THE ORGANIZATIONAL IDENTIFICATION OF ACADEMIC DIRECTORS IN ACADEMIC MEDICAL ...

147 Pages·2014·2.86 MB·English

BY CHANCE OR BY DESIGN:
THE ORGANIZATIONAL IDENTIFICATION OF ACADEMIC DIRECTORS
IN ACADEMIC MEDICAL CENTERS IN THE U.S.

Krista Hoffmann-Longtin

Submitted to the faculty of the University Graduate School
in partial fulfillment of the requirements for the degree
Doctor of Philosophy
in the School of Education
Indiana University
December 2014
UMI Number: 3668979
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Accepted by the Graduate Faculty, Indiana University, in partial fulfillment
for the degree of Doctor of Philosophy

Doctoral Committee

____________________________________
Thomas F. Nelson-Laird, Ph.D.
Dissertation Chair and Director

____________________________________
Cherri Hobgood, M.D.

____________________________________
Megan M. Palmer, Ph.D.

____________________________________
John Parrish-Sprowl, Ph.D.

June 26, 2014

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Copyright © 2014
Krista Hoffmann-Longtin
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Acknowledgements
This process couldn’t have been possible without an amazing group of individuals who
provided support and guidance. First, I want to express my sincerest gratitude to my dissertation
advisory committee including Drs. Tom Nelson Laird, Megan Palmer, John Parrish-Sprowl, and
Cherri Hobgood. All of you provided me with countless hours of guidance and feedback. I am a
better writer and scholar because of you. Additionally, Dr. Nancy Chism, my first advisor in the
IU School of Education, gave me career advice and support to pursue this work during a time
when I needed it most. I am forever in debt to you for helping me to see what was possible.
During my coursework at IU, I have been fortunate to work with an amazing cohort of
fellow students. Thanks to each of you for all the times you allowed me to think through ideas
aloud and discuss controversial topics respectfully. You all have bright careers ahead! A
number of program alumni took the time to meet with me to discuss topics and methods as a
planned my project. In particular, Rob Aaron, Tony Ribera, and Gen Shaker were all generous
with their time and expertise. I am especially thankful for my work husband, Matt Holley, who
will be following soon after me in the dissertation writing process. Your friendship and support
is one of the greatest gifts I have ever received.
This project is complete, in part, because of the very positive social pressure of my
dissertation writing group at IUPUI. Lauren Easterling, Erin Fillmore, Jerry Guillot, Joe Hayes,
Kate Henkin, Leslie Hoffmann, Matt Holley, Sarah Nathan, and Kristin Norris all gave me
feedback and support weekly on writing and the dissertation process. In addition, my non-
academic writing group, Melody Coryell, Kara Glennon, Becky Huehls, and Stephanie Ralph,
allowed me to show up at their houses, eat their snacks, drink their wine, and talk about critical
theory. Thank you for always listening and reminding me to make my work matter outside the
academy. I am also in debt to the scholarly team we affectionately call “The Girlfriends.” Kari
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Anderson, Sarah Feldner, Claire Procopio, Kristy Sheeler, and Helen Tate adopted me into their
tribe over ten years ago, and have been unwaveringly supportive since.
Working full-time while completing a project would not have been possible without my
compassionate and accommodating colleagues. Drs. Steve Bogdewic, Randy Brutkiewicz, Mary
Dankoski, Megan Palmer, Emily Walvoord, and Julie Welch in the Indiana University School of
Medicine Office of Faculty Affairs and Professional Development gave me the time and support
I needed to finish this project. And, my amazing staff team, Britt Booram, Jon Eynon, Lauren
Stafford, and Liz Whitaker, regularly picked up the balls I dropped. I am honored to call you my
colleagues, coauthors, and friends. In addition, I am especially thankful to Drs. Maryellen Gusic
and Alex Djuricich, who provided me with the professional connections I needed to recruit my
study participants.
My family was incredibly patient as I brought my computer to just about every gathering
for two years. My mom, dad, and brother, Joan Longtin, Don Longtin, and Donnie Longtin,
taught me to work hard and commit to a project. My wonderful husband, Bob Hoffmann-
Longtin and step-children, Al and Jeff Hoffmann, always reminded me to put things in
perspective. Thank you all so much for your support. I couldn’t have done this without you. All
of my success is yours.
Lastly, I want to thank my eight, anonymous participants. You are the best of medical
education in this country. I am humbled by how smart and creative you are, and by how hard
you work. Thank you from the bottom of my heart for your willingness to trust me. Your stories
motivate me to make academic medicine a place where you, and those who come after you, will
thrive.

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Krista Hoffmann-Longtin
BY CHANCE OR BY DESIGN: THE ORGANIZATIONAL IDENTIFICATION OF
ACADEMIC DIRECTORS IN ACADEMIC MEDICAL CENTERS IN THE U.S.
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
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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.
____________________________________
Thomas F. Nelson Laird, Ph.D.
Dissertation Chair and Director

____________________________________
Cherri Hobgood, M.D.

____________________________________
Megan M. Palmer, Ph.D.

____________________________________
John Parrish-Sprowl, Ph.D.

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Table of Contents
Chapter 1: Introduction ................................................................................................................... 1
Statement of Problem .................................................................................................................. 1
Faculty development. .............................................................................................................. 5
Organizational and policy development. ................................................................................ 5
Field of medical education. ..................................................................................................... 6
Research Questions ..................................................................................................................... 6
Study Design ............................................................................................................................... 6
Definitions of Terms ................................................................................................................... 7
Dissertation Overview .............................................................................................................. 13
Chapter 2: Review of Literature ................................................................................................... 14
Historical Overview: Early Academic Medicine ...................................................................... 14
The Structure and Values of AMCs Today............................................................................... 16
Defining the Faculty Role in AMCs and Research Universities .............................................. 17
Defining the role of academic directors. ............................................................................... 19
Framing Academic Directors’ Organizational Identification ................................................... 21
How Faculty Become ADs: Socialization and OID ................................................................. 21
The Organizational Identification Process ................................................................................ 23
Management of organizational identification. ...................................................................... 24
Post-Structuralist Views of Organizations and OID ................................................................. 25
Chapter 3: Methodology ............................................................................................................... 28
Philosophical Concepts ............................................................................................................. 28
Qualitative approach. ............................................................................................................ 28
Constructivist grounded theory and dendritic crystallization. .............................................. 29
Method ...................................................................................................................................... 32
Sites. ...................................................................................................................................... 32
Participants. ........................................................................................................................... 33
Sampling. .............................................................................................................................. 34
Data collection. ..................................................................................................................... 35
Data analysis. ........................................................................................................................ 36
Thematic analysis.............................................................................................................. 37
Narrative analysis.............................................................................................................. 38
Ethical and Trustworthiness Considerations ............................................................................. 40
Chapter 4: Participant Profiles and Significant Narratives ........................................................... 43
Institutional and Participants’ Background Characteristics ...................................................... 43
Participant Profiles and Significant Narratives ......................................................................... 45
Al: Northern medical school, non-primary care. .................................................................. 45
Al’s narrative: Collaboration around an event. ..................................................................... 46
Faith: Western medical school, primary care. ...................................................................... 47
Faith’s narrative: The politics of education. ......................................................................... 47
John: Eastern medical school, non-primary care. ................................................................. 49
John’s narrative: Just dealing with it. ................................................................................... 50
Kathleen: Midwestern medical school, non-primary care. ................................................... 51
Kathleen’s narrative: A family of educators. ........................................................................ 51
Levi: Western university, non-primary care. ........................................................................ 52
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Levi’s narrative: Negotiating commitments to department and school. ............................... 53
Mitch: Eastern medical school, non-primary care. ............................................................... 54
Mitch’s narrative: Somehow finances work. ........................................................................ 55
Salima: Northern medical school, primary care. .................................................................. 56
Salima’s narrative: Not feeling alone. .................................................................................. 57
Scott: Midwestern medical school, non-primary care. ......................................................... 58
Scott’s narrative: In a position to lead. ................................................................................. 59
Chapter Summary ..................................................................................................................... 60
Chapter 5: Negotiating a Fit: Study Findings ............................................................................... 63
Socialization .............................................................................................................................. 64
Falling into medical education. ............................................................................................. 64
Learning on the fly. ............................................................................................................... 66
Unclear expectations. ............................................................................................................ 68
Sense-Making and Multiple Targets of OID ............................................................................ 69
Not enough time. ................................................................................................................... 69
Where and how do I fit?........................................................................................................ 71
Struggling to find a home. ................................................................................................ 72
Managing multiple perspectives. ...................................................................................... 73
Learning to fight for support. ............................................................................................ 74
Unavoidable tensions. ....................................................................................................... 75
How Context Shapes Roles and Values .................................................................................... 77
Extrinsic factors that shape roles and values. ....................................................................... 78
Organizational values........................................................................................................ 78
Reporting structure............................................................................................................ 80
Organizational structure. ................................................................................................... 82
Intrinsic factors that shape roles and values. ........................................................................ 83
Individual values of ADs. ................................................................................................. 83
How ADs define their colleagues. .................................................................................... 85
Chapter Summary ..................................................................................................................... 86
Chapter 6: Constructivist Grounded Theory and Conclusions ..................................................... 88
A Grounded Theory of ADs OID ............................................................................................. 88
The organization and the individual. .................................................................................... 89
Connecting outcomes with bureaucracy. .............................................................................. 92
Connecting emotions with relationships. .............................................................................. 93
Values and structures. ........................................................................................................... 93
Connections to the Literature .................................................................................................... 96
Balancing role clarity and ambiguity. ................................................................................... 96
The right people, with the right resources. ........................................................................... 98
Clearer structures. ............................................................................................................... 100
Limitations of the Study.......................................................................................................... 103
Suggestions for Future Research ............................................................................................ 104
Conclusion .............................................................................................................................. 107
References ................................................................................................................................... 109
Appendix A: Semi-structured Interview Protocol ....................................................................... 119
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