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The National Initiative on Gender, Culture and Leadership in Medicine, (also known as "C - Change" for culture change) addresses the imperative of developing women and under-represented minority faculty members' full potential and leadership in academic medicine in the United States. The project engages medical schools in action research with Brandeis University to analyze the current situation and to facilitate culture change so that all faculty members can contribute fully.
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 medical school deans agreed to embark on a multiyear project to change the culture of their medical schools for these underrepresented faculty. A recent survey of medical school deans conducted by the Association of American Medical Colleges (AAMC) on leadership recruiting practices in U.S. medical schools revealed that the deans responding were highly dissatisfied with the numbers of women and racial and ethnic minority finalists in all department chair searches, particularly in those for clinical chairs.1 This survey and the deans' responses illustrate the reality for academic medicine today.
Even though we now have a large female cohort of highly trained potential leaders, senior physicians, and research scientists, women are still markedly underrepresented in senior academic and leadership positions in our medical schools and teaching hospitals.
In 1980, women constituted 29% of students admitted to medical schools, and this proportion has increased steadily. Since 2003, medical school admissions for men and women have been virtually equal.2 As of 2008, women constituted 35% of clinical science faculty and 31% of basic science faculty at U.S. medical schools. However, female full professors as a proportion of all female faculty at medical schools only rose from 9% in 1980 to 12% in 2008 (compared with 30% male full professors of all male faculty). In clinical science departments, less than one-fifth (17%) of all professors are women. Currently, only 17% of tenured faculty at U.S. medical schools are women. In medical schools, where half our trainees are women, there is an average of 35 female and 188 male professors per school. In 2008, female full professors constituted 4% of all faculty in the basic and clinical sciences. Only 8% of clinical science department chairs and 13% of basic science department chairs are female, and many schools have never had a female department chair. About 7% of deans (not including interim deans) are women.3
Similarly, despite the increasingly diverse U.S. population and medical student bodies (including 16% of students from underrepresented minority groups), academic medicine has been unable to recruit and sustain faculty from underrepresented minority groups. Only 3% of medical faculty are African American, 4% Hispanic/Latino and 0.1% Native American.4 Diversity among faculty enhances the ability of academic medicine to fulfill its educational, research, and patient-care missions.5 Failure to realize the full participation and leadership potential of all faculty-especially women and underrepresented minority faculty members-remains a pressing problem and challenge in academic medicine today.
In addition to this lack of diversity in leadership, a new generation of students and faculty, both male and female, seek balance across their personal and professional priorities, which may influence their future career choices away from the challenging environment of academic medicine. Additional indication of problems in the culture of academic medicine is that 37% to 47% of medical faculty may experience burnout.6 There appears to be a mismatch between the prevailing organizational approach and culture in academic medicine and its vital faculty workforce. It is increasingly clear that addressing these serious issues requires dedicated and innovative efforts and a renewed focus on the culture of academic medicine.
The National Institutes of Health (NIH) and the National Academy of Sciences, including the Institute of Medicine, have proposed directives to address the lack of women in leadership in biomedical sciences.7,8 The presidential address at the November 2007 AAMC annual meeting called for embracing a change in the culture of medical schools using leadership, courage, collaboration, and transparency.9
This realization of a need for an organizational approach to recurrent problems in academic medicine led the medical school deans to join a coalition to address culture in a more ambitious way than previously undertaken. The schools are very different geographically and organizationally, but their problems are strikingly similar. The deans realized that the time had come to address more purposefully these cultural issues in their institutions, and committed their institutions to partnering in C - Change.
C - Change has been generously funded by the Josiah Macy, Jr. Foundation and with supplemental collaborative support from the Office of Public Health and Science Offices on Women's Health and Minority Health, the NIH Office of Research on Women's Health, the Agency for Healthcare Research and Quality, the Health Resources and Services Administration, and the Centers for Disease Control and Prevention, and Brandeis University Women's Studies Research Center.
Much prior research regarding the lack of women and underrepresented minority faculty in leadership has focused on perceived deficiencies in these faculty subsets and work-life balance issues that may differentially affect women. Instead of studying the characteristics and behaviors of the individuals who are underrepresented among our leadership, C - Change chose to focus on the aspects of the institutional culture that could be contributing to this phenomenon. We wanted to develop a cross-institutional partnership which, through rigorous qualitative and quantitative research, would enable us to understand the culture of our schools and facilitate solutions for change. A hallmark of C - Change is that it simultaneously addresses culture, organizational approach, and the personal experience of faculty within academic medicine. Early in the process, an interview study and a survey were conducted of a subset of faculty in each of the schools, and the results were shared anonymously with the group.10-12
As part of the project, we initiated a Learning Action Network among the schools to draw on each other's combined experiences to implement individualized change processes at each of the schools. Each school chose what seemed right to work on first, and learned from each other's ideas and critiques. Facilitated by the project, the schools continue to work toward incorporating lessons about bias from social science research, innovative professional development of faculty, changes in policy and practice, effective leadership, communication strategies, and comprehensive efforts to make the environment of academic medicine more humane. We are confident our course of action is fully aligned with the national recommendations of the AAMC, NIH, and the National Academy of Sciences.
The deans have committed resources and time- their own and those of some of their senior faculty and administrators-because they believe that something different must be done to alter the status quo. As we build on the findings of the C - Change research and start to introduce changes in the schools, we will make these lessons learned available to the larger academic community. But since these changes take time, and since the problems of faculty culture are real and immediate, and we hope to enlist more participants as we continue this work.
1. Mallon WT, Corrice A. Leadership recruiting practices in US medical schools. Washington, DC: Association of American Medical Colleges; August 2009.
2. Association of American Medical Colleges. 2007 AAMC Databook: Medical Schools and Teaching Hospitals by the Numbers. Available at: http://www.aamc.org/data/databook/start.htm. Accessed February 8,2010.
3. Association of American Medical Colleges. Faculty Roster. Available at: http://www.aamc.org/data/facultyroster. Accessed February 8, 2010.
4. Castillo-Page L. Diversity in medical education: Facts & figures 2008. Washington, DC: Association of American Medical Colleges; 2008.
5. Kington R, Tisnado D, Carlisle DM. Increasing racial and ethnic diversity among physicians: An intervention to address health disparities? In: Smedley BD, Stith AY, Colburn L, Evans CH. The Right Thing to Do, the Smart Thing to Do: Enhancing Diversity in the Health Professions. Washington, DC: National Academy Press; 2001:57-90.
6. Shanafelt TD, Sloan JA, Haberman TM. The well-being of physicians. Am J Med. 2003;114:513-519.
7. National Institutes of Health. Available at: http://www.nih.gov/news/pr/jan2007 and http://orwh.od.nih.gov.
8. National Academy of Sciences; Institute of Medicine. Beyond Bias and Barriers. Fulfilling the Potential of Women in Academic Science and Engineering. Washington, DC: National Academies Press; 2007.
9. Kirch DG. AAMC President's Address 2007: Culture and Courage to Change. Available at: http://www.aamc.org/newsroom/pressrel/2007/2007presidentsaddress.pdf. Accessed February 8, 2010.
10. Pololi L, Conrad P, Knight S, Carr P. A study of the relational aspects of the culture of academic medicine. Acad Med. 2009;84:106-114.
11. Carr PL, Pololi L, Knight S, Conrad P. Collaboration in academic medicine: Reflections on gender and advancement. Acad Med. 2009;84:1447-1453.
12. Pololi L, Kern DE, Carr P, Conrad P, Knight S. The culture of academic medicine: Faculty perceptions of the lack of alignment between individual and institutional values. J Gen Intern Med. 2009;24:1289-95.
Linda Pololi, MBBS, MRCP
Senior Scientist and Resident Scholar
Director, National Initiative on Gender, Culture and Leadership
in Medicine: C - Change
415 South Street, Mail Stop 079
Waltham, MA 02454