Leadership Experiences and Perceptions of Mid-Career to Senior Clinician-Scientists: A Qualitative Exploration.

PURPOSE: This study aimed to elucidate the experiences and perceptions of mid-career to senior clinician-scientists in academic medicine regarding pursuing, attaining, or rejecting leadership roles as well as their conceptualization of the influence of leadership in their broader career trajectories. METHOD: The authors conducted a qualitative analysis of in-depth, semistructured interviews conducted in 2022 with a diverse sample of clinician-scientists who received new National Institutes of Health K08 or K23 Career Development Awards between 2006 and 2009. A total of 859 of the 915 survey respondents (94%) were eligible to be recruited for the qualitative study. Qualitative analysis was informed by thematic analysis and used a social constructionist approach to understanding participants' conceptualizations of their experiences. Interview transcripts were coded using an iterative, inductive coding process. Themes were generated by reviewing coded data and identifying common patterns in participant narratives, affording particular attention to participants' discussion of the effect of race and/or gender on their leadership experiences. RESULTS: Sixty clinician-scientists participated in individual interviews. Five themes were generated surrounding participants' conceptualizations of their leadership experiences. Themes were (1) feeling unprepared for leadership roles, (2) reluctance and lack of intention in attaining leadership positions, (3) influence of networks on leadership access and decision-making, (4) impact-related benefits and downsides of leadership, and (5) confining ideas of who leaders are. CONCLUSIONS: The study highlighted the need for formal leadership training in academic medicine and the importance of mentorship and sponsorship in attaining and succeeding in leadership positions. Individuals from communities underrepresented in leadership positions faced additional challenges internalizing a leadership identity. Efforts to encourage current leaders to engage in intentional succession planning and development of faculty towards leadership roles, including expansion of institutional leadership development programs, are needed to promote equitable distribution of leadership opportunities.

Professional Experiences and Career Trajectories of Mid- to Senior-Career Women Clinician-Scientists: A Qualitative Study.

Importance: Despite increasing evidence and recognition of persistent gender disparities in academic medicine, qualitative data detailing the association of gender-based experiences with career progression remain sparse, particularly at the mid- to senior-career stage. Objective: To investigate the role gender has played in everyday professional experiences of mid- to senior-career women clinician-scientists and their perceptions of gender-related barriers experienced across their careers. Design, Setting, and Participants: In this qualitative study, a total of 60 of 159 invited clinician-scientists who received National Institutes of Health K08 or K23 awards between 2006 and 2009 and responded to a survey in 2021 agreed to participate. Invitees were selected using random, purposive sampling to support sample heterogeneity. Semistructured in-depth interviews were conducted January to May 2022. For this study, interviews from 31 women were analyzed using the framework approach to thematic analysis. Data analyses were performed between August and October 2023. Main Outcomes and Measures: Descriptive themes of participant experiences of gender and gender-based barriers in academic medicine. Results: A total of 31 women clinician-scientists (8 identifying as Asian [25.8%], 14 identifying as White [45.2%], and 9 identifying as members of a minority group underrepresented in medicine [29.0%]; 14 aged 40-49 years [45.2%] and 14 aged 50-59 years [45.2%]) were included. Among them, 17 participants (54.8%) had children who required adult supervision or care, 7 participants (22.6%) had children who did not require supervision or care, and 6 participants (19.4%) did not have children. There were 4 dominant themes identified within participant experiences in academic medicine: the mental burden of gendered expectations at work and home, inequitable treatment of women in bureaucratic processes, subtle and less subtle professional exclusion of women, and value of communities built on shared identities, experiences, and solidarity. Conclusions and Relevance: This study found that women perceived the institution of academic medicine as a male-centric system misaligned with the needs of women, with associated feelings of exclusion, disillusionment, and loss of trust in their institutions. Findings suggest that the confluence of domestic obligations and unaccommodating institutional environments may make it difficult for women clinician-scientists to achieve established timelines of career progression and productivity; these findings may have long-term implications for the well-being and retention of women in academic medicine.

The Disproportionate Effects of the COVID-19 Pandemic on the Time Allocation of Recipients of NIH Career Development Awards Who Are Women or Caregivers of Dependents.

PURPOSE: To understand time allocation of a national medical faculty cohort 1.5-2 years after the COVID-19 pandemic began, compared to before. METHOD: From August 2021-April 2022, the authors conducted a retrospective survey of 1,430 clinician-researchers who received National Institutes of Health career-development awards between 2006-2009 asking about domestic and professional time allocation pre-pandemic and at the time of surveys (TOS). Of 915 respondents (64%), the 830 who remained in academic positions constituted the analytic sample. Multivariable regression models identified demographic factors associated with each time outcome and change in time between pre-pandemic and TOS, and having experienced ≥8-hour increase of total self-reported weekly professional work hours and domestic labor hours. RESULTS: Median self-reported weekly professional work hours were 55 hours/week pre- pandemic and 60 at TOS. On multivariable analysis, significant predictors of self-reported weekly professional work hours at TOS were having a non-child other dependent (+2.6 hours, P = .03), academic rank (associate -3.1 hours, assistant -9.0 hours; P < .001), and specialty (P < .001). Average self-reported TOS weekly domestic-labor hours were 23.1 among men and 30.2 among women (P < .001). Predictors of total self-reported TOS weekly domestic hours were being a woman (+5.6 hours; P < .001) and having children requiring supervision (+10.2 hours; P < .001). Overall, 9.3% of men (42/450) and 21.6% of women (88/407) experienced a ≥ 8 hour increase in domestic labor (P < .001). On multivariable analysis, women had higher odds of substantial domestic-labor increase (OR = 2.33, 95% CI: 1.47, 3.68), as did those with children requiring supervision (OR = 1.93, 95% CI: 1.25, 2.98) or other dependents (OR = 1.83, 95% CI: 1.13, 2.98). CONCLUSIONS: This study illuminates demands on women and faculty with dependents during the COVID-19 pandemic and suggests increased flexibility and resources are of heightened importance.

Gender Differences in Faculty Perceptions of Mentorship and Sponsorship.

This survey study examines gender differences in mid- to senior-career faculty experiences of receiving and providing mentorship and sponsorship during early career development.

Workplace Harassment, Cyber Incivility, and Climate in Academic Medicine.

Importance: The culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized groups) and compromises workforce vitality. Existing research has been limited by a lack of comprehensive, validated measures, low response rates, and narrow samples as well as comparisons limited to the binary gender categories of male or female assigned at birth (cisgender). Objective: To evaluate academic medical culture, faculty mental health, and their relationship. Design, Setting, and Participants: A total of 830 faculty members in the US received National Institutes of Health career development awards from 2006-2009, remained in academia, and responded to a 2021 survey that had a response rate of 64%. Experiences were compared by gender, race and ethnicity (using the categories of Asian, underrepresented in medicine [defined as race and ethnicity other than Asian or non-Hispanic White], and White), and lesbian, gay, bisexual, transgender, queer (LGBTQ+) status. Multivariable models were used to explore associations between experiences of culture (climate, sexual harassment, and cyber incivility) with mental health. Exposures: Minoritized identity based on gender, race and ethnicity, and LGBTQ+ status. Main Outcomes and Measures: Three aspects of culture were measured as the primary outcomes: organizational climate, sexual harassment, and cyber incivility using previously developed instruments. The 5-item Mental Health Inventory (scored from 0 to 100 points with higher values indicating better mental health) was used to evaluate the secondary outcome of mental health. Results: Of the 830 faculty members, there were 422 men, 385 women, 2 in nonbinary gender category, and 21 who did not identify gender; there were 169 Asian respondents, 66 respondents underrepresented in medicine, 572 White respondents, and 23 respondents who did not report their race and ethnicity; and there were 774 respondents who identified as cisgender and heterosexual, 31 as having LGBTQ+ status, and 25 who did not identify status. Women rated general climate (5-point scale) more negatively than men (mean, 3.68 [95% CI, 3.59-3.77] vs 3.96 [95% CI, 3.88-4.04], respectively, P < .001). Diversity climate ratings differed significantly by gender (mean, 3.72 [95% CI, 3.64-3.80] for women vs 4.16 [95% CI, 4.09-4.23] for men, P < .001) and by race and ethnicity (mean, 4.0 [95% CI, 3.88-4.12] for Asian respondents, 3.71 [95% CI, 3.50-3.92] for respondents underrepresented in medicine, and 3.96 [95% CI, 3.90-4.02] for White respondents, P = .04). Women were more likely than men to report experiencing gender harassment (sexist remarks and crude behaviors) (71.9% [95% CI, 67.1%-76.4%] vs 44.9% [95% CI, 40.1%-49.8%], respectively, P < .001). Respondents with LGBTQ+ status were more likely to report experiencing sexual harassment than cisgender and heterosexual respondents when using social media professionally (13.3% [95% CI, 1.7%-40.5%] vs 2.5% [95% CI, 1.2%-4.6%], respectively, P = .01). Each of the 3 aspects of culture and gender were significantly associated with the secondary outcome of mental health in the multivariable analysis. Conclusions and Relevance: High rates of sexual harassment, cyber incivility, and negative organizational climate exist in academic medicine, disproportionately affecting minoritized groups and affecting mental health. Ongoing efforts to transform culture are necessary.

Becoming Jane Barney: Developing a generative identity as an engaged citizen.

OBJECTIVE: We propose that analysis of the life of Jane Lockwood Barney provides insight into the notion of a "generative identity"-an integrated sense of self constructed around caring for others and the world. During her 104 years, the socially prescribed roles for women grew in range; Barney's own roles included minister's wife, mother of four, theological philosopher, social work student and professional, and community activist. We outline her life, focusing on three periods defined by her time at Parishfield, a Christian 'think tank' that focused on community-engaged advocacy for structural change, based in Brighton, Michigan. METHOD: Using thematic analysis, we identify three main themes from documents written by and about Barney, as well as interviews conducted later in her life. RESULTS: Consistent with Erikson's notion of epigenesis, these themes-belonging, self-reliance/self-expression and generative identity-are evident throughout Barney's adult life to varying degrees. However, we show that the first two themes, belonging and self-reliance/self-expression, act as precursors to the development of her generative identity. CONCLUSION: Barney's experience at Parishfield in midlife was pivotal to her generative identity, acting as a sort of crucible and turning point; from that time forward the focus of her activities broadened to caring and working tirelessly for the underserved in her community.

Gendered Impact of Caregiving Responsibilities on Tenure Track Faculty Parents' Professional Lives.

Navigating a career while raising a family can be challenging, especially for women in academia. In this study, we examine the ways in which professional life interruptions due to child caregiving (e.g., opportunities not offered, professional travel curtailed) affect pre- and post-tenure faculty members' career satisfaction and retention. We also examine whether sharing caregiving responsibilities with a partner affected faculty members' (particularly women's) career outcomes. In a sample of 753 tenure track faculty parents employed at a large research-intensive university, results showed that as the number of professional life interruptions due to caregiving increased, faculty members experienced less career satisfaction and greater desire to leave their job. Pre-tenure women's, but not pre-tenure men's, career satisfaction and intention to stay were negatively affected when they experienced at least one professional life interference. Pre-tenure men's desire to stay in their job and career satisfaction remained high, regardless of the number of professional life interferences they experienced. Sharing parenting responsibilities with a partner did not buffer the demands of caregiving on pre-tenure women's career outcomes. Our work highlights the need to consider the varied ways in which caregiving affects faculty members' careers, beyond markers such as publications, and how institutions can support early career stage women with family-friendly practices.

Body Image Among Sexual and Gender Minorities: An Intersectional Analysis.

Body image is consequential for overall well-being and has a complex relation to gender. Sexual and gender minority (SGM) individuals develop body image amid intersecting systems of oppression, such as sexism, cisnormativity, heteronormativity, and gender binary pressures. This study used an intersectionality framework to examine how various aspects of gender identification (cis/trans, binary/nonbinary, woman/man identification) related to body image differences among SGM individuals. We also assessed whether identification with conventionally masculine and feminine personality traits predicted body image. We used one-way and two-way ANOVAs and linear regressions to analyze two indicators of body image (body appreciation and drive for muscularity) in a sample of 643 SGM individuals (148 sexual minority (SM) cis women, 171 trans women, 121 SM cis men, 43 trans men, 160 nonbinary individuals). Results implicated cisnormativity as an influential and hierarchical force for body image, although woman/man and binary/nonbinary identification also played roles in group differences. With a few exceptions, masculine but not feminine trait identification significantly predicted body appreciation and drive for muscularity, indicating a complicated association with overall body image. These findings underscore the value of an intersectional lens for analyzing how broad social forces may manifest in individual-level body image for SGM individuals.

Stereotypes in Attributions About Women's Gender-Based Mistreatment.

Using an intersectional framework, we assessed how gender stereotypes applied to women with different race and class identities who experienced gender-based mistreatment. Thematic content analysis of 238 responses to a woman in a vignette, who varied in terms of race and class, revealed three themes: action or inaction, living conditions, and education. Sexual assault drew significantly more comments about the woman's actions and inaction than sexual harassment, as did a middle-class versus a working-class woman. Conversely, living conditions surfaced more for the working-class woman. Finally, education came up most in sexual harassment accounts. Qualitative features of the responses are also discussed.

Level of choice in older women's decisions to retire or continue working and associated well-being.

Retirement is a complex life transition. Women's retirement, like their work lives, may be further complicated, for example, by family or financial obligations; they may feel forced to retire or to continue working or feel they have the choice to do so. This study examines the role of voluntary versus involuntary retirement or continued work participation among retirement-age women; specifically, the relationships between choice, work status, and well-being. Compared to women forced to retire, women who chose retirement or continuing to work had higher levels of life satisfaction. Findings highlight the importance of examining retirement within the life course context.

The road not taken: Women's life paths and gender-linked personality traits.

Key studies have established an association between women's social roles and their midlife personalities. The current research expands our understanding by examining personality traits in midlife women who followed normative or non-normative life paths. The normative/non-normative distinction was based on two kinds of social roles that college-educated women undertook until midlife: work and family. Gender-linked personality traits were compared between (1) women in high status professions and women in moderate status professions; (2) women without children and women with children; and (3) single mothers and married mothers. Composite measures of gender-linked traits, based on expert-identified Q-sort items, were used. Each non-normative social role group exhibited a different pattern of gender-linked personality traits inconsistent with conventional female gender roles.

Dyadic support in stepfamilies: buffering against depressive symptoms among more and less experienced stepparents.

Stepparenting is a common but stressful experience that has been linked to depressive symptoms. This study examines the associations among years of experience stepparenting, support, and validation from three sources-partner, the children's other biological parent (i.e., the spouse's ex-partner), and stepchildren-and depressive symptoms. Participants included 125 stepparents (84 female) recruited online. Using cross-sectional data, findings suggested that although support and validation from all three sources were associated with fewer depressive symptoms, when included in a single model, partner support emerged as the only significant predictor. Partner support was most associated with lower symptoms in the early years of stepparenting, highlighting the particular importance of partners' facilitation and support while the family is still adjusting to its new structure.

Narcissism in midlife: longitudinal changes in and correlates of women's narcissistic personality traits.

We examined changes in and correlates of 3 kinds of narcissism--hypersensitivity, willfulness, and autonomy--during middle adulthood. Few studies have examined narcissistic personality traits beyond young adulthood, and none has assessed longitudinal changes in narcissism during midlife. In a sample of 70 college-educated women, we found that observer ratings of hypersensitive narcissism were associated with more negative outcomes at ages 43 and 53 (i.e., more depressive symptoms and physical health problems, lower life satisfaction and well-being). Ratings of willfulness and autonomy predicted more positive outcomes. All 3 kinds of narcissism showed considerable rank-order stability over 10 years, but there were also mean-level changes: Hypersensitivity and autonomy decreased, whereas willfulness increased. More positive outcomes were associated with decreases in hypersensitivity and increases in willfulness and autonomy. However, in multivariate analyses, autonomy did not show any significant associations with women's health and well-being outcomes, suggesting that it may have less predictive utility compared to hypersensitivity and willfulness. Our findings highlight developmental changes in and correlates of women's narcissistic personality traits and the importance of assessing different aspects of narcissism in midlife.

What makes the political personal? Openness, personal political salience, and activism.

People who attach personal meaning to social and political events or are high in Personal Political Salience (PPS) are more likely to engage in political activism (Duncan & Stewart, 2007). Although research suggests that PPS is consequential for activism, we know little about its origins or, more generally, about indirect effects of personality on activism. In this study we examined the possibility that the personality trait of Openness to Experience may be one source of PPS and an indirect predictor of activism. In addition, we proposed that Openness would also be directly related to political activism in young adults but not in middle-aged and older adults. Analyses confirmed these predictions in cross-sectional and over-time data from six samples. We argue that Openness may predispose some individuals both to find personal meaning in distant political events and to engage in social activism in their youth.

Legal and social contexts and mental health among lesbian and heterosexual mothers.

This study examines the role of legal and social context (the level of legal and social support offered by one's country of residence) and sexual orientation in the mental health of lesbian and heterosexual mothers. Participants were sampled from the United States and Canada because the two countries have many similarities (North American location, reliance on English language, and democratic structures) but provide different legal and social rights to their lesbian citizens. The study included 52 lesbian mothers and 153 heterosexual mothers in the United States and 35 lesbian mothers and 42 heterosexual mothers in Canada. Although there were no differences between heterosexual mothers as a function of legal and social context, lesbian mothers from the United States reported more family worries about legal status and discrimination (but not more general family worries) and more depressive symptoms than did lesbian mothers in Canada. Results indicate that legal and social context moderates the role of sexual orientation in maternal mental health.

Regret resolution, aging, and adapting to loss.

Both theory and empirical evidence suggest that people who have unresolved regrets experience lower levels of well-being than do those who resolve their regrets. In this study, the authors examined the role of regret resolution during bereavement by assessing whether (a) regret resolution would aid in adapting to the death of a loved one and (b) older adults would be more successful at resolving their bereavement-related regrets than would younger adults. Mixed models were run with longitudinal data from an age-heterogeneous sample of 147 men and women who were eventually bereaved after providing care for a loved one through a hospice. As expected, regret resolution contributed to adjustment as indicated by postloss patterns of depressive symptoms, well-being, and rumination; further, older adults were more likely to resolve their regrets than were younger adults. Implications for encouraging regret resolution early in bereavement are discussed.

Gender, social class, and the subjective experience of aging: self-perceived personality change from early adulthood to late midlife.

This study explored the applicability of previous research (obtained with groups of college-educated women) about the subjective experience of aging in midlife to men and less-educated people. Two-hundred fifty-nine men and women who graduated from a public high school in 1955-1957 retrospectively assessed their feelings of identity certainty, confident power, generativity, and concern about aging for their 60s, 40s, and 20s. Participants reported higher levels of identity certainty, confident power, and concern about aging at each age, and a leveling off of generativity in their 60s. There were some gender and social class differences. Although men and women recalled the same trajectory of these feelings, men reported higher levels of identity certainty and confident power across age. Non-college-educated men recalled the highest levels of concern about aging across age. We discuss how these findings add to our understanding of the experience of aging in these domains.

Gender in psychology.

Gender is increasingly understood as defining a system of power relations embedded in other power relations. Psychological research on gender-which has most often focused on analysis of sex differences, within-sex variability, and gender roles-has begun to incorporate this new understanding. By drawing on three resources, psychologists can make more rapid progress in understanding gender's significance for psychological processes: social science theories that link the individual and social levels of analysis; constructs (such as identity) that bridge the social and individual levels; and conceptual tools generated in feminist theory, perhaps especially intersectionality. We review these resources, cite active research programs that have employed them, and conclude by offering some practical suggestions about how to incorporate these resources into our research.

Patterns of depressive symptomatology in women smokers, ex-smokers, and never-smokers.

To investigate the possibility that specific symptom patterns contribute differentially to excess depression among smokers, we analyzed Center for Epidemiological Studies-Depression (CES-D) and subscale scores in 931 women current smokers (CS), ex-smokers (ES), and never-smokers (NS). After adjusting for differences in age, education, and marital status, significant group differences were found for the CES-D overall and for Depressed Affect, Anhedonia, and Somatic Features, but not Interpersonal Distress. Both CS and ES scored significantly higher than NS on most measures, whereas differences between CS and ES failed to reach significance. CS were significantly more likely than NS to be taking antidepressants. Alcohol intake also showed significant group differences, with CS>ES>NS, suggesting that the link between current smoking and alcohol intake is mediated by factors other than depression, since CS and ES were comparably depressed. We conclude that studying specific symptom patterns may elucidate the smoking-depression link. Our observation that ES and CS exhibit similar levels of depressive symptomatology further suggests that interventions for depressed smokers need to take into account the likely persistence of depression following cessation.

College-educated women's personality development in adulthood: perceptions and age differences.

Adulthood encompasses a large time span and includes a series of psychosocial challenges (E. H. Erikson, 1950). Five aspects of personality (identity certainty, confident power, concern with aging, generativity, and personal distress) were assessed in a cross-sectional study of college-educated women who at the time of data collection were young adults (age: M = 26 years), middle-aged adults (age: M = 46 years), or older adults (age: M = 66 years). Respondents rated each personality domain for how true it was of them at the time, and they then rated the other 2 ages either retrospectively or prospectively. Results are discussed with attention to the ways in which women's adult development may have been shaped by experiences particular to both gender and birth cohort, and to how these women fit with E. H. Erikson's theory of adult development.