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The subject of gender-based harassment and violence is a difficult one. It makes people uncomfortable. As such, important conversations rarely happen, but they must. The discomfort of breaking the silence is often when and where progress happens. [ABSTRACT FROM AUTHOR]

Phenomenon: Faculty career success in academic medicine is complex. Dynamic interactions among faculty and between faculty and their socio-cultural working environments contribute to the mystique of academic advancement. There are few empirical studies that analyze the social practice of faculty career advancement in academic medicine, especially those that focus on relations between individual and environmental contexts. This study aimed to investigate various faculty members' experiences around career advancement in a medical school. Through the analytical lens of Bourdieu's theory of practice, we focused on the relationship among individuals, positions, and environmental contexts. Approach: Following a general process of interpretive grounded theory, we collected faculty members' perceptions and experiences related to their career development and advancement via in-depth semi structured-interviews of 23 faculty at a medical school in the United States. We analyzed the interview transcripts using thematic and constant-comparison analyses, informed by Bourdieu's theory of practice emphasizing the concepts of habitus, field, doxa, illusio, and capital. Findings: While there was a general perception of collaborative success in the school, access to resources seemed to be unequally distributed and linked to faculty positions. Career opportunities, such as leadership and promotion, were mostly granted by leaders based on interpersonal relationships (social capital). Clinical faculty's limited access to professional development activities (cultural capital), including research, limited their likelihood for promotion (symbolic capital) at the school. An institutional emphasis on clinical productivity reinforced clinical faculty's constraints on academic scholarship, which led to perceived inequities by clinical faculty. Participants also perceived subtle gender bias and an unequal distribution of power among the specialties, which contradicted a culture of collaboration and support in the school. Insights: Complex power structures influence faculty career success. Unequal access and differential power among faculty positions resulted in disparities in career advancement. Greater transparency, equity, and inclusivity are obvious suggestions for change to allow all faculty to benefit from essential resources and career building opportunities. Furthermore, building high-quality relationships between leaders and faculty and mutual respect between specialties are essential to sustaining an organizational culture conducive to career success for all faculty. Faculty will benefit from a greater awareness of the structural and normative aspects of a medical school that are less obvious and more difficult to change. This is the value of applying Bourdieu's theory of practice to the socio-cultural dynamics of the medical school. [ABSTRACT FROM AUTHOR]

Phenomenon: Training and assessing communication skills requires flexible and holistic approaches, including feedback practices. Historically, assessing communication skills has predominantly relied on itemized scoring, which is less useful for providing meaningful feedback to learners. Even more troublesome, theoretical scoring criteria tend to become a refractive lens allowing observation of only the conduct that aligns with the theory. Few skills assessment efforts have embraced a holistic understanding of how physician-patient communication skills are enacted in real patient care. Therefore, this study focused on what experts refer to when they speak about physicians' communication skills and what they treat as important when evaluating these skills enacted during real patient encounters. Approach: This qualitative study was based on observations and grounded theory. Residents' encounters with real patients were recorded as part of a formative communication skills assessment program from July 2015 to June 2016. Evaluation panels with diverse backgrounds (e.g., medicine, education, communication, conversation analysis, and layperson) listened to these recordings and jointly developed feedback comments for the resident from January 2016 to July 2017. For this study, we recorded forty-one panel discussions to observe their consensus evaluation. We conducted open and axial coding using a constant comparison approach to generate themes from the data. Findings: Elements of communication skills were connected and interdependent around the concepts of thoroughness and natural flow, which were not addressed by formative assessment criteria. Themes included (1) thoroughness within a boundary via agenda-setting; (2) natural yet, controlled flow: authentic conversation by active listening and questioning; (3) making agenda setting explicit to all parties in the beginning; (4) designing questions using both open-ended and closed questions; (5) pre-/post-conditions for patient education: patient contextual factors and teach-back; (6) preconditions for shared decision-making: patient education and patient contextual factors; and (7) multifaceted empathy demonstrated in multiple ways. Insights: The main message of the study findings is that communication skills criteria should be treated as organically interrelated and connected in assessing physicians' communication skills. Current communication skills assessment practice should be revisited as it itemizes physicians' communication skills as distinct and separate constructs rather than mutually affecting dynamics. Rather than imposing a theoretical rubric, assessment criteria should evolve through naturalistic observations of physician-patient communication. [ABSTRACT FROM AUTHOR]

Women comprise more than one third of the active physician workforce, an estimated 46% of all physicians-in-training, and more than half of all medical students in the United States. Although progress has been made toward gender diversity in the physician workforce, disparities in compensation exist and inequities have contributed to a disproportionately low number of female physicians achieving academic advancement and serving in leadership positions. Women in medicine face other challenges, including a lack of mentors, discrimination, gender bias, cultural environment of the workplace, imposter syndrome, and the need for better work–life integration. In this position paper, the American College of Physicians summarizes the unique challenges female physicians face over the course of their careers and provides recommendations to improve gender equity and ensure that the full potential of female physicians is realized. [ABSTRACT FROM AUTHOR]