Racial/Ethnic Differences in Burnout: a Systematic Review.

BACKGROUND: Awareness of burnout and its implications within the medical field has been growing. However, an understanding of the prevalence and consequences of burnout among underrepresented minority (URM), specifically underrepresented minority in medicine (UiM) populations, is not readily available. OBJECTIVE: To examine literature investigating burnout among UiM compared to non-UiM, with particular attention to which measures of burnout are currently being used for which racial/ethnic groups. METHODS: The authors identified peer-reviewed articles, published in English through systematic examination using PubMed, PsycINFO, Countway Discovery Medicine, and Web of Science databases. Studies meeting the inclusion criteria were summarized and study quality was assessed. RESULTS: Sixteen studies assessing racial/ethnic differences in burnout were eligible for inclusion. Nearly all studies were cross-sectional (n = 15) in design and conducted among populations in North America (n = 15). Most studies examined burnout among medical students or physicians and used the Maslach Burnout Inventory. Differences in burnout among UiM and non-UiM are inconclusive, although several studies have nuanced findings. CONCLUSION: Increased focus on burnout measurement, conceptualization, and mitigation among UiM populations may be useful in improving recruitment, retention, and thriving.

Common Types of Gender-Based Microaggressions in Medicine.

PURPOSE: Microaggressions are subtle verbal or nonverbal everyday behaviors that arise from unconscious bias, covert prejudice, or hostility. They may contribute to the persistent disparities faced by women in medicine. In this study, the authors sought to identify common microaggressions experienced by women faculty in medicine and to determine if specific demographic characteristics affect the reported frequencies of these microaggressions. METHOD: The authors used chain referral sampling to collect real-life anecdotes about microaggressions from women faculty across the nation. Thirty-four unique experiences from those reported were identified and scripted then reenacted using professional actors to create 34 videos of the real-life microaggressions and 34 corresponding fictional "control" versions of the same situations. The videos, presented in a random order, were evaluated by faculty from 4 academic medical centers from 2016 to 2018. RESULTS: A total of 124 faculty (79 women, 45 men) participated. Women reported higher frequencies of microaggressions than men in 33 of the 34 videos depicting microaggressions (P value range: < .001 to .042, area under the curve range: 0.60-0.69). No such differences were seen with the control videos. Women identified 21 microaggressions as occurring frequently. No significant differences were found with respect to participants' age, race/ethnicity, academic rank, or years in medicine. Post hoc analyses showed that the microaggressions fell into 6 themes: encountering sexism, encountering pregnancy- and child care-related bias, having abilities underestimated, encountering sexually inappropriate comments, being relegated to mundane tasks, and feeling excluded/marginalized. CONCLUSIONS: Privilege is often invisible to those who have it, whereas bias and discrimination are readily apparent to those who experience it. Knowledge of common microaggressions will allow for targeted individual, interpersonal, and institutional solutions to mitigate disparities in medicine.

Gender Differences in Receipt of National Institutes of Health R01 Grants Among Junior Faculty at an Academic Medical Center: The Role of Connectivity, Rank, and Research Productivity.

OBJECTIVE: To determine whether there were gender differences in likelihood of receiving a first National Institutes of Health (NIH) R01 award among 5445 instructors and assistant professors at Harvard Medical School (HMS). MATERIALS AND METHODS: Data on R01 award principal investigators were obtained from NIH ExPORTER and linked with faculty data. Using Cox proportional hazard regression, we examined the association of gender with receipt of first R01 award between 2008 and 2015 accounting for demographics, research productivity metrics, and professional characteristics. RESULTS: Compared to males, females had fewer publications, lower h-index, smaller coauthor networks and were less likely to be assistant professors (p < 0.0001). Four hundred and thirteen of 5445 faculty (7.6%) received their first R01 award during the study period. There was no gender difference in receipt of R01 awards in age-adjusted (hazard ratio [HR]: 0.87, 95% confidence interval [CI]: 0.70-1.08) or multivariable-adjusted models (HR: 1.07, 95% CI: 0.86-1.34). Compared to white males, there was a nonsignificant 10%, 18%, and 30% lower rate of R01 receipt among white, Asian or Pacific Islander, and underrepresented minority females, respectively. These differences were eliminated in the multivariable-adjusted model. Network reach, age, HMS start year, h-index, academic rank, previous K award, terminal degree, and HMS training were all significant predictors of receiving an R01 award. CONCLUSIONS: A relatively small proportion of HMS junior faculty obtained their first NIH R01 award during the study period. There was no significant gender difference in likelihood of award. However, we are unable to distinguish faculty that never applied from those who applied and were not successful.

Organizational Context and Female Faculty's Perception of the Climate for Women in Academic Medicine.

PURPOSE: Gender inequalities in the careers of faculty in academic medicine could partially be attributed to an organizational climate that can exclude or be nonsupportive of women faculty. This study explores the climate for women faculty from a systems perspective at the organizational and individual levels based on the perceptions of women faculty. Race differences were also investigated. MATERIALS AND METHODS: Cross-sectional survey data from women faculty (N = 3127) at 13 purposively sampled medical schools and an institutional assessment of organizational characteristics were used. Organizational factors related to the climate for women were identified using bivariate statistics. The association between perceived climate for women and organizational characteristics, individual perceptions of the work environment and individual career, and personal characteristics with control variables were investigated using hierarchical linear regression models. Organizational effects by race/ethnicity were estimated using interaction terms. RESULTS: The climate for women faculty varied across institutions and by classification as minority-serving institutions (MSIs). Respondent's report of existence of an office for women's affairs, trust in leadership, and satisfaction with mentoring were positively associated with the climate for women. Perceived workplace discrimination and work-family conflict were inversely associated with a positive climate. No race/ethnicity differences were observed in the multivariable analysis. CONCLUSIONS: The climate for women faculty in academic medicine should not be regarded constant across organizations, specifically between MSIs and non-MSIs. Efforts to advance a positive climate for women could focus on improving trust in leadership, increasing support for structures/offices for women, and mitigating perceived discrimination and work-family conflict.

Variability in Women Faculty's Preferences Regarding Mentor Similarity: A Multi-Institution Study in Academic Medicine.

PURPOSE: To investigate which mentor-similarity characteristics women faculty in academic medicine rate most important and to determine whether this importance differs among women faculty on the basis of current and prior mentoring, demographic and personal factors, and career factors. METHOD: Cross-sectional survey data from 3,100 women faculty at 13 purposively sampled U.S. medical schools were collected in 2012. The preferences of participants regarding the importance of mentor similarity in terms of race/ethnicity, gender, personal and career interests, and department and institution were studied. Analysis entailed chi-square tests and multivariable ordered logistic models. RESULTS: Overall, respondents ranked having a mentor in the same department and institution as most important. Same department and institution were less important for those without a current mentor and for senior faculty, and were more important for Asian faculty. Same career and personal interests were less important for older faculty and more important for those with a doctorate only. Same gender was more important for black faculty, faculty at the rank of instructor, and those without current mentoring. Overall, same race/ethnicity was rated least important; however, it was more important for racial-ethnic minorities, U.S.-born faculty, and those who had never had a mentor. CONCLUSIONS: Mentor preferences, as indicated by level of importance assigned to types of mentor similarity, varied among women faculty. To advance effective mentoring, characterized by good mentor-mentee fit, the authors provide recommendations on matching strategies to be used in academic medicine when considering the diverse mentor preferences of women faculty.

Rationale and Design of the Women and Inclusion in Academic Medicine Study.

BACKGROUND AND OBJECTIVE: Women of color (WOC) (African American, Hispanic, Native American/Alaskan Native, and Asian American) faculty remain disproportionately underrepresented among medical school faculty and especially at senior ranks compared with White female faculty. The barriers or facilitators to the career advancement of WOC are poorly understood. The Women and Inclusion in Academic Medicine (WIAM) study was developed to characterize individual, institutional and sociocultural factors that influence the entry, progression and persistence, and advancement of women faculty in academic medical careers with a focus on WOC. METHODS: Using a purposive sample of 13 academic medical institutions, we collected qualitative interview data from 21 WOC junior faculty and quantitative data from 3,127 (38.9% of 8,053 eligible women) respondents via an online survey. To gather institutional data, we used an online survey and conducted 23 key administrative informant interviews from the 13 institutions. Grounded theory methodology will be used to analyze qualitative data. Multivariable analysis including hierarchical linear modeling will be used to investigate outcomes, such as the inclusiveness of organizational gender climate and women faculty's intent to stay. CONCLUSION: We describe the design, methods, rationale and limitations of one of the largest and most comprehensive studies of women faculty in academic medicine with a focus on WOC. This study will enhance our understanding of challenges that face women, and, especially WOC, faculty in academic medicine and will provide solutions at both the individual and institutional levels.

Faculty Promotion and Attrition: The Importance of Coauthor Network Reach at an Academic Medical Center.

BACKGROUND: Business literature has demonstrated the importance of networking and connections in career advancement. This is a little-studied area in academic medicine. OBJECTIVE: To examine predictors of intra-organizational connections, as measured by network reach (the number of first- and second-degree coauthors), and their association with probability of promotion and attrition. DESIGN: Prospective cohort study between 2008 and 2012. SETTING: Academic medical center. PARTICIPANTS: A total of 5787 Harvard Medical School (HMS) faculty with a rank of assistant professor or full-time instructor as of January 1, 2008. MAIN MEASURES: Using negative binomial models, multivariable-adjusted predictors of continuous network reach were assessed according to rank. Poisson regression was used to compute relative risk (RR) and 95 % confidence intervals (CI) for the association between network reach (in four categories) and two outcomes: promotion or attrition. Models were adjusted for demographic, professional and productivity metrics. KEY RESULTS: Network reach was positively associated with number of first-, last- and middle-author publications and h-index. Among assistant professors, men and whites had greater network reach than women and underrepresented minorities (p < 0.001). Compared to those in the lowest category of network reach in 2008, instructors in the highest category were three times as likely to have been promoted to assistant professor by 2012 (RR: 3.16, 95 % CI: 2.60, 3.86; p-trend <0.001) after adjustment for covariates. Network reach was positively associated with promotion from assistant to associate professor (RR: 1.82, 95 % CI: 1.32, 2.50; p-trend <0.001). Those in the highest category of network reach in 2008 were 17 % less likely to have left HMS by 2012 (RR: 0.83, 95 % CI 0.70, 0.98) compared to those in the lowest category. CONCLUSIONS: These results demonstrate that coauthor network metrics can provide useful information for understanding faculty advancement and retention in academic medicine. They can and should be investigated at other institutions.

Considering context in academic medicine: differences in demographic and professional characteristics and in research productivity and advancement metrics across seven clinical departments.

PURPOSE: To understand the disciplinary contexts in which faculty work, the authors examined demographics, professional characteristics, research productivity, and advancement across seven clinical departments at Harvard Medical School (HMS) and nationally. METHOD: HMS analyses included faculty from seven clinical departments-anesthesiology, medicine, neurology, pediatrics, psychiatry, radiology, and surgery-in May 2011 (N = 7,304). National analyses included faculty at 141 U.S. medical schools in the same seven departments as of December 31, 2011 (N = 91,414). The authors used chi-square and Wilcoxon Mann-Whitney tests to compare departmental characteristics. RESULTS: Heterogeneity in demographics, professional characteristics, and advancement across departments was observed in HMS and national data. At HMS, psychiatry had the highest percentage of underrepresented minority faculty at 6.6% (75/1,139). In anesthesiology, 24.2% (128/530) of faculty were Asian, whereas in psychiatry only 7.9% (90/1,139) were (P < .0001). Female faculty were the majority in pediatrics and psychiatry, whereas in surgery 26.3% (172/654) of the faculty were female (P < .0001). At HMS, surgery, radiology, and neurology had the shortest median times to promotion and the highest median number of publications, H-index, and second-degree centrality. Neurology also had the highest percentage of faculty who had been principal investigators on a National Institutes of Health-funded grant. CONCLUSIONS: There were differences in demographics, professional characteristics, and advancement across clinical departments at HMS and nationally. The context in which faculty work, of which department is a proxy, should be accounted for in research on faculty career outcomes and diversity inclusion in academic medicine.