Women’s Wellness Through Equity and Leadership (WEL): A Program Evaluation

Approved by the AAP Institutional Review Board and conducted by 2 independent consultants, this evaluation incorporated a mixed-methods design with both qualitative and quantitative data.^24,25  The dominant–less dominant framework was used for combining these methodologies, with the qualitative data taking a more prominent role.²⁵ 

The recruitment strategy for the 18-member cohort varied across partner organizations; several used a competitive review process, and others invited leadership-selected candidates to participate. Organizations were asked to (1) identify women physicians with demonstrated leadership or leadership potential and (2) intentionally attend to diversity across key characteristics, including age, race and/or ethnicity, year in practice (early career and midcareer²⁶  women were recruited), geographic location, and type of position (eg, practitioner versus academic).

In the evaluation, we used data from 3 sources developed by the evaluation consultants with input from the WEL staff and leadership team.

Three postseries evaluation surveys assessed cohort members’ self-reported change in knowledge and confidence after the leadership, equity, and wellness series. These surveys were administered electronically and by paper. Thirteen (72%), 17 (94%), and 10 (56%) cohort members completed the wellness, equity, and leadership postseries evaluation surveys, respectively.

A postprogram evaluation survey containing questions about WEL overall was administered after the last in-person cohort meeting, on paper for those who attended in-person and electronically for those who attended virtually. Thirteen cohort members (72%) completed a postprogram survey.

Ninety-minute telephone interviews were conducted with cohort members by using a semistructured discussion guide; when feasible, cohort members of partner organizations were interviewed together. Questions were focused on 2 themes: program experience and outcomes and impacts. Interviews were recorded with participant permission. All 18 cohort members completed an in-depth interview.

Descriptive statistics were generated for postprogram survey responses. Interview responses were transcribed verbatim and reviewed for accuracy. An iterative consensus-based process was used by the 2 evaluators to identify key content and themes.

Eighteen women physicians were enrolled in the pilot implementation of WEL; 13 (72%) completed a demographics questionnaire (Table 2). Their median age was 42 years (range = 34–48); 6 identified as white (46%), 4 as Black (31%), and 1 each as Asian American (8%), Native Hawaiian and/or other Pacific Islander (8%), and white and Asian American (8%). At the time WEL began, 7 were early career (1–10 years posttraining; 54%) and 6 midcareer (11–20 years posttraining²⁶ ; 46%), and 11 worked full-time (≥40 hours per week; 85%) and 2 part-time (<40 hours per week; 15%). Regarding (sub)specialty, participants practiced family medicine (3: 23%), obstetrics and/or gynecology (3: 23%), internal medicine (2: 15%), pediatrics (2: 15%), allergy and/or asthma and/or immunology (1: 8%), psychiatry (1: 8%), and pulmonary and/or critical care (1: 8%). Six were employed at an academic and/or medical school or parent university (46%), 2 within nongovernment hospitals and/or clinics (15%), 1 within a US government hospital or clinic (8%), and 1 within a multispecialty practice (8%);1 was self-employed in solo practice (8%), and 2 reported some other type of employment setting (15%).

Evaluation findings are presented according to the following questions: (1) What themes emerged as important to project success? (2) What considerations emerged regarding project improvement? (3) What was the project impact in terms of knowledge and behavior? Within each question, themes are presented, and representative quotes from cohort participants are provided in corresponding tables.

Throughout interviews and survey comments, cohort members identified several factors that fostered project success (see representative participant quotes in Table 3).

Participant responses were nearly unanimous that WEL in-person meetings and webinars were key to program success. This included comments about the high-quality curriculum and the importance of having time away from normal life and routines to focus on learning. As described below, in-person meetings were particularly critical to providing participants time to connect with each other.

Multiple cohort members identified the first in-person meeting as the setting in which they developed sufficient comfort to trust and begin to build meaningful relationships with other participants. Several cohort members reported initial feelings that they were not worthy to participate in WEL but felt more comfortable after that first meeting because of the vulnerability they all shared. Key to the first meeting was the process of each participant drafting her impact statement. Statements varied by participant and included intentions to improve medical training and/or education, foster physician diversity by focusing on pipeline initiatives, foster patient outcomes and health and gender equity, improve physician wellness, and address racism. Participants also discussed the program structure as fostering accountability as participants made progress on their impact statements.

Another helpful aspect of the program discussed by participants was peer support and networking. Participants talked about the validating nature of these relationships, and how they found camaraderie in their similar experiences. Participants also mentioned appreciating the multidisciplinary nature of the project and being exposed to women from other areas of medicine. Providing dedicated time and space to participants to develop and grow their relationships throughout the 18-month program was critical to project success.

Cohort members repeatedly stressed the synergy, or interconnectedness, between the 3 WEL topics: wellness, equity, and leadership. Participants discussed both the novelty and utility in considering these concepts together.

WEL leadership intentionally attended to diversity across a variety of personal and workplace characteristics when recruiting WEL cohort members. Similarly, program leaders sought out a diverse group of program faculty, and 39% of the faculty were Black, Indigenous, and/or people of color (BIPOC). Reflecting on their WEL experience, numerous cohort members spoke about the value and importance of this diversity. Some participants specifically talked about the value of the cohort’s racial and/or ethnic diversity, and the validating nature of the diverse composition of the group.

Cohort members also identified several opportunities to improve the WEL experience. Many of the areas mentioned mirrored those discussed in terms of program strengths (see representative participant quotes in Table 4).

Suggestions to improve the impact statement experience included creating more frequent opportunities to share progress updates. Cohort members also recommended encouraging updates that not only celebrate successes and accomplishments but also explore, with appropriate peer support and coaching, barriers and challenges.

Opportunities to improve webinars were focused largely on scheduling. Cohort members recognized the difficult logistics of planning across time zones but recommended establishing a standing webinar time to allow participants to protect time on their calendars. Additionally, some participants requested greater access to the impressive WEL webinar faculty.

Cohort members made recommendations to enhance specific aspects of the curriculum; these were largely individualized and included adding content addressing the finances of health care, socioeconomic and racial equity, and supporting other women. Importantly, it was noted that content around balancing professional and personal life should include women who do not have children.

On the basis of the value ascribed to the cohort network, members unequivocally advocated for additional opportunities to facilitate peer support and relationship building within their partner organization subcohort and across the WEL cohort. Several cohort members suggested the development of check-in groups, teams, or affinity groups (eg, regional, topic-specific, or leadership level) as an informal way to stay connected outside of structured WEL touchpoints.

Consistent across the cohort, a lack of mentorship was identified as a program shortcoming. Most cohort members anticipated mentorship as part of their WEL experience but reported informal to nonexistent opportunities. As a result, cohort members advocated for a more structured mentorship program in future iterations of WEL. Some participants talked specifically about the benefits mentorship would have had when trying to navigate opportunities for participation in their sponsoring medical associations.

Overall, cohort members were uniformly positive about having participated in WEL. In response to a postprogram survey question asking whether cohort members would recommend WEL to another early career or midcareer woman physician, all 13 cohort members who responded indicated yes.

In addition, several descriptors, illustrated here in exemplar comments, were used repeatedly throughout interviews:

“This is life and career changing.”

“Participating in this series has been a fantastic experience and a game changer for me. I was at a point in my career and life where there wasn't a clear path laid out. The dedicated time to developing an [impact statement] in addition to the strong focus on leadership development, removal of internal/external barriers, and the networking opportunities have not only opened doors, but they opened my mind to the possibility that the next part of my story was only waiting for me to fully author and inhabit it… Having access to mentorship, sponsorship, role models, peers, resources, a structured program, and knowing that an investment was made so that my story could be written differently have been the key difference makers.”

Although enthusiasm was broad for the program overall, cohort member assessment of the individual program components varied. In the end-of-program survey, in-person meetings, webinars, peer support, and developing cross-specialty relationships were rated as the most useful program components (Table 5); impact statements were also rated highly.

Evaluation of program impact assessed the degree to which cohort participants acquired the intended knowledge, skills, attitude, confidence, and commitment on the basis of their participation in WEL. This assessment was based on cohort member self-reports (interviews and surveys); the evaluators did not, for example, administer pretests and posttests to directly assess changes in knowledge or attitudes.

Across postseries surveys, participants reported improved knowledge and confidence in WEL topics after program participation. In addition, participants reported that each of the 3 series (wellness, equity, and leadership) contributed to the development of their leadership skills and that the curriculum content was pertinent to helping them move forward with achieving their goals (Table 6).

In interviews with cohort members, specific content or topics in each series were highlighted as having the most value or contributing significantly to achieving new skills, knowledge, and attitudes (see Table 7 for representative participant quotes). Specific to wellness, participants highlighted WEL’s focus on the business case for wellness and presentation of burnout as an organizational rather than strictly personal issue. Being offered concrete examples and strategies increased confidence in participants’ ability to make change in their workplace or personal life. In addition, some cohort members reflected that WEL had helped them identify their own burnout.

The equity series brought new content to some of the participants and helped others apply equity principles in new ways. The intentional diversity of the cohort seemed to heighten their experiences. Other participants reported the equity section was liberating because it helped normalize their experiences.

Specific to leadership, participants consistently cited improved confidence, commitment, and skill across the topics presented. Several participants indicated that this was the most impactful of the series. Among individual leadership topics, negotiation and organizational change were most frequently cited as useful. Some cohort members described these as “hard skill sessions;” one noted “those are things not typically taught in a formal way in medicine.” Participants indicated the program’s particular emphasis on applying these skills as a woman was key. In addition, perceptions of what a leader is or what the role entails shifted over time for several cohort members.

In addition to changes in knowledge, cohort members’ interview and survey responses spoke to how participants had begun applying WEL learnings. A sense of greater awareness and intentionality underpinned much of the behavior change described by the cohort. Participants reflected on the WEL experience as a catalyst for recognizing the power of their own voice to advocate and negotiate for themselves and on behalf of others. Cohort members also reported increased understanding of the intersections between leadership, inequality, and wellness but acknowledged, as leaders, the insufficiency of awareness alone. The WEL experience provided tools to support cohort members in moving from awareness to action. For several participants, the WEL experience empowered change or intent to change to foster professional and personal wellness and satisfaction.

Cohort members also reported early changes they made because of WEL. At the time the cohort experience formally concluded in January 2020, cohort members had already begun to use their experience to promote WEL learnings and principles and detailed a broad range of activities and accomplishments they ascribed to their WEL participation, both in the context of their workplace and sponsoring medical association.

Several women reported acting in their workplaces to advance equity principles, such as one participant who proposed a new position within her organization that “embraces the need for community collaboration to advance equitable care to our population.” WEL participation led 3 cohort members to examine their institutions’ residency and fellowship programs regarding gender balance among faculty and trainees and to advocate for changes, such as blinding applicant-identifying information and step scores. One cohort member reported that the WEL experience reenergized a recently developed business. Another is serving as coinvestigator on a grant focused on early career to midcareer women physicians. Yet another implemented an idea introduced by WEL webinar faculty to “boost morale and mitigate burnout” among her departmental colleagues. Two other cohort members described their emerging roles as advocates and resources for other women dealing with issues of inequality.

Most cohort members were eager for greater involvement in their respective partner organization and sought out opportunities for engagement. Several recounted recently completed and upcoming activities with their partner organization at local, state, and national levels, in which they infused WEL learnings and concepts. These included serving on their partner organization’s national review panel and national committees, subcommittees, and task forces relevant to WEL topics; securing leadership roles with local partner organization affiliates; submitting an invited commentary on gender equality; starting a podcast devoted to issues of gender, diversity, and inclusion; leading activities relevant to WEL topics at professional conferences and meetings, including hosting a session, moderating a forum, and presenting a workshop, presentation, or poster; and developing a wellness reference guide and/or workbook.

WEL was designed to foster more equitable work experiences for diverse groups of early career and midcareer women physicians. In this program evaluation, findings indicated the 18 cohort members experienced improved confidence, commitment, and skills in wellness, equity, and leadership. Findings suggested several factors that facilitated program success and several areas for improvement in future work.

The current study makes several significant contributions to the existing literature. First, WEL involved a collaboration between 6 major US medical associations. Independently, each of these organizations is contributing significant work to foster wellness, equity, and leadership for its members. However, this work can at times be siloed and duplicative as a result. For example, several studies have been published in which researchers explore the challenges faced by women physicians; although critically important, these accounts are often specific to one area of medicine and repetitive across fields. Bringing these 6 organizations together to work toward a shared, common, solutions-focused goal was a significant step in breaking down these silos. The supplement in which this article appears, including the call to action, which appears at the end of the issue, is a concrete example of the power that these 6 organizations can have when speaking in one unified voice.

Second, WEL offered a longitudinal cohort design intended to provide participants with peer support. With few notable exceptions,²⁷  this type of program is rare; yet, as seen throughout evaluation findings, peer support was critically important to fostering the success of the current group of women. Particularly in medicine, in which physicians are held up as infallible heroes, there is a tremendous culture of silence when it comes to discussing challenges.²⁸  Genuine peer networks and support can help change this culture of silence and provide needed support to women.²⁸  The value of peer relationships was repeatedly mentioned throughout evaluation findings because participants discussed the importance of the vulnerability they were able to share with their peers, as well as the importance of their ongoing peer networks and support. In addition, participants repeatedly commented on the value and importance of convening a cohort and faculty members who were diverse in terms of medical specialty and demographic and workplace characteristics and how they were able to connect with others who they would not usually be exposed to in their normal professional circles. The value stemming from expanding participants networks in this way validated the cross-specialty nature and intentional diversity of WEL.

Third, WEL adopted both an individual and organizational lens. As shown in Table 1, several sessions throughout the curriculum highlighted the importance of organizational influences in terms of wellness, equity, and leadership and offered strategies for impacting organizational change. Throughout evaluation findings, several participants commented on the utility of moving beyond the individual to focus on organizational approaches.

Finally, equity and explicit conversations about intersectionality²⁹  were intentionally woven throughout discussions of all WEL topics. Several participants commented on the novelty and utility of the interconnectedness between the program components of wellness, equity, and leadership. To truly forge more equitable work environments for women physicians, equity must be engrained in all conversations.

Several limitations are important to consider when interpreting the results. First, the sample size of this pilot was small, because only 18 women were enrolled in this inaugural WEL cohort. Response rates for some of the evaluation surveys were also relatively low. Although there were several programmatic advantages to having such a small and cohesive group, the small sample size limited the type of analyses conducted and conclusions that can be drawn. Second, in this study, we relied on self-report methodology because evaluation findings that were included were assessed after the program’s completion, and no additional, more objective measures of participants’ professional growth were assessed. Future research should examine participant growth incorporating a variety of measures, including preassessments and postassessments and/or analyses of curriculum vitae and participants’ professional networks. Third, involvement in WEL required participants to take time away from their jobs and families. Therefore, it is likely that the women who were able to participate already had a certain level of support, professionally and personally, and therefore may not be representative of all women physicians. Finally, nearly half of the WEL participants were currently working in academic medicine, yet most women physicians are not in academic settings. Findings should therefore be interpreted in light of this context.

Research should continue to investigate how to effectively and efficiently provide women in medicine with the support they need to advance in their careers. The current study involved an 18-month program that included 4 in-person meetings and monthly webinars. In future work, researchers should investigate whether the same professional networks can be developed in virtual environments. At the time of this writing, the coronavirus pandemic is in its eighth month; in cases in which travel and in-person meetings are not possible, can virtual initiatives foster the same kind of meaningful relationships? In addition, programs like WEL are incredibly resource-intensive, both in terms of labor and travel costs. In future work, researchers should investigate how models like WEL can be sustained after, for example, grant funds end; and how leadership programs like WEL can be tailored for larger groups of women. In future efforts, researchers should also seek to involve women from other medical specialties in which they are particularly underrepresented, such as surgery. In addition, initiatives should be developed for, tailored to, and promoted among women who are not in academic settings. Meeting women where they are and providing supports to help them succeed in their current environments will help magnify the impact of WEL.

Findings from the current study indicate the importance of providing women physicians with training around wellness, equity, and leadership and time and space to develop networks with other women. As mentioned above, it is likely that women who had support at work and/or home were more likely to be able to participate in WEL. All organizations employing physicians should provide support and opportunities for their women leaders to connect with other women physicians. This may include offering opportunities to attend programs like WEL, with protected time for their growth and development as professional leaders. Medical associations can also provide support to their women members by providing grants or sponsorships for individuals to participate in these types of activities.

This longitudinal cohort initiative resulted from a successful collaboration between 6 medical associations. Evaluation findings suggest that providing opportunities for women physicians to connect with and support each other while building knowledge and skills can be an effective way to advance wellness, equity, and leadership for women in medicine.

We thank the Physicians Foundation for their support of WEL, including program evaluation activities; the WEL Program Director, V. Fan Tait, MD, FAAP; the WEL Steering Committee members, Heather Farley, MD, FACEP, Laurie Gregg, MD, Clif Knight, MD, FAAFP, CPE, and Nancy Spector, MD, FAAP (in addition to Drs Miskimen and Hingle); the WEL cohort members; and Linda Radecki, MS, who, along with Laura Peterson, conducted the WEL program evaluation.

AAFP

American Academy of Family Physicians

AAP

American Academy of Pediatrics

ACOG

American College of Obstetricians and Gynecologists

ACP

American College of Physicians

AHA

American Hospital Association

APA

American Psychiatric Associations

BIPOC

Black, Indigenous, and/or people of color

WEL

Women’s Wellness through Equity and Leadership