The Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program for Women is designed to promote the careers of senior female leaders in academic health care in a way that ...ultimately seeks to transform culture and promote gender equity far beyond the careers of its participants. In an era of increased awareness of gender inequity within academic medicine, the longevity of the ELAM program raises several important questions. First, why is such a program still needed? Second, what exactly does it do, and what has been its influence on its participants and beyond? And third, what lessons can ELAM's example provide to help guide the medical profession as it strives to promote gender equity in the field? In this Invited Commentary, the authors seek to answer these questions from the perspective of a recent program participant and the current program director. The authors review the evidence that identifies how women, even today, face accumulating disadvantage over the course of their academic careers, stemming from repeated encounters with powerful unconscious biases and stereotypes, societal expectations for a gendered division of domestic labor, and still-present overt discrimination and sexual harassment. They describe ELAM's approach, which builds the knowledge and skills of the women who participate in the program, while also intentionally raising their visibility within their home institutions so that they have opportunities to share with institutional leaders what they have learned in ways that not only promote their own careers but also support gender equity in the broader environment. The authors conclude by offering thoughts on how ELAM's model may be leveraged in the future, ideally in partnership with the numerous professional societies, funding agencies, and other organizations that are committed to accelerating the rate of progress toward gender equity at all levels of academic medicine.
The culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized groups) and compromises workforce ...vitality. Existing research has been limited by a lack of comprehensive, validated measures, low response rates, and narrow samples as well as comparisons limited to the binary gender categories of male or female assigned at birth (cisgender).
To evaluate academic medical culture, faculty mental health, and their relationship.
A total of 830 faculty members in the US received National Institutes of Health career development awards from 2006-2009, remained in academia, and responded to a 2021 survey that had a response rate of 64%. Experiences were compared by gender, race and ethnicity (using the categories of Asian, underrepresented in medicine defined as race and ethnicity other than Asian or non-Hispanic White, and White), and lesbian, gay, bisexual, transgender, queer (LGBTQ+) status. Multivariable models were used to explore associations between experiences of culture (climate, sexual harassment, and cyber incivility) with mental health.
Minoritized identity based on gender, race and ethnicity, and LGBTQ+ status.
Three aspects of culture were measured as the primary outcomes: organizational climate, sexual harassment, and cyber incivility using previously developed instruments. The 5-item Mental Health Inventory (scored from 0 to 100 points with higher values indicating better mental health) was used to evaluate the secondary outcome of mental health.
Of the 830 faculty members, there were 422 men, 385 women, 2 in nonbinary gender category, and 21 who did not identify gender; there were 169 Asian respondents, 66 respondents underrepresented in medicine, 572 White respondents, and 23 respondents who did not report their race and ethnicity; and there were 774 respondents who identified as cisgender and heterosexual, 31 as having LGBTQ+ status, and 25 who did not identify status. Women rated general climate (5-point scale) more negatively than men (mean, 3.68 95% CI, 3.59-3.77 vs 3.96 95% CI, 3.88-4.04, respectively, P < .001). Diversity climate ratings differed significantly by gender (mean, 3.72 95% CI, 3.64-3.80 for women vs 4.16 95% CI, 4.09-4.23 for men, P < .001) and by race and ethnicity (mean, 4.0 95% CI, 3.88-4.12 for Asian respondents, 3.71 95% CI, 3.50-3.92 for respondents underrepresented in medicine, and 3.96 95% CI, 3.90-4.02 for White respondents, P = .04). Women were more likely than men to report experiencing gender harassment (sexist remarks and crude behaviors) (71.9% 95% CI, 67.1%-76.4% vs 44.9% 95% CI, 40.1%-49.8%, respectively, P < .001). Respondents with LGBTQ+ status were more likely to report experiencing sexual harassment than cisgender and heterosexual respondents when using social media professionally (13.3% 95% CI, 1.7%-40.5% vs 2.5% 95% CI, 1.2%-4.6%, respectively, P = .01). Each of the 3 aspects of culture and gender were significantly associated with the secondary outcome of mental health in the multivariable analysis.
High rates of sexual harassment, cyber incivility, and negative organizational climate exist in academic medicine, disproportionately affecting minoritized groups and affecting mental health. Ongoing efforts to transform culture are necessary.
Depression and burnout are highly prevalent among residents, but little is known about modifiable personality variables, such as resilience and stress from uncertainty, that may predispose to these ...conditions. Residents are routinely faced with uncertainty when making medical decisions.
To determine how stress from uncertainty is related to resilience among pediatric residents and whether these attributes are associated with depression and burnout.
We surveyed 86 residents in pediatric residency programs from 4 urban freestanding children's hospitals in North America in 2015. Stress from uncertainty was measured with the use of the Physicians' Reaction to Uncertainty Scale, resilience with the use of the 14-item Resilience Scale, depression with the use of the Harvard National Depression Screening Scale; and burnout with the use of single-item measures of emotional exhaustion and depersonalization from the Maslach Burnout Inventory.
Fifty out of 86 residents responded to the survey (58.1%). Higher levels of stress from uncertainty correlated with lower resilience (r = −0.60; P < .001). Five residents (10%) met depression criteria and 15 residents (31%) met burnout criteria. Depressed residents had higher mean levels of stress due to uncertainty (51.6 ± 9.1 vs 38.7 ± 6.7; P < .001) and lower mean levels of resilience (56.6 ± 10.7 vs 85.4 ± 8.0; P < .001) compared with residents who were not depressed. Burned out residents also had higher mean levels of stress due to uncertainty (44.0 ± 8.5 vs 38.3 ± 7.1; P = .02) and lower mean levels of resilience (76.7 ± 14.8 vs 85.0 ± 9.77; P = .02) compared with residents who were not burned out.
We found high levels of stress from uncertainty, and low levels of resilience were strongly correlated with depression and burnout. Efforts to enhance tolerance of uncertainty and resilience among residents may provide opportunities to mitigate resident depression and burnout.
Gender bias and discrimination have profound and far-reaching effects on the health care workforce, delivery of patient care, and advancement of science and are antithetical to the principles of ...professionalism. In the quest for gender equity, medicine, with its abundance of highly educated and qualified women, should be leading the way. The sheer number of women who comprise the majority of pediatricians in the United States suggests this specialty has a unique opportunity to stand out as progressively equitable. Indeed, there has been much progress to celebrate for women in medicine and pediatrics. However, many challenges remain, and there are areas in which progress is too slow, stalled, or even regressing. The fair treatment of women pediatricians will require enhanced and simultaneous commitment from leaders in 4 key gatekeeper groups: academic medical centers, hospitals, health care organizations, and practices; medical societies; journals; and funding agencies. In this report, we describe the 6-step equity, diversity, and inclusion cycle, which provides a strategic methodology to (1) examine equity, diversity, and inclusion data; (2) share results with stakeholders; (3) investigate causality; (4) implement strategic interventions; (5) track outcomes and adjust strategies; and (6) disseminate results. Next steps include the enforcement of a climate of transparency and accountability, with leaders prioritizing and financially supporting workforce gender equity. This scientific and data-driven approach will accelerate progress and help pave a pathway to better health care and science.
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