Association of Women Surgeons

Achieving Decanal Positions in Medical Schools

Introduction

Dean's office appointments in a Medical School are known as Decanal positions. These include several hierarchical levels, and the evolution of a career that may ultimately lead to becoming "The Dean," usually starts with roles at the lower decanal levels, such as Assistant or Associate Dean.

There is significant variability among medical schools, but most will have one or more Vice Deans (or Senior Associate Deans), several Associate Deans, and some Assistant Deans. The general roles and responsibilities for each rank are summarized in Table 1.

The most common operational offices within the administration of a Medical School are usually led by an Associate Dean, and may have one or more Assistant Deans reporting to the Associate Dean. Some of these roles are mandated by the Medical School credentialing body, the Liaison Council for Medical Education (LCME). Other offices are not required, but are usually present, as they enhance the smooth functioning of a school. All Vice Deans, Associate Deans and Assistant Deans represent the school and the dean. Therefore clear duties, expectations and communication between the Dean and his/her Associate Deans is vital. Several common offices in a Medical School are usually filled by individuals who do not necessarily have a medical school faculty background, such as Finance, Information Technology or Business, where degrees other than the MD degree or equivalent, such as an MBA, are preferred.

A typical career progression in Medical School Administration may include major administrative departmental roles (such as Division Chief or Department Chair), followed by an Assistant, Associate or Vice Dean role. Understandably, a much smaller number of individuals will achieve the title of "Dean." Interestingly, it was once thought that these purely administrative roles would be of little interest to physicians in very "hands on" specialties, such as surgeons, and it was thought that the "personality of the surgeon" was not ideal for the job of a Dean. Yet in recent years, more and more surgeons have in fact reached this top position, and have been very successful in this capacity as well.

Following is a discussion of the specific responsibilities for each of the most common administrative offices in the Medical School. Only those most applicable to surgeons are discussed here.

Decanal Positions - Description

The Associate (or Assistant) Dean for [Undergraduate] Medical Education (Or Curriculum) is usually responsible for all aspects of the Medical School Curriculum, including the development and continued improvement of undergraduate medical education programs to enhance medical students' learning and subsequent performance as graduate physicians, evaluation processes and methodologies, medical educator development, research in undergraduate medical education, and the development of policies dealing with undergraduate medical education.

As stated by the Association of American Medical Colleges (AAMC), the goal of Undergraduate Medical Education offices is to "promote excellence in the education of medical students from selection to graduation and thereby contribute to the health of the public."

The Associate (or Assistant) Dean for Student Affairs is the person responsible for the well-being of the medical student body, with responsibilities that include assuring that the students have advisors, have appropriate resources and facilities available to them, stay on track with their courses and grades, and advance successfully to graduation from medical school and into residency. The Associate Dean for Student Affairs oversees student orientation, ceremonial events (such as White Coat Ceremony and Graduation), the matching process for the students, writing "dean letters", and oversight of all committees with responsibilities for the students.

The AAMC defines this office as "representing the interests of medical schools and medical students in the areas of admissions, student affairs, financial aid, minority affairs, and student records."

The Associate Dean (or Assistant) for Faculty Affairs (may include Academic Affairs, Faculty Development and/or Diversity) is responsible for all activities, processes and regulations dealing with the faculty of the Medical School. The overarching mission is to build and sustain faculty vitality. This is accomplished by a wide range of responsibilities and tasks, from faculty recruitment, development and retention, to promotion and tenure processes and policies, development and implementation of institutional policies and professional development activities that advance the faculty's roles in the academic missions of teaching, research, and clinical care.

The AAMC describes the goal of Faculty Affairs offices as to "facilitate dialogue, debate and communication on emerging issues and challenges to faculty in medical schools; foster professional development of faculty relevant to faculty and institutional policies and practices and career pathways; encouraging research and scholarship; measuring and analyzing outcomes of professional development; . . .to create synergy that contributes to faculty vitality and thriving institutions."

The Associate (or Assistant) Dean for Graduate Medical Education is usually also the DIO (Designated Institutional Official), who represents the School in all matters dealing with the Accreditation Council on Graduate Medical Education (ACGME).
This individual is responsible for oversight of all residency and fellowship programs in his/her school and affiliated facilities, including the development and continued improvement of those programs, promoting research in graduate medical education, the development of policies relating to graduate medical education, and compliance with all ACGME rules and guidelines.

As stated by the AAMC, the goal of a GME office is to promote excellence in the education of physicians during residency training and thereby contribute to the health of the public.

The Associate (or Assistant) Dean for Continuing Medical Education has oversight of all CME programs geared towards the life-long, ongoing education of practicing health professionals, that are carried out under the auspices of his/her school. This includes planning, peer review, evaluation and documentation of all CME activities. The Associate Dean for CME is also responsible for compliance with the rules set by the Accreditation Council for Continuing Medical Education (ACCME).

The AAMC defines the purpose of the CME office to "promote excellence in the education of physicians throughout their careers and thereby contribute to the health of the public."

The Associate (or Assistant) Dean for Research is charged with oversight of all research programs and policies in the Medical School. This includes basic science research, clinical research and translational research. In general, this individual is responsible for compliance with local, national and federal rules, oversight of review bodies such as the IRB and IACUC, and animal care facilities. The Associate Dean for Research also helps in preparing and supporting faculty members for productive research careers.

The AAMC describes its research constituencies' roles "to provide a national forum for the promotion, support, development, and conduct of biomedical research in medical schools and teaching hospitals, through the exchange of information and the examination of issues critical to the research enterprise."

It is important to understand the differences between these administrative areas: the individual's own interests and abilities will usually dictate which will be the best fit. For example, for surgeons actively involved in the administrative aspects of medical education, such a the surgical clerkship, a role in the Office of Medical Education may be the logical next step, while significant involvement in the Promotion and Tenure process, may lead to a role in faculty affairs.

Preparation for Decanal positions

A surgeon becomes a desirable candidate for a senior level decanal position such as Associate Dean or Dean, at a fairly senior career level. Typically he/she will hold the rank of Professor, will be tenured (if the school offers tenure, and the individual is on the tenure track), and will have held other administrative roles that will help to prepare for the next major career step. Understanding institutional culture and critical issues (or being a quick learner when moving to another Medical School), and developing an understanding of the institutional financial status and strategic planning are useful preliminary steps.

Membership in key professional organizations and invitation to participate in national committees serve as objective indicators of visibility in the selected field. These organizations may include major surgical specialty or subspecialty societies (ex: Fellowship in the ACS, AAS, SUS), and participation in organizations that cross specialty boundaries, such as the Association of American Medical Colleges (AAMC), the American Medical Association, or the National Board of Medical Examiners. Other desirable attributes include strong interpersonal skills and administrative experience and/or training. Mentoring and/or executive coaching play a valuable role in the preparation for a decanal position and should never be perceived as a sign of weakness.

Finally, it cannot be overstated that maintaining balance in one's personal life is absolutely critical. The biggest mistake leading to failure in leadership positions is neglecting personal life, family, outside interests and hobbies. Keeping a good sense of humor will get the budding leader through many tough times. We all get cranky when we do not have time to do things that recharge our internal batteries. Decanal jobs can be all consuming, and the risk of falling into this trap is huge. This simply should not be allowed to happen.

Interpersonal Skills

In dean's offices, it is important to have strong interpersonal skills, and for most surgeons, that requires shedding some of the traits that made us good surgeons in the first place. The concept of the "captain of the ship", as encouraged in the trauma setting, no longer applies: the ability to see "both sides" of a discussion is key, listening moderating and negotiating skills are a must. This may require a great deal of effort and even specific training. Some of the available training opportunities are listed below.

Administrative Experience

Hands-on experience is always worth the time spent on it. The opportunity to assist or shadow a leader in one's own institution is priceless. Taking on a first leadership role, regardless of how big or small, may be nerve wracking, but will eventually pay off. This may range from chairing a major committee or task force, becoming a Division Chief, Center Director or Course Director -- all of these will provide valuable apprenticeship for bigger roles, leading to a dean's office position.

Administrative and Leadership Training

Internal leadership or administrative courses may be worth pursuing, but opportunities no longer end there. Over the past 10-20 years, opportunities for formal leadership training have grown significantly. Even many national specialty organizations now offer courses in leadership, management and interpersonal skills. For surgeons, these include the Association of Women Surgeons, the Association for Academic Surgery, and the Society of University of Surgeons. Non-specialty specific courses are ideal, since a decanal role will bridge all of the specialties (and associated personality types) represented in a Medical School. Degree-granting program such as an MBA or MHA may be useful in some situations, but are not essential.

A more comprehensive list of training opportunities is included in Table 2.

Mentoring and Executive Coaching

Mentors are crucial at any career stage, and decanal positions are no exception. An individual should be able to identify at least one mentor, ideally someone with knowledge of the specific administrative area being sought. By default, this mentor will often not be at the same institution. This is a big advantage, since it allows for frank discussions of problems and issues that are best not discussed with potentially interested parties.

Executive Coaching has historically been perceived as a last resort tool, when an individual is "in trouble." This is unfortunate, and nothing could be farther from the truth. A good coach will provide a valuable "third opinion", will be a sounding board to prepare for key meetings, will help to make major decisions, and in general may be the best form of "preventive medicine" for the administrator, by providing tools and strategies to make the right choices and stay out of trouble. Executive Coaches with experience in the academic medical environment are readily available. A partial list is available in the References section.

Breaking into the dean's world: how does one get the job?

The first step is to make it known that the individual is interested in a role in the dean's office. This may lead to an opportunity in his/her own school, where an internal recruitment is more cost effective than a major national search, and the availability of a local, interested faculty member, may even stimulate the creation of a new role, geared to take advantage of a particular skill or interest.

Positions with a national search are advertised in many different ways, ranging from notices at AAMC meetings, ads in Academic Medicine or Academic Physician and Scientist, and always by word of mouth.

Once an attractive position has been identified, a good strategy is to solicit a formal nomination from a colleague in the field. This is the time to "toot one's horn", and to make sure that the nominator is aware of all relevant training, skills and aspirations. It may take a few tries, but eventually contacts by search firms and search committees will begin. The recruitment process is fairly "standard", including a preliminary review of a CV (which should always be up to date and ready to be sent off at the drop of a hat, followed by a series of interviews. These may start with phone interviews or "airport" interviews. As the process advances, there may be one or more invitations for campus interviews. A good coach will be very helpful in preparing for all of these. It is important to be at ease with both the process and the topic: knowledge of the general requirements and potential difficulties of any job is essential. Selecting the proper references is also important: these should be individuals with knowledge of the field, as well as the candidate's qualifications, personality and style.

Finding the right fit is more often than not a "gut feeling." This may not always be correct, but it is often the best we can do. It may be helpful to write out the pro's and cons of the position, and weigh each one with a trusted family member and a mentor or coach. Items to consider include job description, reporting structure, available resources, compensation and benefits, geography, cost of living, and suitable environment for both work and family life.

One point to remember: unlike a faculty position, administrators serve at the pleasure of the next person up in the pecking order. These positions may disappear in a flash, especially if there is a change in leadership. It is therefore imperative, especially before relocating, to make sure that the new boss is a good fit and likely to be around for a while -- it helps if he/she is a prior acquaintance or colleague, but this is rare and not essential. In addition, no offer should be accepted without some assurances of financial security for a certain period of time that make the move worthwhile, even knowing that the unexpected could happen.

Summary

Decanal positions are extremely rewarding, and may be the ideal culmination of a successful career, allowing for an ongoing, productive career in academic medicine, even outside of a full time clinical career. These positions are not stress free, although the stressors are very different from those encountered by surgeons in clinical practices. The lifestyle is usually far better than what most surgeons are accustomed to. Preparation, training in new and different skills, good mentoring and a solid life-work balance are the keys to a successful life in the dean's office.

Table 1: Roles of Dean's Office Staff

Table 2

Formal or informal leadership and administrative training opportunities

Surgical Associations

• Association of Women Surgeons
• American College of Surgeons
• Association for Academic Surgery
• Society of University Surgeons

Professional Organizations - Administrative

• Association of American Medical Colleges (AAMC)
  • Annual Meeting
  • AAMC Professional Development Seminars
    o Early Career Women Faculty Professional Development Seminar
    o Mid Career Women Faculty Professional Development Seminar
    o Minority Faculty Career Development Seminar
    o Executive Development Seminar for Associate Deans/Department Chairs
  • AAMC Council of Deans Fellowship
• American College of Physician Executives
• Harvard CCPE Programs
• SkillPath Seminars
• Center for Creative Leadership courses
• Executive Leadership in Academic Medicine (ELAM)
• ACE Fellowships
• Robert Wood Johnson Foundation

Executive Coaching Connections

http://www.elamalliance.org/
http://www.brynmawr.edu/neli/index.html
http://www.avantistrategies.com/about.htm

REFERENCES

1. Rich EC, Magrane D, Kirch DG: "Qualities of the medical school dean: insights from the literature." Academic Medicine, 83(5):483-7, 01/06/2008.

2. Faculty Vitae - AAMC
http://www.aamc.org/members/facultydev/facultyvitae/spring06/perspectives.htm

3. J. Lobas: "Leadership in Academic Medicine: Capabilities and Conditions for Organizational Success." The American Journal of Medicine, Volume 119, Issue 7, Pages 617-621

4. J. Nocks: Executive coaching--who needs it? Physician Executive, 01-MAR-07

5. http://www.acphysci.com/aps/resources/PDFs/APS 0309_CareerWatch.pdf

6. http://www.acphysci.com/aps/resources/PDFs/APS 0109_CareerWatch.pdf

7. http://www.acphysci.com/aps/resources/PDFs/APS 1108_FiveMinutesMentor.pdf

8. http://www.acphysci.com/aps/resources/PDFs/Oct_05_career.pdf

9. http://www.acphysci.com/aps/resources/PDFs/June_05_Feature.pdf

10. http://www.acphysci.com/aps/resources/PDFs/May_05_Feature.pdf

11. http://www.acphysci.com/aps/resources/PDFs/Feb_05_Feature.pdf