Academic medicine in the US has seen the entry and subsequent advancement of women in the profession of medicine increasing from single digit numbers over 50 years ago to greater than 35% today. With the entry of women into this previously male-dominated profession, programs have arisen to support their advancement in the academic environment. Instrumental has been the AAMC, which for several decades has sponsored faculty development courses for individuals, collected data from our schools of medicine, and helped to support WIM (Women in Medicine) groups throughout the country. ELAM (Executive Leadership in Academic Medicine), now celebrating its 25th anniversary, is a leadership program for selected women who aspire to become leaders. The NSF (ADVANCE), the NIH, and the Josiah Macy Jr. Foundation have all supported institutional programs to elucidate barriers, create opportunities, and study interventions that foster the advancement of women in academic science and medicine. Yet, reaching gender equity within our institutions remains an unrealized goal, at least in part due to our long-standing culture and the unique structures of our schools of medicine.
Other countries have recognized the significant challenge of advancing women in academia in the science and technology arenas, and the long-term dire consequences of failing to do so. The United Kingdom has led the way, with an institutional approach dating back to 2005. At that time, the ATHENA SWAN (Scientific Women’s Academic Network) charter to advance women in academic sciences was initiated as a voluntary opportunity for universities to study themselves, undergo peer review, and then be acknowledged for their work. In 2011, ATHENA SWAN was expanded to university departments beyond science and technology. External evaluation of the ATHENA SWAN program in 2013 acknowledged its early effectiveness, and in 2016, participation became a requirement for government funding (Eval, 2013). Most recently, the 2019 external evaluation of ATHENA SWAN found that 70% of UK universities (the majority of non-participants were arts schools) utilized the Charter to address gender challenges, and that there was “strong evidence that the Charter processes and methodologies have supported cultural and behavioral change – not just around gender equality, but equality and diversity in all its forms” (Eval 2019; Rosser et al, Lancet 2019). Programs in Australia (SAGE), and Canada (Dimensions), both reflective of their own country’s needs and cultures, have been developed to address gender equity in academia within the sciences and beyond. In 2018, the AAAS, initially with private funding and later with support from the NIH, began a pilot for US universities modeled after the ATHENA SWAN Program but with a broader diversity charter, entitled SEAChange. During its initial pilot phase, three science departments within universities were awarded Bronze status. Given the importance of Schools of Medicine in the education, training, and US scientific enterprise (50% of all NIH funding is in Schools of Medicine), inclusion of biomedicine in this SEAChange effort is an opportunity to address the culture and behavioral change that is necessary to advance gender equity and equity for all within our schools and our profession.
Albeit limited, efforts directed at culture (specifically gender) change within academic medicine are not new. For example, C-Change, an effort from Brandeis initiated over a decade ago, engaged some schools in the development and use of a faculty/climate survey (Krupat, et al, Academic Medicine 2013). Likewise, there have been attempts to collect data with a limited number of metrics from departments submitting funding requests to the the New York Stem Cell Foundation (Smith, et al, Cell 2015). A recent publication of four years of metrics collected from basic science and clinical departments of 541 institutions in 38 countries (70% US) confirm that the pipeline of students and graduate students is robust. Yet the numbers of women decline with progression up the academic ladder and into leadership. Women also lag behind in participation in influential institutional committees and inclusion as named speakers (Beeler et al, Cell 2019). A bold initiative, it again re-affirms the complexity of issues that influence the attainment of gender equity. However, these issues are not new and have been repetitively acknowledged over the last few decades. Most recently, national leaders in science have published an urgent call to action to address the failure of our approaches in attaining gender equity (Greider et al, Science 2019).
In the US, a school of medicine may be distant from the rest of the university (in some cases it may even be a stand-alone entity), frequently has a structure that includes an extensive clinical enterprise with a significant budget, often has a very large faculty, and can include work-environments with hundreds of post-graduate trainees in addition to graduate students. Schools of medicine comprise a major component (50% of NIH dollars) of the scientific enterprise in the US. The inclusion of medical schools in SEAChange is a critical opportunity to use a national structure to engage in culture change that can be enduring, systematic, and effective. In order to be effective, though, the development of the process and metrics must occur with the understanding of the medical school’s culture. Thus, a structure that recognizes the unique characteristics of medical schools has been acknowledged by SEAChange in its Biomedicine initiative.
SEAChange’s BioMedicine (in which CWAMS is a partner, representing the culture of medical schools) is a significant opportunity to advance enduring culture change. This voluntary program: a) awards a seal of approval (bronze, silver, gold) as judged by peer review; b) helps institutions develop their own baselines and continuously improve in their own unique environments; and c) disseminates best practices and effective tools. This self-improvement approach is familiar in our healthcare environments. One example is the attainment of Magnet status, a voluntary program designed by experts within the field, that signifies nursing excellence. Like Magnet, early adopters of ATHENA SWAN in the United Kingdom did so because it was the “right thing to do”. An important component of success was involvement of senior leadership. In SEAChange’s BioMedicine, the intent is to engage senior leadership in the schools of medicine (deans) along with other experts at the outset of the initiative. This is critical in developing the metrics and process that are deemed relevant to these schools, that avoids the undue burden of duplicative data collection, and finally, that is seen as a desirable public acknowledgement of the ongoing journey toward equity in medicine and science.