Academic Medicine, Vol. 88, No. 7 / July 2013 960 Research Report The role of the department chair in academic medicine is multifaceted. They oversee a variety of missions, guide recruitment and retention, administer the academic infrastructure, raise funds, and maintain the school’s profile. 1 They often find themselves “between a rock and a hard place,” 2 eliciting support from leaders at the medical school and teaching hospitals while at the same time gaining and maintaining the confidence of faculty. 3 Their role constantly evolves in response to the changing landscape of health care reform, care delivery models, economic constraints, health care and educational innovations, scientific understanding, technology, and recommendations for the future and advancement of medical education. 4–10 Why then does the literature—which has looked at the needs and experiences of deans in academic health science centers 11,12 —pay so little attention to the role of department chairs? The literature that does exist is predominantly anecdotal or opinion, with few empirical data. Commentaries have explored specific traits or resources that help chairs succeed, including strong communication skills, emotional competence, administrative support, and continuous self-assessment. 13,14 Yet, although these personal reflections provide some insights, further exploration is needed to understand the “real” needs of department chairs. Few empirical studies have explored the experiences of department chairs, in general, or of chairs in academic medicine, in particular. Studies in higher education and community colleges have begun to identify factors for success, emphasizing the importance of providing specific development and support. 15,16 In academic medicine, suggested ways to enhance the success of chairs of internal medicine include changing the selection process to measure emotional intelligence, using organizational and leadership development, and instituting mentoring, coaching, and learning collaboratives. 17 However, empirical research to support these recommendations is scarce. This article attempts to fill that gap by providing further empirical evidence to guide the design of support and development programs that can meet the complex needs of university department chairs in academic medicine. Method To help us understand the needs of chairs, we adopted an exploratory qualitative case study approach. 18 Case study methodology, used for in-depth investigation of individuals, groups, or events, allows researchers to continuously analyze data with the purpose of better understanding the phenomenon they are studying. 18 We explored the experiences of department chairs in a faculty of medicine. 19 Specifically, we wanted to describe the areas they felt were essential for success, were particularly challenging, or required more support or development. Setting We studied the department chairs within a faculty of medicine at a large Canadian university in a multicultural urban center. 20 The faculty of medicine has 2,667 full-time and 2,702 non- Abstract Purpose The challenges for senior academic leadership in medicine are significant and becoming increasingly complex. Adapting to the rapidly changing environment of health care and medical education requires strong leadership and management skills. This article provides empirical evidence about the intricate needs of department chairs to provide insight into the design of support and development opportunities. Method In an exploratory case study, 21 of 25 (84%) department chairs within a faculty of medicine at a large Canadian university participated in semistructured interviews from December 2009 to February 2010. The authors conducted an inductive thematic analysis and identified a coding structure through an iterative process of relating and grouping of emerging themes. Results These participants were initially often insufficiently prepared for the demands of their roles. They identified a specific set of needs. They required cultural and structural awareness to navigate their hospital and university landscapes. A comprehensive network of support was necessary for eliciting advice and exchanging information, strategy, and emotional support. They identified a critical need for infrastructure growth and development. Finally, they stressed that they needed improvement in both effective interpersonal and influence skills in order to meet their mandate. Conclusions Given the complexities and emotional burden of their role, it is necessary for chairs to have a range of supports and capabilities to succeed in their roles. Their leadership effectiveness can be enhanced by providing transitional processes and supports, development, and mentoring as well as facilitating the development of communities of peers. Acad Med. 2013;88:960–966. First published online May 22, 2013 doi: 10.1097/ACM.0b013e318294ff36 Understanding the Needs of Department Chairs in Academic Medicine Susan Lieff, MD, MEd, MMan, FRCPC, Jeannine Girard-Pearlman Banack, MEd, PhD, Lindsay Baker, MEd, Maria Athina Martimianakis, MA, MEd, PhD, Sarita Verma, LLB, MD, Catharine Whiteside, MD, PhD, FRCPC, and Scott Reeves, PhD, MSc Please see the end of this article for information about the authors. Correspondence should be addressed to Dr. Lieff, Centre for Faculty Development, University of Toronto, Li Ka Shing International Healthcare Education Centre at St. Michael’s Hospital, 209 Victoria St., Room 480, Toronto, Ontario, M5B 1T8; telephone: (416) 864-5929; e-mail: s.lieff@utoronto.ca.