Workplace Harassment, Cyber Incivility, and Climate in Academic Medicine

Gender Disparities in Cardiology: Learning From History to Envision the Future

Gender disparities within the field of cardiology are often described in the literature. However, it is not always clear how they came about, why they persist, or practically, what to do about them. Furthermore, the individuals usually tasked to address these disparities within an organization are usually the same individuals who are disproportionately affected by these disparities-women. In this review, the authors discuss the complex historical and systemic roots for the observed gender disparities within cardiology. They also highlight how men can not only be educated regarding experiences they may not face but also work toward fostering an improved working environment and eliminating of these gender disparities.

Responsibilities of Medical Professionals Amidst Geopolitical Conflict

The ethical responsibilities of healthcare professionals amidst geopolitical conflict, particularly regarding their impact on patient care and healthcare delivery, present a significant challenge, especially during current strife. With the rise of national and international discord and debate, and the close relationship between war and healthcare, healthcare organizations are increasingly pressured to comment, which can reflect societal engagement, but also pose demands for maintaining professionalism. This article discusses the need for healthcare practitioners to navigate their roles in advocacy without compromising patient care, emphasizing the importance of self-reflection, adherence to ethical standards, and effective communication. We also address the implications of politicization within healthcare settings, offering strategies to uphold professional integrity and prioritize patient-centered care amidst the complexities of geopolitical tensions. While the premise of this paper was prompted by geopolitical conflict, the principles emphasized are broadly applicable to an array of controversial issues. By fostering a culture of inclusivity and respect, healthcare professionals can mitigate the risks associated with politicization and ensure a commitment to the fundamental principle of "do no harm."

Workplace Mistreatment in U.S. Cardiology: A Comprehensive Analysis of Experiences and Implications

BACKGROUND

Discrimination and harassment are common in cardiology but data on its impact are limited.

OBJECTIVES

This study sought to identify the prevalence and impact of workplace mistreatment among U.S. cardiologists overall and when engaged in clinical and academic work.

METHODS

The American College of Cardiology conducted an online survey of 1,583 U.S. cardiologists in 2022. Demographics, types of mistreatment, professional experiences, and impact were self-reported. Multivariable logistic regression analyses were used to determine the predictors of "negative professional impact" defined as a composite of any of the following outcomes: being less productive, taking sick time, leaving a position, leaving cardiology, or leaving medicine.

RESULTS

Three-quarters of cardiologists experienced workplace mistreatment, including incivility (34%), discrimination (62%), emotional or physical harassment (32%), and sexual harassment (13%). Unfair treatment was reported by 54% working in any clinical setting, including issues related to professional advancement (31%), clinical work expectations (27%), and compensation (23%). Unfair treatment was reported by 58% during academic work. Consequently, 20% avoided training, employment, or promotion opportunities, 20% felt silenced, and 16% reported social avoidance; 11% considered leaving medicine. Predictors of negative professional impact included type of mistreatment (harassment [OR: 10.01; 95% CI: 5.25-19.10], discrimination [OR: 3.03; 95% CI: 1.56-5.80]), identification as homosexual (OR: 5.60; 95% CI: 1.87-16.78), and woman gender (OR: 1.57; 95% CI: 1.19-2.07).

CONCLUSIONS

Three of 4 U.S. cardiologists report workplace mistreatment, including two-thirds reporting discrimination and/or harassment. Mistreatment negatively impacts professional lives, career trajectory, well-being, productivity, workforce retention, and ultimately impacts the delivery of patient care. These data highlight the need to improve the climate within cardiology.

Underrepresentation of Hispanic women in science, technology, engineering, mathematics, and medicine

Despite ongoing efforts to increase the number of women in science, technology, engineering, and mathematics (STEM) and in medicine, Hispanic women remain severely underrepresented in these fields. This disparity not only hinders scientific innovation and the delivery of culturally competent medical care but also perpetuates a systemic exclusion. Research specifically addressing the challenges faced by Hispanic women, the extent of underrepresentation in these disciplines, and strategies to mitigate these issues is sparce. The authors conducted a systematic analysis of peer-reviewed articles to address this gap. The findings reveal a stark underrepresentation of Hispanic women across all examined fields, particularly compared with White women. In addition, the underrepresentation persists when compared with Hispanic men, although the disparity is less pronounced. The authors identify ongoing disparities in promotion, compensation, and retention rates for Hispanic women; present data for barriers to entry and retention; and highlight existing programs and strategies aimed at addressing this underrepresentation. Finally, a framework is presented for future studies and actionable initiatives, and the broader implications of these findings for the field of oncology are highlighted.

Pediatric subspecialty workforce: what is needed to secure its vitality and survival?

IMPACT

The pediatric subspecialty workforce is challenged by shortages and geographic maldistribution of subspecialists. We invited leaders in pediatrics to discuss how the field's vitality and survival can be secured. These leaders presented their own opinions and not the opinion of the society or organization that they are presenting. Early exposure of future trainees to pediatrics and advocacy for improved reimbursement structures, loan repayment, and funded programs for physician scientists will enhance the recruitment and retention of pediatric subspecialists to guarantee advancement of knowledge and the appropriate care of children with chronic and complex diseases.

Examining the Prevalence and Effects of Gender-based Violence in Academic Settings: A Systematic Review and Meta-analyses

Gender-based violence (GBV) in the academic job sector is a critical issue that intersects with broader systemic and structural inequities, but research is limited. To study the prevalence, effects, and prevention measures of interpersonal GBV within the academic job sector, a meta-analysis and systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol. Rigorous searches were conducted across the databases PubMed, OVID, Scopus, Web of Science, and CINAHL, using specific keywords related to GBV, workplace, and virtual work environments, identifying papers published between January 2013 and February 2023. Studies were evaluated based on the Population, Intervention, Comparison, Outcomes framework. Data from papers were extracted and grouped by reported instances, and prevalence data for interpersonal GBV were reported in university settings, including in-person, hybrid, and virtual environments, and among men, women, and those who identify as 2SLGBTQ+. A random effects meta-analysis of proportions was conducted to evaluate the reported point prevalence rates of interpersonal GBV in academia between 2012 and 2015. Subgroup analyses were performed for university staff only, females only, and males only. Out of the 1,290 records, 16 studies met the inclusion criteria. The types of violence identified include sexual harassment, workplace bullying and online harassment, which affects career advancement, and employee well-being. The meta-analyses, conducted with a 95% confidence interval [CI], identified that 51.4% (95% CI [39.9%, 63.0%]) of university staff members experience GBV, with females, 59.3% [38.1%, 80.5%], experiencing greater rates than males, 44% [28.1%, 44.1%]. The findings underscore the need for institutional interventions to address interpersonal GBV in academic workplaces.

The Relationship between Laissez-Faire Leadership and Cyberbullying at Work: The Role of Interpersonal Conflicts

A person can experience cyberbullying at work when exposed to repetitive and intrusive negative acts facilitated by new information and communication technologies (ICTs). The incidence of workplace cyberbullying has rapidly increased following the COVID-19 pandemic. This issue does not arise in isolation; leadership plays a critical role. Leaders who fail to set clear rules and provide minimal supervision may exacerbate interpersonal conflicts among subordinates. This study explores the role of laissez-faire leadership and interpersonal conflicts on workplace cyberbullying from a gender perspective. A two-wave panel study was conducted (N = 1995; 53.6% women; M age = 42.02 years old; SD = 9.23; age range: 18-74 years old). Our findings indicate no direct relationship between laissez-faire leadership and workplace cyberbullying; however, there is a significant indirect relationship. Laissez-faire leadership is associated with a higher frequency of interpersonal conflicts, which in turn are related to cyberbullying, making interpersonal conflicts a mediator. Additionally, gender moderates the relationship between interpersonal conflicts and workplace cyberbullying. Our results suggest that interpersonal conflicts may increase exposure to cyberbullying, particularly for men under laissez-faire leadership. These findings have managerial implications for introducing tailored interventions to prevent workplace cyberbullying.

Midcareer Satisfaction and Likelihood of Leaving Current Position of Former Career Development Awardees

This study assesses career satisfaction, discrepancies between ideal and expected careers, and likelihood of leaving current positions among former K awardees.

Igniting the Fire of Discovery: Creating Partnerships Between Research, Education, and Practice

In the 28th H.P. Maley Lecture, Stacey Dusing, PT, PhD, FAPTA, shares a perspective on the importance of clinician-scientists in bridging the chasm that currently exists between scholarship and clinical practice. Describing herself as a clinician-scientist, or a qualified health care professional who functions mainly as a career scientist with the other portion of time dedicated to clinical practice, Dusing highlights the potential impact of limited training for clinician-scientists in the physical therapist profession and its impact on the future of physical therapy. She challenges all physical therapists to consider the impact of Commission on Accreditation in Physical Therapy Education requirements on scholarship and the lack of requirement for clinical practice while also recognizing that training programs for clinician-scientists are quite limited. Reviewing some historical data and highlighting possible areas for growth, Dusing calls physical therapists to action in 4 areas. This paper calls all physical therapists, especially educators and administrators, to consider the role of clinician-scientist in promoting physical therapy and knowledge translation. The author challenges the profession to consider whether we are helping to train or embed clinician-scientists in our clinical workplaces to promote knowledge translation. Suggestions are made to improve research and clinical training programs to increase the number of clinician-scientists in physical therapy.

Burnout Among Mid-Career Academic Medical Faculty

Importance

Studies reveal that most physicians report symptoms of burnout. Less is known about burnout in mid-career medical faculty specifically.

Objective

To characterize burnout and its risk factors, particularly differences by gender, among mid-career medical faculty.

Design, Setting, and Participants

Between August 2021 and August 2022, a survey was sent to 1430 individuals who received new National Institutes of Health K08 and K23 career development awards from 2006 to 2009. Data were analyzed between June and October 2023.

Main Outcomes and Measures

Personal and work-related burnout as evaluated using the Copenhagen Burnout Inventory (CBI). The CBI score ranges from 0 to 100, with a score of 50 or higher indicating a high degree of burnout. Multivariable models were used to investigate associations between burnout and participant characteristics, including race and ethnicity, sexual orientation and gender identity, academic rank, work climate, experiences of workplace sexual harassment, sleep hours, work and domestic caregiving time, and time allocation changes in work and domestic work hours compared with before the COVID-19 pandemic. Work climate was evaluated by a general climate elements scale assessing elements such as friendliness, respect, and collegiality, and a diversity, equity, and inclusion climate elements scale assessing elements such as homogeneity, sexism, and homophobia; higher scores indicated a more favorable view of the climate.

Results

In all, 1430 surveys were sent, 926 candidates responded (65% response rate), and the analytic cohort was limited to the 841 respondents who were still in academic medicine (50.7% men). Burnout was significantly more common for women than men (mean [SD] CBI personal scores, 46.6 [19.4] vs 37.5 [17.2]; P < .001; mean [SD] CBI work-related scores, 43.7 [20.4] vs 34.6 [19.7]; P < .001). In multivariable models, personal burnout was significantly more likely for women (adjusted odds ratio [AOR], 2.29 [95% CI, 1.54-3.41]; P < .001) and with more weekly hours of patient care (AOR, 1.07 [95% CI, 1.00-1.15] for each 5-hour increase; P = .04). Personal burnout was less likely with more nightly sleep hours (AOR, 0.68 [95% CI, 0.56-0.81] for each 1-hour increase; P < .001) and with an improved general work climate rating (AOR, 0.64 [95% CI, 0.48-0.85] for each 1-point increase in general work climate scale score; P = .002). Work-related burnout was also significantly more likely for women than men (AOR, 1.77 [95% CI, 1.17-2.69]; P = .007). Greater work-related burnout was associated with an increase of 8 or more work hours per week compared with before the COVID-19 pandemic (AOR, 1.87 [95% CI, 1.13-3.08]; P = .01), more weekly hours of patient care (AOR, 1.11 [95% CI, 1.03-1.19] for each 5-hour increase; P = .007), and a workplace sexual harassment experience in the past 2 years (AOR, 1.71 [95% CI, 1.11-2.62]; P = .01). Work-related burnout was significantly less likely with more nightly sleep hours (AOR, 0.80 [95% CI, 0.66-0.96] for each 1-hour increase; P = .02) and with an improved general work climate rating (AOR, 0.49; [95% CI, 0.36-0.65] for each 1-point increase in general work climate scale score; P < .001).

Conclusions and Relevance

This survey study of K grant awardees revealed substantial rates of burnout among mid-career medical faculty, and burnout rates differed by gender. Evidence-based interventions are needed to realize the benefits of workforce diversity and vitality.

National science foundation grant awardees' perspectives on Article X and sexual harassment in science

Federal scientific agencies seek to make an impact on the continued prevalence of sexual harassment in the scientific academic community beyond institutional self-regulation. The National Science Foundation's Article X, released in 2018, is one of the most significant and ambitious federal policy initiatives to address sexual harassment. The present article presents the results of the first study to examine scientists' knowledge and attitudes about this important recent policy. We found, although overall knowledge about Article X was fairly low, the majority of participants responded positively to it. Crucially, impressions of the policy varied based on past experience and demographic factors. Individuals who had experienced harassment in the past year were less likely to believe the policy would help reduce sexual harassment in the sciences compared to those who had not experienced harassment (OR = 0.47, 95% CI:0.23-0.97, p = .034) and had greater odds of endorsing that the policy failed to go far enough (OR = 2.77, 95% CI:1.15-6.66, p = .023). Associations between demographic factors and views of the policy were less pronounced, but it is notable that, compared to their White counterparts, Black participants were more likely to believe the policy went too far (OR = 5.87, 95% CI:1.04-33.17, p = .045). Additionally, concerns were raised about the institutional enforcement of these policies and the existence of sufficient protections for survivors. Our work has implications for NSF's continued evaluation of the efficacy of this program as well as for other federal agencies implementing or considering similar policies.

Professional Experiences and Career Trajectories of Mid- to Senior-Career Women Clinician-Scientists: A Qualitative Study

Importance

Despite increasing evidence and recognition of persistent gender disparities in academic medicine, qualitative data detailing the association of gender-based experiences with career progression remain sparse, particularly at the mid- to senior-career stage.

Objective

To investigate the role gender has played in everyday professional experiences of mid- to senior-career women clinician-scientists and their perceptions of gender-related barriers experienced across their careers.

Design, Setting, and Participants

In this qualitative study, a total of 60 of 159 invited clinician-scientists who received National Institutes of Health K08 or K23 awards between 2006 and 2009 and responded to a survey in 2021 agreed to participate. Invitees were selected using random, purposive sampling to support sample heterogeneity. Semistructured in-depth interviews were conducted January to May 2022. For this study, interviews from 31 women were analyzed using the framework approach to thematic analysis. Data analyses were performed between August and October 2023.

Main Outcomes and Measures

Descriptive themes of participant experiences of gender and gender-based barriers in academic medicine.

Results

A total of 31 women clinician-scientists (8 identifying as Asian [25.8%], 14 identifying as White [45.2%], and 9 identifying as members of a minority group underrepresented in medicine [29.0%]; 14 aged 40-49 years [45.2%] and 14 aged 50-59 years [45.2%]) were included. Among them, 17 participants (54.8%) had children who required adult supervision or care, 7 participants (22.6%) had children who did not require supervision or care, and 6 participants (19.4%) did not have children. There were 4 dominant themes identified within participant experiences in academic medicine: the mental burden of gendered expectations at work and home, inequitable treatment of women in bureaucratic processes, subtle and less subtle professional exclusion of women, and value of communities built on shared identities, experiences, and solidarity.

Conclusions and Relevance

This study found that women perceived the institution of academic medicine as a male-centric system misaligned with the needs of women, with associated feelings of exclusion, disillusionment, and loss of trust in their institutions. Findings suggest that the confluence of domestic obligations and unaccommodating institutional environments may make it difficult for women clinician-scientists to achieve established timelines of career progression and productivity; these findings may have long-term implications for the well-being and retention of women in academic medicine.

Editorial bullying: an exploration of acts impacting publication ethics and related environment

Bullying and misconduct in the realm of scientific and scholarly publishing have the potential to jeopardize the transparency and integrity of academic discourse. While misconduct issues among authors have been extensively discussed, the role of editors in perpetuating or mitigating such problems has garnered less attention. Scientific publishing serves as the gateway for disseminating innovative research findings globally, and the role of editors, especially Editor/s-in-chief, is pivotal in safeguarding the rigor and credibility of published research. Editor bullying and misconduct involve behaviors that undermine the scientific process, compromise research integrity, and harm the careers and wellbeing of individuals. These actions may manifest as biased decision-making, suppression of dissenting voices, or the exploitation of power dynamics in the peer review process. To address these issues, preventive and therapeutic approaches are suggested, including enhancing awareness, recognizing and mitigating exacerbating factors, and upholding professionalism. Moreover, the importance of a conflict-of-interest declaration for editors is highlighted to ensure transparency and integrity in the editorial process. The present mini-review aims to shed light on editor bullying, illuminating its gravity and the urgency to address these issues within the academic publishing domain/s. This review underscores the more subtle, yet equally significant, issue of professional misconduct in the editorial realm of scientific journals.

Development of a Tool to Measure Student Perceptions of Equity and Inclusion in Medical Schools

Importance

Creating an inclusive and equitable learning environment is a national priority. Nevertheless, data reflecting medical students' perception of the climate of equity and inclusion are limited.

Objective

To develop and validate an instrument to measure students' perceptions of the climate of equity and inclusion in medical school using data collected annually by the Association of American Medical Colleges (AAMC).

Design, Setting, and Participants

The Promoting Diversity, Group Inclusion, and Equity tool was developed in 3 stages. A Delphi panel of 9 members identified survey items from preexisting AAMC data sources. Exploratory and confirmatory factor analysis was performed on student responses to AAMC surveys to construct the tool, which underwent rigorous psychometric validation. Participants were undergraduate medical students at Liaison Committee on Medical Education-accredited medical schools in the US who completed the 2015 to 2019 AAMC Year 2 Questionnaire (Y2Q), the administrations of 2016 to 2020 AAMC Graduation Questionnaire (GQ), or both. Data were analyzed from August 2020 to November 2023.

Exposures

Student race and ethnicity, sex, sexual orientation, and socioeconomic status.

Main Outcomes and Measures

Development and psychometric validation of the tool, including construct validity, internal consistency, and criterion validity.

Results

Delphi panel members identified 146 survey items from the Y2Q and GQ reflecting students' perception of the climate of equity and inclusion, and responses to these survey items were obtained from 54 906 students for the Y2Q cohort (median [IQR] age, 24 [23-26] years; 29 208 [52.75%] were female, 11 389 [20.57%] were Asian, 4089 [7.39%] were multiracial, and 33 373 [60.28%] were White) and 61 998 for the GQ cohort (median [IQR] age, 27 [26-28] years; 30 793 [49.67%] were female, 13 049 [21.05%] were Asian, 4136 [6.67%] were multiracial, and 38 215 [61.64%] were White). Exploratory and confirmatory factor analyses of student responses identified 8 factors for the Y2Q model (faculty role modeling; student empowerment; student fellowship; cultural humility; faculty support for students; fostering a collaborative and safe environment; discrimination: race, ethnicity, and gender; and discrimination: sexual orientation) and 5 factors for the GQ model (faculty role modeling; student empowerment; faculty support for students; discrimination: race, ethnicity, and gender; and discrimination: sexual orientation). Confirmatory factor analysis indicated acceptable model fit (root mean square error of approximation of 0.05 [Y2Q] and 0.06 [GQ] and comparative fit indices of 0.95 [Y2Q] and 0.94 [GQ]). Cronbach α for individual factors demonstrated internal consistency ranging from 0.69 to 0.92 (Y2Q) and 0.76 to 0.95 (GQ).

Conclusions and Relevance

This study found that the new tool is a reliable and psychometrically valid measure of medical students' perceptions of equity and inclusion in the learning environment.

Gender Differences in Faculty Perceptions of Mentorship and Sponsorship

This survey study examines gender differences in mid- to senior-career faculty experiences of receiving and providing mentorship and sponsorship during early career development.