Our research adds to the literature on the culture of academic medicine by more comprehensively and explicitly identifying faculty values, and faculty perceptions of the lack of alignment of their own and perceived institutional values. Faculty reported being most energized when they were engaged in clinical caring, the social mission of medicine to provide excellent care for all patients regardless of means, teaching, intellectual stimulation and advancement of knowledge. These valued activities aligned with the stated values of their five institutions. The faculty members we interviewed often inferred the values of their institution by observing behaviors and actions. They reported a significant lack of alignment between their own and perceived institutional values. In particular, numerous faculty perceived a lack of attention to the social mission of providing care for all people and to the community, a lack of prioritization of excellence in clinical care, a devaluing of educational roles, questionable ethical behavior among leadership or management, and the necessity for self-promoting behavior to achieve success. Values incongruence was associated with dissatisfaction, demoralization and sometimes with intent to leave their institution or academic medicine. Several quotations were from former faculty, but the same perspectives were expressed within all career categories.
Others have written about the link between authenticity and productivity. Authenticity reflects acting in accordance with one’s values, preferences and needs, as opposed to acting merely to please others, to attain rewards or avoid punishments.6,23,24
Faculty are more likely to instill a passion for medicine in their students or conduct stellar research if they are working on something that they are personally passionate about and that is aligned with their values.6
The contrasting state of ‘burnout’ results in lesser performance and ‘depersonalization’ or the absence of bringing one’s personal self to work.24
Literature from other fields suggests that institutions need the ideas, self-expression, questioning and creativity that comes from empowering employees.25,26
Faculty values aligned well with the stated missions of most medical schools: clinical care, education and research. However, faculty based their perceptions of institutional values on observed behaviors rather than mission statements. An organization achieves congruence when its espoused principles and actions are aligned; our faculty frequently reported the lack of such congruence. Outside medicine, Waterman,27
found that nine companies that practiced according to their values outperformed the Dow Jones industrial average by 350%. Collins also found that organizations were most successful where their values were embodied in the fabric of the organization, in its systems, practices, process and rewards.28
Our results align with the research findings29
that women value consistently more than men benevolence and universalism (understanding, appreciation, tolerance and protection for the welfare of all people), and female physicians are more motivated by helping others than males.8
This would suggest that lack of alignment of values as shown in our data may contribute to women’s lack of advancement in academic medicine. Another study from our interview data set shows that URM faculty report a call to serving their own underserved communities.30
The latter data suggest that values incongruence may be one factor contributing to the difficulty of academic medicine in recruiting and retaining URM faculty members.31,32
One limitation of our study is that our data were drawn from just five medical schools, but the schools were chosen to be representative of the nation in regional and organizational characteristics, and their faculty demographics at the time of this study were almost identical to national means. However, for a qualitative hypothesis-generating study, the large number of respondents and multi-institutional sample are strengths. The responses may not be representative of the responses of all faculty, but do come from a diverse group of faculty in terms of gender, discipline, career stage and race within each of the five disparate medical schools. The themes we heard were dominant in the data and evident across all career stages of faculty. To assess for generalizability, the findings from this study are being tested in a nationally representative survey of faculty from 26 medical schools. Another strength of the study is that it involved a research team from different disciplines and used accepted and rigorous approaches to hypothesis- generating qualitative research. The carefully maintained confidentiality and anonymity of interviews protected respondents and probably increased their willingness to be frank. Many interviewees commented that they were grateful to have the opportunity to express their views. However, this strength is also a limitation as it prevented us from analyzing data by subgroups, which might have jeopardized the anonymity of participants.
By identifying faculty’s deeply held values as expressed when they feel most vital and successful, we hope that this study will increase medical school leaders’ awareness and promote congruence between individual values and institutional values, assisting the realization of the full potential and contributions of a diverse faculty. What may be more challenging are faculty perceptions that the stated social and educational missions of academic medical centers, which are well aligned with their individual values, are not fully congruent with institutional behaviors. The findings of this study should encourage academic medical institutions to address these faculty perceptions of the culture.