There have been a number of contributions to the literature regarding obstacles women face in academia and organized medicine (1—5), and there are currently lectures and courses on this topic, facilitated by women who are prominent at the national level, at the annual meetings of the American Psychiatric Association (APA). Some of these issues involve socialization patterns ingrained in the broader society, possessing inherent biases and discriminatory practices, and the medical field, viewed as a microcosm of the broader culture. Although recent historical developments have been encouraging to women, many institutional and interpersonal obstacles remain as more women enter medicine and biases have weakened. An example might be the disproportionate number of teaching assignments or choice of teaching activities for women, as, in some academic settings, teaching may be less valued and not rewarded as well as research. There are also many noninstitutional or personal factors that arise for women, including the involvement in creating and caring for a family, which often takes place at critical junctures during their careers.
The purpose of the seminar entitled "Women as Leaders: Strategies and Opportunities for Success" was to provide a structured forum for psychiatric trainees and faculty to develop an understanding of leadership issues, both nationally and locally, and to enhance their leadership skills. This type of educational experience may be missing from the curricula of residency programs, though workshops have been facilitated at national meetings. The intent was to present the material in a constructive manner that would encourage participants to explore various avenues for leadership, to introduce successful women within our own institution, Yale University, who could serve as role models, and to provide an opportunity to discuss specific dilemmas, with which participants have been faced.
The seminar was offered as an elective to all residents and postdoctoral fellows within the Yale University Department of Psychiatry. We met for eight sessions, each lasting 1½ hours, over the course of 5 months. A list of readings was provided and is included in the references of this article. Additional materials that were distributed included a list of APA programs for women psychiatrists, the APA's "tip sheet on the role of mentorship in career advancement for women," and the Yale Medical School description of faculty tracks and ranks. Several junior women faculty members joined the seminar as participants, and four senior women within the medical school were invited as guest presenters for one session each.
The main topics were: 1) exploration of leadership roles in various areas, including research, clinical practice, teaching, and administration (e.g., chief resident, unit chief, agency medical director, or director); 2) organizational dynamics and gender; 3) negotiation skills and conflict resolution strategies; 4) role of consultation, seminars, peer support, and mentoring by both men and women in the development of leadership skills; and 5) "keeping the balance: work, relationships, and personal health."
The first session was devoted to introductions and a review of the goals of the course, an overview of relevant gender issues, and development of a set of questions that we would pose to guest speakers in subsequent meetings. The main questions involved strategies for negotiating salary and position, balancing family and career, and developing leadership skills. Participants were asked to volunteer to summarize the papers provided as references. These presentations were woven into the sessions discussed below.
The guest speakers were each asked to speak about a particular topic such as "mentoring, networking, and other strategies for success as a researcher" and "medical school and national organizations—roles, political power, and other issues for women." The director of Yale's Office for Women in Medicine, who is also the ombudsperson and associate dean, gave a presentation on "negotiation skills and conflict resolution." (6, 7) There was time within each session for the participants to pose planned and spontaneous questions. All of the participants were encouraged to present "case examples" from their own experiences, which included complex negotiations with powerful mentors and dual career issues.
Many issues related to the socialization of women were noted by the speakers, who mentioned repeatedly the impact of participation in team sports, which occurred traditionally for males. Boys are taught that it is okay to compete fiercely against friends and that it is more important to win than to be liked, whereas girls are not necessarily encouraged to be competitive. It has been noted that women often are able to achieve personal satisfaction within smaller groups and family, with less of a need to succeed on a larger "playing field." Several presenters used sports metaphors (e.g. how to "get in the game") to frame their advice. Specific suggestions included making comments in meetings in a positive manner, emphasizing team membership, and moving forward together to reach goals. Supporting arguments with data rather than emotion was also critical.
Group dynamics specific to women as group leaders were addressed. Possible transference reactions toward female leaders include the expectation that they will be nurturing all the time, and anger and disappointment can arise when they are not perceived as such. Female managers must learn how to say "no" to those they supervise and to those whom they report, at the risk of not being liked. One presenter encouraged participants to find ways to support other women in leadership roles and not to adopt the overt or covert biases toward women in powerful roles.
The importance of developing a set of personal priorities and making "choices" rather than "sacrifices" was discussed. Since it may not be feasible to reach the highest degrees of achievement in research, clinical work, teaching, family involvement, and income level, it is in the best interest of any leader to have a clear idea of her or his goals and to make small and large career decisions accordingly. Participants were encouraged to persevere and "stay on the bus" and to find peers with whom they can confide along the way. The importance of receiving support (and how to negotiate for it) from partners and paid household and childcare workers was also discussed.
Presenters and participants identified multiple strategies for success that were considered to be both effective and encouraging. At the institutional level, suggestions were offered regarding the creation of nondiscriminatory policies and procedures for hiring, promotion, and leaves of absence; mentorship programs; reward systems for valued activities such as teaching; and the establishment of new cultural "norms" for work hours (i.e., not holding mandatory meetings at 8 a.m. or 5 p.m., which present conflicts for both women and men with childcare responsibilities). Participants were encouraged to become involved politically and to affect change by joining organizations and speaking out on important issues. At the personal level, we acknowledged the value of understanding organizational dynamics and using these insights as navigational tools to create alliances and to establish information-sharing and mutual support networks. Specific techniques were presented to enhance the participants' ability to "confront with tact" and to negotiate effectively. The relative merits of part-time versus full-time careers were also discussed and debated.
There were 10 participants who attended regularly and 3 who came occasionally. Although the seminar was offered to all of the residents and fellows, only women attended. A few noted that their male and female supervisors were very supportive and accommodating in terms of making sure that they were free to participate.
During the final session, the participants were asked for feedback and suggestions for additional topics or seminars. The feedback that was received endorsed the course as one that succeeded in meeting its goal: providing useful content in a constructive format. Only three participants returned the formal evaluation form used by the Department of Psychiatry which asks five questions on the quality of a course with a rating scale of 1 (unsatisfactory) to 5 (outstanding.) The average of those ratings was 4.6 per item (range 4—5.) The respondents added written comments about the value of the outside speakers who provided "variety" and were "helpful and refreshing." They also noted that the process of joining other members of the department in this seminar provided an important venue for meeting people as well discussing important issues. One participant wrote that she was "motivated and inspired" by the others in the group as well as the speakers.
A follow-up survey was mailed to all 13 participants, including those who attended intermittently, 18 months after the completion of the seminar, and 10 responses (77%) were obtained. Because the survey was sent anonymously, the nonresponders could not be characterized. One question asked participants to give their overall impression of the course at the time of its completion and the second asked for their current impression of its value. These were rated on a 5-point scale, with 1 representing "unsatisfactory" and 5 representing "outstanding." The result of the first question was a mean of 4.2 or "excellent" (range=3—5 or good—outstanding) and the second was 4.0 (range=3—5). The respondents were unanimous in their agreement that the seminar should be offered again, and each believed that there has been a positive effect on her professional life. Examples of comments on the latter item include: "encouraged me to seek out mentors," and "the modeling of professional behavior was very helpful" (e.g. how Dr. X said she conducts herself at meetings … familiarized me with other women in the department, some of whom have been helpful resources). With follow-up data available for three-fourths of the participants, it was clear that the seminar had been a meaningful experience that had a positive and lasting impact on many residents.
A seminar on women as leaders was a successful venture within an academic department of psychiatry. The course offered a mixture of didactics by the course director; presentations by senior women from the medical center, who provided useful insights and served as role models; and opportunities for open discussion and mutual support among the participants. The residents and junior faculty members who attended were enthusiastic about this educational experience. The structure of the course, which incorporated specific teaching materials plus "local" expertise, could serve as a model for such seminars in other programs or could be integrated into an existing course for all residents.