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msJAMA
February 2, 2000

Encouraging the Advancement of Women

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JAMA. 2000;283(5):671. doi:10.1001/jama.283.5.671-JMS0202-6-1
Mentoring Is Key

Cohort studies comparing men and women faculty have found that women remain substantially less likely than men to be promoted to senior ranks,1 even after adjusting for number of publications, grant support, tenure vs other academic tracks, hours worked, and specialty. One possible cause of this discrepancy is that women receive inadequate mentoring and encouragement in their career development. In part this is because women are more likely to think of relationships in terms of support and affiliation, whereas men are more accustomed to competition and hierarchy,2 which more accurately describe relationships in professional education and the workplace. Female medical students more than male students seek "kindness" and "approachability" in a mentor,3 qualities hard to find in busy faculty.4

Many women would prefer a woman as mentor, but the number of senior women available to mentor remains comparatively limited; only 2556 full professors are women compared with 20,035 men.3 Compared with men, women anticipate greater risks in becoming a mentor, women have less time to mentor, and women more often believe they lack the qualifications to be a mentor.5

Multiple Approaches Needed

A comprehensive approach to improve women's advancement in academic medicine also needs to emphasize leadership skill-building opportunities and ways to improve the academic climate for women. The Association of American Medical Colleges' (AAMC's) Women in Medicine program works with all North American medical schools along these lines. The 515 Women Liaison Officers, representing 238 schools and 247 teaching hospitals and 30 academic societies, form a network promoting career development of women physicians and focusing attention on gender equity at all levels. The AAMC's annual professional development seminars include workshops on financial management, negotiating skills, and conflict management.

One of the AAMC's goals is to stimulate medical centers to conduct self-studies examining, for instance, faculty commitment to academic medicine, faculty mentoring, and skill development needs. Under the aegis of its Committee on Increasing Women's Leadership in Academic Medicine,6 the AAMC annually surveys schools on the representation of women. Johns Hopkins' Department of Medicine based a series of interventions on a self-study conducted with support from the AAMC; from 1990 through 1995, the university undertook interventions to correct gender-based obstacles reported by women faculty by improving faculty development and mentoring and reducing isolation and structural career impediments.7 The number of women associate professors rose from 4 to 26 in the 5-year interval under study.8

Two other initiatives deserve highlighting. The Hedwig van Ameringen Executive Leadership in Academic Medicine Program for Women, sponsored by MCP–Hahnemann University, offers 35 fellows each year an in-depth curriculum to support their advancement to leadership positions within academic medicine. A high proportion of fellows are achieving promotions to important administrative positions.9 One of the principle goals of this program is to bring together senior ranking women faculty for mentoring, networking, and professional development, creating an extended peer network that reduces their sense of isolation.

To help advance women faculty, the US Department of Health and Human Services included leadership as a component of its selection of Centers of Excellence in Women's Health. Eighteen medical schools have been selected, and each school has initiated strategies to support the advancement of their women faculty.

Conclusion

As medicine faces increasing challenges, it must tap into the commitment and leadership potential of all of its members as never before. Now that 46%3 of entering medical students are women, institutions that fail to encourage and support the advancement of women are missing out on a high proportion of available talent. Some leaders assume that because there are so many young women students and faculty, gender equity problems are solved. But it is still true that only 10.5% of women faculty are full professors compared to 31% of men.3 The full potential of the increasing number of women physicians will not be realized without continuing efforts to improve the environments in which they are educated and the mentoring women receive.

References
1.
Tesch  BNattinger  A Career advancement and gender in academic medicine. J Irish Coll Phys Surg. 1997;26172- 176
2.
Miller  JB Towards a New Psychology of Women.  Boston, Mass Beacon Press1996;
3.
Bickel  JClark  VLawson  R Women in U.S. academic medicine statistics, 1998-1999. Available at: http://www.aamc.org/wim. Accessed December 12, 1999.
4.
Limacher  MCWalsh  MNWolf  WJDouglas  PSSchwartz  JBWright  JS  et al.  The ACC professional life survey: career decisions of women and men in cardiology. J Am Coll Cardiol. 1998;32827- 835Article
5.
Haapanen  KEllsbury  KSchaad  D Gender differences in the perceptions of mentorship among first- and second-year medical students. Acad Med. 1996;71794
6.
Association of American Medical Colleges, Increasing women's leadership in academic medicine. Acad Med. 1996;71800- 811
7.
Fried  LPFrancomano  CAMacDonald  SMWagner  EMStokes  EJCarbone  KM  et al.  Career development for women in academic medicine: multiple interventions in a department of medicine. JAMA. 1996;276898- 905Article
8.
Valian  V Why So Slow? The Advancement of Women.  Cambridge, Mass MIT Press1998;
9.
Executive Leadership in Medicine (ELAM), Available at: http://www.auhs.edu/institutes/iwh/elam. Accessed December 12, 1999.
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