From leadership research to district action: Representation of medical specialties in dean’s cabinets at the top 40 NIH-funded United States medical schools

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Background Academic leadership within medical schools shapes institutional culture, policy, and educational priorities. While demographic diversity has been studied, specialty representation in leadership is less understood. This study evaluates the distribution of medical specialties in dean’s cabinets at the top 40 National Institutes of Health (NIH)-funded United States medical schools compared with national and hospital-based physician workforce data. Methods Publicly available institutional websites were reviewed to identify dean’s cabinet members across eight common leadership roles. Degree type and specialty (for MD/DO holders) were obtained from institutional profiles. Specialty representation was compared with 2023 national and hospital-based physician workforce data using paired t-tests. Results Of 320 leaders identified, 287 (89.7%) held an MD or DO. Internal Medicine (IM) accounted for 46.0%, followed by Pediatrics (13.2%) and Obstetrics/Gynecology (5.6%). Compared with the national workforce, IM (p < 0.0001), Pediatrics (p = 0.006), and Neurosurgery (p = 0.003) were overrepresented, while Family Medicine (FM; p < 0.0001), Emergency Medicine (p = 0.04), Anesthesiology (p = 0.008), Orthopedic Surgery (p = 0.016), and Ophthalmology (p = 0.037) were underrepresented. Similar trends were observed against hospital-based workforce data, with additional overrepresentation of Dermatology (p = 0.0008), ENT (p = 0.0005), and Plastic Surgery (p < 0.00001). Among IM leaders, 41.4% were generalists and 58.6% subspecialists, most commonly in Cardiology, Infectious Disease, and Pulmonary/Critical Care. Conclusions Dean’s cabinets at top NIH-funded medical schools are dominated by IM and Pediatrics, with primary care, acute care, and procedural specialties underrepresented. These disparities may influence curriculum design, mentorship, and educational priorities related to community-based care, interprofessional education, interdisciplinary collaboration, and specialty-specific career pathways. Leadership development initiatives targeting underrepresented specialties could diversify expertise in academic medical governance.

Study methods

A review of publicly available institutional websites was conducted to identify dean’s cabinet members of the top 40 NIH-funded medical schools. The top 40 U.S. medical schools were selected based on total NIH funding as reported by the Blue Ridge Institute for Medical Research (BRIMR), in order to focus the analysis on highly research-intensive academic medical centers with comparable institutional missions and leadership structures [6].

Limitations

This study has several limitations. First, focusing on the top 40 NIH-funded medical schools may introduce selection bias and limit generalizability, including the ability to assess alignment between leadership composition and institution-specific physician workforces. This analysis also excludes osteopathic, community-based, or rural medical schools, which may prioritize different leadership models and clinical specialties. Additionally, this is a cross-sectional study that relies on publicly available websites to identify dean’s cabinet members, allowing for the possibility of inaccuracies due to outdated or incomplete information, including the inclusion of interim or acting leadership appointments alongside permanent appointees. Finally, this study limited inclusion to the eight most common leadership titles, which may exclude other, institutionally specific, influential leadership roles and in turn underrepresent certain specialties that may be more likely to fill these less common roles.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one school improvement question with teachers. Protect a short shared planning cycle, agree an instructional change and use a common rubric for examining student work. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Review implementation fidelity, teacher time and independently scored student work against a recorded baseline. Examine access differences and competing explanations before attributing changes to leadership. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Anagha Balaji Thiagarajan; Luke Horton; Ajay Nair Sharma; Nathan W. Rojek. Representation of medical specialties in dean’s cabinets at the top 40 NIH-funded United States medical schools. BMC Medical Education (2026-01-05). https://doi.org/10.1186/s12909-025-08548-y

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.