Becoming by doing: How women in academic health sciences build a leadership identity through project experiences.

PURPOSE: Leadership development programs often use institutional projects to activate learning. We explored how project work shaped leadership identity formation in senior women leaders from one academic health science center who enrolled in The Hedwig von Ameringen Executive Leadership in Academic Medicine (ELAM®) program. MATERIALS AND METHODS: We interviewed ELAM Fellows and conducted a qualitative analysis of transcripts. Our primary analysis focused on the influences of projects on Fellows and institutions. Leadership identity formation emerged as a distinct pattern, so this narrative content was separated for secondary analysis. All authors approved the final assignment of themes and codes. RESULTS: Participants described a multi-dimensional process for developing a leadership identity. Themes encompassed participants' View of Self and One's Image as a Leader, Interpersonal Relationships, and Commitment to a Value-based Goal. These internal factors grounded external influences, such as interactions with colleagues and institutional leaders, and the world beyond the institution. CONCLUSIONS: We examined the process of leadership identity formation from the perspective of women leaders in academic health sciences who completed an institutional project during a leadership development program. Findings illustrate how internal and external forces, experienced in the context of project work, combine to influence leadership identity formation in women.

Gender, religion, and sociopolitical issues in cross-cultural online education.

Cross-cultural education is thought to develop critical consciousness of how unequal distributions of power and privilege affect people's health. Learners in different sociopolitical settings can join together in developing critical consciousness-awareness of power and privilege dynamics in society-by means of communication technology. The aim of this research was to define strengths and limitations of existing cross-cultural discussions in generating critical consciousness. The setting was the FAIMER international fellowship program for mid-career interdisciplinary health faculty, whose goal is to foster global advancement of health professions education. Fellows take part in participant-led, online, written, task-focused discussions on topics like professionalism, community health, and leadership. We reflexively identified text that brought sociopolitical topics into the online environment during the years 2011 and 2012 and used a discourse analysis toolset to make our content analysis relevant to critical consciousness. While references to participants' cultures and backgrounds were infrequent, narratives of political-, gender-, religion-, and other culture-related topics did emerge. When participants gave accounts of their experiences and exchanged cross-cultural stories, they were more likely to develop ad hoc networks to support one another in facing those issues than explore issues relating to the development of critical consciousness. We suggest that cross-cultural discussions need to be facilitated actively to transform learners' frames of reference, create critical consciousness, and develop cultural competence. Further research is needed into how to provide a safe environment for such learning and provide faculty development for the skills needed to facilitate these exchanges.

Project-based faculty development by international health professions educators: practical strategies.

BACKGROUND: Project design and implementation, applied to real life situations, is emerging as an educational strategy for application of health professions faculty development learning within a supportive environment. AIM: We conducted a retrospective analysis of project evolution to identify common experiences, challenges, and successful strategies of 54 mid-career faculty members from 18 developing countries who attended the Foundation for the Advancement of International Medical Education and Research Institute between 2001 and 2006 and designed, conducted, and evaluated education innovations at their home institutions. METHODS: Chronological analysis of the evolution of 54 projects over the initial 16-18 months of the 2-year Fellowship was based on an iterative qualitative analysis of 324 reports and individual interview transcripts collected over 6 years. RESULTS: Useful skill areas for project implementation included educational methods, leadership and management, and relationships/collaboration. Common challenges included competing responsibilities, lack of protected time, and limited resources. Themes identified with the evolution and success of education innovation projects included leadership and organization, collaboration, personal professional growth, and awareness of the relevant societal context. CONCLUSIONS: Common challenges and success factors in project-based faculty development were identified. Twelve practical strategies to promote successful project-based faculty development emerged that can be generalized for faculty development.

FAIMER Global Faculty Development: A Sustainable Partnership Model to Advance Health Professions Education.

The Foundation for Advancement of International Medical Education and Research (FAIMER), a member of Intealth, offers longitudinal faculty development programs (LFDPs) in health professions education (HPE) and leadership through its International FAIMER Institute (IFI) in the United States and FAIMER Regional Institutes (FRIs) globally. FAIMER fosters mutual collaboration and delineates shared responsibilities for FRI development in partnership with local institutions, using an adapted hub-and-spoke organizational design. This paper describes FAIMER's model, its sustainability, and its impacts at individual, institutional, and national levels. IFI was launched in 2001 in Philadelphia, Pennsylvania, as a 2-year part-time hybrid LFDP; with the COVID-19 pandemic onset, IFI transitioned to a fully online program. Since FAIMER's launch, 11 FRIs developed in Brazil, Chile, China, Egypt, India, Indonesia, and South Africa, each modeled on the IFI curriculum and adapted to local context. The more than 1,600 IFI and FRI graduates (fellows) from over 55 countries now form a global community of health professions educators who have shared exposure to HPE methods and assessment, leadership and management, educational scholarship and research, and project management and evaluation. Across all global locations and program formats, fellows self-reported a similar increase in knowledge and skills in HPE. All programs center on the fellows' institutional projects as experiential learning; these projects have focused primarily on educational methods and curriculum revisions. An increased quality of education was reported as the top impact resulting from fellows' projects. As a result of these programs, fellows have influenced education policy in their countries and established academic societies for HPE, thus contributing to recognition of the HPE academic specialty. FAIMER has successfully developed a sustainable model for advancing HPE globally, creating a vibrant network of health professions educators who have influenced country-specific educational policy and practice. FAIMER's model offers one approach to building global capacity in HPE.

Leadership Programs for Academic Women: Building Self-Efficacy and Organizational Leadership Capacity.

Background: Although numerous programs have evolved to develop leadership skills in women, few have conducted rigorous longitudinal evaluation of program outcomes. The purpose of this evaluation study is to measure the continuing impact of the Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM®) program in its third decade of operation and to compare outcomes for graduates across the two programs (ELAM and Executive Leadership in Academic Technology, Engineering and Science [ELATES at Drexel®]), using a revised Leadership Learning and Career Development (LLCD) Survey. Methods: The LLCD survey was administered to program graduates between 2013 and 2016 upon entry, immediately after graduation, and 2 years after program completion. Two-way mixed effects analysis of variances were used to analyze differences between programs and changes over time. Descriptive statistics and narrative responses were analyzed for trends and themes. Results: Of 287 graduates, 69% responded to all three survey administrations. Respondents rated competencies in strategic finance, organizational dynamics, communities of leadership practice, and personal and professional leadership development as highly important at all points of measurement. Ratings of ability to conduct the selected competencies (i.e., self-efficacy), increased during the program and were maintained over the 2 years that followed. Applications and offers for leadership positions increased over the course of the program and the subsequent 2 years. Respondents showed a strong preference for serving the institution that both sponsored their participation in the leadership program development and supported their continuing contributions to the institution. Personal development goals became more elaborated, institutionally focused, and strategic. Conclusions: The findings support the effectiveness of two national leadership programs in supporting growth and maintenance of graduates' self-efficacy as they advanced in institutional leadership roles. The findings also provide practical direction for leadership professional development curricula and institutional support that can help to decrease the gender gap in academic leadership.

Leadership Development Projects: Bidirectional Impact on Faculty and Institutions.

INTRODUCTION: The Hedwig von Ameringen Executive Leadership in Academic Medicine program (ELAM) is a national professional development program for women that includes institutional action projects (IAPs). Although benefits of ELAM participation are well documented, the value of the IAPs has not been specifically evaluated. We explored the experience of ELAM Fellows and leaders from one institution to elucidate how institutional factors influence project implementation and outcomes. METHODS: Fellows and deans participated in semistructured interviews. We analyzed the transcripts qualitatively to develop themes and describe factors that influenced IAP implementation and outcomes. We used the New World Kirkpatrick Model, an updated version of the widely used Kirkpatrick model of educational program evaluation, as a framework to elucidate how participants applied their leadership learning through project work, and to analyze early results of projects that indicated institutional impact. RESULTS: Project work had bidirectional impact on the fellows in the program and on the institution itself. Project enablers included: focusing projects on institutional priorities, obtaining sustainable support, and navigating institutional complexity. Leading indicators of institutional outcomes included contributions to institutional leadership and culture, and mutual enhancement of the reputation of the fellow and of the institution. DISCUSSION: By examining enablers and barriers for institutionally based projects conducted in a national leadership development program, we identified the drivers that facilitated application of leadership learning. Leading indicators of project outcomes reflected bidirectional impact on fellows and the institution, demonstrating outcomes at the highest levels of the New World Kirkpatrick Model.

Increasing Promotion of Women Faculty in Academic Medicine: Impact of National Career Development Programs.

Background: Three national career development programs (CDPs)-Early and Mid-Career Programs sponsored by the Association of American Medical Colleges and the Hedwig van Ameringen Executive Leadership in Academic Medicine sponsored by Drexel University-seek to expand gender diversity in faculty and institutional leadership of academic medical centers. Over 20 years of success and continued need are evident in the sustained interest and investment of individuals and institutions. However, their impact on promotion in academic rank remains unknown. The purpose of the study is to compare promotion rates of women CDP participants and other faculty of similar institutional environment and initial career stage. Methods: The study examined retrospective cohorts of 2,719 CDP participants, 12,865 nonparticipant women, and 26,810 men, from the same institutions, with the same degrees, and first years of appointment in rank. Rates of promotion to Associate and Full Professor ranks in respective cohorts of Assistant and of Associate Professors were compared using Kaplan-Meier survival curves and log-rank tests, and logistic regression adjusting for other predictors of academic success. Results: In adjusted analyses, participants were more likely than men and non-participant women to be promoted to Associate Professor and as likely as men and more likely than non-participant women to be promoted to Full Professor within 10 years. Within 5 years, CDP participants were more likely than nonparticipant women to be promoted to Associate Professor and as likely as to be promoted to Full Professor; in the same interval, participants were promoted to both higher ranks at the same rates as men. For both intervals, nonparticipant women were significantly less likely than men to be promoted to either rank. Conclusions: The higher rates of promotion for women participating in national CDPs support the effectiveness of these programs in building capacity for academic medicine.

Improving the teaching skills of residents as tutors/facilitators and addressing the shortage of faculty facilitators for PBL modules.

BACKGROUND: Residents play an important role in teaching of medical undergraduate students. Despite their importance in teaching undergraduates they are not involved in any formal training in teaching and leadership skills. We aimed to compare the teaching skills of residents with faculty in facilitating small group Problem Based Learning (PBL) sessions. METHODS: This quasi experimental descriptive comparative research involved 5 postgraduate year 4 residents and five senior faculty members. The study was conducted with all phase III (Final year) students rotating in Gastroenterology. The residents and faculty members received brief training of one month in facilitation and core principles of adult education. Different aspects of teaching skills of residents and faculty were evaluated by students on a questionnaire (graded on Likert Scale from 1 to 10) assessing i) Knowledge Base-content Learning (KBL), ii) PBL, iii) Student Centered Learning (SCL) and iv) Group Skills (GS). RESULTS: There were 33 PBL teaching sessions in which 120 evaluation forms were filled; out of these 53% forms were filled for residents and 47% for faculty group. The faculty showed a statistically greater rating in "KBL" (faculty 8.37 Vs resident 7.94; p-value 0.02), "GS" (faculty 8.06 vs. residents 7.68; p-value 0.04). Differences in faculty and resident scores in "the PBL" and "SCL" were not significant. The overall score of faculty facilitators, however, was statistically significant for resident facilitators. (p = .05). CONCLUSION: 1) Residents are an effective supplement to faculty members for PBL; 2) Additional facilitators for PBL sessions can be identified in an institution by involvement of residents in teacher training workshops.

Medical Education to Enhance Critical Consciousness: Facilitators' Experiences.

PURPOSE: To analyze educators' experiences of facilitating cultural discussions in two global health professions education programs and what these experiences had taught them about critical consciousness. METHOD: A multicultural research team conducted in-depth interviews with 16 faculty who had extensive experience facilitating cultural discussions. They analyzed transcripts of the interviews thematically, drawing sensitizing insights from Gramsci's theory of cultural hegemony. Collaboration and conversation helped the team self-consciously examine their positions toward the data set and be critically reflexive. RESULTS: Participant faculty used their prior experience facilitating cultural discussions to create a "safe space" in which learners could develop critical consciousness. During multicultural interactions they recognized and explicitly addressed issues related to power differentials, racism, implicit bias, and gender bias. They noted the need to be "facile in attending to pain" as learners brought up traumatic experiences and other sensitive issues including racism and the impact of power dynamics. They built relationships with learners by juxtaposing and exploring the sometimes-conflicting norms of different cultures. Participants were reflective about their own understanding and tendency to be biased. They aimed to break free of such biases while role modeling how to have the courage to speak up. CONCLUSIONS: Experience had given facilitators in multicultural programs an understanding of their responsibility to promote critical consciousness and social justice. How faculty without prior experience or expertise could develop those values and skills is a topic for future research.

Changing the Culture of Academic Medicine: Critical Mass or Critical Actors?

PURPOSE: By 2006, women constituted 34% of academic medical faculty, reaching a critical mass. Theoretically, with critical mass, culture and policy supportive of gender equity should be evident. We explore whether having a critical mass of women transforms institutional culture and organizational change. METHODS: Career development program participants were interviewed to elucidate their experiences in academic health centers (AHCs). Focus group discussions were held with institutional leaders to explore their perceptions about contemporary challenges related to gender and leadership. Content analysis of both data sources revealed points of convergence. Findings were interpreted using the theory of critical mass. RESULTS: Two nested domains emerged: the individual domain included the rewards and personal satisfaction of meaningful work, personal agency, tensions between cultural expectations of family and academic roles, and women's efforts to work for gender equity. The institutional domain depicted the sociocultural environment of AHCs that shaped women's experience, both personally and professionally, lack of institutional strategies to engage women in organizational initiatives, and the influence of one leader on women's ascent to leadership. CONCLUSIONS: The predominant evidence from this research demonstrates that the institutional barriers and sociocultural environment continue to be formidable obstacles confronting women, stalling the transformational effects expected from achieving a critical mass of women faculty. We conclude that the promise of critical mass as a turning point for women should be abandoned in favor of "critical actor" leaders, both women and men, who individually and collectively have the commitment and power to create gender-equitable cultures in AHCs.

Implementing the logic model for measuring the value of faculty affairs activities.

In today's environment of increasing accountability in higher education and health care, it is critical that administrative units of a medical school demonstrate the added value of their activities to the school's mission and that these units discriminate those activities that demonstrate the most return on investment. This is particularly important for administrative units whose activities may not be considered essential to the basic functioning of the medical school. For example, admissions would likely be considered an essential administrative unit that the medical school cannot do without, while faculty development might be considered nonessential. Effective measurement systems serve two purposes. They guide decision making throughout the organization and they serve as a basis for evaluating performance. This article describes use of the program logic model to measure the contribution of faculty affairs and development offices to the recruitment, retention, and development of a medical school's teaching faculty, an outcome central to the mission of the medical school. The process of developing and rewarding faculty for teaching is used to illustrate the application of this method in linking activities of faculty affairs and development offices to outcomes that are of importance to the medical school.

New challenges facing interinstitutional social science and educational program evaluation research at academic health centers: a case study from the ELAM program.

Since the mid-1990s, the protection of human subjects through institutional review boards (IRBs) has progressively broadened in scope. In this case study, the authors describe their challenges in effectively handling IRB processes to conduct educational and social sciences research within academic health centers, particularly (1) complications in conducting longitudinal interinstitutional research that involves multiple IRBs, each with different procedures that changed over ten years; and (2) factors affecting consent form and survey response rates when applying the biomedical IRB process to obtain the consent of human subjects for participation in social and educational research. The authors had a unique opportunity to follow the effect of changes in consent forms (from no form to a one-page form to a three-page form requiring signature of a witness), ways of administration (in person or by mail), and time of administration (at the time of the program or years later) on consent form and survey response rates among medical and dental school faculty members. The authors explore the extended timelines required for data collection and increased costs in dealing with these issues, as well as the effects on response rates of consent form language and administration procedures. The authors recommend strategies to lessen adverse effects of dealing with multiple IRBs at different institutions for social science and educational research, and discuss policy implications for funders, institutions and investigators.

Slowing the brain drain: FAIMER education programs.

Migration of physicians has produced serious shortages in many developing countries. The Foundation for Advancement of International Medical Education and Research (FAIMER) is attempting to show this international brain drain through creation of faculty development programs for medical school faculty from developing countries in order to strengthen medical education and help build a sustainable discipline of medical education. The goals of these programs are to allow Fellows to acquire basic skills in medical education, skills in leadership and management, and build a strong community of practice. Acquisition of these skills will improve medical education in their home country, stimulate growth of the field of medical education, and improve opportunities for professional advancement. Three programs currently exist: the FAIMER Institute, a two year fellowship with residential and distance learning components; International Fellowships in Medical Education, which funds selected Institute alumni to obtain masters degrees in medical education; and FAIMER regional institutes, which use the principles and structure embedded in the FAIMER Institute to build faculty development programs overseas. Evaluation of FAIMER programs indicates approximately one-third of Fellows have been promoted, and that a community of medical educators is being created in many developing countries which may promote retention of these physicians.

Cultural hegemony? Educators' perspectives on facilitating cross-cultural dialogue.

BACKGROUND: We live in an age when education is being internationalized. This can confront students with 'cultural hegemony' that can result from the unequal distribution of power and privilege in global society. The name that is given to awareness of social inequality is 'critical consciousness'. Cross-cultural dialogue provides an opportunity for learners to develop critical consciousness to counter cultural hegemony. The purpose of this research was to understand how learners engage with cross-cultural dialogue, so we can help them do so more effectively in the future. METHOD: The setting for this research was an online discussion in an international health professions educator fellowship program. We introduced scenarios with cultural references to study the reaction of participants to cultural conversation cues. We used an inductive thematic analysis to explore power and hegemony issues. RESULTS: Participants reflected that personally they were more likely to take part in cross-cultural discussions if they recognized the context discussed or had prior exposure to educational settings with cultural diversity. They identified barriers as lack of skills in facilitating cross-cultural discussions and fear of offending others. They suggested deliberately introducing cultural issues throughout the curriculum. CONCLUSION: Our results indicate that developing critical consciousness and cross-cultural competency will require instructional design to identify longitudinal opportunities to bring up cross-cultural issues, and training facilitators to foster cross-cultural discussions by asking clarifying questions and navigating crucial/sensitive conversations.

Identity text: an educational intervention to foster cultural interaction.

BACKGROUND: Sociocultural theories state that learning results from people participating in contexts where social interaction is facilitated. There is a need to create such facilitated pedagogical spaces where participants can share their ways of knowing and doing. The aim of this exploratory study was to introduce pedagogical space for sociocultural interaction using 'Identity Text'. METHODS: Identity Texts are sociocultural artifacts produced by participants, which can be written, spoken, visual, musical, or multimodal. In 2013, participants of an international medical education fellowship program were asked to create their own Identity Texts to promote discussion about participants' cultural backgrounds. Thematic analysis was used to make the analysis relevant to studying the pedagogical utility of the intervention. RESULT: The Identity Text intervention created two spaces: a 'reflective space', which helped participants reflect on sensitive topics such as institutional environments, roles in interdisciplinary teams, and gender discrimination, and a 'narrative space', which allowed participants to tell powerful stories that provided cultural insights and challenged cultural hegemony; they described the conscious and subconscious transformation in identity that evolved secondary to struggles with local power dynamics and social demands involving the impact of family, peers, and country of origin. CONCLUSION: While the impact of providing pedagogical space using Identity Text on cognitive engagement and enhanced learning requires further research, the findings of this study suggest that it is a useful pedagogical strategy to support cross-cultural education.

Narratives of Participants in National Career Development Programs for Women in Academic Medicine: Identifying the Opportunities for Strategic Investment.

BACKGROUND: Academic medicine has initiated changes in policy, practice, and programs over the past several decades to address persistent gender disparity and other issues pertinent to its sociocultural context. Three career development programs were implemented to prepare women faculty to succeed in academic medicine: two sponsored by the Association of American Medical Colleges, which began a professional development program for early career women faculty in 1988. By 1995, it had evolved into two programs one for early career women and another for mid-career women. By 2012, more than 4000 women faculty from medical schools across the U.S and Canada had participated in these intensive 3-day programs. The third national program, the Hedwig van Ameringen Executive Leadership in Academic Medicine(®) (ELAM) program for women, was developed in 1995 at the Drexel University College of Medicine. METHODS: Narratives from telephone interviews representing reflections on 78 career development seminars between 1988 and 2010 describe the dynamic relationships between individual, institutional, and sociocultural influences on participants' career advancement. RESULTS: The narratives illuminate the pathway from participating in a career development program to self-defined success in academic medicine in revealing a host of influences that promoted and/or hindered program attendance and participants' ability to benefit after the program in both individual and institutional systems. The context for understanding the importance of these career development programs to women's advancement is nestled in the sociocultural environment, which includes both the gender-related influences and the current status of institutional practices that support women faculty. CONCLUSIONS: The findings contribute to the growing evidence that career development programs, concurrent with strategic, intentional support of institutional leaders, are necessary to achieve gender equity and diversity inclusion.

Retaining Faculty in Academic Medicine: The Impact of Career Development Programs for Women.

BACKGROUND: For more than two decades, national career development programs (CDPs) have addressed underrepresentation of women faculty in academic medicine through career and leadership curricula. We evaluated CDP participation impact on retention. METHODS: We used Association of American Medical Colleges data to compare 3268 women attending CDPs from 1988 to 2008 with 17,834 women and 40,319 men nonparticipant faculty similar to CDP participants in degree, academic rank, first year of appointment in rank, and home institution. Measuring from first year in rank to departure from last position held or December 2009 (study end date), we used Kaplan-Meier curves; Cox survival analysis adjusted for age, degree, tenure, and department; and 10-year rates to compare retention. RESULTS: CDP participants were significantly less likely to leave academic medicine than their peers for up to 8 years after appointment as Assistant and Associate Professors. Full Professor participants were significantly less likely to leave than non-CDP women. Men left less often than non-CDP women at every rank. Participants attending more than one CDP left less often than those attending one, but results varied by rank. Patterns of switching institutions after 10 years varied by rank; CDP participants switched significantly less often than men at Assistant and Associate Professor levels and significantly less often than non-CDP women among Assistant Professors. Full Professors switched at equal rates. CONCLUSION: National CDPs appear to offer retention advantage to women faculty, with implications for faculty performance and capacity building within academic medicine. Intervals of retention advantage for CDP participants suggest vulnerable periods for intervention.

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.