October 2009

Grant Results

SUMMARY

The Hedwig van Ameringen Executive Leadership in Academic Medicine Program for Women (ELAM program) is a leadership training fellowship program at Drexel University College of Medicine (formerly MCP Hahnemann University). The program seeks to help qualified senior women faculty advance into and succeed in leadership positions in academic medicine and dentistry.

From 2001 to 2006, ELAM project staff and evaluators at George Washington University evaluated the effectiveness of this program through surveys and interviews. They assessed:

  • The impact of the ELAM program on the fellows' leadership and career development.
  • The impact of the presence of ELAM program fellows on their schools' climate regarding women's issues.
  • How women develop into leaders.

Key Findings

  • For 15 of 16 leadership indicators, ELAM fellows scored higher than other senior women faculty at medical schools. The indicators were in the following areas:
    • Administrative leadership attainment (4 items)
    • Full professor academic rank (1 item)
    • Leadership competencies and readiness (8 items)
    • Leadership aspirations and education (3 items).

    The differences were statistically significant for 12 indicators.
  • Deans of medical and dental schools indicated slight to moderate agreement (range of 5.11 to 6.15 on a 7 point scale) that the ELAM program had a positive effect on the school.
  • Some 95 percent of ELAM fellows indicated the program provided benefits in building a critical component of leadership, self-efficacy (the belief in the capability to attain goals).

Funding
The Robert Wood Johnson Foundation (RWJF) provided partial support for this project with two grants totaling $358,368. The Jessie Ball duPont Fund, Vanderbilt University School of Medicine, University of Michigan Medical School, Mayo Medical School and Wright State University Boonshoft School of Medicine contributed $215,000.

 See Grant Detail & Contact Information
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THE PROBLEM

By 2000, the number of women in medical and dental schools was nearly equal to that of men, yet few women had advanced to senior administrative positions in academic health centers. According to the Association of American Medical Colleges, in 2000:

  • Some 11 percent of female faculty at U.S. medical schools were full professors, compared with 31 percent of male faculty.
  • Women accounted for 7.5 percent of department chairs.
  • Only seven medical schools (out of 125) had female deans.

Leadership Training for Female Faculty

The ELAM program, founded in 1995, is a one-year part-time fellowship program of leadership training at Drexel University College of Medicine. The program includes coaching, networking and mentoring to help qualified senior faculty advance into and succeed in leadership positions in academic medicine and dentistry.

From 1995 to 2001, the program accepted between 25 and 42 fellows each year. Fellows must be nominated by the dean of their schools, which generally pay the program fee. The fee does not cover the complete cost of the ELAM program, which is also supported from a partial endowment and annual fundraising.

By 2001, ELAM fellows held positions at 78 percent of medical schools and 38 percent of dental schools. Many had risen to senior academic positions.

Evaluating the Program

ELAM staff evaluated the program since its inception. Staff worked with Sharon McDade, Ph.D., and other outside evaluators at the Center for Educational Leadership and Transformation at George Washington University.

They surveyed fellows on their first day of the program (pre-survey) and again 18 months later by mail (post-survey). The survey covered:

  • Knowledge of leadership, management and organizational theory.
  • Environmental scanning (sense of external trends, institutional culture and issues in education and health care delivery).
  • Financial management.
  • Communications.
  • Networking and coalition building.
  • Conflict management.
  • General leadership.
  • Assessment of strengths and weaknesses.
  • Acceptance of leadership demands.
  • Career advancement sophistication.

The post-survey also asked about the usefulness of the ELAM program.

They also conducted in-depth telephone interviews with members of selected classes of fellows (1995–1996, 1996–1997, 1998–1999 and 1999–2000; staff interviewed the class of 1995–1996 in person). The interviews covered specific skills acquired through the ELAM program and the fellows' subsequent leadership in their home institutions.

Project staff wanted to conduct a more substantive evaluation of the ELAM program.

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RWJF STRATEGY

RWJF has been interested in the progress of women in medicine since the 1980s. In 1985, RWJF funded a research team at Boston University School of Medicine to survey nearly 2,000 faculty at 24 medical schools about the academic advancement of women, minority and generalist faculty in medical school departments, compared to that of male, majority and specialty faculty. See Grant Results on ID# 019600.

The researchers reported the findings in peer-reviewed journals, including Academic Medicine and Annals of Internal Medicine. Two key findings focused on women faculty:

  • Professional characteristics of male and female faculty, minority and majority faculty and generalist and specialty faculty (medical school attended, fellowship training and membership in the Alpha Omega Alpha Honor Medical Society are comparable.
  • Female faculty had half the probability of becoming a full professor as male faculty.

In 1998–1999, RWJF funded the Association of American Medical Colleges (AAMC) to conduct a study of the challenges facing medical school department chairs, with particular attention to issues confronting women in such leadership positions. See Grant Results on ID# 033444.

The findings included the following:

  • Interviewees universally acknowledged the existence of barriers to the advancement of women. They agreed that, without significant institutional change, women will continue to be underrepresented among the leadership in academic medicine.

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THE PROJECT

From 2001 to 2006, with two grants from RWJF to MCP Hahnemann University (now Drexel University College of Medicine) and the Philadelphia Health and Education Corporation, project staff at the ELAM program and McDade and other evaluators at George Washington University evaluated the ELAM program. They assessed:

  • The impact of the ELAM program on the fellows' leadership and career development.
  • The impact of the presence of ELAM program fellows on their schools' climate regarding women's issues.
  • How women develop into leaders.

The evaluators from George Washington University worked under a sub-contract from the ELAM program.

Methodology

Project staff and evaluators used surveys and interviews to collect data from ELAM fellows, comparison groups and medical and dental school deans.

They also analyzed earlier data from surveys of and interviews with ELAM fellows. This included:

  • Two surveys of ELAM fellows and two comparison groups in 2002 and 2006:
    • 57 ELAM program fellows from the classes of 2001–2002 and 2002–2003 (57 out of 80; a combined 71 percent response rate).
    • 178 senior women faculty at medical schools from the Association of American Medical Colleges (AAMC) database matched to ELAM fellows in terms of age, academic rank and years as a faculty member (178 out of 468; a combined 38 percent response rate).
    • 28 applicants to the ELAM program who were not accepted (28 out of 63; a 44 percent response rate).

    Project staff and evaluators surveyed the three groups in fall 2002 and spring 2006 by mail (except for ELAM fellows in the class of 2001–2002, who completed the 2002 survey in person). The survey covered:
    • Self-perceived administrative knowledge and skills.
    • Attitudes toward administrative responsibilities.
    • Nature and extent of networking.
    • Aspirations for administrative leadership positions.
    • Participation in leadership training programs.
    • Academic and administrative rank.
    • Other leadership positions held.
  • A Web-based survey of deans of U.S. and Canadian medical and dental schools in 2006. One hundred and seventeen deans out of 217 (a 54 percent response rate) completed the survey, which covered:
    • Work environment.
    • Practices used to support leadership development.
    • The existence of family-friendly policies.
    • The impact of the ELAM program on fellows.
    • The impact of the ELAM program on the school.

As they had been doing, ELAM staff and the George Washington evaluators also surveyed ELAM fellows upon entering the program and 18 months later and conducted telephone interviews with selected classes. They interviewed fellows in the classes of 2002–2003 and 2003–2004, and they conducted second interviews with fellows in the classes of 1995–1996, 1996–1997, 1998–1999 and 1999–2000.

They used these data, as well as survey responses and interviews dating to the start of the ELAM program, in their assessment of the program. Project staff and evaluators developed a database with project data for use in future evaluations of the ELAM program.

Challenges

Researchers experienced the following challenges in conducting the evaluation.

  • Inadequate survey response: In the surveys of ELAM fellows and two comparison groups, the researchers felt that the initial response rates from the AAMC and non-accepted groups were inadequate for analysis. They requested and received a supplemental grant of $4,000 from RWJF (ID# 048687) to re-send the surveys by Priority Mail with delivery notification required. They also included a $3 coupon for Starbucks coffee as an incentive to respond.

    In the follow-up mailing, researchers shortened the surveys and rewrote or eliminated questions that other respondents had ignored or failed to answer in usable form. These measures increased the response rate to 38 percent for the AAMC group and 44 percent the non-accepted group.
  • Delays due to the Institutional Review Board process: The Institutional Review Board process, required for the protection of human subjects, was complex and changed during the project. Researchers experienced delays in getting joint approval from Drexel and George Washington universities for surveys and interview scripts, delaying the project.
  • Insufficient data for a portion of the study: The project originally included a second survey of the ELAM classes of 1995–1996 and 1996–1997 compared to matched women from the AAMC. With a response rate of 36 percent, the researchers did not have sufficient data for analysis and had to drop this portion of the study.

Communications

Researchers published an article, "Effects of Participation in the Executive Leadership in Academic Medicine Program (ELAM) on Women Faculty's Perceived Leadership Capabilities," in Academic Medicine. (Abstract available online.) They also published another article, in Academic Medicine about challenges related to the Institutional Review Board process. See the Bibliography for details.

Other Funding

The Jessie Ball duPont Fund, Vanderbilt University School of Medicine, University of Michigan Medical School, Mayo Medical School and Wright State University Boonshoft School of Medicine contributed a combined $215,000 to the project. Each organization contributed $50,000, except for Wright State University Boonshoft School of Medicine, which contributed $15,000.

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FINDINGS

Researchers reported the following findings in journal articles, unpublished manuscripts and reports to RWJF.

Findings About the Impact of the ELAM Program on Leadership and Career Development

(Source: Dannels SA, Yamagata H, et al. "Evaluating a Leadership Program: A Comparative, Longitudinal Study to Asses the Impact of the Executive Leadership in Academic Medicine (ELAM) Program for Women," unpublished manuscript, in press, Academic Medicine, May 2008.)

  • For 15 of 16 leadership indicators, ELAM fellows scored higher than other senior women faculty at medical schools (from the Association of American Medical Colleges database). They also scored higher than applicants to the ELAM program who were not accepted. The differences were statistically significant for 12 of these indicators.

    The indicators were:
    • Administrative leadership attainment (4 items).
    • Full professor academic rank (1 item).
    • Leadership competencies and readiness (8 items).
    • Leadership aspirations and education (3 items).

    (See the Appendix for a complete list of the indicators.)

    Administrative leadership attainment is defined as holding positions of department chair or higher, for example, center director or senior administrative staff in the dean's office:
    • 63.5 percent of the ELAM fellows.
    • 22.5 percent of the AAMC group.
    • 37 percent of the non-accepted group.

    Increase in full professor academic rank between 2001 and 2006:
    • ELAM fellows: From 44.8 percent in 2001 to 69.8 percent in 2006.
    • AAMC group: From 55.4 percent to 68.6 percent.
    • Non-accepted group: From 46.1 percent to 48 percent.

    Leadership competencies and readiness:
    The ELAM group scored higher than the AAMC and non-accepted groups on knowledge and confidence in leadership. The differences were statistically significant in seven of eight areas:
    • Knowledge of leadership theory.
    • Conflict management.
    • Leadership positioning.
    • Environmental scanning.
    • Financial management.
    • Communication skills.
    • Tolerance for the demands of leadership.

    Diversity competence was not statistically significant.

    Leadership aspirations and education defined as interest in attaining a higher leadership position in an academic health center:
    • ELAM fellows: 76.4 percent.
    • AAMC group: 49.4 percent.
    • Non-accepted group: 63 percent.

The following findings are based on survey data from 79 ELAM fellows in the classes of 1997–1998, 1998–1999 and 2000–2001. Data are from surveys the fellows completed upon entering the program and 18 months later.

  • ELAM fellows believed they increased their leadership capabilities between starting the program and 11 months after completing the program. These increases were statistically significant in all 10 areas surveyed.

    Perceived gains were greatest in knowledge of leadership, management and organizational theory, environmental scanning, financial management and general leadership skills.

    Gains in networking and coalition building, conflict management, assessment of strengths and weaknesses and career advancement sophistication were substantial. Gains in communication and acceptance of demands of leadership were more modest, but still statistically significant.

Conclusions from this Study

(Source: McDade SA, Richman RC, et al. "Effects of Participation in the Executive Leadership in Academic Medicine Program (ELAM) on Women Faculty's Perceived Leadership Capabilities." Academic Medicine, 79: 302–309, 2004.)

  • "The ELAM program provides tangible benefits to the women participants in terms of attainment of leadership positions, mastery of leadership competencies and aspiration to and education in leadership."

Findings About the Impact of the Presence of ELAM Program Fellows on Their Schools' Climate Regarding Women's Issues

(Source: Dannels SA, McDade SA , et al. "Gender Equity, Leadership Development and the Impact of ELAM: A Survey of Medical and Dental School Deans." Unpublished.)

  • Deans portrayed an improved environment for faculty, especially for women, and reported that they actively engaged in practices to promote leadership. The deans strongly agreed that the faculty work environment at their school was better than it was 10 years ago, and this was particularly evident for women.
  • Approximately 75 percent of deans frequently to always nominated faculty for leadership training within their institution. Some 70 percent frequently to always nominated faculty for leadership training outside their institution.
  • The deans indicated slight to moderate agreement (range of 5.11 to 6.15 on a 7 point scale) that the ELAM program had a positive effect on the school. This covered statements such as "ELAM fellows have become a valuable resource within my school."
  • Deans from schools with three or more ELAM fellows on their faculty were significantly more positive about the program's impact on the school than those from schools with fewer ELAM fellows.
  • Deans indicated moderate to strong agreement about the positive impact of the ELAM program on fellows' leadership, management and business skills, self-confidence and ability to think more broadly about issues in academic medicine and dentistry.
  • Every female dean "frequently to always" provided mentoring, compared to 73 percent of male deans. Nearly 75 percent of the female deans and 40 percent of male deans "always provide public support when a person makes a difficult or unpopular decision."
  • Female deans identified outside leadership training (73 percent), mentoring (64 percent) and appointment to high level committees (55 percent) as particularly useful to support women in leadership development. Male deans thought women particularly benefited from appointment to high level committees (54 percent) and outside leadership training (50 percent).

Findings About How Women Develop Into Leaders

(Source: Sloma-Williams L, McDade SA, et al. "The Role of Self-Efficacy in Developing Women Leaders: A Case of Women Leaders in Academic Medicine and Dentistry." In Women in Academic Leadership: Professional Strategies, Personal Choices. Dean DR, Bracken SJ and Allen JK (eds), Sterling, Va.: Stylus Publishing, 2008.)

These findings are based on telephone interviews with 41 ELAM fellows in the classes of 1995–1996, 1996–1997 and 1998–1999. Researchers conducted the first set of interviews when the fellows were in the ELAM program and the second set during the grant period.

  • Ninety-five percent of ELAM fellows indicated the program provided benefits in building self-efficacy. Self-efficacy is a person's belief in his/her capability to attain goals. It is one of the critical components of leadership development and leadership behavior.
  • The ELAM program increased the fellows' sense of competence by providing opportunities for them to feel successful, resulting in an improvement in self-efficacy in specific content-related areas. For example:
    • Nearly 83 percent of the fellows reported an increased sense of capacity on the job as a result of their practical skill development during the ELAM program.
    • 73 percent of the fellows said they felt confident enough to speak out where otherwise they would have remained silent.

Limitations

  • In the study comparing ELAM fellows, senior medical school women faculty from the AAMC and applicants to the ELAM program who were not accepted:
    • The researchers could not conclude that participation in ELAM was the only reason for the differences seen between the groups.
    • The AAMC database was not up to date and there were differences between the database and the survey data in faculty ranks and administrative positions. Thus, the ELAM fellows and AAMC group were not as closely matched and the comparison was less robust than expected. There was some indication that the ELAM fellows were ahead of the AAMC group at study entry in administrative positions.
  • In the study based on surveys of 79 ELAM fellows in the classes of 1997–1998, 1998–1999 and 2000–2001, the researchers could not conclude "with assurance" that participation in the ELAM program caused the perceived increase in leadership skills, since the participants were sufficiently interested in leadership to apply to ELAM and researchers did not compare them to a group that was not interested in leadership.

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LESSONS LEARNED

  1. Build an extra six months into a project time table when Institutional Review Board approval is required. Researchers experienced delays in getting joint approval from Drexel and George Washington universities for surveys and interview scripts, delaying the project. The project director suggested that other researchers allow about six months for Institutional Review Board approval. (Project Director/Page Morahan)
  2. Make mailed surveys more visible to recipients and provide incentives for recipients to complete and return them. In this project, researchers had to use Priority Mail and Starbucks coupons to get an adequate response rate to some surveys. Priority Mail increased responses by drawing recipients' attention to the survey. The project director suggested using a carrier such as FedEx for future surveys. (Project Director/Page Morahan)
  3. Carefully assess any database before basing a study on it. The problems with the AAMC database made the study less robust than the researchers had planned. "We should have done more up front to make sure we were working with up-to-date data." (Project Director/Page Morahan)
  4. Make surveys as short and simple as possible. Researchers found that survey respondents tended to fill out simpler questions and leave the complicated questions, and that they answer more questions earlier in the survey. In follow-up mailings, the researchers shortened the surveys and rewrote or eliminated complicated questions. (Project Director/Page Morahan)

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AFTER THE GRANT

As of November 2007, researchers continued to analyze study data and were writing articles on subjects including isolation among senior level women and the impact of financial training provided by the ELAM program on women's confidence and success.

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GRANT DETAILS & CONTACT INFORMATION

Project

Evaluation of a Program to Increase the Number of Women Leaders in Academic Medicine

Grantee

MCP Hahnemann University (now Drexel University College of Medicine) (Philadelphia,  PA)

  • Evaluation of a Program to Increase the Number of Women Leaders in Academic Medicine
    Amount: $ 354,368
    Dates: September 2001 to August 2006
    ID#:  038594

Contact

Page S. Morahan, Ph.D.
(215) 255-7349
page.morahan@drexelmed.edu
Rosalyn C. Richman, M.A.
(215) 255-7312
rosalyn.richman@drexelmed.edu

Grantee

Philadelphia Health and Education Corporation (Philadelphia,  PA)

  • Evaluating the Number of Women Leaders in Academic Medicine
    Amount: $ 4,000
    Dates: August 2003 to January 2004
    ID#:  048687

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APPENDICES


Appendix 1

Leadership Indicators Studied

Administrative leadership attainment

  • Administrative title of chair or above held between 2001 and 2006.
  • Chairing one or more college or university committees.
  • Holding one or more national positions.
  • Reporting an average of 51 percent to 100 percent of time spent per week on administrative duties.

Full professor academic rank

Leadership competencies and readiness

  • Knowledge of leadership theory.
  • Conflict management.
  • Leadership positioning.
  • Environmental scanning.
  • Financial management.
  • Communication skills.
  • Tolerance for the demands of leadership.
  • Diversity competence.

Leadership aspirations and education

  • Do you aspire to a higher leadership position within your own or another academic health center?
  • Do you aspire to a higher leadership position outside of academic health centers?
  • Have you participated in one or more leadership/management trainings?

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Book Chapters

Sloma-Williams L, McDade SA, et al. "The Role of Self-Efficacy in Developing Women Leaders: A Case of Women Leaders in Academic Medicine and Dentistry." In Women in Academic Leadership: Professional Strategies, Personal Choices. Sterling, VA: Stylus Publishing, 2008.

Articles

Dannels S, McLaughlin J, Gleason K, Dolan T, McDade S, Richman R and Morahan P. "Dental School Deans' Perceptions of the Organizational Culture and Impact of the ELAM Program on the Culture and Advancement of Women Faculty." Journal of Dental Education, 73(6): 676–688, 2009. Abstract available online.

Dannels SA, Yamagata H et al. "Evaluating a Leadership Program: A Comparative Longitudinal Study to Assess the Impact of the Executive Leadership in Academic Medicine (ELAM) Program for Women." In press, Academic Medicine, May 2008.

Elliot J, McDade SA et al. "A Modern Day Oregon Trail: Career Advancement of Women Within a Community of Practice." Unpublished.

McDade SA, Nooks KA et al. "A Window Into the Culture of Leadership Within Higher Education Through the Leadership Definitions of Women Faculty: A Case Study of ELAM Women Faculty Alumnae." Journal About Women in Higher Education, 1(1): 2008.

McDade SA, Nooks KA et al. "Defining Leadership From the Perspective of Women Leaders in Academic Medicine and Dentistry." Unpublished.

McDade SA, Richman RC et al. "Effects of Participation in the Executive Leadership in Academic Medicine Program (ELAM) on Women Faculty's Perceived Leadership Capabilities." Academic Medicine, 79(4): 302–309, 2004. Abstract available online. Article available for a fee.

Metzger T, McDade SA et al. "Transformational Leadership From a Feminist Perspective: A Case Study of ELAM Fellows." Unpublished.

Morahan PS, Yamagata H et al. "New Challenges Facing Interinstitutional Social Science and Educational Program Evaluation Research at Academic Health Centers: A Case Study From the ELAM Program." Academic Medicine, 81(6): 527–534, 2006. Abstract available online. Article available for a fee.

Sloma-Williams L, McDade SA et al. "Achieving Effective Organizational Oversight in Academic Medicine." Unpublished.

White FS, McDade SA et al. "The Relationship Between Gender and Career Progression Variables and Service Factors for Deans of U.S. Medical Schools from 1980–2006." Washington: The George Washington University, August 31, 2009. Available online.

Williams T, McDade SA et al. "An Analysis of the Comparative Processes of Men and Women Pre-, During and Post-U.S. Dental School Deanships." Washington: The George Washington University, May 18 2008. Available online.

Survey Instruments

"Post-ELAM Survey — Short Form," Drexel University College of Medicine and George Washington University, fielded November 2002 and Spring 2006.

"Post-ELAM Survey—Long Form," Drexel University College of Medicine and George Washington University, fielded November 2002.

"Pre-ELAM Survey—Long Form," Drexel University College of Medicine and George Washington University, fielded each September.

"Deans' Survey," Drexel University College of Medicine and George Washington University, fielded May 2006.

Presentations and Testimony

McDade SA, Nooks KA et al. "Themes in Definitions of Leadership from Women Academics in Medicine and Dentistry," at the Third International American Dental Education Association Women's Leadership Conference, August 28–30, Montreal, 2005. Abstract available online.

Richman RC, Morahan PS et al. "Designing a Leadership Program for Women Faculty in Medicine and Dentistry," at the Third International American Dental Education Association Women's Leadership Conference, August 28–30, Montreal, 2005. Abstract available online.

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Report prepared by: Paul Jablow
Reviewed by: Lori De Milto
Reviewed by: Molly McKaughan
Program Officer: Jeane Ann Grisso

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