Career obstacles for women in medicine.
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Career Choice↗
Biomedical subjects
P S Morahan
Publications and source records attributed to P S Morahan.
Advancing women and closing the leadership gap: the Executive Leadership in Academic Medicine (ELAM) program experience.
Women are persistently underrepresented in the higher levels of academic administration despite the fact that they have been entering the medical profession in increasing numbers for at least 20 years and now make up a large proportion of the medical student body and fill a similar proportion of entry level positions in medical schools. Although there are no easy remedies for gender inequities in medical schools, strategies have been proposed and implemented both within academic institutions and more broadly to achieve and sustain the advancement of women faculty to senior level positions. Substantial, sustained efforts to increase programs and activities addressing the major obstacles to advancement of women must be put in place so that the contributions of women can be fully realized and their skills fittingly applied in meeting the medical education and healthcare needs of all people in the 21st century.
Career Mobility↗
Ensuring the success of women faculty at AMCs: lessons learned from the National Centers of Excellence in Women's Health.
Since the early 1970s, the numbers of women entering medical school and, subsequently, academic medicine have increased substantially. However, women faculty have not advanced at the expected rate to senior academic ranks or positions of leadership. In 1996, to counter this trend, the U.S. Department of Health and Human Services (DHHS) Office on Women's Health included women's leadership as a required component of the nationally funded Centers of Excellence in Women's Health to identify effective strategies and initiate model programs to advance women faculty in academic medicine. The authors describe the experience of Centers at seven U.S. medical schools in initiating and sustaining leadership programs for women. The processes used for program formation, the current programmatic content, and program evaluation approaches are explained. Areas of success (e.g., obtaining support from the institution's leaders) and difficulties faced in maintaining an established program (such as institutional fiscal constraints and the diminishing time available to women to participate in mentoring and leadership activities) are reviewed. Strategies to overcome these and other difficulties (e.g., prioritize and tightly focus the program with the help of an advisory group) are proposed. The authors conclude by reviewing issues that programs for women in academic medicine will increasingly need to focus on (e.g., development of new kinds of skills; issues of recruitment and retention of faculty; and increasing faculty diversity).
Faculty, Medical↗
Innovative mentoring programs to promote gender equity in academic medicine.
The authors describe the history, characteristics, and goals of four innovative programs, each in a medical school, that were established in 1998 to help faculty members of both sexes obtain mentors and thereby facilitate their career advancement. The programs were established as the result of an initiative by the Office on Women's Health (OWH) within the U.S. Department of Health and Human Services. Specifically, the OWH convened the National Task Force on Mentoring for Health Professionals, which determined that two principles are paramount to the success of any mentoring relationship or program: institutional commitment and institutional rewards and recognition to mentors. In accordance with the task force findings, the OWH created the National Centers of Leadership in Academic Medicine, one at each of four medical schools: MCP Hahnemann School of Medicine; the University of California, San Diego, School of Medicine; East Carolina University School of Medicine; and Meharry Medical College School of Medicine. The authors give highlights of each program's goals and progress, and note that, ideally, these programs will eventually serve as models for similar programs at other schools. Programs such as these foster the advancement of a diverse faculty, a more supportive academic environment, and the education of providers who are sensitive to the needs of all their patients, staff, and colleagues.
Faculty, Medical↗
Training future leaders of academic medicine: internal programs at three academic health centers.
The authors review the need for internal programs for leadership training at academic health centers and then describe in detail three programs of this type that have operated during the 1990s: (1) the Allegheny Leadership Institute, founded by the Allegheny Health, Education and Research Foundation, Pittsburgh, Pennsylvania; (2) the Physician Executive Management Development Program (PEMDP) of Saint Louis University School of Medicine; and (3) the University of Nebraska Medical Center Leadership Institute. Educational elements common to these programs include having a small class size and participants from many areas of academic medicine and health care, focusing on educational strategies that draw on participants' experiences and training, conducting the training away from the participants' institutions, having short sessions, using faculty from both within and outside the participants' institutions, and creating strategies to reinforce learning. Lessons learned reflect the unique context of each institution; the authors list the major lessons learned by each of the three programs they surveyed (e.g., leaders of the Saint Louis University PEMDP program believe that it is important to help participants implement desired changes in their work areas once they return to work, and are investigating how to do this). The authors conclude with an extensive list of recommendations to optimize the effects of leadership development training carried out in AHCs' internal programs (e.g., "Focus on specific skills that can be learned, and link the learning experiences to real work situations in health care and higher education") and explain why they think internal leadership institutes have at least three distinct advantages over external programs.
Academic Medical Centers↗
Strategies to expand the definition of scholarship for the health professions.
Standards for promotions and tenure for health professions faculty must require the same intellectual and methodologic rigor as those in other academic areas. The challenge is to expand the traditional view of scholarship as research to include scholarship of teaching, application, and integration and to develop methods for documenting these. This article describes four strategies instituted by Allegheny University of the Health Sciences to address this challenge. Results of two of the strategies, a workshop for appointments and promotions and tenure committee members, and a workshop for preparing junior faculty for academic advancement are discussed. The four strategies described are intended to serve as models to stimulate discussion and innovation at other institutions.
Career Mobility↗
Implementing a comprehensive approach to managing faculty roles, rewards, and development in an era of change.
The current environment in which medicine is taught and practiced requires that medical schools pay increased attention to the faculty member's roles, rewards, career development, and productivity. Medical schools must make strategic decisions about the allocation of resources that can nurture their faculties and support the activities in academic and community settings in which faculty are involved. From 1993 to 1995 Allegheny University of the Health Sciences (formerly Medical College of Pennsylvania and Hahnemann University) designed a comprehensive system for the professional development of faculty. This system is based upon expanded categories of faculty academic activity and scholarship. New programs were implemented to reorient faculty toward conducting and documenting the expanded array of scholarly activities. The main characteristics of the new system are the establishment of formally defined performance expectations, the vertical alignment of the individual faculty member's objectives with the department's mission and the school's mission, and an increasing emphasis upon faculty interdependence, accountability, and use of sound business practices. The authors describe these and other aspects of the design of the new system in detail and report initial results and lessons learned from the system's implementation, evaluation, and dissemination throughout the university. The long-term success of this comprehensive professional development program will be assessed over time by observing how this institution advances its mission in a well-planned and cost-effective manner that retains talented, productive, and professionally fulfilled faculty.
Academic Medical Centers↗
The Pennsylvania Local Interdisciplinary Team: journey into collaborative learning and community health improvement.
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Community Health Planning↗
A multisite collaborative for the development of interdisciplinary education in continuous improvement for health professions students.
In 1994, The Institute for Healthcare Improvement, in Boston, Massachusetts, formed the Interdisciplinary Professional Education Collaborative (the Collaborative). The mission of the Collaborative is to create an interdisciplinary teaching and learning environment in which future health professionals learn to work together to improve health care delivery. Apart from emphasizing interdisciplinary collaboration, the Collaborative focuses on teaching the methods of continuous improvement (CI), a system of management first developed for manufacturing industries that is increasingly being used in the management of health care delivery. The Collaborative consists of four local interdisciplinary teams (LITs): the Cleveland LIT, the "George" LIT (a collaboration between George Washington University in Washington, D.C., and George Mason University in Fairfax, Virginia), the South Carolina LIT, and the Pennsylvania LIT; and a coordinating committee. This paper describes each LIT's approach to achieving the Collaborative's commitment to give health professions students the opportunity to work in interdisciplinary teams to learn about and practice CI methods, training the Collaborative believes will enable them to be effective providers in a variety of health care systems. The paper describes the overall goals of the Collaborative, presents reports from the four LITs, and discusses common lessons learned.
District of Columbia↗
Decreases in macrophage mediated antitumor activity with aging.
We have demonstrated that immunotherapy of young (6-10 weeks old), and aged, (greater than 24 months old), tumor bearing mice with biological response modifiers enhanced survival and inhibited tumor growth, while treatment of aged mice had little or no effect. We hypothesized that the antitumor activity in young mice was principally mediated by activated macrophages (M phi) and predicted that the change in aged mice was caused by an intrinsic M phi defect which develops with advancing age. To directly test our hypothesis, we examined the antitumor activity of resident peritoneal M phi, purified and activated in vitro with IFN gamma plus LPS. Paralleling the results seen in vivo, M phi from aged mice exhibited reduced antitumor activity in comparison with M phi from younger mice. Moreover, there was reduced capacity of in vitro activated M phi from aged mice to produce TNF, IL-1 and nitric oxide, which are critical monokines and effector molecules that have been established to either directly inhibit tumor growth or cause tumor cell destruction. These studies establish that peritoneal M phi from aged mice have an intrinsic defect which prevents them from fully expressing their antitumor potential.
Aging↗
Review of the macrophage disappearance reaction.
Macrophages (M phi s) undergo a physiological response known as the macrophage disappearance reaction (MDR) in response to certain stimuli in the peritoneal compartment. The types of stimuli that can cause the MDR, the relationship of the MDR to the host immunological response, and the possible role of the MDR in M phi activation are reviewed. The data indicate that the MDR occurs in response to both acute nonspecific inflammatory and specific immune delayed hypersensitivity processes and that the MDR may play an important role in M phi activation.
Acute Disease↗
Comparing selection criteria of residency directors and physicians' employers.
In 1993, the Medical College of Pennsylvania (MCP), mindful of the rapidly changing environments of health care delivery, created three surveys to gather information from outside the school that would help the faculty plan how the curriculum and advising system could better prepare students and residents for the demands of twenty-first-century medicine. The first survey focused on the MCP seniors graduating that year and asked about their perceptions of their medical education and their specialty and residency choices. The second survey, directed to 40 medical residency program directors in family medicine, internal medicine, pediatrics, and surgery, sought to identify the characteristics of applicants that these directors valued when selecting entrants to their programs. The third survey, of 30 employers of physicians representing four practice environments (private practice, hospitals/other health systems, academic medical centers, and health maintenance organizations), sought information on hiring and recruitment practices and the skills, competencies, and attitudes these employers valued most when hiring recently graduated physicians. The responses showed several differences and/or misperceptions among the views held by the three groups surveyed and suggest that medical educators have not adapted as rapidly as have employers to changes in the health care environment. Academic health centers must broaden their missions and make changes in their own institutional cultures, both to maintain their own viability and to train physicians who have the balance between scientific and technical competency and essential personal characteristics (such as empathy) that the next century's practice will probably demand.
Academic Medical Centers↗
What medical schools and universities can learn from one another.
Colleges and universities devoted to undergraduate education and non-medical graduate education (hereafter called "universities") have much to teach medical schools and much to learn from them. Universities and medical schools differ significantly in their sources of revenue, cultures of promotion and tenure, academic values, and decision-making processes. Yet from the experience of universities, medical schools can learn innovative techniques of curriculum assessment and teaching, how to handle diversity issues, and ways to expand the definition of scholarship. In turn, medical schools can help teach universities the importance of fiscal and regulatory accountability, the benefits of interdisciplinary efforts, the practical benefits of problem-based learning, and techniques for adjusting to rapid change. The authors, all with medical school faculty backgrounds, developed the views reported in this article when they were Fellows in a leadership training program sponsored by the American Council on Education (ACE). They urge their colleagues to reach out beyond their specialties and departments and learn from higher education institutions that are grappling with problems analogous to those faced by medical schools.
Schools, Medical↗
Optimizing the detection of cell surface antigens on elicited or activated mouse peritoneal macrophages.
Blocking conditions that are optimal for the detection of surface antigens on resident peritoneal macrophages (PM phi) by flow cytometry are not ideal for elicited or activated PM phi. A blocking step of 10% goat serum can be used routinely to detect the F4/80 and Mac-1 antigens on resident PM phi. In contrast, high concentrations (33-50% each) of combined goat and mouse sera were required to reduce nonspecific binding and to improve the detection of the F4/80 antigen on PM phi elicited by thioglycollate broth (TG) or activated by maleic anhydride divinyl ether copolymer (MVE-2). However, even low concentrations of goat serum masked the expression of the Mac-2 antigen on TG and MVE-2 PM phi. Thus, within a given elicited or activated PM phi population, different blocking conditions may be necessary to detect different surface antigens optimally. In addition to blocking, the use of isotypic controls that match the monoclonal antibody isotypes was found to be necessary for the optimal detection of antigen expression on TG and MVE-2 PM phi.
Animals↗
Role of macrophages in the immunotherapy of Lewis lung peritoneal carcinomatosis.
The underlying cellular mechanisms for the antitumor effects of biological response modifiers (BRMs) have not been clearly resolved. We have investigated this issue in the Lewis lung (3LL) peritoneal carcinomatosis model in which treatment with the BRM MVE-2 slows tumor growth and enhances survival. MVE-2 is a potent inducer of cytotoxic macrophages (m phi s); however, in the vivo tumoricidal properties of these m phi s remain to be firmly established. To directly establish that m phi s were at least in part responsible for the in vivo efficacy of MVE-2, a novel method of obtaining highly enriched m phi suspensions was developed which gave high purity, satisfactory yield, and excellent viability without affecting antitumor activity. Using the 3LL peritoneal carcinomatosis model and adoptive transfer techniques, we directly demonstrate that the majority of antitumor activity was associated with the adherent cell fraction enriched for m phi s. Histological observations supported this conclusion, indicating that MVE-2 treatment initially activated cells associated with nonspecific immunity, retarding tumor growth in the ascites long enough for a multifaceted immune response to develop.
Animals↗
Herpes simplex virus type 1 replication and IL-1 beta gene expression in mouse peritoneal macrophages activated in vivo by an attenuated Salmonella typhimurium vaccine or Corynebacterium parvum.
Activated macrophages (M phi) from mice given Salmonella typhimurium or Corynebacterium parvum were compared with resident peritoneal macrophages at the molecular level for permissiveness for herpes simplex virus type 1 (HSV-1) replication and for expression of interleukin-1 beta (IL-1 beta). Peritoneal macrophages were harvested from mice injected 7 days previously with live, avirulent S. typhimurium (Sal-PM phi) or heat-killed C. parvum (CP-PM phi) and infected with HSV-1 in vitro. Both Sal-PM phi and CP-PM phi were activated as evidenced by characteristic changes in an ectoenzyme, by increased permissiveness for infectious virus production and viral cytopathic effect, and by induction of IL-1 beta mRNA. Analysis at the molecular level revealed that both types of activated M phi demonstrated increased patterns of HSV-1 immediate-early gene expression and viral DNA replication as compared with resident cells. A novel finding was that viral infection reduced IL-1 beta mRNA in both types of activated M beta. This observation has implications for the efficacy of Salmonella vaccines given in proximity to HSV-1 infection and for potential deleterious effects of HSV-1 infection in immunosuppressed patients receiving immunotherapy.
Animals↗
Role of macrophages in the host response to Lewis lung peritoneal carcinomatosis.
Lewis lung (3LL) peritoneal carcinomatosis elicits a complex host response in the peritoneal compartment. The response was delayed, showing few inflammatory cells through day 6 after lethal challenge with 3LL cells. Responses began in about half the mice on day 7 and had appeared in all mice by day 11. On day 7, some mice still showed no detectable 3LL growth in the pertioneal lavage fluid, and no differences in the peritoneal cell populations as compared with the control group. Other tumor-bearing mice, however, had evidence of 3LL cells and hemorrhagic ascites in the peritoneal compartment, with increased numbers of peritoneal macrophages (PM) and polymorphonuclear neutrophils (PMN). By day 11, all tumor-bearing mice had 3LL growth and hemorrhagic ascites. On days 7-11, there was a major influx of macrophages with a later influx of PMN between days 11 and 14. Two distinct PM populations were detected on day 7 in mice that showed detectable 3LL peritoneal carcinomatosis: resident PM, which did not express the Mac-2 antigen, and recruited PM, which were Mac-2+. At least some resident PM remained in the peritoneal compartment through day 14. Analysis of the kinetics of the cytotoxic capabilities of PM from tumor-bearing mice showed that by day 7 macrophages were able to kill the B16 melanoma tumor target, but not the 3LL target. The PM, however, were able to be activated further to kill the 3LL target by treatment in vitro with lipopolysaccharide and interferon gamma. No inhibition of PM tumoricidal activity could detected in the peritoneal wash of tumor-bearing mice. A lack of activation of PM from 3LL tumor-bearing mice may be involved in progression of peritoneal carcinomatosis.
Animals↗
The role of macrophages and macrophage cytokines in host resistance to herpes simplex virus.
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Animals↗