health care equity

The Center for Women in Medicine and Science (CWIMS)

Advancing the science of gender equity

BY Jerica M. Berge, PhD, MPH and Sima Patel, MD, FAES

To address these known gender disparities, CWIMS created four action groups to confront gender equity issues in the medical school head on. The four groups are:

• Recruitment and Retention (R&R).
• Salary, Resource and Leadership Equity.
• Mentoring.
• Strategic Collaboration and Communications.

Dr. Patel (CWIMS action group member) said, “Overall, the CBPR framework and the CWIMS action groups form the scaffolding of our approach that then allows for the successful infrastructures, initiatives, metrics, and trainings to be developed and disseminated targeting gender equity.”

Recruitment and Retention (R&R) Action Group

 “The R&R action group works to develop strategies to both recruit and retain women and Black, Indigenous, and People of Color (BIPOC) faculty members,” described Dr. Spencer (R&R action group leader).

Specific initiatives developed over the last 2.5 years include:

• “Early Pathways to Success” program.
• Best practices for exit interviews.
• Focus groups to identify barriers to retention and promotion/tenure for women faculty.
• A COVID-19 survey.
  

U.S. women physicians earn 28% less than men.

The “Early Pathways to Success” program was created to acclimate and support new faculty to the University, with the goal of increasing the likelihood of retention. This yearlong cohort includes 10-12 new faculty and is facilitated by two faculty-a PhD from a basic science department and an MD from a clinical department. Content is guided by a conceptual model for adult learning and career advancement, with specific topics (e.g., mentoring/sponsoring, promotion/tenure, human resource benefits and leadership) that are key to a new faculty member’s success.

The R&R action group has worked on another initiative, compiling best practices for exit interviews. The group conducted a systematic review, as well as an institutional tour of other academic health centers, to identify best practices for exit interviews. Given several losses of women and BIPOC faculty before the CWIMS was established, we wanted to build an interview process that would better capture the reasons faculty were leaving our institution. We could then create resources and mechanisms to reduce these barriers and challenges. The Office of Faculty Affairs at the medical school now utilizes the action group’s results to conduct exit interviews with faculty.

This action group also worked on a third initiative, conducting focus groups to identify barriers to retention, promotion and tenure for women faculty. Similar to other institutions, our medical school has a large gender gap between men versus women in moving from associate professor to full professor. Only about one quarter of full professors are women faculty. Data from these focus groups will inform the development of programs and resources for women faculty to assist them in moving successfully along the continuum of promotion from assistant to associate to full professor.

The action group recently carried out its final initiative, creating a COVID-19 survey. Early in the pandemic, it became clear that COVID-19 was not affecting all groups in the same way. For example, women faculty with children and junior faculty were identified as potential faculty members that would be most negatively affected by COVID-19. In order to examine whether this hypothesis was true, we created a survey for our academic health center faculty so we could scientifically test whether there were disparities between men and women faculty with regard to how COVID-19 was affecting them. Publications are in process.

Salary, Resource and Leadership Equity (Equity) Action Group

“The equity action group takes on issues related to salary disparities, resource allocation, and leadership opportunity distribution,” said Dr. Kunin-Batson (equity action group lead).

Over the last 2.5 years work from this group has included:

• A salary equity study.
• Creating a Salary Equity Review Committee (SERC).
• Developing a “Gender Equity Metrics Dashboard.”
• Creating a “Gender Equity Report: Pulse on Gender.”

The salary equity study included all faculty within the 27 medical schools. This was the first salary equity review conducted in the medical school at the UMN. Results of this study exposed gender discrepancies we were able to correct and created a process for ongoing reviews, both on an annual basis and a three-year in-depth review. One of the outcomes of the salary equity study was the creation of the SERC. This standing review committee is a resource for faculty members wanting their salaries reviewed for equity, in addition to department heads using it for feedback on faculty members’ salaries.

The SERC also built an online gender equity metrics dashboard to track our gender equity work. Example metrics include: representation of women by department, percentage of women by rank and track, percentage of women giving prestigious presentations and holding augmented leadership roles, percentage of women chairing search committees, percentage of search committee members taking implicit bias training, and several other key metrics. These data are available in real time on a dean’s dashboard also available to department heads. Results of the metrics were also compiled into the “Gender Equity Report: Pulse on Gender” for transparency and accountability in our work.

There is a known gap between women and men faculty receiving prestigious awards.

Mentoring Action Group

“The mentoring action group has focused on both the important area of mentoring the next generation and ongoing mentoring throughout the faculty lifecycle,” said Dr. Church (mentoring action group lead). The mentoring action group has carried out the following initiatives in the last 2.5 years:

• “Mentoring at Your Fingertips” resources.
• An annual conference and spring workshop.
• The “Distinguished Women Visiting Scholar” (DWIMS) mechanism.

The “Mentoring at Your Fingertips” resources include a collated online directory of tips and connected links with articles, trainings, curriculum, etc., that mentors at the medical school and externally can access and use in their mentoring of junior faculty.

The mentoring action group also takes responsibility for carrying out our annual Fall retreat/conference and Spring workshop, which brings important topics and trainings to faculty, such as negotiation skills, conflict resolution, imposter syndrome, risk taking, executive presence, and other important topics.

The DWIMS is a mechanism and resource for department heads that allows them to pay an honorarium through CWIMS funds to bring in women speakers to present at their prestigious lectures. The speakers then share their story as a woman in medicine and as a science scholar at a CWIMS reception. This has been a highly effective way of increasing the medical school department’s hosting of women scholars for prestigious lectures. 

Strategic Collaboration and Communications (SCC) Action Group

“The SCC action group understands the importance of developing collaborations in carrying out gender equity work and in disseminating the work,” stated Dr. Nakib (SCC action group lead).

There is a known gap between women and men faculty receiving prestigious awards. In order to increase awards given to women faculty in the medical school at the UMN, the SCC group created an awards nomination toolkit with gender neutral letters for award nominations to women faculty. We have had a 100% success rate in nominations resulting in awards conferred to date. This toolkit is also available for others to use on our website. The SCC action group also worked to nominate and thereby appoint women faculty to important boards and committees, such as the University Senate, Faculty Advisory Committee, UMPhysicians Board, and Promotion and Tenure committees in departments and in the medical school to ensure a gender equity voice is at the table where key decisions are made.

A Pacesetter in Gender Equity Reform and Science

The CWIMS aims to not only facilitate a gender equity movement at the UMN, but also to become a pacesetter in the science of gender equity work.

CWIMS actively works on the following initiatives:

• Rapid response mechanism. Rapidly respond to important timely gender equity issues.
• Pathways to Publication. Publish and present our work so it is disseminated widely and available for others to use.
• Receive grants to conduct rigorous studies on our work.
• Consultation with other institutions who which are adapting our approach.
• Share our data dashboard and logic model with others to replicate.

The rapid response mechanism is a section of our website where any faculty member, administrative leaders, staff, or students can submit important issues to bring to CWIMS attention instantly. One example of how this rapid response mechanism works was when differences in our practice plan’s benefits for parental leave versus the medical school’s benefits were identified due to a recent change in insurance companies. When this issue was brought to our attention via the rapid response mechanism, CWIMS was able to work together with other groups to bring our practice plan to the attention of the dean and CEO within days of the issue surfacing, thereby ensuring the benefits between the two entities were adjusted to be equivalent.

CWIMS created the Pathways to Publications initiative to support more faculty members in publishing, especially clinical faculty with less direct access to research data, to improve their dossiers for tenure and promotion. Given that fewer women achieve tenure or are promoted from assistant to associate professor, this pilot program addressed that gap. The leadership team identified CWIMS members with large datasets and sent out potential upcoming publishing opportunities via the CWIMS listserv. Interested clinical faculty responded to the email, and CWlistIMS staff matched faculty members and conducted check-ins on the progress of the collaboration toward publication. To date, 14 clinical faculty have been successfully included as co-authors on publications.

In order to ensure CWIMS work is more than a movement and informs the science of gender equity, the leadership team has written and successfully been awarded grants, published manuscripts, and presented at national conferences regarding our work. Partner/stakeholder meetings with the dean, Department Head Council, Office of Diversity, Equity, and Inclusion, and the Office of Faculty Affairs are also strategically utilized to garner support for specific initiatives, or to request specific action. We have also integrated staff within these offices (e.g., share effort across offices) to ensure CWIMS initiatives are front-and-center on the medical school’s agenda.

Multiple Benefits of Being Involved with CWIMS

“CWIMS is designed to not only carry out the important work of gender equity in the medical school, but also to benefit the CWIMS members as they engage in the work. For example, 

CWIMS provides leadership positions, publishing opportunities, and scholarship funding for action groups members to help them in their own faculty development and promotion/tenure at the medical school,” explained Dr. Berge. The CWIMS action group members have numerous opportunities to take on leadership roles, such as being CWIMS action group leaders or being nominated to serve on medical school committees (e.g., promotion and tenure committee, UMPhysicians Governing Board, University Senate, or Faculty Advisory Committee). In addition, there are publication opportunities to advance their own requirements for promotion/tenure (e.g., “Pathways to Publications, COVID-19 papers, focus group papers). Finally, CWIMS sponsors members via scholarships to receive leadership training, including local and national opportunities (e.g., AAMC workshops, OP Ed project). All of these opportunities make participating in CWIMS mutually beneficial for both faculty members individually and CWIMS collectively.

CWIMS is always looking for new members to join. If you are interested in learning more, or possibly joining CWIMS, please visit: HYPERLINK “https://med.umn.edu/odei/about/cwims”.

J.M. Berge, PhD, MPH, LMFT, CFLE, is a professor, Vice Chair for Research in the Department of Family Medicine and Community Health, Director for Center for Women in Medicine and Science, and Director of the Women’s Health Research Program/Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) program at the University of Minnesota Medical School, Minneapolis, MN.

S. Patel, MD, FAES, is an assistant professor in the Department of Neurology at the University of Minnesota, member of Center for Women in Medicine and Science - Salary, Resources, Leadership Equity Action Group, and gender equity task force member for American Women Medicine Association.

Bottom Up and Top Down Collaboration

The CWIMS’s gender equity work is guided by an evidence-based framework called community-engaged participatory research (CBPR). CBPR approaches facilitate collaborative partnerships to co-develop and co-implement solutions to difficult-to-change issues, such as gender equity. This approach flattens hierarchical differences which can often arise between leadership (e.g., deans, department heads) and community members (e.g., faculty), increasing the potential for effective change and sustainability of initiatives. All of the gender equity initiatives CWIMS carries out have participatory involvement across multiple levels, from faculty members to department chairs and directors of centers, to the dean of the medical school. In addition, collaboration occurs across all 27 clinical and basic science departments, as well as the over 3,700 faculty of all genders to ensure all faculty benefit from the work.

CWIMS recently received two prestigious awards for advancing gender equity. The first award was from the Association of American Medical Colleges (AAMC) for “Emerging Leadership in Gender Equity.” The second award was from the National Institutes of Health (NIH) for “Enhancing Faculty Gender Diversity in Biomedical and Behavioral Science.” These awards highlight and give credibility to CWIMS’s unique participatory approach for engaging in gender equity work that is innovative and fast paced.