Organizational Savvy: Critical to Career Development in Academic Medicine.

Organizational savvy is critical to career development, but is rarely discussed as a learnable skill. Drawing on >45 years of working closely with Academic Health Center professionals, the author offers an introduction to navigating organizational dynamics that will be especially valuable to women, as they tend to be less effectively mentored than men; mentors may also find this guide of use in coaching these skills. Common misconceptions that interfere with acquiring organizational savvy include assuming that academic medicine is a meritocracy, that hard work will assure success, and that disagreements are personal. People who learn to navigate competitive hierarchies are continuously expanding their understanding of significant events, of how their unit fits within the larger system, and of which constraints they can influence. Strategies suggested for developing a political compass focus on building relationships, learning from surprises and disappointments, facilitating dialogue with open-ended questions, and handling sensitive topics as they arise. The author opens with a case illustrating common new faculty dilemmas and closes with examples applying the mentioned recommendations. Becoming more organizationally savvy helps professionals advance not only their own careers but also improvements in their institutions.

Not Too Late to Reinvigorate: How Midcareer Faculty Can Continue Growing.

The continuing engagement of midcareer faculty is critical to the functioning of academic health systems (AHSs). However, despite their strong desire for ongoing meaningful work, many midcareer faculty are at a standstill, with further promotion unlikely. Drawing on more than 40 years of working closely with AHS faculty, the author describes growth-promoting strategies that midcareer faculty can tailor to individual needs, including questions for personal reflection. Research on adult devel opment and resilience indicates that reexamining commitments at this career stage is healthy and begins with individuals taking a fresh look at what they value most. When individuals shift attention from constraints to those aspects of themselves and their situations that they can modify, they often discern new possibilities and become more agile. AHSs also can do a great deal to assist faculty with adjustments inherent in this midlife stage, including incorporating into annual reviews assessment of a faculty member's satisfaction with effort distribution; setting term limits on leadership roles to create more opportunities; and facilitating fresh ways of thinking about career success.

Through a Gender Lens: A View of Gender and Leadership Positions in a Department of Medicine.

BACKGROUND: Despite increasing numbers in academic medicine, women remain underrepresented in top leadership positions. The objectives of this study were to characterize leadership positions held by department of medicine (DOM) faculty at all ranks at one Academic Health Center and to compare leadership positions held by male and female faculty. METHODS: This was a cross-sectional survey to collect information on all leadership positions from 16 divisions in the DOM at the Johns Hopkins University School of Medicine in early 2012, including type of position, method used to fill the position, and financial compensation. Chi-square testing was used to compare leadership position characteristics by rank and gender. RESULTS: The study included 474 DOM faculty at the rank of instructor or higher; 38% were women. Of the 258 leadership positions identified, 35% were held by women. More leadership positions among assistant professors were held by women compared with men (56% of positions vs. 44%), with women assistant professors more likely to hold a leadership position than men (p=0.03). Numbers of women faculty declined at higher ranks, with leadership positions remaining proportionate to faculty representation. Most division director positions (88%) were held by men, and most leadership positions were compensated (89%) and appointed by the DOM chair or a division director (80%). CONCLUSIONS: Leadership positions held by women and men were proportionate to faculty representation, although the top leadership positions were held almost exclusively by men. While female assistant professors were more likely to hold leadership positions than male assistant professors, these positions appear to be low status positions and it is not clear that they contribute to professional advancement, as few women hold the rank of full professor. Effective interventions are needed to address the gender disparity in top leadership positions.

Discussing the undiscussable with the powerful: why and how faculty must learn to counteract organizational silence.

Dialogue is essential for transforming institutions into learning organizations, yet many well-known characteristics of academic health centers (AHCs) interfere with open discussion. Rigid hierarchies, intense competition for resources, and the power of peer review in advancement processes all hamper difficult conversations, thereby contributing to organizational silence, and at great cost to the institution. Information necessary for critical decisions is not shared, individuals and the organization do not learn from mistakes, and diverse perspectives from those with less power are not entertained, or worse, are suppressed. When leaders become more skilled at inviting multiple perspectives and faculty more adept at broaching difficult conversations with those in power, differences are more effectively addressed and conflicts resolved. In this article, the authors frame why this skill is an essential competency for faculty and leaders alike and provide the following recommendations to institutions for increasing capacity in this area: (1) develop leaders to counteract organizational silence, (2) develop faculty members' skills in raising difficult issues with those in positions of power, and (3) train mentors to coach others in raising difficult conversations. The vitality of AHCs requires that faculty and institutional leaders develop relational communication skills and partner in learning through challenging conversations.

How men can excel as mentors of women.

Most male professionals have more experience mentoring men than they do mentoring women, and their male mentees progress further than their female mentees. Yet, in academic medicine, men have few forums in which to discuss the gender-related issues that they encounter. To address the gender-related questions that commonly arise, the author of this commentary offers perspectives and recommendations, consolidated from over 25 years of experience leading career and talent development programs, to assist men in successfully mentoring women. Her recommendations are organized around three questions: (1) How do women's and men's experiences in mentoring relationships tend to differ? (2) What interferes with the accurate evaluation of women's skills? and (3) Is the current generation of female trainees still at a gender-related disadvantage? She argues that men's ability to effectively mentor women depends to a great extent on their understanding of the challenges that women disproportionately face in developing their careers. Mentors who are skilled in adapting to the gender-related needs of mentees will contribute to women's retention and development in academic medicine, enhance the leadership capacity of their organizations and the profession, and extend their own legacies.

Difficult issues in mentoring: recommendations on making the "undiscussable" discussable.

Many mentoring relationships do not reach fruition because the individuals fail to bridge a critical difference. When a difference prevents a learning partnership from achieving its potential, the loss is multidimensional for the individuals and the institution--wasting opportunities for the fostering of current and future talent. Insights into when such impasses are likely to arise may help both mentors and mentees address what feels "undiscussable." The authors offer numerous examples of how differences related to ethnicity, language, gender, and generation may interfere with the development of mentoring relationships. Next, the authors offer recommendations on preparing for and handling difficult conversations, including creating safety, noticing assumptions and emotions, and raising sensitive issues. Virtually all faculty can become more effective at communicating across differences and addressing difficulties that prevent mentoring relationships from achieving their potential. The pay-offs for these efforts are indisputable: increased effect in the limited time available for mentoring, an expanded legacy of positive influence, and enhanced communication and leadership skills. The honing of these relational skills enhances the colleagueship and teamwork on which virtually all research, clinical, and educational enterprises depend. Academic health centers that systematically support mentoring enhance institutional stability, talent development, and leadership capacity.

Career development as a long-distance hike.

Traditional images of achievement do not capture today's more complex career development realities. Approaching career development as a long-distance expedition can help professionals in addressing the strenuous challenges they face, in seeing that a career can be built in many ways, and in taking a long-term view of their journeys. Skills are like muscles, self-efficacy is like sturdy boots, advancement "how-to's" are like maps, and mentors are like trail guides. Among the tasks each hiker faces are selecting destinations, navigating through rough terrain and weather, and balancing their packs. To further their hikers' resilience, departments should pay more attention to the career development ecology, including improving access to qualified trail guides and to alternate paths.

The work that remains at the intersection of gender and career development.

Building on the study by Wagner et al, this commentary opens with a discussion of the persistence of gender disparities in career development and the challenge of interpreting those disparities. Given the multifaceted challenges facing rehabilitation medicine, facilitation of the career and leadership development of women physiatrists is critical. I suggest 3 areas of targeted action to facilitate the realization of women physiatrists' intellectual capital: (1) updated approaches to faculty and leadership development and mentoring, (2) more flexible faculty structures, and (3) chair support and accountability. Each member of the rehabilitation medicine community who cares about the future of the discipline is challenged to contribute to the dialogues that are necessary to carry these recommendations forward.