Increasing women's leadership in academic medicine: report of the AAMC Project Implementation Committee

Positive Value of a Women's Junior Faculty Mentoring Program: A Mentor-Mentee Analysis

BACKGROUND

Recently appointed women faculty in academic medicine face many challenges during their careers and can become overwhelmed managing their multiple faculty roles as teacher, scholar, and clinician, in addition to their roles in personal life. Although a mentor can be invaluable in assisting a woman junior faculty member to adjust to faculty life and providing critical career guidance, not all medical institutions have faculty mentoring programs. We created a mentoring program specifically for our women junior faculty to address this issue at our own institution.

MATERIALS AND METHODS

To assess the value of this program, we conducted a novel mentor-mentee paired-data analysis of annual surveys collected from 2010 to 2015. Of the 470 responses received, 83 were from unique mentees and 61 from unique mentors.

RESULTS

Career development, research, and promotion were the top topics discussed among the mentoring pairs, followed by discussions of institutional resources and administration/service. There was high congruency among the mentoring pairs that they thought these discussions, as well as other conversations about mentee professional development and well-being, had been helpful. However in some instances, mentors felt they had not been helpful to their mentee, whereas their mentees felt otherwise; this finding speaks to the value and importance of mentees providing positive feedback to their mentors. Overall, both mentees and mentors thought that the mentees had significantly benefited from the mentorship. Unexpected outcomes of these relationships included promotion, grant applications/awards, articles, presentations, and professional memberships. The use of a Mentee Needs Assessment Form to individualize the mentoring relationship for each mentee may explain the high overall satisfaction and participant recommendations of the program.

CONCLUSIONS

Our findings demonstrate the value in establishing mentoring programs specifically for women faculty, especially in environments in which other mentoring opportunities do not exist.

Influences for Gender Disparity in Academic Psychiatry in the United States

Introduction Academic undertakings, including research, lead to career progression. However, the career paths of female psychiatrists appear to diverge significantly from that of their male counterparts. This article reviews the pervasiveness of the trend of women being less likely to pursue active research in psychiatry. In addition, we examine the correlation between academic rank and research productivity. Methods We searched the American Medical Association's (AMA) Fellowship and Residency Electronic Interactive Database (FREIDA) to identify training programs for psychiatry. A total of 5234 psychiatrists met our inclusion criteria. The gender, academic rank, research work, and h-index of faculty members were compared. The ratio of women reaching senior ranks as compared to men was also calculated. The Scopus database was used to determine the h-index of the individuals included in this study. Data analysis was done with SPSS 22.0 Release 2013 (IBM SPSS Statistics for Windows, IBM, Armonk, NY, USA). Kruskal-Wallis and Mann-Whitney U tests were used where required, with the P-value set at less than 0.05. Results In our study sample, 2181 (42%) of the psychiatrists were women. However, according to the information obtained from the websites of 23 programs, few women reached higher ranks, full professorship, or positions such as the chairperson of a program, and only 9% of women achieved the designation of chairperson of the psychiatry department, with men representing the other 91%. Higher academic rank correlated with higher h-index. A statistically-significant difference between the genders in terms of h-index was found for the assistant professor rank as well. However, this difference was not observed at the level of an associate professor. Conclusions Despite adequate representation of women in the academic workforce in psychiatry, there appears to be a discrepancy in the research productivity of the two genders. This study highlights the need for targeted interventions to address gender disparities in academic psychiatry.

Longitudinal Gender Disparity in Female Urology Resident Primary Authorship at an American Urological Association Sectional Meeting

OBJECTIVE

To further evaluate the academic representation of female urology residents in the United States, we reviewed abstracts from the Mid-Atlantic American Urological Association (MA-AUA) sectional meetings to determine if the recent increase in the number of female urology residents mirrored an increase in this group's abstract authorship.

MATERIALS AND METHODS

Full text abstracts from the MA-AUA meetings were analyzed from 2008 to 2014 excluding 1 joint section meeting. First-author gender was determined by querying publicly available institutional websites, social media platforms, and the U.S. News & World Report. First-author gender was indeterminable in 10 abstracts based on search criteria and these were excluded. Individual abstracts were broadly categorized based on keywords into 1 of several topics. Chi-square statistical tests examined the relationship between first-authorship gender, publication year, and abstract category.

RESULTS

The number of female urology residents in the MA-AUA increased over the study period. A total of 484 abstracts were analyzed. Three hundred ninety-three abstracts (81%) included a male first-author, whereas 81 abstracts (17%) included a female first-author. Female first-authorship ranged from 13% to 25% annually. Comparison of male-to-female first-authorship was statistically significant in all years evaluated (P <.001). There was a statistically significant difference between male and female first-authorship in all topic categories (P <.01), except Education/Other (P = .56).

CONCLUSION

Despite continued gains and increasing female representation in urology, these data highlight significantly fewer female first-authors at the regional Mid-Atlantic section meetings. Larger studies are necessary to identify contributing factors and further areas for improvement toward decreasing gender imbalances within the academic community.

Women physicians as healthcare leaders: a qualitative study

Purpose - The purpose of this paper is to explore the under-representation of women physicians in clinical leadership by examining the issue from their perspective. Design/methodology/approach - The authors used large group engagement methods to explore the experiences and perceptions of women physicians. In order to capture common themes across this group as a whole, participants were selected using purposeful sampling. Data were analysed using a structured thematic analysis procedure. Findings - This paper provides empirical insights into the influences affecting women physicians' decision to participate in leadership. The authors found that they often exclude themselves because the costs of leadership outweigh the benefits. Potential barriers unique to healthcare include the undervaluing of leadership by physician peers and perceived lack of support by nursing. Research limitations/implications - This study provides an in-depth examination of why women physicians are under-represented in clinical leadership from the perspective of those directly involved. Further studies are needed to confirm the generalizability of these findings and potential differences between demographic groups of physicians. Practical implications - Healthcare organizations seeking to increase the participation of women physicians in leadership should focus on modifying the perceived costs of leadership and highlighting the potential benefits. Large group engagement methods can be an effective approach to engage physicians on specific issues and mobilize grass-roots support for change. Originality/value - This exploratory study provides insights on the barriers and enablers to leadership specific to women physicians in the clinical setting. It provides a reference for healthcare organizations seeking to develop and diversify their leadership talent.

Sex Differences in Faculty Rank Among Academic Cardiologists in the United States

BACKGROUND

Studies demonstrate that women physicians are less likely than men to be full professors. Comprehensive evidence examining whether sex differences in faculty rank exist in academic cardiology, adjusting for experience and research productivity, is lacking. Therefore, we evaluated for sex differences in faculty rank among a comprehensive, contemporary cohort of US cardiologists after adjustment for several factors that impact academic advancement, including measures of clinical experience and research productivity.

METHODS

We identified all US cardiologists with medical school faculty appointments in 2014 by using the American Association of Medical Colleges faculty roster and linked this list to a comprehensive physician database from Doximity, a professional networking website for doctors. Data on physician age, sex, years since residency, cardiology subspecialty, publications, National Institutes of Health grants, and registered clinical trials were available for all academic cardiologists. We estimated sex differences in full professorship, adjusting for these factors and medical school-specific fixed effects in a multivariable regression model.

RESULTS

Among 3810 cardiologists with faculty appointments in 2014 (13.3% of all US cardiologists), 630 (16.5%) were women. Women faculty were younger than men (mean age, 48.3 years versus 53.5 years, P<0.001), had fewer total publications (mean number: 16.5 publications versus 25.2 publications; P<0.001), were similarly likely to have National Institutes of Health funding (proportion with at least 1 National Institutes of Health award, 10.8% versus 10.4%; P=0.77), and were less likely to have a registered clinical trial (percentage with at least 1 clinical trial, 8.9% versus 11.1%; P=0.10). Among 3180 men, 973 (30.6%) were full professors in comparison with 100 (15.9%) of 630 women. In adjusted analyses, women were less likely to be full professors than men (adjusted odds ratio, 0.63; 95% confidence interval, 0.43-0.94; P=0.02; adjusted proportions, 22.7% versus 26.7%; absolute difference, -4.0%; 95% confidence interval, -7.5% to -0.7%).

CONCLUSIONS

Among cardiology faculty at US medical schools, women were less likely than men to be full professors after accounting for several factors known to influence faculty rank.

Are Female Applicants Disadvantaged in National Institutes of Health Peer Review? Combining Algorithmic Text Mining and Qualitative Methods to Detect Evaluative Differences in R01 Reviewers' Critiques

BACKGROUND

Women are less successful than men in renewing R01 grants from the National Institutes of Health. Continuing to probe text mining as a tool to identify gender bias in peer review, we used algorithmic text mining and qualitative analysis to examine a sample of critiques from men's and women's R01 renewal applications previously analyzed by counting and comparing word categories.

METHODS

We analyzed 241 critiques from 79 Summary Statements for 51 R01 renewals awarded to 45 investigators (64% male, 89% white, 80% PhD) at the University of Wisconsin-Madison between 2010 and 2014. We used latent Dirichlet allocation to discover evaluative "topics" (i.e., words that co-occur with high probability). We then qualitatively examined the context in which evaluative words occurred for male and female investigators. We also examined sex differences in assigned scores controlling for investigator productivity.

RESULTS

Text analysis results showed that male investigators were described as "leaders" and "pioneers" in their "fields," with "highly innovative" and "highly significant research." By comparison, female investigators were characterized as having "expertise" and working in "excellent" environments. Applications from men received significantly better priority, approach, and significance scores, which could not be accounted for by differences in productivity.

CONCLUSIONS

Results confirm our previous analyses suggesting that gender stereotypes operate in R01 grant peer review. Reviewers may more easily view male than female investigators as scientific leaders with significant and innovative research, and score their applications more competitively. Such implicit bias may contribute to sex differences in award rates for R01 renewals.

Structured Annual Faculty Review Program Accelerates Professional Development and Promotion: Long-Term Experience of the Duke University Medical Center's Pathology Department

This retrospective observational study on faculty development analyzes the Duke University Pathology Department's 18-year experience with a structured mentoring program involving 51 junior faculty members. The majority had MD degrees only (55%). The percentage of young women faculty hires before 1998 was 25%, increasing to 72% after 2005. Diversity also broadened from 9% with varied heritages before 1998 to 37% since then. The mentoring process pivoted on an annual review process. The reviews generally helped candidates focus much earlier, identified impediments they individually felt, and provided new avenues to gain a national reputation for academic excellence. National committee membership effectively helped gain national exposure. Thirty-eight percent of the mentees served on College of American Pathologists (CAP) committees, exponential multiples of any other national society. Some used CAP resources to develop major programs, some becoming nationally and internationally recognized for their academic activities. Several faculty gained national recognition as thought leaders for publishing about work initiated to serve administrative needs in the Department. The review process identified the need for more protected time for research, issues with time constraints, and avoiding exploitation when collaborating with other departments. This review identified a rigorous faculty mentoring and review process that included annual career counseling, goal-oriented academic careers, monitored advancement to promotion, higher salaries, and national recognition. All contributed to high faculty satisfaction and low faculty turnover. We conclude that a rigorous annual faculty review program and its natural sequence, promotion, can greatly foster faculty satisfaction.

A Randomized Controlled Trial to Improve the Success of Women Assistant Professors

Background: Given the persistent disparity in the advancement of women compared with men faculty in academic medicine, it is critical to develop effective interventions to enhance women's careers. We carried out a cluster-randomized, multifaceted intervention to improve the success of women assistant professors at a research-intensive medical school.

Materials and Methods: Twenty-seven departments/divisions were randomly assigned to intervention or control groups. The three-tiered intervention included components that were aimed at (1) the professional development of women assistant professors, (2) changes at the department/division level through faculty-led task forces, and (3) engagement of institutional leaders. Generalized linear models were used to test associations between assignment and outcomes, adjusting for correlations induced by the clustered design.

Results: Academic productivity and work self-efficacy improved significantly over the 3-year trial in both intervention and control groups, but the improvements did not differ between the groups. Average hours worked per week declined significantly more for faculty in the intervention group as compared with the control group (−3.82 vs. −1.39 hours, respectively, p = 0.006). The PhD faculty in the intervention group published significantly more than PhD controls; however, no differences were observed between MDs in the intervention group and MDs in the control group.

Conclusions: Significant improvements in academic productivity and work self-efficacy occurred in both intervention and control groups, potentially due to school-wide intervention effects. A greater decline in work hours in the intervention group despite similar increases in academic productivity may reflect learning to “work smarter” or reveal efficiencies brought about as a result of the multifaceted intervention. The intervention appeared to benefit the academic productivity of faculty with PhDs, but not MDs, suggesting that interventions should be more intense or tailored to specific faculty groups.

Speaker Introductions at Internal Medicine Grand Rounds: Forms of Address Reveal Gender Bias

BACKGROUND

Gender bias has been identified as one of the drivers of gender disparity in academic medicine. Bias may be reinforced by gender subordinating language or differential use of formality in forms of address. Professional titles may influence the perceived expertise and authority of the referenced individual. The objective of this study is to examine how professional titles were used in the same and mixed-gender speaker introductions at Internal Medicine Grand Rounds (IMGR).

METHODS

A retrospective observational study of video-archived speaker introductions at consecutive IMGR was conducted at two different locations (Arizona, Minnesota) of an academic medical center. Introducers and speakers at IMGR were physician and scientist peers holding MD, PhD, or MD/PhD degrees. The primary outcome was whether or not a speaker's professional title was used during the first form of address during speaker introductions at IMGR. As secondary outcomes, we evaluated whether or not the speakers professional title was used in any form of address during the introduction.

RESULTS

Three hundred twenty-one forms of address were analyzed. Female introducers were more likely to use professional titles when introducing any speaker during the first form of address compared with male introducers (96.2% [102/106] vs. 65.6% [141/215]; p < 0.001). Female dyads utilized formal titles during the first form of address 97.8% (45/46) compared with male dyads who utilized a formal title 72.4% (110/152) of the time (p = 0.007). In mixed-gender dyads, where the introducer was female and speaker male, formal titles were used 95.0% (57/60) of the time. Male introducers of female speakers utilized professional titles 49.2% (31/63) of the time (p < 0.001).

CONCLUSION

In this study, women introduced by men at IMGR were less likely to be addressed by professional title than were men introduced by men. Differential formality in speaker introductions may amplify isolation, marginalization, and professional discomfiture expressed by women faculty in academic medicine.

Advancing Women's Health and Women's Leadership With Endowed Chairs in Women's Health

Gender-based bias and conflation of gender and status are root causes of disparities in women's health care and the slow advancement of women to leadership in academic medicine. More than a quarter of women physicians train in internal medicine and its subspecialties, and women physicians almost exclusively constitute the women's health focus within internal medicine. Thus, internal medicine has considerable opportunity to develop women leaders in academic medicine and promote women's health equity.To probe whether holding an endowed chair-which confers status-in women's health may be an effective way to advance women leaders in academic medicine and women's health, the authors explored the current status of endowed chairs in women's health in internal medicine. They found that the number of these endowed chairs in North America increased from 7 in 2013 to 19 in 2015, and all were held by women. The perceptions of incumbents and other women's health leaders supported the premise that an endowed chair in women's health would increase women's leadership, the institutional stature of women's health, and activities in women's health research, education, and clinical care.Going forward, it will be important to explore why not all recipients perceived that the endowed chair enhanced their own academic leadership, whether providing women's health leaders with fundraising expertise fosters future success in increasing the number of women's health endowed chairs, and how the conflation of gender and status play out (e.g., salary differences between endowed chairs) as the number of endowed chairs in women's health increases.

Changing the Culture of Academic Medicine: Critical Mass or Critical Actors?

PURPOSE

By 2006, women constituted 34% of academic medical faculty, reaching a critical mass. Theoretically, with critical mass, culture and policy supportive of gender equity should be evident. We explore whether having a critical mass of women transforms institutional culture and organizational change.

METHODS

Career development program participants were interviewed to elucidate their experiences in academic health centers (AHCs). Focus group discussions were held with institutional leaders to explore their perceptions about contemporary challenges related to gender and leadership. Content analysis of both data sources revealed points of convergence. Findings were interpreted using the theory of critical mass.

RESULTS

Two nested domains emerged: the individual domain included the rewards and personal satisfaction of meaningful work, personal agency, tensions between cultural expectations of family and academic roles, and women's efforts to work for gender equity. The institutional domain depicted the sociocultural environment of AHCs that shaped women's experience, both personally and professionally, lack of institutional strategies to engage women in organizational initiatives, and the influence of one leader on women's ascent to leadership.

CONCLUSIONS

The predominant evidence from this research demonstrates that the institutional barriers and sociocultural environment continue to be formidable obstacles confronting women, stalling the transformational effects expected from achieving a critical mass of women faculty. We conclude that the promise of critical mass as a turning point for women should be abandoned in favor of "critical actor" leaders, both women and men, who individually and collectively have the commitment and power to create gender-equitable cultures in AHCs.

Factors that Can Promote or Impede the Advancement of Women as Leaders in Surgery: Results from an International Survey

BACKGROUND

Compared with male surgeons, women have less success advancing their careers and are underrepresented in leadership positions in surgery. The purpose of this study is to identify the qualifications necessary to become leaders in surgery and the career barriers faced by women surgeons in various cultural environments.

METHODS

A survey was performed with women surgeons in Japan, USA, Finland, and Hong Kong, China, to assess various barriers faced by women surgeons in the respective countries. To develop appropriate survey tool, a preliminary questionnaire was distributed to leaders in surgery and also in various organizations worldwide.

RESULTS

The response rate was 23 % with 225 of 964 survey returned. Japanese women surgeons identify lacked family support as impeding a successful surgical career. US women surgeons feel more latent gender discrimination. Finnish women surgeons are less likely to need to sacrifice work-life balance, when holding leadership positions. Women surgeons worldwide are highly motivated to develop their career and agree the percentage of women surgeons in leadership positions should be increased.

CONCLUSIONS

Women surgeons in different countries perceive different challenges. We must develop strategies and should not hesitate to negotiate to overcome these issues to reach leadership positions in surgery. This may be accomplished through networking worldwide to improve current conditions and obstacles.

Women in medical education: views and experiences from the Kingdom of Saudi Arabia

CONTEXT

Although research from Western contexts suggests that considerable inequalities for female medical educators exist in the workplace, we do not yet know the views and experiences of women within non-Western contexts. By examining the influence of context, intersecting identities and language use, this study explores female medical educators' views and experiences of gender, career progression and leadership in academic medicine in the Kingdom of Saudi Arabia (KSA).

METHODS

We conducted individual interviews employing narrative interviewing techniques with 25 female medical educators from five schools in the KSA (June to December 2014). Data were analysed using framework analysis and drew on intersectionality theory.

RESULTS

Participants expressed their views and experiences of career progression, leadership and gendered workplace cultures. Women's experiences of career progression and leadership in the KSA were influenced by their gender and varied according to their career stage, work environment and specialty. Participants discussed the gendered organisational cultures of academic medicine in the KSA in terms of gender inequalities (e.g. females being overlooked for leadership positions), gender stereotypes (e.g. women perceived as more likely to take part in shared leadership) and gendered specialties (e.g. surgery being male dominated). We revealed women's more tacit understandings about gender, career progression and leadership by examining how they talk (e.g. metaphoric, pronominal and emotional talk). Finally, participants constructed multiple intersecting personal (e.g. female, mother and young) and professional identities (e.g. doctor, teacher and leader) for themselves through their narratives.

CONCLUSION

This study provides important new insights into female medical educators' experiences of career progression and leadership in a non-Western context. Investment in the future of women's careers in the KSA through faculty development initiatives and equality and diversity policies is now essential to help close the gender gap.

Retaining Faculty in Academic Medicine: The Impact of Career Development Programs for Women

BACKGROUND

For more than two decades, national career development programs (CDPs) have addressed underrepresentation of women faculty in academic medicine through career and leadership curricula. We evaluated CDP participation impact on retention.

METHODS

We used Association of American Medical Colleges data to compare 3268 women attending CDPs from 1988 to 2008 with 17,834 women and 40,319 men nonparticipant faculty similar to CDP participants in degree, academic rank, first year of appointment in rank, and home institution. Measuring from first year in rank to departure from last position held or December 2009 (study end date), we used Kaplan-Meier curves; Cox survival analysis adjusted for age, degree, tenure, and department; and 10-year rates to compare retention.

RESULTS

CDP participants were significantly less likely to leave academic medicine than their peers for up to 8 years after appointment as Assistant and Associate Professors. Full Professor participants were significantly less likely to leave than non-CDP women. Men left less often than non-CDP women at every rank. Participants attending more than one CDP left less often than those attending one, but results varied by rank. Patterns of switching institutions after 10 years varied by rank; CDP participants switched significantly less often than men at Assistant and Associate Professor levels and significantly less often than non-CDP women among Assistant Professors. Full Professors switched at equal rates.

CONCLUSION

National CDPs appear to offer retention advantage to women faculty, with implications for faculty performance and capacity building within academic medicine. Intervals of retention advantage for CDP participants suggest vulnerable periods for intervention.

Where is the leak in the pipeline? Investigating gender differences in academic promotion at an academic medical centre

BACKGROUND

Women are still under-represented in the senior ranks of academic medicine. As local surveys represent a critical initial step in addressing the challenges of gender disparities in academic promotion within institutions, we surveyed faculty at an academic medical centre to identify factors to improve the academic advancement of women.

METHODS

We conducted an electronic survey of all full-time faculty members in a Department of Medicine assessing academic rank and factors important in consideration for promotion.

RESULTS

106 faculty members (46 %) responded to the survey; 40 % of the respondents were women. There was a statistically significant gender gap in faculty rank (p = 0.002), with only 2 of 17 full professor positions occupied by women. Among faculty who had not yet requested promotion, women were more likely to report that they did not think an academic promotion would benefit them (69 vs. 32 % in men, p = 0.01), and to report a lack of encouragement for requesting promotion (50 vs. 29 %, p = 0.08).

CONCLUSIONS

Targeting the perceived value of academic promotion among women faculty, increasing junior faculty mentorship and modifying annual review processes could address gender disparities in academic medicine ranks.

Habilitations as a bottleneck? A retrospective analysis of gender differences at the Medical University of Vienna

BACKGROUND

The share of female physicians who drop out of a university career increases disproportionately with every career step. In this project, we analysed careers at the Medical University of Vienna (formerly the Medical Faculty at the University of Vienna) in the time span from 1992 to 2012 to explore the particular role of habilitations as a potential obstacle for women striving to pursue a career in science.

METHODS

To gain both a macro- and micro-view of the phenomenon of habilitations, a descriptive analysis of the data found in the archive of the Medical University of Vienna was carried out as a first step. Building on these results, structured interviews with the female physicians who were involved in the habilitation procedures at that time were conducted.

RESULTS

While hardly any gender-based differences or discrimination can be reported for the habilitation procedures themselves, the research clearly reveals that the disparity in habilitations by men and women is a manifestation of unequal access to informal networks, differences regarding integration in the scientific community and available time resources. It is unlikely that the rising number of women completing doctoral studies in the field of medicine will automatically lead to a harmonisation of habilitation numbers.

CONCLUSION

The analysis of existing gender-based differences with regard to habilitations in the field of medicine shows that they result from multiple processes that are subtle and relatively resistant to change.

Positive trends in neurosurgery enrollment and attrition: analysis of the 2000-2009 female neurosurgery resident cohort

OBJECTIVE

Women compose a minority of neurosurgery residents, averaging just over 10% of matched applicants per year during this decade. A recent review by Lynch et al. raises the concern that women may be at a higher risk than men for attrition, based on analysis of a cohort matched between 1990 and 1999. This manuscript aims to characterize the trends in enrollment, attrition, and postattrition careers for women who matched in neurosurgery between 2000 and 2009.

METHODS

Databases from the American Association of Neurological Surgeons (AANS) and the American Board of Neurological Surgery (ABNS) were analyzed for all residents who matched into neurosurgery during the years 2000-2009. Residents were sorted by female gender, matched against graduation records, and if graduation was not reported from neurosurgery residency programs, an Internet search was used to determine the residents' alternative path. The primary outcome was to determine the number of women residents who did not complete neurosurgery training programs during 2000-2009. Secondary outcomes included the total number of women who matched into neurosurgery per year, year in training in which attrition occurred, and alternative career paths that these women chose to pursue.

RESULTS

Women comprised 240 of 1992 (12%) matched neurosurgery residents during 2000-2009. Among female residents there was a 17% attrition rate, compared with a 5.3% male attrition rate, with an overall attrition rate of 6.7%. The majority who left the field did so within the first 3 years of neurosurgical training and stayed in medicine--pursuing anesthesia, neurology, and radiology.

CONCLUSIONS

Although the percentage of women entering neurosurgical residency has continued to increase, this number is still disproportionate to the overall number of women in medicine. The female attrition rate in neurosurgery in the 2000-2009 cohort is comparable to that of the other surgical specialties, but for neurosurgery, there is disparity between the male and female attrition rates. Women who left the field tended to stay within medicine and usually pursued a neuroscience-related career. Given the need for talented women to pursue neurosurgery and the increasing numbers of women matching annually, the recruitment and retention of women in neurosurgery should be benchmarked and assessed.

Supervisor or mentor: is there a difference? Implications for paediatric practice

The formal roles of educational and clinical supervisor focus on education planning and goal setting against required training elements. Assessment of performance is integral to these roles that necessarily involve some elements of developmental support to trainees. Mentoring is increasingly seen as a desirable route to support doctors in training. Definitions vary, but core expectations of mentors are that they encourage personal development and offer psychosocial support to a trainee within a longitudinal relationship. A key question is whether a supervisor is the appropriate individual to act as a mentor to an individual trainee. The supervisor's role as an assessor of performance can pose challenges and potential conflicts when providing support relating to other personal needs of trainees along their career paths. It is apparent from the literature that mentoring is a multifaceted role, with different actions required of mentors and supervisors. There is evidence that mentorship can affect specialty choice, academic output and commitment to organisations. Addressing the challenges posed by an ideal of providing mentoring to all trainees is potentially as important as ensuring supervisors of competence. The potential benefits for the profession are of enhancing the development and retention of trainees of high calibre within the paediatric discipline.

Sex Differences Among Career Development Awardees in the Attainment of Independent Research Funding in a Department of Medicine

BACKGROUND

National data suggest that women are overall less likely than men to attain independent research funding. However, it remains unclear whether such sex differences are also observed in academic institutions that have integrated diversity in the workplace as a priority.

METHODS

During 1999-2008, all National Institutes of Health (NIH) Career Development (K01, K08, or K23) awardees in the Department of Medicine at Johns Hopkins University School of Medicine were identified to investigate differences in the attainment of independent funding by sex, including NIH Research Project Grant (R01) or equivalent awards, (U01, P01, P50), and any R award (also R03, R21, R34) through 2012.

RESULTS

A similar number of men (n = 49) and women (n = 43) received a K award. There were no significant sex differences in attaining an R01/equivalent award or any R award. The median time to attaining the first R01/equivalent award was similar for men and women (5.6 vs. 5.3 years, p = 0.93). The actuarial rate of R01/equivalent award attainment at 10 years was 64% overall (56% among men vs. 74% among women; log-rank p = 0.41). For any R award, the rate was 72% overall (70% among men vs. 76% among women; log-rank p = 0.63). In Cox proportional hazards models, adjusting for race/ethnicity, age, Doctor of Medicine (MD) degree, and funding period, sex was not an independent predictor of R01/equivalent or any R award attainment. Interestingly, black race and/or Hispanic ethnicity significantly predicted any R award attainment (adjusted hazard ratio [HR] = 2.34, 95% confidence interval [CI] 1.02-5.37).

CONCLUSIONS

No sex differences were found in the attainment of independent funding by K awardees in our study. Future studies to investigate the impact of specific diversity initiatives on subsequent success in attaining independent research funding are needed.

A facilitated peer mentoring program for junior faculty to promote professional development and peer networking

PURPOSE

To explore the design, implementation, and efficacy of a faculty development program in a cohort of early career junior faculty.

METHOD

Interested junior faculty members were divided into interdisciplinary small groups led by senior faculty facilitators. The groups met monthly for 1.5 hours to review a modular curriculum from 2011 to 2013. Using a survey at two time points (September 2011 and 2013) and an interim program evaluation, the authors collected data on participants' demographics, faculty interconnectedness, and self-reported knowledge, skills, and attitudes (KSA) in the domains of professional development and scholarship, including the ability to write career goals and align activities with those goals.

RESULTS

A total of 104 junior faculty participated in the program. They demonstrated changes in self-reported KSA in the domains of professional development (P = .013, P = .001) and scholarship (P = .038, P = .015) with an increase in ability to write career goals (P < .001), ability to align activities with those goals (P < .001), and number of and amount of time spent pursuing activities related to those goals (P = .022). These changes were more significant among female faculty and were not affected by academic rank or time since last training. Interconnectedness among faculty increased during the period of study-the number of nodes and ties between nodes within the network increased.

CONCLUSIONS

This facilitated peer mentoring program for junior faculty was effective in improving the KSA necessary to promote early career advancement and peer networking, especially for women.

Implementation and evaluation of the Johns Hopkins University School of Medicine leadership program for women faculty

BACKGROUND

Women continue to be underrepresented in top leadership roles in academic medicine. Leadership training programs for women are designed to enhance women's leadership skills and confidence and increase overall leadership diversity. The authors present a description and evaluation of a longitudinal, cohort-based, experiential leadership program for women faculty at the Johns Hopkins University School of Medicine.

METHODS

We compared pre- and post-program self-assessed ratings of 11 leadership skills and specific negotiation behaviors from 3 cohorts of leadership program participants (n=134) from 2010 to 2013.

RESULTS

Women reported significant improvements in skills across 11 domains with the exceptions of 2 domains, Public Speaking and Working in Teams, both of which received high scores in the pre-program assessment. The greatest improvement in rankings occurred within the domain of negotiation skills. Although women reported an increase in their negotiation skills, we were not able to demonstrate an increase in the number of times that women negotiated for salary, space, or promotion following participation in the program.

CONCLUSIONS

The Johns Hopkins School of Medicine Leadership Program for Women Faculty has demonstrable value for the professional development of participants and addresses institutional strategies to enhance leadership diversity and the advancement of women.

Ethnic and gender diversity in hand surgery trainees

PURPOSE

To evaluate whether the lack of diversity in plastic and orthopedic surgery persists into hand surgery through assessment of trainee demographics.

METHODS

Demographic data were obtained from compilations on graduate medical education by the Journal of the American Medical Association. Ethnic diversity was assessed using the proportions of minority trainees. We analyzed the trends in ethnic diversity in hand, orthopedic, and plastic surgery from 1995 to 2012 by evaluating changes in proportions of African American, Hispanic, and Asian trainees. In addition, we compared the proportions of minority trainees in various surgical specialties during 2009 to 2012. Trends in gender diversity were similarly analyzed using the proportions of female trainees.

RESULTS

During 1995 to 2012, the proportions of minority and female trainees increased significantly in the fields of orthopedic, plastic, and hand surgery. To assess the current state of diversity in various specialties, we compared minority and female population proportions using pooled 2009 to 2012 data. The percentage of non-Caucasian trainees in hand surgery was significantly higher than that in orthopedic sports medicine and orthopedic surgery and significantly lower than in general surgery. The percentage of female trainees in hand surgery was significantly higher than that in orthopedic sports medicine and orthopedic surgery and significantly lower than in plastic and general surgery.

CONCLUSIONS

Ethnic and gender diversity in hand surgery increased significantly between 1995 and 2012. Women constitute a fifth of hand surgery trainees. Efforts to increase diversity should be further pursued using proven strategies and innovating new ones.

CLINICAL RELEVANCE

Diversity in the medical field has shown to be a beneficial factor in many aspects including research productivity and patient care. Understanding how the field of hand surgery has changed with regard to the diversity of its trainees may aid in providing more equitable and effective health care.

Developing a mentorship program for psychiatry residents

OBJECTIVE

The authors sought to evaluate a formal mentorship program for second-year psychiatry residents at the University of Toronto after the program's first year of implementation.

METHODS

Ten mentees and ten faculty mentors were interviewed by fellow second-year residents and an independent researcher, respectively, about their experiences in the program. Interview data were thematically coded and analyzed using a grounded theory approach.

RESULTS

Three major themes were identified. First, participants emphasized the importance of a natural, flexible, and engaging matching process for mentors and mentees. Many experienced the random assignment approach to matching and the mandatory nature of the program as barriers to developing a meaningful relationship with their mentors. Second, participants expressed a preference for geographic proximity between mentor and mentee workplaces and for meetings to take place in informal settings in order to improve the quality and quantity of their interactions. Lastly, participants felt that clear directions and expectations about the program's goals should be communicated, and that a forum for information sharing among mentors was needed.

CONCLUSIONS

Overall, the majority of participants believed that the program facilitated growth and development and provided positive opportunities for both mentors and mentees. While challenges were present in the program, participants provided tangible recommendations to improve the process.

How men can excel as mentors of women

Most male professionals have more experience mentoring men than they do mentoring women, and their male mentees progress further than their female mentees. Yet, in academic medicine, men have few forums in which to discuss the gender-related issues that they encounter. To address the gender-related questions that commonly arise, the author of this commentary offers perspectives and recommendations, consolidated from over 25 years of experience leading career and talent development programs, to assist men in successfully mentoring women. Her recommendations are organized around three questions: (1) How do women's and men's experiences in mentoring relationships tend to differ? (2) What interferes with the accurate evaluation of women's skills? and (3) Is the current generation of female trainees still at a gender-related disadvantage? She argues that men's ability to effectively mentor women depends to a great extent on their understanding of the challenges that women disproportionately face in developing their careers. Mentors who are skilled in adapting to the gender-related needs of mentees will contribute to women's retention and development in academic medicine, enhance the leadership capacity of their organizations and the profession, and extend their own legacies.

Perceptions of skill development of participants in three national career development programs for women faculty in academic medicine

PURPOSE

The Association of American Medical Colleges (AAMC) and Drexel University College of Medicine have designed and implemented national career development programs (CDPs) to help women faculty acquire and strengthen skills needed for success in academic medicine. The authors hypothesized that skills women acquired in CDPs would vary by career stage and program attended.

METHOD

In 2011, the authors surveyed a national cohort of 2,779 women listed in the AAMC Faculty Roster who also attended one of three CDPs (Early- and Mid-Career Women in Medicine Seminars, and/or Executive Leadership in Academic Medicine) between 1988 and 2010 to examine their characteristics and CDP experiences. Participants indicated from a list of 16 skills whether each skill was newly acquired, improved, or not improved as a result of their program participation.

RESULTS

Of 2,537 eligible CDP women, 942 clicked on the link in an invitation e-mail, and 879 (93%) completed the survey. Respondents were representative of women faculty in academic medicine. Participants rated the CDPs highly. Almost all reported gaining and/or improving skills from the CDP. Four skills predominated across all three programs: interpersonal skills, leadership, negotiation, and networking. The skills that attendees endorsed differed by respondents' career stages, more so than by program attended.

CONCLUSIONS

Women participants perceived varying skills gained or improved from their attendance at the CDPs. Determining ways in which CDPs can support women's advancement in academic medicine requires a deeper understanding of what participants seek from CDPs and how they use program content to advance their careers.

Long-term follow-up of a facilitated peer mentoring program

BACKGROUND

Mentoring plays an important role in career success of academic medical faculty. New mentoring models such as peer mentoring have emerged.

AIM

To evaluate the long-term impact of a facilitated peer mentoring program on academic achievements.

METHOD

Women faculty at the instructor or assistant professor rank were recruited to voluntarily participate in a facilitated peer mentoring program. Recruitment occurred over 3.8 years between 2005 and 2009. A 26-item questionnaire to assess academic skill, career satisfaction, and self-efficacy was administered before program participation and again with seven additional questions in 2011. Curriculum vitae were reviewed retrospectively to tally peer-reviewed publications, other academic activities, and promotions.

RESULTS

Participants had long-term improvement in their perceived mastery of academic skills. Peer-reviewed publications, book chapters, abstracts, posters, and other academic activities increased when activities before the program were compared to those in the five years after program enrollment. At follow-up, participants reported positive perceptions of the program and 44% continued to work with their original peer mentor groups.

CONCLUSIONS

Involvement in the facilitated peer mentoring program was associated with increased skills and academic activities for most participants. Future studies are needed to assess its applicability and success among various demographic groups in academic medicine.

Gender distribution of U.S. medical school faculty by academic track type

PURPOSE

Over the past 30 years, the number and type of academic faculty tracks have increased, and researchers have found differences in promotion rates between track types. The authors studied the gender distribution of medical school faculty on the traditional tenure track (TTT) and clinician-educator track (CET) types.

METHOD

The authors analyzed gender and academic track type distribution data from the March 31, 2011, snapshot of the Association of American Medical Colleges' Faculty Roster. Their final analysis included data from the 123 medical schools offering the TTT type and the 106 offering the CET type, which excluded any schools with 10 or fewer faculty on each track type.

RESULTS

The original dataset included 134 medical schools representing 138,508 full-time faculty members, 50,376 (36%) of whom were women. Of the 134 medical schools, 128 reported at least one of four track types: TTT, CET, research track, and other. Of the 83 medical schools offering the CET type, 64 (77%) had a higher proportion of female than male faculty on that track type. Of the 102 medical schools offering the TTT type, only 20 (20%) had a higher proportion of female than male faculty on that track type.

CONCLUSIONS

Medical schools offering the CET type reported higher proportions of female faculty on that track type. Given that faculty on the CET type lag behind their TTT colleagues in academic promotion, these findings may contribute to continued challenges in gaining academic and leadership parity for women in academic medicine.

Strategies for building an effective mentoring relationship

Mentoring has been recognized as a critical aspect of the professional and/or personal development of the student, resident or faculty member. This career development resource discusses strategies for building effective mentoring relationships and outlines some of the challenges to contemporary mentoring.

Geographic mobility advances careers: study of the Executive Leadership in Academic Medicine (ELAM) program for women

PURPOSE

To explore whether geographic mobility is associated with career advancement of women in U.S. medical schools who are entering mid- to executive-level positions.

METHOD

Using an existing dataset of 351 participants in academic medicine who attended the Executive Leadership in Academic Medicine (ELAM) Program for Women (1996-2005) (adjusted to 345 participants in some analyses because data on initial faculty rank were missing), the authors conducted a quantitative study in 2009 to determine whether geographic mobility was associated with administrative promotion for those who relocated geographically (from employer while attending ELAM to employer at last job of record).

RESULTS

Twenty-four percent of women (83/345) relocated geographically (movers) after attending ELAM. Moving had a positive association with career advancement (P = .001); odds for promotion were 168% higher for movers than for stayers [odds ratio Exp(β) = 2.684]. Movers attained higher administrative positions (P = .003), and more movers (60%) were promoted at the most recent job compared with stayers (40%) (P = .0001). Few movers changed city size; 70% already resided in large or urban cities where most medical schools are located. Age was not a barrier to mobility. Career advancement was not related to research reputation (National Institutes of Health grant award ranking) of participants' schools (either at time of attending ELAM or post-ELAM).

CONCLUSIONS

Similar to findings outside academic medicine, 24% of women classified as geographic "movers" among midcareer faculty in medical schools attained career advantages. Psychosocial and socioeconomic factors underlying women's relocation decisions require additional study.

Sponsorship: a path to the academic medicine C-suite for women faculty?

Despite increases in the percentages of women medical school graduates and faculty over the past decade, women physicians and scientists remain underrepresented in academic medicine's highest-level executive positions, known as the "C-suite." The challenges of today and the future require novel approaches and solutions that depend on having diverse leaders. Such diversity has been widely shown to be critical to creating initiatives and solving complex problems such as those facing academic medicine and science. However, neither formal mentoring programs focused on individual career development nor executive coaching programs focused on individual job performance have led to substantial increases in the proportion of women in academic medicine's top leadership positions.Faced with a similar dilemma, the corporate world has initiated sponsorship programs designed to accelerate the careers of women as leaders. Sponsors differ from mentors and coaches in one key area: They have the position and power to advocate publicly for the advancement of nascent talent, including women, in the organization. Although academic medicine differs from the corporate world, the strong sponsorship programs that have advanced women into corporations' upper levels of leadership can serve as models for sponsorship programs to launch new leaders in academic medicine.

Global health experiences of U.S. Physicians: a mixed methods survey of clinician-researchers and health policy leaders

BACKGROUND

Interest and participation in global health activities among U.S. medical trainees has increased sharply in recent decades, yet the global health activities of physicians who have completed residency training remain understudied. Our objectives were to assess associations between individual characteristics and patterns of post-residency global health activities across the domains of health policy, education, and research.

METHODS

Cross-sectional, mixed methods national survey of 521 physicians with formal training in clinical and health services research and policy leadership. Main measures were post-residency global health activity and characteristics of this activity (location, funding, products, and perceived synergy with domestic activities).

RESULTS

Most respondents (73%) hold faculty appointments across 84 U.S. medical schools and a strong plurality (46%) are trained in internal medicine. Nearly half of all respondents (44%) reported some global health activity after residency; however, the majority of this group (73%) reported spending ≤10% of professional time on global health in the past year. Among those active in global health, the majority (78%) reported receiving some funding for their global health activities, and most (83%) reported at least one scholarly, educational, or other product resulting from this work. Many respondents perceived synergies between domestic and global health activities, with 85% agreeing with the statement that their global health activities had enhanced the quality of their domestic work and increased their level of involvement with vulnerable populations, health policy advocacy, or research on the social determinants of health. Despite these perceived synergies, qualitative data from in-depth interviews revealed personal and institutional barriers to sustained global health involvement, including work-family balance and a lack of specific avenues for career development in global health.

CONCLUSIONS

Post-residency global health activity is common in this diverse, multi-specialty group of physicians. Although those with global health experience describe synergies with their domestic work, the lack of established career development pathways may limit the benefits of this synergy for individuals and their institutions.

"A good career choice for women": female medical students' mentoring experiences: a multi-institutional qualitative study

PURPOSE

The career decisions, practice patterns, and approach to patient care of current female students, who make up close to 50% of medical school classes, will have a profound impact on the profession. This study explores the role gender plays in the mentoring experiences of female medical students.

METHOD

In 2011, the authors conducted focus groups with 48 third- and fourth-year female medical students at four U.S. medical schools. Using a template organizing style, they derived themes in an iterative process to explore female medical students' mentoring relationships and the impact of gender on those relationships.

RESULTS

The authors identified four major themes: (1) Optimal mentoring relationships are highly relational. Students emphasized shared values, trust, and a personal connection in describing ideal mentoring relationships. (2) Relational mentoring is more important than gender concordance. Students identified a desire for access to female mentors but stated that when a mentor and mentee developed a personal connection, the gender of the mentor was less important. (3) Gender-based assumptions and stereotypes affect mentoring relationships. Students described gender-based assumptions and expectations for themselves and their mentors. (4) Gender-based power dynamics influence students' thinking about mentoring. Students stated that they were concerned about how their mentors might perceive their professional decisions because of their gender, which influenced what they disclosed to male mentors and mentors in positions of power.

CONCLUSIONS

Gender appears to play a role in female medical students' expectations and experience with mentoring relationships and may influence their decision making around career planning.

Experiencing the culture of academic medicine: gender matters, a national study

BACKGROUND

Energized and productive faculty are critical to academic medicine, yet studies indicate a lack of advancement and senior roles for women.

OBJECTIVE

Using measures of key aspects of the culture of academic medicine, this study sought to identify similarity and dissimilarity between perceptions of the culture by male and female faculty.

DESIGN

The C - Change Faculty Survey was used to collect data on perceptions of organizational culture.

PARTICIPANTS

A stratified random sample of 4,578 full-time faculty at 26 nationally representative US medical colleges (response rate 52 %). 1,271 (53 %) of respondents were female.

MAIN MEASURES

Factor analysis assisted in the creation of scales assessing dimensions of the culture, which served as the key outcomes. Regression analysis identified gender differences while controlling for other demographic characteristics.

KEY RESULTS

Compared with men, female faculty reported a lower sense of belonging and relationships within the workplace (T = -3.30, p < 0.01). Self-efficacy for career advancement was lower in women (T = -4.73, p < 0.001). Women perceived lower gender equity (T = -19.82, p < 0.001), and were less likely to believe their institutions were making changes to address diversity goals (T = -9.70, p < 0.001). Women were less likely than men to perceive their institution as family-friendly (T = -4.06, p < 0.001), and women reported less congruence between their own values and those of their institutions (T = -2.06, p < 0.05). Women and men did not differ significantly on levels of engagement, leadership aspirations, feelings of ethical/moral distress, perception of institutional commitment to faculty advancement, or perception of institutional change efforts to improve support for faculty.

CONCLUSIONS

Faculty men and women are equally engaged in their work and share similar leadership aspirations. However, medical schools have failed to create and sustain an environment where women feel fully accepted and supported to succeed; how can we ensure that medical schools are fully using the talent pool of a third of its faculty?

Systems of career influences: a conceptual model for evaluating the professional development of women in academic medicine

BACKGROUND

Surprisingly little research is available to explain the well-documented organizational and societal influences on persistent inequities in advancement of women faculty.

METHODS

The Systems of Career Influences Model is a framework for exploring factors influencing women's progression to advanced academic rank, executive positions, and informal leadership roles in academic medicine. The model situates faculty as agents within a complex adaptive system consisting of a trajectory of career advancement with opportunities for formal professional development programming; a dynamic system of influences of organizational policies, practices, and culture; and a dynamic system of individual choices and decisions. These systems of influence may promote or inhibit career advancement. Within this system, women weigh competing influences to make career advancement decisions, and leaders of academic health centers prioritize limited resources to support the school's mission.

RESULTS AND CONCLUSIONS

The Systems of Career Influences Model proved useful to identify key research questions. We used the model to probe how research in academic career development might be applied to content and methods of formal professional development programs. We generated a series of questions and hypotheses about how professional development programs might influence professional development of health science faculty members. Using the model as a guide, we developed a study using a quantitative and qualitative design. These analyses should provide insight into what works in recruiting and supporting productive men and women faculty in academic medical centers.