| 2023 Journal of the Academy of Health Sciences: A Pre-Print Repository | Categories Paper

Women Leaders in Academic Medicine: A Qualitative Study Addressing the Leaky Pipeline

by Candace Chow, PhD ↓; Meganne N. Ferrel, MD ↓; Emily M. Graham, MD ↓ & Megan Fix, MD ↓

Published in Cureus: Chow C J, Ferrel M N, Graham E M, et al. (April 10, 2024) Perspectives From Students and Faculty on How Women Achieve Leadership Roles in Academic Medicine: An Exploratory Qualitative Study . Cureus 16(4): e57969. doi:10.7759/cureus.57969

Abstract

Introduction: The glass ceiling in academic medicine is characterized by lower pay, fewer career advancement opportunities, and fewer tenured faculty positions held by women despite increasing numbers of women entering medicine. Creating change relies on preparing early-career women for positions of leadership, but most leadership programs focus on faculty, not trainees. The present study investigates how to prepare women medical students to be leaders in academic medicine.

Methods: This qualitative study used the theory of gendered organizations as a conceptual framework. Focus groups with women medical students and faculty were conducted at an academic medical center in the West. A total of 25 individuals (10 students and 15 faculty) participated. Recordings of focus groups were transcribed and coded using thematic analysis until saturation of themes was achieved.

Results: Codes were organized into three themes: obstacles, support systems, and self-presentation. Obstacles identified included the subthemes microaggressions, macroaggressions, lack of women role models in leadership, and personal characteristics such as ability to self-promote and remain resilient. Support systems included sponsorship, allyship, mentorship, networking, and gender-specific role modeling subthemes. Self-presentation involved learning behaviors in demonstrating leadership and exuding confidence, being strategic about career moves, resiliency, and navigating social norms.

Discussion: The key themes of obstacles, support systems, and self-presentation are targets for systemic and individualistic improvement in leadership development. The theory of gendered organizations underscores the importance of mitigating obstacles and increasing support from at the systemic, rather than individual, level.

Introduction

The glass ceiling is a familiar concept in medicine characterized by lower pay, fewer career advancement opportunities, and fewer tenured faculty positionsheld by women physicians across the nation, despite increasing numbers of women entering medicine.1-5 It is not for lack of trying either – research demonstrates that women are not given the same opportunities as men, such as for networking and serving on hiring committees – which translates to fewer opportunities for career advancement.6Likewise, we see attrition of women leaders, or a “leaky pipeline,” which is partially attributed to a lack of positive mentors and role models, discrimination, and gender bias.1,7  While there are programs designed to help women circumvent these obstacles, most of these programs are designed to help women that are already in positions of leadership.8,9 These programs, while needed, do not reach women at the beginning of their medical careers. Given that more women are starting to enroll in medical school than men, it is important to understand how to prepare early-career women, including students and trainees, to become leaders and break the glass ceiling. 

Two of the authors on this team are former leaders of a grassroots women’s leadership group named WE WILL (Women Empowering Women in Leadership) at the Spencer Fox Eccles School of Medicine at the University of Utah. WE WILL aims to create space and promote women leaders in medicine utilizing mentorship and professional development through networking events and skill-building workshops for women students and physicians. Preliminary results from WE WILL programming show success in empowering women for leadership positions after networking and skill workshop events.10  Based upon WE WILL outcomes and greater University support, we think developing and implementing a leadership curriculum will motivate more women to choose careers as academic leaders in medicine and better prepare them to succeed in those roles. Ultimately, by better-preparing women for positions of leadership within medicine, important perspectives and representation will be added to our healthcare system, along with enhanced patient care and decision-making processes.11-14

Conceptual Framework

The Theory of Gendered Organizations15-17 assumes that the workplace was created and is divided along gendered lines. Instead of arguing that gender discrimination exists, this theory helps us understand how gender discrimination happens and is reproduced. Acker15,16 explains that organizations are gendered with respect to divisions along gendered lines (e.g., men assume positions of power while women are tasked with unskilled work). Symbols, such as clothes, help to reinforce these gender divisions. In turn, the way in which individuals express themselves at work is also gendered. For example, suits, which are considered typical workplace attire, are traditionally masculine. Finally, organizations are also gendered with respect to how individuals interact with one another (e.g., turn-taking in meetings).

Research Questions

This qualitative study was conducted to understand the challenges women medical students and faculty face in academic medicine to inform the creation and implementation of a leadership curriculum for women medical students. The study explored the support systems and resources participants have used to buffer these challenges. Using the Theory of Gendered Organizations as the conceptual framework,15 we are specifically interested in understanding how these challenges are reflective of gendered organizations such as academic medical centers and what support systems participants utilize to overcome these challenges.

Methods

This project was deemed exempt by the University of Utah Institutional Review Board. Focus groups were conducted with University of Utah women medical students and physician faculty holding positions of leadership. Student participants self-selected to participate after an open recruitment email was distributed to the school of medicine. One of the faculty authors assisted with identifying women faculty in positions of leadership to engage in purposive sampling of women leaders. As this study was focused on women, only women-identifying medical students and faculty were asked to participate. Three student and three faculty focus groups were held. A total of 25 individuals participated (10 students and 15 faculty). Student focus groups were conducted by MNF and EMG, and faculty focus groups by MF. Participant consent was obtained by the individual conducting the focus group. Questions for the semi-structured focus groups were pilot tested by the authors. Questions were designed to inquire about individual determination, aspiration, support, and obstacles in becoming a leader in medicine. Focus groups were conducted and analyzed until there was a saturation of themes.11 To ensure focus group leaders understood participants correctly, accuracy was corroborated during the focus groups through reflexive feedback.

Focus groups were transcribed verbatim and transcripts were coded and analyzed using thematic analysis.12 The primary investigator reviewed all transcripts in detail and developed an initial codebook. Other authors then coded the transcripts. Disagreements were resolved by consensus and revisions were made to the codebook. Authors (CJC, MNF, EMG) then reviewed all transcripts to ensure the data were well-described by this revised codebook.

Positionality of Researchers

The authors include one physician, one medical education researcher, and two medical students (both of whom are now residents). Having both faculty and students on the team afforded us rapport with the two participant groups of focus (faculty and students) and allowed us to explore faculty and student perceptions of the data.

Results

Codes were organized into three themes: obstacles, support systems, and self-presentation. In the subsequent paragraphs, we share exemplary quotes that illustrate these themes, many of which reflect gendered processes at work. We use ‘S’ to denote when a quote is from a student focus group and ‘F’ when a quote is from a faculty-student group. The number is used to distinguish between the student and faculty focus groups.

Obstacles

Participants reported various obstacles in their careers. Most obstacles are reflective of the ways in which gendered organizations continue to reinforce differences and disparities between men and women. Obstacles included microaggressions, macroaggressions, a lack of women in leadership, lack of role models, and personal characteristics.

Participants shared about various microaggressions they had experienced as women. A common refrain was not being recognized as the physician: “when you’re a petite female … I used to always get, ‘Hey nurse, am I going to see a doctor?’” (F4). Participants shared about how they were viewed differently because they were mothers: “whatever we were juggling, I always contributed, I always worked hard or as hard, if not harder, I think, than a lot of people, and to have little barbs thrown at you because you were on maternity leave or because you went to your child’s kindergarten…performance” (F3). Several faculty members commented on the “mind clutter, the worry you have to go through about ‘what am I going to wear today?’” (F4). Students shared similar concerns: “…we have a patient presentation and they just say, “Dress professionally.” If you look around the room, the men just get to wear a button up shirt and slacks, and that is professional and it’s easy. And the women have to figure out, ‘Is this dress long enough? Is this dress too low cut? Am I going to get looked at because my shoulders are out? Is a pencil skirt unprofessional?’ … These are things that are both internal and external barriers” (S2).

Participants also shared macroaggressions. Some reflected on hiring conversations: “sometimes more overt comments about like ‘are we trying to hire a woman or are we trying to hire the best person for the job?’” (F3). Another shared: “…I found out recently that there was a discussion that there should be a non-compete on my contract when I came here because I was going to get pregnant…but [it didn’t happen because] …somebody else had spoken up and said, “No, you can’t do that, that’s gender discrimination” (F3). Participants also disclosed instances of sexual harassment: “I have had one patient where I had to stop standing at a certain part of his bed because he could reach my leg and he would like grab and pat my leg…I just started standing on the far end of his bed where he couldn’t reach it” (S2).

The lack of women in leadership was a major concern shared among participants: “we still aren’t seeing very many women leaders… there’s systemic discrimination against women,” (S1). Faculty shared the same sentiment: “I think this is an amazing institution, but … some of the things that frustrate me here are not indirectly related to [the fact that… department chair is] the only woman in that room where those decisions get made right now and that’s just a problem” (F1).

Participants also mentioned how a lack of role models made their entry into medicine difficult. Whether it was because they did not “have any physicians in [their] family” (S3) or because “no one in [their] family…is in academia” (F4), these students and faculty discussed having to navigate a new field of study on their own. Others said they had a hard time picturing themselves in medicine because they had not seen themselves reflected in role models: “growing up, I never saw a woman who’s a minority in places that I wanted to be. I never saw a Latino doctor… I had so many questions growing up. Like ‘how do I even get to this place?’” (S1).

Participants also discussed how their own characteristics, which they had been socialized to adopt, got in the way of themselves. One student reflected: “… a man is going to … take charge, and people will maybe listen to him more, and that’s a fear in the back of my mind…it’s definitely something I consider when I’m like, oh should I go after this position? Maybe it’s not a good fit for me, and I think I tie that into being a female” (S3). Faculty experienced similar internal struggles: “[My] biggest barrier has been myself. But going back to what [she] … said is, self-advocating. If you look at studies, women have been known to be, to undervalue themselves” (F2).

Support Systems

Participants spoke at length about support systems that helped them overcome the obstacles mentioned in the section above. Much of this support involved navigating and even circumventing the gendered system, including sponsorship, allyship from men in their lives, mentorship from colleagues, and gender-specific role modeling.

Faculty recalled how important sponsorship was to their success. They shared that sponsors are not necessarily long-term mentors but are individuals who “put themselves on the line and give you an opportunity” (F3). One shared: “The most important factor for me was a sponsor…He had just, he only spent two years in our department, but I happened to be his chief resident. And he sponsored me. I would have never had the job I had without him. I am 100 percent sure” (F2). Similarly, another participant said, “it was actually my immediate…supervisor within my division who saw my potential from my clinical interests to take over and was very great about…guiding me…into that role” (F3). Another faculty member said that their network was key to opportunities: “the value of the relationships has always been really important to me and has created mentorship and sponsorship [for me]” (F2).

Participants also shared how mentorship played a key role in their success. Several faculty across focus groups reflected on how mentorship programs advanced their careers, like the Association of American Medical College’s (AAMC) Executive Leadership in Academic Medicine (ELAM) program and other career-advancement programs designed specifically for women.18 Others explained that specific mentors helped pave their paths: “He also helped me say no to things and be like “You’re too busy.” So that was also, I think, a very important trait of a mentor, being interested and aware of everything that I was doing and to help me make the best choices” (S2). Participants noted that “it wasn’t necessarily people who looked like me or had the same path” (F1) that mentored them, but people who recognized their potential and provided encouragement.  

More than one participant commented on how men colleagues were key to their success: “…[he] was actually really important for me because I didn’t have female mentors because they didn’t exist” (S2). Others spoke about the importance of having men who understood the discriminatory system as mentors: “… it’s kind of put me in this place where finding male mentors who recognize that it was harder to be a woman [is helpful]” (S2). Participants also shared about the significance of having supportive life partners: “it’s hard enough to have to go learn all these things. I do Step studying. I didn’t do anything useful. I didn’t do the dishes. I didn’t my laundry. My husband did it all for me. … I think it’s huge” (S1).

Finally, students and faculty spoke about gender-specific advice they had received. One shared about lessons she had learned from her mother, who did not go to college until having children: “my mom would always say things like, “You’re going to college,” not like, “Are you going to college?…She was like, “…you’re going to college, and you’re doing it before you have kids. And you’re not getting married before you graduate college’” (S2). A faculty member also reflected on the importance of her mother’s example: “my mom was always the boss in my house, and she was always…the leader in any groups…And I would always see her running the show, and that was what I would look up to” (F3). Participants also shared about learning to respond to sexism from women role models: “I think the most helpful thing for me has been to see the behavior modeled by my attendings and residents to show how they handle it. Because unfortunately, it happens to them on rounds in front of the entire team, just as much as it happens to me alone in an exam room before I go get the attending” (S2).

Self-Presentation

Participants (mainly the faculty) shared that another way to overcome obstacles was to learn how to act in ways that demonstrated leadership and/or exuded the confidence needed to succeed in academic medicine. These included learning to be strategic in their careers, be resilient, and navigate social norms. Participants also discussed how important it is for women to advocate for one another.

Participants shared how they strategized to get where they were. This included knowing what you wanted: “Find what motivates you and then go for it. Totally unabashedly. Go for it.” (F1). This also included learning to “gracefully self-promote” themselves (F4) to share their accomplishments. Others mentioned being comfortable with themselves: “embrace…knowing who you are and being authentic to who you are. Don’t try on somebody else’s thing. And there’s not a type of person that is a leader; the effective people are the ones that know themselves well and are comfortable with being that person in that leadership space” F3.

Resilience was also mentioned multiple times: “roll with the punches instead of feeling flattened and demoralized” (F4). Others felt being challenged was what helped them succeed: “I guess my own resilience and persistence has kind of kept me in the game. I’m also a little rebellious like, ‘You think I can’t do this? Well, let me show you, I actually can’” (F3). Similarly, someone shared: “I think we faced all these different challenges, but as I reflect, I think they’ve made me stronger, more resilient. All these little battles that you have to fight. All these little obstacles on the road, and you kind of just keep plowing through” (F2). Students also said that reflecting on what they had accomplished was helpful: “looking back and see how far you’ve come can be a huge thing. Just remembering where you started and how hard it was just to get into medical school and how hard it was just to get through college…And just remembering that you can do hard things and you’re totally capable” (S1).

Faculty shared how they learned to navigate the social norms. In response to the discussion about constant criticism about how to dress, faculty discussed strategies for not having to make time-consuming decisions about what to wear: “I went through this process where I got rid [of it]… I only wear black, gray, and blue because then I only need black belts and black shoes” (F1). Another participant shared: “I went to Singapore and I got a tuxedo made. And I wore tuxedos for events for a number of years” (F4). Faculty also shared that handling the “whole guilt thing” (F4) related to being a working mother involved prioritizing their children and their well-being. One elaborated: “pay other people to do all of that menial stuff for you, because you will be saner and calmer at the end of the day..If you were trying to do all the other stuff, you’d just be exhausted and frazzled and frustrated. [This way] you’re fulfilling your potential.” (F4).

Finally, participants spoke about the importance of women advocating for each other. One said that hearing about other women’s paths was helpful: “[Someone told me ‘This is going to be hard. There’s no such thing as a good time for when you have kids. There’s no such thing, … you just do it when you’re ready. And that was really reassuring to me…” (F3). Another said having women confidantes was key: “…I had a …situation where incidentally, a male in a position of leadership said, ‘Don’t ask for that. Don’t ask for too much; just be grateful of what you’re getting.’ And I went to some other women colleagues, and they said, ‘Ask for it; you need to make sure you get what you’re worth and ask for these different opportunities in your leadership position,’ and I took the advice I wanted and asked for it.” (F3). Others said women “have to identify and help each other and point out ways to improve and be better so that everybody can reach their maximum potential of where they want to be” (F2).

Discussion

This qualitative study explored the external and internal challenges women medical students and faculty in academic medicine face to ultimately assist in creating a leadership curriculum for women medical students. A curriculum that addresses women’s gendered barriers may more effectively prevent career attrition and foster a break through the “glass ceiling” of academic medicine. Three key themes were identified within the student and faculty discussions: obstacles, support systems, and self-presentation. Obstacles were further subdivided into external and internal factors, with external factors including microaggressions, macroaggressions, few women in existing leadership appointments, and a lack of career role models, whereas internal factors included personal characteristics such as self-doubt and feelings of imposter syndrome. The support systems theme included positive influences such as sponsorship, allyship from men within and outside medicine, and role modeling from women within academia. The final theme, self-presentation, encompassed introspective and extrospective factors such as knowledge of self-identity, clear goals, resilience amid adversity and setbacks, and strategizing how colleagues and society perceive them. Understanding these primary themes and their subdivisions will likely assist medical schools in charting a curriculum for women students.

Obstacles

Overt macroaggressions and microaggressions are public health threats that medical schools and healthcare institutions should eliminate.19 As a multifaceted issue, numerous strategies have been proposed to improve women physicians’ situation. Some of those solutions include creating a clear mission statement that supports pluralism and diversity and providing support programs to minority students.20-22 Partnering with organizations such as TIME’S UP, which aims to improve the safety, power, and equity for all women in healthcare and other organizations, may be one way institutions can demonstrate their commitment to diversity and equity.23 Maintaining a zero-tolerance policy for sexual assault and gender discrimination for all staff members is another useful way institutions can demonstrate allyship.24 Institutions should also consider providing annual or regular training to students, faculty, and staff on recognizing and combating explicit and internal bias.25 Finally, for women students who experience macroaggressions and microaggressions, additional resources that teach coping and communicating skills to combat such events may also be warranted since aggressions will likely stem from both patients and healthcare team members.26

Another barrier to the advancement of women in academic medicine identified by our focus groups was the lack of women role models and mentors. While nearly every academic physician would argue the need for mentorship and coaching for personal and career growth, discussion ensues on maximizing mentoring relationships. As a hot topic in academic medicine, new studies highlight that one size does not fit all for mentoring, especially when it comes to mentoring women.27-29 This sentiment was echoed by participants in this study. Unlike men, women mentees frequently prefer and perform better with women mentors.28,29 For example, a woman mentee may feel more comfortable discussing clothing items for conferences and meetings with a woman mentor. Similarly, a woman mentor might be more approachable to a woman mentee who wants to discuss the struggles of balancing societal, social, and professional expectations and norms. Men and women have also been shown to network differently, which may add further support the importance of having at least one mentor of the same gender.30 Thus, in addition to enforcing equitable hiring practices, institutions should prioritize establishing formal mentoring programs and matching mentees and mentors of similar backgrounds and career goals.27 These formal mentoring relationships would likely benefit medical students, residents, and junior faculty members. Regularly evaluating mentoring relationships is also warranted to ensure mentor-mentee satisfaction and fit.  

As highlighted in the discussion groups, multiple students and faculty members expressed moments of self-doubt that often negatively influenced their actions and career trajectory. These internal obstacles may be best encompassed by the term ‘imposter syndrome’, an experience identified roughly 50 years ago and encompasses feelings of anxiety, undervaluing of one’s career potential, and lack of belonging in the field.31 Imposter syndrome is also linked to poor performance and faulty decision-making, which may produce significant career detriments.32,33 Although students of all backgrounds may experience imposter syndrome to some degree during their training and career, studies show that women are more likely to carry and persist in these feelings. Several argue that this phenomenon originates from women constantly overcoming societal norms and gender discrimination to be perceived as competent.34,35 Many cite that being authoritative, decisive, and loud, especially in high-acuity settings, are generally socially acceptable traits for men but are usually perceived as negative traits for women, who are better perceived when they are agreeable and approachable. However, regardless of the cause of the high incidence of imposter syndrome in women trainees, learning how to address negative internal dialog will likely benefit women aspiring towards academic leadership roles.36 In addition to teaching mindfulness strategies, this obstacle may serve as another motivation to partner women medical students with women faculty members. Witnessing first-hand how women faculty members lead and organize teams may empower women students to lead boldly. Other strategies include peer-to-peer and/or student-to-faculty meetings to create space for discussing failures and emotionally charged events and identifying external and internal areas for improvement.

Support Systems

Sponsorship and allyship were identified as crucial components of the support systems theme in this study and are essential themes commonly identified for career growth in the literature.37-39 However, notwithstanding the importance of sponsorship and allyship, without a broad audience and network, it can be challenging for women to find sponsors who advocate for local and/or national promotion. Additionally, women have been shown to network differently from men, and simply being present at meetings is unlikely to help women foster the kind of relationships needed for promotion.30,39 In a recent multi-institutional study exploring men and women’s experiences with networking within academic medicine, participants of all genders stated that gendered networking practices exist and are catered to men, citing the “boys’ club” as a source of promotion for men and a disadvantage for women.40 Through gendered networking events, men in academic medicine obtain research opportunities, letters of recommendation, and contact with individuals in prominent leadership positions. These advantages increase professional accomplishments and, subsequently, more opportunities for promotion and leadership appointment.40 Women, conversely, have fewer networking opportunities and are significantly less likely to ask for professional favors or opportunities from those within their network in fear that it would be unethical to leverage a personal relationship for professional advancement.30,39,40 There are a few avenues for combatting this phenomenon. Individuals in positions of power should strive to host inclusive, gender-neutral activities and be cognizant of all voices when making decisions that will impact group practice. When leadership positions open, all faculty should be notified of the opportunity. Individuals in leadership positions should also be aware of how they sponsor women sponsees. For example, gender bias is common in reference letters and when colloquially describing women sponsorees.41,42 Program and section leaders should strive to avoid describing women’s physical attributes or gendered adjectives and instead use agentic descriptors and focus on highlighting products and results. Institutions can also demonstrate allyship broadly by employing equitable hiring practices and equal compensation for starting salaries and bonus pay structures. Institutions should also provide protected maternity and paternity leave with each child, daycare resources, and flexibility when childcare services are needed to alleviate child-rearing burden for women students and faculty.43,44 Other strategies include allowing parents to bring their families to work social events and providing child care resources at national meetings.43,44 Women, in turn, should be vocal about their career goals and aspirations. Directly asking leaders and sponsors for endorsement when leadership opportunities arise may also be needed for women trainees and faculty members. Thus, skills-building resources for communication and emotional intelligence would also likely be useful in a leadership curriculum.

Another related topic to allyship and sponsorship highlighted by this study is the importance of male allyship. One female faculty commented the following on how a male leader provided support: “…he texted back to me, ‘You are no longer allowed to have imposter syndrome. Trust me; you’re the real deal.’ … I needed someone else to say that to me, even today, to get me over this hump that like, I don’t belong here in these leadership roles” (F3). This study example echoes the findings from the well-cited article by Pololi et al.,45 which found that women frequently report a lower sense of belonging and fewer, poorer relationships at work.45 Although this sentiment is likely multifactorial in origin, since most academic appointments are held by men, the importance of male allyship is imperative to improve feelings of belonging. It should also be noted that women are not seeking validation or approval from their male colleagues, but are instead seeking support from their professional peers and supervisors.46,47 Creating a supportive community may be especially important for women in fields where men predominantly occupy academic appointments; such as surgical specialties. This was also noted in our study with many women faculty highlighting the importance of male mentors and sponsors in their career.46,47 Other studies have also echoed the importance of this cross-gendered mentoring.48  In addition to backing from male colleagues, women also expressed the importance of allyship within the home. Regarding domestic responsibilities, several female students and faculty members commented that they could better focus on professional goals when their male significant others performed most of the domestic work. These findings echo those of others and support that traditional, gendered home roles are dissolving and are becoming more equal.49,50 These pooled study findings affirm that women who are supported by their peers, leaders, and life partners are more likely to report satisfaction at home and work.

Self-Presentation

            As displayed in this study and others, proficiency in setting short- and long-term goals is crucial to attaining career advancement and overall satisfaction.51,52 While various studies define short- and long-term goals, short-term goals generally comprise action items that can be measurable within 6- to 12 months and work in concert to achieve overarching long-term goals. Interestingly, study participants did not pinpoint how to set effective short- and long-term goals; instead, they pointed out why goals should be set, and focused on the significance of authenticity and self-awareness. Accurately estimating one’s ability and regularly examining one’s motivation have recently been explored as key factors for improving overall resiliency and preventing burnout.53,54 In fact, understanding and reviewing one’s purpose and ‘why’ in medicine is considered so valuable that medical schools and healthcare systems throughout the nation are dedicating educational and training resources to increase self-consciousness in trainees and faculty members alike.55-57 This is not entirely surprising since individuals at the medical school level and beyond generally already have proficiency in setting and achieving goals. In many instances, the leaky pipeline appears more attributable to losing focus on why the goals and lists of tasks were set.58 Thus, with the ever-increasing burdens placed on women medical students and physicians, systems and programs that help keep women’s ‘why’ forefront may be essential to prevent burnout and provide encouragement as they climb the academic ladder. Maintaining a clear vision of self-identity, purpose, and ability will also enable women to appropriately select which academic avenues to pursue and allow more ‘all-in’ focus on what matters most. Minimizing distractions and turning down opportunities that do not contribute to one’s overall ‘why’ or overarching career goals will also promote resiliency and decrease burnout.

            Navigating societal and professional norms can cause significant decision-making fatigue and distress for women physicians. In addition to the previously mentioned solutions, women faculty emphasized the importance of delegating minute tasks and nonessential decisions whenever possible to lighten daily cognitive burdens. Some strategies faculty members recommended include minimizing their professional wardrobes to coordinating pieces, asking other healthcare team members to carry out administrative duties that don’t require a physician-level education to perform, and hiring others to perform household responsibilities. Appropriate delegation of tasks and decisions may greatly reduce women’s pressure to be full-time physicians and caretakers. Learning to delegate also has positive implications for leadership attainment, as efficient delegation is critical to creating effective teams.59 In addition to delegating, societal and professional pressures can also be better managed by supporting and relying on other women in medicine to be mentors and sponsors.60 This point mentioned by women faculty members reiterates the importance of having at least one mentor of the same gender and effectively using one’s network to promote other women in medicine. In addition to providing individual support, solidarity among women faculty and trainees may also serve as a catalyst for improving systemic barriers.60

Limitations

            One study limitation is the inclusion of participants from a single center, which may differ from the experiences of women from other institutions and regions. However, since this study was ultimately performed to assist with the creation of a women medical school leadership curriculum at the Spencer Fox Eccles School of Medicine at the University of Utah, results are significant for study investigators and will likely be useful to others with similar goals.

Conclusion

This exploratory study of women medical students and faculty identified three key themes to remedy the leaky pipeline in academic medicine: obstacles, support systems, and self-presentation. Obstacles were further defined by a lack of mentors and role models, discrimination, and gender bias. Support systems emphasized the importance of mentorship, sponsorship, gender-neutral networking, and male allyship. Self-presentation focused on the gravity of being authentic, keeping one’s purpose forefront while pursuing short- and long-term goals, appropriate delegation of tasks, and solidarity with other women in medicine. These themes and their respective subdivisions are areas for structured improvement for women to circumvent the effects of the leaky pipeline and ultimately break the glass ceiling of academic medicine.

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Return to Table of Contents: 2023 Journal of the Academy of Health Sciences: A Pre-Print Repository

Women Leaders in Academic Medicine: A Qualitative Study Addressing the Leaky Pipeline by Candace Chow, PhD, Meganne N. Ferrel, MD, Emily M. Graham, MD & Megan Fix, MD