Academic Plastic Surgery Research Articles

Abstract 15: First Job and Promotion: Is There an Internal Bias in Academic Plastic Surgery Employment?

Background: Following completion of training, a physician’s training institution has a lasting impact on career trajectory. Training program influence on first job placement and academic promotions remain uncertain in academic plastic surgery. The aim of this study is to determine the impact of training and internal bias in academic plastic surgery employment and promotion. Methods: Academic plastic surgery faculty were identified through all ACGME-accredited residency training programs. Online faculty profiles and other public websites were used to gather faculty demographics. Analysis examined the impact of internal recruitment bias on first job employment, training history on institutional leadership promotion, and alumni effect on academic employment. Results: 931 academic plastic surgeons were identified. For assistant professors that graduated in the past 3 years, 38.6% practice at their training institution. Of the 229 institutional leaders, 31.5% of Chairs, 39.6% of Residency Directors, and 37.5% of Fellowship Directors were internal hires. The top 5 programs that have the most faculty who trained there are Harvard, USC, UCLA, University of Michigan and Albert Einstein. Overall, 54% of plastic surgery departments employ 2 or more faculty who share a common external training program. Those top 5 programs are Methodist Houston, Hofstra, Stanford, Wisconsin, USC. Conclusion: The study highlights that an internal bias exists in the recruitment for first jobs and leadership promotions. However, a clear bias of internal hiring exists at several institutions. In addition, an alumni effect was identified, where some programs have a bias of hiring faculty who trained at the same external institution.

Clinically Applied Anatomy

Today, medical education emphasizes clinical applications of anatomic knowledge. In 2014, we instituted Clinically Applied Anatomy (CAA) within first-year Human Gross Anatomy at our university. The course was designed and overseen by academic plastic surgery. We hypothesized CAA would positively impact students' understanding, performance, and interest in human anatomy. From 2014 to 2018, 13 CAA case-based didactics were integrated into the anatomy curriculum without changing the total anatomy-related student hours; each emphasized the clinical relevance of overlooked (or memorized) anatomic detail. Clinically Applied Anatomy instructors led associated clinical cadaver dissections. Upon course completion, students from each participating class were anonymously surveyed. One hundred sixty-four students completed the survey (75% response). Eighty-six percent reported CAA increased mastery of human anatomy, 77% stated CAA improved examination performance, 87% agreed CAA increased interest in anatomy itself, and 96% reported CAA increased their critical thinking of how understanding anatomy affects clinical care. Nearly half (49.4%) responded that CAA increased interest in applying for a procedurally oriented residency. When considering future integration of CAA into the medical school curriculum, 9% of students wanted less CAA, 61% wanted the same, and 30% wanted more. Clinically Applied Anatomy significantly impacts medical students' anatomy education. Currently, 17 CAA faculty from 7 departments/divisions participate in all 26 of our school's anatomy sessions. As per our institution, we advocate this cost-effective and impactful initiative be led by academic plastic surgeons. These clinicians possess broad and specialized anatomic expertise as well as the leadership and interdisciplinary working relationships needed to enroll a multidisciplinary team of clinical educators.

Is the Glass-Ceiling Higher Than We Think? Sex Disparity Trends in Physician Executive Positions and Academic Plastic Surgery.

Advanced levels of professorship and executive positions are considered markers of success in medical academia. Despite sex parity in medical school graduates, sex disparities within positions of power remain unequal. The purpose of this study was to analyze sex composition at different levels of leadership at multiple academic, highly ranked institutions. Hospital executives and academic plastic surgery faculty were identified through an internet-based search of all Accreditation Council for Graduate Medical Education-accredited plastic surgery integrated and independent residency training programs. Institutions from the U.S. News 2018-19 Top 20 Best Hospitals Honor Roll and Beckers Review 2018: 100 Great Hospitals in America were also included. Information on board of directors/trustees (BOD), administrators, and plastic surgery faculty with focus on title, sex, degree, specialty, and academic rank was collected from departmental and hospital websites. Duplicate institutions were excluded. Data on chief executive officers (CEOs)/presidents (n = 275) and BOD members (n = 5347) from 153 medical institutions were analyzed. Physicians consisted of 40.7% (n = 112) of CEOs/presidents, of which 10.7% (n = 12) were surgeons, and 15.6% (n = 835) of the BOD membership. Female physicians in executive roles were disproportionally low, consisting of 5% (n = 14) of CEOs/presidents, reaching significance (P = 0.033).Sex representation within plastic surgery departments demonstrated similar trends. Women comprised 18.3% of the overall plastic surgery faculty (n = 1441). Significant differences between mean male and female plastic surgeons (8.2 vs 1.84, P = <0.001) were observed. In addition, female plastic surgeons represented only 26.3% of all assistant professors (P = <0.001), 18.75% of total associate professors (P = <0.001), and 7.8% of full professors (P = <0.001). Although women are increasingly pursuing careers in medicine and surgery, the data suggest that there remains a paucity of female physicians in top leadership roles. At the departmental level, female plastic surgeons are also underrepresented. At the executive level, men make up over 88% of physician CEOs at the highest-ranked medical institutions. This study further highlights the need for the development of educational, mentorship, and career pathways to further improve female representation in positions of power within academia.

A Report on the Representation of Women in Academic Plastic Surgery Leadership.

The year 2017 marked the first year women comprised a majority of U.S. medical school matriculants. While more women are pursuing surgical training, within plastic surgery, there is a steady attrition of women advancing in leadership roles. The authors report the current status of women in academic plastic surgery, from trainees to chairwomen and national leadership positions. The Electronic Residency Applications Service, San Francisco Match, National Resident Matching Program, Association of American Medical Colleges, American Council of Academic Plastic Surgeons, Plastic Surgery Education Network, and professional websites for journals and national societies were accessed for demographic information from 2007 to 2017. The number of female integrated pathway applicants remained stable (30 percent), with an increased proportion of female residents from 30 percent to 40 percent. There was an increase in female faculty members from 14.6 percent to 22.0 percent, an increase of less than 1 percent per year. Twelve percent of program directors and 8.7 percent of department heads were women. Nationally, major professional societies and administrative boards demonstrated a proportion of female members ranging from 19 percent to 55 percent (average, 27.7 percent). The proportion of female committee leaders ranged from 0 percent to 50 percent (average, 21.5 percent). Only six societies have had female presidents. No major journal had had a female editor-in-chief. The proportion of female editorial board members ranged from 1 percent to 33 percent (average, 16.1 percent). The authors' study shows a leak in the pipeline at all levels, from trainees to faculty to leadership on the national stage. This report serves as a starting point for investigating reasons for the underrepresentation of talented women in plastic surgery leadership.

Establishing a Telemedicine Program for Breast Reconstruction.

Summary:Telemedicine is an application of modern technology that allows for the remote delivery of healthcare services to diagnose and treat patients. The potential patient benefits of such a program include added convenience, lowered costs, and improved access. From a practical standpoint, establishing a telemedicine program may seem daunting to the plastic surgeon; success requires not only patient and provider adoption, but also integration of new technology. Despite these challenges, breast reconstruction patients are among those who stand to benefit most from telemedicine technology, as this patient population remains vulnerable to limitations to access following an emotion-provoking breast cancer diagnosis. Geographical limitation, especially in rural areas, represents a major barrier to access. To date, the application of telemedicine in caring for breast reconstruction patients has not been described in the literature. In this article, we describe the protocol developed and implemented by our academic plastic surgery group to care for new breast reconstruction candidates and discuss the role of telemedicine in improved access to breast reconstruction care.

Discussion: A Report on the Representation of Women in Academic Plastic Surgery Leadership.

Discussion: A Report on the Representation of Women in Academic Plastic Surgery Leadership.

Plastic Surgery Patient Expectations for Postoperative Opioid Prescriptions.

The opioid epidemic is a healthcare crisis perpetuated by analgesic overprescribing. Despite public health attention on this issue, expectations for pain management and opioid use by plastic surgery patients are poorly understood. This study aimed to evaluate patient expectations of postoperative pain, concern for opioid dependence, and anticipated analgesic plan after plastic surgery. New patients presenting to an academic plastic surgery clinic were prospectively enrolled from November 2017 to September 2018. These patients completed a preconsultation survey regarding their pain history and anticipated postoperative pain and analgesics regimens. Responses between cohorts expecting and not expecting postoperative opioids were compared using descriptive and univariate analyses. A total of 168 patients (63.9% female, 36.1% male; mean ± SD age 46 ± 17 years) completed the survey before breast (21.9%), cosmetic (5.3%), craniofacial (3.0%), general reconstruction (13.0%), hand (3.0%), and skin and soft tissue (49.1%) surgeries. Twenty-eight percent of patients expected opioid prescriptions. On a standard visual analog scale, patients who expected opioids anticipated greater postoperative pain (6.9 vs 4.6, P < 0.05). They were more concerned about experiencing pain (5.8 vs 4.9, P < 0.05), expected a longer duration of opioid use (63.0% vs 37.0%, P < 0.05), and were less interested in nonnarcotic analgesic alternatives (57.9% vs 19.8%, P < 0.05). Less than one-third of plastic surgery patients in this study expect opioid pain medications after surgery. This supports broader use of nonopioid, multimodal pain regimens. Identification and management of patient pain expectations, especially among those anticipating a need for opioids, provide a critical opportunity for preoperative education on the benefits of nonopioid analgesics, thus minimizing opiate prescribing.

Reducing Opioid Prescribing After Ambulatory Plastic Surgery With an Opioid-Restrictive Pain Protocol.

Opioids are often prescribed in excess, or unnecessarily, after ambulatory surgery. Perioperative opioid stewardships should be a priority with an emphasis on multimodal pain control. In this prospective cohort study, prescribing patterns after implementation of an opioid-restrictive pain protocol, Plastic Surgery Initiative to provide Controlled Analgesia and Safe Surgical Outcomes (PICASSO), were compared with historical controls in an academic plastic surgery department. The protocol was initiated on July 1, 2018, and applied to all adult patients undergoing outpatient plastic surgery. Plastic Surgery Initiative to provide Controlled Analgesia and Safe Surgical Outcomes provides an algorithm for analgesic prescribing based on type of surgery and patient factors. A hospital-based pharmaceutical database was used to identify prescriptions, and univariate analyses were used to compare cohorts. The preprotocol and postprotocol cohorts consisted of 539 and 632 patients, respectively. There was no difference in age (48.2 years vs 48.3 years) or sex (72.2% vs 67.8% female). The proportion of patients filling opioid prescriptions went down from 95% to 76% after PICASSO. The total oral morphine equivalent per opioid prescription (217.5 ± 109.5 vs 87.2 ± 43.4) was significantly less in the PICASSO cohort. Additionally, the proportion of patients receiving nonopioid prescriptions, acetaminophen (60.7% vs 86.9%), ibuprofen (8.7% vs 74.2%), and gabapentin (23.6% vs 57.9%), increased significantly. Opioid refill rates were not increased after implementation (9.1% vs 7.3%, P = 0.35). The PICASSO pain protocol resulted in a 20% decrease in opioid prescriptions and a 2.5-fold decrease in the oral morphine equivalent per prescription, equivalent to eighteen 5-mg oxycodone pills. This opioid-restrictive protocol can improve the analgesic prescribing culture in a plastic surgery department.

An Evaluation of Race Disparities in Academic Plastic Surgery.

Academic plastic surgery has a history of underrepresentation of ethnic and racial minority groups. Recent policy shifts by national medical groups and plastic surgery societies have focused on reversing these inequalities. This study seeks to measure ethnic and racial representation at academic and leadership positions following recent changes. A cross-sectional study was conducted in June of 2018, measuring ethnic and racial diversity of U.S. academic plastic surgery faculty. Among faculty, career qualifications, years of experience, faculty positions, and leadership ethnicity were compared. A total of 930 academic plastic surgeons were included in the study. Classified collectively as nonwhite, this group graduated more recently than other academic plastic surgeons (2006 versus 2001; p < 0.0001) and had greater rates of clinical fellowship attainment (OR, 1.62; 95 percent CI, 1.16 to 2.26). Nonwhite individuals were less likely to be employed in the full professor position compared with their white colleagues (OR, 0.6; 95 percent CI, 0.42 to 0.88; p = 0.0077). However, after adjustment for differences in years of postresidency experience, this disparity was no longer significant (OR, 1.06; 95 percent CI, 0.62 to 1.83; p = 0.82), indicating the importance of current cohort experience differences. Assessment of program leadership found that nonwhite chairs employed significantly more nonwhite faculty (42.5 percent versus 20.9 percent; p < 0.0001). Academic plastic surgery continues to face disparities in representation of both ethnic and racial minorities. Current inequalities are most severe at senior academic positions and may be linked to cohort experience differences along with leadership and promotion biases.

Analysis of Trends in the Selection and Production of U.S. Academic Plastic Surgery Faculty.

Purpose:In academic plastic surgery, there is a paucity of data examining the relationship between program rank, faculty training history, and production of academic program graduates. The purpose of this study is to determine objective faculty characteristics that are associated with a high program reputation.Methods:Accreditation Council for Graduate Medical Education-accredited integrated Plastic and Reconstructive Surgery (PRS) programs were ranked using Doximity and divided into Top-quartile programs and Other programs. Accredited medical schools were ranked using U.S. News and World Report. Individual faculty profiles were reviewed on program websites for information on prior training.Results:Seventy-nine programs with 712 faculty were identified and objectively analyzed. Compared to Other PRS programs, Top-quartile programs had a higher proportion of faculty that trained at Top-quartile residency programs (P < 0.0001) and Top-quartile medical schools (P < 0.0001). Top-quartile programs also had the highest proportion of faculty that trained at the same institution for fellowship (P = 0.0001), residency (P = 0.03), medical school (P = 0.4), or any prior training (medical school, residency, or fellowship) (P = 0.002). Top-quartile programs were associated with the largest total faculty size (P < 0.0001) and the largest number of graduates entering the field of academic plastic surgery (P < 0.0001).Conclusions:Program reputation is associated with PRS faculty selection and production. Top-ranked programs are more likely to have faculty that previously trained at the same institution or at top-ranked programs. Top-ranked programs are more likely to graduate residents that will become academic plastic surgeons.

Discussion: An Evaluation of Race Disparities in Academic Plastic Surgery

Discussion: An Evaluation of Race Disparities in Academic Plastic Surgery

YouTube for Cosmetic Plastic Surgery: An Effective Patient Resource?

YouTube is increasingly being utilized as a major educational resource by patients. It is important for plastic surgeons to understand the quality and characteristics of videos that patients are likely to view about procedures of interest. The aim of this study was to evaluate the quality of the videos that patients are most likely to encounter when searching YouTube for the most common cosmetic plastic surgery procedures. Based on Google Trends data, the most searched medical and colloquial terms were identified for common cosmetic surgery procedures: "abdominoplasty," "tummy tuck," "breast augmentation," "boob job," "liposuction," "lipo," "mastopexy," "breast lift," "reduction mammoplasty," and "breast reduction." On YouTube, videos were searched by relevance (default) and view count; the top 10 results were collected in each group and rated according to the DISCERN criteria. Each video was assigned an overall and bias DISCERN score (DS). A score of 1 indicates high bias and low overall quality and a score of 5 indicates the opposite. In total, 143 unique videos were identified, which resulted in a mean bias DS of 2.29 and mean overall DS of 2.44. Seventy-two videos included US board-certified plastic surgeons and 58 were classified as patient experience. Videos had 667,373,209 total views and were an average of 4.27 years old. Videos including US board-certified plastic surgeons were of significantly higher quality and showed lower bias than videos without these practitioners (P < 0.05). Overall, YouTube videos showed high bias and low quality. Plastic surgeons should be aware of this popular resource and counsel patients about the bias that is often present. Plastic surgeons and academic plastic surgery organizations should strive to upload high-quality, unbiased videos to provide patients with a more appropriate resource.

Assessing the Key Predictors of an Academic Career After Craniofacial Surgery Fellowship

PURPOSE: Craniofacial surgery fellowship positions continue to outnumber the availability of academic craniofacial jobs. Therefore, it is important to understand the factors that affect the likelihood of securing an academic position. This information is not only valuable for applicants who aspire to be academic surgeons but also for fellowship programs and educators who can utilize these data to identify applicants with a propensity for academics. The purpose of this study was to evaluate the impact of bibliometric indices and other trainee demographics on the ability to obtain a full-time academic plastic surgery position upon completion of craniofacial surgery fellowship. METHODS: Craniofacial fellowship graduates between 2009 and 2018 (n = 182) were identified. Job placement out of fellowship, training information, and demographic data were collected. Bibliometric indices, total publications, and total citations were calculated up to and including the year of fellowship completion. Groups were stratified according to the trainee’s initial job placement as academic or nonacademic. Chi-square and/or Fisher’s exact tests and multinomial logistic regression were used to evaluate the relationship between job placement and selected factors. RESULTS: Of the 45.1% of fellows that secured academic positions, 43.9% trained at 6 fellowship institutions. Completing residency at a top tier (P < 0.001) and integrated (P = 0.001), plastic surgery program was associated with academic placement. The odds of academic job placement increased with each unit increase in h-index (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.10–1.29; P < 0.001), g-index (OR, 1.07; 95% CI, 1.03–1.11; P < 0.001), hinorm (OR, 1.33; 95% CI, 1.17–1.51; P < 0.001), total manuscripts (OR, 1.04; 95% CI, 1.02–1.07; P < 0.001), and total citations (OR, 3.29; 95% CI, 1.78–6.08; P < 0.001). Of the craniofacial fellows entering academics, 24 (29.3%) were female, 10 (12.2%) had other fellowship training, and 20 (24.4%) earned advanced degrees; these factors were not associated with job placement. Geography was significantly associated with placement (P = 0.018), as 63.6% of trainees in the Northeast secured academic positions. Craniofacial fellows (20.3%; n = 37) completed dedicated postgraduate research time. Among these, 70.3% (n = 26) went into academics; dedicated postgraduate research time was associated with academic placement (P = 0.001). CONCLUSIONS: The findings of this study are important for plastic surgery faculty, training surgeons, and medical students alike. We conclude that residency training institution, type of residency training program, fellowship geographic location, and dedicated postgraduate research time can significantly impact one’s ability to secure an academic position upon craniofacial fellowship completion. Additionally, this study identifies bibliometric indices as objective measures of academic productivity and predictors of an academic job after completion of craniofacial surgery fellowship. It is our hope that these findings may serve to guide program directors in selecting applicants with higher likelihood of future academic practice, and plastic surgery residents, fellows, and medical students who aspire to be craniofacial surgeons at an academic center.

Deconstructing a Leader: An In-Depth Analysis of the Commonalities between Plastic Surgery Chiefs and Chairmen.

The authors sought to identify factors associated with current chiefs and chairpersons in academic plastic surgery to encourage and shape future leaders of tomorrow. Academic chairpersons in plastic surgery (n = 94) were identified through an Internet-based search of all Accreditation Council for Graduate Medical Education-accredited residency training programs during the year 2015. Sex, ethnicity, academic rank, board certification, time since certification, medical school attended, residency program attended, fellowships training, advanced degrees, obtaining leadership roles at trainee's institution, and h-index were analyzed. Of the 94 chiefs and chairpersons, 96 percent were male and 81 percent obtained full professor status, and 98 percent were certified by the American Board of Plastic Surgery. Mean time since certification was 22 years (range, 7 to 45 years). Fifty-one percent graduated from 20 medical schools, whereas 42 percent graduated from only nine plastic surgery training programs. Fifty-six percent had pursued fellowship beyond their primary plastic surgery training. Eighteen percent had obtained advanced degrees. Twenty-nine percent of chiefs and chairpersons obtained leadership roles at the institution where they had completed plastic surgery training. The mean h-index was 17.6 (range, 1 to 63). Graduates of the nine most represented residency programs had a mean h-index of 21 versus 15 when compared with the remaining chief/chairpersons (p < 0.0062). Leaders in plastic surgery are more likely to be male, hold academic rank of professor, and have completed a fellowship after residency.

Gender Imbalance at Academic Plastic Surgery Meetings.

Participation in scientific meetings yields multiple benefits, yet participation opportunities may not be equally afforded to men and women. The authors' primary goal was to evaluate the representation of men and women at five major academic plastic surgery meetings in 2017. Secondarily, the authors used bibliometric data to compare academic productivity between male and female physician invited speakers or moderators. The authors compiled information regarding male and female invited speakers from meeting programs. Bibliometric data (h-index, m-value) and metrics of academic productivity (numbers of career publications, publications in 2015 to 2016, career peer-reviewed publications, first and senior author publications) for invited speakers were extracted from Scopus and analyzed. There were 282 academic physician invited speakers at the five 2017 meetings. Women constituted 14.5 percent. Univariate analysis showed no differences in h-index, m-value, or numbers of total career publications or first and last author publications at the assistant and associate professor ranks, but higher values for men at the professor level. A model of academic rank based on bibliometric and demographic variables showed male gender significantly associated with increased probability of holding a professor title, even when controlling for academic achievement markers (OR, 2.17; 95 percent CI, 1.61 to 2.92). Although the impact of women's published work was no different than that of men among junior and midcareer faculty, women constitute a minority of invited speakers at academic plastic surgery meetings. Sponsorship is imperative for achieving gender balance within plastic surgery and to ultimately create more diverse and effective teams to improve patient care.

Abstract 3: Diversity and Inclusion in Academic Plastic Surgery: the ACAPS National Survey to Assess and Compare Attitudes, Knowledge, and Behavior in Faculty and Residents in Plastic Surgery Training Programs

Abstract 3: Diversity and Inclusion in Academic Plastic Surgery: the ACAPS National Survey to Assess and Compare Attitudes, Knowledge, and Behavior in Faculty and Residents in Plastic Surgery Training Programs

Abstract 8: The Impact of Fellowship Training in Academic Plastic Surgery

Abstract 8: The Impact of Fellowship Training in Academic Plastic Surgery

Abstract 22: Change is Happening: An Evaluation of Gender and Race Disparities in Academic Plastic Surgery

Abstract 22: Change is Happening: An Evaluation of Gender and Race Disparities in Academic Plastic Surgery

Abstract 40: Leadership in Academic Plastic Surgery: Current Representation of Women

PURPOSE: 2017 marked the first year women comprised a majority of United States medical school matriculants. While more women are pursuing surgical training, within plastic surgery, there is a steady attrition of women advancing in academics and leadership. We aim to report the current status of women in academic plastic surgery, from trainees to chairwomen and national leadership positions. METHODS: ERAS,SF match, NRMP, AAMC, ACAPS, PSEN, and professional websites for journals and national societies were accessed or contacted for demographic information for the last decade. RESULTS: At the trainee level, in the integrated applicant pathway, the number of female applicants has remained relatively stable, at around 30%, but the proportion of female residents has increased, from 30% to 40%. In the independent pathway, the proportion of female applicants and residents has remained relatively stable, with three men to every woman. At the faculty level, from 2006 to 2016, there was an increase in female faculty members from 14.6% to 22.0%, an increase of <1% per year. Twelve percent of program directors are currently female, and 8.7% of department heads. Nationally, major professional societies and administrative boards were evaluated, including ASPS, ABPS, and the residency accreditation committee. For all committees, the proportion of female members ranged from 19% to 55%, with an average of 27.6%. For committee leaders, the proportion of women ranged from 0% to 50%, with an average of 21.5%. Presidents of these societies were historically led by men, with only six having a history of female presidents. Major journals were evaluated for composition of editorial boards. No journals had a female Editor-in-Chief. The proportion of female editorial board members ranged from 1% to 33%, with an average of 15.3%. CONCLUSION: Recent literature has shown patients of female physicians to have better outcomes, and even a preference of female patients for female plastic surgeons. However, when it comes to academic leadership, women lag behind. As with other women in surgery, women in plastic surgery share a cumulative career disadvantage (personal, networking, clinical, academic, etc). Upward mobility is a challenge, as is recruitment and retention. Our study shows a leak in the pipeline at all levels, from trainees to faculty, to leadership on the national stage. This report serves as a starting point for investigating reasons for this loss of talented women in plastic surgery leadership.

Abstract 21: Melting the Plastic Ceiling: Quantifying Resources for and Identifying Barriers to Women Seeking Academic Plastic Surgery Leadership Positions

PURPOSE: To quantify departmental resources available to female plastic surgeons and identify remaining barriers to advancement for women in academic plastic surgery. METHODS: Academic plastic surgery departments were identified and a female faculty member or male program director was selected. Representatives were surveyed on their department’s resources for promoting women leaders. An optional follow-up interview discussed current barriers to women seeking leadership positions. RESULTS: 49 of 93 survey recipients participated (52.7% response rate). Departments on average provided 2.69 of 11 resources (Table 1). Departments with female chairs provided 4.30 resources vs. 2.26 resources at departments with male chairs (p=0.014). Departments with female program directors provided 4.45 resources vs. 2.22 resources at departments with male program directors (p=0.006). Of the 49 survey respondents, 9 completed the interview (18.4% completion rate). The most frequently identified barriers to aspiring women leaders (Table 2) were opaque promotion criteria (cited by 66.7% of interviewees), compensation disparities (55.6%), faculty homogeneity (55.6%), and motherhood bias (55.6%). CONCLUSIONS: The presence of a female chair or program director is associated with a greater quantity of resources for promoting female leaders. Remaining barriers to women ascending to academic leadership include compensation and promotion disparities, faculty homogeneity, and motherhood bias.