Recent Trends in Faculty Promotion in U.S. Medical Schools: Implications for Recruitment, Retention, and Diversity and Inclusion

Leadership in Equity, Diversity, and Inclusion: What Skills and Attributes Are Documented in the Literature?

OBJECTIVES

Equity, diversity, and inclusion (EDI) leadership has recently been scrutinized, and many institutions have had to repurpose EDI leaders due to recent legislation. The skills or attributes of EDI leaders are not well understood. The authors sought to identify skills or attributes associated with EDI leaders.

METHODS

The authors searched the PubMed database using the search terms "Diversity," "Equity," "Inclusion," "Leadership," "Chief diversity officer," "Diversity leadership skills," and "Diversity officer." The authors then reviewed titles, abstracts, and papers to identify the skills or attributes of EDI leaders.

RESULTS

The search yielded 580 items. The authors analyzed the 10 remaining papers after the abstract, title, and paper review. All of the authors reviewed the articles and constructed the following list of skills: motivating others, fostering potential, inspiring trust, thinking strategically, setting goals and expectations, giving feedback, and being authentic.

DISCUSSION

EDI leaders are well equipped for leadership in other spaces because the skills and attributes identified in this review are transferrable to assistant and associate dean positions, chair positions, and other leadership positions in academic medicine. Individual EDI leaders can use these documented skills and attributes to reposition their leadership in this ever-changing political environment. Institutional leaders also can use this information to retain talented EDI leaders in influential leadership positions.

Trends in Faculty Advancement for Underrepresented groups in Academic Radiology

RATIONALE AND OBJECTIVES

The aim of this study was to analyze demographic data of academic radiology faculty to assess rank equity by gender and race/ethnicity and trends from 2000 to 2023.

METHODS

Data was collected from the AAMC Faculty Salary Roster, which collects information for self-reported gender and race/ethnicity for faculty at different ranks in U.S. medical schools. To determine parity between faculty ranks across gender and race/ethnicity, rank equity index (REI) was calculated for associate/assistant, professor/associate, and professor/assistant professor comparisons.

RESULTS

The percentage of women faculty increased from 23.6% in 2000 to 30% in 2023. REI increased steadily for women, and White women reached parity in 2023 for Associate/Assistant comparison but not for Professor/Assistant. REI remained low for Asian and URM women (0.67-0.69 for Professor/Assistant comparison). Only Asian men reached parity for Professor/Assistant comparison, and REI decreased for URM men over the study period. Black faculty had a modest improvement in REI from 2000 (0.41) to 2009 (0.67) but remained unchanged since then (0.67 in 2023).

CONCLUSION

Advancement along the academic ladder has been uneven in academic radiology. While rank equity for women has improved over time, for URM and Asian women it remains substantially below parity. URM men have actually seen a decline in rank equity across ranks. Further efforts are needed to identify barriers to recruitment, retention, and promotion for these sub-groups in academic radiology and create interventions that diversify radiology faculty at all ranks.

Institutional characteristics, faculty rank and URM faculty representation

INTRODUCTION

It has been well documented that underrepresented faculty in academic medicine are concentrated in lower faculty ranks than their well represented counterparts. This promotion disparity has resulted in concerted efforts by medical institutions to change academic culture and climate surrounding this group. This study provides a more detailed characterization of minority faculty underrepresentation, evaluating longitudinal trends in faculty rank among US medical schools looking particularly at academic rank, region, ownership, institution type, social mission score and research intensity ranking.

MATERIALS AND METHODS

Using data from the AAMC Faculty Roster, AAMC Organizational database, and Mullan et al.'s social mission score, multiple adjusted Generalized Estimating Equation (GEE) models were constructed to evaluate trends in faculty number by race/ethnicity, academic rank, and specific institutional characteristics as noted above.

RESULTS AND DISCUSSION

Compared to URM faculty in the South, the change rate of URM faculty is higher by 1.7 % in the West. At the Instructor rank, there are increased rates of change for all racial groups in the West when compared to the South by 6.3 % for Asian faculty, 5.1 % for White faculty, and 5 % for URM faculty. URM faculty at HBCUs at the Instructor level have decreased rates of change by 4.9 % as compared to predominantly white institutions. URM Professor rank faculty at private institutions showed significant increased rates of change of 1.7 % as compared to public institutions. URM faculty at the Professor rank had a decreased rate of 1.4 % at schools with high social mission score compared to low social mission scores.

IMPLICATIONS

There are differences in overall URM faculty trends based on region, ownership, institution type, social mission score and research intensity ranking. All institutional characteristics showed different effects on URM faculty at specific academic ranks and the reasons for these differences need further study to be more fully understood.

Improving Academic Promotion Success via Implementation of Targeted Preparation Strategies and Coaching Processes

PROBLEM

Academic promotion is important for faculty career development and retention in academic medicine. However, the promotion process is time consuming, with little guidance offered to ensure successful outcomes. The authors describe their institution's standardized approach to providing clear and reliable academic promotion support and share associated outcomes.

APPROACH

An academic promotion support process, comprising 4 targeted preparation strategies and 3 coaching processes, was implemented in 2020 at Children's Mercy Kansas City to prepare faculty to submit promotion applications. Targeted preparation strategies include communication plans, an intent to apply process, how-to guides and templates, and institutional promotion committee review. Coaching processes include structured conversations with an immediate faculty leader, an Office of Faculty Development director, and, after committee review of applications, an institutional promotion committee reviewer. Descriptive statistics and promotion outcomes were compared preimplementation (2012-2019) and postimplementation (2020-2023).

OUTCOMES

In 2012-2019 (8 promotion cycles), prior to implementation of the academic promotion support process, 247 faculty applied for academic promotion. After implementation, in 2020-2023 (4 cycles), 196 faculty applied. From pre- to postimplementation, the mean volume of applications per cycle significantly increased from 31 to 49 (P = .03), and the proportion of approved promotion applications significantly increased from 89.5% (221/247) to 99.0% (194/196) (P < .001). No significant differences were observed in the proportions of applicants who were female (P = .77) or non-White (P = .51).

NEXT STEPS

Creation of an institutional academic promotion support process can be effective in increasing the volume of applications and the likelihood of successful outcomes. Future research should focus on increasing the proportions of non-White faculty and female faculty who apply for promotion and analyzing longer-term outcomes for faculty who are promoted, such as progression to leadership roles.

Developmental Coaching for Clinician Educators: Just What the Doctor Ordered

ABSTRACT

Despite intensive attempts to create scholarship equity at academic medical centers, clinician educators continue to face a challenging professional promotion environment that puts them at risk for burnout, stalled career advancement, and abandonment of academic medicine altogether. Coaching, which has a wealth of supportive evidence from outside of medicine, is distinguished by (1) being driven by the agentic coachee that is inherently capable, creative, and resourceful, (2) not requiring the coach and coachee to have shared content expertise, and (3) not being centered around transfer of expertise from the more knowledgeable or experienced party to the recipient. Initial evidence from within medicine indicates that coaching reduces burnout and improves learner self-reflection, teaching effectiveness, goal setting, reflective capacity, professional identity formation, career planning, and development of adaptive expertise. In this article, faculty coaching is presented as a powerful means to help clinician educators overcome the myriad challenges to professional advancement and career fulfillment. The current evidence in support of coaching-both within and outside of medicine-is reviewed. Finally, a conceptual model is provided, as are guidelines demonstrating specific roles, behaviors, and responsibilities for faculty coaches and coachees.

Implementing a Holistic Review Toolkit for Faculty Recruitment and Retention

Introduction

A diverse workforce improves health care, educational outcomes, and research agendas. Currently, faculty from historically excluded groups remain underrepresented in academic medicine. Resources are needed in academic medical centers for those charged with recruiting and retaining a diverse and talented workforce.

Methods

Informed by the successful use of holistic review in medical student admissions, the Association of American Medical Colleges (AAMC) developed and piloted a toolkit for use in faculty recruitment and retention at five academic medical centers. Institutions led toolkit-guided holistic review workshops ranging from 2.5 to 3 hours in duration for leaders and faculty to identify and prioritize selection criteria used to modify faculty recruitment and retention materials and processes. AAMC surveys at pilot initiation and at two time points during implementation assessed satisfaction with and perceptions of the toolkit.

Results

At the first survey time point, the average toolkit rating across five institutions ranged from 3.2 to 4.4 (out of a maximum of 5.0) for helpfulness and from 3.5 to 4.9 for ease of use. At the second survey time point, the helpfulness of the tools received average ratings of 3.0-4.8. In respondents' qualitative comments, we identified varying strategies for implementation and few barriers to implementation other than reluctance of some faculty to use scripted tools and concerns about anonymity in the exit interviews.

Discussion

The toolkit was well received and easy to implement. It will be important to study the use of these materials across other institutions, with attention to their impact on faculty diversity.

Promotion and Tenure Database Creation and Utilization: A 12-Year History

Trends in faculty demographic composition, promotion success, and retention are important considerations in Academic Health Centers (AHC). This paper reviews the design, implementation, and utility of a faculty promotion and tenure (P&T) database (PROMO/TE©) over 12 years in a large southwestern academic health center. Review of the system design, portfolio creation, P&T tracking, interface with other faculty databases, and lessons learned will be offered. PROMO/TE© was developed to improve the P&T packet creation, application, and review process in one College and was expanded to other colleges at the AHC. The PROMO/TE© system is integrated with Workday® and FACFACTS© to track trends in recruitment, attrition, and P&T trends across gender, underrepresented minorities, and other subgroups. PROMO/TE© has several advantages including improving communication, transparency, uniformity, and efficiency in the P&T packet creation, application, and review process. Increased cost savings ($217,198 annually) were noted with elimination of hard copy packets and decreased time spent. The first college reviewed 743 dossiers in the PROMO/TE© system since its creation in 2012 and there has been on average a 10% increase in P&T approvals since its inception. PROMO/TE© facilitates and tracks trends in the P&T process and has many benefits as well as significant cost savings. PROMO/TE© serves as a potential model for other institutions.

Race and Ethnicity, Gender, and Promotion of Physicians in Academic Medicine

Importance

The ranks of academic physicians do not reflect the diversity of the US population. To create a diverse and effective medical workforce, it is important to know the extent to which gender, race and ethnicity, and the intersection of these factors are associated with career advancement.

Objective

To assess whether race and ethnicity and gender are associated with appointment to or promotion within academic medicine.

Design, Setting, and Participants

This cohort study used Association of American Medical Colleges data on graduates of all US MD-granting medical schools from 1979 to 2019 merged with faculty appointment data since 2000. Data for this study are based on a February 19, 2021, snapshot. The analysis was performed from March 8, 2021, to May 5, 2023.

Exposure

Gender and race and ethnicity among physician graduates.

Main Outcomes and Measures

The main outcome was full-time faculty appointments and promotions to the ranks of instructor, assistant professor, associate professor, full professor, and department chair. Cox proportional hazards models were used to examine the differences in likelihood of appointment and promotion for racial and ethnic minority men and women compared with White men.

Results

The analytic sample included 673 573 graduates (mean [SD] age at graduation, 28.1 [3.2] years; 59.7% male; and 15.2% identifying as Asian, 6.1% as Black, and 69.6% as White). White men accounted for the largest subgroup of graduates (43.8%). Asian men, Asian women, Black women, and White women were more likely than White men to be appointed to entry-level positions. Among physicians graduating both before and after 2000, White men were more likely to be promoted to upper ranks compared with physicians of nearly every other combination of gender and race and ethnicity. Among physicians graduating prior to 2000, Black women were 55% less likely (HR, 0.45; 95% CI, 0.41-0.49) to be promoted to associate professor (n = 131 457) and 41% less likely (HR, 0.59; 95% CI, 0.51-0.69) to be promoted to full professor (n = 43 677) compared with White men. Conversely, Black men (HR, 1.29; 95% CI, 1.03-1.61) were more likely to be appointed as department chair (n = 140 052) than White men.

Conclusions and Relevance

These findings indicate that preferential promotion of White men within academic medicine continues to persist in the new millennium, with racially and ethnically diverse women experiencing greater underpromotion. To achieve a workforce that reflects the diversity of the US population, this study suggests that academic medicine needs to transform its culture and practices surrounding faculty appointments and promotions.

Increasing Diversity, Equity, and Inclusion in the Health and Health Services Research Workforce: A Systematic Scoping Review

Health and health services research institutions seek to increase diversity, equity, and inclusion (DEI) to overcome structural bias. The objective of this review is to identify, characterize, and evaluate programs aimed to strengthen DEI in the health and health services research workforces. We conducted a systematic scoping review of literature of 2012-2022 North American peer-reviewed empirical studies in PubMed and Embase using the Arksey and O'Malley approach. This review identified 62 programs that varied in focus, characteristics, and outcomes. Programs focused on supporting a spectrum of underrepresented groups based on race/ethnicity, gender identity, sexual orientation, disability status, and socioeconomic status. The majority of programs targeted faculty/investigators, compared to other workforce roles. Most programs were 1 year in length or less. The practices employed within programs included skills building, mentoring, and facilitating the development of social networks. To support program infrastructure, key strategies included supportive leadership, inclusive climate, resource allocation, and community engagement. Most programs evaluated success based on shorter-term metrics such as the number of grants submitted and manuscripts published. Relatively few programs collected long-term outcomes on workforce pathway outcomes including hiring, promotion, and retention. This systematic scoping review outlined prevalent practices to advance DEI in the health and health services research field. As DEI programs proliferate, more work is needed by research universities, institutes, and funders to realign institutional culture and structures, expand resources, advance measurement, and increase opportunities for underrepresented groups at every career stage.

Medical Educator Perceptions of Faculty Effort and Intent to Stay in Academic Medicine

Purpose

Core roles of medical school faculty are increasingly diverse, substantial, and evolving. In alignment with this dynamic nature of medical education, faculty effort should be accurately appraised, constantly evaluated, and rewarded to ensure faculty satisfaction and promote a culture of belonging. The study goal was to examine the imbalance in official assignments and perceptions of medical school faculty effort in various educator domains.

Materials and Methods

An 80-item survey was designed to collect quantitative and qualitative measures of faculty perceptions of effort. Survey questions collected data on faculty demographics, intent to stay, and perceptions of effort in the following educator domains: teaching, educational leadership and administration, research and scholarship, and service. A mixed methods approach was utilized in data analysis.

Results

Eighty-eight complete survey responses were collected between February and May of 2022 from respondents from 27 states. There was a significant disparity between assigned and perceived effort in the educator domains of teaching, research, and service (P < 0.01). Faculty satisfaction with percent effort dedicated to teaching significantly correlated with intent to stay (P < 0.05). Satisfaction with workload assignments was higher with advanced academic rank and male gender. Qualitative analysis identified many key themes in the categories of promotion, workload, resources, and retention.

Conclusions

Our study revealed that satisfaction with workload directly correlates with intent to stay, and principles of equitable workload distribution are violated from the perspective of the medical educator. This data provides critical information that can be used to assist medical schools in developing metrics to evaluate faculty performance in medical education and improve retention in academic medicine.

Workforce Initiatives to Advance Health Equity and Diverse Representation

The persistence of health inequity and the need for workforce diverse representation within child and adolescent psychiatry require systemic solutions. There are recommendations and strategies particularly for the training programs with "all of the above" approach to tackle these complex systemic issues. One of the ways is to think through existing and innovative training pipelines by making them less leaky, enhancing quality, expanding the type and size, and connecting them to reach children and adolescents in need.

Gender Disparity in Full Professor Rank Among Academic Physicians: A Systematic Review and Meta-Analysis

PURPOSE

The gender gap in promotion in academic medicine is well established. However, few studies have reported gender differences in promotion adjusted for scholarly production and national or international reputation, namely, career duration, publications, grant funding, and leadership positions. The authors performed a systematic review and meta-analysis of the differences between men and women in achieving benchmarks for promotion and analyze where such differences lie geographically and within specialties.

METHOD

A systematic search of Academic Search Premier, Business Source Complete, Cochrane Library, ERIC, GenderWatch, Google Scholar, Embase, MEDLINE, PubMed, Scopus, and Web of Science was conducted from inception to August 17, 2022. All studies that reported the number of male and female full professors on medical school faculty were included. The primary outcome was the adjusted odds ratio (AOR) for promotion to full professor for women compared with men.

RESULTS

Two hundred forty-four studies met the inclusion criteria. The unadjusted OR for promotion to full professor for women was 0.38 (95% confidence interval [CI], 0.36-0.41). Sixteen studies reported an AOR. The pooled AOR of promotion for women to full professor was 0.60 (95% CI, 0.46-0.77). The AOR for promotion to full professor was 0.55 (95% CI, 0.34-0.88) in surgery and 0.80 (95% CI, 0.57-1.11) in internal medicine. Statistical heterogeneity was high ( Q = 66.6, I2 = 79.4%, P < .001). On meta-regression, 77% of the heterogeneity was from studies outside the United States, where more disparity was reported (AOR, 0.29; 95% CI, 0.22-0.38).

CONCLUSIONS

Most studies continued to find decreased promotion of women. Gender disparity was particularly notable in surgery and in studies from outside the United States. The results suggest that differences in promotion were due to differences in productivity and leadership and to gender bias.

Limitations in Faculty Advancement for Underrepresented Groups in Academic Otolaryngology

OBJECTIVE

Despite the increasing racial diversity of the United States, representation in academic medicine faculty does not reach concordance with the general population and worsens with higher rank. Few studies have examined this within academic Otolaryngology and surgical subspecialties. This project aims to compare rank equity in academic Otolaryngology on self-reported gender and race/ethnicity between the years 2000 and 2020.

METHODS

Publicly available data were obtained from the Association of American Medical Colleges under the "Data & Reports" section for the years 2000 and 2020. The report comprised of full-time faculty from all U.S. medical schools. To determine parity between faculty ranks across gender and race/ethnicity, rank equity index (REI) was calculated for associate/assistant, professor/associate, and professor/assistant professor comparisons.

RESULTS

The percentage of women faculty in Otolaryngology has increased from 21% in 2000 to 37% in 2020; however, they did not achieve parity at all rank comparisons for both years. On the contrary, men were above parity at all rank comparisons. Improvements in rank equity occurred for Black/African American (Black) and Hispanic Latino/Spanish Origin (Latine) faculty between the years 2000 and 2020; however, when accounting for gender, benefits were concentrated among men.

CONCLUSION

Advancement along the academic ladder is limited for women of all racial groups in academic Otolaryngology. While improved rank equity was seen for Black and Latine faculty, these improvements were largely among men. Future directions should aim to identify barriers to recruitment, retention, and promotion for women and underrepresented in medicine (URiM) academic otolaryngologists and create interventions that diversify Otolaryngology faculty at all ranks.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:1625-1632, 2024.

Addressing the Elephant in the Room: Perceptions and Treatment of Underrepresented in Medicine Physician Assistants/Associate Educators

ABSTRACT

On Thursday, June 27, 2023, the US Supreme Court struck down race-conscious admission practices in higher education. While other demographic factors, such as the traditional Health Resources and Services Administration-disadvantaged background indicators, can be considered during the holistic admission process, explicit consideration based on race and/or ethnicity is prohibited. As a result, physician assistant/associate (PA) programs are tasked with developing novel ways to address equity, diversity, and inclusion during the admission and hiring processes. As Drumgold et al note, closing the PA workforce diversity gap is necessary to achieve health equity. Despite this, PA programs consistently struggle to attract and retain underrepresented in medicine (URiM) faculty, staff, and students. The latest PA Education Association Student Report indicates that more than 75% of applicants consider faculty and student body diversity when applying to programs. As such, addressing disparities in the recruitment, promotion, evaluation, and retention of URiM faculty is paramount. Here, the authors outline ongoing recruitment and retention challenges for URiM faculty along with institutional recommendations to ensure URiM PA faculty success and engagement.

Disparities in Promotion and Retention Rates Among Underrepresented in Medicine Faculty in U.S. Ophthalmology Departments

PURPOSE

This study examines the rates and trends of faculty promotions within the field of ophthalmology, with comparative emphasis on the rates of promotion among underrepresented in medicine (URiM) faculty.

DESIGN

A retrospective panel study was conducted using the Association of American Medical Colleges Faculty Roster database.

METHODS

We used the Association of American Medical Colleges Faculty Roster data to assess trends in academic faculty promotions within U.S. ophthalmology departments. Full-time assistant and associate professors appointed between 2000 and 2010 were included in the analysis, and tracked until November 2021 to determine promotion rates. Pearson χ2 and Fisher exact tests were used to evaluate differences in promotion and retention rates based on gender, race and ethnicity, advanced degree, and tenure status.

RESULTS

The demographics of 1436 assistant and 680 associate faculty members were obtained for analysis through the Association of American Medical Colleges. Black faculty had lower promotion rates when compared with White faculty (20% vs 37%, P < .001). Faculty with MD and PhD degrees demonstrated higher promotion rates than faculty with MD degrees alone (59% vs 36%, P < .001). In addition, faculty not on tenure track had lower rates of promotion than those on tenure track (35% vs 48%, P < .001). With respect to faculty retention, among assistant and associate professors combined, Black faculty and faculty without tenure track appointments were more likely to leave academic medicine (46% vs 33%, P < .001) and (36% vs 27%, P < .001), respectively.

CONCLUSION

In this study, promotion rates varied significantly by race/ethnicity. Specifically, Black faculty had lower rates of promotion and retention in academic medicine. These findings underscore the need to explore and implement strategies and policies to address equity in promotion rates and retention of URiM faculty within academic ophthalmology.

Racial, Ethnic, and Gender Diversity Among Academic Surgical Leaders in the US

Importance

Surgical department chairs remain conspicuously nondiverse despite the recognized importance of diverse physician workforces. However, the extent of diversity among non-chair leadership remains underexplored.

Objective

To evaluate racial, ethnic, and gender diversity of surgical department chairs, vice chairs (VCs), and division chiefs (DCs) in the US.

Design, Setting, and Participants

For this cross-sectional study, publicly accessible medical school and affiliated hospital websites in the US and Puerto Rico were searched from January 15 to July 15, 2022, to collect demographic and leadership data about surgical faculty. Two independent reviewers abstracted demographic data, with up to 2 additional reviewers assisting with coding resolution as necessary. In all, 2165 faculty were included in the analyses.

Main Outcomes and Measures

Proportions of racial, ethnic, and gender diversity among chairs, VCs, and DCs in general surgery and 5 surgical specialties (neurosurgery, obstetrics and gynecology, ophthalmology, orthopedics, and otolaryngology).

Results

A total of 2165 faculty (1815 males [83.8%] and 350 females [16.2%]; 109 [5.0%] African American or Black individuals; 347 [16.0%] Asian individuals; 83 [3.8%] Hispanic, Latino, or individuals of Spanish origin; and 1624 [75.0%] White individuals as well as 2 individuals [0.1%] of other race or ethnicity) at 154 surgical departments affiliated with 146 medical schools in the US and Puerto Rico were included in the analysis. There were more males than females in leadership positions at all levels-chairs (85.9% vs 14.1%), VCs (68.4% vs 31.6%), and DCs (87.1% vs 12.9%)-and only 192 leaders (8.9%) were from racial or ethnic groups that are underrepresented in medicine (URiM). Females occupied more VC than chair or DC positions both overall (31.6% vs 14.1% and 12.9%, respectively) and within racial and ethnic groups (African American or Black females, 4.0% VC vs 1.5% chair and 0.6% DC positions; P < .001). URiM individuals were most commonly VCs of diversity, equity, and inclusion (DEI, 51.6%) or faculty development (17.9%). Vice chairs of faculty development were split equally between males and females, while 64.5% of VCs for DEI were female. All other VCs were predominantly male. Among DC roles, URiM representation was greatest in transplant surgery (13.8%) and lowest in oral and maxillofacial surgery (5.0%). Except for breast and endocrine surgery (63.6% female), females comprised less than 20% of DC roles. Nearly half of DCs (6 of 13 [46.2%]) and VCs (4 of 9 [44.4%]) had no female URiM leaders, and notably, no American Indian, Alaska Native, or Native Hawaiian or Other Pacific Islander individuals were identified in any surgical leadership positions.

Conclusions and Relevance

While it is unclear whether promotion from VC to chair or from DC to chair is more likely, these findings of similar gender distribution between chairs and DCs suggest the latter and may partially explain persistent nondiversity among surgical chairs. Female and URiM surgical leaders are disproportionately clustered in roles (eg, VCs of DEI or faculty development) that may not translate into future promotion to department chairs.

Are committee experiences of minoritized family medicine faculty part of the minority tax? a qualitative study

BACKGROUND AND OBJECTIVES

Because much of the work in academic medicine is done by committee, early career URiM faculty, are often asked to serve on multiple committees, including diversity work that may not be recognized as important. They may also be asked to serve on committees to satisfy a diversity "check box," and may be asked more often than their non-URiM peers to serve in this capacity. We sought to describe the committee experiences of early career URiM faculty, hypothesizing that they may see committee service as a minority tax.

METHODS

Participants in the Leadership through Scholarship Fellowship (LTSF) were asked to share their experiences with committee service in their careers after participating in a faculty development discussion. Their responses were analyzed and reported using qualitative, open, axial, and abductive reasoning methods.

RESULTS

Four themes, with eight sub-themes (in parenthesis), emerged from the content analysis of the LTSF fellows responses to the prompt: Time commitment (Timing of committee work and lack of protected time for research and scholarship), URiM Committee service (Expectation that URiM person will serve on committees and consequences for not serving), Mentoring issues (no mentoring regarding committee service, faculty involvement is lacking and the conflicting nature of committee work) and Voice (Lack of voice or acknowledgement).

CONCLUSIONS

Early career URiM faculty reported an expectation of serving on committees and consequences for not serving related to their identity, but other areas of committee service they shared were not connected to their URiM identity. Because most of the experiences were not connected to the LTSF fellows' URiM identity, this group has identified areas of committee service that may affect all early career faculty. More research is necessary to determine how committee service affects URiM and non-URiM faculty in academic family medicine.

Exploring the viewpoint of faculty members of medical sciences universities about effective factors on their organizational retention: a qualitative study

BACKGROUND AND AIM

Faculty retention in medical sciences universities is one of the most important values for the survival of the educational system. This study aimed to explore the viewpoint of faculty members of medical sciences universities in Iran about effective factors affecting their organizational retention.

METHODS

Qualitative study using deep interviews collected by maximum variation sampling. A purposively selected sample of 15 faculty members was recruited throughout two Iranian medical sciences universities (Tehran University of Medical Sciences and Kerman University of Medical Sciences) during 2021-22.

RESULTS

Qualitative data analysis provided 3 main categories and 10 sub-categories. Three main categories were identified that affected the faculty's organizational retention included individual factors, institutional factors, and socio-political factors.

CONCLUSION

Factors that contribute to the improvement of faculty retention encompass various aspects. These include consideration given to the personal and social requirements of faculty members, support provided by the organization along with effective resource management, a fair and transparent organizational structure, and the maintenance of political stability both within the university and the nation.

Diversity in the pediatric research workforce: a scoping review of the literature

The purpose of this scoping review is to determine trends in racial and ethnic representation, identify barriers and facilitators to greater diversity, and assess strategies and interventions to advance diversity among those in the pediatric research workforce in the U.S. We conducted a scoping review of PubMed supplemented with the authors' personal library of papers published from January 1, 2010, to December 31, 2021. To be eligible, papers had to provide original data, be published in English, report information from a U.S. healthcare institution, and report on outcomes of interest relevant to the child health field. The diversity of faculty has modestly increased over the past decade but reflects a worsening representation compared to overall population trends. This slow increase reflects a loss of diverse faculty and has been referred to as a "leaky pipeline." Strategies to plug the "leaky pipeline" include greater investments in pipeline programs, implementation of holistic review and implicit bias training, development of mentoring and faculty programs targeted to diverse faculty and trainees, alleviation of burdensome administrative tasks, and creation of more inclusive institutional environments. Modest improvements in the racial and ethnic diversity of the pediatric research workforce were identified. However, this reflects worsening overall representation given changing U.S. population demographics. IMPACT: Racial and ethnic diversity in the pediatric research workforce has shown modest increases but worsening overall representation. This review identified barriers and facilitators at the intrapersonal, interpersonal, and institutional levels that impact BIPOC trainees and faculty career advancement. Strategies to improve the pathway for BIPOC individuals include greater investments in pipeline and educational programs, implementation of holistic review admissions and bias training, institution of mentoring and sponsorship, alleviation of burdensome administrative responsibilities, and creation of inclusive institutional climates. Future studies should rigorously test the effects of interventions and strategies designed to improve diversity in the pediatric research workforce.

Publishing on a Shoestring: Understanding Barriers, Challenges, and Unique Opportunities to Academic Productivity in Psychiatry

PURPOSE OF REVIEW

Clinical track faculty within psychiatry may struggle to meet goals for academic scholarship, particularly publishing. In this review, we explore potential barriers to publication and solutions to support early career psychiatrists.

RECENT FINDINGS

Current evidence highlights challenges for faculty throughout academic practice, including barriers at the individual and systems levels. Within psychiatry, publication has favored biological studies with significant gaps in the literature serving as both an opportunity and challenge. Interventions underscore the importance of mentorship and propose incentivization to facilitate academic scholarship among clinical track faculty. Barriers to publication within psychiatry exist at the level of the individual, system, and field itself. This review shares potential solutions from across the medical literature and an example of an intervention from our own department. More studies are needed within the field of psychiatry to understand how to best support early career faculty members in their academic productivity, growth, and development.

Peer mentoring to support career advancement among underrepresented minority faculty in the programs to increase diversity among individuals engaged in health-related research (PRIDE)

Although mentoring is critical for career advancement, underrepresented minority (URM) faculty often lack access to mentoring opportunities. We sought to evaluate the impact of peer mentoring on career development success of URM early career faculty in the National Heart Lung and Blood Institute-sponsored, Programs to Increase Diversity Among Individuals Engaged in Health-Related Research-Functional and Translational Genomics of Blood Disorders (PRIDE-FTG). The outcome of peer mentoring was evaluated using the Mentoring Competency Assessment (MCA), a brief open-ended qualitative survey, and a semi-structured exit interview. Surveys were completed at baseline (Time 1), 6 months, and at the end of PRIDE-FTG participation (Time 2). The following results were obtained. Between Time 1 and Time 2, mentees' self-assessment scores increased for the MCA (p < 0.01) with significant increases in effective communication (p < 0.001), aligning expectations (p < 0.05), assessing understanding (p < 0.01), and addressing diversity (p < 0.002). Mentees rated their peer mentors higher in the MCA with significant differences noted for promoting development (p < 0.027). These data suggest that PRIDE-FTG peer mentoring approaches successfully improved MCA competencies among URM junior faculty participants with faculty ranking peer mentors higher than themselves. Among URM faculty, peer mentoring initiatives should be investigated as a key strategy to support early career scholar development.

Gender Discrepancies in Middle Author Publications in US Academic General Surgery

INTRODUCTION

To explore gender discrepancies in publications at general surgery departments, we performed a cross-sectional comparing the number of women and men at each academic rank and their number of first author (FA), middle author (MA), last author (LA), and total publications.

METHODS

Thirty academic general surgery departments were randomly selected. For each faculty, we tabulated: first, middle, last names, gender, academic rank, educational leadership, year of medical school graduation, and additional graduate degrees. Bibliography, H-index, and citations were downloaded from the Scopus database.

RESULTS

One thousand three hundred twenty-six faculty sampled, 881 (66.4%) men and 445 (33.5%) women. Men outnumbered women at all ranks, with increasing disparity at higher ranks. Men outnumbered women in all subspecialties-largest difference in transplant surgery (84.4% versus 15.6%, P < 0.001). Men at all ranks had more MA publications: assistant professor (rate ratio 1.20; 95% confidence interval, 1.01-1.43, P = 0.024), associate professor (1.65; 1.31-2.06, P < 0.001), and professor (1.50; 1.20-1.91, P = 0.008). Men associate professors had more LA publications (1.74; 1.34-2.37, P < 0.001). No differences found in FA publications at any rank, nor LA publications at assistant professor and professor ranks. At subspecialty level, men in surgical oncology (1.95; 1.55-2.45, P < 0.001) and transplant surgery (1.70; 1.09-2.66, P = 0.02) had more MA publications.

CONCLUSIONS

While FA and LA publications did not differ significantly across genders, the largest difference lies in MA publications, beginning at junior ranks and persisting with seniority. Discrepancies in MA publications may reflect gender discrepancies in collaborative opportunities, hence total publications should be used cautiously when determining academic productivity.

Recommendations for remaining agile in the face of a dental faculty workforce shortage

PURPOSE

Dental education is facing a faculty workforce shortage. Lack of preparation risks faculty, student, and staff morale and is an impediment to institutional growth and innovation. Administrators and faculty must consider strategies to better prepare for, and be successful within, a faculty shortage environment.

METHODS

We review strategies utilized by health professional institutions that have confronted faculty workforce shortages.

RESULTS

These strategies were grouped into four domains reflecting the organizational units that typically direct and initiate change within dental education institutions: budget and finance, human resources, organizational structure, and curricular structure. Recommendations using a four-pronged approach based on these domains have been developed for remaining agile in the face of a faculty workforce shortage.

CONCLUSIONS

Local needs assessments and strategic planning are the first steps in highlighting institutional strengths and identifying gaps within each of the domains. Faculty development and retention efforts, as well as increasing curricular efficiencies, are essential for success across all domains.

Mission Critical: Reimagining Promotion for Clinician-Educators

Academic clinician-educators who teach health professions trainees and lead educational programs have been penalized by the mismatch between their daily contributions to the academic mission and traditional promotion criteria focused on peer-reviewed publications and external reputation. Despite two decades of incremental approaches, inconsistency and inequity persist in the promotion process for clinician-educators. The authors propose five steps to mark a new approach to academic advancement for clinician-educators: (1) elevate the scholarly approach to teaching over peer-reviewed publications; (2) allow clinician-educators to identify an area of focus; (3) broaden the evidence for educational excellence; (4) prioritize internal referees; and (5) increase clinician-educator representation on promotion committees. Achieving meaningful change requires transforming entrenched traditions and policies at multiple levels. Changes that advance equity are necessary to retain academic faculty members who train the next generation of health professionals.

Enhancing Mentorship Networks through the Experiences of Women Professors of Ophthalmology

Purpose  The aim of this study is to identify and characterize women professors in ophthalmology to enhance professional development and equity of women in academic ophthalmology. Design  Cross-sectional descriptive survey study. Participants  Participants in the survey were women in ophthalmology departments who have obtained full professor rank at their respective institutions. Methods  A cross-sectional study was conducted using data from an electronic survey of women ophthalmologists and researchers who had obtained full professorship rank in ophthalmology. The survey included questions about degree obtained, training path, fellowship, length and trajectory of academic career, family or medical leave participation, previous positions, and mentorship involvement. Statistical comparisons were made based on response. Main Outcome Measures  Survey responses to questions pertaining to three domains: education and training, academic career, and mentorship. Results  Women that obtained the professor title within ophthalmology largely held Doctor of Medicine/Doctor of Osteopathic Medicine degrees, were more likely to have completed fellowship training, and on average took 11 to 15 years to obtain the full professor title. The participants held a variety of other positions and titles throughout their academic careers. The vast majority of women reported having between 1 and 3 mentors during their careers with the majority also noting they currently participate in mentoring programs. Surveys were completed by 62 (30% response rate) women full professors of ophthalmology. Conclusion  The experiences women have along the academic path to professorship are described in this survey and can help to inform junior faculty. Literature review highlights the importance of mentorship for work productivity, retention, and promotion within academic medicine which is an element seen in the vast majority of our participants' career paths. Guided by the identification of women professors within departments of ophthalmology and characterization of their experiences, a new initiative called Women Professors of Ophthalmology was formed under the Association of University Professors of Ophthalmology's organizational structure in 2021. This group that is tailored for women professors of ophthalmology to foster peer mentorship and guidance is poised to increase the retention and promotion of women in academic ophthalmology.

Diversity in Academic Ophthalmology: Disparities and Opportunities from Medical School to Practice

INTRODUCTION

Compared to the United States population as a whole, physicians are more likely to identify as men, identify as Asian or non-hispanic White, and be raised in wealthier households. Racial, ethnic, gender, and socioeconomic representation in ophthalmology is often blamed on the pipeline of matriculants.

METHODS

This review collects recent data from the US census, AAMC, and primary literature on gender, racial, ethnic, and socioeconomic diversity from medical school to ophthalmology practice.

RESULTS

Data from the medical and ophthalmology literature shows that medical students are less diverse than medical school applicants, ophthalmology residencies are less diverse than graduating medical students, and ophthalmology departments are less diverse than those of most other specialties.

DISCUSSION

At each level, there are limitations in representation beyond the pipeline of medical school applicants or medical students applying to ophthalmology. There are many practical steps the field can take at each level of training to move the specialty toward more equitable representation.

An Empirical Study of Promotion Pressure among University Teachers in China Using Event History Analysis

OBJECTIVE

We sought to understand the status of promotion pressure among university teachers in China. This study explored the promotion duration and influencing factors among teachers in different disciplines of the social sciences.

METHODS

Using event history analysis, this study collected data regarding university teachers of China. The sample included 536 teachers who had been promoted from assistant to associate professor and 243 teachers promoted from associate to full professor. Our results revealed that the overall time required for promotion in the social sciences is relatively long. For those promoted from assistant to associate professor, the mean time for promotion was 14.155 years, with a median of 11 years, while for the transition from associate to full professor, the mean was 13.904 years with a median of nine years. Furthermore, in the survival function of the promotion duration, there is a stage pattern for both assistant to associate professor and associate to full professor. In addition, the Kaplan-Meier results showed that the mean promotion time in economics was the shortest. The Cox regression results indicated that males had a higher chance of promotion than females, and faculty members with doctoral degrees had a higher likelihood of promotion than those without. For those advancing from assistant to associate professor, the university of employment had significant positive effects on promotion. This paper provides empirical support for the current societal concerns regarding promotion pressure among university teachers.

Sparking a Movement, Not a Moment: Framework and Outcomes From a Pediatrics Department-Wide Coalition to Advance Anti-Racism

OBJECTIVE

The Stanford Pediatrics Advancing Anti-Racism Coalition (SPAARC) was created to promote a culture of anti-racism through immediate action, development of nimble systems, and longitudinal commitment toward equity. Evaluate gaps in the Stanford Department of Pediatrics (DoP) efforts to advance anti-racism and form a coalition of faculty, staff, and trainees to prioritize, design, and implement targeted activities with immediate and long-term measurable outcomes.

METHODS

A needs assessment was conducted across all DoP members in July to August 2020 to identify gaps in anti-racism efforts. Listening sessions were recorded and transcribed to extrapolate key themes and 2 rounds of consensus surveys were done to identify and prioritize actions. Actions teams were created and co-led by faculty-staff dyads with trainee representation. A final activity survey was conducted in January 2021 to determine the specific activities (ie, interventions) each team would design and implement.

RESULTS

Ten small group listening sessions (70 participants) and 3 surveys (1005 responses) led to the creation of 7 action teams with associated activities 1) training, 2) community engagement and research, 3) communication, 4) faculty and staff recruitment and advancement, 5) leadership representation, 6) human resources, and 7) staff engagement. Four hundred forty-three (41%) DoP members were directly involved in SPAARC through participation in the needs assessment, action teams, and/or implementation of activities.

CONCLUSION

SPAARC can serve as an adaptable framework for how a DoP can create a coalition to identify gaps in anti-racism efforts and create and implement targeted activities with associated outcomes.

Doing the Work-or Not: The Promise and Limitations of Diversity, Equity, and Inclusion in US Medical Schools and Academic Medical Centers

While the number of positions, committees, and projects described as "Diversity, Equity, and Inclusion (DEI)" work has grown rapidly in recent years, there has been little attention to the theory, praxis, or lived experience of this work. In this perspective, we briefly summarize the research and concepts put forth by DEI leaders in higher education more broadly, followed by an analysis of the literature's application to academic medicine. We then discuss the ways in which language obscures the nature of DEI and the necessity of scholarship to evaluate the extensive range of practices, policies, statements, and programs the label is given to.

Workforce solutions to address health disparities

PURPOSE OF REVIEW

This review focuses on physician workforce racial & ethnic diversity as a solution to improve perioperative and peripartum health equity.

RECENT FINDINGS

Black, Indigenous, and Hispanic physicians remain underrepresented in medicine (URiM) and anesthesiology, and efforts to expand this workforce have had limited impact. Psychological forces, including implicit bias, aversive racism, outgroup bias, racial attention bias, stereotype threat, and imposter syndrome all act to reinforce structural racism and decrease opportunity for advancement. Evidence based solutions are emerging, but require institutional commitment and widespread engagement of the entire medical community.

SUMMARY

Academic medicine has recognized the need to diversify the physician workforce for more than 50 years, and yet Black, Indigenous, and Hispanic physicians remain URiM. Foundational assumptions and power structures in medicine limit entry, advancement, and retention of URiM physicians. Solutions require leadership and institutional commitment to change the policies, procedures, priorities, and culture of academic medicine.

Microaggressions, Bias, and Equity in the Workplace: Why Does It Matter, and What Can Oncologists Do?

Despite efforts to embrace diversity, women and members of racial, ethnic, and gender minority groups continue to experience bias, inequities, microaggressions, and unwelcoming atmospheres in the workplace. Specifically, women in oncology have lower promotion rates and less financial support and mentorship, and they are less likely to hold leadership positions. These experiences are exceedingly likely at the intersection of identities, leading to decreased satisfaction, increased burnout, and a higher probability of leaving the workforce. Microaggressions have also been associated with depression, suicidal thoughts, and other health and safety issues. Greater workplace diversity and equity are associated with improved financial performance; greater productivity, satisfaction, and retention; improved health care delivery; and higher-quality research. In this article, we provide tools and steps to promote equity in the oncology workplace and achieve cultural change. We propose the use of tailored approaches and tools, such as active listening, for individuals to become microaggression upstanders; we also propose the implementation of education, evaluation, and transparent policies to promote a culture of equity and diversity in the oncology workplace.

An evaluation of programs designed to increase representation of diverse faculty at academic medical centers

PURPOSE

Minority physicians have been persistently underrepresented in medicine (URiM) when compared with their representation in the general U.S.

POPULATION

There is evidence that diversifying the physician workforce would have a positive impact on healthcare delivery. While programs have been implemented to diversify the physician workforce, there has been less emphasis and progress in diversifying academic medical centers (AMCs) at the faculty level. This review sought to provide an update in the literature on the published outcomes and components of programs designed to increase the racial/ethnic diversity of faculty at AMCs.

METHOD

A scoping review study design was used. Search terms-academic medical faculty, diversity, and recruitment or retention-were used to search literature published from August 2012 through February 4, 2021. Eligible studies (1) evaluate structured organization/institutional programs to increase the representation of faculty who identify as URiM; (2) include faculty who identify as URiM as defined by the Association of American Medical Colleges (individuals who identify as African Americans and/or Black, Hispanic/Latino, Native American (American Indians, Alaska Natives, and Native Hawaiians), Pacific Islander, and mainland Puerto Rican); (3) describe interventions for the academic medicine setting; and (4) report either quantitative or qualitative data.

RESULTS

Ten papers describing eight programs were included in the review. Program components were heterogeneous. Most studies described funded research-focused programs and fewer studies were institution-wide efforts or included institutional culture (i.e., rules, values, beliefs, behaviors, and customs that shape how people behave within an organization) or climate (i.e., perception regarding the culture) efforts. Four studies reported outcomes that included changes in faculty representation and six included faculty retention efforts such as promotion, leadership positions, grants, and scholarly productivity.

CONCLUSIONS

This review summarizes and updates the literature on programs to improve the diversity of faculty at AMCs. It includes specific recommendations for components that can provide a foundation for programs to improve faculty diversity. Future research should use high quality methods to compare different interventions to improve the diversity of faculty in AMCs.

More than grit: growing and sustaining physician-scientists in obstetrics and gynecology

Obstetricians know the statistics-1 out of every 10 babies is born premature; preeclampsia affects 1 in 25 pregnant people; the United States has the highest rate of maternal mortality in the developed world. Yet, physicians and scientists still do not fully understand the biology of normal pregnancy, let alone what causes these complications. Obstetrics and gynecology-trained physician-scientists are uniquely positioned to fill critical knowledge gaps by addressing clinically-relevant problems through fundamental research and interpreting insights from basic and translational studies in the clinical context. Within our specialty, however, physician-scientists are relatively uncommon. Inadequate guidance, lack of support and community, and structural barriers deter fellows and early stage faculty from pursuing the physician-scientist track. One approach to help cultivate the next generation of physician-scientists in obstetrics and gynecology is to demystify the process and address the common barriers that contribute to the attrition of early stage investigators. Here, we review major challenges and propose potential pathways forward in the areas of mentorship, obtaining protected research time and resources, and ensuring diversity, equity, and inclusion, from our perspective as early stage investigators in maternal-fetal medicine. We discuss the roles of early stage investigators and leaders at the institutional and national level in the collective effort to retain and grow our physician-scientist workforce. We aim to provide a framework for early stage investigators initiating their research careers and a starting point for discussion with academic stakeholders. We cannot afford to lose the valuable contributions of talented individuals due to modifiable factors or forfeit our voices as advocates for the issues that impact pregnant populations.