"No One Really Prepares You": Lived Experiences of Women Division Chiefs in Academic Medicine.

Although women have comprised at least 50% of medical school classes for decades, women remain underrepresented in leadership positions. Although the proportion of women division chiefs in the U.S. academic medical centers is small, it is growing. Division chief positions can be a precursor to more senior level leadership positions. Our objective was to explore the lived experience of women division chiefs across specialties. We conducted a qualitative study using semi-structured interviews of women division chiefs from medical and surgical subspecialties in 2023 at a major academic medical center in the northeastern United States. We used the grounded theory approach and the constant comparative method until thematic sufficiency was reached. We interviewed 18 of a total of 29 women division chiefs (62%). The following major themes emerged: (1) Most women are externally motivated to seek out the division chief role, (2) formal preparation or leadership development prior to taking on the section chief role is lacking, (3) leaders (both men and women) who sponsor and mentor women facilitate their success, and (4) women leaders face specific challenges including promotion delays and lack of recognition of their authentic leadership styles. We found the following minor themes: (1) Lack of formal onboarding to the division chief role; (b) positive influence of women in senior leadership roles within the institution; and (c) barriers to leadership roles include feeling undervalued in preceding leadership roles, navigating parenthood, and need for broader sponsorship. Opportunities to support the continued growth of women division heads include more deliberate recruitment and succession planning; a structured, formal onboarding process; acceptance of authentic leadership styles; and more practical ways to support parenting.