Preserving Psychological Safety and Building Bridges: A Both/And Imperative for Leadership Development in Academic Medicine

Leadership in academic medicine is not solely about rank or recognition; it is about voice, visibility, and the power to shape a better future. For women and other historically excluded groups, leadership development programs can provide more than skills and strategy; they offer a rare space for solidarity, psychological safety, and authenticity. These are places where participants can explore leadership as the power to uplift others, to transform culture, and to advocate for equity.

The EMPOWER program, featured in this issue, exemplifies the value of identity-centered, gender-aware leadership training. Participants described not only professional growth, but personal renewal; gaining confidence, clarity, and connection through peer mentoring and shared experience. And yet, the authors rightly acknowledge the challenging moment in which this program was developed and studied: a time of increasing institutional and sociopolitical pressure to deconstruct or de-identify affinity-based initiatives.

Many institutions today are being forced to reassess gender-specific programs due to legal and political scrutiny. In response, some have adopted a reflexive “one-size-fits-all” approach in the name of inclusion. But in doing so, they may unintentionally erase the very conditions that allow marginalized leaders to flourish. Too often, this tension is framed as a binary choice: either inclusivity or identity. Either everyone is welcome at once, or no one can be supported intentionally.

This is a false choice.

The Case for a Both/And Model

We need a both/and mindset. One that honors the unique developmental needs of individuals from historically marginalized groups and upholds institutional commitments to inclusion. We must expand beyond “access for all” to ask: What kinds of access? What types of experiences? With what supports in place?

An important shift in thinking is required here. In the current climate, institutions often feel compelled to defend identity-specific programming by proving that it is either “for everyone” or not permissible at all. But this assumes that equity requires offering every opportunity to everyone all at once; a stance that ultimately undermines both justice and effectiveness.

Instead, we must adopt a more sophisticated understanding: that equity is not about uniformity. It is about ensuring that similar opportunities exist for everyone, even if those opportunities take different forms. A leadership development initiative might offer shared core content on negotiation, influence, systems change, but deliver it through multiple cohorts, tailored to different identity groups, lived experiences, or stages of career. Another institution might offer parallel programs for women, Black faculty, LGBTQIA+ professionals, and first-generation physician leaders; each rooted in shared leadership competencies but grounded in the specific cultural, institutional, and psychological contexts that shape those leaders’ experiences. The content is aligned, but the delivery, discussion, and mentoring reflect the nuances of each group. In another setting, a leadership initiative could be structured around interwoven tracks: one focused on professional advancement and another on identity and resilience, with each participant able to engage with the elements most relevant to their needs. Still another model might host a shared core curriculum but divide coaching circles or action learning teams based on identity or affinity, allowing for deeper connection and targeted support while still building cross-cohort collaboration.

These models remind us that inclusion isn’t achieved by placing everyone in the same room at the same time, but that it is achieved by designing pathways where everyone can thrive, with the safety, support, and affirmation they need to lead authentically and powerfully.

This is not special treatment. It is equitable design.

No one is excluded from leadership development, but participants are invited to engage in ways that affirm their reality, maximize their growth, and foster community.

Why Identity-Centered Spaces Still Matter

Leadership development is not neutral terrain. For women in academic medicine, particularly those with intersecting marginalized identities, generic spaces often reinforce dominant norms. The burden of explaining, translating, or suppressing one’s lived experience can be exhausting. In contrast, identity-aligned groups can provide:

Psychological safety, where vulnerability is not a risk but a catalyst for growth;

Relational power, rooted in shared experiences, mutual support, and collective vision;

Resistance to assimilation, by fostering new models of leadership grounded in equity and authenticity.

These programs are not about exclusion. They are about deep inclusion and creating space for voices that are too often marginalized in mixed settings. As the EMPOWER participants affirm, these environments offer a chance not just to learn, but to breathe.

Hybrid and Layered Design: Pathways Forward

The answer is not to retreat from inclusion but to design better. Programs like EMPOWER show us the potential of virtual formats, peer mentoring, and modular content. But there is room to grow further by building hybrid models that include optional in-person gatherings for connection; by developing identity-centered cohorts within larger programs; and by offering parallel tracks for shared learning that allow for tailored facilitation and networking.

Importantly, institutions must shift their evaluative lens. Instead of asking, “Is this opportunity open to everyone?” they must ask: “Is this ecosystem designed to serve everyone well?”

This shift opens the door for differentiated pathways that converge on a shared goal: equity in leadership, representation, and voice.

A Call for Courageous Leadership

As we face legal and cultural headwinds, academic medicine must lead not with fear, but with courage and clarity. We cannot afford to flatten our programs into generic offerings that ignore structural inequity. Nor can we rely on outdated definitions of fairness that equate sameness with justice.

We must create opportunities that meet people where they are, support them in how they identify, and prepare them to lead in ways that align with their values. We must recognize that many women view power not as conquest, but as capacity and the power to advocate, to mentor, to transform. Our leadership programs should reflect and reinforce that worldview.

The EMPOWER study reminds us what is possible when we do.

Let us build ecosystems where all leaders can rise with clarity, courage, and connection. Let us choose both/and over either/or. The future of academic medicine demands nothing less.