On February 5, AWN President Sherida Tollefsen addressed the Executive Faculty at the invitation of Dean William A. Peck. In her talk, Tollefsen noted that the AWN represents approximately 150 women faculty at WUMS and outlined the accomplishments of the organization. This included sponsoring seminars by prominent women physicians and scientists, establishing a leadership award for graduating female medical students and graduate students and producing the Family Resource Handbook.

She then described the status of women at WUMS in 1997. Since 1986, the number of women at the level of assistant professor and above has risen from 10% of the total faculty to nearly 16% of the faculty. Although the number of women has increased somewhat, they are still disproportionately represented at the lower ranks. While half of the men hold the rank of Associate or Full Professor, only 20% of the women hold these ranks. In addition, women account for only 5% of the full professors and 14% of the associate professors. Nationally, women represent 10% of full professors and 21% of associate professors at medical schools according to AAMC statistics. Thus, women are significantly under represented in the upper ranks at WUMS.

Tollefsen described the success of a recent program undertaken in the Dept. of Medicine at the Johns Hopkins School of Medicine (see accompanying excerpt) to increase the representation of women on the faculty. She proposed that a task force be established to develop a similar program at WUMS and offered to work with the Administration accomplish this goal. At the end of her talk, Dean Peck agreed to appoint such a task force.

On February 11, Dean William A. Peck established the Task Force of the Status of Women at Washington University School of Medicine. The purpose of the committee is to make recommendations on mechanisms to enhance the number of women faculty at WUMS, ensure pay equity and improve the quality of professional life for all women faculty at the medical school. Chaired by Dr. Ronald Evens, the committee also includes Drs. Linda Pike, Penny Shackelford, Marilyn Siegel, Philip Stahl, and Sherida Tollefsen.

As a first step, the Task Force has decided to carry out a survey of WUMS faculty to delineate concerns and identify solutions to problems encountered by all faculty at the medical school. The survey will be carried out during the summer of 1997 and results will be communicated to faculty and Administration shortly thereafter.

Anyone wishing to make suggestions regarding topics/questions to be included in the survey should send them to Linda Pike (Box 8231 or pike@biochem.wustl.edu).

The annual AWN Spring Dinner Meeting has been scheduled for Monday May 19 and will be held at the Whittemore House. The after dinner speaker is Diane Wara, M.D., Associate Dean of Women at the University of California, San Francisco, School of Medicine. The title of her talk is "Developing Diversity in Academic Medical Centers". Please plan to attend. Invitations have already gone out. If you did not receive one, contact Kathy Sheehan at 362-8744.

Rita Basuray was promoted to Associate Professor in the Dept. of Obstetrics and Gynecology.

Kathleen Hall was promoted to Associate Professor in the Dept. of Biochemistry and Molecular Biophysics.

M’Liss Hudson was promoted to Associate Professor in the Dept. of Surgery.

Leslie Kahl was featured in the Washington People section of the Record. She was also accepted into the ELAM program.

Ellen Li was promoted to Professor in the Dept. of Internal Medicine.

Susan Mallory was Elected President of the Society for Pediatric Dermatology for 1996-1997.

Barbara Monsees was interviewed by "Good Morning, America’s" Dr. Nancy Snyderman for a piece on radiolucent breast implants.

As many of you know, I reported on the AWN to the Executive Faculty of the School of Medicine in February. I updated the department chairmen on our organization's policy objectives and activities and reviewed the number of women faculty here. Our institution lags behind other medical schools in the percentage of women at each rank: 10% of medical school professors are women nationally compared to 5% at WUSM; 21% of associate professors are women nationally compared to 14% here; 33% of assistant professors are women nationally compared to 26% here. This is not simply a "pipeline problem" since women have comprised 25% of all American medical school graduates since the early 1980s and ~40% since 1990.

I stressed that it will be important to draw proportionately from this pool of highly-qualified graduates to sustain our institution's competitiveness and excellence in the 21st century, but to do this, the obstacles that women experience in academic scientific careers must be identified. The American College of Physicians and the Association of American Medical College (AAMC) have urged all medical schools to design and implement institutional strategies that will foster the success of women faculty. The AWN Board of Directors is pleased that Dean Peck agreed to establish a Task Force on Women's Academic Careers at WUSM.

The speaker at our spring dinner meeting, Dr. Diane Wara, Associate Dean for Women at UCSF School of Medicine, will bring considerable insight and experience to the topic, "Developing Diversity in Academic Medical Centers." I am looking forward to the evening and hope many of you can attend.

Sherida Tollefsen

The March 1997 Lancet published a supplement on women’s health. The journal included an eclectic mix of topics. Topics included depression, "state accountability for wife-beating: the Indian challenge", hearts, hormones, breast cancer and bones. The forward stated that "to focus on women’s health is to set medicine in a far wider social context--where all health care belongs." Some of the papers made reference to the ill-health women suffer in the developing countries.

"Breast Cancer: The New Legislative Rage" is the title of a recent article in "Breast Cancer Action". The article reports that "any doubt that breast cancer has become a hot political issue can now be laid to rest. Politicians are clamoring to sponsor legislation on breast cancer issues. Some of these elected representatives--such a Diane Feinstein, Olympia Snowe, Nancy Pelosi, Anna Eshoo, Rosa DeLauro and Louise Slaughter in Washington have been long-time leaders on issues related to women’s health. Others have found that mentioning breast cancer gets the attention of women voters and seem to be tripping over themselves to take credit for introducing measures related to the disease." This writer suggests that since women have been neglected for so long, we might be wise to utilize the attention now!

"They want what we’ve got (for once!)." The "National Women’s Health Network" writes "Imitation is the sincerest form of flattery and clinicians and others are trying to imitate the success of women’s grassroots activism in securing more government funding for breast cancer research. However, the breast cancer movement is primarily a consumer-driven movement, made up of hundreds of local groups and thousands of individual activists. In contrast, the Journal of the National Cancer Institute reported on January 15, 1997, that the newly formed National Prostate Cancer Coalition emerged from the American Foundation for Urologic Disease, a ‘patient-oriented’ group founded by the American Urological Association and funded through a grant from Zenecca Pharmaceutical, manufacturer of tamoxifen." (Is this imitation or competition?)

Women are less likely to succeed in academic medical careers in the United States than men. Compared with men, women are underrepresented in leadership roles, have slower rates and lower likelihood of promotion, and are less likely to become professors in their departments. Among the more subtle factors that may underlie the lesser likelihood of success for women in academic scientific careers are reduced access to mentoring and to rewards, including promotions, salary, and recognition. Other key factors are isolation from colleagues and career-related professional information. It has been shown that women receive fewer resources to accomplish their goals, including necessary personnel, space and equipment. Further, academic institutions are often organized on the assumption of a "social and emotional support structure provided to the male scientist by an unpaid full-time housewife or done without," leading to structural, institutional impediments to careers for individuals without this support structure. Outright gender discrimination is another obstacle.

Attaining a critical mass may not be sufficient to remove the obstacles that women experience in academic scientific careers. For this reason, the American College of Physicians and the Association of American Medical Colleges (AAMC) have urged all medical schools to design and implement institutional strategies that will foster the success of women faculty and their promotion to senior faculty positions.

In a study reported in the September 18, 1996 issue of JAMA, Fried et al. set out to determine the gender-based career obstacles for women in an academic department of medicine and they outlined the interventions adopted to correct such obstacles. They also reported the results of these interventions.

Initially their Task Force on Women’s Academic Careers in Medicine carried out a baseline evaluation of faculty perceptions by carrying out an anonymous survey of the faculty in the Department of Medicine. Significantly more women than men perceived a wide variety of career impediments, many gender-based, involving promotions, collaborative interactions, networking, male-female interactions, and general climate. Notable differences included the relative lack of effective mentoring for women as well as meetings occurring at times that conflict with family responsibilities. Differences in future expectations were also noted. A lower proportion of women expected to be promoted than did men. Notably, only 40% of the women who wanted to be in academic medicine 10 years later expected that they would be, compared with 66% of the men. Conversely, almost two thirds of the women were seriously considering leaving academic medicine, compared with 43% of the men. Among the reasons cited for considering leaving academic medicine, a perception of isolation was the only one that differed significantly by gender (cited as a reason by 80% of women compared with 34% of men).

Overall, women faculty reported a high prevalence of gender-based career obstacles. While some were structural in origin, the majority appeared to be more informal and subtle. The latter were consistent with the definition of gender discrimination as "behavior, actions, policies, procedures, or interactions that adversely affect a woman’s work due to disparate treatment or impact, or the creation of a hostile or intimidating work or learning environment." It appeared that gender-based obstacles occurred in many different aspects of a woman’s career, perhaps leading to what Bickel has described as the "cumulative disadvantages" that have a summary dampening effect on careers. Since there appeared to be multiple impediments to women’s careers , the resolution of any one impediment would not be sufficient in itself to correct the overall career-dampening effects.

Multiple interventions were thus implemented in the Department of Medicine in October 1990, with the long term goal of eliminating the gender-based obstacles to women’s careers. The department chair and the task force committed to a long-term, 15 year intervention to meet this goal. The short term 5-year goals were: to retain excellent women faculty; to establish and maintain salary equity among faculty; and to increase the number of qualified women at the associate professor rank to a proportion equivalent to the percentage of men at the rank.

Interventions were initially developed by the task force and/or the department chair, with decisions for implementation made collaboratively. Areas to which interventions were targeted included, leadership, education as to the nature of gender-based obstacles, isolation, faculty development, mentoring, rewards, structural obstacles, and monitoring and evaluation.

Leadership was defined as the most critical element of the intervention and had three components. The first was strong and visible leadership by the department chair regarding the necessity of eliminating gender-based obstacles. The second leadership component was the Task Force on Women’s Academic Careers in Medicine. Many interventions were developed and implemented by the task force, but under the legitimizing auspices of the department chair. After 2 years, the task force was formalized as one of only three standing committees in the department. The third leadership component was a faculty/organization development specialist with skills in organizational assessment and change management. This specialist worked to evaluate departmental and divisional structure and decision-making methods and helped to institute changes that would be more inclusive and supportive of the careers of all faculty. She also served in ombuds-like roles in the department, helping to analyze problems experienced by women faculty and trainees and, with the department chair, mediate solutions.

For all faculty, outside consultants provided lectures, workshops, and focus groups to legitimize and develop understanding in these areas. Results of surveys and recommendations of the task force were distributed to all faculty and discussed at town meetings of faculty, in leadership development meetings for division chiefs, at divisional faculty meetings, and at the departmental retreat. For the women faculty, a monthly colloquium was sponsored by the department and organized by the task force to foster consensus about gender-based career obstacles and to perform evaluation of progress and needs. The monthly colloquium also targeted the development of essential career knowledge and skill.

The months colloquium also provided opportunity for women faculty to get to know each other, which resulted in a sense of critical mass and thereby reduced isolation. For the first time, women had a substantial presence as speakers at medical grand rounds and the major annual departmental educational conference. A concerted effort was made to identify women, as well as men, as leaders in planning subcommittees and as speakers at these retreats. Two or more women were included on every search committee in the department and the task force nominated women for all departmental searches.

A review of promotions in the Department of Medicine revealed that, prior to 1990, many women were first evaluated for promotions at the limit of time at rank. It appeared to the Department of Medicine promotions committee that women, more than men, either were not aware of the types of productivity required for promotions or had job descriptions less likely to facility this. Therefore, the Department of Medicine promotions committee was instructed to review the C.V. of each woman faculty member annually. This intervention led to early identification of women whose careers were not progressing adequately, allowing time for effective action by the department chair. This review was found to be so useful that it was expanded to include male faculty.

It also appeared that most women were not receiving adequate mentoring. To compensate, the monthly colloquium was used to provide information on tasks and goals at each level of a faculty career, characteristics of quality mentoring and conflict management and negotiation. To enhance the mentoring by leaders, the department chair modeled annual review and mentoring sessions by initiating these with the division directors. An instrument for use in a standardized annual review that incorporated all aspects essential to career development and success was developed by the task force and recommended for implementation. Most divisions are now performing such annual reviews.

The faculty/organization development specialist worked with the department chair and most division directors to evaluate divisional rewards, communication, and decision-making processes and to recommend structural and style changes that would make them more explicit, equitable and inclusive of women. Additionally, the school of medicine lengthened the time limits at each rank to enhance the possibility of promotion for individuals needing to devote time to personal demands.

The task force annually presented a written evaluation of progress at the departmental and divisional levels and recommended goals and additional methods to correct gender-based obstacles to women’s careers. In addition, a follow-up evaluations of faculty concerns and progress was performed by questionnaire in late 1993.

In the 3-year follow-up study, the faculty reported changes in many of the areas targeted for interventions. From one-half to two-thirds of women faculty reported improvements in timeliness of promotions, manifestations of gender bias, access to information needed for faculty development, isolation and salary equity. One quarter of women faculty said that mentoring had improved. Men also reported improvements in each of these areas.

Future expectations also changed. There was a 66% increase in the proportion of women who expected to be promoted (from 44% to 73%) and a similar decline in the proportions of women considering leaving academic medicine. Notably, among those considering leaving in 1993, the importance of isolation as a factor had declined (50% in 1993 compared with 80% in 1990). While there was little change in the proportion of women who wanted to be in academic medicine in 10 years, there was a 183% increase in the proportion who expected that they would still be in academic medicine (from 23% to 65%). With regard to these future goals, men’s expectations changed similarly to women’s in direction but at a lesser magnitude. Unchanged after 3 years were responses to questions about male-female professional interactions, collaborations or mentoring relationships and reported sexual harassment.

The authors concluded that the strategy of targeted efforts to decrease gender-based career obstacles led to substantial positive changes in the experiences of women faculty and in their future expectations of success. Men also perceived benefit in association with these interventions.

Several key components of the intervention strategy deserve emphasis. The first is that active support from the department chair was essential to the success. Second, it was anticipated that all interventions had to be long term because of the complexity of the obstacles and the extent to which they are imbedded in academic and societal culture. Third, the multifaceted nature of obstacles to women’s careers necessitated similarly complex interventions. Fourth, the intervention was progressive and implemented in small steps. With better understanding, new concerns have been sequentially identified and new five year goals established.

(Excerpted from Fried et al. JAMA 276: 898.)

On April 9, AWN sponsored a brown bag lunch on gender-based differences in public speaker. The panel included AWN member Helen Kornblum, MSW, Dr. Lynn Kipnis (SLU) and Melanie Dryer from the Dept. of Performing Arts at Washington University. The discussion on early development of gender differences in communication skills was enlightening and the pointers on public speaking given by Melanie Dryer were extremely useful. The meeting was well attended by female faculty and female students.