Hierarchy as a barrier to advancement for women in academic medicine

Background: Research on barriers to professional advancement for women in academic medicine has not adequately considered the role of environmental factors and how the structure of organizations affects professional advancement and work experiences. This article examines the impact of the hierarchy, including both the organization's hierarchical structure and professionals' perceptions of this structure, in medical school organization on faculty members' experience and advancement in academic medicine. Methods: As part of an inductive qualitative study of faculty in five disparate U.S. medical schools, we interviewed 96 medical faculty at different career stages and in diverse specialties, using in-depth semistructured interviews, about their perceptions about and experiences in academic medicine. Data were coded and analysis was conducted in the grounded theory tradition. Results: Our respondents saw the hierarchy of chairs, based on the indeterminate tenure of department chairs, as a central characteristic of the structure of academic medicine. Many faculty saw this hierarchy as affecting inclusion, reducing transparency in decision making, and impeding advancement. Indeterminate chair terms lessen turnover and may create a bottleneck for advancement. Both men and women faculty perceived this hierarchy, but women saw it as more consequential. Conclusions: The hierarchical structure of academic medicine has a significant impact on faculty work experiences, including advancement, especially for women. We suggest that medical schools consider alternative models of leadership and managerial styles, including fixed terms for chairs with a greater emphasis on inclusion. This is a structural reform that could increase opportunities for advancement especially for women in academic medicine. © 2010 Copyright Mary Ann Liebert, Inc.

Empowering Human Services Organizations to Embrace Evidence-informed Practice: International Best Practices

Human service organizations are increasingly using knowledge as a mechanism for implementing change. Knowledge emerging from many sources that may include academic publications, grey literature, and service user and practitioner wisdom contributes toward informing best practice. The question is: how do we harness this knowledge to make practice more effective? This paper synthesizes the lessons learned from eight international organizations that have made a commitment to knowledge mobilization as an important priority in their mission and operation. The paper provides a conceptual model, tools and resources to help human services organizations create strategies for building, enhancing or sustaining their knowledge mobilization efforts. The paper describes a flexible blueprint for human service organizations to leverage knowledge mobilization efforts at all levels of service delivery.