see what the other had done and get ideas for expanding or modifying our own lessons. All can benefit when sharing rooms.

 You’ll also want to have an efficient way of storing and moving your materials from place to place. A two-shelf rolling cart worked well for me. On it would be a set of hanging files that I’d want to have in the room during classes and in the office during prep time—grade book, seating charts, lesson plans, textbooks, and other resources (dictionary, USB drive, etc.). I’d also have any supplies or handouts for the day’s (or week’s) lessons. Some teachers also kept a box of extra office supplies, such as pencils, staplers, scissors, tape and even a box of tissues.

Determine whether or not your room will have stationary or movable seats. Desks? Tables and chairs? What size tables? How easy to move? The more flexible the seating, the more configurations available for different lessons. Teach your students how to move the furniture quickly— explain it precisely or draw it on the board—and then give them until the count of ten to move the seats, reseat themselves, and give you their attention.

 How accessible is technology?  Do you have a smart classroom, already set up for high-tech instruction?  Are computer labs available?  Still using laptops on carts?  Are students assigned laptops?  Do they bring their own cell phones through which they can access the internet?

 If you know what have, what you want, and plan ahead, your clear expectations will usually get results. Of course, if things don’t work well the first time, simply rethink them, get advice, and try again. Also keep in mind the needs of the next class; I used a kitchen timer to go off seven or eight minutes before the end of class, allowing just enough time to reorganize seating, review the lesson for the day, and remind the students of the homework assignment. Just remember: Anticipate. Plan. Execute. The Golden Rule doesn’t hurt, either.

 Why Must I Teach a Certain Way? 

 Why plan multiple ways to teach the same lesson? First, because people learn and demonstrate understanding in different ways (Cunningham & Allington, 2006; Jackson & Davis, 2000; Tchudi & Tchudi, 1999). Second,  flexibility creates interest for the students and you. It is as important for you to enjoy teaching as it is for students to enjoy learning. Teaching is your job, but it also can be fun devising clever and effective ways to share your knowledge and love of the English language arts. Third, the new Common Core Standards are best taught that way.

You know that young adolescents have short attention spans (Developing Adolescents, 2003), are easily bored, and seek instant diversion. “. . . remember that we now have several generations limited to a thirty second attention span as maximum. If you don’t have their interest in the first five seconds, they are gone!” (State of Victoria, 2006). Many students are accustomed to controlling what they experience through television, DVDs, the Internet, ipods, and smart phones, etc. Perhaps this is one of the reasons that few teens are willing to give anyone or anything their sustained attention for more than 12 or 13 minutes. We, teachers, therefore, must develop lessons that address different learning styles and accommodate the attention span of contemporary teenage students as well as maximize their skill with a range of technology.

Consider, too, the work of Dr. Howard Gardner of Harvard University who has published research in which he proposes the “multiple intelligences” theory (Gardner, 1985). Try developing lessons that take into account the numerous ways that young people can be taught and assessed based on their specific age, maturation, and individual learning style (Gardner, 2000). That variety will interest them . . . and you. I thoroughly enjoy learning from my students and find that each time I offer them options to demonstrate their understanding of literature; I gain a greater insight into the topics, themes, or literary works we’re studying as well as a deeper understanding of the students and their ways of looking at literature and life.

 It is from the work of Louise Rosenblatt and Fran Claggett that you can draw inspiration to incorporate assignments that accommodate many of the multiple intelligences described in Howard Gardner’s work. The recent publications about incorporating twenty-first century literacies (Roseboro, 2010) also provide a wealth of knowledge for adapting lessons you developed as pre-service teachers and in your other school settings.

 First, Louise Rosenblatt (1938/1996) encourages us to rely on students’ prior knowledge to help them make sense of the literature. This approach can free you of the burden of “knowing what the book means” and will give you permission to let the literary works (fiction, non-fiction, graphic, video) speak to the students and to trust their responses about what it says to them. You may design lessons that encourage students to use art, other graphics (Claggett, 1992), as well as  technology to represent what they’ve learned but you’ll want to encourage them to ground their responses in the text to keep them from straying too far afield during oral or written discussion. Although digressions may sometimes yield relevant lessons, as a new teacher, it is important to keep your eyes on the curriculum goals so that you (or an observer) are confident that you are in control, even while permitting student choice.

How Can I Become an Effective Teacher?

 The truth is, you may not do it your first year. And maybe not even the second. But here are a few tips that will give you an excellent start:

• Learn ways to use prep and class time effectively.
• As you observe experienced teachers, ask questions so you can begin to understand why they do what they do and what makes their strategies work so well. Asking questions and listening carefully to good teachers will be  key to your early and continued success and satisfaction as a professional educator.
• Join a professional organization, like NCTE or one of its local affiliates and attend as many of their conferences and workshops as you can. Funds to attend conferences and workshops are available from a variety of sources. But, be prepared to pay the majority of the expenses yourself.  You’ll find that the financial outlays are worth the investment primarily because the people you meet and the friends you make will be crucial to your growth and development as a successful and satisfied educator.
• NCTE also has several online options through their Connected Community and Pathways Professional Development Program  that connect teachers who are interested in collaborating electronically.
• Stay connected with the professors you’ve had in college. Many are willing to maintain electronic communication with you or to direct you to retired teachers who would be thrilled to share their storehouse of knowledge and experience.
• Most of all, give yourself time and use that time wisely.

Every year of your career, students will look to you to provide engaging and enjoyable experiences while they develop the skills and gain the knowledge needed to be successful. Read the works and view the videos from the authors mentioned; mull over the ideas offered here—both will give you a running start as you assemble your own cache of strategies, activities, and develop professional wisdom for a lifetime of teaching well.

 References

 Caught in the middle: Educational reform for young adolescents in California public schools. (1987). Report of the Superintendents Middle Grade Task Force. Sacramento: California State Department of Education.

 Claggett, F., with Brown, J. (1992). Drawing your own conclusions: Graphic strategies for reading, writing, and thinking. Portsmouth, NH: Heinemann.

 “Common Core Standards for English Language Arts & Literacy in History/Social Studies, Science, and Technical Subjects” (2010).  Retrieved July 17, 2011. http://www.corestandards.org/assets/CCSSI_ELA%20Standards.pdf

Cunningham, P. M., & Allington, R. L. (2006). Classrooms that work: They call all read and write. Boston: Pearson Allyn and Bacon.

 Developing adolescents: A reference for professionals. (2003). Washington, DC: American Psychological Association.

 Gardner, H. (1985). Frames of mind: The theory of multiple intelligences. New York: Basic.

 Gardner, H. (2000). How children learn. In J. D. Bransford, A. L. Brown, & R. R. Cocking (Eds.), How people learn:Brain, mind, experience, and school: Expanded edition (p.109). Washington, DC: National Academy Press.

 Jackson, A. W., & Davis, G. A. (2000). Turning points 2000: Educating adolescentsin the 21st century. New York: Teachers College Press.

 National Council of Teachers of English. (2006). Professional development. Retrieved July 17, 2011, from http://www.ncte.org/pathways.

 A parents’ guide to English language arts grade level content expectations: What your child needs to know by the end of eighth grade. (2006). Lansing: Michigan Department of Education.

 Reutzel, D. R., & Cooter, R. B. Jr. (2003). Strategies for reading assessment and instruction: Helping every child succeed (2nd ed.). Columbus, OH.: Prentice Hall.

 Roseboro, Anna J. Small (2010) Teaching Middle School Language Arts: Incorporating Twenty-first Century Literacies. Lanham, Md.:Rowman & Littlefield Education.

 Rosenblatt, L. (1996). Literature as exploration (5th ed.). New York: Modern Language Association. [Original work published in 1938.]

 Shafer, G. (2001). Standard English and the migrant community. English Journal, 90(4), 37–43.

 Standards for the English language arts(a project of the National Council of Teachers of English and International Reading Association). (1996). Urbana, IL: National Council of Teachers of English.

 State of Victoria Department of Education & Training. (2006). Internet planning. Retrieved June 8, 2006, from http:/ to use technology skillfully and responsibly. htm.

 Tchudi, S. J., & Tchudi, S. N. (1999). The English language arts handbook: Classroom strategies for teachers (2^nd ed.). Portsmouth, NH: Heinemann.

 Wheeler, R. S., & Swords, R. (2006). Codeswitching:Teaching standard English in the urban classrooms. Urbana, IL: National Council of Teachers of English.

 Wiggins, G. & McTighe, J. (2005) Understanding by design (2nd ed.).Alexandria, VA: Association for Supervision & Curriculum Development.

 * Adapted from article printed in English Leadership Quarterly, October, 2006. “Copyright 2006 by the National Council of Teachers of English.  Posted with permission.”

In great part the cost and quality of healthcare are determined at the point of service where the physician ministers to the patient and prescribes the appropriate medicinal intervention. It is logical to initiate cost and quality improvements at this level. For example, creating more cohesive department teams are helpful to achieve performance outcomes, facilitate the flow of the delivery of care, improve communication, implement and review best medical and administrative practices, and establish a more effective learning environment. It is the ability to monitor and improve service at this micro-level that has the most direct, lasting, and beneficial benefits for providers, patients, and insurers alike.

What happens at the point of service is in part determined by the quality of local leadership. The work of each medical department is monitored by department chairs. Each specialty is lead by a physician department chair who typically provides oversight of the coordination of services, ensures the practice meets its financial and quality goals, responds to disciplinary matters, and provides information to and from senior management. Department chairs are often called upon to navigate complex and time consuming issues.

Unfortunately, most administrators and physicians expect the department chairs to play limited roles—to solve problems and ensure operational efficiencies are realized. They expect them to address physician personality peccadilloes, enforce policies, and intercede when conflicts erupt. Perhaps because of these limited expectations, department chairs are expected to maintain almost a full patient workload and receive limited additional remuneration. They typically have little time to exercise those activities that most of us consider crucial to implement change. They are forced to react to problems rather than spending adequate time strategizing, developing commitment to a larger vision, building department competencies, and building higher levels of engagement.

Elevating the expectations and role of department chair to provide proactive leadership can easily and cost-effectively improve critical aspects of the health care system. To do so requires following a three-course prescription: improve the roles and expectations of the position, provide additional leadership education, and create the time and the subsequent remuneration to undertake this work.

Improve the roles and expectations of the position

Most physicians chose the medical profession to improve the quality of life. In the course of their practice however, they are confronted with rules and regulations and administrative responsibilities that detract from the realization of their original mission. In many healthcare systems physicians feel less like healers and more like replaceable commodities. Many physicians prefer a stronger connection both to their professional colleagues and to the organizations they serve. But with health care delivery systems themselves under financial siege and a reward structure that incents piece work, physicians naturally become inclined to focus on their own short term performance.

The role of the department chair could easily be elevated to a team leader who inspires the department members to create and execute a more highly valued vision. Research indicates that focusing on possibilities rather than reacting to problems improves morale and increases productivity and performance outcomes. Department chairs would be expected to ask their members such questions as, “What’s really important to us? How can we distinguish ourselves? If we were working to our best, what would that look like?” Then they would organize all the players to achieve those possibilities.

The quality of health care cannot be improved by each specialty working alone. It is the integration of skills across specialties that has particular power to improve patient outcomes. Department chairs can also provide the mechanism to break down the silos between departments that typically plague most health care systems. These additional nodes of the internal network facilitate planning, communication, and feedback between the specialties.

Leadership education

Many department chairs avoid the critical work because they have never been taught how to do it. Just because they are great clinicians and/or researchers does not mean they know how to create a vision, deal with interpersonal conflict, or have the knowledge to conduct a productive meeting. My experience has been that though they are eager to learn and practice these new behaviors, few have the opportunity to do so.

Department chairs need a defined curriculum; they need to have regular opportunities to learn new skills and to practice them on real situations. Coaching by the Chief Medical Officer, Human Resources department or an outside consultant on a regular basis is required. This can be accomplished efficiently in bi-weekly or monthly joint department chair sessions that create greater skills, improve relationships between department heads, and ultimately contribute to a healthier culture and climate.

Time and remuneration

Department chairs devote almost all their time to direct patient care. If their role is primarily administrative, then perhaps the arrangement is acceptable. But if they are to have a significant impact on the manner in which their departments practice medicine, then they must have the dedicated quality time to do the leadership work. Higher level department objectives can be established. In addition to receiving remuneration for patient care, department chairs should be financially rewarded for accomplishing higher-level department and organization-wide initiatives. Perhaps they should also receive coaching support to help them achieve those objectives. The return on investment in terms of physician satisfaction, production, and quality outcomes are significant.

Making improvements to the health care system do not necessarily require new Congressional mandates or legislation. They do require a decision by senior leadership.

The book is interactive and has questions for reflection, etc.   I am looking more forward to the second part of the book with those and with practical suggestions.  Will, naturally, keep you all posted.