Interventions.\p=m-\Multifacetedintervention from 1990 through 1995 to correct gender-based career obstacles reported by women faculty, including problem identification, leadership, and
Trang 1Career Development for Women
Linda P Fried, MD, MPH; Clair A Francomano, MD; Susan M MacDonald, MD; Elizabeth M.Wagner, PhD;
Emma J Stokes, PhD; Kathryn M Carbone, MD; Wilma B Bias, PhD; Mary M Newman, MD; John D Stobo, MD
Objective.\p=m-\Todetermine thegender-basedcareerobstaclesforwomeninan
academicdepartmentof medicine andto reportthe interventions to correctsuch
obstacles(resulting from theevaluation) andthe resultsof these interventions
Design.\p=m-\Interventionstudy, before-aftertrial,with assessment offaculty
con-cernsandperceived change through structured,self-administeredquestionnaires.
Setting.\p=m-\The DepartmentofMedicine,The JohnsHopkins UniversitySchool
ofMedicine, Baltimore, Md
Participants.\p=m-\Full-timefaculty.
Interventions.\p=m-\Multifacetedintervention from 1990 through 1995 to correct
gender-based career obstacles reported by women faculty, including problem
identification, leadership, and education offaculty, and interventions to improve
faculty development, mentoring,and rewards andtoreduce isolationand structural
careerimpediments.
MainOutcome Measures.\p=m-\Retentionandpromotionofdeservingwomen
fac-ulty, salary equity, qualityofmentoring,decreased isolationfrominformation and
colleagues, integration of women faculty into the scientific community, and
decreased manifestations ofgenderbias
Results.\p=m-\Juniorwomen were retained and promoted, reversing previous
experience,with a550% increase in the numberofwomenatthe associate
pro-fessorrankover5 years (from4 in 1990 to 26 in 1995). Interim 3-year follow-up
showed a183% increase in theproportion ofwomenfacultywho expected they
would still be in academicmedicinein 10years(from 23%[7/30]in 1990to65%
[30/46]in1993).Onehalfto twothirds ofwomenfaculty reported improvementsin
timeliness of promotions, manifestations of gender bias, access to information
needed forfaculty development, isolation,andsalary equity.Menalsoreported
im-provementsin theseareas.
Conclusions.\p=m-\Theoutcomesreportedhereindicate thatitispossibletomake
substantiveimprovementsin thedevelopmentofwomen'scareers,thatan
institu-tionalstrategytothis endcanbe successful inretainingwomenin academic
medi-cine,and that such interventionsarelikelytobenefit allfaculty Long-term
interven-tionsappearessential.
JAMA. 1996;276:898-905
WOMEN ARE lesslikelytosucceed in academic medicalcareersin the United States than men.1"7Comparedwithmen,
women are underrepresented in lead¬
ership roles,1'8,9 have slowerrates and lower likelihood ofpromotion,1·10'11 and
are lesslikelytobecomeprofessors in theirdepartments.2Inan11-year
follow-up study ofUS medical school faculty
appointed in 1980, only 5% of women
becameprofessors, comparedwith 23%
ofmen,despite comparableoverallrates
ofleavingacademic medicine forwomen
andmen overthisperiod.10Women also received lower salaries in comparable
positions.3,9,10
These datasuggestthat the lowpro¬
portionofwomenfacultyatsenior and
leadershiplevelsmaynotresult froma
cohort effect alone Among the more
subtle factors that may underlie the lesser likelihood ofsuccessforwomenin academic scientificcareers arereduced
accesstomentoring12"14andtorewards,
including promotions, salary, and rec¬
ognition.1416Other key factorsare iso¬ lation fromcolleaguesand career-related
professionalinformation.14·16·17Ithas been shown that women receive fewer re¬
sources to accomplish their goals, in¬
cludingnecessarypersonnel,space,and
equipment.10,15 Further,academic insti¬ tutions are often organized on the as¬
sumptionofa"social and emotionalsup¬
port structure provided to the male scientist byan unpaidfull-time house¬ wifeordonewithout,"16 leadingto struc¬
tural, institutional impediments to ca¬ reersfor individuals without thissupport
structure Outright genderdiscrimina¬ tion is anotherobstacle.6·7·14While these
findings prevail,there has beenno com¬
prehensiveevaluation of the differences
incareerdevelopmentbetweenmenand
women.1
Theproportionofwomen onacademic medical faculties increased from 13% in
1967 to 24% in 1994,1·2 and 42% ofen¬
trants tomedical schoolsare now wom¬
en.1·18However, attainingacriticalmass
may notbe sufficienttoremovethe ob¬ stacles that women experience inaca¬
demic scientificcareers.16For thisrea¬
son,the AmericanCollegeofPhysicians10
and the Association of American
Medi-From the Department of Medicine, The Johns
Hop-kinsUniversitySchool of Medicine, Baltimore, Md (Drs
Fried, Francomano, MacDonald,Wagner,Stokes,
Car-bone, Bias, Newman, and Stobo); Medical Genetics
Branch, National Center for Human Genome Research,
National Institutes of Health, Bethesda, Md (Dr
Fran-comano); and Johns Hopkins HealthCare LLC,
Balti-more, Md(Dr Stobo)
Reprints: Linda P Fried, MD, MPH, Welch Center for
Prevention,Epidemiologyand Clinical Research, 2024 E
Monument St, Suite 2-600, Baltimore, MD 21205-2223.
at Boston University on August 1, 2011
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Trang 2cal Colleges (AAMC)19 have urged all
medical schoolstodesignandimplement
institutionalstrategies that willfoster
thesuccessofwomenfacultyand their
promotionto seniorfaculty positions.
This articlereportstheresults of such
an institution-based strategy, the first
majoreffort ofaUSdepartmentof medi¬
cinetodefine and interveneaggressively
to correct the structural and subtle
impedimentsto the careers ofwomen
faculty. This article describes, in 3
phases,the identification ofgender-re¬
latedcareerobstacles(phase 1),the in¬
terventionsimplementedto correctthe
multiple obstacles identified (phase 2),
and the results of the first 5 years of
intervention, including improvementsin
promotion rates,careerexperiences,and
gender-basedobstacles forwomeninthe
department (phase 3). We also report
dataindicatingthatcareersofmale,as
well as female, faculty benefited from
these interventions
PHASE 1:IDENTIFICATION OF
GENDER-RELATEDOBSTACLES
(BASELINE EVALUATION)
Backgroundand Methods
In 1989,the Provost's Committeeon
theStatusof WomenatTheJohnsHop¬
kinsUniversity, Baltimore, Md,issued
areport documentinglower salaries for
womenfaculty comparedwithmenand
substantiallyslowerratesofpromotion,
the latteraresult of lowerratesof nomi¬
nation.11Consequently,in1990,the chair
of the Department of Medicine, The
Johns Hopkins University School of
Medicine (J.D.S.), appointed the Task
ForceonWomen's AcademicCareersin
Medicinetoevaluate whether therewere
career obstacles for women faculty in
theDepartmentof Medicineand,ifso,
to characterize them This task force
(L.P.F., chair; CF., E.M.W., M.M.N.)
performedstructured interviews ofwo¬
menfacultyandtrainees(aconvenience
sampleofasmanywomen asthis small
group had time tointerview, approxi¬
matelyhalf thewomenatallranks)over
a6-monthperiod.Theseinterviews iden¬
tifiedrecurrently described, significant
problems that appeared to be generic
ones, tobegender-basedandthat crossed
ranks anddivisional lines These obser¬
vationsweredevelopedinto the follow¬
ing hypotheses for further evaluation:
(1)womenfaculty, comparedwithmen
faculty, were less likely to be nomi¬
nated forpromotion, to have mentors
whoactively fostered theircareers, to
besoughtfor collaborative research ef¬
forts,tohaveequalaccesstoresources
andcomparable salaries,andtopartici¬
pateininformalinstitutional networks
and decisionmaking; (2)womenfaculty
were morelikelythan their malecoun¬
terpartstohaveamentorwho used the
woman faculty member's research ac¬
tivities for the mentor's own career
needs,toexperienceisolation and lack
ofsupportfrom the academic environ¬
ment,andtoexperienceconflict between theexpectationsof academic culture and
personal responsibilities (eg, regularly
scheduled meetings on evenings and weekendsconflictingwithfamilyrespon¬
sibilitiesprimarilycarriedoutbywom¬
en); and (3) obstacles to women's ca¬
reers resulted both from institutional
policy and structure and from the in¬
formal culture
To evaluate thesehypotheses,a self-administeredanonymousquestionnaire20
wasmailedtoall full-timefacultyin June
1990bythedepartmentchair Thegoal
of thequestionnaire was to determine thecareerdevelopment experiencesand futureexpectationsoffacultyand their
perceptions as togender-based differ¬
ences in these areas. Response rates
werecalculated, and responsestoindi¬
vidualquestionswereanalyzed overall,
by gender,andby facultyrank Statis¬
ticalcomparisons by genderandfaculty
rankwereperformed using 2orttests,
asappropriate.
Results of Baseline Evaluation
Seventy percentofwomen(30/43)and 67% ofmen (97/145) on the full-time,
tenure-trackfaculty completedthe base¬
line questionnaire in 1990 (Table 1).
Significantly more women than men
perceived a wide variety of career
impediments, many gender-based, in¬
volving promotions,collaborative inter¬
actions, networking, male-female in¬
teractions,andgeneral climate,asshown
inTable 2 Ofnote,morethan half of the
responding women perceived
gender-related obstacles in thedepartment.In
contrast to the high frequency with whichwomenperceivedtheserelatively
subtle obstaclesto careers,only10%of
womenfaculty reportedovertsexual ha¬
rassmentonthejob (Table 2).
Table 3 describes mentoring experi¬
ences.One third of both female and male
faculty reported havingamentor.Low butequal proportionsofwomenandmen
reported that their mentors critiqued
their work and fostered theircareers.
However, in other respects, the per¬
ceivedqualityof thementoringdiffered
by gender First, men's mentorswere
significantlymorelikelytofacilitate their externalvisibility,suchasthroughchair¬
ing conferences or participating in in¬
vitedmanuscripts Second,onethird of
womenreportedthat theirmentorsused the womanfacultymember's work for the mentor'sown careerbenefit,rather thantobenefit the woman'scareer;10%
Table1.—ResponseRates for Full-timeFacultyat
Baseline Evaluation in 1990
Faculty Women,
%
(No.·) Men,(No.*)%
Instructor Assistant professor
Associateprofessor
Professor Total
43(3/7)
68(19/28)
100(4/4) 100(4/4)
70 (30/43)
38 (3/8)
49 (28/57)
84(38/45)
80(28/35)
67 (97/145)
"Numberresponding/totalnumber in group.
of men reported similar experiences
(P=.004).
Four institutionalpolicies thatpref¬ erentially inhibited women's careers wereidentified (Table 4) Meetingsaf¬
ter 5PMandonweekends causedprob¬
lems for two thirds ofwomen and al¬
most onethird ofmen becausefaculty
members with competing personal re¬
sponsibilities were excluded from this essential informationexchangeandnet¬
working.Thepresenceofrigidlimitsto
timeatrankwasalso citedbywomen as
causing problems;thispolicylimited the
ability offaculty to meet personal re¬
sponsibilities ifthey were to be com¬
petitive forpromotion within the time allotted The lack ofapart-timetenure
track and the lack of on-site child care were seen asobstacles bywomen fac¬
ulty significantly (P=.001 and .04, re¬
spectively)morefrequentlythanbymen.
Finally,futureexpectationsvariedby gender (Table 5).A lowerproportionof
women expected to bepromoted than didmen;this didnotdiffersignificantly
byrank (P=.66) Notably, only40% of the women who wanted to be in aca¬
demic medicine 10yearslaterexpected
thattheywouldbe, comparedwith66%
of the men. Conversely, almost two
thirds of thewomen wereseriouslycon¬
sidering leavingacademicmedicine,com¬
paredwith43% of themen (P=.22for thesecomparisons) Amongthereasons
cited for considering leaving academic
medicine,aperception of isolationwas
theonlyone that differedsignificantly
by gender (citedas a reasonby80%of
women compared with 34% of men,
P<M).
Discussion of Baseline Results
Overall, women faculty reported a
high prevalenceofgender-basedcareer
obstacles in1990.Whilesome werestruc¬
turalinorigin,themajority appearedto
bemoreinformal and subtle The latter
were consistent with the definition of
genderdiscriminationas"behaviors,ac¬
tions, policies, procedures, or interac¬ tions that adversely affect a woman's work duetodisparatetreatmentorim¬
pact, orthe creation ofahostile orin¬
timidating work or learning environ¬
ment."21Itappearedthatgender-based
obstacles occurred inmanydifferentas¬
pectsofawoman'scareer,perhaps
at Boston University on August 1, 2011
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Trang 32.—FacultyPerceptions Obstacles, 1990
Agree With
Statement, %
Perception
Women
(n=30)
Men
(n=97)
There aregender-basedobstacles In my division to career success and
Climate less supportive of women than of men in the department 52 30 05
Climate less supportive of women than of men In my division 38
I feel like a welcomed member of the institution 38 74 001
Womenfacultyare put up for promotion later than men of comparable
accomplishments and time at rank 66
48 75
23
32
.001 Men are more likely to besoughtfor collaborative research, given comparable
Professional,collégialrelationships more difficult betweenfacultyof different
genders
Men havedifficulty takingcareers of women faculty seriously and accepting
women as colleagues
_
.001 Men faculty are denigrating to womencolleaguesbased on theirgender .001
Informal networking in divisionsystematicallyexcludesfacultyon basis of
gender
I have been harassedsexuallyon the job 10 05
Table3.—MentoringExperienceof Full-timeFaculty, 1990
Experience
Proportion
RespondingYes
Women, %
(n=30) Men,
%
(n=97)
.73
.94 26 39
If no mentorcurrently,had a mentor in the past 62 57
Mentor actively advises and fosters career 73
Mentor promotes participation in externalprofessionalactivities 48 63
Mentor facilitated(participationin)
Chairing a conference 39
Mentor used your work to advance his/her own career, rather than your career 32 10
Mentoringrelationships more difficult between a faculty member and trainee
of differentgendersthan of the samegender 19 001
.02 Division directorprospectivelyadvises about criteria for promotion 26 50
ingtowhat Bickel has describedasthe
"cumulativedisadvantages"that havea
summarydampeningeffectoncareers.14
Fromourevaluations,itappearedthat
there were multiple impediments to
women'scareersand that resolution of
anyone impediment wouldnot be suf¬
ficient in itself to correct the overall
career-dampeningeffects
Oursurveyassessedperceptionsand
experiences of faculty because it ap¬
pearedfrom the initial interviews that
these factorswereimportantin career
decisions In1990,few datawereavail¬
abletoprovide insightinto thedispari¬
ties incareerexperiencesbetweenmen
andwomen.Itwasobservedbythe task
force thatwomenappearedtoleave ei¬
ther the institution oracademic medi¬
cineearlyin theircareers(ie,after hold¬
ingthe assistantprofessorrank for4or
more years), and no information was
available on the women who had left
Therefore, self-reportfromcurrentfac¬
ulty appearedtobeareasonable
start-ing point. Since thisquestionnairewas
administered, manyof theperceptions
of the women faculty have been sub¬
stantiated in nationaldata4"10,12"16and in
reports from otheruniversities.13,17,22"24
The perceptionsofwomenfacultythat
they were less likely to be promoted
than men and that there were salary discrepancies by genderwerealsosup¬
ported by 1989 data compiled by the Provost's Committee of theUniversity.11
Thefindingin thisquestionnairethat isolationwas a serious obstacle (itwas
the secondmostimportantfactor forwom¬
eninconsidering leavingacademic medi¬
cine)has also beenreportedtobea com¬
monproblemforwomenfacultyatother
institutions.14,16,17,22National data also in¬
dicate thatwomenhave lesssupportfor theirprofessionalactivitiesinsome areas
ofmedicine than domen,22asmeasured
byless time forresearch,lessaccess to space, and fewer research assistantsor
secretaries.9,10,17 Other studies indicate thatalthough havingamentoris
impor-stacles to Career Success or Satisfaction in Aca¬ demic Medicine, 1990
Factor
AgreeThat Factor Is an
Obstacle, %
I-1
Women Men
(n=30) (n=97) Meetingsafter 5 pm and on
weekends
Rigid promotion timelines
No emergency child care
Nopart-timetenure track
No formal parental leave
policy
No on-site child care
63 28 001
59 16 001
35 21 10
32 7 001 32
27
17 11
.06
.04
tantincareeradvancement and satisfac¬
tion,women arelesslikelythanmen to
haveamentor.8·12,13Thus,inthesubset of
areasinvestigated by others,the results
ofourevaluations have beensubstantially
corroborated and validated
Based on these findings, itwas de¬ cided that there was evidence ofper¬ vasivegenderdiscrimination andstruc¬
turalcareerobstacles forwomeninthe
DepartmentofMedicine,and that these obstacleswere multiple, complex, and often subtle Itwas decided that con¬
structive interventions that could shift theseexperiencesandperceptionswere
reasonabletoattemptiftheywouldre¬
tain women in academic medicine and enhanceperformance.
PHASE2: INTERVENTIONS
IMPLEMENTED TO CORRECT MULTIPLE OBSTACLES
Multiple interventions were imple¬
mented in theDepartment ofMedicine
beginningin October1990,withthe
long-term goal of eliminating the
gender-based obstaclestowomen'scareers.The
departmentchair and thetaskforcecom¬
mittedtoalong-term, 15-yearinterven¬ tiontomeetthisgoal.The short-term, 5-year goals were as follows:to retain excellentwomenfaculty;toestablishand maintainsalary equityamongfacultyin
theDepartmentofMedicine;andtoin¬
crease the number ofqualifiedwomen
atthe associateprofessorranktoapro¬
portion equivalenttothepercentageof
menatthat rank
Thedepartmentchair and the task force
agreedthat interventions wouldoriginate
from the departmentchair and be tar¬
getedtoall members of thedepartment.
Interventionswereinitially developed by
the task force and/or the department
chair,with decisions forimplementation
madecollaboratively.Interventionswere
designed to improve generic problems
identified in the evaluations andtopro¬
vide thecareerdevelopmentandsupport
essentialtomeeting goals.Themajorar¬ eas of intervention are summarized in Table6
at Boston University on August 1, 2011
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Trang 4Table 5.—CareerExpectationsand Factors Associated WithConsideringLeavingAcademic Medicine, 1990
Expectationsand Factors Women, %
%
(n=97)
Expect to be promoted 59 <.001
Want to be in academic medicine In 10 years 58 <.001
Expect to be in academic medicine in 10years* 23 <.001
Seriouslyconsidering leaving academic medicine
Factors cited by those seriously considering leaving
Uncertaintyof externalfunding
Unsupportive atmosphere 64 47
Too stressful
"Excludingthoseplanningto retire.
Leadership was defined as the most
critical element of the intervention and
had 3components.Thefirstwasstrong
and visibleleadership bythedepartment
chairregardingthenecessityof eliminat¬
ing gender-based obstacles This factor
was essentialto legitimizetheissue, to
decrease thevulnerabilityofwomenwho
were onthe task force orattended rel¬
evantmeetings,andto setamodel for the
department.6·16Thedepartmentchair im¬
plementedthe interventionstargetedto
all faculty, leading discussion at active
staffmeetingsandintroducing workshops,
andpersonally interveningwithfaculty
andleadershiptoaddressspecific
gender-basedproblems.
The secondleadership componentwas
the Task Force onWomen's Academic
Careers in Medicine The memberswere
appointed bythedepartmentchair and
workedcloselywith himtoidentify prob¬
lemson anongoing basis,todevelopand
implement proposalsforinterventions,
and to monitor progress. Many inter¬
ventions were developed and imple¬
mentedbythe taskforce,but under the
legitimizing auspicesof thedepartment
chair The results of this work are re¬
portedin thefollowingsections The task
force provided a model for collabora¬
tive, reasoned, and constructive solu¬
tions and offered the firstopportunity
for formalleadership bywomenwithin
thedepartment.After2 years,the task
forcewasformalizedas1ofonly3 stand¬
ing committees in the department. It
wasprovidedanoperating budgetthat
covered thecostsofprinted materials,
mailings,staffsupport, meetings, speak¬
ers, data analysis, and sending 2 to 6
womenper year to the AAMCfaculty
developmentconferencesforjuniorand
seniorwomen.
The thirdleadership componentwas a
faculty/organization development special¬
ist with skills in organizational assess¬
ment andchange management.Thisin¬
dividual (E.J.S.) worked with the
department chair,the taskforce,division
chiefs,and individualfacultyandfellows,
providingfrom25%to50%ofher time In thisrole,she workedintensivelytoevalu¬
atedepartmentaland divisionalstructure anddecision-makingmethods andhelped
toinstitutechangesthat would bemore
inclusive andsupportiveof thecareersof allfaculty. She also served in ombuds-like roles in the department, helpingto
analyze problems experienced bywomen
faculty and trainees and, with the de¬
partment chair,mediate solutions
Education of Faculty
Interventions were instituted to le¬
gitimizeconcernsand educatefacultyas
tothe natureofgenderdiscrimination and bias in academic medicine, tomo¬
tivatefacultyforchange,andtodevelop
the skillstoaccomplishsuchchange.For allfaculty,outside consultantsprovided lectures, workshops, and focus groups
to legitimize and develop understand¬
ingin theseareas.The consultants used
anonymouscasehistories ofexperiences
ofwomenfacultyinthedepartmentas
the basis of discussion (thesewere col¬
lected fromwomenfacultyand trainees
bythetaskforce).Results ofsurveysand recommendations of the task force25"27
were distributed to all faculty and dis¬
cussed at town meetings offaculty, in
leadership development meetingsfor di¬
vision chiefs,atdivisionalfacultymeet¬
ings, and at the departmental retreat
For thewomenfaculty,amonthlycollo¬
quiumwassponsored bythedepartment
andorganized bythe task forcetofoster
consensusaboutgender-basedcareerob¬
stacles and to perform evaluation of
progress and needs The monthlycollo¬
quiumalsotargetedthedevelopmentof essentialcareerknowledgeand skills and discussion of all of these issues with in¬
ternational, national, and institutional leaders The department chair and the
organization development specialistrec¬
ommendedchanges atboth the depart¬
mental and divisional levels and instituted
programstoenhance thesensitivityand
Table 6.—Areas to Which Interventions Were
TargetedtoImproveOutcomes for WomenFaculty
Leadership
Education as to nature ofgender-based
obstacles and motivation forchange
Isolation
Faculty development Mentoring
Rewards Structural obstacles
Monitoring and evaluation
the skills of the division chiefstoaccom¬
plish changein theseareas.
DecreasetheIsolation
of Women Faculty
Interventions were designed to de¬
creasewomen's isolation fromcolleagues, leadership, recognition,andqualitymen¬
toring and to increase information and skillsnecessaryforfaculty development Standing meetings were moved from weekends and evenings so that faculty
withfamily responsibilitiescouldpartici¬
pate.Medicalgrand rounds,heldonSat¬
urdaysfor 100years,waschangedto Fri¬
day mornings. Attendance by full-time
faculty,bothwomenandmen,increased
substantially.Basedonthissuccessand
theurgingof thedepartment chair,other
meetingswererescheduledtoweekday
workinghours Themonthly colloquium
forwomenfacultyand fellowsprovided opportunityforwomenfacultyacrossdi¬ visionstogettoknow eachother,which resulted ina senseofacriticalmassatthe
departmentallevel(often lackingwithin
divisions) and, thereby,reduced isolation For the firsttime,womenhadasubstan¬ tialpresenceasspeakersatmedicalgrand
rounds and themajorannualdepartmen¬
tal educationalconference, Topicsin In¬ ternal Medicine.Departmental retreats
wereinstituted forkey departmentalis¬
sues.Aconcerted effortwasmadetoiden¬
tifywomen,aswellas men, asleadersin
planningsubcommittees andasspeakers
attheseretreats,toprovide visibilityfor women'saccomplishmentsandleadership.
To fosterdevelopmentofwomen as in¬
stitutionalleaders,thedepartmentspon¬
sored 2 to3 senior women per year to
attend theFaculty Development Program
forSeniorWomenin Academic Medicine
of the AAMC Twoor more women were
included on every search committee in the department, and the task force no¬
minated women for all departmental
searches
Faculty Developmentand Mentoring
A review of promotions in the De¬
partment of Medicine revealed that,
priorto 1990, many women were first evaluated forpromotionatthe limit of time at rank It appeared to the De¬
partmentof Medicinepromotionscom¬
mittee thatwomen,morethanmen,
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Trang 5Figure1.—Facultyreport¡ 1993 ofimprovementssince 1990 In areastargetedfor interventions Data are
stratifiedby gender
ther were not aware of the types of
productivity requiredforpromotion or
hadjob descriptionslesslikelytofacili¬
tatethis.Therefore,theDepartmentof
Medicinepromotionscommitteewasin¬
structedtoreview the curriculum vitae
of each woman faculty memberannu¬
ally.This intervention ledtoearlyiden¬
tification ofwomenwhosecareers were
not progressing adequately, allowing
timefor effective actionbythedepart¬
ment chair, workingwith the division
director and the facultymember This
reviewwasfoundtobesouseful that it
was expandedtoinclude malefaculty.
Second,itappearedthatmostwomen
were notreceiving adequate mentoring,
basedonquestionnairesand interviews
Tocompensate,aprogramtoprovidees¬
sentialgenericinformation and skillswas
instituted Themonthly colloquiumwas
usedtoidentifycareerdevelopmentneeds
ofwomen faculty and to provide infor¬
mationontasks andgoalsateach level of
afacultycareer,characteristics ofquality
mentoring,and conflictmanagementand
negotiation.The information foundtobe
mostgenerallyusefulwassubsequently
presented to all faculty by the depart¬
mentchair The essential characteristics
of effectivementoringweredefinedina
monthly colloquium and then made ex¬
plicitinadocument authoredbywomen
faculty. Itwaspresentedtothedepart¬
mentand has been used sincetoeducate
facultyand fellows inmentoringand be¬
ingmentored.27Thedepartmentalso spon¬
sored 3to 5womenassistantprofessors
per year toattend the AAMC Faculty
Development Programfor Junior Wom¬
enin Academic Medicine
To increase theperceivedvalue ofmen¬
toring throughoutthedepartment,afac¬
ultysubcommitteeonmentoringand fac¬
ulty developmentwasconvened(W.B.B.,
chair), and it identified departmental
needs To enhance thementoring bylead¬
ers, the department chair modeled an¬
nual review and mentoring sessions by initiatingthese with the division direc¬
tors An instrument for use in a stan¬
dardized annual review thatincorporated
all aspects essential to career develop¬
mentandsuccess wasdeveloped bythe task force and recommended forimple¬
mentation Most divisions are nowper¬
forming such annual reviews, although
they have not yet been standardized
throughoutthedepartment.
AcademicRewards
The department chair instituted sal¬
aryequity by reviewingsalaries within each division andincreasingthose ofwom¬
enwhowerebelow scale He alsoannu¬
allyreviewed theprogressofwomenfac¬
ultywith each division director Women
ready for promotion were identified
throughthese reviews and also by the
departmental promotionscommittee'san¬
nual review of curriculum vitae The fac¬
ulty/organization development specialist
worked with thedepartment chair and
mostdivision directors toevaluate divi¬
sional rewards, communication,and de¬
cision-making processes and to recom¬
mend structural andstyle changes that would make themmoreexplicit, equitable,
and inclusive ofwomen.Additionally,the school of medicinelengthened the time limits at each ranktoenhance the pos¬
sibilityofpromotionfor individuals need¬
ingtodevote timetopersonaldemands
Monitoringand Evaluation The task force annually presented a
written evaluation ofprogress atthe de¬
partmental and divisional levels to the
departmentchair and recommendedgoals
and additional methodsto correct
gender-based obstaclestowomen'scareers.26In
addition,afollow-upevaluation offaculty
concernsand progresswasperformed by questionnaireinlate 1993
PHASE3: RESULTS OF THE INTERVENTIONS
Methods
In late1993,theDepartmentof Medi¬ cine readministered the 1990question¬
naire20toall full-time faculty,with ad¬ ditionalquestionstoassesschange.The
questionnairewasanonymous,and the
mailingand dataanalysis werecarried
outasin 1990
Results ofFollow-up Surveys
The 3-year follow-up questionnaire
had a response rate of 80% of female
(47/59)and 60% of male (126/209) full-time faculty. The faculty reported changes in manyof theareas targeted
for interventions(Table 6) Overall,86%
ofwomenand 83% ofmenreportedthat
gender bias had decreased in the de¬
partmentbetween 1990and 1993 (Fig¬
ure 1). From one halfto two thirds of
womenfaculty reported improvements
(inrank order)in timeliness ofpromo¬
tions,manifestations ofgender bias,ac¬ cess to information needed for faculty development, isolation, and salary eq¬
uity.Onequarterofwomenfacultysaid thatmentoringhadimproved.Menalso
reported improvementsin each of these
areas(Figure 1),withproportionsrang¬
ingfrom 21% to45%
In1993,therewas a58%decline in the
proportion ofwomen who felt that the climateinthedepartmentwasless sup¬
portiveofwomen(from53% to22%),and
a40%increase in theproportionofwom¬
en who felt welcomed in the institution
(from 38% to 53%) (Table 7) Notably,
therewas a77%increase in the propor¬ tion ofwomenreportingthat their divi¬ sion directors advised them about pro¬ motion criteria (increased from 26% to
46%),anda110% increase in thepropor¬ tion who hadmentors(from31%in1990
to65% in1993).Inaddition,thequalityof
mentoring appeared to have improved
forwomen.Therewas a74%increase in theproportion reportingthat theirmen¬
torscritiquedtheir scientific work(from
42%in1990 to 73%in 1993)anda27% increase in theproportionofwomen re¬
portingthat theirmentorspromotedtheir external visibility (from 48% to 61%),
amongthose withmentors.Therewas a
39% increaseintheproportionofwomen
instructors and assistantprofessorswho said that theirmentorsactivelyfostered theircareers(increasefrom65%in 1990
to90%in 1993).Inaddition,therewas a
decline, although not significant, in the
proportionofwomenwho were uncom¬
fortableraisingissuesconcerning gender
discrimination with theircolleagues (from
at Boston University on August 1, 2011
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Trang 6Table 7.—Three-YearChangeinExperiencesReported byWomenFaculty
Women
Responding
Yes*
Change
From 1990
to 1993, %t Department is less supportive of women than of men 52(15/29) 22(10/46) .008 -57.7
I feel like a welcomed member of the institution 38(11/29) 53(24/45) .10 1-39.5
Division directorprospectivelyadvises about promotion criteria 26(7/27) 46(21/46) .08 +76.9
Currentlyhave a mentor 31(9/29) 65(30/46) .005 + 109.7
Mentor critiques scientific work 42(3/7) 73(22/30) .12
Mentoractivelyadvises and fosters career 67 (6/9) 73(22/30) .51 +9.0
Mentor facilitates invited manuscripts 28(2/7) 46(13/28) .71 +64.3
Mentor uses your work for his/her career, not yours 32(3/9) 18(5/28) .39 -43.8
Meetingsafter 5 pm and on weekends are an obstacle 63(19/30) 28(13/47) .003 -55.6
"Data areexpressedas % (No.agreeing/No.responding)
tCalculated as([%yes 1993
-% yes1990J/%yes 1990).
Table8.—Three-yearChange¡n FutureExpectationsAmongWomenFaculty
WomenRespondingYes*
Expectation 1990 1993
Change
From 1990
to 1993, %t Expect to be promoted 44(13/29) 73 (33/45) +65.9
Seriously considering leavingacademic medicine 63(19/30) 28 (13/47)
Expectto be in academic medicine In 10 years 23(7/30) 65t-(30/46) -182.6
*Data are expressed as % (No.agreeing/No responding)
tCalculated as([%yes 1993
-% yes1990]/%yes 1990).
<.001 difference from 1990 to 1993.
58%in 1990to 45%in 1993).Ingeneral,
menalsoreported improvementsinthese
measures.
Futureexpectationsalsochangeddur¬
ingthisperiod.AsseeninTable8,there
was a66%increaseintheproportionof
women who expected to be promoted
(from44%to73%),andasimilar decline
in theproportions ofwomen consider¬
ing leavingacademicmedicine(from63%
to28%) Notably,among those consid¬
ering leavingin1993,theimportanceof
isolation as afactorhaddeclined (50%
in 1993, compared with 80% in 1990;
P<.001).Whilethere waslittlechange
in theproportionofwomenwhowanted
tobe in academic medicine in10 years
(Table 5),therewas a 183%increase in
theproportionwhoexpectedthatthey
wouldstillbe inacademicmedicine(from
23%to 65%).With regardtothese fu¬
turegoals,men'sexpectations changed
similarlytowomen's indirection,butat
a lessermagnitude Specifically, there
was a29% increase in theproportionof
men who expected to be promoted, a
42%declinein theproportionconsider¬
ing leaving academic medicine, and a
57%increase in theproportionwhoex¬
pectedtobe in academicmedicinein 10
years (datanotshown).
There werealsoperceptionsthat did
notchangeoverthis time Forexample,
therewas nochangeintheopinionthat
thereweregender-specificbiasesinone's
division(49%ofwomensaid yes in1993;
datanot shown).Also unchanged were
responses toquestionsaboutmale-female
professional interactions, collaborations
ormentoring relationships,andreported
sexualharassment (Tables2and3).
Finally, the department separately
monitoredpromotionratesfrom 1990to
1995.Thenumber ofwomen atthe rank
of associateprofessorincreased from4
to26,a550%increase,withnochanges
inpromotioncriteriaoverthisinterval
The proportionof associate professors
among women faculty increased from 9%(4/45 women)in1990,to32%(20/62)
in 1993,to 41%(26/64)in 1995(Figure
2), and the proportion became compa¬
rablewith theproportionofmenatthis senior rankafter 3 years. During this
period,12women(including4associate
professors)and 37men(including26as¬
sociateprofessors)left thefaculty.The number ofwomenandmen onthe full-timetenuretrackincreasedby33% dur¬
ingthistime
CONCLUSION
This isthe first trial in an academic
departmentof medicine of multifaceted
interventionstoimprovecareer success
and satisfactionofwomenfaculty.The
strategyoftargetedeffortstodecrease
gender-basedcareerobstaclesledtosub¬
stantialpositive changesin theexperi¬
ences ofwomenfacultyand in their fu¬
ture expectations ofsuccess. Men also
perceived benefit in association with these interventions
Thegenderdiscriminationandcareer
impediments reported by facultyatThe Johns Hopkins University in 1990 are
consistent withreports ofproblemar¬
eas in salary, promotions, mentoring,
andisolation1·2·417·22-24·28and similarpreva¬ lence rates among women faculty at
other institutions At the same time,
there has beentheperception ofalow incidence ofreporting ofproblemsbe¬
causeof fear ofreprisals, exceptin in¬
stances where womenvoice theircon¬
cerns as agroup.7
The short-termgoalsofthe interven¬ tions described in this study were to
retain andpromote qualifiedwomenfac¬
ultyandtherebyincrease thenumber of
womenat seniorfaculty ranksby50%
over3years. As 1 measureofsuccess, thenumber ofwomen at the associate
professorrank increasedover550%in 5
years,with no alteration in promotion
criteria The increase in the number of associate professors created a critical
mass ofwomen at senior ranks in the
departmentfor the first time Thesein¬
terventionsare nowbeing expandedto
also address thecareerneeds ofwomen
at the associate professorlevel It is
hoped that,as aresult,thenext5 years
will show substantial increase in the numbers ofwomen promoted to pro¬
fessor
Overall,theresults indicateimprove¬
ment forwomen across a rangeof im¬
portantobstaclestocareer success.Most
importantly,therewas asubstantial de¬ cline in theproportionofwomenantici¬
patingthattheywould leaveacademic medicine Atbaseline,amuch lowerpro¬
portionofwomenthanmenanticipated remaininginacademicmedicine;thiswas
consistent withthedepartment'sobser¬
vation,up to1990,ofdifficulty retaining
womenand withreportselsewhere ofa
"leaky pipeline"forwomeninscience.16,29
We intervened in areas where faculty perceived problems;someofthesewere
substantiatedattheuniversitylevelor
reportedin studiesatother institutions
Follow-upevaluation indicated that fac¬
ultysawimprovementsin manyof these
targeted areas. The results reported
hereindicate that the interventions in¬ creased theoptimismofwomenfaculty
about their careersand decreased the substantialdisparitybetween women's
highinterest inremainingin academic medicine and their lowexpectationsthat
theywould Gender discrimination has been showntoresultincareerimpedi¬
mentsforwomenphysicians, including
lower aspirations, motivation, commit¬
ment tomedicalinstitutions,andcareer
derailment and changes.28·30 Our data
suggestthatchangesinexperiencesand
perceptions modifyfutureexpectations
andcareerdecisions
Thesubstantial increase in retention andpromotionofwomen wasperceived
toresult primarilyfrom several inter¬ ventions: promotions committee moni¬
toringofwomen'scareerprogress,
at Boston University on August 1, 2011
jama.ama-assn.org
Downloaded from
Trang 7Figure 2.—Proportionof all women and all men on the full-time, tenure-trackfacultyin theDepartmentof
Medicine(atranks of instructor, assistantprofessor,associateprofessor,andprofessor)who were asso¬
ciateprofessorsfrom 1988 to 1995 The total number of women and of men,respectively,on the tenure track
faculty (denominator)and at the associateprofessorrank(numerator)In each year is indicated in theap¬
propriatebars Associateprofessorsare the focus here because the number of women associateprofes¬
sors(4)was constant In the 1980sthrough1990 The number andproportionof women at this senior rank
has increasedsteadilysince 1991,reaching comparable proportionsof female and malefacultyat this rank
after 3 years.
proved mentoring,and institution ofa
careerdevelopmentprogramforwom¬
en.Amajorcontributortoretentionwas
the increasedoptimism bywomenabout
theircareersandspecificallyabout their
opportunitiesatJohnsHopkins.This op¬
timism resultedheavilyfrom the
legiti-mization of the problems they experi¬
enced, improved rewards (salary and
recognition),and thedepartmentchair's
demonstratedwillingnesstointervene,
whenneeded,onbehalf of women's ca¬
reers.
Thecostsof the interventionwerein
severalareas. Direct expendituresfor
the interventions totaled $46000 per
year,comprising $15000for thefaculty/
organizational development specialist,
$10000 operating budget for the task
force, $15000 forfaculty time,and$6000
for educationbyconsultants Dataanaly¬
siscost$10000overthecourseof 5years.
Inaddition,therewerethelegallynec¬
essary costsofincreasingwomen'ssa¬
laries to reach equity Finally, many
women facultycontributed substantial
amounts of timetothis work
This study has implications for the
broader social question of affirmative
action Itappears that targeted inter¬
ventionscanimprovetheinclusion ofa
marginalizedgrouptothe benefit of the
entirecommunitywithoutloweringstan¬
dards However, there remains a dis¬
paritybetweenreportsthat somespe¬
cificareashaveimprovedbut that
male-female interactions have not done so
eommensuratelyorsufficiently, suggest¬
ingthat the overall culture hasnotyet
evolvedsufficientlytoremovethe need
forongoinginterventions As inanysuc¬
cessful intervention directedat
margin-alized groups, differential attention to
womenwilllikelybe abletobe decreased
overtime
As in many interventions to assist
marginalized groups, there has been
backlashbymalefaculty,aswellasfear
bywomenofreprisalsiftheywereiden¬
tifiedasparticipants inthesechanges.
These have been concerns from the
outsetof theseinterventions,and much effortwasmadetomake the interven¬
tionsalwaysconstructive andtoquickly generalize useful interventions tomen
aswellas women.Thedepartmentchair hasexplicitlyandconsistently expressed
theimportanceof thesechangesfor the
long-term good of thedepartmentand
institution, helpingallfaculty recognize
that, since women constitute half the talentpool,notdrawing proportionately
from thatpoolwill limitthe institution's
competitiveness and excellence The chair hasconsistently expressedan ex¬
pectationof behaviorbyallfacultythat
is constructive and collégial and does
notdiscriminate onthe basis ofgender
orcreateanadverse work environment forwomen.Theleadershiphas worked with individuals and programsto help
make theadaptationsthatwereneeded
These efforts have helped maintain a
general, although notuniform,percep¬
tion that these changes are necessary
and beneficial
Methodological limitations of this
studyincluded the fact thatitwasspe¬
cific to 1 department of medicine and
was not acontrolled trial It ispossible
thatsomeof thechanges reportedhere
may have occurred without an inter¬
vention as a result of secularchanges occurringin academic medicine
How-ever,therelativelyshort timeinwhich thechanges occurred,the fact thatap¬
proximatelyhalf of thewomenpromoted
wereidentifiedasbeing readyfor pro¬ motionthrough the processofpromo¬ tions committee review,and the much
greater improvements for women, to whommostinterventionswereinitially targeted, suggestthat the interventions
playedasignificantrole in thechanges.
Another limitation is the possibilityof bias introduced into the baseline and
follow-updataby havingless thancom¬
pleteascertainment
Severalkey componentsof the inter¬
ventionstrategydeserveemphasis.The first is that activesupportfrom the de¬
partmentchairwasessentialtothesuc¬ cess. Many womenfelt vulnerable and
not valued in their academic unit and
perceivedthat identification with gen¬ der-basedconcernswould increase their isolation from colleagues Consistent, strong leadership from the top legiti¬
mized discussion and problem solving
related toissues that otherwise might
have beenperceived bythecommunity
as negativeanddestructive.6·16
Second,itwasanticipatedthat all in¬ terventions hadtobelongtermbecause
of the complexityof the obstacles and theextent towhichtheyareimbedded
in academic and societal culture.Thus,
theDepartmentof Medicine envisioned the need foratleasta15-yearinterven¬ tionstrategy. The results after 5years
that are presented here constitute an
interim report, documenting the sub¬ stantial improvements for women ac¬
complished in a relatively short time New5-year goalshave been established for1996 to2000,andthey targetreten¬
tion andpromotionofwomentoprofes¬
sor and senior leadership positions, as
wellasmaintenance ofcurrentchanges.
Third,the multifacetednatureof ob¬ staclestowomen'scareersnecessitated
similarly complexinterventions.Among
themostdifficult andpowerfulobstacles
are the subtleways in which women's
accomplishmentsandcapabilitiesarede¬
valued;thesephenomena requiredpar¬
ticularlyextensiveanalysisandmultiple, ongoingactions While there were im¬
provements in specific areas and the overallclimate,these short-term inter¬ ventions didnoteliminategenderbias
Inparticular,theareain which the least
change was seen overthe short term
wasinteractions betweenmenandwom¬
en. These appeartorequiremore
long-term interventions In addition, some
interventionsmustbeimplemented at
levels of the universityother than the
department. For example, duringthis
interval, the School of Medicine in¬ creased the time limits at eachfaculty
rank.Theuniversityis alsodeveloping
at Boston University on August 1, 2011
jama.ama-assn.org
Downloaded from
Trang 8Fourth,the interventionwasprogres¬
sive and implemented in small steps.
Problem identification at baseline was
notsufficient for thelong term,andan¬
nual réévaluationwasfruitful With bet¬
terunderstanding, new concerns have
been sequentially identified For ex¬
ample,the1993follow-up questionnaire
identifiedaperceptionthatwomenhad
lessaccess toresourcesthan men and
that allocationswerenotequitable.Fur¬
ther evaluation and interventions for this
and otherconcernsidentifiedatourin¬
stitution and in the literatureareunder
development, including sexual harass¬
ment5and the lack of institutional sup¬
portforfacultymembers whoarepar¬
ents.31"36
It has been stated that the academic culturemust be changedso that it fa¬
cilitates women'scareers and entry of
womeninto academic medicine—or else
begin the21st centurywithout includ¬
ing half of the most qualified pool of
academicians.1·8·16·18·31·32·37Wereporthere
a model for institutional strategies to
make such changes. The outcomes re¬
portedheresuggestthat it ispossibleto
make substantive improvements for
women in academic medicine and that suchinterventionsarelikelytobenefit allfacultyin both the shorttermand the
long road to academic equality and
quality.
Dr Fried was a KaiserFamilyFoundation Fac¬
ultyScholar in General Internal Medicineduring
theperformanceof this work.
The authors thankJoseph B. Margolick, MD, PhD,and Adrienne F.Block, PhD,foranalyticin¬
put,JesseRoth, MD,for the constructive review of themanuscript, Ray Burchfield for his excellent
manuscript preparation,and Carol Sulak forprepa¬ ration of theDepartmentof Medicine data on pro¬
motions.
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