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A Qualitative Comparison of Women s Leadership Programs at Local and National Levels

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A Qualitative Comparison of Women’s

Leadership Programs at Local and

National Levels

Sharon P. Turner, D.D.S., J.D.; Karen P. West, D.M.D., M.P.H.

Dr. Turner is Dean and Dr. West is Associate Dean for Academic Affairs—both at the University of Kentucky College of Dentistry. Direct correspondence to Dr. Sharon Turner, University of Kentucky College of Dentistry, 800 Rose Street, Lexington, KY 40536-0297; 859-323-5786 phone; 859-257-9497 fax; turnersp@uky.edu.

A

review of the most recent data maintained by the American Dental Education As-sociation 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 indi-cated that 46.7 percent of those enrolled in 145 medi-cal 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

For the 2003-04 academic year, 29 percent of full-time faculty at dental schools in the United States were women. Of the 8,453 persons holding academic ranks, only 2.7 percent of professors, 5.6 percent of associate professors, and 14.6 percent of assistant professors were women.4 Of administrative positions

in medical schools, women comprised 18 percent of division chiefs, 13 percent of department chairs, and 10 percent of deans, thirteen of whom are in the 125 allopathic schools and five in the twenty osteopathic medical schools (see Table 3). 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

Table 1. Percentage of women in the total population of students in U.S. medical and dental schools

U.S. Medical U.S. Dental Schools (n=145) Schools (n=55)*

2003 46.7% 42.0%

2004 48.6% 43.8%

*There were 56 total dental schools in 2004.

Table 2. Percentage of women faculty members at U.S. medical and dental schools

U.S. Medical U.S. Dental

Schools Schools 2004 2005 Professor 4% 3% Associate professor 6% 6% Assistant professor 15% 15% Total 32% 29%

Table 3. Percentage of women holding administrative positions at U.S. medical and dental schools

U.S. Medical U.S. Dental

Schools Schools

Deans* 10% 18%

Division chiefs and 18% 14%

department heads 13%

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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.

Administrators are generally drawn from among the most senior faculty members. When so few of them are women, it is difficult to imagine that the number of women administrators will increase greatly without some proactive programs designed to recruit and retain more women in faculty roles. Only a significant effort will overcome both real or subtle discrimination against women, such as differences in the amount of space assigned, underpayment, exclusion from positions of power, less prestigious committee assignments, and fewer departmental awards and distinctions.6 The classic “glass ceiling,”

the invisible barrier that blocks women or persons of color from advancement to the top positions in the workplace organizational structure, also holds many women back in their careers. According to Lisa Tedesco,the glass ceiling exists because institutional culture embraces beliefs that hinder the advancement of women, such as stereotypes that women are easily diverted from careers by family; women cannot be tough, aggressive, and competitive; and women are only competent in certain roles in areas peripheral to core business activity.7 This phenomenon is also

described with the phrase “the higher, the fewer” and is well documented as causing exaggerated feelings of being different for those in significantly under-represented groups within an organization.

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 un-comfortable 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 advance-ment. To assist individual faculty and institutions, in 1996 the U.S. Department of Health and Human Services (DHHS) Office on Women’s Health in-cluded 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 Uni-versity 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 se-lected 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.

Leadership Program

Descriptions

Circles of Power

The COPS program was established at the University of Kentucky College of Medicine in 1998 at the behest of then Dean Emery Wilson, who was concerned about the atmosphere for women at the college. Wilson’s charge to the program director was to improve the climate for women within the college. The initial goals were to provide a network of women in the college who could support one another and who had a shared background of business acumen and leadership skills. The program was expanded in 1999 to include representatives from four other colleges: dentistry, pharmacy, health sciences, and nursing.

COPS became a campus-wide program in 2003. Although it has broadened its circle of influ-ence, 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 relation-ships, 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

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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 lead-ership 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 Instru-ment.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 evalu-ation was performed at that time.

Executive Leadership in Academic

Medicine

The ELAM program was begun in 1992 by then Chancellor D. Walter Cohen and Vice Presi-dent of Development Patricia Cormier as a method to showcase the history and legacy of the Medical College of Pennsylvania, the first established medi-cal school for women. They thought a leadership program for women at medical schools could help increase the numbers of women in upper administra-tive positions. They performed a needs assessment of medical school deans, who indicated an interest in a leadership program for women faculty. A Jessie Ball du Pont Fund grant was obtained to conduct the planning for the program.

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 organiza-tional structure and dynamics. The second focus was personal self-assessment and skill building and included the use of several structured

instru-ments such as the Myers-Briggs Type Indicator and Benchmarks,13 the Center for Creative Leadership’s

360-degree feedback instrument designed to encour-age 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 par-ticipants 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’ an-nual 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 organi-zation, the Society for Executive Leadership in Aca-demic 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

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simultane-ously 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.

Methods

In addition to interviews with the directors and codirectors of the two programs, a structured list of questions was designed for interviews with five graduates of each program. After discussion and review of the information gained from interviews with the directors and of the literature describing the two programs, we created sixteen questions that were asked of each of the ten individuals surveyed. The questions were designed to determine the par-ticipants’ assessment of strengths and weaknesses of the curriculum, benefits gained from participation, barriers they may have experienced during participa-tion, potential differences in experience for dental faculty and medical faculty, changes in career goals as a result of having participated in the programs, perceived value of the program, perceived change in their value to their institution as a result of hav-ing completed the program, applicability of specific skills learned in the program, previous leadership training, and whether participants would repeat the experience or recommend it to others. At the end of the structured interview, each participant was given the opportunity to make final comments.

Institutional Review Board approval was ob-tained 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 re-mained 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, dif-ferences, and recurring themes. Responses were categorized by agreement between the two authors.

Results

Clearly, participation in the leadership pro-grams affected the majority of the respondents in a positive manner by giving them more self-confidence and specific technical skills to pursue leadership roles within their institutions. It also allowed one participant to recognize that she did not want to assume leadership positions, and she stepped down from an administrative role following the program. Regardless, both programs affected the career goals of participants in some manner.

Both COPS and ELAM participants identified communication skills development, group dynam-ics, and team building as curricular strengths. Lack of flexibility in scheduling was noted as a common curricular weakness among both groups. Also iden-tified as a barrier or difficulty encountered by all participants was time spent away from their institu-tion or job site. When answering the quesinstitu-tions 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 ex-perienced. 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 sig-nificant 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.

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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 increas-ing 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 diffi-culty 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 con-junction with their deans that involved applying new leadership skills or sharing new skills with others. Participants said that they gained visibility and cred-ibility in the eyes of their home institutions and were seen as much more valuable following ELAM.

In terms of the programs’ overall main empha-sis, 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 re-flecting 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.

Discussion

Both the COPS and the ELAM programs pro-vided participants with new leadership knowledge and skills through a variety of topics that addressed personal and professional attributes that contribute to the development of leadership skills. This training was provided in a multitude of venues, some of which consisted of formalized didactic group instruction, peer learning groups, role playing, simulations, self-assessment inventories, reflection, journaling, and

individual coaching. Both programs were seen as valuable by all participants.

A clear need exists at both the local and na-tional levels for women’s leadership programs such as ELAM and COPS because of the increasing num-bers 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 col-laborative 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 con-cerns 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 ap-proaches may help address this challenge.

Overall, the outcomes obtained from our sam-ple population indicate that leadership programs such as COPS and ELAM are beneficial to the advance-ment 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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REFERENCES

1. Association of American Medical Colleges. Facts: ap-plicants, matriculants, and graduates. At: www.aamc. org/data/facts/start.htm. Accessed: July 12, 2005. 2. American Dental Association. Survey of predoctoral

dental education institutions. Chicago: American Dental Association, 2004.

3. Association of American Medical Colleges. Women in U.S. academic medicine: statistics and medical school benchmarking, 2004-05. Washington, DC: Association of American Medical Colleges, 2005.

4. Survey data from American Dental Education Association, Center for Equity and Diversity.

5. American Dental Education Association. Directory of ADEA institutional members and association officers. Washington, DC: American Dental Education Association, 2005.

6. Miller DW, Wilson R. MIT acknowledges bias against female faculty members. Chronicle of Higher Education 1999;45(30):A18.

7. Tedesco LA. Understanding the glass ceiling. J Dent Educ 1999;63(3):244-56.

8. Kanter RM. A tale of “O”: on being different in an orga-nization. New York: Harper & Row, 1980.

9. Morahan PS, Voytko ML, Abbuhl S, Means LJ, Wara DW, Thorson J, Cotsonas CE. Ensuring the success of women

faculty at AMCs: lessons learned from the National Centers of Excellence in Women’s Health. Acad Med 2001;76(1):19-31.

10. Briggs IM, Briggs KD. Myers-Briggs type indicator instru-ment: a personality inventory. Palo Alto, CA: Consulting Psychologists Press Inc., 1988.

11. Belbin RM. Belbin self-perception inventory of team roles—team role: a tendency to behave, contribute and interrelate with others in a particular way. Cambridge, UK: Henly Management College, 2004.

12. Interview with COPS program director Edythe Lach and program application brochure, February 25, 2004. 13. Center for Creative Leadership. Benchmarks development

reference points: an instrument for assessing leadership skills and enhancing the development process. Greens-boro, NC: Center for Creative Leadership, 1996. 14. McDade SA, Richman RC, Jackson GB, Morahan PS.

Effects of participation in the Executive Leadership in Academic Medicine (ELAM) program on women faculty’s perceived leadership capabilities. Acad Med 2004;79(4):302-9.

15. Richman RC, Morahan PS, Cohen DW, McDade SA. Advancing women and closing the leadership gap: the Executive Leadership in Academic Medicine (ELAM) program experience. J Womens Health Gend Based Med 2001;10(3):271-7.

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