Introduction
The university is composed of professors, students, and staff. While professors and students perform the university’s frontline functions—education, research, and service—staff handle the administrative duties to ensure their smooth operation. University administration involves planning and coordinating operations to meet goals and manage human and material resources [1]. As universities have become more complex and the importance of administration has been emphasized, the focus has shifted from simple execution and management, support, and services to developing strategies for university advancement, reviewing policies, and developing new businesses [2]. Thus, administration expertise and staff importance are emphasized.
Medical schools often have separate administrations from the university due to separate campuses or integrated hospitals. Thus, administrative approaches must be tailored to each medical school’s mission and context [3]. Administrative functions in medical schools include tasks associated with the university headquarters, medical centers, hospitals, and unique administrative tasks like admissions, graduate schools, planning, research, finance, and academic, student, and general affairs. Specialized tasks include managing basic and clinical medicine classes, medical education support, clinical skills and practice support, educational program development, postgraduate medical education, faculty development, and medical education accreditation evaluation. Notably, basic and clinical medicine departments, affiliated research institutes and centers, committees, and professors, students, and a large number of personnel are among the administrative organizations.
Administrative management is a key criterion for evaluations in medical schools. The World Federation for Medical Education accreditation standards for medical schools includes Governance and Administration as an independent evaluation domain, stating that the university needs adequate administrative support to achieve its goals [4]. The Korean Institute of Medical Education and Evaluation also has accreditation standards for university operating systems and administration. In particular, Korean accreditation standards for medical schools set high standards for administrative excellence by aligning with international standards and focusing on dedicated systems, adequate staffing, and staff involvement [5]. Korean medical schools have at least five administrative staff to meet accreditation requirements [6], increasing staff involvement in core tasks.
Thus, advancing medical schools need a stable, highperforming administrative backbone to support seamless education and research. University productivity depends on attracting, developing, and retaining top administrative staff [7]. Lack of administrative development innovation leaves medical schools with underutilized staff and systems. Moreover, staff faces challenges in being recognized as agents on par with professors and students, leading the administrative core. The cultural characteristics in medical schools make this gap wider, and members often view university administration as merely supporting professors and students. This perception fuels communication gaps and hampers tackling administrative challenges.
Understanding how staff views the medical school and their roles is the first step to solving these problems. This study used the Weisbord’ Six-Box model and job attitudes to examine how medical school administrative staff view the organization and job attitudes. The Six-Box model evaluates an organization’s “purpose, structure, relationship, reward, leadership, and helpful mechanism.” Purpose is to determine what business the company is in and whether there are any expected changes in the future. Structure is how the company is organized and who does what in the various departments of the organization. Relationships are the connections between people, customers, and the technologies and systems they use. Rewards include motivation by appropriate rewards not just in money but in the recognition, they receive for the job they do. Leadership is about understanding the organization and its requirements and adjust leader qualities to suit. Helpful mechanisms are the “lubrication” that helps an organization operate efficiently [8,9].
Job attitudes are organizational members’ positive or negative assessments of the work environment. This study assessed job attitudes based on “perceived organizational support, organizational commitment, and job satisfaction.” Perceived organizational support measures how much members think the company values them and their wellbeing. Meanwhile, organizational commitment means feeling connected and wanting to stay, while its absence causes turnover and stress. Job satisfaction measures employees’ overall enjoyment and assessment of their jobs, significantly impacting organizational performance and productivity [10].
Some research has been conducted on university or hospital employees. For instance, Kwak and Jeong [11] examined organizational vision, job engagement, and group efficacy in Korean university staff perceptions and recommended optimizing university operations. Kim [12] investigated role conflict in national university administrative officials and identified factors and subindicators. Meanwhile, Ryu et al. [13] examined how organizational commitment mediates the customer orientation of private college staff. Kim [14] found that university hospital staff with higher organizational conflict, job stress, and burnout had lower job satisfaction. Moreover, Kim [15] polled university staff about administrative advancement and organizational status. Ahn and Kwon [16] used the Six-Box model to study organizational diagnosis, job satisfaction, and organizational commitment in a single-grade Korean medicine hospital and found that they value relationships and have low rewards for and attitudes toward change. Meanwhile, for participants with higher organizational diagnostic scores, their job satisfaction and organizational commitment were high. However, few studies have focused on medical school administrative staff or comprehensively dealing with administrative staff perceptions of the organization and job attitudes.
This study provides foundational lessons for medical school administration improvement. Analysis of the perceptions of the medical school staff about the organization and their job attitudes. The study also highlights administrative challenges and suggests strategies. The study’s research questions are as follows: (1) How does administrative staff perceive the medical school organization? (2) What is the attitude of the administrative staff toward their jobs in the medical school? (3) What are the challenges encountered by administrative staff in medical schools, and what strategies can be employed to overcome them?
Methods
1. Study design
This study takes a mixed-methods approach, integrating quantitative and qualitative research methods to investigate the perceptions and attitudes of medical school administrative staff. Using a convergent parallel design, this study collects both types of data simultaneously, analyzes them separately, and then merges the findings in the interpretation phase for a complete understanding of the issues at hand. The convergent parallel design is pivotal in this study. This enables the collection of quantitative (survey response analysis) and qualitative (content analysis of workshop discussions) data simultaneously. In the final phase, each data set was analyzed using its own methodology, and the results were merged and compared.
2. Study participants
The subjects of this study were administrative staff from Korean medical schools. This group encompassed regular staffs, contract staffs, and assistants working in either administrative or educational support departments. For the quantitative study, the survey was first distributed to the qualitative research participants and received 33 responses (35.1% response rate), and secondly distributed to 40 medical schools and received 34 responses. It included total 67 medical school administrative staff of various genders, ages, educational levels, work experiences, enrollment capacities, job rotation status, positions, and contract types (Table 1). Clinical internship, laboratory management, curriculum, budget, faculty development, technology, endowment, research, and management were among the participants’ duties.
The qualitative research included 94 participants from 29 medical schools. In terms of enrollment capacity, 13 (45%) having “less than 50 students,” 11 (38%) having “50 to 100 students,” and 5 (17%) having “more than 100 students.” Positions varied across 23 categories, with “employee” being the most prevalent at 24 individuals (26%). “Assistant manager” was followed with 7 (7%), “staff” 6 (6%), and “leader” 5 (5%).
3. Data collection tool
This study analyzes anonymized data from a survey conducted in June 2023 and two, 1-hour consensus workshops held in July 2022 and June 2023, respectively, for administrative staff at a medical school. This study used a survey with nine characteristics and 53 researchspecific questions to collect quantitative data. The questions related to the characteristics consisted of seven general characteristic questions and three organizational characteristic questions. The general characteristics consisted of the gender, age, educational level, work experience, position, and job, and the job was excluded from the results because there were many multiple responses and were too diverse. Organizational characteristics consisted of job rotation status, enrollment capacity, and contract type, which was to find out that the organizational culture, school size and number of staffs, division of duties, and job content were different accordingly.
Organizational perception was assessed using 35 questions from the Organizational Diagnosis Questionnaire (ODQ), which is based on Weisbord’s Six-Box model. This tool used for organizational diagnosis because of its user-friendliness and straightforward interpretation of results. The standardized diagnostic questionnaire is designed to provide information on readiness for change by adding the last area, “change attitude” to the first six areas of the Six-Box model [17,18]. In the case of job attitudes, perceived organizational support was employed the format for the eight-item survey of perceived organizational support (SPOS), and this was chosen for its ability to effectively capture the extent to which employees perceive their organization values their contributions and demonstrates genuine interest in their well-being [19,20]. To assess organizational commitment and job satisfaction, five questions each were used in previous studies [21]. All questions were translated and tailored for Korean universities. Content validity was established through expert review by a panel consisting of one medical school professor, one medical education specialist, and two medical school administrative staff members. Their feedback informed modifications and refinements to the sentence expression and composition of answers. A 5-point Likert scale was used in the written and online survey (Google Form; Google LLC, Mountain View, USA). The reliability coefficient (Cronbach’s α) for each factor was 0.953, indicating high reliability.
Qualitative research on consensus workshops focused on semi-structured open-ended questions that could not be included in the survey or required broader context. These questions included “What words come to mind when you think of medical school?” “What are the realistic problems or obstacles while working at a medical school?” and “What should a university or institution do to eliminate or alleviate obstacles?”
4. Data analysis
The staff survey data was quantitatively analyzed using descriptive statistics and regression analysis to examine dependent–independent variable relationships. These methods were run in IBM SPSS ver. 25.0 (IBM Corp., Armonk, USA). The study used a one-way analysis of variance (ANOVA) and independent samples t-test to compare medical school organization perception and job attitudes by general and organizational characteristics. For the one-way ANOVA, a post-hoc test using the Scheffe method was conducted to ascertain the specific differences between various groups.
5. Ethics statement
This study was conducted with the approval of the Clinical Research Institute at Seoul National University Hospital in South Korea belong to (IRB approval no., 2310-059-1475). All data were collected anonymously, protecting participant privacy, adhering to ethical guidelines, and respecting all participants’ voluntary participation, rights, and privacy.
Results
1. Quantitative research results
1) Organizational perception and job attitudes
This study examined seven organizational variables (purposes, structure, leadership, relationship, rewards, helpful mechanisms, and attitude toward change) and three job variables (perceived organizational support, organizational commitment, and job satisfaction) among medical school staff. In the case of perception of the organization, “purposes” was rated highest with an average of 3.80, followed by “relationships” (3.73), “leadership” (3.69), “helpful mechanisms” (3.36), “attitude toward change” (3.31), and “structure” (3.18). Rewards was the lowest rated variable (2.72). As for job attitudes, “job satisfaction” was highest (3.63), followed by “organizational commitment” (3.30). “Perceived organizational support” was the lowest rated variable (2.96) (Table 2).
2) Group differences by general and organizational characteristics
We examined how general and organizational characteristics affect medical school organizational perceptions and job attitudes. We found significant differences in organizational perceptions and job attitudes across several general and organizational characteristics.
Analysis of organizational perceptions revealed gender differences in rewards and helpful mechanisms. There were also significant differences in perceived organizational support for job attitudes (Appendix 1). Notably, men scored higher than women in these areas.
Enrollment capacity was also a significant difference. Organizational perceptions showed differences in rewards and helpful mechanisms. Post-hoc tests (Scheffe) showed that staff at schools with enrollment capacity of less than 50 students and 50–100 students scored higher on rewards than staff at schools with enrollment capacity of more than 100 students. They also showed that staff at schools with enrollment capacity of 50–100 students scored higher on helpful mechanisms than staff at schools with enrollment capacity of more than 100 students. Among job attitudes, staff at schools with 50–100 students reported higher perceived organizational support and organizational commitment enrollment capacity of more than 100 students on the post-hoc tests (Appendix 2).
In the case of contract type, there were differences in rewards and helpful mechanisms of organizational perceptions and perceived organizational support and organizational commitment of job attitudes. Post-hoc tests (Scheffe) showed that “regular” and “nonregular” were higher than indefinite term contract type in terms of organizational rewards, and “regular” were higher than “nonregular” type in helpful mechanisms of organizational perception and perceived organizational support of job attitudes. Organizational commitment among job attitudes showed a similar pattern, but there was no difference in the post-hoc test (Appendix 3).
Age, education, work experience, and job rotation status were not statistically significant in all seven organizational variables and three job attitude variables.
2. Qualitative research results
1) Analysis of words associated with “medical school”
From the consensus workshop for medical school staff, keywords related to “medical school” were categorized as doctor training, emotional experiences, administrative characteristics, personal traits, culture, and miscellaneous content. Doctor training was most often mentioned in terms of doctor, doctor training, hospital, university, university institution, anatomical practice, national medical exam, medical school student, and medical scientist. Next, emotional experiences were categorized as challenging, complex, difficult, elegant battlefield, ugly duckling, patience, pride, impressive, and discouraging. Administrative characteristics include outskirts, uniqueness, no vacation, chronic deficit, large staff, tremendous workload, and accreditation. Study, smart people, lack of character, commanding personalities, helicopter parents, and silver spoon were personal trait keywords. Culture topics included busy, life, collective, professionalism, respect, passion, and conservatism. Additionally, miscellaneous content included workplace, no particular thoughts, and others (Table 3).
2) Analysis of medical school administrative challenges and strategies
Medical school administrative challenges included tasks, faculty, communication, and organization. First, task-related challenges included overwhelming workload, constant new tasks, and long hours. Additionally, many tasks, complex regulations, and frequent curriculum changes were mentioned. Medical education accreditation, complaint handling, and lack of breaks and vacations were also mentioned.
Second, regarding faculty, there were issues such as being busy with clinical work and research, had little medical education knowledge, and lack commitment toward education. Some clinical professors resisted regulations and procedures, showing a lack of administrative understanding. Moreover, the “make the impossible possible!” attitude suggested administrative understanding was unnecessary. The staff felt alienated from dean leadership, disrupting leadership continuity. Additionally, professors’ attitudes toward staff and many professors’ concerns were also discussed.
Third, deans, professors, students, and staff had trouble communicating. Participants described professors’ unresponsiveness to emails and delays in receiving required documents, requiring repeated communication via email, messaging, and phone calls. Concerns included poor student–staff communication.
Fourth, organizational issues included the separate systems between the main university and medical school, difficulties in establishing an organic relationship between the university and hospital, and issues with other departments. Staff shortages, recruitment issues, and budget constraints were also discussed (Table 4).
To address these issues, universities or medical school suggested increasing regular employment ratios and contract employment conditions for staff. Long-term employee incentives, reward systems, vacations, and respect were also highlighted. Recruitment and budget support, deployment of specialized staff, faculty education, focusing on individual staff competencies, providing education specifically for medical school staff, enforcing mandatory faculty education, and creating joint education opportunities for faculty and staff were manpower and budget improvement suggestions. Helping the main university and others understand medical schools’ uniqueness and seek financial and administrative independence from it was also emphasized. At the level of medical school-related institutions or organizations, suggestions included creating teaching methods, accreditation education, staff competency workshops, leadership workshops, and simplifying and standardizing accreditation criteria. Further networking support was proposed by distributing staff opinions, cases, and concerns to faculty and creating platforms for faculty–staff communication. Guidelines for coronavirus disease 2019 and medical accidents and standards like computer-based test (CBT) and portfolios were also mentioned (Table 5).
Discussion
This study examined medical school administrative staff’s organizational perceptions and job attitudes. It also investigated medical school administrative challenges and coping strategies related to administrative work. The purpose of this study was to provide baseline data to improve the administrative functions of medical schools.
Based on interpretations of the ODQ in the quantitative study, scores of below 3 would indicate a problem with organizational functioning [17]. The Six-Box model showed that medical schools with the highest “Purpose” score have clear missions. This mission is understood by employees, who recognize the medical school’s goals and their roles. In the first domain of the Accreditation Standards for Korean Medical Schools (ASK2019), the emphasis is on mission and outcomes. The unique educational goal of medical schools to train doctors is clearly evident. It supports the view of medical school administrators that these institutions train medical professionals in the qualitative study. The “Relationship” category received the next highest score in the survey, but the qualitative study found that professor–student relationships, communication, and administrative work were difficult. The survey questions, similar to those used in general businesses to assess staff relationships, may have contributed to these results. Given the importance of professor–student relationships, further research may be needed to understand them fully. Low “Structure” scores, supported by qualitative data, indicate task allocation and organizational system concerns. Participants described tasks as challenging, complex, and plentiful, highlighting the need for improved task distribution. Dean turnover, curriculum renovations, and accreditation requirements seem to cause policy changes that increase workload and disorganization. The lowest “Rewards” score indicates that growth opportunities, salary, benefits, and incentives are inadequate for task quantity and complexity. “Structure” and “Rewards” differ significantly between regular and nonregular employment contracts. Medical schools with many nonregular contracts and substantial work hours have fewer promotion opportunities and lower pay and benefits than regular contracts.
The job satisfaction score was the highest in job attitude, which supports the high frequency of words about passion, achievement, recognition of task importance, shaping future doctors, and respect for life in qualitative research. These findings support the qualitative analysis, where medical school administrative staff expressed pride in developing future doctors and dealing with tasks crucial to the preservation and respect for life. However, the lowest perception scores were for organizational support, indicating a tendency to perceive insufficient recognition of personal values, efforts, dissatisfaction with accommodation, and inadequate welfare. Organizational support was lower for nonregular contractors than for regular employees. This aligns with the organizational perception that showed lower scores for the Six-Box model “Rewards” category and significant differences between regular and nonregular contracts.
Taken together, the qualitative data suggest that staff view the organization’s structure as essential to educating competent medical professionals. Administrative tasks are challenging but rewarding. Medical schools sometimes have a reputation as an “isolated training ground.” The culture is also busy, conservative, and characterized by academic and financial success but may lack interpersonal skills. Medical school administration faces several practical challenges, including heavy workloads, accreditation and complaint handling, and many professors with varying degrees of interest in education or administrative knowledge. Some professors’ negative attitudes toward staff indicate areas for improvement. Professors, students, and staff must communicate and understand each other. Moreover, university and hospital organizations should recognize medical schools’ uniqueness and provide personnel and budgetary support. Medical college associations can help medical schools become more skilled, connected, and effective by investing in staff development and administrative networks.
In light of the findings, we suggest several medical school administrative system improvements. First, we recommend creating a medical school-specific administrative organization. The need for an independent medical education organization and a skilled workforce has long been debated to improve education quality and efficiency [23-25]. Therefore, administrative staff must be able to develop careers within medical school structures, actively contribute to historical practices, hone medical schoolspecific competencies, and showcase their expertise. This may require a separate administrative system and internal medical school staff rotation system. Second, medical schools must have working conditions that match their professionalism and dedication. Many long-term staffs have master’s or doctoral degrees and a strong sense of mission and pride in the medical school. The results of this study show that educational attainment and work experience have a significant impact on job satisfaction and perceptions of compensation. Given that reasonable wages, promotion systems, and self-development opportunities significantly affect job satisfaction [26], expanding the regular staff base, instituting internal and external compensation structures, and providing comprehensive education and training support are essential. Third, professors, students, and staff must develop trust-based communication. Job satisfaction increases when administrative staff opinions are valued and communication flows smoothly when developing university policies [27]. Moving away from the idea that administrative work only supports professors and students requires acknowledging the passion and dedication of staffs who tirelessly contribute day and night. Breaking the top-down communication culture in medical schools [28] and promoting horizontal communication is crucial. Regular communication forums and programs can contribute significantly to this cultural shift.
PDF Links
PubReader
ePub Link
XML Download
Full text via DOI
Download Citation 
Print 
