ACADEMIC EMERGENCY MEDICINE 2011; 18:981–987 © 2011 by the Society for Academic Emergency Medicine
Objectives: Due to the rapid growth in academic emergency departments over the past 20 years, recent significant changes in leadership have occurred. To prepare for future transitions, leaders in academic emergency medicine (EM) should identify those skills and characteristics desired in future academic chairs. The authors sought to determine which skills and characteristics are more important than others to help guide the development of EM-specific leadership courses.
Methods: A survey of the current academic chairs in EM included questions pertaining to demographics, career time course, expected career longevity, and ratings of skills and characteristics deemed necessary for academic chairs. Chairs were asked to rate the qualities twice, to identify qualities that must be obtained prior to becoming chair, and those that may be obtained during chair tenure.
Results: Ninety-seven percent of the membership of the Association of Academic Chairs in Emergency Medicine (AACEM) completed the survey. Most chairs have been in practice for over 15 years, and a minority, for less than 10 years. One-third predict less than 6 more years in their current position, and almost 50% predict their careers as chair will continue an additional 6–10 years. The highest-rated formal training was an administrative or leadership training course or certification. Chairs noted that academic experience (including scholarly productivity, peer-reviewed publication, faculty development, and graduate medical education) was the most important skill set to obtain prior to becoming a chair, while hospital governance and cross-departmental collaboration skills can be obtained once in the role. Managerial skills were also felt to be of importance. Personal characteristics were overall rated highly. No differences were found between responses from early chairs and those later in their careers.
Conclusions: Leadership courses for aspiring chairs in EM should foster the development of academic experience and managerial skills. Advanced degrees in leadership or administration are highly desirable in future chairs.
Academic emergency medicine (EM) has existed for nearly four decades. The first two decades saw modest growth in the number of academic department chair positions. There were 18 academic departments of EM in 1989, and rapid growth occurred between the years 1985 and 2009, when 64 academic departments were founded.1,2
Over the past several years, a significant number of career changes have occurred in academic EM department leadership. These changes resulted from new departments being established and career transitions of existing chairs. Some moved up (e.g., dean’s position, hospital administrator), some moved over (returned to a faculty role), and others moved out (retired, state, federal, or private position) of their institutions. It follows that this trend will continue for the near future, as current chairs age and advance, alter, or end their careers. Considering these trends in leadership turnover, the faculty development committee of the Society for Academic Emergency Medicine (SAEM) began developing courses to prepare mid-level faculty for leadership roles. In this manner, the specialty can pursue an active role in identifying and preparing its future academic leadership. This approach has successfully been pursued by other specialties,3,4 but the committee felt that these courses were both financially expensive and not geared specifically toward emergency physicians (EPs) and therefore not ideal for the academic EP (R. Hockberger, personal communication, January 2011).
The objectives of this study were to define the demographics of the current academic chairs and to ask those responsible for the role to identify skills and personal characteristics they deem necessary for success in attaining and maintaining the academic chair level of EM leadership. The information obtained may be used for continued topic development of the recently created leadership courses.
Study Design and Population
A survey was circulated to the membership of the Association of Academic Chairs in Emergency Medicine (AACEM) for their input in development. Four individuals who were former chairs and remain on the AACEM membership were included, as their input was felt to be valuable. The survey link was e-mailed to the AACEM members in early 2009, and three reminders were sent over a 4-month period to improve the return rate. This study received approval from the authors’ university institutional review board.
Survey Content and Administration
The survey was derived from the Association of American Medical Colleges publication “The Successful Medical School Department Chair: A Guide to Good Institutional Practice.”5 In this series, characteristics and skills were identified that defined traits and capabilities of the “generic” academic department chair. Survey Monkey (http://www.surveymonkey.com) was used to present the final survey. Each respondent was asked to rank skills and personal characteristics on a 4-point Likert scale, from 1 (“not important”) to 4 (“very important”), using as a reference point his or her personal path to attaining and sustaining the chair’s role. We surmised that there might be certain skills and characteristics that chairs would identify as necessary to become a successful chair and others that might be important to maintain that role. Therefore, two sets of similar listings were offered in the survey. Demographic information such as age, sex, race, academic rank, prior administrative positions, and advanced degrees were also obtained. A copy of the survey instrument is available online in Data Supplement S1.
Survey data were entered into a spreadsheet using Microsoft Excel (Microsoft Corp, Redmond, WA). One-way repeated-measures analysis of variance (ANOVA) was used to compare the mean importance among the characteristics and skills in each area before becoming chair and after becoming chair. In each area, post hoc tests, using Tukey’s honestly significant difference, were run to determine which characteristics and skills differed significantly in importance. The means were ordered from largest to smallest, and the choices of most and least important were made from the top and bottom of the list, respectively. The Wilcoxon signed rank test with Bonferroni correction for multiple tests was used to compare the importance of each characteristic in each area before becoming chair and after becoming chair, without adjusting for category. The Wilcoxon rank sum test was used to compare responses from those chairs with fewer than 5 years of chair tenure to those with more than 5 years in the chair position. Character traits were also compared to look for significant differences in importance. For ANOVAs, the least square means of the Likert scale data are reported.
Of the 84 potential respondents, 82 completed the survey, giving a 97.6% response rate. Three respondents (3.6%) answered only demographics questions. Characteristics assessed can be found in Table 1.
|Formal training||Character traits|
|Administrative or leadership education certification course||Problem solver|
|Project management training|
|Management degree||Sense of humor|
|Business degree||Open to new ideas|
|Lobbying/political process exposure||Good listener|
|Faculty development role||Effective at communication|
|Undergraduate (medical student) experience||Idealism|
|Graduate (residents) experience||Pragmatism Vision|
|Scholarly productivity||Sensitivity (cultural, gender, etc.)|
|Clinical medicine research||Curiosity (academic, clinical)|
|Basic science research|
|NIH study section/reviewer||Entrepreneurial|
|Academic leadership experience||Team builder|
|Cross-departmental collaborative experience||Conscientiousness to others|
|Mentorship role||Social skills|
|Committee chairmanship in medical school|
|Hospital governance position||Willingness to hold unpopular positions|
|Academic program administration||Defined leadership style|
|Regional/state governance position||Collaborative|
|National/international leadership role||Trustworthy|
|Human resources experience|
|Information technology management|
|Delegation and supervision|
Currently, EM chairs are overwhelmingly male, white, and above 50 years old. Seventy-five percent have attained the rank of professor, and most have been chair at only one institution. Preceding administrative positions include program director (54%), vice chair (41%), medical or clinical director (17%), research director (6%), and several fellowship directors. More than half hold other degrees, primarily Master of Public Health or Master of Science. Additional degrees included Master of Education, Clinical Leadership, or Health Care Management. Many have had advanced training in physician executive courses. Sixteen respondents (23%) completed fellowships, including medical toxicology, pediatric EM, and research (Table 2).
|Number of institutions in chair position|
|Administrative positions held|
|Assistant program director||13||20.6|
|Prior chair position||9||14.3|
|Other advanced degrees|
Most chairs (75%) have more than 15 years in academics, and only 8.5% fewer than 10 years of experience. Over half (56%) have spent their entire careers in academics. Almost 40% of current chairs have served for less than 5 years. One-third predict less than 6 more years in their current position, nearly 50% responded their chair tenure will continue an additional 6 to 10 years, and less than 25% of current chairs expect to remain in this role for longer than an additional 10 years (Figure 1).
Skills and Characteristics Assessment
The primary intent of the survey was to identify specific characteristics and skills felt by current chairs to be important in becoming a chair and to determine if others were uniquely important once the position was attained. As perceived by the current academic EM leadership, the characteristics suggesting success as an initial and continuing chair are as follows (Table 3).
|Formal training||Admin/leadership certification||2.844*||2.905*|
|Project management training||2.339||2.447|
|Academic experience||Scholarly productivity||3.776*||3.479*|
|Faculty development role||3.648||3.771*|
|Graduate (residents) experience||3.456||3.291|
|Clinical medical research||3.392||3.200|
|Undergraduate (medical student) experience||3.000||2.793|
|Lobbying/political process exposure||2.904||3.129|
|NIH study section/reviewer||2.316†||2.153†|
|Basic science research||2.115†||1.893†|
|Academic leadership experience||Cross-departmental collaborative experience||3.709*||3.793*|
|Academic program administration||3.342||3.342|
|Committee chairmanship in medical school||2.937†||2.960†|
|National/international governance role||2.848†||3.000|
|Regional/state governance role||2.747||2.945|
|Managerial skills||Conflict resolution||3.795*||3.803*|
|Delegation and supervision||3.771||3.775*|
|Information technology management||2.992†||2.930†|
Formal Training. Administrative or leadership training courses or certifications were considered by the chairs to be the most important formal training, and attainment of a finance degree was deemed to be less necessary than the others. These relationships were true as skills to be obtained prior to, as well as after, becoming chair. Other recommended courses included physician executive courses, including the American College of Physicians Executives (ACPE) courses, as well as negotiation and conflict resolution courses.
Academic Leadership. Respondents noted the two most important academic leadership experiences were cross-collaboration with other academic individuals or units, and mentorship, and that the least important were medical school committee chairmanship, national/international governance positions, and regional/state governance positions. These were true both prior to and after becoming chair. Hospital governance was an important characteristic in the sitting chair. Again, negotiation and conflict resolution appeared prominently in the other suggested experiences.
Academic Experiences. In the time period prior to as well as after becoming chair, the most important academic experiences were active faculty development, especially scholarly productivity, graduate education experience, and peer-reviewed publications. Clinical medical research experience was considered important prior to becoming a chair, but not with the level of significance as the others, and was rated as less important for the sitting chair. Basic science research and National Institutes of Health (NIH) reviewer experience were considered the least important.
Managerial Skills. In terms of managerial skills, ratings were consistently high, with the categories of information technology, human resources management, and media and public relations scoring significantly lower than the others. Fund raising was suggested as another area for chair development, but not ranked highly.
In virtually all areas, skills ranked as highly for the “preparation for the chair position” as they did for “during chair tenure.” The most notable exception is hospital governance (more important during chair tenure). In addition, performance measurement becomes more important once chair status is reached, and clinical medical research less important.
Personal Characteristics. Importance of personal characteristics was only assessed once. In most categories, scores were high, suggesting that personal characteristics are very important for the role of chair, and therefore, certain individuals may be more temperamentally suitable for academic leadership. The least important character traits were idealism, charisma, presence of a defined leadership style, and an entrepreneurial spirit (Table 4).
|Characteristic||Mean Likert Score|
|Effective at communication||3.849|
|Conscientiousness to others||3.821|
|Open to new ideas||3.745|
|Sensitivity (cultural, gender, etc.)||3.577|
|Willingness to hold unpopular positions||3.550|
|Sense of humor||3.487|
|Curiosity (academic, clinical)||3.485|
|Defined leadership style||3.173*|
Miscellaneous. Respondents were also asked to provide other topics or areas they considered important for chair development or execution of the chair position. An underlying theme of “teambuilding” was suggested. Formal team training or collaborative experiences within the institution were deemed beneficial during preparation for, and tenure in, the chair position. In addition, a basic understanding of finances relative to the department and an understanding of the values, funding, and research structure of the institution were listed as valuable. Finally, several respondents noted the need to manage the stress of academia and avoid being insulated from the day-to-day activities of an EP. Clinical activities were deemed important for personal and professional development, as well as for visibility in the department. While not necessarily academic, parenting was also suggested as a necessary experience.
When not adjusting for category, the individual characteristics and skills with significant differences in levels of importance prior to and after becoming chair were in the areas of academic experience and academic leadership experience. Clinical medical research, scholarly productivity, graduate and undergraduate medical education experiences, and peer-reviewed publications all had significantly greater importance as skills necessary prior to attaining chair status, while hospital governance and collaborative relationships showed significantly increased importance as a chair. The importance of public relations as a skill to develop after becoming chair was marginally significant (Table 5). There were no differences seen when comparing responses from those chairs in their position for 5 years or less with those respondents with more than 5 years of experience.
|Category||Characteristic||Mean Pre||Mean Post||p-value|
|Formal training||Admin/leadership certification||2.84||2.91||0.4612|
|Project management training||2.29||2.43||0.4141|
|Academic experience||Lobbying/political process exposure||2.90||3.13||0.0213|
|Faculty development role||3.64||3.77||0.0370|
|Undergraduate (medical student) experience||3.00||2.80||0.0064*†|
|Graduate (residents) experience||3.46||3.29||0.0006*†|
|Clinical medical research||3.39||3.20||0.0041*†|
|Basic science research||2.12||1.88||0.0411|
|NIH study section/reviewer||2.32||2.14||0.1403|
|Academic leadership experience||Cross-departmental collaborative experience||3.71||3.79||<0.0001*‡|
|Committee chair in medical school||2.94||2.96||0.6650|
|Academic program admin||3.35||3.34||0.8718|
|Regional/state governance role||2.75||2.96||0.0161|
|National/international governance role||2.85||3.00||0.0495|
|Managerial skills||Change agent||3.58||3.59||0.9542|
|Information technology management||2.99||2.93||0.2632|
|Delegation and supervision||3.77||3.77||1.0000|
The current academic EM chair positions are in transition. The past 20 years have seen significant growth, and the near future promises slowed but continued growth. Over the past decade nearly 30% of chair positions have changed leadership, and based on our findings, it is expected that during the next decade nearly 40% of current chair positions will open and 5 to 10 new departments will be established. Not including new positions, annual turnover will be approximately 5% to 7%.
Current academic departments of EM have more faculty members at higher academic ranks and are responsible for a larger clinical load while training more medical students and residents. They may offer additional training programs through fellowships and advanced degrees. They certainly have more complex relationships inside and outside the medical center. As the visibility and stature of our specialty within academic medicine increases, preparation for the chair role becomes correspondingly more important.6
The data obtained in this survey can serve as a content guideline for planning EM-specific leadership courses or conferences, and the preexisting models from dermatology3 and Drexel University’s Executive Leadership in Academic Medicine (ELAM) course4 can be used as templates for structuring our own curricula. Content for these courses should foster the development of academic experience in publications, graduate medical education, and faculty development. In addition, a focus on managerial skills is desired, as many of the skills in this area were felt to be important both prior to and after becoming chair. Whether through an EM-sponsored course or an external one, faculty seeking the chair role should pursue an administration or leadership degree.
This study asks only the opinions of current and former chairs of EM and as such may reflect skills possessed as opposed to those that are truly important. The possibility exists that the sets of skills and characteristics deemed important by deans and other medical school leadership may differ from these data. In addition, we have not attempted to define which skills determine success as a chair, as skills desired may not be the same as those necessary. Three respondents (3.5%) only provided demographic data, so did not contribute data to the skills and characteristics portion of the results.
Characteristics and skills deemed by current chairs to be the most important for an academic chair in EM include mentorship roles, cross-departmental collaboration, scholarly productivity, peer-reviewed publication, and managerial skills. Scholarly productivity, undergraduate and graduate medical educational experience, peer-reviewed publications, and clinical research were rated as most important to gain prior to chair tenure, while hospital governance and cross-departmental collaborative experiences can be obtained as chair.