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Advancement of Women |
A review of the most recent data maintained by the American Dental Education Association and its counterpart for medical education, the American Association of Medical Colleges, reveals that the number of women serving in significant administrative or leadership positions in medical and dental colleges in the United States remains a small percentage of those employed. This disparity is particularly of concern as the number of female students enrolled in these same institutions has steadily increased.
At the time that this presentation was prepared, enrollment data for the 2002–03 academic year indicated that 46.7 percent of those enrolled in 145 medical colleges throughout the country were female,1 and similarly, 42 percent of those enrolled in the country’s then fifty-five dental colleges were women (see Table 1
).2 Subsequent to this presentation, new survey data became available demonstrating that, in the fall of 2004, 48.6 percent of medical students and 43.8 percent of dental students were women in what had then increased to fifty-six dental schools. In fall 2005, 31.5 percent of all faculty members in medical schools were women, but only 4 percent of professors, 6 percent of associate professors, and 15 percent of assistant professors were women (see Table 2).3
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). Among dental schools in the United States and Puerto Rico, ten (18 percent) of the deans or interim deans are female, and 14 percent of division chiefs and department chairs are women, which represented ninety individuals.5 In 2003–04, among the 125 allopathic medical schools, the range of females on the administrative team ranged from 0 percent at fifteen schools to 36 percent at two schools (University of Hawaii and Meharry University). That same year, thirty medical schools had only one woman in an administrative position. Thus, although the number of female enrollees is growing significantly, it is not commensurate with the growth in the number of senior female faculty and administrators.
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Perhaps the most illustrative work about the impact of this underrepresentation is Rosabeth Moss Kanter’s book A Tale of "O": On Being Different in an Organization.8 Kanter describes the inadvertent spotlighting of those who are different, which leads to scrutiny; the development of a double standard; a sorting out of the group by common identities, which isolates those who are different; development of an uncomfortable awareness of difference; overprotection of those who are different; and development of networks of similar people, which provides backups for them and leads to isolation of those who are different.
Against this backdrop, women in academic medical and dental institutions have had to develop their own strategies and coping styles for advancement. To assist individual faculty and institutions, in 1996 the U.S. Department of Health and Human Services (DHHS) Office on Women’s Health included women’s leadership as a required component of the nationally funded Centers of Excellence in Women’s Health to identify effective strategies and initiate model programs to advance women faculty.9 Although the Executive Leadership in Academic Medicine (ELAM) program preceded the DHHS mandate, it is an example of the type of programs DHHS intended to spawn, as is the Circles of Power (COPS) program. ELAM was incorporated into the Center of Excellence in Women’s Health, and Drexel University College of Medicine is the host institution for the national program. COPS is a campus-based program at the University of Kentucky.
As female senior administrators at the University of Kentucky College of Dentistry who are interested in enhancing leadership training and opportunities for women, our initial interest was in determining which women faculty should be selected for which of the existing women’s leadership programs at what point in their faculty careers. To learn about the programs, we interviewed five past participants from each program and the director of each of the programs.
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Leadership Program Descriptions |
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COPS became a campus-wide program in 2003. Although it has broadened its circle of influence, it has remained true to its established purposes, which are to increase the recruitment and retention of women faculty members, establish a network of colleagues, stimulate new collaborative relationships, and create an environment in which women faculty will achieve their full leadership potential. After including women from disciplines outside the medical center, the issues and need for skill building were determined to be similar for women in faculty positions throughout the entire university.
COPS is a multiphased program built on the premise that the knowledge and tools of leadership cannot develop as a result of an isolated workshop but rather must evolve over a period of time. The program now consists of four phases, beginning with a two-day retreat that introduces participants to their own leadership attributes, decision-making styles, potential leadership blocks, and the theoretical basis of group formation and development. Structured evaluation instruments are used, including the Myers-Briggs Type Indicator and the Belbin Team Building Instrument.10,11 Phase Two is a series of monthly sessions focusing on specific skill building, including conflict management, team building, communications, goal setting, negotiating techniques, the art of saying no, emotional intelligence, and decision making. Phase Three provides an opportunity in a retreat format for participants to integrate previous learning with the latest in management theory and practice.12 Phase Four, an ongoing network of COPS graduates who assemble monthly, was initiated by the graduates.
COPS is currently sponsored by the President’s Commission on Women and accepts fifteen to twenty women each year. By 2004, sixty-five women had completed the program. A five-year outcomes evaluation was performed at that time.
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Executive Leadership in Academic Medicine |
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The initial programming was to have three curricular foci. One focus was strong in finance, conceived of as a "mini-MBA," and included conflict management, change management, and organizational structure and dynamics. The second focus was personal self-assessment and skill building and included the use of several structured instruments such as the Myers-Briggs Type Indicator and Benchmarks,13 the Center for Creative Leadership’s 360-degree feedback instrument designed to encourage introspection. The second focus also included enhancement of presentation skills and one-on-one career consultations. The third focus was on emerging issues and the concept that women lead differently from men.
As with COPS, the curriculum has evolved in response to feedback from a formally structured participant evaluation, a national advisory committee, and observations of involved faculty. For example, the curriculum currently includes a significant segment on technology and its application, and the program is designed to include more skill building than theory. Deans from the fellows’ schools must attend final programming segments and set expectations for the fellow during and after completion of the program. External funding for program evaluation and research on how women learn leadership has been acquired from the Robert Wood Johnson Foundation since the beginning of the program.
The program began in the fall of 1995 with a class of twenty-five, all from medical schools. Two fellows from dental schools were selected in 1996 as part of a three-year pilot, and dental school participants have been included since that time. In 2005 the ELAM Advisory Committee approved the trial inclusion of faculty from schools of public health as well. The class size has gradually increased from twenty-five to a maximum of forty-five, and by spring 2005, 375 women had completed the fellowship.
The format of the fellowship includes three sessions, the first and last of which are held at a conference center close to the Philadelphia campus of Drexel University College of Medicine (formerly the Medical College of Pennsylvania-Hahnemann). The intermediate session is held in conjunction with the American Association of Medical Colleges’ annual meeting and its sessions on women in medicine. Several articles have been published detailing the outcomes of the ELAM program.14,15
As with COPS, graduates of the first ELAM class established an organization for continuation of their network and learning experience. This organization, the Society for Executive Leadership in Academic Medicine (SELAM), is a separate 501(c)(3) entity and holds annual meetings in conjunction with the beginning of the third session of ELAM. SELAM underwrites part of the programming costs for the third session of ELAM by offering its members continuing education in leadership that is simultaneously suitable for the ELAM fellows. Membership in SELAM is open to men and women holding M.D., D.D.S., D.M.D., or Ph.D. degrees who are faculty or administrators in medical or dental schools or are personal career consultants to faculty.
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Methods |
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Institutional Review Board approval was obtained for this study. All interviews were conducted by the two authors, and notes of responses were kept from each interview. Each interview was scheduled for no more than sixty minutes. Individuals were selected to represent both dentists and nondentists employed as full-time faculty at academic dental institutions. All faculty interviewed continue to be employed full time at academic dental institutions. All of the COPS participants interviewed have remained at the University of Kentucky, four of the five ELAM participants remain at the institution that sponsored their participation in ELAM, and one ELAM participant advanced to an administrative position in another dental school.
We then took the notes from the completed interviews and analyzed them for similarities, differences, and recurring themes. Responses were categorized by agreement between the two authors.
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Results |
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Both COPS and ELAM participants identified communication skills development, group dynamics, and team building as curricular strengths. Lack of flexibility in scheduling was noted as a common curricular weakness among both groups. Also identified as a barrier or difficulty encountered by all participants was time spent away from their institution or job site. When answering the questions on skills learned during the leadership program that had applicability to future career goals, participants in both groups identified improved communication skills and a better understanding of leadership styles. Personal benefits gained by both groups included an enhanced self-awareness or self-confidence and the opportunities for networking that the programs offered. The greatest values of the program by far were seen in the networking that took place across the varied health professions that participated and the personal/professional growth that each participant experienced. This growth continued in many instances such as 1) the development of SELAM, 2) informal alumni programs or groups developed to preserve the relationships forged during the programs, and 3) development programs at home institutions for dissemination of information learned.
One of the major dissimilarities between the COPS and ELAM programs was in curricular content. ELAM included significant instruction in understanding the financial position of the health sciences environment. COPS did not include a significant financial curriculum, and this was identified as an area that would have been a helpful addition. The levels of difficulty in assignments or curricular challenges were also seen as differences between the programs, with ELAM considered to be much more rigorous. Unlike COPS, participants in ELAM had individual and group assignments or projects that had to be completed between sessions.
Another major difference between the two programs was the expectations placed on participants by their home institution once the leadership training was completed. All interviewed COPS participants responded that no articulated expectation of increasing responsibility or application of skills learned was placed on them by their administration either before or after their participation. Some participants were frustrated because of this and related this to a difficulty to advance within their home institution. They felt no change in value to their institution following completion of the program. ELAM, on the other hand, had defined projects identified by participants in conjunction with their deans that involved applying new leadership skills or sharing new skills with others. Participants said that they gained visibility and credibility in the eyes of their home institutions and were seen as much more valuable following ELAM.
In terms of the programs’ overall main emphasis, COPS had a focus on the individual participant’s self-development and a personal focus on leadership skills that included such tools as journaling and reflecting on feedback from testing instruments, while ELAM took a global institution-wide approach to leadership training that encompassed both personal and professional training in leadership but included more group projects and peer learning. The ELAM program also involved interaction and mentoring with national role models in a variety of professions, while COPS did not.
Another dissimilarity was the lack of ability to change the institutional culture. ELAM has an articulated goal to change the culture in institutions to value the contributions of all and to improve women’s health. The lack of significant numbers of graduates in any single institution, however, makes it difficult for ELAM graduates to change institutional culture, as opposed to those who completed COPS, where a critical mass of graduates exists on a single campus to enhance networking and support.
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Discussion |
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A clear need exists at both the local and national levels for women’s leadership programs such as ELAM and COPS because of the increasing numbers of women leaders in dental and medical schools who have had no formalized leadership training or mentoring. Such programs will prepare women to assume leadership positions and thus improve the culture for women in the academic health centers. Articulated expectations or objectives by deans or the administration following completion of the program will aid participants in assuming leadership roles or applying leadership skills in their institutions, thus maximizing the benefits to both the participants and their respective institutions.
Networking gained through getting to know others within the programs has the potential for both short- and long-term effects, whether for collaborative opportunities, role models and mentors, or assistance in advancement to higher positions at home or other institutions. Optimal timing for participation may vary, depending on an individual’s current position, short- or long-term individual goals, or personal needs, including family obligations. Due to its curricular emphasis on academic health center issues, ELAM may be more valuable later in a woman’s career when she is already in a position of leadership, while COPS provides an introspective aspect that may serve somewhat more junior faculty who are considering leadership positions. Adding subject areas to the COPS program would strengthen its appeal to more senior-level faculty as well.
Two problems related to any leadership program that is intensive and encompassing in its scope are resources and time. Due to the shortage of available faculty in dental education, respondents found that time away from the institution and time to complete assignments were major areas of concern. These concerns pose a challenge for administrators when they are considering the nomination of a faculty member for participation in the programs. More creative use of residential time coupled with virtual learning approaches may help address this challenge.
Overall, the outcomes obtained from our sample population indicate that leadership programs such as COPS and ELAM are beneficial to the advancement of women to positions of leadership in academic health centers. In addition, if clear expectations are defined for the participant before starting the training program, substantial benefits for the home institution and the individual will be gained.
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Footnotes |
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REFERENCES |
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This article has been cited by other articles:
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  H. C. Slavkin and L. Lawrence Incorporating Leadership Knowledge and Skills into the Dental Education Community J Dent Educ., June 1, 2007; 71(6): 708 - 712. [Abstract] [Full Text] [PDF]
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