Women and Teaching in Academic Psychiatry
http://www.100md.com
《精神病学术期刊》
ABSTRACT
OBJECTIVE: This article explores past, present, and future issues for women and teaching in academic psychiatry. A small study of didactic teaching responsibilities along faculty groups in one academic psychiatry department helps to illustrate challenges and opportunities for women in psychiatric teaching settings. Background: Although women have comprised half of all medical school admissions for over a decade, tenure-track positions are still largely dominated by men. In contrast, growing numbers of women have been entering academic medicine through clinical-track positions in which patient care and teaching, rather than research, are the key factors for promotion. Thus, the authors hypothesized better representation of clinical-track women in formal, didactic teaching within the medical school setting. METHODS: The authors compared the numbers of tenure and clinical-track men and women teaching lectures to medical students and residents at the University of Michigan, Department of Psychiatry. RESULTS: Contrary to the hypothesis, the majority of didactic teaching was done by tenure-track men. DISCUSSION: Possible explanations and remedies for the continuing under-representation of women in academic psychiatry, particularly teaching settings, are explored. Suggestions are made for future areas in which female faculty might have opportunities for participation and leadership.
Academic medical teaching, as we know it now in the United States, originated in the educational reforms of medical schools in the late 19th and early 20th centuries (1). At that time, leaders in medical education made a self-conscious effort to change training from an informal network of lectures and/or preceptorship (2) to a German model of medical education (3). The core ideas of the new model included basing academic practice on research, directly transmitting research ideas to medical students, and teaching at the patients’ bedside (4). In the last part of the 19th and early part of the 20th centuries, a number of university-based medical schools in the U.S. began to lengthen courses of study, insist on higher standards for entrance, and develop faculties that were comprised of individuals who devoted much (if not all) of their effort to the institution (5).
The academic medical model has faced a number of challenges in the last few decades (6, 7). The growing research enterprise has necessitated that research faculty emphasize their research, publications, and grants, sometimes at the expense of their teaching (8). There is also an increasing distance between a molecular emphasis in research and the patient care and clinical teaching in academic medical centers (9). Further, social and economic pressures have pushed academic medical centers to focus more energy on the provision of patient care, sometimes at the risk of under-emphasizing teaching or research (10, 11). At many institutions, a distinct category of clinical faculty has been created to separate faculty into those who primarily do research and those who primarily see patients. While research faculty still have a great deal of (at least theoretical) responsibility for teaching, some institutions have placed more responsibility on clinical faculty and have created clinician-educator tracks (9).
Historically, academic medical centers have not been places of opportunity for women (12). While female students started to gain admission to most university-affiliated medical schools in the late 19th century, female faculty members have been much more rare (13). Recent statistics show a significant increase in women in academic medical centers in the last few decades, but much of that increase has been for junior-level clinical-track faculty (14). A recent study of cohorts of male and female academic faculty found that while women were more likely than men to pursue academic careers, they were less likely than men to be advanced to associate or full professor on either tenure or nontenure tracks (15). Although women have comprised nearly one-half of all medical school admissions for over a decade, women are not being promoted to the higher ranks of academic medicine at the same rate as men (16). A number of factors contribute to difficulties for women in academic settings such as networking that excludes women, general environmental inequalities, and work-family conflicts (17). Significant efforts have been made by the American Association of Medical Colleges and the U.S. Department of Health and Human Services in their Offices of Women, but the status of women in academic medicine remains an important problem (18). Psychiatry has been a hospitable field for women (19), and the environment for women in psychiatry has substantially improved in the last 20 years (20), but there are still few senior faculty women or Chairs in our field (21).
So how do women fit into academic teaching in psychiatry? What are the implications for women of separating research from clinical work and/or teaching? Do women bring something special to teaching in psychiatry? In this article, we review the issues facing women who teach in academic psychiatry. First, we illustrate some of the teaching challenges that women face, using as an illustration a small study of medical student and resident core lecture teaching distribution in the University of Michigan Department of Psychiatry. We use this example to explore the broader context of women’s teaching in psychiatry. We also discuss possible future opportunities for women and gender issues in psychiatry.
TEACHING DIVISION OF LABOR AT ONE INSTITUTION
Background and Hypothesis
At the University of Michigan Department of Psychiatry, teaching takes place on a number of levels including large lectures to first- and second-year medical students, small lectures on core topics to third-year medical students, small lectures on core topics to residents in different years, and individual supervision of residents and medical students. All members of the psychiatry faculty are involved in teaching, but the time commitment for and scope of the teaching vary considerably. In the academic year 2001–2002, the department had 60 full-time MD faculty, 41 men and 19 women. Over 60% of the men were on the tenure track (N=26) while only 26% of the women were on the tenure track (N=5). The numbers of clinical-track men and women were about equal (15 men and 14 women), but 74% of the women were on the clinical track while only 37% of the men were on this track. Thus men comprised 84% of the tenure track and 52% of the clinical track, while women comprised 16% of the tenure track and 45% of the clinical track (Table 1).
Our original hypothesis was that clinical-track faculty would perform the bulk of the teaching, particularly as the clinical track at the University of Michigan is identified as a clinician-educator track and teaching portfolios are required for promotion of clinical track faculty. We were concerned about teaching burden, and thought that clinical-track women might be vulnerable to being overwhelmed with teaching loads.
METHODS
We analyzed one form of teaching performed by the faculty (small didactic lectures given during the academic year 2001–2002) to see how teaching responsibilities were allocated between tenure-track and clinical-track men and women. We assembled lists of core lectures (all one to one and one-half hour in length) given to third-year medical students, first through fourth year adult residents (PGI-IV), and first- and second-year child fellows. We classified these lectures into those given by tenure-track men, tenure-track women, clinical-track men, and clinical-track women. We did not include the lectures given by other lecturers such as Ph.D. faculty, adjunct faculty, residents, and faculty from other departments. We then compared the proportion of the lectures given by each faculty category to the proportion of faculty in that category.
The third-year medical student lectures are offered during the required 4-week psychiatry rotation. These lectures are in basic categories of illness and treatment, and the whole sequence is repeated for every group of students that rotates through (12 times in one year). These lectures are available for faculty who volunteer to teach, and the schedule is maintained by a woman clinical faculty member and her administrator. The PG-I through PG-IV core sequences are coordinated by different men clinical-track faculty for each year. The topics to be covered are determined by RRC guidelines and the Resident Education Committee within the department. Individuals are asked by the core coordinators to coordinate a sequence and/or give one or more lectures. The child core is coordinated through clinical faculty in the child division, also by invitation.
RESULTS
Contrary to our hypothesis, we found that much of the core teaching in the psychiatry department was performed by tenure-track men. Clinical-track men participated in most teaching areas, but the teaching load assigned to clinical-track women was significantly less than would be expected given the percentage of faculty in this track. (Table 2) In the third-year medical student lectures (M-3), clinical-track men were the best represented, while clinical-track women had fewer lectures than either track of men. The first year of the adult residency showed a distribution of faculty teaching that corresponded to the number of faculty in each category. By the fourth year of the resident core, however, the teaching shifted almost entirely toward tenure-track men. The topics of the third- and fourth-year resident core, which were generally given by tenure-track men, were in both therapy and biological science. More than half of the fourth year core was devoted to a neuroscience review, and faculty involved in research presented their latest research findings to the residents. In the child fellow core, clinical-track men were much better represented than other categories. Overall, clinical-track women were significantly under-represented in teaching.
DISCUSSION
Although this was a small study, limited to one department in one institution, it does raise questions about women teaching in an academic environment. This study only measured didactic teaching sessions, mostly because it is extremely difficult to quantify other types of teaching. Yet as educators have found in Great Britain and the U.S., didactic teaching continues to have a significant effect on students (22, 23). In addition, incorporating women into teaching has been a rapidly changing process in residency programs over the last few decades. As recently as 1974, Benedek and her colleagues found that 30% of surveyed residency programs had no women in any teaching role at all (24). Thus the question of the impact of women teaching in didactic sessions remains an important one, and it would be useful to compare this information at different institutions.
Even with its limitations, this small study on the distribution of core lecture teaching among the tenure-track and clinical-track men and women in our department illustrates a number of issues. Some of the factors that influence selection of faculty for teaching are the variety of topics necessary in psychiatry education, the relative expertise of different kinds of faculty, and the personal networks that influence how faculty members are selected to teach. First, residents and students need to be exposed to a wide array of educational topics from molecular science to managed care. The research faculty are key participants in providing expertise in basic science areas, but clinical-track faculty provide important perspective in patient care. While clinical teaching was clearly important in the core curriculum, clinical-track women were not proportionately represented in providing this teaching. Further, the identification of women with the clinician-educator track (instead of the tenure track) could have consequences in terms of role models for women and messages to women residents and medical students about difficulties doing research as a woman. Both of these observations about women and academic teaching bear closer investigation.
Many of the core lectures given to medical students, residents, and child fellows were organized around important clinical issues. While the tenure-track research faculty (comprised largely of men) provided a sizeable proportion of the teaching, the clinical-track faculty played an important role in educating students and residents about patient care. As the framers of the academic model intended, physicians engaged in research conveyed their findings to the students and residents. But the framers of academic medicine in the early 20th century did not anticipate the distance between molecular research and current patient care, a distance that is often bridged by clinical faculty.
At the University of Michigan, men and women comprise equal portions of the clinical-track faculty. Despite this distribution of job titles, however, the teaching load for core teaching was not equally distributed among men and women on the clinical track. The breakdown of core lectures does not represent all of the teaching done in the department by female clinical-track faculty, and several women are engaged in very intensive educational pursuits (one manages the medical student clinic, another advises residents on Michigan’s resident Clinician-Educator Track, and another serves as the Associate Dean for Student Affairs at the medical school). Although some women do participate in teaching in other ways, it is particularly important for women on the clinical track to have opportunities to teach since a teaching portfolio is required for promotion at this institution. Further, exposure to female faculty through didactic lectures could provide an important avenue to develop mentoring relationships. The underrepresentation of clinical-track women in the core curriculum might be due to a number of factors, including the possibility that women have not been asked to teach as much as the men or that they have turned down teaching opportunities. Although we can only speculate at this point, it is possible that women are not seen (by themselves [25] or others) as experts and thus as desirable for teaching, or that they are (or are perceived to be) overloaded with clinical and/or family responsibilities. This question deserves further exploration.
OUTLOOK FOR THE FUTURE
Although this small study focused primarily on didactic teaching, learning occurs not only in formal didactic sessions, but also within the more general sociocultural environment of academic centers. In these centers, men, not women, currently occupy the majority of leadership positions. While women have made tremendous gains in medicine and psychiatry in the last few decades, there remain significant challenges for the future, as well as exciting possibilities. One challenge is the way women fit into the sometimes tense relationship between teaching and research within academic medicine. Some have suggested that research faculty need to be more involved with teaching in order to provide greater exposure to research for students and residents (26). But since the research faculty consists largely of men, what message is given to female students and residents about the possibility of doing research as a woman? Some have suggested that women might be less interested in research than men, and subsequently less interested in academic medicine (27). But could this lack of interest be the result of inadequate mentoring or faulty perceptions about research (28)? Moreover, might the traditional institutional track system—currently front-loaded with publishing and grant-writing demands highest for early career psychiatrists—make women feel as though they need to choose between research and family life (especially with young children)? Within academic medicine, are women choosing clinical tracks because of genuine interest in teaching and clinical work, or are they pushed (internally or externally) away from research (29)? And, are women who choose to teach risking the loss of opportunities for promotion (30, 31)?
Although there remain concerns for women who are attempting to pursue a career in academic medicine, there are also opportunities for women to have an impact on the future of academic teaching, patient care, and research. Innovation is necessary if academic medical centers, including departments of psychiatry, are going to survive changes in health care financing and organization (32). As many have suggested, it is also important to change approaches toward teaching in the new health care environment (33–35). Some older academic physicians have illustrated the difficulties of accomplishing change (36), but most women have been outside the academic inner circle and could be less invested in existing structures. Further, women as former outsiders might be able to provide fresh perspective on how to approach new elements in medical curricula.
Although it is unfair to both women and men to assume that women have a monopoly on perspectives relating to gender issues, there are areas of curricular reform that can benefit from the input of women. First, there are still some examples of sex bias in medical education (37, 38). Second, some have suggested that teaching in areas of empathy and ethics can be best approached from questions raised by women in and out of medicine about power structures in medicine (39). In addition, there has been widespread interest in the inclusion of specific materials related to issues of race, gender, and class in psychiatry curricula (40, 41).
The traditional model of academic medicine depended on two assumptions: that the faculty doing research were the best equipped to teach, and that research findings were directly relevant to clinical medicine. In the last few decades, however, both of these assumptions have been questioned. Teaching is not necessarily something that comes naturally to everyone in academic medicine, and training in teaching techniques needs to be a part of the academic enterprise. Women, as a large pat of most clinical faculties, have the opportunity to obtain training in teaching techniques. More effective (and relevant) teaching is clearly valued by students and residents (42). Research needs to be conducted to promote innovation in teaching techniques and curriculum content (43–45), and greater inclusiveness of gender and race in the academic environment.
Finally, and perhaps most importantly to the future of women in psychiatry, women in teaching roles, both in clinical and research tracks, can help students and residents develop mentoring relationships (46). Mentoring relationships are clearly important for academic medical faculty (47), and a lack of mentoring could be acting as a deterrent to women entering academic medicine (48). Informal mentoring relationships, such as those developed with increased exposure to teaching by female faculty, could significantly help women advance in academic medicine (49). Now that women comprise more than 45% of medical school classes nationally (50), it is even more important to think about educating women for academic careers in the future. Leaders within psychiatry have worried that the physician-scientist might be a dying breed (51). A critical means of addressing this problem will be to provide opportunities for faculty women to develop and share their clinical and research (and possibly personal) expertise and strategies with the next generation of women (and men) residents and medical students.
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OBJECTIVE: This article explores past, present, and future issues for women and teaching in academic psychiatry. A small study of didactic teaching responsibilities along faculty groups in one academic psychiatry department helps to illustrate challenges and opportunities for women in psychiatric teaching settings. Background: Although women have comprised half of all medical school admissions for over a decade, tenure-track positions are still largely dominated by men. In contrast, growing numbers of women have been entering academic medicine through clinical-track positions in which patient care and teaching, rather than research, are the key factors for promotion. Thus, the authors hypothesized better representation of clinical-track women in formal, didactic teaching within the medical school setting. METHODS: The authors compared the numbers of tenure and clinical-track men and women teaching lectures to medical students and residents at the University of Michigan, Department of Psychiatry. RESULTS: Contrary to the hypothesis, the majority of didactic teaching was done by tenure-track men. DISCUSSION: Possible explanations and remedies for the continuing under-representation of women in academic psychiatry, particularly teaching settings, are explored. Suggestions are made for future areas in which female faculty might have opportunities for participation and leadership.
Academic medical teaching, as we know it now in the United States, originated in the educational reforms of medical schools in the late 19th and early 20th centuries (1). At that time, leaders in medical education made a self-conscious effort to change training from an informal network of lectures and/or preceptorship (2) to a German model of medical education (3). The core ideas of the new model included basing academic practice on research, directly transmitting research ideas to medical students, and teaching at the patients’ bedside (4). In the last part of the 19th and early part of the 20th centuries, a number of university-based medical schools in the U.S. began to lengthen courses of study, insist on higher standards for entrance, and develop faculties that were comprised of individuals who devoted much (if not all) of their effort to the institution (5).
The academic medical model has faced a number of challenges in the last few decades (6, 7). The growing research enterprise has necessitated that research faculty emphasize their research, publications, and grants, sometimes at the expense of their teaching (8). There is also an increasing distance between a molecular emphasis in research and the patient care and clinical teaching in academic medical centers (9). Further, social and economic pressures have pushed academic medical centers to focus more energy on the provision of patient care, sometimes at the risk of under-emphasizing teaching or research (10, 11). At many institutions, a distinct category of clinical faculty has been created to separate faculty into those who primarily do research and those who primarily see patients. While research faculty still have a great deal of (at least theoretical) responsibility for teaching, some institutions have placed more responsibility on clinical faculty and have created clinician-educator tracks (9).
Historically, academic medical centers have not been places of opportunity for women (12). While female students started to gain admission to most university-affiliated medical schools in the late 19th century, female faculty members have been much more rare (13). Recent statistics show a significant increase in women in academic medical centers in the last few decades, but much of that increase has been for junior-level clinical-track faculty (14). A recent study of cohorts of male and female academic faculty found that while women were more likely than men to pursue academic careers, they were less likely than men to be advanced to associate or full professor on either tenure or nontenure tracks (15). Although women have comprised nearly one-half of all medical school admissions for over a decade, women are not being promoted to the higher ranks of academic medicine at the same rate as men (16). A number of factors contribute to difficulties for women in academic settings such as networking that excludes women, general environmental inequalities, and work-family conflicts (17). Significant efforts have been made by the American Association of Medical Colleges and the U.S. Department of Health and Human Services in their Offices of Women, but the status of women in academic medicine remains an important problem (18). Psychiatry has been a hospitable field for women (19), and the environment for women in psychiatry has substantially improved in the last 20 years (20), but there are still few senior faculty women or Chairs in our field (21).
So how do women fit into academic teaching in psychiatry? What are the implications for women of separating research from clinical work and/or teaching? Do women bring something special to teaching in psychiatry? In this article, we review the issues facing women who teach in academic psychiatry. First, we illustrate some of the teaching challenges that women face, using as an illustration a small study of medical student and resident core lecture teaching distribution in the University of Michigan Department of Psychiatry. We use this example to explore the broader context of women’s teaching in psychiatry. We also discuss possible future opportunities for women and gender issues in psychiatry.
TEACHING DIVISION OF LABOR AT ONE INSTITUTION
Background and Hypothesis
At the University of Michigan Department of Psychiatry, teaching takes place on a number of levels including large lectures to first- and second-year medical students, small lectures on core topics to third-year medical students, small lectures on core topics to residents in different years, and individual supervision of residents and medical students. All members of the psychiatry faculty are involved in teaching, but the time commitment for and scope of the teaching vary considerably. In the academic year 2001–2002, the department had 60 full-time MD faculty, 41 men and 19 women. Over 60% of the men were on the tenure track (N=26) while only 26% of the women were on the tenure track (N=5). The numbers of clinical-track men and women were about equal (15 men and 14 women), but 74% of the women were on the clinical track while only 37% of the men were on this track. Thus men comprised 84% of the tenure track and 52% of the clinical track, while women comprised 16% of the tenure track and 45% of the clinical track (Table 1).
Our original hypothesis was that clinical-track faculty would perform the bulk of the teaching, particularly as the clinical track at the University of Michigan is identified as a clinician-educator track and teaching portfolios are required for promotion of clinical track faculty. We were concerned about teaching burden, and thought that clinical-track women might be vulnerable to being overwhelmed with teaching loads.
METHODS
We analyzed one form of teaching performed by the faculty (small didactic lectures given during the academic year 2001–2002) to see how teaching responsibilities were allocated between tenure-track and clinical-track men and women. We assembled lists of core lectures (all one to one and one-half hour in length) given to third-year medical students, first through fourth year adult residents (PGI-IV), and first- and second-year child fellows. We classified these lectures into those given by tenure-track men, tenure-track women, clinical-track men, and clinical-track women. We did not include the lectures given by other lecturers such as Ph.D. faculty, adjunct faculty, residents, and faculty from other departments. We then compared the proportion of the lectures given by each faculty category to the proportion of faculty in that category.
The third-year medical student lectures are offered during the required 4-week psychiatry rotation. These lectures are in basic categories of illness and treatment, and the whole sequence is repeated for every group of students that rotates through (12 times in one year). These lectures are available for faculty who volunteer to teach, and the schedule is maintained by a woman clinical faculty member and her administrator. The PG-I through PG-IV core sequences are coordinated by different men clinical-track faculty for each year. The topics to be covered are determined by RRC guidelines and the Resident Education Committee within the department. Individuals are asked by the core coordinators to coordinate a sequence and/or give one or more lectures. The child core is coordinated through clinical faculty in the child division, also by invitation.
RESULTS
Contrary to our hypothesis, we found that much of the core teaching in the psychiatry department was performed by tenure-track men. Clinical-track men participated in most teaching areas, but the teaching load assigned to clinical-track women was significantly less than would be expected given the percentage of faculty in this track. (Table 2) In the third-year medical student lectures (M-3), clinical-track men were the best represented, while clinical-track women had fewer lectures than either track of men. The first year of the adult residency showed a distribution of faculty teaching that corresponded to the number of faculty in each category. By the fourth year of the resident core, however, the teaching shifted almost entirely toward tenure-track men. The topics of the third- and fourth-year resident core, which were generally given by tenure-track men, were in both therapy and biological science. More than half of the fourth year core was devoted to a neuroscience review, and faculty involved in research presented their latest research findings to the residents. In the child fellow core, clinical-track men were much better represented than other categories. Overall, clinical-track women were significantly under-represented in teaching.
DISCUSSION
Although this was a small study, limited to one department in one institution, it does raise questions about women teaching in an academic environment. This study only measured didactic teaching sessions, mostly because it is extremely difficult to quantify other types of teaching. Yet as educators have found in Great Britain and the U.S., didactic teaching continues to have a significant effect on students (22, 23). In addition, incorporating women into teaching has been a rapidly changing process in residency programs over the last few decades. As recently as 1974, Benedek and her colleagues found that 30% of surveyed residency programs had no women in any teaching role at all (24). Thus the question of the impact of women teaching in didactic sessions remains an important one, and it would be useful to compare this information at different institutions.
Even with its limitations, this small study on the distribution of core lecture teaching among the tenure-track and clinical-track men and women in our department illustrates a number of issues. Some of the factors that influence selection of faculty for teaching are the variety of topics necessary in psychiatry education, the relative expertise of different kinds of faculty, and the personal networks that influence how faculty members are selected to teach. First, residents and students need to be exposed to a wide array of educational topics from molecular science to managed care. The research faculty are key participants in providing expertise in basic science areas, but clinical-track faculty provide important perspective in patient care. While clinical teaching was clearly important in the core curriculum, clinical-track women were not proportionately represented in providing this teaching. Further, the identification of women with the clinician-educator track (instead of the tenure track) could have consequences in terms of role models for women and messages to women residents and medical students about difficulties doing research as a woman. Both of these observations about women and academic teaching bear closer investigation.
Many of the core lectures given to medical students, residents, and child fellows were organized around important clinical issues. While the tenure-track research faculty (comprised largely of men) provided a sizeable proportion of the teaching, the clinical-track faculty played an important role in educating students and residents about patient care. As the framers of the academic model intended, physicians engaged in research conveyed their findings to the students and residents. But the framers of academic medicine in the early 20th century did not anticipate the distance between molecular research and current patient care, a distance that is often bridged by clinical faculty.
At the University of Michigan, men and women comprise equal portions of the clinical-track faculty. Despite this distribution of job titles, however, the teaching load for core teaching was not equally distributed among men and women on the clinical track. The breakdown of core lectures does not represent all of the teaching done in the department by female clinical-track faculty, and several women are engaged in very intensive educational pursuits (one manages the medical student clinic, another advises residents on Michigan’s resident Clinician-Educator Track, and another serves as the Associate Dean for Student Affairs at the medical school). Although some women do participate in teaching in other ways, it is particularly important for women on the clinical track to have opportunities to teach since a teaching portfolio is required for promotion at this institution. Further, exposure to female faculty through didactic lectures could provide an important avenue to develop mentoring relationships. The underrepresentation of clinical-track women in the core curriculum might be due to a number of factors, including the possibility that women have not been asked to teach as much as the men or that they have turned down teaching opportunities. Although we can only speculate at this point, it is possible that women are not seen (by themselves [25] or others) as experts and thus as desirable for teaching, or that they are (or are perceived to be) overloaded with clinical and/or family responsibilities. This question deserves further exploration.
OUTLOOK FOR THE FUTURE
Although this small study focused primarily on didactic teaching, learning occurs not only in formal didactic sessions, but also within the more general sociocultural environment of academic centers. In these centers, men, not women, currently occupy the majority of leadership positions. While women have made tremendous gains in medicine and psychiatry in the last few decades, there remain significant challenges for the future, as well as exciting possibilities. One challenge is the way women fit into the sometimes tense relationship between teaching and research within academic medicine. Some have suggested that research faculty need to be more involved with teaching in order to provide greater exposure to research for students and residents (26). But since the research faculty consists largely of men, what message is given to female students and residents about the possibility of doing research as a woman? Some have suggested that women might be less interested in research than men, and subsequently less interested in academic medicine (27). But could this lack of interest be the result of inadequate mentoring or faulty perceptions about research (28)? Moreover, might the traditional institutional track system—currently front-loaded with publishing and grant-writing demands highest for early career psychiatrists—make women feel as though they need to choose between research and family life (especially with young children)? Within academic medicine, are women choosing clinical tracks because of genuine interest in teaching and clinical work, or are they pushed (internally or externally) away from research (29)? And, are women who choose to teach risking the loss of opportunities for promotion (30, 31)?
Although there remain concerns for women who are attempting to pursue a career in academic medicine, there are also opportunities for women to have an impact on the future of academic teaching, patient care, and research. Innovation is necessary if academic medical centers, including departments of psychiatry, are going to survive changes in health care financing and organization (32). As many have suggested, it is also important to change approaches toward teaching in the new health care environment (33–35). Some older academic physicians have illustrated the difficulties of accomplishing change (36), but most women have been outside the academic inner circle and could be less invested in existing structures. Further, women as former outsiders might be able to provide fresh perspective on how to approach new elements in medical curricula.
Although it is unfair to both women and men to assume that women have a monopoly on perspectives relating to gender issues, there are areas of curricular reform that can benefit from the input of women. First, there are still some examples of sex bias in medical education (37, 38). Second, some have suggested that teaching in areas of empathy and ethics can be best approached from questions raised by women in and out of medicine about power structures in medicine (39). In addition, there has been widespread interest in the inclusion of specific materials related to issues of race, gender, and class in psychiatry curricula (40, 41).
The traditional model of academic medicine depended on two assumptions: that the faculty doing research were the best equipped to teach, and that research findings were directly relevant to clinical medicine. In the last few decades, however, both of these assumptions have been questioned. Teaching is not necessarily something that comes naturally to everyone in academic medicine, and training in teaching techniques needs to be a part of the academic enterprise. Women, as a large pat of most clinical faculties, have the opportunity to obtain training in teaching techniques. More effective (and relevant) teaching is clearly valued by students and residents (42). Research needs to be conducted to promote innovation in teaching techniques and curriculum content (43–45), and greater inclusiveness of gender and race in the academic environment.
Finally, and perhaps most importantly to the future of women in psychiatry, women in teaching roles, both in clinical and research tracks, can help students and residents develop mentoring relationships (46). Mentoring relationships are clearly important for academic medical faculty (47), and a lack of mentoring could be acting as a deterrent to women entering academic medicine (48). Informal mentoring relationships, such as those developed with increased exposure to teaching by female faculty, could significantly help women advance in academic medicine (49). Now that women comprise more than 45% of medical school classes nationally (50), it is even more important to think about educating women for academic careers in the future. Leaders within psychiatry have worried that the physician-scientist might be a dying breed (51). A critical means of addressing this problem will be to provide opportunities for faculty women to develop and share their clinical and research (and possibly personal) expertise and strategies with the next generation of women (and men) residents and medical students.
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