Experiencing the Culture of Academic Medicine: Gender Matters,
A National Study
Linda H. Pololi, MD1, Janet T. Civian, EdD1, Robert T. Brennan, EdD2, Andrea L. Dottolo, PhD1,3,
and Edward Krupat, PhD4
1Women’s Studies Research Center, National Initiative on Gender, Culture and Leadership in Medicine: C - Change, Brandeis University,
Waltham, MA, USA;2Harvard School of Public Health, Boston, MA, USA;3Department of Psychology, University of Massachusetts, Lowell, MA,
USA;4Harvard Medical School, Boston, MA, USA.
BACKGROUND: Energized and productive faculty are
critical to academic medicine, yet studies indicate a lack
of advancement and senior roles for women.
OBJECTIVE: Using measures of key aspects of the
culture of academic medicine, this study sought to
identify similarity and dissimilarity between percep-
tions of the culture by male and female faculty.
DESIGN: The C - Change Faculty Survey was used to
collect data on perceptions of organizational culture.
PARTICIPANTS: A stratified random sample of 4,578
full-time faculty at 26 nationally representative US
medical colleges (response rate 52 %). 1,271 (53 %) of
respondents were female.
MAIN MEASURES: Factor analysis assisted in the
creation of scales assessing dimensions of the culture,
which served as the key outcomes. Regression analysis
identified gender differences while controlling for other
KEY RESULTS: Compared with men, female faculty
reported a lower sense of belonging and relationships
within the workplace (T=−3.30, p<0.01). Self-efficacy
for career advancement was lower in women (T=−4.73,
p<0.001). Women perceived lower gender equity (T=
−19.82, p<0.001), and were less likely to believe their
institutions were making changes to address diversity
goals (T=−9.70, p<0.001). Women were less likely than
men to perceive their institution as family-friendly (T=
−4.06, p<0.001), and women reported less congruence
between their own values and those of their institutions
(T=−2.06, p<0.05). Women and men did not differ
significantly on levels of engagement, leadership aspi-
rations, feelings of ethical/moral distress, perception of
institutional commitment to faculty advancement, or
perception of institutional change efforts to improve
support for faculty.
CONCLUSIONS: Faculty men and women are equally
engaged in their work and share similar leadership
aspirations. However, medical schools have failed to
create and sustain an environment where women feel
fully accepted and supported to succeed; how can we
ensure that medical schools are fully using the talent
pool of a third of its faculty?
KEY WORDS: culture; academic medicine; female faculty; gender.
J Gen Intern Med
© Society of General Internal Medicine 2012
For 30 years now, women have constituted between 30 %
and 50 % of medical students; currently, a third of medical
faculty are women; faculty attrition due to dissatisfaction1
and attrition rates2are similar for men and women. Yet, the
average medical school has only 43 female full professors
compared with 192 male counterparts,3resulting in female
full professors making up only 4 % of all the faculty.3Just
12 % of clinical department chairs are women.4National
reports show that the career advancement of female faculty
in academic health centers (AHC) is much slower than that
of their male peers.5,6Recognizing these disparities, we
sought to better understand how female faculty experience
the culture of academic medicine and the extent to which
this differs from their male counterparts.
Female faculty’s perceptions of gender discrimination
and sexual harassment in academic medicine were docu-
mented by a 1995 national survey,7and women surgeons
have reported feeling isolation and that career advance-
ment opportunities were not equally available to them.8
One study found higher clinical research self-efficacy
beliefs in male than in female medical faculty.9Studies
focused on the lack of advancement of female faculty,
mostly conducted in a single institution or a single
specialty, have documented substantial gender differences in
the rewards and opportunities of academic medicine.10–12
These studies highlight disparities in outcomes for
women, such as salary, recommendation letters, promo-
tion, tenure and leadership opportunities. Several national
studies have documented sexism in peer review13–16and
remuneration17of female researchers. Taking a broader
approach, the research reported here focuses on the
organizational culture and the perceptions of the female
and male faculty about dimensions of the culture in their
Received April 26, 2012
Revised July 18, 2012
Accepted July 23, 2012
Prior qualitative research studies of the National Initiative
on Gender, Culture and Leadership in Medicine (known as
the C - Change project) have documented the professional
experiences of male and female faculty and the culture of
academic medicine.18–26We found that a lack of relation-
ships emerged as a central theme for both sexes across all
career categories18Other negative attributes of the culture
included competitive individualism, undervaluing of hu-
manistic qualities, deprecation, disrespect and the erosion of
trust. Many faculty, both men and women, also described
behaviors that led them to conclude that their institutions
were not focused enough on their espoused social and
educational missions.20,23A dominant theme expressed by
female faculty in their interviews was the experience of
feeling marginalized and invisible.19
The main aim of this paper is to delineate the
comparative experiences of women and men, and to gain
a quantitative assessment of their relative perspectives on
institutional culture. To do so, we surveyed faculty
members in 26 representative U.S. medical schools, to our
knowledge the first large-scale national study of male and
female faculty perceptions of the culture across multiple
medical schools and disciplines. Our hypothesis was that
female faculty would hold more negative perceptions of the
culture than their male counterparts. Our goal was to
determine the strength of association between gender and
the perceptual/attitudinal variables concerning the culture of
academic medicine, while controlling for the role of other
relevant variables, such as ethnicity and seniority.
The domains and items of the C - Change survey were
derived in large part from themes identified in the C -
Change qualitative study,18–22,25in conjunction with an
extensive search of the literature and reviews of relevant
instruments.27–32Faculty responded to a survey1containing
74 items related to advancement, engagement, relationships,
feelings about workplace, diversity and equity, leadership,
institutional values and practices, and work-life integration.
Items used 5-point Likert response scales (range: 1 =
strongly disagree to 5 = strongly agree).
Human subject institutional approvals were obtained at
Brandeis and Boston Universities, and the Association of
American Medical Colleges (AAMC).
Selecting Schools. Schools were selected in a multi-stage
process. First, we included the five schools that were part of
the C - Change consortium associated with the project from
which this study derived. These schools had been selected to
vary by region and public–private status. Then, from the
AAMC list of all US medical schools, we created a stratified
random sample of an additional 21 medical schools to ensure
that the 26 schools together 1) spanned all important types
(purposefully including in the 21 one small and one
historically Black school), and 2) achieved a distribution
similar to the overall proportion of AAMC schools by
geographic region and public/private sector. The dean at
each school was approached to participate. Three schools
declined, citing recent survey efforts; in each case a school
from the same stratum was randomly selected as replacement.
Because the first five schools had not been selected at
random, the data from these five were systematically
compared to the other 21. We found no significant
differences in respondents’ perceptions on all but one of the
scales measuring attributes of the work environment, and no
differences in demographic characteristics between the
original five and the additional 21 schools, suggesting that
the combined 26 school sample was representative of the
larger population of US medical schools.
Sampling Faculty Within Schools. The AAMC provided
names and demographic characteristics of full-time faculty
at each school (PhD, EdD and MD), and deans provided e-
mail addresses. For sampling, each faculty member was
categorized by sex, chronological age (under 39 years of
age, 39–47 years, and 48 years and older), under-
represented minority in medicine (URMM) status (yes or
no), and surgical specialty (yes or no). At each school, 25
faculty members were selected from each of six sex-by-age
categories for a base sample of 150 per school. To ensure
adequate numbers of URMM and female surgical faculty,
we added faculty at each school to the 150 members
sampled by sex and age. We followed NIH definitions in
coding the following as URMM: American Indian or
Alaska Native, Black or African American, Hispanic/
Latino, Native Hawaiian or other Pacific Islander. At each
school, we added URMM faculty to each age group, up to a
maximum of 20 URMM faculty per group. Female
surgeons were a group of interest because of the
particularly low representation of women in this large
specialty. To ensure their representation, additional female
surgeons were selected until the pool was exhausted.
Sample weights were employed in the analyses to adjust
The selection process resulted in a list of 4,578 sampled
faculty. The survey was administered electronically, with
reminders at 2–3 week intervals and eventual follow-up
with phone contact and a hard copy mailing, as needed. The
survey was distributed as schools were recruited in waves
from 2007 through early 2009.
Pololi et al.: Gender and Faculty Perceptions of Culture
We constructed weights based on sex, age, and URMM
characteristics of the 2008 AAMC all-school faculty
population, to be able to generalize our findings to the
national population of academic faculty. To address missing
values, ten multiply imputed data sets were estimated using
IVEware 2002 (Survey Research Center, Institute for Social
Research, University of Michigan).33Under certain
assumptions, multiple imputation yields unbiased point
estimates and confidence intervals.34IVEware uses chained
equations in combination with a Markov chain Monte Carlo
To determine the conceptual structure underlying
faculty responses, we subjected 46 items related to
institutional culture to a factor analysis using SAS/STAT
Version 8.2 for Windows. 2004 (SAS Institute, Cary, NC).
First, we examined unrotated principal component load-
ings showing the linear consistency among all items,
retaining items with unrotated loadings ≥0.40. Then we
used an equamax rotation to identify distinct factors, or
sub-dimensions of institutional culture.35The research
team used these in conjunction with semantic review of
the items to guide final scale development; an additional
five scales were content-derived (indicated in Table 1).
Negatively stated individual questions were reverse-
coded, responses summed, and scores divided by the
number of items in each scale to allow for a consistent
interpretation in the metric of the original Likert 5-point
scale across scales, regardless of the number of items.
Cronbach’s α reliability coefficients were estimated to
assess the internal consistency of each scale (see Table 1
for a list of the scales, their properties and descriptive
Exploratory data analysis included comparison of
group means by gender on 11 scales representing dimen-
sions of the culture (see Table 1), as well as a comparison
of differences by other demographic characteristics in-
cluding age, rank, URMM status and primary role
(clinician, researcher, administrator or educator). Because
these demographic characteristics are not independent of
one another, we used a multivariate approach to under-
stand the unique contribution of gender as a predictor of
each dimension of the culture, while controlling for other
demographic characteristics. Regressions were estimated
using IVEware to accommodate the ten imputed data sets,
including “school” as the cluster variable to accommodate
the nesting of the data. For each dimension of the culture,
we first estimated a model with gender, URMM status,
age, rank, and primary role. We next tested for interaction
effects with gender when other demographic predictors
were found to be statistically significant. Multiple regres-
sion permits the elimination of factors whose influence on
a certain outcome merely reflects their dependence on
Of the 4,578 faculty invited to participate, 2,381 responded
for a response rate (RR) of 52 %. The median school RR was
54 %; one school had an RR of 28 %, while the others ranged
from 40 % to 62 %. Faculty reporting their rank as instructor,
lecturer2or “other” were omitted from this analysis, because
of the very small numbers and role ambiguity, for a final
study sample of 2,218. Unweighted and weighted descriptive
statistics for the sample are presented in Table 2. The 1,172
women represented 53 % of the sample, and 512 (23 %) of
respondents were from URMM groups.
Effect of Gender
The estimated regression models demonstrated that gender
was a significant predictor of perceptions in six dimensions
of the culture. Holding constant the other demographic
predictors in the model (i.e., URMM status, age, faculty
rank and primary role), female faculty had more negative
perceptions than male faculty on the following six dimen-
sions: self-efficacy for career advancement (T=−4.73, p<
0.001) relatedness/inclusion (feelings of trust, inclusion and
connection) (T=−3.30, p<0.01), values alignment (align-
ment of personal values and observed institutional values)
(T=−2.06, p<0.05), perceptions of equity for female faculty
(T=−19.82, p<0.001), work-life integration (institutional
support for managing work and personal responsibilities)
(T=−4.06, p<0.001), and perception of institutional change
efforts for diversity (T=−9.70, p<0.001) (see Table 3).
There were no significant gender differences for five of the
dimensions of the culture scales. Men and women responded
similarly about engagement, institutional support, ethical/
moral distress, leadership aspirations and perceptions of
institutional change efforts related to faculty support.
Effect of Other Variables in the Models
Other demographic descriptors, such as belonging to an
URMM group, age, faculty rank and primary role
(research, education, clinical care), were inconsistently
predictive. URMM was a factor in only one of these
outcomes (relatedness/inclusion), and age and faculty rank
were associated with the outcomes in two measures (self-
efficacy for career advancement and relatedness/inclu-
sion). Administrators reported higher self-efficacy, relat-
edness/inclusion and values alignment than clinical
faculty. Researchers were more likely to perceive gender
inequity than clinical faculty. Researchers and educators
were more positive than clinical faculty about effectively
integrating career and family or personal demands. Self-
efficacy increased with rank; however, increasing age
mitigated this effect in both males and females. Under-
represented minority faculty reported lower relatedness/
inclusion than non-minority faculty.
Pololi et al.: Gender and Faculty Perceptions of Culture
The central finding of this study is that male and female
faculty have equal feelings of being engaged and enthusiastic
about their work and have equal leadership aspirations, yet
women faculty do not feel as confident about career
advancement as men, do not feel equally included in the
environment of academia, and their personal values are more
likely to be at odds with institutional values. Whereas gender
is a predictor of six important dimensions of the culture,
other key demographic variables that might have been
expected to make a difference, such as race/ethnicity, rank,
and role, were less consistent in their predictive ability.
In the management literature, where women’s lack of
advancement has been well studied, Ely and Meyerson
examined the ways in which the culture of organizational life
and work centers primarily on men’s needs and expectations,
and showed endemic gender bias in both the implicit and
explicit practices of the workplace contributing to margin-
alization.36Our findings point to similar patterns of gender
inequity in academic medicine, in that women feel less
included—or as “outsiders,” are more aware than men of
gender inequity, and are less likely than men to believe that
their institutions are making a good faith effort to facilitate
diversity among faculty. The study finding of female
faculty’s perceived bias against women in the presence of
leadership aspirations reveals ideal conditions for women to
be subject to stereotype threat. Stereotype threat could itself
promote reduction in self confidence and self-efficacy.37We
Table 1. Definitions and Estimated Statistical Characteristics (Unadjusted) of Dimensions of the Culture Scales for Study Sample Overall
and by Sex (n=2,218)
Engagement: being energized by work*
Self-efficacy: confidence in ability to advance in career*
Institutional support: perception of institutional commitment to
Relatedness/inclusion: faculty feelings of trust, inclusion and
Values alignment: alignment of faculty personal values and
observed institutional values*
Ethical/moral distress: feeling ethical or moral distress and being
adversely changed by the culture*
Leadership aspirations: aspiring to be a leader in academic
Gender equity: perceptions of equity for female faculty
Work-life integration: institutional support for managing work
and personal responsibilities
Institutional change efforts for diversity: good faith effort by
institution to advance women and URMM faculty
Institutional change efforts for faculty support: good faith effort
by institution to improve support for faculty
6 0.84 3.57 (0.019)3.45 (0.037)3.63 (0.029)
9 0.85 3.24 (0.025)3.20 (0.033) 3.26 (0.029)
8 0.78 2.35 (0.019)2.39 (0.029) 2.33 (0.024)
2 0.66 3.99 (0.026) 3.96 (0.031)4.01 (0.037)
3 0.86 3.64 (0.044)3.41 (0.044)3.76 (0.051)
6 0.87 3.00 (0.030) 2.96 (0.033)3.02 (0.037)
SE standard error; URMM under-represented minority in medicine
Weighted means and standard errors estimated on the analysis sample (n=2,218) based on ten multiply imputed data sets. The imputation procedure
does not estimate standard deviations
*Indicates factors identified by equamax rotation and semantic review
Table 2. Unweighted and Weighted Demographic Characteristics of Study Sample Overall and by Sex (n=2,218)
No. and (U %)(W %)*U/W mean†
No. and (U %)(W %)*U/W mean†
No. and (U %)(W %)*U/W mean†
*(U %) refers to the unweighted percent in the study sample and (W %) refers to the weighted percent
†U refers to the unweighted mean in the study sample and W refers to the weighted mean
Pololi et al.: Gender and Faculty Perceptions of Culture
note that researchers are less likely to report gender equity
and also that, traditionally in medical schools, leaders are
expected to have demonstrated research productivity. The
additive effect of gender and research role may further
explain the lack of women in leadership positions. Women
also feel less support from their institution to combine their
work and personal life. All of these factors, combined with
lower self-efficacy, unconscious bias, and lack of sponsor-
ship, likely contribute to the slow pace of professional
advancement for female faculty in academic medicine. Our
finding of equal leadership aspirations among men and
women further generalizes a similar finding from a study
conducted in a single medical school.11
It is of concern that highly accomplished women,
successful by many measures, would exhibit lower self-
efficacy about their careers than similarly successful men.
In social science research, self-efficacy is a predictor of
career interest, perceived career options, and persistence in
scientific fields,38,39and self-efficacy in career advance-
ment can be linked to the idea of “possible selves,” a term
coined by Markus and Nurius.40For example, a girl who
sees only male airline pilots, priests, or corporation
presidents will not easily construct possible selves that
encompass these occupations.41Similarly, female faculty in
academic medicine who rarely observe other women in the
highest positions of the medical academy will likely have
less self-confidence in career advancement.
Lower self-efficacy may also be explained by documented
negative response to women in positions of authority or
leadership roles, especially in male-associated fields.42–44
Another manifestation, consistent with the notion of non-
conscious bias, is that self-promotion in women invokes a
more negative response from men and women than self-
promotion in men.45Consequently, women are behaviorally
conditioned from an early age to prevent or minimize these
negative responses to their person.
Prior research, as well as this study, shows that
incongruence of personal and institutional values is an
important issue for all faculty, but even more so for
women.1,20,46Further research on what faculty perceive as
incongruent in their values is warranted, and it would be
interesting to explore the interrelationship of self-efficacy,
stereotype threat, values alignment, and realizing women’s
potential and full contributions, to shaping academic
Study Strengths and Limitations
The strengths of the study include: its national, multi-
institutional nature, a large cross-disciplinary representative
sample size, the very reasonable response rate for a medical
faculty survey, and the theoretical grounding of the methods
and survey development. Many studies of the impact of
gender in academic medicine have been at a single
institution. Survey items were based upon a hypothesis-
generating qualitative analysis of prior faculty interviews; our
survey included numerous non-customary questions and
domains relating to relationships, values, ethical and moral
climate, on being changed by the culture, diversity, equity
and support/advancement. The faculty sample included
members from both clinical practice and basic sciences, and
also identified major roles of the faculty respondents and
Table 3. Demographic Predictors of Six Dimensions of the Culture Scales Using Multiple Regression Analysis (n=2,218)
Change efforts for
Coefficient (SE) Coefficient
Coefficient (SE) Coefficient (SE)
3.566*** (0.020) 3.242***
3.299*** (0.036) 3.640*** (0.046)
Rank: Full Prof. (ref.)
−0.056 (0.074) 0.053 (0.069)
Role: Clinician (ref.)
−0.016 (0.054)0.021 (0.039)
Administrator0.209** (0.075) 0.257** (0.083)0.255**
0.181 (0.103) 0.172 (0.092)
Educator0.138 (0.082)0.124 (0.094) 0.000 (0.103) 0.281*** (0.078)0.050 (0.109)
SE standard error
p<0.05, **p<0.01, ***p<0.001
Pololi et al.: Gender and Faculty Perceptions of Culture
detailed demographic data. The rigorous analysis allows
specific factors to be identified while controlling for other
factors—in this case, we have been able to isolate gender as a
factor while controlling for seniority, rank and primary role.
Within schools, faculty were randomly selected, although
the AAMC roster used for sampling was not fully up-to-
date regarding recent attrition, nor were the e-mail lists of
their faculty provided by schools. The RR could have been
higher had we been able to exhaustively determine all
sampled faculty who were ineligible for inclusion. Espe-
cially given this, a 52 % RR compares well with other
reported surveys of medical faculty;2,27,47–49even so, there
is the possibility of non-response bias. Those who have
studied physician response rates and their impact on the
representativeness of the data have concluded that response
rates among physicians are approximately 10 % below
those of non-physicians, and that response bias (e.g., non-
representativeness of responses) is not as large a concern as
had been previously thought.50,51
Our findings concur with social science research showing
that people whose identities and values are not traditionally
those of the institutional culture, or who feel different or are
perceived as different, experience exclusion, marginaliza-
tion, and alienation.52–55Those faculty whose identities are
most similar to the majority in their AHC are more likely to
feel valued, experience a sense of belonging, and success-
fully navigate its formal and informal structures.46Those
whose identities, attitudes, and beliefs do not “fit” with the
culture of academic medicine are more likely to struggle,
both personally and professionally.52As expected, women,
as compared with men, were more aware of inequities.
Feminist scholars have described this as “situated knowl-
edge,” or a different way of knowing, that is derived from
occupying a position of less power than the dominant
group. Groups with less power perceive inequality differ-
ently as a result of being discriminated against.56
Our studies show that female faculty have a different
experience of the culture of academic medicine, and suggest
that their experience of the culture may contribute to the lack
of women’s advancement. These findings add to the medical
faculty professional development and workforce literature by
demonstrating that female faculty, when compared with male
faculty, feel a lack of inclusion and relationships within the
workplace, and to some extent perceive less congruence
between their own values and those of their institutions. They
report gender inequality and that their institutions are failing
to adequately make change to address diversity goals. Despite
these challenges, female faculty continue to be highly
engaged in the demanding work of academic medicine and
have leadership aspirations similar to male faculty.
Women in medicine hold expanded and varied perspec-
tives, and will be essential as participants in helping to
bring about positive change in health care delivery and
medical research. Realizing the full potential of female
physicians and scientists will more fully use the nation’s
human capital and resources devoted to medical training.
Academic medicine needs its highly skilled and deeply
dedicated female physicians and biomedical scientists to
implement their own vision of leadership and health
priorities for the nation.
Contributors: The authors wish to thank all the members of the C -
Change research team who participated in developing items for the
survey, data collection and supporting the process of C - Change work.
The authors thank the AAMC for assisting in the initial phase of the
project. The authors are indebted to the medical faculty who generously
shared their perspectives in the survey.
Funders: The authors gratefully acknowledge the critical funding
support of the Josiah Macy, Jr. Foundation and Brandeis University
Women’s Studies Research Center. Funding supported the design
and conduct of the study; and collection, management, analysis and
interpretation of the data. Supplemental funds to support data
analysis were provided by the U.S. Health and Human Services
Office of Public Health and Science, Office on Women’s Health, and
Office of Minority Health; National Institutes of Health, Office of
Research on Women’s Health; the Agency for Healthcare Research
and Quality; the Centers for Disease Control and Prevention and the
Health Resources and Services Administration.
Prior Presentations: None
Other Disclosures: The C - Change Faculty Survey and its items,
described in this report, are copyrighted by C - Change, Brandeis
University. Please contact firstname.lastname@example.org to use this survey.
Conflict of Interest: The authors declare that they do not have a
conflict of interest.
Corresponding Author: Linda H. Pololi, MD; Women’s Studies
Research Center, National Initiative on Gender, Culture
and Leadership in Medicine, C - Change, Brandeis University,
Mailstop 079, South Street, Waltham, MA 02454-9110, USA
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