INTRODUCTION:Despite the recognized need for effective mentoring for faculty in academic medicine, mechanisms driving successful mentoring interventions remain underexplored. Two consecutive cohorts of 20 academic medicine mid-career research faculty from 27 US medical schools participated in a randomized controlled trial of the yearlong C-Change Mentoring & Leadership Institute intervention. Participants convened quarterly for 2- and 3-day intensive sessions in 2020 to 2022. METHODS:We examined how this complex group peer-mentoring intervention produced positive changes in the perspectives, attitudes, and practices of individual faculty participants and the group. Qualitative data included ethnographic observations, participant writings, and semi-structured interviews. We used codebook thematic analysis to characterize changes in individuals and the group, paired with a realist evaluation framework to identify essential functions and activities within the C-Change Institute. RESULTS:The mechanisms that produced change consisted of four key functions, each involving multiple forms (or activities): (1) forming group culture through participatory activities, establishing psychological safety and mutual affirmation; (2) encouraging self-reflection through introspective exercises and structured storytelling; (3) forming empathic relationships, telling life stories, and discussing experiences of difference and power; and (4) envisioning a successful future through aligning personal values and professional goals, using structured stepwise short and long-term career planning. The authors illustrate the interactions of these functions and activities. DISCUSSION:This successful mentoring experiment of learning and career development in a changed culture provides a blueprint for broader culture change in academic medicine that must honor values, encourage reflective practice, team building, and relational leadership in career development.

Introduction:This mixed-method study sought to elucidate the impact of COVID-19 on the professional environments and career trajectories of midcareer research faculty in U.S. medical schools. Methods:Participants were 40 midcareer medical school faculty enrolled in the Brandeis University C-Change Mentoring and Leadership Institute, a group peer mentoring career development course being tested in a National Institutes of Health-funded randomized controlled trial. Results:We observed a gender disparity in both the quantitative and qualitative data, with women faculty describing COVID-19 more negatively impacting their career trajectory. This negative impact was independent of having children in the home. Participants largely reported no change in their commitment to conducting research or interest in applying for research funding. A total of 54% of faculty reported no effect of the pandemic on their relationships with colleagues (n = 21) and 33% reported a negative effect (n = 13). A trend emerged when examining the data by degree, however, with PhD faculty about twice as likely as physicians to report a negative effect of the pandemic on their relationship with colleagues (47% n = 9 vs. 20% n = 4, respectively). The ordinal test on the 5-point scale approached statistical significance but did not meet the standard 0.05 cut-off (p value = 0.06; Z-value = -1.86). Conclusions:While faculty initially reported some positive outcomes of the SARS-CoV-2 pandemic in their own experiences in April 2020, their experiences 1 year later reflected negative impacts of the pandemic on career trajectory, especially for women, and on relationships with colleagues, with a higher intensity signal for PhD scientists.

Introduction:Research faculty often experience poor mentoring, low vitality, and burnout. We report on our logic model inputs, activities, measurable outcomes, and impact of a novel mentoring intervention for biomedical research faculty: the C-Change Mentoring & Leadership Institute. We present a) a detailed description of the curriculum and process, b) evaluation of the program's mentoring effectiveness from the perspective of participants, and c) documentation of mentoring correlated with key positive outcomes. Methods:A yearlong facilitated group peer mentoring program that convened quarterly in person was conducted twice (2020-2022) as part of an NIH-funded randomized controlled study. The culture change intervention aimed to increase faculty vitality, career advancement, and cross-cultural competence through structured career planning and learning of skills essential for advancement and leadership in academic medicine. Participants were 40 midcareer MD and PhD research faculty, half women, and half underrepresented by race or ethnicity from 27 US medical schools. Results:Participants highly rated their mentoring received at the Institute. Extent of effective mentoring experienced correlated strongly with the measurable outcomes of enhanced vitality, self-efficacy in career advancement, research and work-life integration, feelings of inclusion in the program, valuing diversity, and skills for addressing inequity. Conclusions:The mentoring model fully included men and women and historically underrepresented persons in medicine and minimized problems of power, gender, race, and ethnicity discordance. The intervention successfully addressed the urgencies of sustaining faculty vitality, developing faculty careers, facilitating cross-cultural engagement and inclusion, and contributing to cultivating cultures of inclusive excellence in academic medicine.

Introduction:Diverse perspectives are considered essential for achieving the best science and education in biomedicine. To evaluate attitudes and abilities necessary to achieve the benefits of drawing on diverse perspectives, we assessed five novel metrics: Valuing Diversity: Attitudes and Behaviors, Antisexism and Antiracism Skills, Change Agency for Equity, Identity Self-Awareness, and Cognitive Empathy. Methods:Using the C-Change Faculty Survey we surveyed faculty in medical and other health profession schools. Psychometric evaluation included: internal consistency, exploratory factor analysis, multiple indicator multiple causes (MIMIC) modeling, item response theory (IRT) analysis, and differential item functioning (DIF) analysis. Results:Sample: 3,724 faculty at medical schools and 591 at other health profession schools; male: 2,193; female: 1,901; 757 were underrepresented by race and ethnicity; 3,290 faculty were adequately represented; mean response rate: 60%. All five scales showed excellent internal consistency. Each scale was well characterized by a unitary factor. MIMIC analysis on three scales demonstrated a three-factor structure. IRT demonstrated strong measurement properties, although DIF between underrepresented and non-underrepresented groups, and males and females was evident. Conclusions and Significance:The conceptual model presented and these psychometrically strong scales will prove useful for institutions looking to evaluate objectively faculty intercultural competence and address health equity.

Introduction Improved mentoring of midcareer researchers in medical schools has been identified as an important potential avenue for addressing low vitality and high burnout rates in faculty, and the scarcity of both underrepresented minority (URM) faculty and women in biomedical research. To address the need for widescale effective mentoring, we sought to determine whether a group peer mentoring intervention (C-Change Mentoring and Leadership Institute) for early midcareer research faculty was effective for different demographic groups in a controlled trial. Methods and materials Thirty-five diverse early midcareer faculty and 70 propensity-matched (PM) control subjects matched to intervention subjects on a) study inclusion criteria; b) gender, race, and ethnicity, degree, rank, years of experience, publications, grants; and c) pretest survey outcome variables, participated in the intervention. The C-Change Participant Survey assessed vitality, self-efficacy in career advancement, research success, mentoring others, valuing diversity, cognitive empathy, and anti-sexism/anti-racism skills at pretest and intervention completion. Analysis using multiple regression models included outcome pretest values and indicator variables for intervention, gender, URM status, and MD vs. PhD. Hypotheses regarding differential effectiveness of the intervention by demographic group were tested by including cross-product terms between the demographic indicator variables and the intervention indicator. Missing data were addressed using chained equations to create 100 data sets. Results and discussion The intervention participants had significantly higher (favorable) scores than PM controls for: self-assessed change in vitality; self-efficacy for career advancement, research, and mentoring others; cognitive empathy; and anti-sexism/racism skills. The benefits of the intervention were nearly identical across: gender, URM vs non-URM faculty, and degree MD/PhD, except vitality significantly increased for non-URM subjects, and not for URM faculty. Self-assessed change in vitality increased for URM and non-URM. Conclusion The intervention worked successfully for enhancing vitality, self-efficacy and cross-cultural engagement across different demographic groups of biomedical research faculty.

We investigated psychological safety (PS) in a randomized controlled study of a group peer mentoring intervention. Forty mid-career academic medicine research faculty participated in the year-long C-Change Mentoring & Leadership Institute, completing a survey after the first session and post-intervention. Qualitative data included ethnographic observations, interviews, and participant writings. A codebook thematic analysis used PS as one sensitizing concept. PS mean scores increased from 5.6 at baseline to 6.1 (range 1-7) post-intervention (t=3.03, p=.005, mean difference=0.48, 95% CI=0.33, 0.81). In qualitative analysis, PS resulted from intervention structure, storytelling/listening curriculum, and skilled facilitation, fostering norms that enabled sharing, repaired trust, and nurtured belonging. PS enabled faculty to be authentic, vulnerable, and responsive, and to develop social bonds within a peer community.

Abstract Introduction: Midcareer research faculty are a vital part of the advancement of science in U.S. medical schools, but there are troubling trends in recruitment, retention, and burnout rates. Methods: The primary sampling frame for this online survey was recipients of a single R01 or equivalent and/or K-award from 2013 to 2019. Inclusion criteria were 3–14 years at a U.S. medical school and rank of associate professor or two or more years as assistant professor. Forty physician investigators and Ph.D. scientists volunteered for a faculty development program, and 106 were propensity-matched controls. Survey items covered self-efficacy in career, research, work-life; vitality/burnout; relationships, inclusion, trust; diversity; and intention to leave academic medicine. Results: The majority (52%) reported receiving poor mentoring; 40% experienced high burnout and 41% low vitality, which, in turn, predicted leaving intention (P < 0.0005). Women were more likely to report high burnout (P = 0.01) and low self-efficacy managing work and personal life (P = 0.01) and to be seriously considering leaving academic medicine than men (P = 0.003). Mentoring quality (P < 0.0005) and poor relationships, inclusion, and trust (P < 0.0005) predicted leaving intention. Non-underrepresented men were very likely to report low identity self-awareness (65%) and valuing differences (24%) versus underrepresented men (25% and 0%; P < 0.0005). Ph.D.s had lower career advancement self-efficacy than M.D.s (P < .0005). Conclusions: Midcareer Ph.D. and physician investigators faced significant career challenges. Experiences diverged by underrepresentation, gender, and degree. Poor quality mentoring was an issue for most. Effective mentoring could address the concerns of this vital component of the biomedical workforce.

Abstract Introduction:Midcareer is a critical transition point for biomedical research faculty and a common dropout point from an NIH-funded career. We report a study to assess the efficacy of a group peer mentoring program for diverse biomedical researchers in academic medicine, seeking to improve vitality, career advancement, and cross-cultural competence. Methods:We conducted a stratified randomized controlled trial with a waitlist control group involving 40 purposefully diverse early midcareer research faculty from 16 states who had a first-time NIH R01 (or equivalent) award, a K training grant, or a similar major grant. The yearlong intervention (2 to 3 days quarterly) consisted of facilitated, structured, group peer mentoring. Main study aims were to enhance faculty vitality, self-efficacy in achieving research success, career advancement, mentoring others, and cultural awareness and appreciation of diversity in the workplace. Results:Compared to the control group, the intervention group’s increased vitality did not reach statistical significance (P = 0.20), but perceived change in vitality was 1.47 standard deviations higher (D = 1.47, P = 0.03). Self-efficacy for career advancement was higher in the intervention group (D = 0.41, P = 0.05) as was self-efficacy for research (D = 0.57, P = 0.02). The intervention group also valued diversity higher (D = 0.46, P = 0.02), had higher cognitive empathy (D = 0.85, P = 0.03), higher anti-sexism/racism skills (D = 0.71, P = 0.01), and higher self-efficacy in mentoring others (D = 1.14, P = 0.007). Conclusions:The mentoring intervention resulted in meaningful change in important dimensions and skills among a national sample of diverse early midcareer biomedical faculty. This mentoring program holds promise for addressing the urgencies of sustaining faculty vitality and cross-cultural competence.

Objectives Evidence on the current status of gender equity in academic rheumatology in Europe and potential for its improvement is limited. The EULAR convened a task force to obtain empirical evidence on the potential unmet need for support of female rheumatologists, health professionals and non-clinical scientists in academic rheumatology. Methods This cross-sectional study comprised three web-based surveys conducted in 2020 among: (1) EULAR scientific member society leaders, (2) EULAR and Emerging EULAR Network (EMEUNET) members and (3) EULAR Council members. Statistics were descriptive with significance testing for male/female responses assessed by χ2 test and t-test. Results Data from EULAR scientific member societies in 13 countries indicated that there were disproportionately fewer women in academic rheumatology than in clinical rheumatology, and they tended to be under-represented in senior academic roles. From 324 responses of EULAR and EMEUNET members (24 countries), we detected no gender differences in leadership aspirations, self-efficacy in career advancement and work–life integration as well as the share of time spent on research, but there were gender differences in working hours and the levels of perceived gender discrimination and sexual harassment. There were gender differences in the ranking of 7 of 26 factors impacting career advancement and of 8 of 24 potential interventions to aid career advancement. Conclusions There are gender differences in career advancement in academic rheumatology. The study informs a EULAR task force developing a framework of potential interventions to accelerate gender-equitable career advancement in academic rheumatology.

Differential rewarding of work and experience has been a longtime feature of academic medicine, resulting in a series of academic disparities. These disparities have been collectively called a cultural or minority "tax," and, when considered beyond academic medicine, exist across all departments, colleges, and schools of institutions of higher learning-from health sciences to disciplines located on university campuses outside of medicine and health. A shared language can provide opportunities for those who champion this work to pool resources for larger impacts across the institution. This article aims to catalog the terms used across academic medicine disciplines to establish a common language describing the inequities experienced by Black, Latinx, American Indian/Alaska Native and Native Hawaiian/Other Pacific Islander, Women, and other underrepresented people as well as queer, disabled, and other historically marginalized or excluded groups. These ideas are specific to academic medicine in the United States, although many can be used in academic medicine in other countries. The terms were selected by a team of experts in equity, diversity, and inclusion, (EDI) who are considered national thought leaders in EDI and collectively have over 100 years of scholarship and experience in this area.

IMPORTANCE As medical faculty have central roles during the COVID-19 pandemic, it is important to study the pandemic's association with the vitality and careers of medical school faculty. OBJECTIVE To examine how the COVID-19 pandemic affected midcareer research faculty in academic medicine. DESIGN, SETTING, AND PARTICIPANTS This qualitative study included medical school faculty who participated in the C-Change Mentoring and Leadership Institute. All US medical school faculty recipients of recent National Institutes of Health (NIH) RO1, RO1-equivalent, and K awards were invited to apply to the institute. The 99 applicants who met inclusion criteria were stratified by degree (MD or MD/PhD vs PhD), gender, and race/ethnicity. Enrollment was offered to applicants randomly selected for 40 spots, demographically balanced by sex, underrepresented in medicine minority (URMM) status, and degree. In April 2020, an inquiry was emailed to faculty enrolled in the institute requesting responses to questions about meaning in work, career choice, and values. A qualitative analysis of narrative data responses, using grounded theory, was undertaken to determine key themes. This study is part of a NIH-funded randomized trial to test the efficacy of a group peer mentoring course for midcareer faculty and study the course's mechanisms of action. MAIN OUTCOMES AND MEASURES Key themes in data. RESULTS Of 40 enrolled participants, 39 responded to the inquiry, for a response rate of 97%. The analytic sample included 39 faculty members; 19 (47%) were women, 20 (53%) identified as URMM, and 20 (53%) had an MD or MD with PhD vs 19 (47%) with PhD degrees. Key themes in the data that emerged describing faculty lived experience of the pandemic included increased meaningfulness of work; professionalism and moral responsibility; enhanced relationships with colleagues; reassertion of career choice; disrupted research; impact on clinical work; attention to health disparities, social justice and advocacy; increased family responsibilities; psychological stress; and focus on leadership. CONCLUSIONS AND RELEVANCE During the pandemic, diverse PhD and physician investigators reported increased meaningfulness in work and professionalism and enhanced relationships, all intrinsic motivators associated with vitality. Working during the pandemic appears to have produced intrinsic rewards positively associated with vitality, in addition to adverse mental health effects. These findings have implications for combatting burnout and retaining investigators in the future.

PURPOSE: We report on the extent of sexual harassment among residents and examine its relationship to specialty and program year and effects. METHODS: Using the C-Change Resident Survey, we surveyed residents in 34 internal medicine, pediatrics, and general surgery programs in 14 academic medical centers (AMCs). A total of 1708 residents completed the survey (70% response-rate); 51% (n = 879) were women. Respondents reported unwanted sexual comments, attention, or advances by a superior or colleagues within the last 2 years. Measures of vitality and ethical or moral distress were included in the surveys. RESULTS: Rates of sexual harassment reported by women differed across the 34 programs, with an interquartile range of 0%-11%. Residents in pediatrics had the lowest frequencies of sexual harassment (mean 2%, 95% confidence interval [CI] 0%, 4%). Residents in internal medicine had higher rates of sexual harassment (mean 7%, 95% CI 1%, 25%). Residents in surgery had the highest rates (mean 12%, 95% CI 2%, 33%). Sexual harassment was associated with lower levels of vitality and higher ethical or moral distress (both, P < 0.05). CONCLUSIONS: Sexual harassment is more common for women residents in Internal Medicine and Surgery programs. The adverse effects of sexual harassment on female residents detracts from an institution's professional workforce. (C) 2019 Elsevier Inc. All rights reserved.

Results of two C-Change surveys of 4997 faculty and staff in medical and social sciences are analysed quantitatively and qualitatively and presented with illustrative quotations giving voice to critical personal perceptions of the culture and efforts to improve it. The C-Change survey included 12 dimensions of the culture: Vitality; Self-Efficacy in Career Advancement; Institutional Support; Relationships/Inclusion/Trust; Values Alignment; Ethical/Moral Distress; Leadership Aspirations; Work-Life Integration; Gender Equity; Black and Minority Ethnic Equity; Institutional Change Efforts for Diversity; Institutional Change Efforts for Faculty Support. Women were less positive than men on six dimensions in medical and ten dimensions in social sciences, suggesting that women's experiences are different to those of men. Both women and men were more positive about the culture in medical than social sciences. A more positive culture in medical sciences is attributed to the wide-spread implementation of Athena SWAN gender equality action plans linked to the NIHR funding incentives.

OBJECTIVE: To clarify our understanding of how the culture of residency training influences the well-being of residents, this study reports on the vitality of residents at 34 programs across the United States and identifies characteristics of the programs, institutions and residents that are associated with high resident vitality. DESIGN: In 2014 to 2015, residents nationally were surveyed using the validated C - Change Resident Survey. The survey assessed residents' vitality and 12 other dimensions that characterize residents' perspectives of the culture of the residency training programs: Self-efficacy, Institutional/program support, Relationships/inclusion/trust, Values alignment, Ethical/moral distress, Respect, Leadership aspirations, Mentoring, Work-life integration, Gender equity, Racial/ethnic minority equity, and self-assessed Competencies. Multilevel models were used to assess vitality within and across programs, and examine predictors including resident, program, and institution characteristics. PARTICIPANTS: Two thousand four hundred and fifty-two residents from 11 General Surgery, 12 Internal Medicine, and 11 Pediatrics programs at 14 U.S. academic health systems. RESULTS: One thousand seven hundred and eight residents responded (70% response rate). The mean Vitality score was 3.6 (range 1-5, where values of 4-5 represent high Vitality). There was wide variation among the 34 programs in the percent of residents who had high Vitality scores, ranging from 17% to 71%. However, the average Vitality scores within specialty (Surgery, Medicine, and Pediatrics) were not significantly different. The strongest predictors of Vitality were Work-life integration, Relationships/inclusion/trust, Institutional/program support, Respect, Values alignment, and Ethical/moral distress, which together accounted for 50% of vitality variance. Individual demographics accounted for just 3% of variance. CONCLUSIONS: Vitality is an essential component of resident well-being, and within each specialty there are programs that have excelled in promoting a culture of high vitality. Our findings suggest that we should test interventions to enhance resident vitality by focusing greater attention on providing institutional support, aligning individual and institutional values, integrating work and personal life, and facilitating relationships, inclusiveness and trust. ((C) 2018 The Authors. Published by Elsevier Inc. on behalf of Association of Program Directors in Surgery.)

A practical, reliable, and valid instrument is needed to measure the impact of the learning environment on medical students’ well-being and educational experience and to meet medical school accreditation requirements.

A practical instrument is needed to reliably measure the clinical learning environment and professionalism for residents.

Global investment in biomedical research has grown significantly over the last decades, reaching approximately a quarter of a trillion US dollars in 2010. However, not all of this investment is distributed evenly by gender. It follows, arguably, that scarce research resources may not be optimally invested (by either not supporting the best science or by failing to investigate topics that benefit women and men equitably). Women across the world tend to be significantly underrepresented in research both as researchers and research participants, receive less research funding, and appear less frequently than men as authors on research publications. There is also some evidence that women are relatively disadvantaged as the beneficiaries of research, in terms of its health, societal and economic impacts. Historical gender biases may have created a path dependency that means that the research system and the impacts of research are biased towards male researchers and male beneficiaries, making it inherently difficult (though not impossible) to eliminate gender bias. In this commentary, we – a group of scholars and practitioners from Africa, America, Asia and Europe – argue that gender-sensitive research impact assessment could become a force for good in moving science policy and practice towards gender equity. Research impact assessment is the multidisciplinary field of scientific inquiry that examines the research process to maximise scientific, societal and economic returns on investment in research. It encompasses many theoretical and methodological approaches that can be used to investigate gender bias and recommend actions for change to maximise research impact. We offer a set of recommendations to research funders, research institutions and research evaluators who conduct impact assessment on how to include and strengthen analysis of gender equity in research impact assessment and issue a global call for action.

Women are under-represented in academic medicine. We reviewed the empirical evidence focusing on the reasons for women's choice or rejection of careers in academic medicine. Using a systematic search, we identified 52 studies published between 1985, and 2015. More than half had methodological limitations and most were from North America. Eight main themes were explored in these studies. There was consistent evidence for four of these themes: women are interested in teaching more than in research; participation in research can encourage women into academic medicine; women lack adequate mentors and role models; and women experience gender discrimination and bias. The evidence was conflicting on four themes: women are less interested in research than men; women lose commitment to research as their education and training progress; women are deterred from academic careers by financial considerations; and women are deterred by concerns about work-life balance. Inconsistency of findings across studies suggests significant opportunities to overcome barriers by providing a more enabling environment. We identified substantial gaps in the scientific literature that could form the focus of future research, including shifting the focus from individuals' career choices to the societal and organisational contexts and cultures within which those choices are made; extending the evidence base to include a wider range of countries and settings; and testing the efficacy of interventions.

Introduction Translational research organisations (TROs) are a core component of the UK's expanding research base. Equity of career opportunity is key to ensuring a diverse and internationally competitive workforce. The UK now requires TROs to demonstrate how they are supporting gender equity. Yet, the evidence base for documenting such efforts is sparse. This study is designed to inform the acceleration of women's advancement and leadership in two of the UK's leading TROs—the National Institute for Health Research (NIHR) Biomedical Research Centres (BRCs) in Oxford and London—through the development, application and dissemination of a conceptual framework and measurement tool. Methods and analysis A cross-sectional retrospective evaluation. A conceptual framework with markers of achievement and corresponding candidate metrics has been specifically designed for this study based on an adapted balanced scorecard approach. It will be refined with an online stakeholder consultation and semistructured interviews to test the face validity and explore practices and mechanisms that influence gender equity in the given settings. Data will be collected via the relevant administrative databases. A comparison of two funding periods (2007–2012 and 2012–2017) will be carried out. Ethics and dissemination The University of Oxford Clinical Trials and Research Governance Team and the Research and Development Governance Team of Guy's and St Thomas’ National Health Service (NHS) Foundation Trust reviewed the study and deemed it exempt from full ethics review. The results of the study will be used to inform prospective planning and monitoring within the participating NIHR BRCs with a view to accelerating women's advancement and leadership. Both the results of the study and its methodology will be further disseminated to academics and practitioners through the networks of collaborating TROs, relevant conferences and articles in peer-reviewed journals.