Leadership Experiences and Perceptions of Mid-Career to Senior Clinician-Scientists: A Qualitative Exploration.

PURPOSE: This study aimed to elucidate the experiences and perceptions of mid-career to senior clinician-scientists in academic medicine regarding pursuing, attaining, or rejecting leadership roles as well as their conceptualization of the influence of leadership in their broader career trajectories. METHOD: The authors conducted a qualitative analysis of in-depth, semistructured interviews conducted in 2022 with a diverse sample of clinician-scientists who received new National Institutes of Health K08 or K23 Career Development Awards between 2006 and 2009. A total of 859 of the 915 survey respondents (94%) were eligible to be recruited for the qualitative study. Qualitative analysis was informed by thematic analysis and used a social constructionist approach to understanding participants' conceptualizations of their experiences. Interview transcripts were coded using an iterative, inductive coding process. Themes were generated by reviewing coded data and identifying common patterns in participant narratives, affording particular attention to participants' discussion of the effect of race and/or gender on their leadership experiences. RESULTS: Sixty clinician-scientists participated in individual interviews. Five themes were generated surrounding participants' conceptualizations of their leadership experiences. Themes were (1) feeling unprepared for leadership roles, (2) reluctance and lack of intention in attaining leadership positions, (3) influence of networks on leadership access and decision-making, (4) impact-related benefits and downsides of leadership, and (5) confining ideas of who leaders are. CONCLUSIONS: The study highlighted the need for formal leadership training in academic medicine and the importance of mentorship and sponsorship in attaining and succeeding in leadership positions. Individuals from communities underrepresented in leadership positions faced additional challenges internalizing a leadership identity. Efforts to encourage current leaders to engage in intentional succession planning and development of faculty towards leadership roles, including expansion of institutional leadership development programs, are needed to promote equitable distribution of leadership opportunities.

Professional Experiences and Career Trajectories of Mid- to Senior-Career Women Clinician-Scientists: A Qualitative Study.

Importance: Despite increasing evidence and recognition of persistent gender disparities in academic medicine, qualitative data detailing the association of gender-based experiences with career progression remain sparse, particularly at the mid- to senior-career stage. Objective: To investigate the role gender has played in everyday professional experiences of mid- to senior-career women clinician-scientists and their perceptions of gender-related barriers experienced across their careers. Design, Setting, and Participants: In this qualitative study, a total of 60 of 159 invited clinician-scientists who received National Institutes of Health K08 or K23 awards between 2006 and 2009 and responded to a survey in 2021 agreed to participate. Invitees were selected using random, purposive sampling to support sample heterogeneity. Semistructured in-depth interviews were conducted January to May 2022. For this study, interviews from 31 women were analyzed using the framework approach to thematic analysis. Data analyses were performed between August and October 2023. Main Outcomes and Measures: Descriptive themes of participant experiences of gender and gender-based barriers in academic medicine. Results: A total of 31 women clinician-scientists (8 identifying as Asian [25.8%], 14 identifying as White [45.2%], and 9 identifying as members of a minority group underrepresented in medicine [29.0%]; 14 aged 40-49 years [45.2%] and 14 aged 50-59 years [45.2%]) were included. Among them, 17 participants (54.8%) had children who required adult supervision or care, 7 participants (22.6%) had children who did not require supervision or care, and 6 participants (19.4%) did not have children. There were 4 dominant themes identified within participant experiences in academic medicine: the mental burden of gendered expectations at work and home, inequitable treatment of women in bureaucratic processes, subtle and less subtle professional exclusion of women, and value of communities built on shared identities, experiences, and solidarity. Conclusions and Relevance: This study found that women perceived the institution of academic medicine as a male-centric system misaligned with the needs of women, with associated feelings of exclusion, disillusionment, and loss of trust in their institutions. Findings suggest that the confluence of domestic obligations and unaccommodating institutional environments may make it difficult for women clinician-scientists to achieve established timelines of career progression and productivity; these findings may have long-term implications for the well-being and retention of women in academic medicine.

The Disproportionate Effects of the COVID-19 Pandemic on the Time Allocation of Recipients of NIH Career Development Awards Who Are Women or Caregivers of Dependents.

PURPOSE: To understand time allocation of a national medical faculty cohort 1.5-2 years after the COVID-19 pandemic began, compared to before. METHOD: From August 2021-April 2022, the authors conducted a retrospective survey of 1,430 clinician-researchers who received National Institutes of Health career-development awards between 2006-2009 asking about domestic and professional time allocation pre-pandemic and at the time of surveys (TOS). Of 915 respondents (64%), the 830 who remained in academic positions constituted the analytic sample. Multivariable regression models identified demographic factors associated with each time outcome and change in time between pre-pandemic and TOS, and having experienced ≥8-hour increase of total self-reported weekly professional work hours and domestic labor hours. RESULTS: Median self-reported weekly professional work hours were 55 hours/week pre- pandemic and 60 at TOS. On multivariable analysis, significant predictors of self-reported weekly professional work hours at TOS were having a non-child other dependent (+2.6 hours, P = .03), academic rank (associate -3.1 hours, assistant -9.0 hours; P < .001), and specialty (P < .001). Average self-reported TOS weekly domestic-labor hours were 23.1 among men and 30.2 among women (P < .001). Predictors of total self-reported TOS weekly domestic hours were being a woman (+5.6 hours; P < .001) and having children requiring supervision (+10.2 hours; P < .001). Overall, 9.3% of men (42/450) and 21.6% of women (88/407) experienced a ≥ 8 hour increase in domestic labor (P < .001). On multivariable analysis, women had higher odds of substantial domestic-labor increase (OR = 2.33, 95% CI: 1.47, 3.68), as did those with children requiring supervision (OR = 1.93, 95% CI: 1.25, 2.98) or other dependents (OR = 1.83, 95% CI: 1.13, 2.98). CONCLUSIONS: This study illuminates demands on women and faculty with dependents during the COVID-19 pandemic and suggests increased flexibility and resources are of heightened importance.

Gender Differences in Faculty Perceptions of Mentorship and Sponsorship.

This survey study examines gender differences in mid- to senior-career faculty experiences of receiving and providing mentorship and sponsorship during early career development.

Authorship climate: A new tool for studying ethical issues in authorship.

Authorship of academic publications is central to scientists' careers, but decisions about how to include and order authors on publications are often fraught with difficult ethical issues. To better understand scholars' experiences with authorship, we developed a novel concept, authorship climate, which assesses perceptions of the procedural, informational, and distributive justice associated with authorship decisions. We conducted a representative survey of more than 3,000 doctoral students, postdoctoral researchers, and assistant professors from a stratified random sample of U.S. biology, economics, physics, and psychology departments. We found that individuals who tend to have more power on science teams perceived authorship climate to be more positive than those who tend to have less power. Alphabetical approaches for assigning authorship were associated with higher perceptions of procedural justice and informational justice but lower perceptions of distributive justice. Individuals with more marginalized identities also tended to perceive authorship climate more negatively than those with no marginalized identities. These results illustrate how the concept of authorship climate can facilitate enhanced understanding of early-career scholars' authorship experiences, and they highlight potential steps that can be taken to promote more positive authorship experiences for scholars of all identities.

Disproportionate impacts of COVID-19 on marginalized and minoritized early-career academic scientists.

Early research on the impact of COVID-19 on academic scientists suggests that disruptions to research, teaching, and daily work life are not experienced equally. However, this work has overwhelmingly focused on experiences of women and parents, with limited attention to the disproportionate impact on academic work by race, disability status, sexual identity, first-generation status, and academic career stage. Using a stratified random survey sample of early-career academics in four science disciplines (N = 3,277), we investigated socio-demographic and career stage differences in the effect of the COVID-19 pandemic along seven work outcomes: changes in four work areas (research progress, workload, concern about career advancement, support from mentors) and work disruptions due to three COVID-19 related life challenges (physical health, mental health, and caretaking). Our analyses examined patterns across career stages as well as separately for doctoral students and for postdocs/assistant professors. Overall, our results indicate that scientists from marginalized (i.e., devalued) and minoritized (i.e., underrepresented) groups across early career stages reported more negative work outcomes as a result of COVID-19. However, there were notable patterns of differences depending on the socio-demographic identities examined. Those with a physical or mental disability were negatively impacted on all seven work outcomes. Women, primary caregivers, underrepresented racial minorities, sexual minorities, and first-generation scholars reported more negative experiences across several outcomes such as increased disruptions due to physical health symptoms and additional caretaking compared to more privileged counterparts. Doctoral students reported more work disruptions from life challenges than other early-career scholars, especially those related to health problems, while assistant professors reported more negative changes in areas such as decreased research progress and increased workload. These findings suggest that the COVID-19 pandemic has disproportionately harmed work outcomes for minoritized and marginalized early-career scholars. Institutional interventions are required to address these inequalities in an effort to retain diverse cohorts in academic science.

Formal Reporting of Identity-Based Harassment at an Academic Medical Center: Incidence, Barriers, and Institutional Responses.

PURPOSE: To examine the incidence of, barriers to, and institutional responses to formal reporting of experiences of identity-based harassment at an academic medical center. METHOD: The authors invited 4,545 faculty and medical trainees at the University of Michigan Medical School to participate in a 2018 survey about civility and respect. This analysis focused on respondents who indicated experiencing at least 1 form of identity-based harassment (sexual harassment, gender policing harassment, heterosexist harassment, racialized sexual harassment) within the past year, perpetrated by staff, students, and faculty or by patients and patients' families. The authors assessed the incidence of formally reporting harassment to someone in authority, barriers to reporting, and institutional responses following reporting. RESULTS: Among the 1,288 (28.3%) respondents with usable data, 83.9% (n = 1,080) indicated experiencing harassment. Of the harassed individuals, 10.7% (114/1,067), including 13.1% (79/603) of cisgender women and 7.5% (35/464) of cisgender men, indicated they formally reported their harassment experiences. Among these reporters, 84.6% (66/78) of cisgender women and 71.9% (23/32) of cisgender men indicated experiencing positive institutional remedies. Many reporters indicated experiencing institutional minimization (42.9% [33/77] of cisgender women; 53.1% [17/32] of cisgender men) or retaliation (21.8% [17/78] of cisgender women; 43.8% [14/32] of cisgender men). Cisgender men were significantly more likely to indicate experiencing specific negative institutional responses, such as being considered a troublemaker (OR 3.56, 95% CI: 1.33-9.55). Among respondents who did not formally report harassment experiences, cisgender women were significantly more likely to cite concerns about institutional retaliation, such as being given an unfair performance evaluation or grade (OR 1.90, 95% CI: 1.33-2.70). CONCLUSIONS: Most respondents who experienced harassment did not formally report it to anyone in authority. Many reporters faced institutional minimization and retaliation. These findings suggest a need to reshape institutional harassment prevention and response systems in academic medicine.

Gendered racism and depression among Black women: Examining the roles of social support and identity.

OBJECTIVE: Black women's experiences of gendered racism have implications for their mental health. The present study tested the associations between gendered racism, social support, and depression, then investigated whether gendered racial centrality buffered the impact of gendered racism on mental health outcomes. METHOD: Data from 237 Black college women (Mage = 22.04, SD = 4.02 years) were collected using an online survey, assessing gendered racism, social support, depression, and gendered racial identity. RESULTS: We found that social support mediated (but did not moderate) the association between gendered racism and depression: More gendered racism was associated with decreased support, and consequently more depression. Also, higher gendered racial centrality buffered the indirect effect of gendered racism on greater depression via lower social support. CONCLUSION: Our results further illustrate the detrimental effect of gendered racism on Black women, while also illuminating areas for intervention useful for this group. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Incidence and Group Comparisons of Harassment Based on Gender, LGBTQ+ Identity, and Race at an Academic Medical Center.

Background: A key recommendation from the landmark National Academies report called for research examining experiences of underrepresented and/or vulnerable groups, including people of color and sexual- and gender-minority people. We examine the prevalence of gender policing harassment (GPH), heterosexist harassment (HH), and racialized sexual harassment (RSH), by gender, LGBTQ+, race, and department grouping, which has not been previously examined in academic medicine. Materials and Methods: All faculty (n = 2723), fellows, residents, and first through third year medical students (n = 1822) at the University of Michigan Medical School (UMMS) who had been working at the organization for at least 1 year were invited to complete a 20-minute online survey. We assessed harassment within the past year, perpetrated by insiders (i.e., staff, students, and faculty) and from patients and patients' families. Results: A total of 705 faculty (25.9% of the targeted sample) and 583 trainees (32.0% of the targeted sample) were in the analytic sample. Women were significantly more likely to experience GPH from both sources than men, and LGBTQ+ individuals were more likely to face HH from both sources than cisgender heterosexual participants. Underrepresented minorities, Asian/Asian American, and female participants had higher rates of RSH perpetrated by insiders. There were significant department-group differences across harassment types. Conclusions: Less-studied forms of harassment are common within academic medicine and are perpetrated from various sources. Identity-based harassment should be investigated further to gain a comprehensive understanding of its impact within academic medicine. Clinical Trial Registration Number not applicable.

#MedToo: A Large-Scale Examination of the Incidence and Impact of Sexual Harassment of Physicians and Other Faculty at an Academic Medical Center.

Background: A landmark National Academies report highlighted the need for rigorous evaluation of sexual harassment in medicine. We examined the prevalence and impact of sexual harassment using the Sexual Experiences Questionnaire, the standard for measurement of sexual harassment, but which has not been previously applied within academic medicine. Materials and Methods: A 20-minute online survey was administered to all faculty who had been working at University of Michigan Medical School for at least 1 year (n = 2723). We assessed sexual harassment within the past year from insiders (i.e., from staff, students, and faculty) and from patients and patients' families. We also evaluated mental health, job satisfaction, sense of safety at work, and turnover intentions. Results: In the final sample (n = 705; which included 25.9% of the originally targeted population), most respondents, 82.5% of women and 65.1% of men, reported at least one incident of sexual harassment from insiders in the past year; 64.4% of women and 44.1% of men reported harassment from patients and patients' families. The most frequently experienced dimension of sexual harassment for women and men was sexist gender harassment. Increased experiences of harassment were independently associated with lower mental health, job satisfaction, and sense of safety at work, as well as increased turnover intentions, with no significant interactions by gender. Conclusions: Sexual harassment against medical faculty is alarmingly common at an institution that is not expected to be atypical. Interventions must address sexual harassment, which affects mental health and career outcomes of male and female physicians.

Team climate mediates the effect of diversity on environmental science team satisfaction and data sharing.

Scientific research-especially high-impact research-is increasingly being performed in teams that are interdisciplinary and demographically diverse. Nevertheless, very little research has investigated how the climate on these diverse science teams affects data sharing or the experiences of their members. To address these gaps, we conducted a quantitative study of 266 scientists from 105 NSF-funded interdisciplinary environmental science teams. We examined how team climate mediates the associations between team diversity and three outcomes: satisfaction with the team, satisfaction with authorship practices, and perceptions of the frequency of data sharing. Using path analyses, we found that individuals from underrepresented groups perceived team climate more negatively, which was associated with lower satisfaction with the team and more negative perceptions of authorship practices and data sharing on the team. However, individuals on teams with more demographic diversity reported a more positive climate than those on teams with less demographic diversity. These results highlight the importance of team climate, the value of diverse teams for team climate, and barriers to the full inclusion and support of individuals from underrepresented groups in interdisciplinary science teams.

Honorary Authorship Practices in Environmental Science Teams: Structural and Cultural Factors and Solutions.

Overinclusive authorship practices such as honorary or guest authorship have been widely reported, and they appear to be exacerbated by the rise of large interdisciplinary collaborations that make authorship decisions particularly complex. Although many studies have reported on the frequency of honorary authorship and potential solutions to it, few have probed how the underlying dynamics of large interdisciplinary teams contribute to the problem. This article reports on a qualitative study of the authorship standards and practices of six National Science Foundation-funded interdisciplinary environmental science teams. Using interviews of the lead principal investigator and an early-career member on each team, our study explores the nature of honorary authorship practices as well as some of the motivating factors that may contribute to these practices. These factors include both structural elements (policies and procedures) and cultural elements (values and norms) that cross organizational boundaries. Therefore, we provide recommendations that address the intersection of these factors and that can be applied at multiple organizational levels.

Sex differences in outcomes and harasser characteristics associated with frightening sexual harassment appraisals.

This study examined data from U.S. military personnel (1,764 men; 4,540 women) to determine whether appraisals of sexual harassment as frightening mediate the relationship between perpetrator characteristics (perpetrator sex and rank) and three psychological/job outcomes (psychological distress, role limitations, and work satisfaction), and whether these relationships were stronger for women than men. Results indicated that frightening appraisals mediated the relationship between perpetrator rank and all outcomes for both sexes. However, frightening appraisals mediated the relationship between perpetrator sex and outcomes only for women. As predicted, having a male perpetrator or a higher status perpetrator was more strongly related to frightening appraisals for women than men. However, unexpectedly, the relationship between frightening appraisals and more psychological distress, more role limitations, and less work satisfaction was stronger for men than women. We discuss the results in terms of expectancy norm violations and sexual harassment as a form of dominance.

Mediators of the relationship between racial identity and life satisfaction in a community sample of African American women and men.

Few empirical studies have explored the mechanisms through which racial identity, the importance of racial group membership, affects well-being for racial/ethnic minorities. Using a community sample of 161 African American adults, the present study examined whether the association between racial identity (centrality, public regard, and private regard) and life satisfaction is mediated by two identity functions, belongingness and discrimination. Our results indicated that the relationships of centrality and private regard with life satisfaction were mediated by perceptions of belongingness. Furthermore, gender moderated the strength of each of these mediating effects, such that belongingness mediated these relationships for women but not for men. Our results also indicated that the relationship between public regard and life satisfaction was mediated by perceptions of discrimination. Furthermore, higher public regard was related to lower perceptions of discrimination for women but not men. However, a combined model for public regard and life satisfaction as mediated by discrimination failed to show moderated mediation. We discuss these results in relation to research and theory on racial identity and intersectionality.

Racial identity and depression among African American women.

This study examines direct, interactive, and indirect effects of racial identity and depression in a sample of 379 African American women. Results indicated that higher racial private and public regard were associated with lower depression. The relationship between private regard and depression was moderated by racial centrality, such that higher private regard was more strongly related to lower depression when women's race was a central part of their self-concept. Finally, results indicated that self-esteem fully mediated the relationship between private regard and depression and partially mediated the relationship between public regard and depression. The authors discuss the results in relation to reflected appraisal, the insulation hypothesis, and identity theory.

Sexual harassment across the color line: experiences and outcomes of cross- versus intraracial sexual harassment among Black women.

The current study examined differences in appraisal, harassment, and severity of posttraumatic stress symptoms among 105 Black women who were sexually harassed by either a White (cross-racial sexual harassment) or a Black man (intraracial sexual harassment). Analyses revealed that women appraised cross-racial more negatively than intraracial harassment, despite there being no significant differences in the likelihood of experiencing gender harassment, unwanted sexual attention, or sexual coercion. Further, cross-racial harassment was more likely to include racialized sexual harassment (harassing behaviors combining race and gender simultaneously) and higher status perpetrators. Finally, cross-racial sexual harassment had an indirect (but not direct) mediated effect on posttraumatic stress via participants' appraisals of their harassment. Specifically, the more negative appraisal associated with cross-racial sexual harassment was associated with increased posttraumatic stress symptoms. In light of these findings, consideration of perpetrator race and racially sexualized behaviors could prove significant additions to current models of sexual harassment.

THROUGH THE LENS OF RACE: BLACK AND WHITE WOMEN'S PERCEPTIONS OF WOMANHOOD.

The intersection of race and gender may create unique experiences for Black and White women in terms of work, family, domestic roles, and interpersonal relationships. Dissimilar gender-role norms may foster different perceptions of gender for these two groups of women. In the current study, we examined similarities and differences in Black and White women's perceptions of their gender using qualitative focus group methodology and grounded theory data analysis. The results identified five themes that were common to Black and White women: Gender-Based Mistreatment, Perceived Advantage, Friendships and Community, Caretaking, and Work and Family Options. One additional theme, Inner Strength, emerged only for Black women. Although many of the broad perceptions of womanhood were similar for Black and White women, analysis of the content within each theme highlighted important differences. We discuss the results in terms of how they may reflect socio-historical factors, gender discrimination, stereotypes, and gender-role norms.

When multiple identities interfere: the role of identity centrality.

The current study extends research in the area of identity conflict or interference by focusing on a new identity combination, the woman and scientist identities. In addition, it examines the influence of identity centrality, or importance, as a predictor of interference and moderator of the relation between interference and well-being and science performance. Supporting hypotheses, greater identity interference was related to lower levels of performance and well-being. Furthermore, woman centrality was unrelated to interference for those with a central scientist identity, but for those without a central scientist identity, they were positively related. Although central identities were related to positive outcomes in the absence of interference, the outcomes of all women suffered when interference was high, contrary to the hypothesis. The implications of identity centrality for understanding the negotiation of potentially conflicting identities, and for the retention of women in the sciences, are discussed.

One role or two? The function of psychological separation in role conflict.

Student athletes vary in how much they view their academic and athletic role identities as separate from and interfering with each other. The authors investigated the relation of these perceptions to psychological well-being in 200 intercollegiate athletes. Measures included role separation, interference, identity, and well-being. Correlations indicated that interference related negatively to well-being, whereas viewing the roles as distinct related positively to well-being. Regression analyses of demographic and role identity variables also showed a positive association between role separation and well-being, and a significant Separation x Interference interaction. Specifically, role interference was negatively related to well-being for those who viewed the two roles as distinct but unrelated for those who did not. The buffering effects of role separation are discussed.