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.

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.

Generation X: implications for faculty recruitment and development in academic health centers.

Differences and tensions between the Baby Boom generation (born 1945-1962) and Generation X (born 1963-1981) have profound implications for the future of academic medicine. By and large, department heads and senior faculty are Boomers; today's residents and junior faculty are Generation X'ers. Looking at these issues in terms of the generations involved offers insights into a number of faculty development challenges, including inadequate and inexpert mentoring, work-life conflicts, and low faculty morale. These insights suggest strategies for strengthening academic medicine's recruitment and retention of Generation X into faculty and leadership roles. These strategies include (1) improving career and academic advising by specific attention to mentoring "across differences"--for instance, broaching the subject of formative differences in background during the initial interaction; adopting a style that incorporates information-sharing with engagement in problem solving; offering frequent, frank feedback; and refraining from comparing today to the glories of yesterday; to support such improvements, medical schools should recognize and evaluate mentoring as a core academic responsibility; (2) retaining both valued women and men in academic careers by having departments add temporal flexibility and create and legitimize less-than-full-time appointments; and (3) providing trainees and junior faculty with ready access to educational sessions designed to turn their "intellectual capital" into "academic career capital."Given the trends discussed in this article, such supports and adaptations are indicated to assure that academic health centers maintain traditions of excellence.

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.

Status of faculty affairs and faculty development offices in U.S. medical schools.

PURPOSE: To collect baseline data and describe how medical schools handle faculty affairs and faculty development responsibilities. METHOD: In January 2000, the authors surveyed faculty affairs designees at 125 U.S. medical schools, using a questionnaire developed in consultation with a group of faculty affairs professionals. RESULTS: The responding 76 medical schools (61%) support over four times as many offices of faculty affairs as faculty development offices. Core functions of faculty affairs offices include administrative support for appointments, promotions, and tenure committees; faculty information and policies; faculty governance processes; and department chairs' recruitment support and personnel management issues. CONCLUSION: While a consensus is emerging about the functions of a faculty affairs office, no school has a comprehensive faculty development system, in contrast to most industries, which must be more forward-looking to compete for talent.

Increasing women's leadership in academic medicine: report of the AAMC Project Implementation Committee.

The AAMC's Increasing Women's Leadership Project Implementation Committee examined four years of data on the advancement of women in academic medicine. With women comprising only 14% of tenured faculty and 12% of full professors, the committee concludes that the progress achieved is inadequate. Because academic medicine needs all the leaders it can develop to address accelerating institutional and societal needs, the waste of most women's potential is of growing importance. Only institutions able to recruit and retain women will be likely to maintain the best housestaff and faculty. The long-term success of academic health centers is thus inextricably linked to the development of women leaders. The committee therefore recommends that medical schools, teaching hospitals, and academic societies (1) emphasize faculty diversity in departmental reviews, evaluating department chairs on their development of women faculty; (2) target women's professional development needs within the context of helping all faculty maximize their faculty appointments, including helping men become more effective mentors of women; (3) assess which institutional practices tend to favor men's over women's professional development, such as defining "academic success" as largely an independent act and rewarding unrestricted availability to work (i.e., neglect of personal life); (4) enhance the effectiveness of search committees to attract women candidates, including assessment of group process and of how candidates' qualifications are defined and evaluated; and (5) financially support institutional Women in Medicine programs and the AAMC Women Liaison Officer and regularly monitor the representation of women at senior ranks.

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.

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.

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.