Energizing the Conversation: How to Identify and Overcome Gender Inequalities in Academic Medicine

Abstract

Gender inequality exists in advanced faculty and leadership positions at academic medical centers; however, despite growing awareness, how to best approach and rectify the issue is unknown. To energize the conversation on gender inequality at one academic medical center, chairs and women faculty were surveyed to identify barriers faced by women navigating their careers. A symposium with short talks to increase awareness, a panel with University leaders to discuss issues and successful strategies to overcome gaps, and focus groups to delve further into key areas that underlie inequity via active café style format were planned and implemented. This multifaceted approach resulted in a wealth of knowledge. The symposium and panel highlighted important relevant issues and offered personal strategies for successful career advancement, while the focus group discussions further identified barriers and inspired ongoing efforts across departments and novel approaches to overcome three key issues (work-life integration, deliberate promotion of mentor/sponsor relationships, and overcoming unconscious bias) identified through the initial surveys. Compiled data was then disseminated to participants and University leaders to enhance awareness of available programs and prompt action in critical areas lacking support. Overall, the approach indicated that securing support from leaders and the academic community alike are pertinent to emphasize actions needed to overcome issues affecting women in academic medicine. Moreover, brining leaders and faculty together for an informational session and brainstorming appears to energize the conversation. Such efforts can ultimately instill change and establish an inclusive environment where all members of the academic medicine community can thrive.

Problem Statement

The recent #MeToo movement pertaining to sexual harassment in the workplace and the increasing awareness of gender inequality in academia and industry reflect a marked ongoing need to identify approaches to overcome these disparities. In academic medicine, women now equal or surpass men in incoming medical school classes; however, a striking disparity remains at all levels of leadership^1,2. In 2013–2014, women represented approximately 46% of incoming medical school applicants but only 38% of faculty, 21% of full professors, and 16% of leadership.³ While this is a minor improvement over the previous decade,⁴ more must be done to combat gender inequality and balance this disequilibrium at leadership levels to ensure women reach their desired career goals.

Over the last decade, significant research has been conducted to identify the ways in which gender bias exists in academic institutions, but the conversation is now shifting towards understanding how gender biases have sustained and how to truly change this long-standing culture. Work in the area of institutionalized gender discrimination has determined that achieving a culture of success requires institutions to support equal access to opportunities, support work-life balance, offer freedom from gender biases, and secure supportive leadership^5,6.

How to actively change academic culture to support gender equity is a difficult task. Our institution is pursuing several targeted strategies to address the issues that underlie gender gaps. We are a national leader in ADVANCE programming,⁷ especially in regard to STRIDE (Strategies and Tactics for Recruiting to Improve Diversity and Excellence), and also offer Leadership Summits, networking events, committees focused on equity and advancement of inclusive leadership, unconscious bias education, and faculty development sessions dedicated to addressing and overcoming gender gaps. Despite these initiatives, female representation in leadership roles at our institution are only slightly better than national averages; women represent 43% of faculty and only 29% of instructional/tenure track faculty⁷. This under-representation energized us to define the inequalities and barriers that women face in their careers in order to create meaningful change.

The Association of American Medical Colleges (AAMC) Group on Women in Medicine and Science (GWIMS) is encouraging institutions to tackle the issues pro-actively through organization of symposia focused on these very topics;⁸ however, there is little guidance on what constitutes the most effective methods to foster such conversations, gather evidence, and pursue actions. Given that one of the first steps needed to change implicit biases is to become aware of them, we sought to start a discussion and then examine our current institutional academic environment to understand specific ways to change our culture. We addressed these issues through an event entitled “Empowering Women to Succeed in Academic Medicine.” Our main goals were to bring together women and leaders at our institution to enlighten the community about the issues, and also determine how to best overcome common hurdles that women face in academia. Here, we share our approach, lessons learned, and guidance for moving forward to foster a community where men and women alike can succeed. The information and actions resulting from our experiences will help guide larger efforts within our organization as well as efforts at other academic medical institutions.

Solution

Our academic medical center is part of a large public R1 Doctoral University that has very high research activity. With a recent university presidential initiative to strategically plan for Diversity, Equity and Inclusion, different units on campus are working to identify issues and strategies. As part of this initiative and to address the issues at hand and ignite the discussion on how to create change in our medical center, we held an event that included a public symposium with panel discussion followed by an invited focus group discussion of key issues (Table 1). The format was the result of extensive conversations with career development experts and leaders engaged in promoting the careers of women, and multiple factors were considered in establishing and implementing this design. Specifically, we had extensive conversations with staff and the director of our Faculty Development program, leadership in ADVANCE, the Associate Dean for Clinical Affairs and Faculty Development, and business school faculty who participated in creating programming or who have researched faculty development in medicine. We further consulted an external expert who has extensively worked with academic medical centers and has researched and addressed gender bias in academic medicine. From these discussions, while there were factors identified such as institutional barriers, external barriers, and the importance of allies and sponsors, it was clear that we needed to engage the broader faculty directly to both overcome any of our own biases and identify the most relevant issues at hand.

TABLE 1.

“Empowering Women to Succeed in Academic Medicine” Event Design

	Audience	Format	Desired outcome
Pre-event inquiries	Female faculty	Email survey	Identification of key topics for discussion
	Deans and chairs for basic science and clinical departments	Solicitation for focus group nominees who are engaged in empowering women in academic medicine	Invite list with diverse representatives from all departments
Symposium	Public event targeting University community and leadership	Keynote presentations: “Gender equity in academic medicine: Where do we stand and where do we go from here?” “Gender, power & advancement: What are we learning about how women can increase their influence?”	Enlighten the audience with social research outcomes and provide insight into leadership and organizational development strategies
		Panel discussion with keynote speakers and University deans, institute and center directors, and chairs	Provide a forum for attendees to voice concerns and gain insight into strategies employed by key leaders along their path to success
Focus groups	Invited focus groups including leaders and department nominees	World café style event focused on three key questions: Question 1) In what ways might we improve work-life integration in our institution? Question 2) How do we deliberately increase mentor-sponsor relationships to promote academic success for women? Question 3) What more can we do to help people anticipate and overcome unconscious biases at our institution?	Robust conversations on relevant topics that draw on the experiences of a diverse crowd to identify key gaps, actions, and recommendations

Hence, given the vast reach of gender inequality in academia and beyond, our first objective was to identify topics that would facilitate informative and engaging discussions pertinent to women faculty at our institution. To accomplish this objective, all female faculty at our medical center were invited to complete a pre-survey with questions addressing what issues or barriers to career advancement they had witnessed or experienced, what support systems for faculty were available or required, what other questions they had for our leaders, and what institutions or programs they knew of that were supporting women to achieve academic success. The data collected highlighted key issues that required attention and represented topics that became part of our event focus, including work-life integration, unconscious bias, role models and mentors, and gender biased expectations.

In parallel, discussions on the best format for the event were held with leaders in Faculty Development and the Office of Health Equity and Inclusion, and with faculty from our School of Business and Medical Center who exhibited interest in promoting the careers of women and junior faculty. These individuals were instrumental in securing the engagement of leaders across the community and provided networking to plan and support implementation of our chosen format.

The resulting design following our extensive literature review, survey of faculty, and discussions with leaders was a two-part event entitled “Empowering Women to Succeed in Academic Medicine” that began with a public symposium consisting of two short talks by leaders in the field of gender equity in academia followed by a panel discussion featuring University leaders. The two keynote addresses, one by a physician faculty member and national leader on gender-based issues in academic medicine and a second external nationally recognized expert in organizational and leadership development, provided the audience with a general overview about the current data and issues. The following panel discussion then highlighted perspectives of the speakers along with both male and female leaders who overcame barriers themselves and who support women faculty in their departments. This panel discussion began with targeted questions collected from the pre-event survey and continued with questions from attendees who asked panelists about their own experiences, challenges, and ways to deal with current barriers for women in medicine.

Following the morning symposium, we delved deeper into three major topics impacting women in academia at an invited luncheon and focus group discussion. Attendees included key leaders from our Medical Center and a targeted group of 2–3 individuals from each department. These individuals were nominated by the deans or chairs from each basic science and clinical department at our Medical Center, and included junior- or mid-level faculty with demonstrated interest in identifying resources and approaches to support advancement of women.

The focus group discussion topics were based on the cumulative feedback solicited from attendees via the pre-event survey. The data revealed three recurring themes:

Question 1) In what ways might we improve work-life integration in our institution?

Question 2) How do we deliberately increase mentor-sponsor relationships to promote academic success for women?

Question 3) What more can we do to help people anticipate and overcome unconscious biases at our institution?

To support informative discussions on these topics, we utilized the world café style approach,⁹ which fosters a collaborative dialogue around relevant questions. Briefly, under direction of a main event moderator, focus group attendees rotated between tables over three rounds to provide their input on each issue. A facilitator at each table initiated the discussion for that question and provided a brief summary of the prior group’s discussions for later rounds. Facilitators also ensured everyone present had the opportunity to contribute to the discussion to ensure a dynamic and diverse perspective on the issues. Throughout each round, notes were transcribed directly on table-top paper, providing a comprehensive record of the discussion points that emanated from the participant conversations. After the three rounds, the major points were then summarized on flip charts by the table facilitators and presented to the group to highlight key gaps, actions, and recommendations, providing a final forum for open discussion. A post-event survey was finally solicited to give attendees an opportunity to highlight what they found most helpful from the event, list possible topics for discussion and continuing efforts, and suggest ways to enhance future events.

The public symposium garnered a great deal of enthusiasm and drew over 200 attendees, while the invited focus groups gathered the insight and perspectives of 75 leaders and departmental nominees. The events produced a vast amount of information from a diverse group (Fig. 1), which we compiled with assistance from the Faculty Development office into event summary and frequently asked questions (FAQ) handouts. The event summary presented the event structure and goals, as well as the resulting themes and suggestions that arose from the discussions. The FAQ handout complemented this memo by offering links to existing guidelines and resources addressing the most common questions that arose during the session. These documents were disseminated to all event attendees as well as our leaders and faculty. Finally, the data and ensuing conversations with leadership formed the basis for a Strategic Plan document outlining the identified needs along with ongoing initiatives that are or will address these needs at our institution in coming years. This information and suggestions collected from the post-event survey will inform future and ongoing initiatives.

FIG. 1. “Empowering Women to Succeed in Academic Medicine” Outcomes.

The multi-stage event in concert with the pre- and post-event inquiries resulted in the collection of a vast amount of data. The initial survey which was distributed among all women faculty provided the foundation for discussions during the panel and focus group portions of the event. Complementing the messages delivered during the symposium and panel discussions, the world café format focus groups then resulted in both table-top paper notes which comprehensively documented each topic discussion as well as flip chart summary of the main points uncovered for each topic. Finally, the data emanating from these forums were compiled into an event summary, FAQ handout containing links to guidelines and resources, and a strategic plan document outlining action items and ongoing initiatives. Other tangible outcomes included information gleaned from the post-event survey, which will be considered in the planning of future events and ongoing initiatives. FAQ, frequently asked question.

Several lessons were gleaned from our experience that are generalizable across institutions. Our event format, which resulted from considerable discussion and was guided by preliminary data collected via the pre-event survey, ensured that we focused our efforts on issues that were both relevant and timely and employed a strategy to foster thorough and effective discussions on the issues. Securing a variety of panelists was also very beneficial, as this meant our leaders had diverse backgrounds and were able to answer the questions asked by attendees. That said, while we were thoughtful about engaging institutional leaders as part of our primary audience and we wanted to truly impact culture change through institutional efforts, we struggled getting this group to attend. Also, while our great efforts put into designing the session and engaging attendees were highly effective, we had difficulty truly understanding how to best evaluate the true impact of the session. Although we prompted discussions, educated many faculty about the issues and solutions, and generated qualitative immediate results, it was difficult to quantify the long-term impact of our efforts. Future evaluations will be required to understand the changes in progression in promotion, career advancement to leadership, and career satisfaction for those who attended. This type of tracking is a current focus for our institution to understand the overall impact of the ongoing efforts of our Diversity, Equity and Inclusion initiatives.

The event generated a vast amount of data. While the format lent itself to honing in on key issues, needs, and recommendations, we, along with Faculty Development representatives, spent considerable time ensuring that these data were accurately summarized and disseminated to the appropriate audiences across campus, including women and leaders. The FAQ sheet was based on realizations that faculty weren’t fully aware of the policies and resources available to them. Likewise, the Strategic Plan highlighted the fact that many of the required initiatives to overcome barriers are larger than one individual or one department. Nonetheless, by focusing the efforts of a subset of engaged individuals and participants selected from our broader faculty, we were able to raise awareness of the issues and energize the necessary conversations that are paving the way for continued progress on an institutional level.

A limitation that became evident during our event was our attempts to reach a diverse audience. The most participation we drew was from women faculty, the group most likely affected by this topic and most passionate to engage in the discussion. In fact, while the symposium and panel discussions drew a large turnout along with considerable interest in the topic, there were very few men in attendance. That said, the men who were present, as well as our male panelists, were highly attentive, engaged, and offered a very important perspective. Upon reflection, we anticipate that if we had involved male as well as female faculty in our pre-survey, this earlier engagement may have facilitated increased male representation in our audience and a more diverse perspective and insightful discussion on gender biases. Similarly, although we personally reached out to institutional leaders and invited them to be part of our primary audience, we only had modest attendance by institutional leaders and many male leaders did not attend. Given that allyship is so important, and knowing that those who did attend the session actively participated and have since facilitated the engagement of additional male leaders through follow-up efforts, we intend to fully emphasize in future events that all are needed for this discussion. Finally, the inherent gender bias that events like this are for women only may have skewed the gender ratios of our attendees. In retrospect, having the word “women” in our title may not have been the best approach for an inclusive audience, especially given that societal understanding of gender is ever changing; hence, a more broadly advertised message would likely help make the event more inclusive. Future efforts will utilize marketing strategies that capture diverse audiences, instead of focusing on the more discriminated group, and more broadly engage leaders.

Conclusions

Planning and creating focused events on issues for women in academia is critical, but more importantly it is essential to evaluate how successful these events are to make true impact. Our approach of pre-surveying faculty, meeting with key leadership groups, and advertising itself had an impact by emphasizing the need for group discussions on this topic. Our impact through the event was further evident from the engagement during the session. Finally, as mentioned above, the dissemination of our event summary and FAQs among the attendees and leadership has prompted continued engagement across several levels. Our institution is also continuing to invest in targeted strategies like those mentioned earlier to create an environment where the identified issues are transparent and open for discussion. Select institutions nationwide have likewise begun to evaluate proactive approaches to address gender inequality; some have focused on bias mitigation, whereas others have attempted more comprehensive cultural transformation.^10–14 Disseminating the granular details of how such interventions are designed and their impact are critical. Recently, this has been done with discussions of family-friendly policies, implicit bias training, salary reviews, mentoring programs, and better harassment reporting.^12,14 Because many initiatives to promote gender equity include symposia and focus groups, understanding exactly how workshops might be optimally structured on an institution level is important. Many identified challenges to using such forums to promote gender equity are generalizable across institutions and industries, so lessons learned at one institution are valuable to help the community more generally to create change.

Moving forward, there is a continued need to maintain focus on the identified action items and support programs focused on these topics. Future events that include men and other leaders are also important to maintain momentum and establish inclusive and engaged communities that support women in academic medicine. Likewise, sharing event outcomes along with successful strategies across institutions will fuel initiatives that can benefit women across career levels, departments, institutions, and even industries. Overall, continued buy-in from leaders and the continued education of the academic community alike are imperative to create change and support an inclusive environment where all members of the academic medicine community can thrive.

Lessons for Practice.

1. Bringing diverse representation to the table for complex gender inequality discussions leads to true delineation of the issue and innovative solutions. There is a gap in the ability to get male faculty engaged in gender discussions, but their role is critical for driving sustained change.

2. Leadership support is critical to promote engagement of faculty and support change or clarification of policies.

3. Clear models for evaluating data from large events of this style, as well as metrics to evaluate success from diversity, equity, and inclusion activities, are still needed.