Introduction

Women in academia, particularly clinician educators (CEs), struggle to advance in their careers due to a variety of identified but often unsuccessfully addressed barriers.^1,2 In a system originally designed for traditional researchers and educators with minimal clinical roles and responsibilities, unique obstacles to promotion exist for CEs, including:

• obtaining outside references/referees,
• the attainment of a regional, national, or international reputation, and
• the production of scholarly work, often narrowly defined as peer-reviewed publications.

Networks and connections are needed for advancement and promotion, but women faculty may have limited access, especially in small academic institutions with fewer senior women faculty for mentorship and sponsorship.^1,3 Our innovation, entitled Promotion Support for Women in Medicine (PSWIM), is an example of a network connecting women seeking promotion to senior faculty to write letters of support for women faculty nationwide.

Methods

PSWIM evolved from a discussion in September 2020 regarding the difficulty of finding regional/national letter writers (LWs) for women seeking promotion on a listserv of the Alliance for Academic Internal Medicine (AAIM), a national organization of more than 10,000 Internal Medicine faculty and administrators of medical schools and their affiliated teaching hospitals.

The PSWIM group, created in March 2021, is composed of 16 AAIM senior-ranked women who are academic leaders, with some serving on their own institutional promotions committees. The PSWIM leader (KAF) initially posted a call to the AAIM listserv for individuals at the associate level or higher to join a shared list of volunteers to be referee LWs for women seeking academic promotion. In response, 106 associate and full professors (men and women) volunteered.

PSWIM members created a database to catalogue the demographics of the volunteer LWs, including writers’ name, e-mail, institution, specialty, professional rank, professional role, primary learners, area of education scholarship, and expertise in medical education. Announcements of PSWIM services were disseminated via the AAIM listserv. AAIM members were also asked to inform their divisions and departments of this resource for women seeking promotion as a clinician educator.

Women letter seekers are asked to complete an electronic survey detailing the same information collected from LWs and the number of letters requested. A PSWIM member then matches the candidates and LWs. Candidates are provided LWs’ contact information and the matched LW(s) are informed of their match with a candidate for an evaluation letter. The group created a document on tips for writing external letters which is shared with LWs and includes ways to avoid gender-biased language. PSWIM tracks the frequency of LWs contacts to avoid overburden and plans to contact candidates to determine success of their promotion. Ongoing support for our PSWIM initiative includes regular communication of our services through multiple channels, such as regional/national meetings and listserv postings and the continual solicitation of additional LW volunteers. Once candidates who use our services are promoted, they are asked to join the LW group.

Results

In 18 months, the PSWIM initiative created a repository of physician volunteers. As of this writing, we have 106 referee writers from over 70 institutions and produced 150 evaluation letters for over 35 institutions. The LWs are comprised of women (N=89); men (N=17); Professor (N=65); Associate Professor (N=37); general internists (N=61); subspecialty-trained (N=45). The LWs encompass a broad range of expertise in the undergraduate, graduate, and faculty development areas with professional roles ranging from core faculty to residency/fellowship directors to vice deans (see table). Letter writers value PSWIM to “pay it forward,” a theme identified as important for sponsorship in academia.2

Discussion

Our PSWIM innovation provides a concrete way for allies to support women during the promotion process and improve parity of women at senior ranks in academic medicine. This initiative can be expanded to other women faculty to help promotions processes in other specialties, with other disadvantaged groups, and in specialties with historically fewer women. In fact, a subsequent AAIM listserv call for Grand Rounds speakers has resulted in the creation of a pool of speakers who can be contacted for invited regional and national talks and provides further opportunities for those seeking promotion (J. Koch, personal communication, March 21, 2022).

Our initiative is well received by junior faculty who have utilized this in their promotions process. Several personal testimonials include the following:

• “Thank you so much. I am in the clinician educator track… It is challenging to go up for P&T and have imposter syndrome about your efforts, and the task of identifying external reviewers is daunting…”
• “I found your … information through the AAIM listserv posts about a database of potential academic referees. This is such a great idea! Thank you for developing this resource.”
• “Thank you. Kudos to you for facilitating and organizing this effort.”
• “… I saw your post regarding promotion support for women in medicine on the AAIM listserv and would be so appreciative to use this resource for promotion from assistant to associate professor. My department unfortunately doesn’t provide help with this process.”

We recognize the challenge of sustaining the PSWIM database as the number of LWs and letter seekers grow. Efforts are ongoing to expand the pool of volunteer LWs with letter seekers and to advertise this resource for widespread adoption by division chiefs, department chairs, and members of promotions’ committees and faculty affairs committees. We plan to solicit more men LWs into the database since men are important allies and many hold high-level leadership positions. Other future steps include collecting data on the number of matches and letters written and tracking the success rate of promotion and leadership for the women faculty utilizing this initiative.

Our PSWIM innovation is one approach to one problem; however, we realize that gender equity in career advancement is complicated. Thus, on a national scale, institutions and organizations should lead efforts to update formalized promotion and tenure policies and practices to reduce gender disparities in academic medicine.