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

A Coaching-Based Leadership Program for Women Postdoctoral Fellows at the National Cancer Institute that Cultivates Self-confidence and Persistence in STEMM

Despite making strides in gender equality, women in Science, Technology, Engineering, Mathematics, and Medicine (STEMM) continue to face a persistent underrepresentation in leadership roles. In an effort to reverse this trend, the National Cancer Institute created the Sallie Rosen Kaplan (SRK) Postdoctoral Fellowship, a year-long coaching-based leadership training program. The SRK program aims to empower women to explore careers across a broad range of fields, including academia, industry, and government, and to excel in leadership positions in those fields. Analyzing a decade of data from 111 participants, we describe the positive impact of the SRK program on participant's self-reported capabilities. Increased self-confidence, improved time management and work/life balance, enhanced goal-setting and attainment skills, and strengthened communication and relationship-building abilities are highlighted as statistically significant outcomes. Moreover, the program's emphasis on coaching, mentorship, peer cohort support, and building lasting professional relationships also contributed to high ratings for satisfaction and value of the program. Successful programs like SRK can serve as a model for institutions striving to close gender gaps in leadership.

Gender Differences in the Path to Medical School Deanship

Importance

Women account for only 28% of current US medical school deans. Studying the differences between women and men in their preparation to becoming deans might help to explain this discrepancy.

Objective

To identify differences in the leadership development experiences between women and men in their ascent to the medical school deanship.

Design, Setting, and Participants

In this qualitative study, volunteers from the roster of the Association of American Medical Colleges Council of Deans were solicited and interviewed from June 15 to November 9, 2023. Women deans were recruited first, then men who had been appointed to their deanships at a similar time to their women counterparts were recruited. Deans were interviewed on topics related to number of applications for deanships, prior leadership roles, leadership development, personal factors, and career trajectories. Interviews were coded, and themes were extracted through conventional content analysis.

Main Outcome and Measures

Career and leadership development experiences were elicited using a semistructured interview guide.

Results

We interviewed 17 women and 17 men deans, representing 25.8% (34 of 132) of the total population of US medical school deans. Most deans (23 [67.6%]) practiced a medicine-based specialty or subspecialty. No statistically significant differences were found between women and men with regard to years to attain deanship (mean [SD], 2.7 [3.4] vs 3.7 [3.7] years), years as a dean (mean [SD], 5.7 [5.2] vs 6.0 [5.0] years), highest salary during career (mean [SD], $525 769 [$199 936] vs $416 923 [$195 848]), or medical school rankings (mean [SD], 315.5 [394.5] vs 480.5 [448.9]). Their reports indicated substantive gender differences in their paths to becoming a dean. Compared with men, women deans reported having to work harder to advance, while receiving less support and opportunities for leadership positions by their own institutions. Subsequently, women sought leadership development from external programs. Women deans also experienced gender bias when working with search firms.

Conclusions and Relevance

This qualitative study of US medical school deans found that compared with men, women needed to be more proactive, had to participate in external leadership development programs, and had to confront biases during the search process. For rising women leaders, this lack of support had consequences, such as burnout and attrition, potentially affecting the makeup of future generations of medical school deans. Institutional initiatives centering on leadership development of women is needed to mitigate the gender biases and barriers faced by aspiring women leaders.

Perspectives From Students and Faculty on How Women Achieve Leadership Roles in Academic Medicine: An Exploratory Qualitative Study

INTRODUCTION

The glass ceiling in academic medicine has resulted in lower pay and fewer career advancement opportunities for women. Creating change relies on preparing early-career women for positions of leadership, but most leadership programs focus on faculty, not trainees. The present exploratory qualitative study investigates how to prepare women medical students to be leaders in academic medicine.

METHODS

Focus groups with medical students and faculty who identify as women were conducted at an academic medical center in the West. A total of 25 individuals (10 students and 15 faculty) participated. Recordings of focus groups were transcribed and coded using thematic analysis until saturation of themes was achieved.

FINDINGS

Codes were organized into three themes: obstacles, support systems, and self-presentation. Obstacles identified included the subthemes microaggressions, macroaggressions, a lack of female role models in leadership, and personal characteristics such as the ability to self-promote and remain resilient. Support systems included sponsorship, allyship, mentorship, networking, and gender-specific role modeling subthemes. Self-presentation involved learning behaviors for demonstrating leadership and exuding confidence, being strategic about career moves, resiliency, and navigating social norms.

CONCLUSIONS

The key themes of obstacles, support systems, and self-presentation are targets for systemic and individualistic improvement in leadership development.

An innovative approach to career development and promotion of diverse faculty

Women and persons from racial and ethnic populations underrepresented in medicine (URiM) comprise a substantially lower proportion of academic internal medicine faculty, particularly at senior ranks (associate professors and professors). Numerous factors lead to this inequity which has broad implications for medical education and healthcare. The Emory University Division of General Internal Medicine Grady Section (GIMG) formed the Faculty Review Committee (FRC) in 2013 to address low promotion rates to senior ranks as part of a strategy to foster a more inclusive, equitable environment. The FRC systematically and proactively reviews all GIMG faculty years prior to possible promotion to provide tailored recommendations to bolster professional development and with a goal to expedite successful advancement to senior ranks. Deidentified GIMG academic rank data was compared with aggregate data from Emory University School of Medicine and the American Association of Medical Colleges. In 2020, GIMG had significantly more senior faculty compared with pre-FRC intervention (odds ratio [OR]: 3.94, 95% confidence interval [CI]: 1.65-9.42). Subgroup analyses of non-URiM women GIMG senior faculty compared with preintervention (OR: 11.6, 95% CI: 2.52-53.7), showed a significant increase. A trend toward increased URiM women faculty was also seen. Descriptive analysis suggests that the GIMG group had a higher promotion to senior ranks among women and URiM compared with national and institutional comparators. The FRC is associated with significant increases in the promotion of all faculty and non-URiM women faculty, and an increasing trend of URiM women faculty, effects which help contribute to an equitable academic medicine environment, fostering a more diverse workforce and improved patient outcomes.

Becoming by doing: How women in academic health sciences build a leadership identity through project experiences

PURPOSE

Leadership development programs often use institutional projects to activate learning. We explored how project work shaped leadership identity formation in senior women leaders from one academic health science center who enrolled in The Hedwig von Ameringen Executive Leadership in Academic Medicine (ELAM^®) program.

MATERIALS AND METHODS

We interviewed ELAM Fellows and conducted a qualitative analysis of transcripts. Our primary analysis focused on the influences of projects on Fellows and institutions. Leadership identity formation emerged as a distinct pattern, so this narrative content was separated for secondary analysis. All authors approved the final assignment of themes and codes.

RESULTS

Participants described a multi-dimensional process for developing a leadership identity. Themes encompassed participants' View of Self and One's Image as a Leader, Interpersonal Relationships, and Commitment to a Value-based Goal. These internal factors grounded external influences, such as interactions with colleagues and institutional leaders, and the world beyond the institution.

CONCLUSIONS

We examined the process of leadership identity formation from the perspective of women leaders in academic health sciences who completed an institutional project during a leadership development program. Findings illustrate how internal and external forces, experienced in the context of project work, combine to influence leadership identity formation in women.

Ophthalmology Education Leadership Attitudes Towards Mentorship of Female Medical Students

PURPOSE

Numerous studies have emphasized the influence of gender-specific mentors in medical students' career decisions, but this has not been explored fully in ophthalmology. Therefore, this study evaluated ophthalmology educators' attitudes towards female mentorship, to better understand how this may relate to medical students' career development and training.

DESIGN

Cross-sectional study.

METHODS

A 22-question survey was sent to AUPO Chairs, Program Directors, and Medical Student Educators. The number of female students applying to ophthalmology residency was compared with the number of female ophthalmology faculty using AUPO and AAMC workforce data. Student's t-tests and chi square were used for analyses, all at a threshold significance level of p<0.05.

RESULTS

75 members responded, including 30 of 72 MSEs (41.7%), 34 of 114 PDs (29.8%), and 17 of 135 Chairs (12.6%). Of respondents, 55.4% identified as female and 44.6% as male. Male and female members had 47.9% and 47.6% female mentees, respectively, (p=0.45). However, 21.2% of male and 56.1% of female members agreed that a mentee of the same gender was important, (p<0.01). Furthermore, 13 of 40 female members (32.5%) reported having a significant female mentor themselves vs. 1 of 29 male members (3%), (p<0.01).

CONCLUSIONS

Male and female AUPO members reported no difference in female mentees but females were more likely to feel gender-specific mentorship was important, suggesting room for further development of this resource. Expansion of female mentorship in ophthalmology can promote equity in training and help address the lack of female representation in leadership.

Evaluation of two longitudinal faculty leadership training programs: behavioral change and institutional impact

Purpose

Building leadership skills among faculty in academic medicine is essential, yet professional development programs focused on leadership are not always attentive to the needs of faculty on diverse career pathways or at differing career stages—nor are they often rigorously assessed. Evaluations commonly focus on participant satisfaction and short-term learning but not behavior change and institutional impact, which are difficult to assess but arguably more meaningful. Given the substantial time and money invested in these programs, more rigorous evaluation is critical.

Design/methodology/approach

The authors evaluated an intensive, shared leadership-focused training program for early-career and mid-career faculty, offered by the University of Pittsburgh’s School of Medicine over the course of a year. They administered a pre/post-program assessment of confidence in key skill areas, and conducted semi-structured interviews with 21 participants between 1–4 years after program completion.

Findings

Participants in both programs showed statistically significant improvement (p < 0.001) on every item measured in the pre/post-test. Analysis of the interviews revealed indications of substantial behavior change as well as institutional impact. The evaluation also suggested particular benefits for female professionals.

Originality/value

The authors conducted a long-term assessment of leadership training focused on career pathway and career stage and found that it (a) prompted both positive behavioral change and institutional impact and (b) suggested benefits for female faculty in particular, which could potentially help to eliminate gender-based disparities in leadership in academic medical centers.

The hard truth about soft skills: Exploring the association between leadership competency and career advancement of allied health professionals

Backgroud:

Globally, employee engagement in healthcare organisations is low, with career advancement one of its main determinants. It may be useful for healthcare organisations to determine the factors of career advancement, to guide them to more effectively engage their workforce. Leadership competency is factor that may be crucial in influencing career advancement for healthcare employees. To our knowledge, a comprehensive analysis on its impact on the perception of career advancement within the healthcare setting has not been conducted.

Research Design:

An ecological, cross-sectional study was conducted, aimed at examining the association between leadership competency of healthcare professionals and perceptions of career advancement. Poisson generalized-estimating-equation models were fitted to estimate the adjusted rate ratios with bootstrap 95% confidence intervals for the associations of the AHEAD items with the number of favourable responses on the career advancement items. In each model, we accounted for clustering by departments and controlled for length of service as a confounder.

Results:

Statistically significant predictors of perception of career advancement were found, and included skills - Interpersonal Skills (aRR 1.53 CI 1.12–2.96), Motivating (aRR 1.31 CI 1.10–2.16), and Mentoring (aRR 1.30 CI 1.08–1.13); and values - Compassion (aRR 1.37 CI 1.17–3.40), and Collegiality (aRR 1.31 CI 1.00–1.99).

Conclusion:

Our findings show an association between some components of leadership competency and the perception of career advancement. These results provide initial evidence that apart from hard skills, soft skills may play an equally (or more important) role in influencing the perception of career advancement.

Women in Academic Urology: A Qualitative Analysis of the Relationship Between Pregnancy, Parenting and Delayed Promotion

OBJECTIVE

To determine the role that the burden of childbearing, including pregnancy and maternity leave, play in academic promotion for women in urology, which has been shown to be delayed as compared to their male counterparts.

METHOD

Female academic urologists of varying academic rank who have children were invited to participate in a semi-structured interview. A representative sample from multiple subspecialties and geographic locations were targeted. Topics addressed included pregnancy, maternity leave, parenting, and promotion in academic urology. Transcripts of the interview were analyzed using grounded theory methodology.

RESULTS

Eleven participants were interviewed, including 3 assistant, 5 associate, and 3 full professors. The majority of participants chose to time pregnancy with training either during less strenuous portions or avoiding residency altogether. Nearly half endorsed self-inflicted hardships during pregnancy or early postpartum to prevent inconveniencing colleagues or to "pull their weight" in accordance with surgical culture. Outsourcing of childcare and household duties, along with spousal support, were discussed as contributing to success. Lack of transparency for promotional criteria was identified as a significant obstacle to promotion. Sponsorship and self-motivated information gathering were identified as critical components to success in promotion.

CONCLUSION

A culture of support created by administration and colleagues is critical for a positive experience with childbearing, and return to clinical practice or training postpartum. Explicit promotional criteria that are accessible in early career development and sponsorship from members of the academic department or subspecialty community are crucial for all urologists, but for women in particular.

Strategies for Achieving Gender Equity and Work-Life Integration in Physician-Scientist Training

Substantial gender inequities persist across academic medicine. These issues are not new: Recent evidence still points to a chilly climate for women in academic medicine, including those in physician-scientist training. The discussion for how to address gender equity and issues of work-life integration typically centers around faculty and rarely includes trainees. The authors delineate specific strategies to address gender inequity in physician-scientist training by identifying key stakeholders for implementation and proposing areas to integrate these strategies with current training timelines. Strategies discussed include multiple-role mentoring, allyship training for trainees and faculty, early implementation of professional development sessions, incorporation of childcare and family-friendly policies, and additional policies for funding bodies to prioritize gender equity practices. The goal of this article is to equip trainees and the academic community with proactive strategies to create a more equitable environment for future generations of trainees in academic medicine.

Gender Disparities Among Burn Surgery Leadership

Gender disparities have been described in the plastic surgery and general surgery literature, but no data have been reported in burn surgery. The aim of this study is to determine gender disparities among burn surgery leadership. A cross-sectional study was performed. Burn surgeons included were directors of American Burn Association (ABA)-verified burn centers, past presidents of the ABA, and International Society for Burn Injuries (ISBI), and editors of the Journal of Burn Care & Research, Burns, Burns & Trauma, Annals of Burns & Fire Disasters, and the International Journal of Burns and Trauma. Training, age, H-index, and academic level and leadership position were compared among surgeons identified. Among the 69 ABA and ISBI past presidents, 203 burn journals' editorial board members, and 71 burn unit directors, females represented only 2.9%, 10.5%, and 17%, respectively. Among burn unit directors, females completed fellowship training more recently than males (female = 2006, male = 1999, P < .02), have lower H-indexes (female = 8.6, male = 17.3, P = .03), and are less represented as full professors (female = 8.3%, male = 42.4%, P = .026). There were no differences in age, residency, research fellowship, or number of fellowships. Gender disparities exist in burn surgery and are highlighted at the leadership level, even though female surgeons have a similar age, residency training, and other background factors. However, gender diversity in burn surgery may improve as females in junior faculty positions advance in their careers.

An Evaluation of Faculty Development Programs for Clinician-Educators: A Scoping Review

PURPOSE

Faculty development (FD) has become increasingly important for clinician-educators. An array of FD programs has been developed, but the impact of these programs on clinician-educators and their learners and workplace is less known. The authors conducted a scoping review to explore the status of program evaluation in FD for clinician-educators to inform future planning and research.

METHOD

Five databases were searched for articles published from January 1998 to August 2018 using Arksey and O'Malley's framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Studies that described evaluation methods and outcomes of FD programs for clinician-educators were included. Data were collected and organized according to program domain (teaching, research/scholarship, leadership, or a combination of skills). A modified version of the Kirkpatrick model was used to compare results among studies.

RESULTS

From a total of 2,091 articles, 1,095 were eligible for full review, and 31 met the inclusion criteria. Seven programs targeted only teaching skills, 3 research/scholarship skills, 7 leadership skills, and 14 a combination of skills. Eighteen programs required the completion of a project; fewer offered fellowships, master's degrees, or certificates. Participant surveys were the most common evaluation method across all domains. Often used metrics included participant satisfaction and self-reported knowledge, skills, behavior changes, scholarly output, and leadership positions. Less common evaluation methods included learner and peer evaluations, interviews, and focus groups. Change at the institutional level was evaluated in 11 programs.

CONCLUSIONS

Program evaluation remains an underdeveloped area in FD for clinician-educators. Developers expend significant effort on program design and implementation but approach evaluation less purposefully. Rigorous metrics that align with program goals and are used longitudinally are needed to accurately assess the impact of FD programs on participants and their learners, workplace, and institutions at large.

Systematic review of interventions to improve gender equity in graduate medicine

Women are substantially underrepresented in senior and leadership positions in medicine and experience gendered challenges in their work settings. This systematic review aimed to synthesise research that has evaluated interventions for improving gender equity in medicine. English language electronic searches were conducted across MEDLINE, CINAHL, Academic Search Complete, PsycINFO and Web of Science. Reference list screening was also undertaken. Peer-reviewed studies published between 2000 and March 2020 that evaluated interventions to improve gender equity, or the experiences of women, in academic or clinical medicine were reviewed. Dual reviewer data extraction on setting, participants, type of intervention, measurement and outcomes was completed. Methodological rigour and strength of findings were evaluated. In total, 34 studies were included. Interventions were typically focused on equipping the woman (82.4%), that is, delivering professional development activities for women. Fewer focused on changing cultures (20.6%), ensuring equal opportunities (23.5%) or increasing the visibility or valuing of women (23.5%). Outcomes were largely positive (87.3%) but measurement typically relied on subjective, self-report data (69.1%). Few interventions were implemented in clinical settings (17.6%). Weak methodological rigour and a low strength of findings was observed. There has been a focus to-date on interventions which Equip the Woman Interventions addressing systems and culture change require further research consideration. However, institutions cannot wait on high quality research evidence to emerge to take action on gender equity. Data collated suggest a number of recommendations pertaining to research on, and the implementation of, interventions to improve gender equity in academic and clinical settings.

Leadership Development Projects: Bidirectional Impact on Faculty and Institutions

INTRODUCTION

The Hedwig von Ameringen Executive Leadership in Academic Medicine program (ELAM) is a national professional development program for women that includes institutional action projects (IAPs). Although benefits of ELAM participation are well documented, the value of the IAPs has not been specifically evaluated. We explored the experience of ELAM Fellows and leaders from one institution to elucidate how institutional factors influence project implementation and outcomes.

METHODS

Fellows and deans participated in semistructured interviews. We analyzed the transcripts qualitatively to develop themes and describe factors that influenced IAP implementation and outcomes. We used the New World Kirkpatrick Model, an updated version of the widely used Kirkpatrick model of educational program evaluation, as a framework to elucidate how participants applied their leadership learning through project work, and to analyze early results of projects that indicated institutional impact.

RESULTS

Project work had bidirectional impact on the fellows in the program and on the institution itself. Project enablers included: focusing projects on institutional priorities, obtaining sustainable support, and navigating institutional complexity. Leading indicators of institutional outcomes included contributions to institutional leadership and culture, and mutual enhancement of the reputation of the fellow and of the institution.

DISCUSSION

By examining enablers and barriers for institutionally based projects conducted in a national leadership development program, we identified the drivers that facilitated application of leadership learning. Leading indicators of project outcomes reflected bidirectional impact on fellows and the institution, demonstrating outcomes at the highest levels of the New World Kirkpatrick Model.

Gender Disparity and Potential Strategies for Improvement in Neurology and Clinical Neurophysiology

Discrimination in the workplace when documented is illegal but is seen to still exist in some forms whether based on culture, race, or gender. Each of these disparities warrants further discussion and study because of their significant impacts on hiring decisions, career advancement, and compensation. In this article, the authors have focused their attention on gender disparity in the fields of neurology and clinical neurophysiology and shared the data currently available to them. At a time when the field of clinical neurophysiology has seen enormous growth, gender disparity in leadership and compensation remain. Despite the increasing number of women entering the fields of neurology and clinical neurophysiology, women remain underrepresented in national leadership positions. Many women physicians report experiencing gender discrimination despite increasing efforts by universities and medical centers to improve inclusivity and diversity. Equity and inclusivity are not the same and there is a disconnect between the increased numbers of women and their shared experiences in the workplace. Implicit bias undermines the ability of women to advance in their careers. For neurologists, data indicate that the latest gender pay gap is $56,000 (24%), increased from $37,000 in 2015, and is one of the largest pay gaps in any medical specialty. One third of the top 12 medical schools in the United States require that maternity leave be taken through disability coverage and/or sick benefits, and most family leave policies constrain benefits to the discretion of departmental leadership. The authors recommend strategies to improve gender disparity include institutional training to Identify and overcome biases, changes to professional organizations and national scientific meeting structure, transparency in academic hiring, promotion and compensation, and mentorship and sponsorship programs.

Leadership Programs for Academic Women: Building Self-Efficacy and Organizational Leadership Capacity

Background: Although numerous programs have evolved to develop leadership skills in women, few have conducted rigorous longitudinal evaluation of program outcomes. The purpose of this evaluation study is to measure the continuing impact of the Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM^®) program in its third decade of operation and to compare outcomes for graduates across the two programs (ELAM and Executive Leadership in Academic Technology, Engineering and Science [ELATES at Drexel^®]), using a revised Leadership Learning and Career Development (LLCD) Survey. Methods: The LLCD survey was administered to program graduates between 2013 and 2016 upon entry, immediately after graduation, and 2 years after program completion. Two-way mixed effects analysis of variances were used to analyze differences between programs and changes over time. Descriptive statistics and narrative responses were analyzed for trends and themes. Results: Of 287 graduates, 69% responded to all three survey administrations. Respondents rated competencies in strategic finance, organizational dynamics, communities of leadership practice, and personal and professional leadership development as highly important at all points of measurement. Ratings of ability to conduct the selected competencies (i.e., self-efficacy), increased during the program and were maintained over the 2 years that followed. Applications and offers for leadership positions increased over the course of the program and the subsequent 2 years. Respondents showed a strong preference for serving the institution that both sponsored their participation in the leadership program development and supported their continuing contributions to the institution. Personal development goals became more elaborated, institutionally focused, and strategic. Conclusions: The findings support the effectiveness of two national leadership programs in supporting growth and maintenance of graduates' self-efficacy as they advanced in institutional leadership roles. The findings also provide practical direction for leadership professional development curricula and institutional support that can help to decrease the gender gap in academic leadership.

The road to academic surgical leadership: Characteristics and experiences of surgical chairpersons

BACKGROUND

The evolving landscape of academic surgery demands leaders who are not only effective clinicians and researchers, but also administrators able to navigate complex hospital organizations, financial pressures in the era of quality measures, and inclusion of an increasingly diverse workforce. The aim of this study was to characterize achievements and assess perspectives in becoming a surgical chair in order to guide young surgeons in their career trajectories to surgical leadership.

METHODS

A survey encompassing demographics, surgical training, nonmedical advanced degrees, academic advancement, and leadership experiences was sent via electronic mail to members of the American College of Surgeons Society of Surgical Chairs in December 2018.

RESULTS

Of 191 Society of Surgical Chairs members, 52 (27.2%) completed the survey, with 6 (11.5%) women, 40 (76.9%) white, and the majority becoming chair between ages 46 and 60 (n = 39, 75.0%). Training beyond residency included fellowships (n = 41, 78.8%) and advanced nonmedical degrees (n = 15, 28.8%). Median H-index was 47 (range 10-120) with 126 (5-500) research publications, and grants received was 2 (0-38) for federal and 5 (0-43) for industry. Female chairs appear to have fewer nonmedical degrees (n = 1) and no difference in age at becoming chair (66.7% vs 79.6% between ages 46 and 60), H-index (26 [10-41] vs 49 [17-120]), or publications (93 [10-189] vs 150 [5,500]). Prior educational (n = 36, 69.2%) and clinical (n = 44, 84.6%) leadership roles were common, with 30 chairs (57.7%) having held both roles. Experiences which respondents felt have most helped them function as chair included serving as a clinical division director (n = 37, 71.2%), residency program director (n = 28, 53.8%), leadership courses (n = 28, 53.8%), a research career (n = 22, 42.3%), and being a vice/interim chair (n = 15, 28.8%). Personal traits felt to be most important in becoming a successful chair included being effective at communication (n = 37, 71.2%), collaborative (n = 35, 67.3%), trustworthy (n = 30, 57.7%), and a problem-solver (n = 27, 51.9%).

CONCLUSION

Becoming a department surgical chair often involves not only surgical subspecialty expertise, but also nonmedical training and prior leadership roles, which help facilitate development of skills integral to navigating the collaborative and diverse nature of academic surgery in the current era.

Increasing Promotion of Women Faculty in Academic Medicine: Impact of National Career Development Programs

Background: Three national career development programs (CDPs)-Early and Mid-Career Programs sponsored by the Association of American Medical Colleges and the Hedwig van Ameringen Executive Leadership in Academic Medicine sponsored by Drexel University-seek to expand gender diversity in faculty and institutional leadership of academic medical centers. Over 20 years of success and continued need are evident in the sustained interest and investment of individuals and institutions. However, their impact on promotion in academic rank remains unknown. The purpose of the study is to compare promotion rates of women CDP participants and other faculty of similar institutional environment and initial career stage. Methods: The study examined retrospective cohorts of 2,719 CDP participants, 12,865 nonparticipant women, and 26,810 men, from the same institutions, with the same degrees, and first years of appointment in rank. Rates of promotion to Associate and Full Professor ranks in respective cohorts of Assistant and of Associate Professors were compared using Kaplan-Meier survival curves and log-rank tests, and logistic regression adjusting for other predictors of academic success. Results: In adjusted analyses, participants were more likely than men and non-participant women to be promoted to Associate Professor and as likely as men and more likely than non-participant women to be promoted to Full Professor within 10 years. Within 5 years, CDP participants were more likely than nonparticipant women to be promoted to Associate Professor and as likely as to be promoted to Full Professor; in the same interval, participants were promoted to both higher ranks at the same rates as men. For both intervals, nonparticipant women were significantly less likely than men to be promoted to either rank. Conclusions: The higher rates of promotion for women participating in national CDPs support the effectiveness of these programs in building capacity for academic medicine.

Meeting the Needs of Mid-Career Women in Academic Medicine: One Model Career Development Program

Background: A gender gap in leadership exists in academic medicine. Medical school faculty rosters indicate an overrepresentation of women in entry-level positions. As positions increase in seniority and leadership responsibilities, there is an underrepresentation of women. The reasons for this discrepancy are not fully understood, but the mid-career transition is one career point that some scholars hypothesize is part of the leaky pipeline. The University of Rochester Medical Center developed a career development program (CDP) to focus on this pivotal career developmental time period. We assessed the impact of the CDP on self-assessed knowledge, competence, self-identified goals, and promotions. Materials and Methods: Four cohorts of mid-career women completed preself-assessment and postself-assessment and ranked their current knowledge and competence on 11 topics grouped into 3 career development domains. They identified three personal goals and ranked their success in achieving them at the end of the program. Facilitators followed participants annually for promotions and accomplishments. Results: Fifty-one participants reported statistically significant improvements in knowledge and competency in all domains-promotional, organizational infrastructure, and communication. They identified 148 individual goals that we grouped into 4 categories: career development (32%), leadership (26%), networking (22%), and negotiation (20%), and the majority achieved their individual goals. Upon the last review, 23.5% of women were promoted or received tenure. Conclusions: A CDP targeting the needs of mid-career women faculty in academic medicine improved knowledge and competency in multiple domains. Longitudinal data and comparison to nonparticipants are needed to fully understand its impact.

Women in academic medicine leadership: correlation between sex of medical school deans and affiliated academic hospital system CEOs

Background

Women are currently under-represented in ‘C-suite’ leadership positions at academic medical centres, including medical school deans, department chairs and hospital chief executive officers (CEOs). There are many potential reasons for the low percentage of women in academic medical leadership, including lack of mentorship and sponsorship, increased non-work responsibilities compared with men, implicit bias, and others.

Methods

We collected data from 136 fully accredited US allopathic medical schools regarding sex of the medical school dean and sex of the CEO of the largest academic medical centre/teaching hospital affiliate. Schools where students rotate at non-academic centres were excluded from the final analysis, leaving 124 schools where we investigated the relationship between sex of US medical school dean and affiliated academic medical centre CEO.

Results

16.9% of current medical school deans and 17.7% of affiliated academic medical centre CEOs were female. Systems with one female leader were significantly (6.25-fold, 95% CI 2.22 to 17.56, p=0.001) more likely to have a second female leader, regardless of geographical region or institution type (public vs private).

Conclusions

There is a significant positive association between medical school dean and affiliated academic hospital centre CEO sex. There are many potential factors that could contribute to this positive association, including mentorship, sponsorship and medical system consciousness about gender equity, among others. This relationship is important to recognise as we strive for more gender parity for women in positions of leadership in academic medicine.

Change Is Happening: An Evaluation of Gender Disparities in Academic Plastic Surgery

BACKGROUND

Gender disparities in academic plastic surgery are known; however, recently, professional societies have endorsed a culture of gender diversification. This study aims to evaluate the effects of these changes at faculty and leadership positions.

METHODS

A cross-sectional study was conducted in June of 2018 to evaluate gender representation among U.S. academic plastic surgery faculty, and compare career qualifications, years of experience, and faculty positions.

RESULTS

A total of 938 academic plastic surgeons were identified, of which only 19.8 percent were women. Female surgeons graduated more recently than men (2009 versus 2004; p < 0.0001) and predominantly from integrated residency programs (OR, 2.72; 95 percent CI, 1.87 to 3.96), were more likely to be an assistant professor (OR, 2.19; 95 percent CI, 1.58 to 3.05), and were less likely to be a full professor (OR, 0.20; 95 percent CI, 0.11 to 0.35) or program chair (OR, 0.32; 95 percent CI, 0.16 to 0.65). After adjustment for differences in years of postresidency experience, only disparities at the full professor position remained significant (OR, 0.34; 95 percent CI, 0.16 to 0.17), indicating that experience-independent gender inequality is prominent at the full professor level and that current differences in cohort experience are a significant contributor to many of the observed positional disparities. Lastly, programs led by a female chair employed significantly more female faculty (32.5 percent versus 18.2 percent; p = 0.016).

CONCLUSIONS

Gender diversity in academic plastic surgery remains a significant issue, but may see improvement as the disproportionately high number of junior female academics advance in their careers. However, leadership and promotion disparities between men and women still exist and must be addressed.

Women's leadership in academic medicine: a systematic review of extent, condition and interventions

OBJECTIVES

Because culture reflects leadership, the making of diverse and inclusive medical schools begins with diversity among leaders. The inclusion of women leaders remains elusive, warranting a systematic exploration of scholarship in this area. We ask: (1) What is the extent of women's leadership in academic medicine? (2) What factors influence women's leadership? (3) What is the impact of leadership development programmes?

DESIGN

Systematic review.

DATA SOURCES

A systematic search of six online databases (OvidMEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library and ERIC) from the earliest date available to April 2018 was conducted. Bridging searches were conducted from April 2018 until October 2019. ELIGIBILITY CRITERIA: (1) Peer-reviewed; (2) English; (3) Quantitative studies (prospective and retrospective cohort, cross-sectional and preintervention/postintervention); evaluating (4) The extent of women's leadership at departmental, college and graduate programme levels; (5) Factors influencing women's leadership; (6) Leadership development programmes. Quantitative studies that explored women's leadership in journal editorial boards and professional societies and qualitative study designs were excluded.

DATA EXTRACTION AND SYNTHESIS

Two reviewers screened retrieved data of abstracts and full-texts for eligibility, assessment and extracted study-level data independently. The included studies were objectively appraised using the Medical Education Research Quality Study Instrument with an inter-rater reliability of (κ=0.93).

RESULTS

Of 4024 records retrieved, 40 studies met the inclusion criteria. The extent of women's leadership was determined through gender distribution of leadership positions. Women's leadership emergence was hindered by institutional requirements such as research productivity and educational credentials, while women's enactment of leadership was hindered by lack of policy implementation. Leadership development programmes had a positive influence on women's individual enactment of leadership and on medical schools' cultures.

CONCLUSIONS

Scholarship on women's leadership inadvertently produced institute-centric rather than women-centric research. More robust contextualised scholarship is needed to provide practical-recommendations; drawing on existing conceptual frameworks and using more rigorous research methods.

Low-Resource Project-Based Interprofessional Development with Psychiatry Faculty

Projects done in interprofessional groups can foster faculty development with minimal resources beyond what is already available at the university or medical center. Each project can yield multiple "wins" in individual faculty growth while meeting the needs of academic medical centers. These projects can build collaborative skills and a sense of community among faculty, trainees, and staff. The combination of low costs, high yields, and improvements in team skills make these approaches appealing and sustainable in resource-constrained medical centers. The authors describe 4 sample projects and their teams, needed resources, and outcomes.

Development of an Innovative Career Development Program for Early-Career Women Faculty

Objective

Our institutional Women in Medicine & Science Program (formerly the Office of Women in Medicine and Science) developed the Early Career Development Program for Women to promote the careers of women faculty. At 6 monthly sessions, participants learn relevant content (imposter syndrome, strengths, change style, career management, assertive communication, feedback, personal influence, conflict management, negotiation, importance of mentors, resilience, and self-care); exchange ideas; and expand their professional networks. Here, we report changes in participants' career skills/knowledge, confidence, and perceptions of the current environment after attending the program.

Method

Between 2014 and 2017, participants (N = 65) completed pre- and post-program surveys that assessed career knowledge and skills, confidence, and perceptions of the current environment and provided program feedback.

Results

Most skills showed pre-post significant improvement. The greatest increases occurred in knowing paths to promotion, tailoring communication style, ability to manage conflict, and ability to handle personal-professional role balance. Women reported a significant increase for all items measuring confidence. Among these items, establishing networks, understanding institutional culture, providing feedback, motivating others, strategic planning, delegating, and conflict management had the largest increases. Overall, 89.3% of respondents rated the program impact as very strong/profound, 98.5% rated the concepts as essential, 95.2% rated the skills as essential, and 90.8% rated the sense of community with women in their class as very/extremely close.

Conclusions

Work-related skills/knowledge, confidence, and perceptions of the current environment increased significantly among program participants. These early-career women faculty indicated that the program augmented the skills needed to develop their careers in an academic medical center.

Developing a Culture of Mentorship to Strengthen Academic Medical Centers

Mentorship is central to academic medicine and its missions, and it has long played a critical role in the training and career development of physicians and scientists. A growing body of literature has documented the positive impact of mentorship on various outcomes, including research productivity, academic promotion, faculty retention, and career satisfaction. These benefits span academic medical centers' missions and have the potential to enhance biomedical research, patient care, education, and faculty diversity and leadership.In this Invited Commentary, the authors argue that a dynamic culture of mentorship is essential to the success of academic medical centers and should be elevated to the level of a major strategic priority. This culture of mentorship would capitalize on an institution's intellectual resources and seek to develop leaders in biomedical discovery, patient care, and education. The bidirectional transmission of knowledge between mentors and mentees, through both formal programs and informal relationships, can foster the growth of faculty members needed to meet the complex challenges currently confronting medical schools and teaching hospitals.Developing a culture of mentorship requires a strong commitment by leaders at all levels to nurture the next generation of physicians and scientists as well as grassroots efforts by trainees and faculty to seek out and create mentorship opportunities. The authors conclude by outlining possible mechanisms and incentives for elevating mentorship to the level of a strategic priority to strengthen academic medical centers across their missions.

A Summary Report from the Research Partnership on Women in Science Careers

BACKGROUND

In response to the landmark report "Beyond Bias and Barriers: Fulfilling the Potential of Women in Academic Science and Engineering," the NIH Office of Research on Women's Health issued a request for applications that funded 14 R01 grants to investigate causal factors to career success for women in STEM. Following completion of the 4-year grants, the grant PIs formed a grassroots collaborative, the Research Partnership on Women in Science Careers.

OBJECTIVE

To summarize the work of the Research Partnership, which resulted in over 100 publications.

METHODS

We developed six themes to organize the publications, with a "Best Practices" for each theme at the end of each section: Barriers to Career Advancement; Mentoring, Coaching, and Sponsorship; Career Flexibility and Work-Life Balance; Pathways to Leadership; Compensation Equity; and Advocating for Change and Stakeholder Engagement.

RESULTS

Women still contend with sexual harassment, stereotype threat, a disproportionate burden of family responsibilities, a lack of parity in compensation and resource allocation, and implicit bias. Strategies to address these barriers using the Bronfenbrenner ecological model at the individual, interpersonal, institutional, academic community, and policy levels include effective mentoring and coaching, having a strong publication record, addressing prescriptive gender norms, positive counter-stereotype imaging, career development training, networking, and external career programs such as the AAMC Early and Mid-Career Programs and Executive Leadership in Academic Medicine (ELAM).

CONCLUSIONS

Cultural transformation is needed to address the barriers to career advancement for women. Implementing the best practices noted of the work of the Research Partnership can help to achieve this goal.

The Association of Pathology Chairs' Pathology Leadership Academy: Experience From the First 2 Years

Leadership development and succession planning are critical to ensure continued strength of academic pathology. The Association of Pathology Chairs developed the Pathology Leadership Academy to prepare future academic leaders. The purpose of this report is to describe: (1) Pathology Leadership Academy’s development and curriculum, (2) how Pathology Leadership Academy has met leadership development needs for individuals and academic departments in its first 2 years, (3) Pathology Leadership Academy’s future directions based on program feedback. Results were analyzed from pre- and postprogram needs assessment surveys of pathology chairs and from evaluations from Pathology Leadership Academy participants in the first 2 years. Pathology Leadership Academy curriculum was developed from topics identified as priorities in the chairs’ survey. Twenty-eight (90%) of 31 responding participants were very satisfied/satisfied with Pathology Leadership Academy. Of the 18 responding chairs who sent a participant to Pathology Leadership Academy, 11 (61%) reported that Pathology Leadership Academy met their faculty development goal. Of all responding chairs, 13 (32%) of 41 reported uncertainty as to whether Pathology Leadership Academy is meeting chairs’ goals. Chairs reported that Pathology Leadership Academy provided value to their faculty through preparation for a future leadership role, enhancing skills for a current role, and enhancing understanding of opportunities and challenges in academic medicine. Most chairs (27/43, 66%) said Pathology Leadership Academy should be offered again; 13 (32%) of 43 were uncertain, and 1 (2%) of 43 said no. Initial experience of Pathology Leadership Academy is positive and promising and provides opportunity for leadership succession planning in academic pathology. Pathology Leadership Academy will use participant and chair feedback for ongoing curricular development to ensure topics continue to address major needs of academic pathology.

A Systematic Review of Development Programs Designed to Address Leadership in Academic Health Center Faculty

INTRODUCTION

To describe Academic Health Center (AHC) faculty leadership development program characteristics and categorize leadership topics into thematic areas suggesting competency domains to guide programmatic curricular development.

METHODS

A systematic literature review was conducted (PubMed/MEDLINE, Scopus, Cumulative Index of Nursing and Allied Health Literature [CINAHL], and Journal Storage [JSTOR databases]). Eligible studies described programs with leadership development intent for faculty in AHCs. Information was extracted using a structured data form and process.

RESULTS

Six hundred ninety citations were screened; 25 publications describing 22 unique programs were eligible. The majority (73%) were institutionally based; mean class size was 18.5 (SD ± 10.2, range 4.5-48); and mean in-person time commitment was 110 hours (SD ± 101.2, range 16-416), commonly occurring in regular intervals over months to years (n = 10, 45%). Six programs provided per participant costs (mean $7,400, range $1000-$21,000). Didactic teaching was the primary instructional method (99.5%); a majority (68%) included project work. Fourteen thematic content areas were derived from 264 abstracted topics. The majority or near majority incorporated content regarding leadership skills, organizational strategy and alignment, management, self-assessment, and finance/budget.

DISCUSSION

Institutions and faculty invest significantly in leadership development programs, addressing perceived needs and with perceived benefit for both. The prevalence of common curricular content indicates that AHCs deem important faculty development in leadership, business, and self-assessment skills.

Twelve tips to promote gender equity in international academic medicine

Gender inequity in academic medicine remains an important issue worldwide, with more female faculty entering academic medicine internationally. Some academic institutions have initiated programs and created policies to promote gender equity, but disparities remain in faculty numbers, promotions rates, research productivity and access to funding and resources. We offer 12 tips for best practices in the broad domains of faculty recruitment, retention and scholarship, promotion and leadership that institutions and individual faculty can adopt to promote gender equity. While the 12 tips form a comprehensive approach, each tip can be implemented individually depending on institutional needs and culture. Each tip includes practical advice for implementation supported by a successful example from the literature.

Assessing the Impact of a Professional Development Program for Physician Assistant Program Directors

PURPOSE

The growth of physician assistant (PA) programs nationally has stretched the available capacity of experienced PA program directors. To address this need, a professional developmental program was designed to provide new program directors with the knowledge, skills, and resources necessary to succeed in the role. This study sought to characterize the impact of program attendance over time. Data were collected from individuals representing 5 cohorts that participated in the annual Physician Assistant Education Association New Program Directors Retreat between 2011 and 2015.

METHODS

An electronic survey was developed and sent to all 5 cohorts (n = 139). Anonymous responses were collected and quantitative data were analyzed in the aggregate and also by year of participation. Qualitative data were analyzed, and a thematic analysis was conducted. Results were compared with baseline data collected during the program registration process and with published national data on program director characteristics.

RESULTS

Seventy-five program participants completed the survey, for a response rate of 57%. Program director stability, educational achievement, and involvement in leadership and service activities were found to be positive outcomes for individuals who had participated in the professional development program.

CONCLUSION

Survey respondents reported positive outcomes after attending a professional development program; these outcomes are consistent with research on similar programs published in the literature. Our findings suggest that new program directors who participated in this professional development program not only derived career-stabilizing benefits but also succeeded in creating supportive peer networks while gaining greater confidence in their new academic role.

A systematic review of interventions to support the careers of women in academic medicine and other disciplines

OBJECTIVE

To summarise quantitative evaluations of interventions designed to support the careers of women in academia of any discipline.

METHOD

A systematic search of English entries in PubMed, CINAHL and Google Scholar was conducted in September 2017. Methodological quality of the studies was independently assessed by two authors using the Joanna Briggs Institute quality appraisal checklists. Meta-analysis was not possible due to heterogeneity in methods and outcomes; results were synthesised and displayed narratively.

RESULTS

Eighteen eligible studies were identified, mostly evaluating programmes in academic medicine departments. The most common interventions were mentoring, education, professional development and/or networking programmes. All programmes took a 'bottom-up' approach in that women were responsible for opting into and devoting time to participation. Study quality was low overall, but all studies reported positive outcomes on at least one indicator. Most often this included improvements in self-rated skills and capabilities, or satisfaction with the programme offered. Results regarding tangible outcomes were mixed; while some studies noted improvements in promotion, retention and remuneration, others did not.

CONCLUSIONS

This review suggests that targeted programmes have the potential to improve some outcomes for women in academia. However, the studies provide limited high-quality evidence to provide information for academic institutions in terms of the best way to improve outcomes for women in academia. The success of an intervention appears to be undermined when it relies on the additional labour of those it is intending to support (ie, 'bottom-up' approaches). As such, academic institutions should consider and evaluate the efficacy of 'top-down' interventions that start with change in practice of higher management.

Perspectives of female medical faculty in Ethiopia on a leadership fellowship program

OBJECTIVES

This study aims to evaluate a leadership fellowship program through perspectives of Ethiopian women medical faculty participants.

METHODS

An intensive two-week leadership development fellowship was designed for women faculty from Ethiopian medical schools and conducted from 2011-2015 at the University of Wisconsin-School of Medicine and Public Health in Madison, Wisconsin. Nine Ethiopian women working in early- or mid-level academic positions were selected. Semi-structured interviews were conducted with the fellows. Transcripts were reviewed through qualitative analysis to assess the perceived impact of the training on their careers. Three male academic leaders were interviewed to solicit feedback on the program.

RESULTS

Eight of 9 fellows were interviewed. Themes describing the benefits of the fellowship included: increased awareness of gender inequities; enhanced motivation for career advancement; increased personal confidence; and improved leadership skills. Fellows provided suggestions for future training and scaling up efforts to promote gender equity. Male leaders described the benefits of men promoting gender equity within academic health centers.

CONCLUSIONS

This paper provides evidence that targeted brief training programs can enhance women's motivation and skills to become effective leaders in academic medicine in Ethiopia. Promoting gender equity in academic medicine is an important strategy to address health workforce shortages and to provide professional role models for female students in the health professions.

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.

Recruitment, Promotion, and Retention of Women in Academic Medicine: How Institutions Are Addressing Gender Disparities

OBJECTIVE

Greater numbers of women in medicine have not resulted in more women achieving senior positions. Programs supporting the recruitment, promotion, and retention of women in academic medicine could help to achieve greater advancement of more women to leadership positions. Qualitative research was conducted to understand such programs at 23 institutions and, using the social ecological model, examine how they operate at the individual, interpersonal, institutional, academic community, and policy levels.

METHODS

Telephone interviews were conducted with faculty representatives (n = 44) of the Group on Women in Medicine and Science, Diversity and Inclusion, or senior leaders with knowledge on gender climate in 24 medical schools. Four trained interviewers conducted semistructured interviews that addressed faculty perceptions of gender equity and advancement, which were audiotaped and transcribed. The data were categorized into three content areas-recruitment, promotion, and retention-and coded a priori for each area based on their social ecological level of operation.

FINDINGS

Participants from nearly 40% of the institutions reported no special programs for recruiting, promoting, or retaining women, largely describing such programming as unnecessary. Existing programs primarily targeted the individual and interpersonal levels simultaneously, via training, mentoring, and networking, or the institutional level, via search committee trainings, child and elder care, and spousal hiring programs. Lesser effort at the academic community and policy levels were described.

CONCLUSIONS

Our findings demonstrate that many U.S. medical schools have no programs supporting gender equity among medical faculty. Existing programs primarily target the individual or interpersonal level of the social ecological interaction. The academic community and broader policy environment require greater focus as levels with little attention to advancing women's careers. Universal multilevel efforts are needed to more effectively advance the careers of medical women faculty and support gender equity.

The Boston Children's Hospital Academy: Development and Initial Assessment of a Hospital-Based Teaching Academy

PROBLEM

Medical education academies play an important role in the recognition and career advancement of educators. However, hospital-based clinical faculty have unique professional development needs that may not be met by medical-school-based academies.

APPROACH

The Boston Children's Hospital Academy was founded in 2008 to serve the needs of its clinician-educators. It was open to junior faculty scholars and to senior faculty scholars and mentors, including interprofessional educators. To maintain membership, individuals must propose and work toward an education project or serve as a project mentor. In 2012, a survey was sent to all members, and annual project reports were reviewed to assess the academy's impact.

OUTCOMES

Sixty-five members completed the survey. The majority agreed that the academy created a community of educators, provided opportunities for networking and scholarship, contributed to their personal identity as an educator, and led to recognition by their chief. Projects addressed curriculum development, faculty development, learner assessment, program assessment, and resource development. They largely focused on graduate medical education and on patient safety and quality. During their tenure in the academy (mean length of membership = 2.4 years), members produced an average of 4.4 education presentations and 1.9 education publications, and 11 members were promoted.

NEXT STEPS

A hospital-based academy provides opportunities for interprofessional faculty development. Next steps include increasing interprofessional membership, wider dissemination of members' successes, better integration with the hospital's mission, specifically regarding graduate medical education and patient safety, and additional evaluation of the academy's impact on project completion and members' accomplishments.

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.

Narratives of Participants in National Career Development Programs for Women in Academic Medicine: Identifying the Opportunities for Strategic Investment

BACKGROUND

Academic medicine has initiated changes in policy, practice, and programs over the past several decades to address persistent gender disparity and other issues pertinent to its sociocultural context. Three career development programs were implemented to prepare women faculty to succeed in academic medicine: two sponsored by the Association of American Medical Colleges, which began a professional development program for early career women faculty in 1988. By 1995, it had evolved into two programs one for early career women and another for mid-career women. By 2012, more than 4000 women faculty from medical schools across the U.S and Canada had participated in these intensive 3-day programs. The third national program, the Hedwig van Ameringen Executive Leadership in Academic Medicine(®) (ELAM) program for women, was developed in 1995 at the Drexel University College of Medicine.

METHODS

Narratives from telephone interviews representing reflections on 78 career development seminars between 1988 and 2010 describe the dynamic relationships between individual, institutional, and sociocultural influences on participants' career advancement.

RESULTS

The narratives illuminate the pathway from participating in a career development program to self-defined success in academic medicine in revealing a host of influences that promoted and/or hindered program attendance and participants' ability to benefit after the program in both individual and institutional systems. The context for understanding the importance of these career development programs to women's advancement is nestled in the sociocultural environment, which includes both the gender-related influences and the current status of institutional practices that support women faculty.

CONCLUSIONS

The findings contribute to the growing evidence that career development programs, concurrent with strategic, intentional support of institutional leaders, are necessary to achieve gender equity and diversity inclusion.

Sustaining the Clinical and Translational Research Workforce: Training and Empowering the Next Generation of Investigators

There is mounting concern that clinician-scientists are a vanishing species and that the pipeline for clinical and translational research (CTR) investigators is in jeopardy. For the majority of current junior CTR investigators, the career path involves first obtaining a National Institutes of Health (NIH)-funded K-type career development award, particularly K08 and K23, and subsequently an NIH R01. This transition, popularly referred to as K2R, is a major hurdle with a low success rate and gaps in funding. In this Perspective, the authors identify factors that facilitate K2R transition and important aspects of increasing and sustaining the pipeline of CTR investigators. They also highlight significant differences in success rates of women and those underrepresented in biomedical research. Early career exposure to research methodology, protected time, multidisciplinary mentoring, and institutional "culture shift" are important for fostering and rewarding team science. Mentoring is the single most important contributor to K2R success, and emerging evidence suggests that formal mentor training and team mentoring are effective. Leadership training can empower junior investigators to thrive as independent CTR investigators. Future research should focus on delineating the difference between essential and supplemental factors to achieve this transition, and mentoring methods that foster success, including those that promote K2R transition of women and those underrepresented in biomedical research. The Clinical and Translational Science Awards National Consortium is well positioned to test existing models aimed at shortening the time frame, increasing the rate of K2R transition, and identifying strategies that improve success.