Leadership Positions In Academic Medicine Research Articles

Breaking Through Barriers: Factors That Influence Behavior Change Toward Leadership for Women in Academic Medicine.

Under-representation of women in leadership at Academic Medical Centers (AMCs) is a known challenge such that, in 2021, women made up only 28% of department chairs. AMCs are addressing the dearth of women leaders through targeted programming to create leadership pipelines of qualified women. The FLEX Leadership Development Program at the Case Western Reserve University (CWRU) School of Medicine prepares women faculty for increased leadership opportunities. FLEX includes the opportunity to leverage executive coaching to accomplish individual goals. The FLEX program has the explicit goal of increasing the number of women in visible leadership positions in academic medicine and health sciences. Semi-structured interviews were conducted with 25 graduates from seven FLEX cohorts (2012–2018). Participants reflected diversity in academic rank, terminal degree, racial/ethnic background, years of employment, and institutional affiliation. Interviews consisted of eight questions with additional probes to elicit lived experiences. Analysis consisted of two-stage open- and axial-coding of interview transcripts to understand: What factors facilitated behavior change following FLEX training? The analysis revealed five overarching themes: (1) Communication skills; (2) Self-Efficacy; (3) Networking; (4) Situational Awareness; and (5) Visioning. FLEX graduates reported achieving both personal and professional growth by drawing upon peer networks to proactively seek new leadership opportunities. These results suggest that the enduring benefits of the FLEX Program include improved communication skills, expanded situational awareness and relational capacity, greater self-efficacy and self-confidence, improved networking with an understanding of the value of networking. All these factors led FLEX graduates to have greater visibility and to engage with their colleagues more effectively. Similarly, FLEX graduates could better advocate for themselves and for others as well as paying it forward to mentor and train the next generation of faculty. Finally, participants learned to re-evaluate their goals and their career vision to be able to envision themselves in greater leadership roles. The five factors that strongly influenced behavior change provide valuable constructs for other programs to examine following leadership development training. Ongoing studies include examining successful leadership position attainment, personal goal attainment, and measuring changes in leadership self-efficacy.

Editorial introductions

Editorial introductions

Gender Disparity in Citations in High-Impact Journal Articles

Women are less likely to be promoted and hold leadership positions in academic medicine. How often academic articles are cited is a key measure of scholarly impact and frequently assessed for professional advancement; however, it is unknown whether peer-reviewed articles written by men and women are cited differently. To evaluate whether academic articles from high-impact medical journals written by men and women are cited differently. In this cross-sectional study of all original research and commentary articles from 5 high-impact medical journals (Annals of Internal Medicine, British Medical Journal, JAMA, JAMA Internal Medicine, and The New England Journal of Medicine) from 2015 to 2018, the gender of the primary and senior authors of each article were identified using an online database, and the number of times each article has been cited was identified using Web of Science. The number of citations by primary and senior author gender were then compared. Data were analyzed from July 2020 to April 2021. Primary and senior authors' genders. Number of citations per article. Among 5554 articles, women wrote 1975 (35.6%) as primary author and 1273 of 4940 (25.8%) as senior author. Original research articles written by women as primary authors had fewer median (interquartile range) citations than articles written by men as primary authors (36 [17-82] citations vs 54 [22-141] citations; P < .001) and senior authors (37 [17-93] citations vs 51 [20-128] citations; P < .001). Articles written by women as both primary and senior authors had approximately half as many median (interquartile range) citations as those authored by men as both primary and senior authors (33 [15-68] citations vs 59 [23-149] citations; P < .001). Differences in citations remained in each year of the study and were less pronounced among commentary articles. In this study, articles written by women in high-impact medical journals had fewer citations than those written by men, particularly when women wrote together as primary and senior authors. These differences may have important consequences for the professional success of women and achieving gender equity in academic medicine.

Redressing Gender Imbalance in Leadership in Academic Medicine.

To the Editor: We write in response to “Seeking Parity for Women in Academic Medicine: A Historical Perspective,” 1 a commentary by Kenneth Ludmerer. We write in our own capacity and on behalf of the Medical Women’s Federation (MWF), the largest body of women doctors in the United Kingdom, and Women Speakers in Healthcare (WSH), the United Kingdom’s largest database of women speakers across health and social care. In his commentary, Ludmerer observes that women remain “highly underrepresented in leadership positions in academic medicine,” such as professorships, department chairs, and medical deans. He attributes this to many complex reasons, including “microinequities” and an academic culture that promotes a single-minded mentality. For example, there is extensive evidence suggesting that women are underrepresented as academic authors in many areas, in both the sciences and humanities, and especially in senior authorship positions. 2 Preexisting gender disparities in research and authorship have been particularly exposed and amplified during the COVID-19 pandemic, in part due to increased caring responsibilities undertaken by women during this time. A case in point: We suggest that Academic Medicine’s editors could have invited a female historian to write a commentary on the issues discussed by Ludmerer. There is no shortage of qualified female historians of health care and of women in academic medicine who are well placed to offer their expertise. The fact that one of them was not invited to write about the issues of women’s leadership in academic medicine means that a prime opportunity to foster authorship by women on this important topic has been missed. Having a female author would have been a way to amplify the voices of women in academia. Addressing the “fundamental paradox” of the continued underrepresentation of women in academic leadership requires disruption of the status quo. To correct established gender disparity, aspiring women leaders and academics need to be actively encouraged and supported to achieve their potential. There are many actions both men and women can take to support women in health care leadership. To that end, WSH was founded in 2019 to ensure balanced gender representation at all U.K. health care conferences and events, with parity of opportunity for all (for more information, see wsih.co.uk). Since its inception, WSH has invited men to join as allies and to nominate women colleagues and has requested that organizers ensure their events are gender-balanced. In addition, in 2019, men were invited as honorary MWF members for the first time. We believe that affirmative action is vital to redress existing gender imbalances and to increase diversity of views, opinions, and experiences. We eagerly await your response to our suggestion above, as we believe an opportunity has been missed to promote gender equity in academia, as Ludmerer advocates.

National Trends of Sex Disparity in the American College of Cardiology/American Heart Association Guideline Writing Committee Authors Over 15 Years.

National Trends of Sex Disparity in the American College of Cardiology/American Heart Association Guideline Writing Committee Authors Over 15 Years.

Editorial introductions

Editorial introductions

"It's a Little Different for Men"-Sponsorship and Gender in Academic Medicine: a Qualitative Study.

Women remain underrepresented in top leadership positions in academic medicine. In business settings, a person with power and influence actively supporting the career advancement of a junior person is referred to as a sponsor and sponsorship programs have been used to diversify leadership. Little is known about how sponsorship functions in academic medicine. To explore perceptions of sponsorship and its relationship to gender and career advancement in academic medicine. Qualitative study using semi-structured, one-on-one interviews with sponsors and protégés. Twelve sponsors (clinical department chairs) and 11 protégés (participants of a school of medicine executive leadership program [N = 23]) at the Johns Hopkins School of Medicine. All sponsors were men and all were professors, six of the 11 protégés were women, and four of the 23 participants were underrepresented minorities in medicine. We identified three themes: (1) people (how and who): women seek out and receive sponsorship differently; (2) process (faster and further): sponsorship provides an extra boost, especially for women; and (3) politics and culture (playing favorites and paying it forward): sponsorship and fairness. Informants acknowledge that sponsorship provides an extra boost for career advancement especially for women. Sponsors and protégés differ in their perceptions of how sponsorship happens. Informants describe gender differences in how sponsorship is experienced and specifically noted that women were less likely to actively seek out sponsorship and be identified as protégés compared to men. Informants describe a tension between sponsorship and core academic values such as transparency, fairness, and merit. Sponsorship is perceived to be critical to high-level advancement and is experienced differently by women. Increased understanding of how sponsorship works in academic medicine may empower individual faculty to utilize this professional relationship for career advancement and provide institutions with a strategy to diversify top leadership positions.

Seeking Parity for Women in Academic Medicine: A Historical Perspective.

In this Invited Commentary, the author applies a historical lens to explore a fundamental paradox in U.S. medical education: the fact that long after women gained parity with men in matriculation to medical school, women remain highly underrepresented in leadership positions in academic medicine. The reasons for this are many and complex, but at the core are the subtle but hurtful indignities ("microinequities") experienced by women physicians and an academic culture that expects single-minded dedication to work, regardless of the costs to faculty members' personal lives. Achieving parity for women in academic leadership will require changing the culture of medical schools and teaching hospitals to correct these 2 fundamental obstacles. In recent years, many medical schools and teaching hospitals have made efforts to improve opportunities and satisfaction for women trainees and physicians, enacting reforms to improve work-life balance for all faculty. It is plausible to imagine a future in which flexible time frames to achieve tenure and promotion are universally available to both women and men, with high scholarly standards firmly maintained. If this occurs, it will represent a profound legacy for women in academic medicine, for their generations of professional sacrifice and advocacy for a more equitable culture will have changed its culture.

Leadership Pathways in Academic Family Medicine: Focus on Underrepresented Minorities and Women

Leadership positions in academic medicine lack racial and gender diversity. In 2016, the Council of Academic Family Medicine (CAFM) established a Leadership Development Task Force to specifically address the lack of diversity among leadership in academic family medicine, particularly for underrepresented minorities and women. The task force was formed in August 2016 with members from each of the CAFM organizations representing diversity of race, gender, and academic position. The group met from August 2016 to December 2017. The task force reviewed available leadership development programming, and through consensus identified common pathways toward key leadership positions in academic family medicine-department chairs, program directors, medical student education directors, and research directors. consensus development: The task force developed a model that describes possible pathways to several leadership positions within academic family medicine. Additionally, we identified the intentional use of a multidimensional mentoring team as critically important for successfully navigating the path to leadership. There are ample opportunities available for leadership development both within family medicine organizations and outside. That said, individuals may require assistance in identifying and accessing appropriate opportunities. The path to leadership is not linear and leaders will likely hold more than one position in each of the domains of family medicine. Development as a leader is greatly enhanced by forming a multidimensional team of mentors.

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Editorial introductions

Parenthood does not explain the gender difference in clinical position in academic medicine among Swedish, Dutch and Austrian physicians

Studies have continuously shown that fewer women than men achieve leadership positions in academic medicine. In the current study we explored gender differences in clinical position among academic physicians at three university hospitals, each in a different European country. These countries, Sweden, the Netherlands and Austria, differ in terms of gender equality. We analyzed whether the number of children, working hours or publications could explain gender differences in physicians’ clinical position. In this cross-sectional questionnaire study 1333 (54% female) physicians participated. Physicians were asked about their gender, age, number of children, working hours and clinical position. We used structural equation models to explore the influence of gender on the physicians’ clinical position in each of the three countries. We explored whether the association between gender and clinical position could be explained by number of children, working hours or publication activity. The analyses revealed that at all three university hospitals gender influenced clinical position. These gender differences in clinical position could be partly explained by gender differences in publication activity. Female physicians as compared to male physicians were likely to publish fewer articles, and in turn these lower publication numbers were associated with lower clinical positions. The number of children or working hours did not explain gender differences in publication activity or clinical position. Therefore, factors other than unequal allocation of household labor, such as the academic working environment, may still disproportionately disadvantage women’s progress, even at universities in countries with high rates of gender equality such as Sweden.

Editorial introductions

Editorial introductions

It Is Time for Zero Tolerance for Sexual Harassment in Academic Medicine.

While more women are in leadership positions in academic medicine now than ever before in U.S. history, evidence from recent surveys of women and graduating medical students demonstrates that sexual harassment continues in academic health centers. Academic medicine's ability to change its culture is hampered by victims' fear of reporting episodes of harassment, which is largely due to fear of retaliation. In this Perspective, the authors describe efforts in scientific societies to address the issue of sexual harassment and to begin to establish safe environments at national meetings. The authors contend that each institution must work to make it safe for individuals to come forward, to provide training for victims and for bystanders, and to abolish "locker room" talk that is demeaning to women.

Editorial introductions

Editorial introductions

Recruiting Faculty Leaders at U.S. Medical Schools: A Process Without Improvement?

Recruiting faculty leaders to work in colleges of medicine is a ubiquitous, time-consuming, costly activity. Little quantitative information is available about contemporary leadership recruiting processes and outcomes. In this article, the authors examine current recruiting methods and outcomes in colleges of medicine and compare academic search approaches with the approaches often employed in intellectual-capital-rich industries.In 2015, the authors surveyed chairs of internal medicine at U.S. medical schools regarding their recruiting practices and outcomes-specifically their selection methods, the duration of searches, the recruitment of women and minorities underrepresented in medicine (URM), and their satisfaction with search outcomes.The authors found that department chairs were extensively engaged in numerous searches for leaders. The recruitment process most commonly required 7 to 12 months from initiation to signed contract. Interestingly, longer searches (19+ months) were much more frequently associated with a recruitment outcome that chairs viewed as unsatisfactory or very unsatisfactory. Most leadership searches produced very few women and URM finalists. The biggest perceived hurdles to successful recruitment were the need to relocate the candidate and family and the shortage of good candidates.The process of recruiting leaders in academic medicine has changed little in more than 25 years. Process improvement is important and should entail carefully structured search processes, including both an overhaul of search committees and further emphasis on leadership development within the college of medicine. The authors propose specific steps to enhance recruitment of members of URM groups and women to leadership positions in academic medicine.

The ASIBS Short Course: A unique strategy for increasing statistical competency of junior investigators in academic medicine.

As clinical researchers at academic medical institutions across the United States increasingly manage complex clinical databases and registries, they often lack the statistical expertise to utilize the data for research purposes. This statistical inadequacy prevents junior investigators from disseminating clinical findings in peer-reviewed journals and from obtaining research funding, thereby hindering their potential for promotion. Underrepresented minorities, in particular, confront unique challenges as clinical investigators stemming from a lack of methodologically rigorous research training in their graduate medical education. This creates a ripple effect for them with respect to acquiring full-time appointments, obtaining federal research grants, and promotion to leadership positions in academic medicine. To fill this major gap in the statistical training of junior faculty and fellows, the authors developed the Applied Statistical Independence in Biological Systems (ASIBS) Short Course. The overall goal of ASIBS is to provide formal applied statistical training, via a hybrid distance and in-person learning format, to junior faculty and fellows actively involved in research at US academic medical institutions, with a special emphasis on underrepresented minorities. The authors present an overview of the design and implementation of ASIBS, along with a short-term evaluation of its impact for the first cohort of ASIBS participants.

Gender disparities in gastroenterology fellowship director positions in the United States

Despite a paucity of women occupying leadership positions in academic medicine, studies have shown a higher ratio of female representation in the program director position compared withdivision chief in multiple specialties. This study aims to determine whether this trend exists in 3-year gastroenterology fellowships in the United States and to evaluate for any factors that may affect these differences. In 2015, data were collected for the 163 U.S. gastroenterology fellowship programs including program director, associate program director, division chief, gender distribution, program size, academic center affiliation, and geographic region. A higher percentage of men than women held the role of program director (82% vs 18%), associate program director (72% vs 28%), and division chief (93% vs 7%). Women in program leadership held lower academic rank than their male counterparts (P< .0001). The program director was more likely to be female if the division chief also was female (P= .03). Programs with a higher number of trainees tended to be led by a female program director (P= .06). A gender disparity exists in all gastroenterology leadership roles, although the magnitude is smaller for program director and associate program director than the role of division chief. Further studies are needed to investigate the impact of this disparity on promotion and academic productivity.

In Pursuit of Genes of Glucose Metabolism

If you don't know where you're going, you might wind up someplace else—Yogi Berra My professional journey, once I accepted the fact that I would not play first base for the Chicago Cubs, was not accomplished in a straight line. I entered medical school intending to become a family physician but soon became interested in research. I took an internal medicine residency at the University of California, San Francisco (UCSF), then a long research fellowship in the nascent field of molecular biology at the National Institutes of Health (NIH), and followed that with training in clinical endocrinology at the University of Wisconsin. I spent the next fifteen years dividing my time between the clinic and laboratory at the University of Iowa. Finally, I decided to concentrate on research and spent the next twenty-three years at Vanderbilt University. For the past eleven years, I have been at the University of Iowa, where I helped establish a new diabetes research center. My research journey also had several different directions. Upon reflection, I guess I ended up “someplace else” by choice, and it certainly has been an interesting trip. It is one I unreservedly recommend.

In Memoriam: William H. Daughaday, MD (1918–2013)

Dr William H. Daughaday, the 51st President of The Endocrine Society, died at age 95 on May 3, 2013. His contributions to endocrinology and to the Society were wide-ranging and numerous, not the least of which was the large cohort of physicians attracted to fundamental and clinical endocrine research by his enthusiasm, energy, and overwhelming intellectual curiosity. Bill Daughaday grew up in greater Chicagoland and attended Harvard College. There he was captain of the wrestling team and was inducted into Phi Beta Kappa. After graduation from Harvard Medical School in 1943, where he was selected for the Alpha Omega Alpha honor society, he served in the Army as a medical officer for 20 months during the latter part of World War II and then returned stateside to continue his clinical and scientific training, initially with Robert H. Williams at Boston City Hospital. In 1947, he moved to Washington University School of Medicine in St Louis as an Assistant Resident in Medicine at Barnes Hospital. He joined the laboratory of Carl and Gerty Cori in 1949 as a Research Fellow and began to investigate the metabolic actions of GH on isolated rat diaphragm. Despite the failure of these studies to explain the (even then) well-known anti-insulin effects of GH, this apparently unpromising exploratory project set into motion a life-long interest in all things GH (1). In 1951, Bill Daughaday formed his own research laboratory and became head of a new Metabolism Division in the Department of Medicine at Washington University (he was acting head in 1950), which he continued to lead for the next 34 years. Under his guidance, the Metabolism Division developed into one of the premier endocrinology units in the country, known for high-level research productivity and superb scientific training, as evidenced by the dozens of former fellows who have occupied leadership positions in academic medicine throughout the world. This drive for excellence was amplified by combined clinical and research activities with the Division of Bone and Mineral Metabolism at neighboring Jewish Hospital of St Louis and with the Division of Endocrinology and Metabolism at St Louis Children’s Hospital. The environment nurtured by Bill guaranteed that trainees

Does stereotype threat affect women in academic medicine?

Multiple complex factors contribute to the slow pace of women's advancement into leadership positions in academic medicine. In this article, the authors propose that stereotype threat--under which individuals who are members of a group characterized by negative stereotypes in a particular domain perform below their actual abilities in that domain when group membership is emphasized--may play an important role in the underrepresentation of women in leadership positions in academic medicine. Research to objectively assess the impact of stereotype threat for women in academic medicine is feasible and necessary to confirm this hypothesis. Still, a number of conditions present in the academic medicine community today have been shown to trigger stereotype threat in other settings, and stereotype threat fits with existing research on gender in academic medicine. In the meantime, academic health centers should implement relatively simple measures supported by experimental evidence from other settings to reduce the risk of stereotype threat, including (1) introducing the concept of stereotype threat to the academic medicine community, (2) engaging all stakeholders, male and female, to promote identity safety by enacting and making faculty aware of policies to monitor potential instances of discrimination, and training faculty to provide performance feedback that is free of gender bias, (3) counteracting the effects of sex segregation at academic health centers by increasing exposure to successful female leaders, (4) reducing gender stereotype priming by avoiding stereotypically male criteria for promotion, grants, and awards, and (5) building leadership efficacy among female physicians and scientists.