Leaders In Academic Medicine Research Articles

Perceptions of Key Responsibilities and Professional Development Interests of Senior Educational Leaders: A Needs Assessment.

High-ranking educational leaders in academic medicine oversee multiple clinical programs. This requires them to prioritize dozens of emergent tasks and responsibilities daily, from educational policy and strategy to staff management, financial planning, onboarding of trainees, and facility planning and management. Identifying their key responsibilities and frequently used skills and competencies may clarify the educational needs of senior educational leaders and facilitate targeted professional development to promote effective and efficient performance. In August 2022 researchers interviewed 12 designated education officers (DEOs) from U.S. Department of Veterans Affairs (VA) Veterans Health Administration medical centers about their daily work and most challenging responsibilities. Content analysis of interview transcripts identified key responsibilities and activities identified by participants and prioritization of the perceived skills needed to complete them. Participants emphasized 4 key areas of responsibility: fiscal, administrative, affiliate partnership, and educational duties. They identified 12 skills as baseline requirements for effective performance for which additional professional development would be useful and suggested that both new and more established educational leaders receive targeted professional development and mentoring to foster these capacities. The key skills participants identified by area of perceived responsibility are relevant to VA DEOs, designated institutional officers, and senior academic leaders who develop health professions education programs, oversee clinical training, and manage educational change. Structured orientation programs and ongoing professional development for senior educational leaders could emphasize these areas of responsibility, potentially enriching DEOs' performance and reducing burnout.

Stanford Network for Advancement and Promotion: The impact of a community building-focused leadership development program on the success of underrepresented groups in academic medicine.

Leadership can be an isolating experience and leaders from underrepresented groups (URGs) may experience even greater isolation and vulnerability because of lack of representation. Given the collaborative nature of medicine, leadership programs for physicians need to address isolation. Social support is one mechanism to combat this isolation; however, most leadership programs focus exclusively on skills building. The Stanford Network for Advancement and Promotion (SNAP) program was developed to reduce isolation among physician leaders from URGs in academic medicine leadership by building a supportive network of peers. Ten women physicians from diverse racial/ethnic backgrounds were invited to participate in SNAP. Annual surveys were administered to participants to assess the effectiveness of SNAP on decreasing feelings of isolation and increasing professional leadership growth. The authors charted the expansion and adaptation of the program model across gender and in additional settings. SNAP effectively created a sense of community among the physician leaders. Participants also reported feeling challenged by the program and that they had grown in terms of critical thinking, organizational knowledge, and empowerment as leaders. Participants found community building to be the most valuable program component. Because of this success, the SNAP model has been adapted to create 10 additional cohorts. Leadership programs like SNAP that focus on reducing isolation are instrumental for retaining and promoting the career advancement of physicians from URGs. Developing a diverse workforce of academic physicians is essential to providing high-quality and equitable clinical care, research, and medical education.

Perceptions of the Leadership Through Scholarship Fellowship Graduates: An Exploratory Qualitative Study of Leadership.

Despite increasing numbers of faculty identifying as underrepresented in medicine (URiM) over the last few decades, URiM representation in academic medicine leadership has changed little. The Society of Teachers of Family Medicine funded the Leadership Through Scholarship Fellowship (LTSF) to target this population and provide a framework for scholarly success. Based on responses to open-ended questions from a leadership survey, we characterize how early-career URiM family medicine faculty view leadership and assess attitudes and perceptions of leadership development. A survey, developed by survey experts from multiple institutions and consisting of multiple-choice and open-ended questions, was sent to the first two cohorts after the LTSF program. All LTSF participants identified as URiM and as early-career (5 years or less since fellowship or residency) family medicine faculty. Fellowship faculty collected anonymous survey responses through Qualtrics (Qualtrics, LLC). We conducted thematic analysis with emergent and iterative coding by two experienced qualitative researchers. All of the fellows surveyed (N=19) completed the survey. The qualitative researchers identified the following themes: leadership development (with subthemes of collaborative scholarship and request for mentoring), and barriers to leadership and scholarship (with subthemes of lack of time, lack of support, and diminished opportunities for advancement). These themes represent lessons learned from URiM faculty participating in a single faculty development fellowship. Collaborative scholarship, both as an early-career faculty need and a leadership responsibility, is a new contribution to the existing literature. While identified by URiM family medicine faculty, these themes are likely familiar to early-career faculty across all medical specialties and faculty identities. These lessons can guide senior academic leaders in preparing early-career faculty for leadership in academic medicine.

Inspiring and Preparing Our Future Leaders: Evaluating the Impact of the Early Career Women's Leadership Program.

The number of women in high-level leadership in academic medicine remains disproportionately low. Early career programs may help increase women's representation in leadership. We evaluated the Early Career Women's Leadership Program (ECWLP). We hypothesized that participants would rate themselves as having increased confidence in their leadership potential, improved leadership skills, and greater alignment between their goals for well-being and leading after the program. We also explored the participants' aspirations and confidence around pursuing high-level leadership before and after the program. We surveyed women physicians and scientists before and after they participated in the 2023 ECWLP, consisting of 11 seminars over six months. We analyzed pre- and post-program data using Wilcoxon signed-rank tests. We analyzed answers to open-ended questions with a content analysis approach. 47/51 (92%) participants responded, and 74% answered pre- and post-program questionnaires. Several metrics increased after the program, including women's confidence in their ability to lead (p<0.001), negotiate (p<0.001), articulate their career vision (p<0.001), reframe obstacles (p<0.001), challenge their assumptions (p<0.001), and align their personal and professional values (p=0.002). Perceptions of conflict between aspiring to lead and having family responsibilities (p=0.003) and achieving physical well-being (p=0.002) decreased. Perceived barriers to advancement included not being part of influential networks, a lack of transparency in leadership, and a competitive and individualistic culture. In the qualitative analysis, women described balancing internal factors such as self-doubt with external factors like competing professional demands when considering leadership. Many believed that becoming a leader would be detrimental to their well-being. Beneficial ECWLP components included support for self-reflection, tactical planning to pursue leadership, and creating a safe environment. The ECWLP improved women's confidence and strategic plans to pursue leadership in a way that supported their work-life integration. Early career leadership programs may encourage and prepare women for high-level leadership.

Business of Medicine: Developing Leaders in Academic Medicine and Learning Health Systems.

To develop healthcare professionals as clinical leaders in academic medicine and learning health system; and uncover organizational barriers, as well as pathways and practices to facilitate career growth and professional fulfillment. The Department of Medicine strategic plan efforts prompted the development of a business of medicine program informed by a needs assessment and realignment between academic departments and the healthcare system. The business of medicine leadership program launched in 2017. This descriptive case study presents its 5th year evaluation. Competencies were included from the Physician MBA program and from specific departmental needs and goals. The program hosted a total of 102 clinical faculty. We had a 37% response rate of those retained at Indiana University School of Medicine. Overall, responses conveyed a positive experience in the course. Over 80% of participants felt that they gained skills in professional reflection, professional socialization, goal orientation, critical thinking, and commitment to profession. Financial literacy was overwhelmingly the skill that was reported to be the most valuable. Finance and accounting were mentioned as the most difficult concepts to understand. Familiar concepts included communication, LEAN, and wellness related topics. One hundred percent of participants said they are utilizing the skills gained in this program in their current role and that they would recommend the course to others. Business of medicine courses are more common now with programs describing elements informed by health system operations. However, few programs incorporate aspects of wellness, equity, diversity, inclusion, and health equity. Our program makes the case for multiple ways to develop inclusive leaders through a focused five-month program. It also recognizes that to really impact the learning health system, health professionals need leadership development and leaders suited to work alongside career administrators, all aiming towards a common goal of equitable patient-centered care.

Optimizing a mentorship program from the perspective of academic medicine leadership – a qualitative study

BackgroundEffective mentorship is an important contributor to academic success. Given the critical role of leadership in fostering mentorship, this study sought to explore the perspectives of departmental leadership regarding 1) current departmental mentorship processes; and 2) crucial components of a mentorship program that would enhance the effectiveness of mentorship.MethodsDepartment Division Directors (DDDs), Vice-Chairs, and Mentorship Facilitators from the Department of Medicine at the University of Toronto Temerty Faculty of Medicine were interviewed between April and December 2021 using a semi-structured guide. Interviews were audio-recorded and transcribed verbatim, then coded. Analysis occurred in 2 steps: 1) codes were organized to identify emergent themes; then 2) the Social Ecological Model (SEM) was applied to interpret the findings.ResultsNineteen interviews (14 DDDs, 3 Vice-Chairs, and 2 Mentorship Facilitator) were completed. Analysis revealed three themes: (1) a culture of mentorship permeated the department as evidenced by rigorous mentorship processes, divisional mentorship innovations, and faculty that were keen to mentor; (2) barriers to the establishment of effective mentoring relationships existed at 3 levels: departmental, interpersonal (mentee-mentor relationships), and mentee; and (3) strengthening the culture of mentorship could entail scaling up pre-existing mentorship processes and promoting faculty engagement. Application of SEM highlighted critical program features and determined that two components of interventions (creating tools to measure mentorship outcomes and systems for mentor recognition) were potential enablers of success.ConclusionsEstablishing ‘mentorship outcome measures’ can incentivize and maintain relationships. By tangibly delineating departmental expectations for mentorship and creating systems that recognize mentors, these measures can contribute to a culture of mentorship.

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

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

Transforming higher education institutions through EDI leadership: A bibliometric exploration

This comprehensive bibliometric study analyzes 1820 journal articles from the Web of Science database to explore Equity, Diversity, and Inclusion (EDI) leadership in higher education institutions (HEIs). Utilizing co-citation and co-word analysis, the study identifies distinct thematic clusters. The co-citation analysis reveals five key themes: Race, Diversity, and Inclusion (RDI), Diversity, Leadership, and Self-Efficacy (DLSE), Gender Dynamics and Leadership Challenges, Women's Representation in Academic Medicine Leadership, and Transformational Leadership in HEIs. Meanwhile, the co-word analysis highlights three critical areas: Transformative Collaborative Resilience in HEIs, Advancing Gender Equality in Academic Medicine and STEM, and Inclusive Educational Leadership in HEIs. These themes collectively provide a deep understanding of the EDI leadership field's intellectual structure, suggesting significant areas for future research and practical application. The study emphasizes the necessity for HEIs to engage comprehensively in EDI leadership research, shedding light on the importance of transformative collaborative resilience, gender equality in STEM, and inclusive leadership. This research offers valuable insights for developing effective EDI leadership policies and practices, highlighting the interconnectedness of these themes in fostering a more equitable, diverse, and inclusive environment in higher education and beyond.

An Approach to Leadership in Academic Medicine: Lessons Learned From the Experience of Dr. John L. Cameron

Dr. John L. Cameron was appointed the chair of surgery at Johns Hopkins in 1984. He subsequently built the largest group of clinician-scientists anywhere in the world who were focused on pancreatic cancer. Trainees were selected over the decades to join the group based on characteristics including self-confidence, a sense of humor, a collegial and congenial personality, and a strong previous track record. Resume items such as prior leadership positions, academic achievements, and participation in team sports can all prove to be important predictors for future success. Many of the trainees that were molded by that group have perpetuated its ideals by pursuing academic careers. Dr Cameron's approach can be distilled to 3 key points: work hard and lead by example, make diamonds by applying the right amount of pressure, and serve your people and give the impression that you are working for your trainees and junior people. With those leadership principles, it should still be possible to build successful academic programs, despite the significant challenges that have arisen.

Narratives of Actionable Medical Leadership From Senior Leaders for Aspiring Leaders in Academic Medicine.

Physicians understand that certain personal attributes are essential in medical leaders, but they often do not know what actions are expected of them as leaders or what they should do to be more effective leaders. We sought to compile, through interviews with senior leaders at an academic institution, real leadership scenarios for a series of case-based examples to be used during group mentoring sessions for aspiring medical leaders. We conducted one-to-one interviews using open-ended questions with 11 current and emeritus chairpersons or chiefs of major departments or divisions at our academic medical center. Questions were designed to elicit anecdotes and examples of actions that demonstrate effective and ineffective leadership. Responses were analyzed with qualitative techniques to generate topics of leadership behaviors, which then were compiled into a collection of illustrative examples. The leaders interviewed discussed challenges they encountered in daily routines and described how they addressed certain dilemmas. Topics included making decisions without complete information, winning over reluctant administrators, building alliances with peers, involving subordinates in initiatives, and using knowledge to defend one's position. Actions requiring interpersonal skills also were discussed, including varying modes of communication, avoiding adversity, displaying gratitude toward subordinates, and safeguarding one's professional image. The leaders' insights and recommendations were compiled into a themed collection of topics to be used during group mentoring sessions to enhance leadership skills. This qualitative study suggests that the wisdom and experience of senior leaders may be gleaned for a collection of case-based topics that could complement other formal training programs for aspiring medical leaders.

Five Strategies Leaders in Academic Medicine Can Implement Now to Enhance Gender Equity

Abundant disparities for women in medicine contribute to many women physicians considering leaving medicine. There is a strong financial and ethical case for leaders in academic medicine to focus on strategies to improve retention. This article focuses on five immediate actions that leaders can take to enhance gender equity and improve career satisfaction for all members of the workplace.

Misconceptions about women in leadership in academic medicine.

Despite progress made over the past decade, women are under-represented in positions of leadership in academic medicine. Women physicians face numerous challenges throughout their careers. Despite achieving leadership positions, women in leadership continue to experience the impact of those challenges. In this review, we describe four misconceptions about women in leadership, along with their impact and recommendations. First, we describe differences between mentorship and sponsorship, as well as their impact on attaining leadership positions. Second, the gender pay gap persists throughout women's careers, regardless of leadership positions. Third, we explore the role of self-efficacy in leadership in the context of stereotype threats. Fourth, gendered expectations of leadership characteristics place an undue burden on women, detracting from their leadership effectiveness. Organizations can address the challenges women face by creating robust mentorship and sponsorship networks, establishing transparent and equitable pay policies, promoting and normalizing a broader range of leadership styles, and improving work flexibility and support structure. Ultimately, such changes serve all members of the organization through increased retention and engagement.

Bullying in Academic Medicine: Experiences of Women Physician Leaders.

Bullying is defined as offenders abusing positions of authority and intentionally targeting individuals through persistent negative behaviors to impede education or career growth. This study sought to estimate the prevalence and nature of bullying experienced by women physician leaders in academic medicine. In this survey-based study, 547 physician graduates of an executive women's leadership training program were invited to complete a survey that measured workplace bullying in 2021. Participants were asked whether and when they had been bullied, how it impacted their careers, and remedies for bullying. Descriptive statistics were used to profile mistreatment and bullying experienced by the respondents during their professional careers and the nature of bullying. Content analysis of open-ended comments was used to describe how bullying impacted women physicians and outline recommendations for bullying prevention and mitigation. The survey response rate was 64.7% (354/547). Most women (302/354 [85.3%]) had experienced mistreatment during their careers, with more than half experiencing bullying while an attending physician (198/302 [65.6%]). Many women (187/302 [61.9%]) who screened positive for mistreatment also reported that they had been bullied at work. Of these 187 respondents, 173 (92.5%) experienced bullying from men and 121 (64.7%) reporting bullying from women (effect size = 0.34, P ≤ .001), and 115 (61.5%) reported that bullies were their immediate supervisors. Qualitative findings suggested that bullying harmed individuals' career advancement, mental health, reputation, and relationships with others. Many had to change roles or leave jobs. Participants proposed that initiatives by top-level leaders, clear definitions of bullying behavior, reporting mechanisms, and upstander training for faculty and staff could mitigate bullying. Most women physician leaders have experienced bullying. These results highlight the need to address bullying in academic medicine so that women can reach their full career potential.

Easing the Transition From Undergraduate to Graduate Medical Education.

Easing the Transition From Undergraduate to Graduate Medical Education.

Physician Men Leaders in Emergency Medicine Bearing Witness to Gender-Based Discrimination

Approximately 60% of women physicians in emergency medicine (EM) experience gender-based discrimination (GBD). Women physicians are also more likely to experience GBD than men physicians, particularly from patients, other physicians, or nursing staff. To describe the responses of men who are academic department chairs in EM to GBD directed toward a woman colleague. This qualitative study was a secondary data analysis drawn from interviews of men EM academic department chairs at 18 sites who participated in a qualitative descriptive study between April 2020 and February 2021 on their perceptions of the influence of gender and leadership in academic medicine. Narrative data related to GBD were extracted and coded using conventional content analysis. Codes were clustered into themes and subthemes and summarized. Data were analyzed from November to December 2021. Semistructured interviews conducted via teleconferencing. Qualitative findings identifying experiences witnessing or learning about incidents of GBD against women colleagues, the impact of these observations, and personal or leadership actions taken in response to their observations. All 18 men participants (mean [SD] age, 52.2 [7.5] years; mean [SD] time as a department chair, 7.2 [5.1] years) discussed witnessing or learning about incidents of GBD against women colleagues. The participant narratives revealed 3 themes: emotional responses to GBD, actions they took to address GBD, and reasons for not taking action to address GBD. When witnessing GBD, participants felt anger, disbelief, guilt, and shame. To take action, they served as upstanders, confronted and reported discrimination, provided faculty development on GBD, or enforced "zero-tolerance" policies. At times they did not take action because they did not believe the GBD warranted a response, perceived a power differential or an unsupportive institutional culture, or sought self-preservation. In this qualitative study of men physician leaders, we found all participants reported feeling troubled by GBD against women colleagues and, if possible, took action to address the discrimination. At times they did not take action because of unsupportive workplace cultures. These findings suggest that institutional culture change that supports the interventions of upstanders and does not tolerate GBD is needed.

Advancing Equity in Graduate Medical Education Recruitment Through a Diversity Equity and Inclusion (DEI) Toolkit for Program Directors.

To increase diversity and inclusion in graduate medical education (GME), the Accreditation Council for Graduate Medical Education (ACGME) issued new diversity standards requiring programs to engage in practices that focus on systematic recruitment and retention of a diverse workforce of trainees and faculty. The literature on how program directors (PDs) can incorporate and prepare for this standard is limited. We developed a diversity, equity, and inclusion (DEI) toolkit for PDs as an example of an institutional GME-led effort to promote inclusive recruitment and DEI awareness among residency and fellowship programs at a large academic center. A survey was sent to 80 PDs before the launch of the toolkit and 6 months afterwards with response rates of 27% (22/80) and 97% (78/80), respectively. At baseline, 45% (10/22) anticipated that the DEI toolkit might provide better resources than those currently available to them and 41% (9/22) perceived that the toolkit might improve recruitment outcomes. At 6 months, 63% (49/78) found the toolkit helpful in the 2021-2022 recruitment season. By contrast, 2% (2/78) of PDs did not find the toolkit helpful, and 33% (26/78) said they did not access the toolkit. When asked if a PD changed their program's recruitment practices because of the toolkit, 31% (24/78) responded yes. Programs that changed recruitment practices started to require unconscious bias training for all faculty and residents involved in the residency interviews and ranking. Others worked on creating a standardized scoring rubric for interviews focused on four main domains: Experiences, Attributes, Competencies, and Academic Metrics. There is a need to support PDs in their DEI journey and their work to recruit a diverse workforce in medicine. Utilizing a DEI toolkit is one option to increase DEI knowledge, skills, awareness, and self-efficacy among PDs and can be adopted by other institutions and leaders in academic medicine.

How Did They Get There? What Perspectives From the Top Tell Us About Developing Women Leaders in Academic Anesthesiology.

How Did They Get There? What Perspectives From the Top Tell Us About Developing Women Leaders in Academic Anesthesiology.

Wondering If I'd Get There Quicker If I Was a Man: Factors Contributing to Delayed Academic Advancement of Women in Infectious Diseases.

Gender inequities in academic advancement persist in many specialties, including Infectious Diseases (ID). Prior studies of advancement disparities have been predominantly quantitative, utilizing large physician databases or surveys. We used qualitative methods to explore ID physicians' experiences and beliefs about causes and ways to mitigate gender inequities in advancement. We conducted semistructured focus group discussions with academic ID physicians in the United States at IDWeek 2019 to explore perceived barriers and facilitators to academic advancement. Participants were assigned to focus groups based on their academic rank and gender. We analyzed focus group transcripts using content analysis to summarize emergent themes. We convened 3 women-only focus groups (1 for instructors/assistant professors, 1 for associate professors, and 1 for full professors) and 1 men-only focus group of full professors (total N = 50). Our analyses identified several major themes on barriers to equitable academic advancement, including (1) interpersonal and institutional gender bias, (2) difficulty balancing the demands of family life with work life, and (3) gender differences in negotiation strategies. Barriers to gender equity in academic advancement are myriad and enduring and span the professional and personal lives of ID physicians. In addition to swift enactment of policy changes directed at critical issues such as ending workplace harassment and ensuring adequate parental leaves for birth and nonbirth parents, leaders in academic medicine must shine a bright light on biases within the system at large and within themselves to correct these disparities with the urgency required.

Why Gender-Based Bullying Is Normalized in Academic Medicine: Experiences and Perspectives of Women Physician Leaders.

Background: Bullying has been identified as a problem in the academic medicine. Bullying behaviors persist because organizational cultures have allowed them to become normalized. In academic medicine, women are more likely to be bullied than men. Our purpose was to explain why gender-based bullying persists in academic medicine and identify mitigation strategies. Methods: We interviewed senior faculty women physicians who graduated from the Hedwig van Ameringen Executive Leadership in Academic Medicine® program. We asked participants about their experience with bullying and its consequence on their careers. We also asked about the types of culture they think perpetuates bullying and their thoughts on how best to mitigate bullying. Interviews were recorded, transcribed, and coded using Averbuch's Cycle of Academic Bullying as a framework. Results: We sampled 30 women physician leaders for interviews from a pool of 96 volunteers who had screened positive for experiencing bullying. All 30 either experienced or witnessed bullying during their careers. Bullying behaviors included public humiliation, defamation, verbal disparagement, and social isolation. Subjects suffered numerous negative effects from bullying such as stress, burnout, depression, and having to leave the job. Participants believed bullying behaviors persisted due to hierarchical organizational cultures. Barriers to reporting and mitigation were thought to originate from lack of leadership combined with ineffective policies and reporting mechanisms. Conclusions: Dysfunctional hierarchies embedded in organizational cultures within academic medicine have contributed to the normalization of bullying. Committed leadership, focused on implementing comprehensive bullying prevention policies, is needed to promote an inclusive culture in which everyone feels that they belong.

Office of Diversity, Equity, and Inclusion: Engagement and Leadership Opportunities for Trainees.

To achieve a healthier future for all, improving diversity through efforts such as diversifying faculty and leadership in academic medicine is imperative. Therefore, medical trainees (medical students, residents, fellows) from groups underrepresented in medicine (UiM) are encouraged to pursue academic careers and have opportunities to gain faculty leadership skills during their training. Trainees also need exposure to the leadership positions within various offices of an academic institution such as the Office of Diversity, Equity, and Inclusion (DEI). The goal of this module is to expose UiM trainees to the Office of DEI and leadership competencies that can be obtained via service and leadership opportunities with it. The Kern model was used in the development, implementation, and evaluation of this 75-minute workshop. The workshop consisted of a PowerPoint presentation, reflection exercises, and case discussion to raise trainees' awareness of the Office of DEI and opportunities to become engaged with and develop faculty leadership competencies through the office. Sixty-six diverse learners across three sites completed pre- and postworkshop surveys. Ninety-five percent of participants agreed or strongly agreed that the learning objectives of the workshop had been met. Overall, this interactive workshop facilitated learners' awareness of the responsibilities of the Office of DEI and opportunities for learners to develop faculty leadership competencies through engagement. Although primarily evaluated among medical students, the module can be of use to learners and faculty of other health professions programs with an Office of DEI.