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ObjectivesEvidence on the current status of gender equity in academic rheumatology in Europe and potential for its improvement is limited. The EULAR convened a task force to obtain empirical evidence on the potential unmet need for support of female rheumatologists, health professionals and non-clinical scientists in academic rheumatology.MethodsThis cross-sectional study comprised three web-based surveys conducted in 2020 among: (1) EULAR scientific member society leaders, (2) EULAR and Emerging EULAR Network (EMEUNET) members and (3) EULAR Council members. Statistics were descriptive with significance testing for male/female responses assessed by χ2 test and t-test.ResultsData from EULAR scientific member societies in 13 countries indicated that there were disproportionately fewer women in academic rheumatology than in clinical rheumatology, and they tended to be under-represented in senior academic roles. From 324 responses of EULAR and EMEUNET members (24 countries), we detected no gender differences in leadership aspirations, self-efficacy in career advancement and work–life integration as well as the share of time spent on research, but there were gender differences in working hours and the levels of perceived gender discrimination and sexual harassment. There were gender differences in the ranking of 7 of 26 factors impacting career advancement and of 8 of 24 potential interventions to aid career advancement.ConclusionsThere are gender differences in career advancement in academic rheumatology. The study informs a EULAR task force developing a framework of potential interventions to accelerate gender-equitable career advancement in academic rheumatology.

Purpose We report on the extent of sexual harassment among residents and examine its relationship to specialty and program year and effects. Methods Using the C–Change Resident Survey, we surveyed residents in 34 internal medicine, pediatrics, and general surgery programs in 14 academic medical centers (AMCs). A total of 1708 residents completed the survey (70% response-rate); 51% (n = 879) were women. Respondents reported unwanted sexual comments, attention, or advances by a superior or colleagues within the last 2 years. Measures of vitality and ethical or moral distress were included in the surveys. Results Rates of sexual harassment reported by women differed across the 34 programs, with an interquartile range of 0%-11%. Residents in pediatrics had the lowest frequencies of sexual harassment (mean 2%, 95% confidence interval [CI] 0%, 4%). Residents in internal medicine had higher rates of sexual harassment (mean 7%, 95% CI 1%, 25%). Residents in surgery had the highest rates (mean 12%, 95% CI 2%, 33%). Sexual harassment was associated with lower levels of vitality and higher ethical or moral distress (both, P Conclusions Sexual harassment is more common for women residents in Internal Medicine and Surgery programs. The adverse effects of sexual harassment on female residents detracts from an institution’s professional workforce.

To clarify our understanding of how the culture of residency training influences the well-being of residents, this study reports on the vitality of residents at 34 programs across the United States and identifies characteristics of the programs, institutions and residents that are associated with high resident vitality.In 2014 to 2015, residents nationally were surveyed using the validated C - Change Resident Survey. The survey assessed residents' vitality and 12 other dimensions that characterize residents' perspectives of the culture of the residency training programs: Self-efficacy, Institutional/program support, Relationships/inclusion/trust, Values alignment, Ethical/moral distress, Respect, Leadership aspirations, Mentoring, Work-life integration, Gender equity, Racial/ethnic minority equity, and self-assessed Competencies. Multilevel models were used to assess vitality within and across programs, and examine predictors including resident, program, and institution characteristics.Two thousand four hundred and fifty-two residents from 11 General Surgery, 12 Internal Medicine, and 11 Pediatrics programs at 14 U.S. academic health systems.One thousand seven hundred and eight residents responded (70% response rate). The mean Vitality score was 3.6 (range 1-5, where values of 4-5 represent high Vitality). There was wide variation among the 34 programs in the percent of residents who had high Vitality scores, ranging from 17% to 71%. However, the average Vitality scores within specialty (Surgery, Medicine, and Pediatrics) were not significantly different. The strongest predictors of Vitality were Work-life integration, Relationships/inclusion/trust, Institutional/program support, Res?pect, Values alignment, and Ethical/moral distress, which together accounted for 50% of vitality variance. Individual demographics accounted for just 3% of variance.Vitality is an essential component of resident well-being, and within each specialty there are programs that have excelled in promoting a culture of high vitality. Our findings suggest that we should test interventions to enhance resident vitality by focusing greater attention on providing institutional support, aligning individual and institutional values, integrating work and personal life, and facilitating relationships, inclusiveness and trust.

Key Points Question How do midcareer medical school faculty perceive the impact of the COVID-19 pandemic on their lives and their work? Findings In this qualitative study of 39 midcareer research faculty, dominant themes included finding increased meaningfulness of work; a sense of professionalism and moral responsibility; enhanced relationships with colleagues; reassertion of career choice; disrupted research; impact on clinical work; attention to health disparities, social justice, and advocacy; increased family responsibilities; psychological stress; and focus on leadership. Meaning In this study of a diverse group of midcareer medical school faculty, the experience of working during the pandemic appeared to have had important positive impacts on physician investigators and PhD scientists, contributing to their vitality and professional dedication that were associated with intrinsic motivators., This qualitative study examines how the COVID-19 pandemic affected midcareer research faculty in academic medicine., Importance As medical faculty have central roles during the COVID-19 pandemic, it is important to study the pandemic’s association with the vitality and careers of medical school faculty. Objective To examine how the COVID-19 pandemic affected midcareer research faculty in academic medicine. Design, Setting, and Participants This qualitative study included medical school faculty who participated in the C-Change Mentoring and Leadership Institute. All US medical school faculty recipients of recent National Institutes of Health (NIH) RO1, RO1-equivalent, and K awards were invited to apply to the institute. The 99 applicants who met inclusion criteria were stratified by degree (MD or MD/PhD vs PhD), gender, and race/ethnicity. Enrollment was offered to applicants randomly selected for 40 spots, demographically balanced by sex, underrepresented in medicine minority (URMM) status, and degree. In April 2020, an inquiry was emailed to faculty enrolled in the institute requesting responses to questions about meaning in work, career choice, and values. A qualitative analysis of narrative data responses, using grounded theory, was undertaken to determine key themes. This study is part of a NIH-funded randomized trial to test the efficacy of a group peer mentoring course for midcareer faculty and study the course’s mechanisms of action. Main Outcomes and Measures Key themes in data. Results Of 40 enrolled participants, 39 responded to the inquiry, for a response rate of 97%. The analytic sample included 39 faculty members; 19 (47%) were women, 20 (53%) identified as URMM, and 20 (53%) had an MD or MD with PhD vs 19 (47%) with PhD degrees. Key themes in the data that emerged describing faculty lived experience of the pandemic included increased meaningfulness of work; professionalism and moral responsibility; enhanced relationships with colleagues; reassertion of career choice; disrupted research; impact on clinical work; attention to health disparities, social justice and advocacy; increased family responsibilities; psychological stress; and focus on leadership. Conclusions and Relevance During the pandemic, diverse PhD and physician investigators reported increased meaningfulness in work and professionalism and enhanced relationships, all intrinsic motivators associated with vitality. Working during the pandemic appears to have produced intrinsic rewards positively associated with vitality, in addition to adverse mental health effects. These findings have implications for combatting burnout and retaining investigators in the future.

A practical instrument is needed to reliably measure the clinical learning environment and professionalism for residents. To develop and present evidence of validity of an instrument to assess the culture of residency programs and the clinical learning environment. During 2014–2015, we surveyed residents using the C - Change Resident Survey to assess residents’ perceptions of the culture in their programs. Residents in all years of training in 34 programs in internal medicine, pediatrics, and general surgery in 14 geographically diverse public and private academic health systems. The C - Change Resident Survey assessed residents’ perceptions of 13 dimensions of the culture: Vitality, Self-Efficacy, Institutional Support, Relationships/Inclusion, Values Alignment, Ethical/Moral Distress, Respect, Mentoring, Work–Life Integration, Gender Equity, Racial/Ethnic Minority Equity, and self-assessed Competencies. We measured the internal reliability of each of the 13 dimensions and evaluated response process, content validity, and construct-related evidence validity by assessing relationships predicted by our conceptual model and prior research. We also assessed whether the measurements were sensitive to differences in specialty and across institutions. A total of 1708 residents completed the survey [internal medicine: n = 956, pediatrics: n = 411, general surgery: n = 311 (51% women; 16% underrepresented in medicine minority)], with a response rate of 70% (range across programs, 51–87%). Internal consistency of each dimension was high (Cronbach α: 0.73–0.90). The instrument was able to detect significant differences in the learning environment across programs and sites. Evidence of validity was supported by a good response process and the demonstration of several relationships predicted by our conceptual model. The C - Change Resident Survey assesses the clinical learning environment for residents, and we encourage further study of validity in different contexts. Results could be used to facilitate and monitor improvements in the clinical learning environment and resident well-being.

Results of two C-Change surveys of 4997 faculty and staff in medical and social sciences are analysed quantitatively and qualitatively and presented with illustrative quotations giving voice to critical personal perceptions of the culture and efforts to improve it. The C-Change survey included 12 dimensions of the culture: Vitality; Self-Efficacy in Career Advancement; Institutional Support; Relationships/Inclusion/Trust; Values Alignment; Ethical/Moral Distress; Leadership Aspirations; Work-Life Integration; Gender Equity; Black and Minority Ethnic Equity; Institutional Change Efforts for Diversity; Institutional Change Efforts for Faculty Support. Women were less positive than men on six dimensions in medical and ten dimensions in social sciences, suggesting that women’s experiences are different to those of men. Both women and men were more positive about the culture in medical than social sciences. A more positive culture in medical sciences is attributed to the wide-spread implementation of Athena SWAN gender equality action plans linked to the NIHR funding incentives.

INTRODUCTION Despite the well-recognized benefits of mentoring in academic medicine, there is a lack of clarity regarding what constitutes effective mentoring. We developed a tool to assess mentoring activities experienced by faculty and evaluated evidence for its validity. METHODS The National Initiative on Gender, Culture, and Leadership in Medicine-"C-Change"-previously developed the C-Change Faculty Survey to assess the culture of academic medicine. After intensive review, we added six items representing six components of mentoring to the survey-receiving help with career and personal goals, learning skills, sponsorship, and resources. We tested the items in four academic health centers during 2013 to 2014. We estimated reliability of the new items and tested the correlation of the new items with a mentoring composite variable representing faculty mentoring experiences as positive, neutral, or inadequate and with other C-Change dimensions of culture. RESULTS Among the 1520 responding faculty (response rate 61-63%), there was a positive association between each of the six mentoring activities and satisfaction with both the amount and quality of mentoring received. There was no difference by sex. Cronbach α coefficients ranged from 0.89 to 0.95 across subgroups of faculty (by sex, race, and principal roles). The mentoring responses were associated most closely with dimensions of Institutional Support (r = 0.58, P < .001), Institutional Change Efforts for Faculty Support (r = 0.52, P < .001), Values Alignment (r = 0.58, P < .001), Self-efficacy (r = 0.43; P < .001), and Relationships/Inclusion/Trust (r = 0.41; P < .001). DISCUSSION Data demonstrated that the Mentoring scale is a valid instrument to assess mentoring. Survey results could facilitate mentoring program development and evaluation.

Faculty with high vitality are essential to the missions of academic health centers (AHCs). Because little is known about how to measure or enhance faculty vitality, the authors assessed current faculty vitality and identified its predictors.In a stratified random sample of 26 nationally representative U.S. AHCs, the authors surveyed 4,578 full-time faculty during 2007-2009. The validated survey measured detailed faculty perceptions of their professional experiences and organizational culture. Vitality was measured with a previously evaluated five-item scale.Of the faculty invited, 2,381 (52%) responded, with 2,218 eligible for analysis. Respondents included 512 (23%) underrepresented in medicine minority (URMM) faculty and 1,172 (53%) women. In a multivariable model including individual- and AHC-level factors, the strongest predictors of vitality were faculty members' perceptions of four dimensions of AHC culture: Relationships/inclusion, Values alignment, Work-life integration, and Institutional support (all P.001). Weaker predictors were faculty age, institution type (public/private), and the AHC's National Institutes of Health funding rank (all P ≤ .03). Half of the respondents scored high on vitality, whereas 25% had low, or suboptimal, scores. Holding perceptions of culture constant, neither female nor URMM faculty had vitality scores that were different on average from male or nonminority faculty.A large percentage of faculty lack the vitality essential to meeting the AHC missions of discovery, education, and patient care. Enhancing faculty vitality, and AHC resilience, requires more attention to strengthening relationships, improving the misalignment between faculty and institutional values, and improving work-life integration.

To address a dearth of mentoring and to avoid the pitfalls of dyadic mentoring, the authors implemented and evaluated a novel collaborative group peer mentoring program in a large academic department of medicine.The mentoring program aimed to facilitate faculty in their career planning, and targeted either early-career or midcareer faculty in 5 cohorts over 4 years, from 2010 to 2014. Each cohort of 9-12 faculty participated in a yearlong program with foundations in adult learning, relationship formation, mindfulness, and culture change. Participants convened for an entire day, once a month. Sessions incorporated facilitated stepwise and values-based career planning, skill development, and reflective practice. Early-career faculty participated in an integrated writing program and midcareer faculty in leadership development.Overall attendance of the 51 participants was 96%, and only 3 of 51 faculty who completed the program left the medical school during the 4 years. All faculty completed a written detailed structured academic development plan. Participants experienced an enhanced, inclusive, and appreciative culture; clarified their own career goals, values, strengths and priorities; enhanced their enthusiasm for collaboration; and developed skills.The program results highlight the need for faculty to personally experience the power of forming deep relationships with their peers for fostering successful career development and vitality. The outcomes of faculty humanity, vitality, professionalism, relationships, appreciation of diversity, and creativity are essential to the multiple missions of academic medicine.

A diverse medical school faculty is critical to preparing physicians to provide quality care to an increasingly diverse nation. The authors sought to compare experiences of underrepresented in medicine minority (URMM) faculty with those of non-URMM faculty in a nationally representative sample of medical schools.In 2007-2009, the authors surveyed a stratified random sample of 4,578 MD and PhD full-time faculty from 26 U.S. medical schools. Multiple regression models were used to test for differences between URMM and other faculty on 12 dimensions of academic culture. Weights were used to adjust for oversampling of URMM and female faculty.The response rate was 52%, or 2,381 faculty. The analytic sample was 2,218 faculty: 512 (23%) were URMM, and 1,172 (53%) were female, mean age 49 years. Compared with non-URMM faculty, URMM faculty endorsed higher leadership aspirations but reported lower perceptions of relationships/inclusion, gave their institutions lower scores on URMM equity and institutional efforts to improve diversity, and more frequently engaged in disparities research. Twenty-two percent (115) had experienced racial/ethnic discrimination. For both values alignment and institutional change for diversity, URMM faculty at two institutions with high proportions (over 50%) of URMM faculty rated these characteristics significantly higher than their counterparts at traditional institutions.Encouragingly, for most aspects of academic medicine, the experiences of URMM and non-URMM faculty are similar, but the differences raise important concerns. The combination of higher leadership aspirations with lower feelings of inclusion and relationships might lead to discouragement with academic medicine.

Global investment in biomedical research has grown significantly over the last decades, reaching approximately a quarter of a trillion US dollars in 2010. However, not all of this investment is distributed evenly by gender. It follows, arguably, that scarce research resources may not be optimally invested (by either not supporting the best science or by failing to investigate topics that benefit women and men equitably). Women across the world tend to be significantly underrepresented in research both as researchers and research participants, receive less research funding, and appear less frequently than men as authors on research publications. There is also some evidence that women are relatively disadvantaged as the beneficiaries of research, in terms of its health, societal and economic impacts. Historical gender biases may have created a path dependency that means that the research system and the impacts of research are biased towards male researchers and male beneficiaries, making it inherently difficult (though not impossible) to eliminate gender bias. In this commentary, we - a group of scholars and practitioners from Africa, America, Asia and Europe - argue that gender-sensitive research impact assessment could become a force for good in moving science policy and practice towards gender equity. Research impact assessment is the multidisciplinary field of scientific inquiry that examines the research process to maximise scientific, societal and economic returns on investment in research. It encompasses many theoretical and methodological approaches that can be used to investigate gender bias and recommend actions for change to maximise research impact. We offer a set of recommendations to research funders, research institutions and research evaluators who conduct impact assessment on how to include and strengthen analysis of gender equity in research impact assessment and issue a global call for action. La inversión global en investigación biomédica ha crecido significativamente en las últimas décadas, alcanzando aproximadamente un cuarto de billón de dólares en 2010. Sin embargo, no toda esta inversión se distribuye de manera uniforme por género. De ello se deduce que los escasos recursos de investigación no pueden invertirse de manera óptima (ya sea porque no apoyan a la mejor ciencia o porque no se investigan temas que beneficien equitativamente a mujeres y hombres). Las mujeres en todo el mundo tienden a estar significativamente subrepresentadas en la investigación, tanto como investigadoras como participantes en la investigación, reciben menos fondos para la investigación y aparecen con menos frecuencia que los hombres como autoras en publicaciones de investigación. También hay cierta evidencia de que las mujeres se encuentran en una situación de desventaja relativa como beneficiarias de la investigación, en términos de su salud, impacto social y económico. Los sesgos históricos de género pueden haber creado una dependencia de ruta que significa que el sistema de investigación y los impactos de la investigación están sesgados hacia los investigadores hombres y los beneficiarios masculinos, por lo que es intrínsecamente difícil (aunque no imposible) eliminar el sesgo de género. En este comentario, nosotros, un grupo de académicos y profesionales de África, América, Asia y Europa, argumentamos que la evaluación de impacto de investigación sensible al género podría convertirse en una fuerza para bien al mover la política y la práctica científica hacia la equidad de género. La evaluación del impacto de la investigación es el campo multidisciplinario de la investigación científica que examina el proceso de investigación para maximizar el rendimiento científico, social y económico de la inversión en investigación. Abarca muchos enfoques teóricos y metodológicos que se pueden utilizar para investigar el sesgo de género y recomendar acciones para el cambio a fin de maximizar el impacto de la investigación. Ofrecemos un conjunto de recomendaciones para las fundaciones de investigación, instituciones de investigación y evaluadores de investigación que realizan evaluaciones de impacto sobre cómo incluir y fortalecer el análisis de equidad de género en la evaluación de impacto de la investigación y emitir una llamamiento global a la acción. La inversió global en recerca biomèdica ha crescut significativament en les últimes dècades, arribant a aproximadament un quart de bilió de dòlars en 2010. No obstant això, no tota aquesta inversió es distribueix de manera uniforme per gènere. D'això es dedueix que els escassos recursos d'investigació no poden invertir-se de manera òptima (ja sigui perquè no donen suport a la millor ciència o perquè no s'investiguen temes que beneficiïn equitativament a dones i homes). Les dones a tot el món tendeixen a estar significativament subrepresentades en la investigació, tant com a investigadores com a participants en la investigació, reben menys fons per a la investigació i apareixen amb menys freqüència que els homes com a autores en publicacions d'investigació. També hi ha certa evidència que les dones es troben en una situació de desavantatge relatiu com a beneficiàries de la investigació, en termes de la seva salut, impacte social i econòmic. Els biaixos històrics de gènere poden haver creat una dependència de ruta que vol dir que el sistema de recerca i els impactes de la investigació estan esbiaixats cap als investigadors homes i els beneficiaris masculins, per la qual cosa és intrínsecament difícil (encara que no impossible) eliminar el biaix de gènere. En aquest comentari, nosaltres, un grup d'acadèmics i professionals de l'Àfrica, Amèrica, Àsia i Europa, vam argumentar que l'avaluació d'impacte d'investigació sensible al gènere podria convertir-se en una força per bé en moure la política i la pràctica científica cap a l'equitat de gènere. L'avaluació de l'impacte de la recerca és el camp multidisciplinari de la recerca científica que examina el procés de recerca per maximitzar el rendiment científic, social i econòmic de la inversió en recerca. Abasta molts enfocaments teòrics i metodològics que es poden utilitzar per investigar el biaix de gènere i recomanar accions per al canvi per tal de maximitzar l'impacte de la investigació. Oferim un conjunt de recomanacions per a les fundacions de recerca, institucions de recerca i avaluadors d'investigació que realitzen avaluacions d'impacte sobre com incloure i enfortir l'anàlisi d'equitat de gènere en l'avaluació d'impacte de la investigació i emetre una crida global a l'acció .

Women are under-represented in academic medicine. We aimed to review the empirical evidence base focusing on the reasons for women’s choice or rejection of careers in academic medicine. Using a systematic search strategy, we identified 52 studies published between 1985 and 2015. Over a half had methodological limitations and most were from North America. Eight main themes had been explored in these studies. There was consistent evidence for four of these: women are interested in teaching more than in research; participation in research can encourage women into academic medicine; women lack adequate mentors and role models; and women experience gender discrimination and bias. The evidence was conflicting on four themes: women are less interested in research than men; women lose commitment to research as their education and training progress; women are deterred from academic careers by financial considerations; and women are deterred by concerns about work-life balance. Inconsistency of findings across studies suggests significant opportunities to overcome barriers by providing a more enabling context. We identified substantial gaps in the scientific literature that could form the focus of future research, including shifting the focus from individuals’ career choices to the societal and organisational contexts and cultures within which those choices are made; extending the evidence base to include a wider range of countries and settings; and testing the efficacy of interventions.

Introduction: Translational research organisations (TROs) are a core component of the UK's expanding research base. Equity of career opportunity is key to ensuring a diverse and internationally competitive workforce. The UK now requires TROs to demonstrate how they are supporting gender equity. Yet, the evidence base for documenting such efforts is sparse. This study is designed to inform the acceleration of women's advancement and leadership in two of the UK's leading TROsthe National Institute for Health Research (NIHR) Biomedical Research Centres (BRCs) in Oxford and London through the development, application and dissemination of a conceptual framework and measurement tool. Methods and analysis: A cross-sectional retrospective evaluation. A conceptual framework with markers of achievement and corresponding candidate metrics has been specifically designed for this study based on an adapted balanced scorecard approach. It will be refined with an online stakeholder consultation and semistructured interviews to test the face validity and explore practices and mechanisms that influence gender equity in the given settings. Data will be collected via the relevant administrative databases. A comparison of two funding periods (2007'2012 and 2012'2017) will be carried out. Ethics and dissemination: The University of Oxford Clinical Trials and Research Governance Team and the Research and Development Governance Team of Guy's and St Thomas' National Health Service (NHS) Foundation Trust reviewed the study and deemed it exempt from full ethics review. The results of the study will be used to inform prospective planning and monitoring within the participating NIHR BRCs with a view to accelerating women's advancement and leadership. Both the results of the study and its methodology will be further disseminated to academics and practitioners through the networks of collaborating TROs, relevant conferences and articles in peerreviewed journals.

Energized and productive faculty are critical to academic medicine, yet studies indicate a lack of advancement and senior roles for women.Using measures of key aspects of the culture of academic medicine, this study sought to identify similarity and dissimilarity between perceptions of the culture by male and female faculty.The C - Change Faculty Survey was used to collect data on perceptions of organizational culture.A stratified random sample of 4,578 full-time faculty at 26 nationally representative US medical colleges (response rate 52 %). 1,271 (53 %) of respondents were female.Factor analysis assisted in the creation of scales assessing dimensions of the culture, which served as the key outcomes. Regression analysis identified gender differences while controlling for other demographic characteristics.Compared with men, female faculty reported a lower sense of belonging and relationships within the workplace (T = -3.30, p 0.01). Self-efficacy for career advancement was lower in women (T = -4.73, p 0.001). Women perceived lower gender equity (T = -19.82, p 0.001), and were less likely to believe their institutions were making changes to address diversity goals (T = -9.70, p 0.001). Women were less likely than men to perceive their institution as family-friendly (T = -4.06, p 0.001), and women reported less congruence between their own values and those of their institutions (T = -2.06, p 0.05). Women and men did not differ significantly on levels of engagement, leadership aspirations, feelings of ethical/moral distress, perception of institutional commitment to faculty advancement, or perception of institutional change efforts to improve support for faculty.Faculty men and women are equally engaged in their work and share similar leadership aspirations. However, medical schools have failed to create and sustain an environment where women feel fully accepted and supported to succeed; how can we ensure that medical schools are fully using the talent pool of a third of its faculty?

Vital, productive faculty are critical to academic medicine, yet studies indicate high dissatisfaction and attrition. The authors sought to identify key personal and cultural factors associated with intentions to leave one's institution and/or academic medicine.From 2007 through early 2009, the authors surveyed a stratified random sample of 4,578 full-time faculty from 26 representative U.S. medical schools. The survey asked about advancement, engagement, relationships, diversity and equity, leadership, institutional values and practices, and work-life integration. A two-level, multinomial logit model was used to predict leaving intentions.A total of 2,381 faculty responded (52%); 1,994 provided complete data for analysis. Of these, 1,062 (53%) were female and 475 (24%) were underrepresented minorities in medicine. Faculty valued their work, but 273 (14%) had seriously considered leaving their own institution during the prior year and 421 (21%) had considered leaving academic medicine altogether because of dissatisfaction; an additional 109 (5%) cited personal/family issues and 49 (2%) retirement as reasons to leave. Negative perceptions of the culture-unrelatedness, feeling moral distress at work, and lack of engagement-were associated with leaving for dissatisfaction. Other significant predictors were perceptions of values incongruence, low institutional support, and low self-efficacy. Institutional characteristics and personal variables (e.g., gender) were not predictive.Findings suggest that academic medicine does not support relatedness and a moral culture for many faculty. If these issues are not addressed, academic health centers may find themselves with dissatisfied faculty looking to go elsewhere.

Research on barriers to professional advancement for women in academic medicine has not adequately considered the role of environmental factors and how the structure of organizations affects professional advancement and work experiences. This article examines the impact of the hierarchy, including both the organization's hierarchical structure and professionals' perceptions of this structure, in medical school organization on faculty members' experience and advancement in academic medicine.As part of an inductive qualitative study of faculty in five disparate U.S. medical schools, we interviewed 96 medical faculty at different career stages and in diverse specialties, using in-depth semistructured interviews, about their perceptions about and experiences in academic medicine. Data were coded and analysis was conducted in the grounded theory tradition.Our respondents saw the hierarchy of chairs, based on the indeterminate tenure of department chairs, as a central characteristic of the structure of academic medicine. Many faculty saw this hierarchy as affecting inclusion, reducing transparency in decision making, and impeding advancement. Indeterminate chair terms lessen turnover and may create a bottleneck for advancement. Both men and women faculty perceived this hierarchy, but women saw it as more consequential.The hierarchical structure of academic medicine has a significant impact on faculty work experiences, including advancement, especially for women. We suggest that medical schools consider alternative models of leadership and managerial styles, including fixed terms for chairs with a greater emphasis on inclusion. This is a structural reform that could increase opportunities for advancement especially for women in academic medicine.

BACKGROUND Energized, talented faculty are essential to achieving the missions of academic medical centers (AMCs) in education, research and health care. The alignment of individuals’ values with workplace experiences are linked to meaningfulness of work and productivity.

Purpose The impact of medical school culture on medical students has been well studied, but little documentation exists regarding how medical faculty experience the culture in which they work. In an ongoing project, the National Initiative on Gender, Culture and Leadership in Medicine, the authors are investigating how the existing culture of academic medical institutions supports all faculty members’ ability to function at their highest potential. Method The authors conducted a qualitative study of faculty in five disparate U.S. medical schools. Faculty in different career stages and diverse specialties were interviewed regarding their perceptions and experiences in academic medicine. Analysis was inductive and data driven. Results Relational aspects of the culture emerged as a central theme for both genders across all career categories. Positive relationships were most evident with patients and learners. Negative relational attributes among faculty and leadership included disconnection, competitive individualism, undervaluing of humanistic qualities, deprecation, disrespect, and the erosion of trust. Conclusions The data suggest that serious problems exist in the relational culture and that such problems may affect medical faculty vitality, professionalism, and general productivity and are linked to retention. Efforts to create and support trusting relationships in medical schools might enhance all faculty members’ efforts to optimally contribute to the clinical, education, and research missions of academic medicine. Future work will document the outcomes of a five-school collaboration to facilitate change in the culture to support the productivity of all medical faculty. Acad Med. 2009; 84:106–114.

The aims of this study were to (1) describe the quantity and quality of mentoring faculty in US academic health centers (AHCs), (2) measure associations between mentoring and 12 dimensions that reflect the culture of AHCs, and (3) assess whether mentoring predicts seriously contemplating leaving one's institution.During 2007-2009, our National Initiative on Gender, Culture and Leadership in Medicine (C - Change) conducted a cross-sectional study of faculty from 26 representative AHCs in the United States using the 74-item C - Change Faculty Survey to assess relationships of faculty characteristics and various aspects of the institutional culture (52% response rate). Among the 2178 eligible respondents (assistant, associate, and full professors), we classified their mentoring experience as either inadequate, neutral, or positive.In this national sample, 43% of the 2178 respondents had inadequate mentoring; only 30% had a positive assessment of mentoring. There was no statistical difference by sex, minority status, or rank. Inadequate mentoring was most strongly associated with less institutional support, lower self-efficacy in career advancement, and lower scores on the trust/relationship/inclusion scale. The percent of faculty who had seriously considered leaving their institution was highest among those who had inadequate mentoring (58%), compared to those who were neutral (28%) or had positive mentoring (14%) (all paired comparisons, p.001).In a national survey of faculty of US AHCs, mentoring was frequently inadequate and this was associated with faculty contemplating leaving their institutions. Positive mentoring, although less prevalent, was associated with many other positive dimensions of AHCs.

In this paper, we discuss an alternative structure and a broader vision for mentoring of medical faculty. While there is recognition of the need for mentoring for professional advancement in academic medicine, there is a dearth of research on the process and outcomes of mentoring medical faculty. Supported by the literature and our experience with both formal dyadic and group peer mentoring programs as part of our federally funded National Center of Leadership in Academic Medicine, we assert that a group peer, collaborative mentoring model founded on principles of adult education is one that is likely to be an effective and predictably reliable form of mentoring for both women and men in academic medicine.

Scholarly writing is a critical skill for faculty in academic medicine; however, few faculty receive instruction in the process. We describe the experience of 18 assistant professors who participated in a writing and faculty development program which consisted of 7 monthly 75-minute sessions embedded in a Collaborative Mentoring Program (CMP). Participants identified barriers to writing, developed personal writing strategies, had time to write, and completed monthly writing contracts. Participants provided written responses to open-ended questions about the learning experience, and at the end of the program, participants identified manuscripts submitted for publication, and completed an audiotaped interview. Analysis of qualitative data using data reduction, data display, and conclusion drawing/verification showed that this writing program facilitated the knowledge, skills, and support needed to foster writing productivity. All participants completed at least 1 scholarly manuscript by the end of the CMP. The impact on participants' future academic productivity requires long-term follow-up.

Introduction: We conducted an assessment of need for faculty development and mentoring in a medical school to guide program planning and use of scarce resources. Methods: A multifaceted approach included semi-structured interviews, nominal group process, and a 36-item questionnaire to reach all faculty in the school, including senior administrators. Results: With a 72% response rate, we validated the questionnaire and, using principal components analysis, identified and prioritized the eight interpretable subdimensions: personal growth, achieving balance, teaching, professional networking, research, administrative skills, career progression, and diversity/ethics. All groups of faculty prioritized learning for sustaining their vitality, balancing their personal and professional lives, finding meaning in their work, relationships, and personal growth. Senior administrators prioritized the following for faculty: time management, an institutional outlook, teamwork, and improved performance in teaching, research, and clinical practice. Junior faculty expressed the need for mentoring, scholarship, research, and career planning. Discussion: Attention to faculty humanistic needs and the disparity between the perceived needs by faculty and senior administrators may help explain the attrition of faculty in academic medicine.

The authors describe the history, characteristics, and goals of four innovative programs, each in a medical school, that were established in 1998 to help faculty members of both sexes obtain mentors and thereby facilitate their career advancement. The programs were established as the result of an initiative by the Office on Women's Health (OWH) within the U.S. Department of Health and Human Services. Specifically, the OWH convened the National Task Force on Mentoring for Health Professionals, which determined that two principles are paramount to the success of any mentoring relationship or program: institutional commitment and institutional rewards and recognition to mentors. In accordance with the task force findings, the OWH created the National Centers of Leadership in Academic Medicine, one at each of four medical schools: MCP Hahnemann School of Medicine; the University of California, San Diego, School of Medicine; East Carolina University School of Medicine; and Meharry Medical College School of Medicine. The authors give highlights of each program's goals and progress, and note that, ideally, these programs will eventually serve as models for similar programs at other schools. Programs such as these foster the advancement of a diverse faculty, a more supportive academic environemnt, and the education of providers who are sensitive to the needs of all their patients, staff, and colleagues.

Introduction Research suggests an ongoing need for change in the culture of academic medicine. This article describes the structure, activities and evaluation of a culture change project: the C - Change Learning Action Network (LAN) and its impact on participants. The LAN was developed to create the experience of a culture that would prepare participants to facilitate a culture in academic medicine that would be more collaborative, inclusive, relational, and that supports the humanity and vitality of faculty. Methods Purposefully diverse faculty, leaders, and deans from 5 US medical schools convened in 2 1/2-day meetings biannually over 4 years. LAN meetings employed experiential, cognitive, and affective learning modes; innovative dialogue strategies; and reflective practice aimed at facilitating deep dialogue, relationship formation, collaboration, authenticity, and transformative learning to help members experience the desired culture. Robust aggregated qualitative and quantitative data collected from the 5 schools were used to inform and stimulate culture-change plans. Results Quantitative and qualitative evaluation methods were used. Participants indicated that a safe, supportive, inclusive, collaborative culture was established in LAN and highly valued. LAN members reported a deepened understanding of organizational change, new and valued interpersonal connections, increased motivation and resilience, new skills and approaches, increased self-awareness and personal growth, emotional connection to the issues of diversity and inclusion, and application of new learnings in their work. Discussion A carefully designed multi-institutional learning community can transform the way participants experience and view institutional culture. It can motivate and prepare them to be change agents in their own institutions.

The culture of academic medicine has been described as hierarchical, competitive, and not highly supportive of female or minority faculty. In response to this, the authors designed the Learning Action Network (LAN), which was part of the National Initiative on Gender, Culture and Leadership in Medicine (C-Change). The LAN is a five-school consortium aimed at changing the organizational culture of its constituent institutions. The authors selected LAN schools to be geographically diverse and representative of U.S. medical schools. Institutional leaders and faculty representatives from constituent schools met twice yearly for four years (2006-2010), forming a cross-institutional learning community. Through their quarterly listing of institutional activities, schools reported a wide array of actions. Most common were increased faculty development and/or mentoring, new approaches to communication, and adoption of new policies and procedures. Other categories included data collection/management, engagement of key stakeholders, education regarding gender/diversity, and new/expanded leadership positions. Through exit interviews, most participants reported feeling optimistic about maintaining the momentum of change. However, some, especially in schools with leadership changes, expressed uncertainty. Participants reported that they felt that the LAN enabled, empowered, facilitated, and/or caused the reported actions.For others who might want to work toward changing the culture of academic medicine, the authors offer several lessons learned from their experiences with C-Change. Most notably, people, structures, policies, and reward systems must be put into place to support cultural values, and broad-based support should be created in order for changes to persist when inevitable transitions in leadership occur.

Background: Women represent a persistently low proportion of faculty in senior and leadership roles in medical schools, despite an adequate pipeline. Objectives: This article highlights women's concerns in the context of the academic medical culture in which they work, and considers the ways in which they cope with and resist marginalizing situations. Methods: To explore the experiences of faculty in academic medicine, a multidisciplinary faculty research team conducted 96 open-ended interviews with faculty representing a broad set of disciplines at 4 different career stages (early career, leaders, plateaued, and left academic medicine) in 5 medical schools. Coded data from interview transcripts indicated situations in which women were marginalized. Experiences of marginality were examined through a systematic secondary analysis of a subset of 17 representative cases using qualitative analysis. Results: Women had a sense of “not belonging” in the organization, perceiving themselves as cultural outsiders and feeling isolated and invisible. They described barriers to advancement, including bias and gender role expectations. Faculty from underrepresented minority groups and PhDs perceived a double disadvantage. Four strategies were identified that helped women cope with and resist professional barriers: self-silencing, creating microenvironments, balancing life and work, and simultaneously holding dual identities—being successful in the organization while trying to change the culture. Conclusions: Although the sample size was small, this analysis found that many women faculty perceive themselves as outsiders within academic medicine. Because of their marginalization, minority and non-minority women are more able to see the bias and exclusion that may operate in academic medical centers as well as other problematic dimensions of the culture. As cultural outsiders, women may be better able to advance change to improve academic medical culture. A next step is to leverage women's awareness to develop a broader vision of what that culture can and should be like.

Authors' Reply: Dialogue on values and professionalism in academic medicine is always welcome, and we thank Drs. Poses and Smith, as well as JGIM for this opportunity. The purpose of our hypothesis-generating research study and the article1 was to document deeply held values of faculty in the context of understanding the culture of academic medicine2. We reported that many faculty are distressed in perceiving that behaviors they witness, and that are rewarded in academic medicine organizations, are not always congruent with their own values. In response to Drs. Poses’ and Smith’s letter, we definitely did not mean to suggest that faculty should become congruent with their leaders when they (leaders) are out of alignment with the mission of academic medical centers to provide excellence in patient care, education, and research, as well as access to all — including underserved vulnerable populations. The questionable behaviors that some faculty described betray the public trust and the lofty intentions of the great academic medical institutions in this country as expressed in their mission statements. In fact, we checked the mission statements of the index medical schools and were reassured by the similarity of faculty values and the mission statements.

Disappointed by the lack of progress in the advancement of women and underrepresented minority faculty to senior positions and leadership roles in academic medicine and concerned by the prospect that these valuable faculty resources were being lost, a group of five medical school deans agreed to embark on a multiyear project to change the culture of their medical schools for these underrepresented faculty. This commentary outlines the rationale and motivation for the project and sets the stage for future reports from and wider participation in this initiative.

Despite compelling reasons to draw on the contributions of under-represented minority (URM) faculty members, US medical schools lack these faculty, particularly in leadership and senior roles.The study's purpose was to document URM faculty perceptions and experience of the culture of academic medicine in the US and to raise awareness of obstacles to achieving the goal of having people of color in positions of leadership in academic medicine.The authors conducted a qualitative interview study in 2006-2007 of faculty in five US medical schools chosen for their diverse regional and organizational attributes.Using purposeful sampling of medical faculty, 96 faculty were interviewed from four different career stages (early, plateaued, leaders and left academic medicine) and diverse specialties with an oversampling of URM faculty.We identified patterns and themes emergent in the coded data. Analysis was inductive and data driven.Predominant themes underscored during analyses regarding the experience of URM faculty were: difficulty of cross-cultural relationships; isolation and feeling invisible; lack of mentoring, role models and social capital; disrespect, overt and covert bias/discrimination; different performance expectations related to race/ethnicity; devaluing of research on community health care and health disparities; the unfair burden of being identified with affirmative action and responsibility for diversity efforts; leadership's role in diversity goals; and financial hardship.Achieving an inclusive culture for diverse medical school faculty would help meet the mission of academic medicine to train a physician and research workforce that meets the disparate needs of our multicultural society. Medical school leaders need to value the inclusion of URM faculty. Failure to fully engage the skills and insights of URM faculty impairs our ability to provide the best science, education or medical care.

Vital and productive academic faculty are critical to the future hospital, yet studies indicate high dissatisfaction and burnout, and a lack of advancement and senior roles for women. This study sought to identify personal and cultural factors associated with vitality and intention to leave academic

BACKGROUND We conducted a longitudinal faculty development programme for medical school faculty, focused on enhancing learner-centred teaching skills, by integrating traditional elements of education, focusing on knowledge, skills and attitudes, with the non-traditional process elements of community building, self-awareness and relationship formation. METHODS This year-long programme enrolled faculty from a range of clinical departments at a single institution. The participants gathered for day-long sessions in each of 9 months and also met at lunchtime once a month for booster meetings. Sessions were organised according to content areas identified as relevant to enhancing teaching skills. In addition to each content area, a variety of experiential and process learning methods were incorporated and modelled in each session. The impact of the programme was assessed using self-report data after each session, and together with paired interviews at the completion of the programme. EVALUATION Programme attendance was 97%. Qualitative thematic and content analysis showed that faculty reportedrenewedenergyandenthusiasmforteaching,as well as skills mastery. Faculty also reported significant improvements in self-awareness and habits of lifelong learning. Many faculty members felt that a singular benefit of the programme was developing and nurturing personal as opposed to instrumental relationships. CONCLUSIONS It is feasible to successfully convene clinical faculty from different departments in the same faculty development programme with little or no concern for competition and conflict. The key to success is integrating content and process dimensions into a framework of community building and collective engagement. From the participants’ perspective, skills and confidence, which by self-report increased for all participants, was less consequential than the opportunity to learn about themselves and their relationships to others in a safe environment. We have conducted this programme for 5 successive years.

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Background The proportion of black, Latino, and Native American faculty in U.S. academic medical centers has remained almost unchanged over the last 20 years. Some authors credit the "minority tax"—the burden of extra responsibilities placed on minority faculty in the name of diversity. This tax is in reality very complex, and a major source of inequity in academic medicine. Discussion The “minority tax” is better described as an Underrepresented Minority in Medicine (URMM) faculty responsibility disparity. This disparity is evident in many areas: diversity efforts, racism, isolation, mentorship, clinical responsibilities, and promotion. Summary The authors examine the components of the URMM responsibility disparity and use information from the medical literature and from human resources to suggest practical steps that can be taken by academic leaders and policymakers to move toward establishing faculty equity and thus increase the numbers of black, Latino, and Native American faculty in academic medicine.