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Arrizabalaga P, Doltra A, Baranda L, Sebastià MC. [The iceberg of discrimination based on gender in Hospital Medicine]. Med Clin (Barc) 2024; 162:343-349. [PMID: 38160197 DOI: 10.1016/j.medcli.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Pilar Arrizabalaga
- I Comisión de Igualdad del Comité de Delegados Médicos, Clínic Barcelona, Barcelona, España; Consultora Senior en Nefrología, ICNU, Clínic Barcelona, Barcelona, España.
| | - Ada Doltra
- I Comisión de Igualdad del Comité de Delegados Médicos, Clínic Barcelona, Barcelona, España; Especialista en Cardiología, ICCV, Clínic Barcelona, Barcelona, España
| | - Lucía Baranda
- Socióloga, Consultora independiente, Barcelona, España
| | - M Carmen Sebastià
- I Comisión de Igualdad del Comité de Delegados Médicos, Clínic Barcelona, Barcelona, España; Consultora en el Centre de Diagnòstic per la Imatge (CDI), Clínic Barcelona, Barcelona, España
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Sheppard G, McIlveen-Brown E, Jacques Q, Barry N, Morris J, Yi Y, Bischoff T, Pham C, Menchetti I, Lim R, Pardhan A, Mann M, Byrne A, Hurley KF, Zia A, Chan TM. Perceptions of gender equity in emergency medicine in Canada. CAN J EMERG MED 2024; 26:271-279. [PMID: 38342855 DOI: 10.1007/s43678-024-00665-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/30/2024] [Indexed: 02/13/2024]
Abstract
INTRODUCTION Women-identifying emergency physicians face gender-based discrimination throughout their careers. The purpose of this study was to explore emergency physician's perceptions and experiences of gender equity in emergency medicine. METHODS We conducted a secondary analysis of data from a previously conducted survey of Canadian emergency physicians on barriers to gender equity in emergency medicine. Survey responses were analyzed using logistic regression to determine the impact that gender, practice setting, years since graduation, race, equity-seeking status, and parental status had on agreement about gender equity in emergency medicine and five of the problem statements. RESULTS A total of 710 participants completed the survey. Most identified as women (58.8%), white (77.4%), graduated between 2010 and 2019 (40%), had CCFP (Emergency Medicine) designation (47.9%), an urban practice (84.4%), were parents (62.4%) and did not identify as equity-seeking (79.9%). Women-identifying physicians were less likely to perceive gender equity in emergency medicine, OR 0.52, CI [0.38, 0.73]. Women-identifying physicians were more likely to agree with statements about microaggressions, OR 4.39, CI [2.66, 7.23]; barriers to leadership, OR 3.51, CI [2.25, 5.50]; gender wage gap, OR 13.46, CI [8.27, 21.91]; lack of support for parental leave, OR 2.85, CI [1.82, 4.44]; and education on allyship, OR 2.23 CI [1.44, 3.45] than men-identifying physicians. CONCLUSION In this study, women-identifying physicians were less likely to perceive that there was gender equity in emergency medicine than men-identifying physicians. Women-identifying physicians agreed that there are greater barriers for career advancement including fewer opportunities for leadership, a gender wage gap, a lack of parental leave policies to support a return to work and a lack of education for men to become allies. Men-identifying physicians were less aware of these inequities. Health systems must work to improve gender equity in emergency medicine and this will require education and allyship from men-identifying physicians.
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Affiliation(s)
- Gillian Sheppard
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
| | - Emma McIlveen-Brown
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Queen Jacques
- Division of Population Health and Applied Health Sciences, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Nicole Barry
- Faculty of Business Administration, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Judy Morris
- Department of Family and Emergency Medicine, University of Montreal, Montreal, QC, Canada
| | - Yanqing Yi
- Division of Population Health and Applied Health Sciences, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Taylor Bischoff
- Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Chau Pham
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Isabella Menchetti
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rodrick Lim
- Department of Pediatrics, Western University, London, ON, Canada
| | - Alim Pardhan
- Division of Emergency Medicine, Department of Medicine and Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Miriam Mann
- Department of Emergency Medicine, Huron Perth Healthcare Alliance, Stratford, ON, Canada
| | - Alyson Byrne
- Faculty of Business Administration, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Katrina F Hurley
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ayesha Zia
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Teresa M Chan
- School of Medicine, Toronto Metropolitan University, Toronto, ON, Canada
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3
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Ruzycki SM, Roach P, Ahmed SB. Unintended consequences of measuring equity, diversity, and inclusion in medicine. BMJ 2023; 381:e073445. [PMID: 37364905 DOI: 10.1136/bmj-2022-073445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Affiliation(s)
- Shannon M Ruzycki
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute, University of Calgary
- O'Brien Institute of Public Health, University of Calgary
| | - Pamela Roach
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary
| | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute, University of Calgary
- O'Brien Institute of Public Health, University of Calgary
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Ruzycki SM, Holroyd-Leduc J, Brown A. Equity, Diversity, and Inclusion moments to raise Equity, Diversity, and Inclusion literacy among physician leaders. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:116-118. [PMID: 37465746 PMCID: PMC10351628 DOI: 10.36834/cmej.75216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Previous research in our department on equity-deserving groups revealed that physician leaders could improve their understanding of barriers faced by physicians from these groups. We developed EDI Moments, a brief, recurring educational intervention, to raise the EDI literacy of physician leaders in our Department of Medicine. In addition to being considered a good use of time by attendees, EDI Moments have led to new processes and policies to improve EDI in our department. Teams that implement EDI Moments should leverage local EDI expertise and select topics suited for their audience's baseline knowledge.
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Affiliation(s)
- Shannon M Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jayna Holroyd-Leduc
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Allison Brown
- Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
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5
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Vallejo MC, Imler LE, Price SS, Lilly CL, Elmo RM, Shapiro RE, Nield LS. Identifying Gender-Related Differences in Graduate Medical Education with the Use of a Web-Based Professionalism Monitoring Tool. South Med J 2023; 116:395-399. [PMID: 37137472 PMCID: PMC10167550 DOI: 10.14423/smj.0000000000001555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Medical education is required to ensure a healthy training and learning environment for resident physicians. Trainees are expected to demonstrate professionalism with patients, faculty, and staff. West Virginia University Graduate Medical Education (GME) initiated a Web-based professionalism and mistreatment form ("button") on our Web site for reporting professionalism breaches, mistreatment, and exemplary behavior events. The purpose of this study was to identify characteristics in resident trainees who had a "button push" activation about their behavior to better understand ways to improve professionalism in GME. METHODS This West Virginia University institutional review board-approved quality improvement study is a descriptive analysis of GME button push activations from July 2013 through June 2021. We compared characteristics of all of those trainees who had specific button activation(s) about their behavior. Data are reported as frequency and percentage. Nominal data and interval data were analyzed using the χ2 and the t test, respectively. P < 0.05 was significant. Logistic regression was used to analyze those differences that were significant. RESULTS In the 8-year study period, there were 598 button activations, and 54% (n = 324) of the activations were anonymous. Nearly all of the button reports (n = 586, 98%) were constructively resolved within 14 days. Of the 598 button activations, 95% (n = 569) were identified as involving one sex, with 66.3% (n = 377) identified as men and 33.7% (n = 192) as women. Of the 598 activations, 83.7% (n = 500) involved residents and 16.3% (n = 98) involved attendings. One-time offenders comprised 90% (n = 538), and 10% (n = 60) involved individuals who had previous button pushes about their behavior. CONCLUSIONS Implementation of a professionalism-monitoring tool, such as our Web-based button push, identified gender differences in the reporting of professionalism breaches, because twice as many men as women were identified as the instigator of a professionalism breech. The tool also facilitated timely interventions and exemplary behavior recognition.
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Affiliation(s)
- Manuel C. Vallejo
- Department of Graduate Medical Education, West Virginia University School of Medicine, Morgantown
| | | | | | - Christa L. Lilly
- Department of Epidemiology and Biostatistics, West Virginia University School of Medicine, Morgantown
| | - Rebecca M. Elmo
- Department of Medical Education, West Virginia University School of Medicine, Morgantown
| | - Robert E. Shapiro
- Department of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown
| | - Linda S. Nield
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown
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Romero CS, Maimeri N, Bonaccorso A, Baiardo-Redaelli M, Lombardi G, Iwuchukwu OF, Ortalda A, Schmid B, Fleming M, Landoni G. Gender-gap in randomized clinical trials reporting mortality in the perioperative setting and critical care: 20 years behind the scenes. Contemp Clin Trials Commun 2023; 33:101117. [PMID: 37091504 PMCID: PMC10119706 DOI: 10.1016/j.conctc.2023.101117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 04/04/2023] Open
Abstract
Background Women researchers might experience obstacles in academic environments and might be underrepresented in the authorship of articles published in peer-reviewed journals. Material and Methods This is a cross-sectional analysis of female-led RCTs describing all interventions reducing mortality in critically ill and perioperative patients from 1981 to December 31, 2020. We searched PubMed/MEDLINE and EMBASE with the keywords RCTs and mortality. The gender of the first author was extracted and descriptive analysis was performed including the year of publication, impact factor, country of the first author, and methodological aspects. Results We analyzed 340 RCTs, of which 42 (12%) were led by female researchers. The presence of women increased from 8% (14/172) until 2010 up to 17% (28/168) in 2010 and beyond. The United States, the United Kingdom, and Brazil were the main countries of origin of female researchers. Women authors conducted mainly single-center and single-nation studies as compared to male authors. The median impact factor of the target journal was 6 (3-27) in women vs. 7 (3-28) in men, with a p-value of 0.67; Critical Care Medicine, JAMA, and The New England Journal of Medicine were the most frequent target journals for both women and men. Conclusion In the last 40 years, only one out of eight RCTs had a woman as the first author but the presence of women increased up to 17% by 2010 and beyond. The impact factor of publication target journals was high and not different between genders.
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Affiliation(s)
- Carolina S. Romero
- Department of Anesthesia, Critical Care and Pain Unit, University General Hospital, Spain
- Department of Methods in Research, European University of Valencia, Valencia, Spain
- Corresponding author. Department of Methods in Research, Universidad Europea de Valencia (Spain). Avenida General Elio 2, 46010, Valencia, Spain.
| | - Nicolò Maimeri
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Bonaccorso
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Gaetano Lombardi
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Otito Frances Iwuchukwu
- American College of Clinical Pharmacology, Fairleigh Dickinson University School of Pharmacy & Health Sciences, New Jersey, United States
| | - Alessandro Ortalda
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Benedikt Schmid
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wurzburg, Wurzburg, Germany
| | - Magdalena Fleming
- Department of Anaesthesiology and Intensive Care, Czerniakowski Hospital, Warsaw, Poland
| | - Giovanni Landoni
- Vita-Salute San Raffaele University, Center for Intensive Care and Anesthesiology (CARE) San Raffaele Hospital Head of SIAARTI Clinical Research Committee, Milan, Italy
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7
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Martin LH, Haslam RE, Agnor R, Collins A, Bassale S, Seideman CA. Perceptions of Gender Equity by Urologic Subspecialty. Urology 2023; 174:35-41. [PMID: 36702444 DOI: 10.1016/j.urology.2022.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/08/2022] [Accepted: 12/18/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To evaluate how urologists in various subspecialties view the climate for female urologists, comparing perceptions of gender inequity based on characteristics including gender, subspecialty training, faculty status, parental status, and years in practice. Despite growth in female representation in urology, gender inequalities in career opportunities and compensation continue to exist. METHODS An IRB approved survey was sent out to the following list-serves: Society of Urological Oncology (SUO), Society of Endourology (ENDO), Genitourinary Reconstructive Surgeons (GURS), Society of Pediatric Urology (SPU), Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), and American Urogynecologic Society (AUGS). A validated study, the Culture Conducive to Women's Academic Success (CCWAS) was used, and scores analyzed using Wilcoxon Rank-Sum and Kruskal-Wallace tests. RESULTS There were 430 survey responses (35.3% female, 64.7% male). There was a statistically significant difference in CCWAS score for gender, parental status, and society. On multiple regression analysis controlling for gender, parental status and society were not statistically significant. Years in practice and practice type were not significant. Male urologists perceived practice culture toward women as more equitable than their female colleagues, (median [interquartile range] CCWAS score, 203.5 [184.25, 225.0] vs 162.5 [130.75, 188.0]; P < .0001). This discrepancy in perception between genders was consistent across all subcategories; equal access, work-life balance, freedom of gender bias, and leadership support. CONCLUSIONS This study suggests that there are gender-based differences in how gender inequities are perceived and experienced in urology. Acknowledgment of these differences is the first step in identifying opportunities for improvement.
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Affiliation(s)
| | | | - Rebecca Agnor
- Biostatistics Shared Resources, Knight Cancer Institute, Portland, OR
| | - Austin Collins
- Biostatistics Shared Resources, Knight Cancer Institute, Portland, OR
| | - Solange Bassale
- Biostatistics Shared Resources, Knight Cancer Institute, Portland, OR
| | - Casey A Seideman
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR.
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8
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Ruzycki SM, Roach P, Holroyd-Leduc J, Barnabe C, Ahmed SB. Experiences and Perceptions of Racism and Sexism Among Alberta Physicians: Quantitative Results and Framework Analysis of a Cross-Sectional Survey. J Gen Intern Med 2023; 38:165-175. [PMID: 35829875 PMCID: PMC9849641 DOI: 10.1007/s11606-022-07734-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The prevalence of harassment and discrimination in medicine differs by race and gender. The current evidence is limited by a lack of intersectional analysis. OBJECTIVE To evaluate the experiences and perceptions of harassment and discrimination in medicine across physicians stratified by self-identified race and gender identity. DESIGN Quantitative and framework analysis of results from a cross-sectional survey study. PARTICIPANTS Practicing physicians in the province of Alberta, Canada (n=11,688). MAIN MEASURES Participants completed an instrument adapted from the Culture Conducive to Women's Academic Success to capture the perceived culture toward self-identified racial minority physicians (Black, Indigenous, and People of Color (BIPOC)), indicated their perception of gender inequity in medicine using Likert responses to questions about common experiences, and were asked about experiences of reporting harassment or discrimination. Participants were also able to provide open text comments. KEY RESULTS Among the 1087 respondents (9.3% response rate), 73.5% reported experiencing workplace harassment or discrimination. These experiences were least common among White cisgender men and most common among BIPOC cisgender women (52.4% and 85.4% respectively, p<0.00001). Cisgender men perceived greater gender equity than cisgender women physicians, and White cisgender men physicians perceived greatest racial equity. Participant groups reporting the greatest prevalence of harassment and discrimination experiences were the least likely to know where to report harassment, and less than a quarter of physicians (23.8%) who had reported harassment or discrimination were satisfied with the outcome. Framework analysis of open text responses identified key types of barriers to addressing racism, including denial of racism and greater concern about other forms of discrimination and harassment. CONCLUSIONS Our results document the prevalence of harassment and discrimination by intersectional identities of race and gender. Incongruent perceptions and experiences may act as a barrier to preventing and addressing harassment and discrimination in the Canadian medical workplace.
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Affiliation(s)
- Shannon M Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Pamela Roach
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jayna Holroyd-Leduc
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sofia B Ahmed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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9
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Slater AC, Thomas AA, Quan L, Bell S, Bradford MC, Walker-Harding L, Rosenberg AR. Gender Discrimination and Sexual Harassment in a Department of Pediatrics. Pediatrics 2022; 150:190097. [PMID: 36412054 DOI: 10.1542/peds.2021-055933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/23/2022] Open
Abstract
The last substantial description of gender discrimination and harassment described in the journal Pediatrics was in 2019. It is unclear whether the field has made progress toward its goal of equity. We aimed to describe: (1) the recent gender-equity climate according to women and men faculty in the department of pediatrics at a single, large academic center, and (2) institutional efforts to address persistent gender discrimination and harassment. In late 2020, we distributed an anonymous survey to all department faculty that included demographic data, a modified version of the Overt Gender Discrimination at Work Scale, questions about experiences/witnessed discriminatory treatment and sexual harassment, and if those experiences negatively affected career advancement. Of 524 pediatrics faculty, 290 (55%) responded. Compared with men, women more commonly reported gender discrimination (50% vs. 4%, P < .01) and that their gender negatively affected their career advancement (50% vs 9%, P < .01). More than 50% of women reported discriminatory treatment at least annually and 38% recognized specific sexist statements; only 4% and 17% of men reported the same (P < .01 for both). We concluded that a disproportionately low number of male faculty recognized the harassment female faculty experienced. In the 18 months since, our department and university have made efforts to improve salary equity and parity in leadership representation, created an anonymous bias-reporting portal, mandated bias training, and implemented new benchmarks of "professionalism" that focus on diversity. Although we acknowledge that culture change will take time, we hope our lessons learned help promote gender equity in pediatrics more broadly.
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Affiliation(s)
- Anne C Slater
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Anita A Thomas
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Linda Quan
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Shaquita Bell
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Miranda C Bradford
- Core for Biostatistics, Epidemiology, and Analytics in Research.,Palliative Care and Resilience Program Analytics in Research, Center for Clinical and Translational Research Seattle Children's Research Institute, Seattle, Washington
| | | | - Abby R Rosenberg
- Department of Pediatrics, University of Washington, Seattle, Washington.,Palliative Care and Resilience Program Analytics in Research, Center for Clinical and Translational Research Seattle Children's Research Institute, Seattle, Washington
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10
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Martin LH, Best SL, Semins MJ, Haslam RE, Agnor R, Seideman CA. Perceptions and Experiences of Gender Equity Among Endourologists. J Endourol 2022; 36:1632-1639. [PMID: 36112672 DOI: 10.1089/end.2022.0236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction: Only 9.9% of practicing urologists in the United States are women. This percentage is even smaller in leadership positions and high-ranking appointments. Endourology is one of the least reported fellowships completed by women urologists. We sought to evaluate how endourologists perceived the climate for women physicians and compare perceptions and experiences of gender equity. Materials and Methods: An IRB approved and validated survey, Culture Conducive to Women's Academic Success (CCWAS) questionnaire was sent out to the Endourological Society listserve. Subcategories of equal access, work-life balance, freedom of gender bias, and leadership support were analyzed. An open comment section was provided for respondents to include their own experiences. Wilcoxon rank-sum and Kruskal-Wallis tests were used to compare CCWAS scores between groups. Results: A total of 104 completed surveys were received. Response rate was 7% (104/1492), 26.9% of which were female. There was a statistically significant difference between male and female respondent CCWAS scores; p < 0.05. The male CCWAS score median was 196.0 (interquartile range [IQR] 176.75-214.0) vs female CCWAS score median of 166.5 (IQR 127.5-210.0). There was no significant difference in CCWAS scores based on years in practice, parental status, or academic vs private practice. Discussion: In this study, male endourologists' perceptions of gender equity were incongruent with the reported experiences of their female colleagues. This indicates that male respondents perceive the culture in their department toward women more positively than their female colleagues. This is suggestive that there are gender-based differences in how gender inequities are perceived and potentially experienced.
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Affiliation(s)
- Leigh H Martin
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Sara L Best
- Department of Urology, University of Wisconsin, Wisconsin, USA
| | - Michelle Jo Semins
- Department of Urology, West Virginia University, Wheeling, West Virginia, USA
| | - Roxanne E Haslam
- Department of Urology, Oregon Health and Science University, Portland, Oregon, USA
| | - Rebecca Agnor
- Biostatistics Shared Resources, Knight Cancer Institute, Portland, Oregon, USA
| | - Casey A Seideman
- Department of Pediatric Urology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA
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11
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Ruzycki SM, Roach P, Ahmed SB, Barnabe C, Holroyd-Leduc J. Diversity of physicians in leadership and academic positions in Alberta: a cross-sectional survey. BMJ LEADER 2022; 6:278-285. [PMID: 36794601 DOI: 10.1136/leader-2021-000554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/10/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Efforts to reduce barriers and disparities faced by marginalised physicians are limited by a lack of data on the current diversity of the Canadian physician workforce. We aimed to characterise the diversity of the Albertan physician workforce. METHODS This cross-sectional survey, open to all Albertan physicians from 1 September 2020 to 6 October 2021, measured the proportion of physicians from traditionally under-represented groups, including those with diverse gender identities, disabilities and from racial minorities. RESULTS There were 1087 respondents (9.3% response rate); of whom 33.4% identified as cisgender men (n=363), 46.8% as cisgender women (n=509) and less than 3% as gender diverse. Fewer than 5% were members of the LGBTQI2S+community. Half were white (n=547), 4.6% were black (n=50) and fewer than 3% were Indigenous or Latinx. Over one-third reported a disability (n=368, 33.9%). There were 303 white cisgender women (27.9%), 189 white cisgender men (17.4%), 136 black, Indigenous or person of colour (BIPOC) cisgender men (12.5%) and 151 BIPOC cisgender women (13.9%). Compared with BIPOC physicians, white participants were over-represented in leadership positions (64.2% and 32.1%; p=0.06) and academic roles (78.7% and 66.9%; p<0.01). Cisgender women had less often applied for academic promotion than cisgender men (85.4% and 78.3%, respectively, p=0.01), and BIPOC physicians had been denied promotion more frequently (7.7% compared with 4.4%; p=0.47). CONCLUSION Many Albertan physicians may experience marginalisation through at least one protected characteristic. There were race-based and gender-based differences in experiences of medical leadership and academic promotion which may explain observed disparities in these positions. To increase diversity and representation in medicine, medical organisations should focus on inclusive cultures and environments. Universities should focus efforts on supporting BIPOC physicians, especially BIPOC cisgender women, in applying for promotion.
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Affiliation(s)
- Shannon M Ruzycki
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada .,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Pamela Roach
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sofia B Ahmed
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jayna Holroyd-Leduc
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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12
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Gender Discrimination and Reporting Experiences among Academic Pediatric Faculty: A Qualitative, Single-institution Study. Acad Pediatr 2022; 23:569-578. [PMID: 36162793 DOI: 10.1016/j.acap.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/15/2022] [Accepted: 09/18/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Gender-harassment is well-described in academic medicine, including pediatrics. We explored academic pediatricians' qualitative descriptions of: 1) workplace gender-harassment; 2) its professional and emotional tolls; 3) barriers to and outcomes of reporting gender-harassment; and 4) tools to intervene. METHODS We conducted a cross-sectional, anonymous, survey-based study within a single, large pediatrics department. Surveys included demographic items, validated measures to assess prevalence of gender-harassment, and optional, free-text boxes to elaborate. Here, we present the directed content analyses of free-text responses. Two trained qualitative researchers coded participant comments to identify types of gender-harassment, its impact, and participants' experiences reporting it. Final agreement between coders was outstanding (Kappa>0.9). A secondary, inductive analysis illustrated the emotional burdens of and opportunities to interrupt gender-harassment. RESULTS Of 524 total faculty, 290 (55%) completed the survey and 144 (27% of total, 50% of survey-respondents) provided text-responses. This sub-cohort was predominantly white women >5 years on-faculty. Compared to the full cohort, sub-cohort participants had more commonly witnessed/experienced workplace-harassment; 92% of sub-cohort women and 52% of men endorsed fear of reporting it. Respondents described harassment by institutional staff (24% of respondents), patients/families (35%), colleagues (50%), supervisors/leadership (50%), and the system (63%). Women used stronger emotional descriptors than men (ie, "humiliated" vs "uncomfortable"). Only 19% of women (and no men) had reported witnessed/experienced harassment; 24% of those described a negative consequence and 95% noted that no changes were made thereafter. CONCLUSIONS This single-center study suggests gender-harassment in academic pediatrics is common. Faculty feel fear and futility reporting it.
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Bharwani A, Ruzycki SM. Closing the empathy gap towards equitable outcomes: gender equity in the medical workforce. BMJ LEADER 2022:leader-2020-000425. [DOI: 10.1136/leader-2020-000425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 08/25/2022] [Indexed: 11/04/2022]
Abstract
BackgroundEmpathy failures lead to equity failures. Women and men physicians experience work differently. Men physicians, however, may be unaware how these differences impact their colleagues. This constitutes an empathy gap; empathy gaps are associated with harm to outgroups. In our previous published work, we found that men had divergent views from women about the experiences of women relating to gender equity; senior men differed most from junior women. Since men physicians hold disproportionately more leadership roles than women, this empathy gap warrants exploration and remediation.AnalysisGender, age, motivation and power each seems to influence our empathic tendencies. Empathy, however, is not a static trait. Empathy can be developed and displayed by individuals through their thoughts, words and actions. Leaders can also influence culture by enshrining an empathic disposition in our social and organisation structures.ConclusionsWe outline methods to increase our empathic capacities as individuals and organisations through perspective-taking, perspective-giving and verbal commitments to institutional empathy. In doing so, we challenge all medical leaders to herald an empathic transformation of our medical culture in pursuit of a more equitable and pluralistic workplace for all groups of people.
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Smith KS, Bakkensen JB, Hutchinson AP, Cheung EO, Thomas J, Grote V, Moreno PI, Goldman KN, Jordan N, Feinberg EC. Knowledge of Fertility and Perspectives About Family Planning Among Female Physicians. JAMA Netw Open 2022; 5:e2213337. [PMID: 35583866 PMCID: PMC9118076 DOI: 10.1001/jamanetworkopen.2022.13337] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Pervasive gender disparities exist in medicine regarding promotion, achievement of academic rank, and appointment to leadership positions. Fertility and childbearing concerns may contribute to these disparities. OBJECTIVE To assess fertility knowledge and concerns and evaluate barriers to family building and impact on academic attrition reported by female physicians. DESIGN, SETTING, AND PARTICIPANTS This qualitative study used mixed methods; first, structured 1:1 interviews exploring fertility knowledge and family-building concerns were conducted among 16 female physicians between November 2019 and May 2020. Transcripts were coded in Dedoose and used to develop a survey instrument with subsequent pilot testing conducted among 24 female physicians between April 2020 and September 2020. Data analysis was performed from January 2021 to March 2021. MAIN OUTCOMES AND MEASURES Fertility knowledge, perceptions of peer and institutional support surrounding childbearing, factors contributing to delayed childbearing, and impact of family planning on career decisions. RESULTS Among 16 women who completed qualitative interviews, 4 (25%) were Asian, 1 (6%) was Black, 1 (6%) was multiracial, and 10 (63%) were White; mean (SD) age was 34.9 (4.0) years. Evaluation of fertility knowledge revealed 3 notable themes: (1) inadequate formal fertility education, (2) informal learning through infertility experiences of patients, peers, or personal struggles, and (3) desire to improve medical education through early introduction and transparent discussions about infertility. Exploration of childbearing concerns similarly revealed several salient themes: (1) high incidence of delayed childbearing, (2) perceived lack of peer and administrative support, and (3) impact of family building on career trajectory. These themes were borne out in pilot testing of the survey instrument: of 24 female physicians (7 Asian women [27%], 1 Black woman [4%], 1 Hispanic or Latinx woman [4%], 1 multiracial woman [4%], 15 White women [58%]; mean [SD] age, 36.1 [6.7] years), 17 (71%) had delayed childbearing and 16 (67%) had altered their career for family-building reasons. CONCLUSIONS AND RELEVANCE Qualitative interviews identified fertility and family building concerns among female physicians and were used to develop a tailored survey for women in medicine. These findings suggest that female physicians may delay childbearing and make substantial accommodations in their careers to support family building. A large-scale national survey is needed to better characterize the unique fertility, childbearing, and parenting needs of women in academic medicine to better understand how these concerns may contribute to academic attrition.
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Affiliation(s)
- Kathryn S. Smith
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer B. Bakkensen
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anne P. Hutchinson
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Shady Grove Fertility in Philadelphia, Philadelphia, Pennsylvania
| | | | - Jessica Thomas
- Preventive Medicine at Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Veronika Grote
- Osher Center for Integrative Medicine at Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patricia I. Moreno
- Department of Public Health Sciences at the University of Miami Miller School of Medicine, Miami, Florida
| | - Kara N. Goldman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Neil Jordan
- Institute for Public Health and Medicine-Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Center of Innovation for Complex Chronic Healthcare at the Edward J. Hines, Jr. VA Hospital, Hines, Illinois
| | - Eve C. Feinberg
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Dyrbye LN, West CP, Sinsky CA, Trockel M, Tutty M, Satele D, Carlasare L, Shanafelt T. Physicians' Experiences With Mistreatment and Discrimination by Patients, Families, and Visitors and Association With Burnout. JAMA Netw Open 2022; 5:e2213080. [PMID: 35587344 PMCID: PMC9121189 DOI: 10.1001/jamanetworkopen.2022.13080] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/01/2022] [Indexed: 11/30/2022] Open
Abstract
Importance Burnout is common among physicians and is associated with suboptimal patient outcomes. Little is known about how experiences with patients, families, and visitors differ by physician characteristics or contribute to the risk of burnout. Objective To examine the occurrence of mistreatment and discrimination by patients, families, and visitors by physician characteristics and the association between such interactions and experiencing burnout. Design, Setting, and Participants This cross-sectional survey was conducted from November 20, 2020, to March 23, 2021, among US physicians. Exposures Mistreatment and discrimination were measured using items adapted from the Association of American Medical College's Graduation Questionnaire with an additional item querying respondents about refusal of care because of the physicians' personal attributes; higher score indicated greater exposure to mistreatment and discrimination. Main Outcomes and Measures Burnout as measured by the Maslach Burnout Inventory. Results Of 6512 responding physicians, 2450 (39.4%) were female, and 369 (7.2%) were Hispanic; 681 (13.3%) were non-Hispanic Asian, Native Hawaiian, or Pacific Islander; and 3633 (70.5%) were non-Hispanic White individuals. Being subjected to racially or ethnically offensive remarks (1849 [29.4%]), offensive sexist remarks (1810 [28.7%]), or unwanted sexual advances (1291 [20.5%]) by patients, families, or visitors at least once in the previous year were common experiences. Approximately 1 in 5 physicians (1359 [21.6%]) had experienced a patient or their family refusing to allow them to provide care because of the physician's personal attributes at least once in the previous year. On multivariable analyses, female physicians (OR, 2.33; 95% CI, 2.02-2.69) and ethnic and racial minority physicians (eg, Black or African American: OR, 1.59; 95% CI, 1.13-2.23) were more likely to report mistreatment or discrimination in the previous year. Experience of mistreatment or discrimination was independently associated with higher odds of burnout (vs score of 0 [no mistreatment], score of 1: OR, 1.27; 95% CI, 1.04-1.55; score of 2: OR, 1.70; 95% CI, 1.38-2.08; score of 3: OR, 2.20; 95% CI, 1.89-2.57). There was no difference in the odds of burnout by gender after controlling for experiencing mistreatment and discrimination score and other demographic factors, specialty, practice setting, work hours, and frequency of overnight call. Conclusions and Relevance In this study, mistreatment and discrimination by patients, families, and visitors were common, especially for female and racial and ethnic minority physicians, and associated with burnout. Efforts to mitigate physician burnout should include attention to patient and visitor conduct.
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Affiliation(s)
- Liselotte N. Dyrbye
- Mayo Clinic, Rochester, Minnesota
- now with University of Colorado School of Medicine, Denver
| | | | | | - Mickey Trockel
- Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, California
| | | | - Daniel Satele
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Rowe SG, Stewart MT, Van Horne S, Pierre C, Wang H, Manukyan M, Bair-Merritt M, Lee-Parritz A, Rowe MP, Shanafelt T, Trockel M. Mistreatment Experiences, Protective Workplace Systems, and Occupational Distress in Physicians. JAMA Netw Open 2022; 5:e2210768. [PMID: 35522279 PMCID: PMC9077480 DOI: 10.1001/jamanetworkopen.2022.10768] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Reducing physician occupational distress requires understanding workplace mistreatment, its relationship to occupational well-being, and how mistreatment differentially impacts physicians of diverse identities. OBJECTIVES To assess the prevalence and sources of mistreatment among physicians and associations between mistreatment, occupational well-being, and physicians' perceptions of protective workplace systems. DESIGN, SETTING, AND PARTICIPANTS This survey study was administered in September and October 2020 to physicians at a large academic medical center. Statistical analysis was performed from May 2021 to February 2022. MAIN OUTCOMES AND MEASURES Primary measures were the Professional Fulfillment Index, a measure of intent to leave, and the Mistreatment, Protection, and Respect Measure (MPR). Main outcomes were the prevalence and sources of mistreatment. Secondary outcomes were the associations of mistreatment and perceptions of protective workplace systems with occupational well-being. RESULTS Of 1909 medical staff invited, 1505 (78.8%) completed the survey. Among respondents, 735 (48.8%) were women, 627 (47.1%) were men, and 143 (9.5%) did not share gender identity or chose "other"; 12 (0.8%) identified as African American or Black, 392 (26%) as Asian, 10 (0.7%) as multiracial, 736 (48.9%) as White, 63 (4.2%) as other, and 292 (19.4%) did not share race or ethnicity. Of the 1397 respondents who answered mistreatment questions, 327 (23.4%) reported experiencing mistreatment in the last 12 months. Patients and visitors were the most common source of mistreatment, reported by 232 physicians (16.6%). Women were more than twice as likely as men to experience mistreatment (31% [224 women] vs 15% [92 men]). On a scale of 0 to 10, mistreatment was associated with a 1.13 point increase in burnout (95% CI, 0.89 to 1.36), a 0.99-point decrease in professional fulfillment (95% CI, -1.24 to -0.73), and 129% higher odds of moderate or greater intent to leave (odds ratio, 2.29; 95% CI, 1.75 to 2.99). When compared with a perception that protective workplace systems are in place "to a very great extent," a perception that there are no protective workplace systems was associated with a 2.41-point increase in burnout (95% CI, 1.80 to 3.02), a 2.81-point lower professional fulfillment score (95% CI, -3.44 to -2.18), and 711% higher odds of intending to leave (odds ratio, 8.11; 95% CI, 3.67 to 18.35). CONCLUSIONS AND RELEVANCE This survey study found that mistreatment was common among physicians, varied by gender, and was associated with occupational distress. Patients and visitors were the most frequent source, and perceptions of protective workplace systems were associated with better occupational well-being. These findings suggest that health care organizations should prioritize reducing workplace mistreatment.
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Affiliation(s)
- Susannah G. Rowe
- Office of Equity, Vitality and Inclusion, Boston University Medical Group, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Miriam T. Stewart
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Sam Van Horne
- Center for WorkLife Wellbeing, ChristianaCare, Wilmington, Delaware
| | - Cassandra Pierre
- Office of Equity, Vitality and Inclusion, Boston University Medical Group, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Hanhan Wang
- Stanford University School of Medicine, Stanford, California
| | - Makaila Manukyan
- Office of Equity, Vitality and Inclusion, Boston University Medical Group, Boston Medical Center, Boston, Massachusetts
| | - Megan Bair-Merritt
- Office of Equity, Vitality and Inclusion, Boston University Medical Group, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Aviva Lee-Parritz
- Office of Equity, Vitality and Inclusion, Boston University Medical Group, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Mary P. Rowe
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge
| | - Tait Shanafelt
- Stanford University School of Medicine, Stanford, California
| | - Mickey Trockel
- Stanford University School of Medicine, Stanford, California
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Ruzycki SM, McFadden C, Jenkins J, Kuriachan V, Keir M. Experiences and Impacts of Harassment and Discrimination Among Women in Cardiac Medicine and Surgery: A Single-Centre Qualitative Study. CJC Open 2022; 4:676-684. [PMID: 36035737 PMCID: PMC9402956 DOI: 10.1016/j.cjco.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022] Open
Abstract
Background Gender- and sex-based harassment and discrimination are consistently reported by about 50% of women physicians, and the prevalence may be even greater among women in cardiology. An exploration of these experiences and their impacts on women in healthcare is necessary to design interventions, create supports, and facilitate empathy, support, and allyship among leadership. Methods To understand and describe the experiences of harassment and discrimination among women working in cardiac sciences, to inform the design of interventions and supports, we performed one-on-one, semi-structured interviews with women in the Department of Cardiac Sciences in a single institute. Interviews were coded independently in parallel using thematic analysis and reconciled by trained qualitative researchers. Experiences were categorized as harassment using the Canadian Human Rights Act. Codes were grouped into themes by iterative discussion. Results There were 15 participants, including trainees, physicians in a variety of cardiac subdisciplines, and nurse practitioners. All participants had experienced sex- or gender-based discrimination at work, though the impact and perception of these experiences varied. Whereas some participants felt that these experiences had little influence on their careers or personal lives, others changed practice specialties or locations due to harassment. Several participants had been sexually assaulted at work. Interviews revealed modifiable barriers to reporting harassment. Conclusions This qualitative dataset enriches the prevalence data on sex- and gender-based harassment among women working in cardiology by describing the impacts and perceptions of this harassment. Organizations should address commonly described barriers to reporting harassment, including addressing retaliation, and create systems-level supports for those affected by harassment.
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Kawano-Dourado L, Glassberg MK, Assayag D, Borie R, Johannson KA. Sex and gender in interstitial lung diseases. Eur Respir Rev 2021; 30:30/162/210105. [PMID: 34789464 DOI: 10.1183/16000617.0105-2021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/01/2021] [Indexed: 12/14/2022] Open
Abstract
Sex and gender differences influence key domains of research, lung health, healthcare access and healthcare delivery. In interstitial lung diseases (ILDs), mouse models of pulmonary fibrosis are clearly influenced by sex hormones. Additionally, short telomeres, a biomarker of telomere regulation gene mutations, are impacted by sex, while heritability unexplained by genetic variation may be attributable to gendered environmental factors that drive epigenetic control. Diseases like idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, occupational ILDs, connective tissue-associated ILDs and lymphangioleiomyomatosis have different prevalence and prognosis between men and women. These differences arise from a complex interplay between biological sex and sociocultural gender influencing genetics, epigenomic modifiers, hormones, immune function, response to treatment and interaction with healthcare systems. Much work remains to be done to systematically integrate sex and gender analysis into relevant domains of science and clinical care in ILD, from strategic considerations for establishing research priorities to guidelines for establishing best clinical practices. Accounting for sex and gender in ILD is essential to the practice of individualised, patient-centred medicine.
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Affiliation(s)
- Leticia Kawano-Dourado
- HCor Research Institute, Hospital do Coracao, Sao Paulo, Brazil.,Pulmonary Division, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil.,INSERM 1152, University of Paris, Paris, France
| | - Marilyn K Glassberg
- Pulmonary, Critical Care, and Sleep Medicine Division, Dept of Medicine, University of Arizona College of Medicine, Phoenix, AZ, USA
| | | | - Raphaël Borie
- Pulmonary Division, Hospital Bichat, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Kerri A Johannson
- Depts of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada .,Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
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Freeman G, Bharwani A, Brown A, Ruzycki SM. Challenges to Navigating Pregnancy and Parenthood for Physician Parents: a Framework Analysis of Qualitative Data. J Gen Intern Med 2021; 36:3697-3703. [PMID: 33959880 PMCID: PMC8642566 DOI: 10.1007/s11606-021-06835-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Some gender-based disparities in medicine may relate to pregnancy and parenthood. An understanding of the challenges faced by pregnant physicians and physician parents is needed to design policies and interventions to reduce these disparities. OBJECTIVE Our objective was to characterize work-related barriers related to pregnancy and parenthood described by physicians. DESIGN We performed framework analysis of qualitative data collected through individual, semi-structured interviews between May and October 2018. Data related to pregnancy or parenthood were organized chronologically to understand barriers throughout the process of pregnancy, planning a parental leave, taking a parental leave, returning from parental leave, and parenting as a physician. PARTICIPANTS Physician faculty members of all genders, including parents and non-parents, from a single department at a large academic medical school in Canada were invited to participate in a department-wide study broadly exploring gender equity. APPROACH Thematic analysis guided by constructivism. KEY RESULTS Twenty-eight physicians were interviewed (7.2% of eligible physicians), including 22 women and 6 men, of which 18 were parents (15 mothers and 3 fathers). Common barriers included a lack of systems-level guidelines for pregnancy and parental leave, inconsistent workplace accommodations for pregnant physicians, a lack of guidance and support for planning parental leaves, and difficulties obtaining clinical coverage for parental leave. Without systems-level guidance, participants had to individually navigate challenges and resolve these difficulties, including negotiating with their leadership for benefits. This led to stress, wasted time and effort, and raised questions about fairness within the department. CONCLUSIONS Physician parents face unique challenges navigating institutional policies as well as planning and taking parental leave. Systems-level interventions such as policies for pregnancy, parental leave, and return to work are needed to address barriers experienced by physician parents.
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Affiliation(s)
- Georgina Freeman
- W21C Research and Innovation Centre, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Aleem Bharwani
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Allison Brown
- Department of Medicine, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Shannon M Ruzycki
- Department of Medicine, University of Calgary, Calgary, Canada. .,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
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Merali Z, Malhotra AK, Balas M, Lorello GR, Flexman A, Kiran T, Witiw CD. Gender-based differences in physician payments within the fee-for-service system in Ontario: a retrospective, cross-sectional study. CMAJ 2021; 193:E1584-E1591. [PMID: 34663601 PMCID: PMC8547248 DOI: 10.1503/cmaj.210437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Differences in physician income by gender have been described in numerous jurisdictions, but few studies have looked at a Canadian cohort with adjustment for confounders. In this study, we aimed to understand differences in fee-for-service payments to men and women physicians in Ontario. Methods: We conducted a cross-sectional analysis of all Ontario physicians who submitted claims to the Ontario Health Insurance Plan (OHIP) in 2017. For each physician, we gathered demographic information from the College of Physicians and Surgeons of Ontario registry. We compared differences in physician claims between men and women in the entire cohort and within each specialty using multivariable linear regressions, controlling for length of practice, specialty and practice location. Results: We identified a cohort of 30 167 physicians who submitted claims to OHIP in 2017, including 17 992 men and 12 175 women. When controlling for confounding variables in a linear mixed-effects regression model, annual physician claims were $93 930 (95% confidence interval $88 434 to $99 431) higher for men than for women. Women claimed 74% as much as men when adjusting for covariates. This discrepancy was present in nearly all specialty categories. Men claimed more than women throughout their careers, with the greatest gap 10–15 years into practice. Interpretation: We found a gender gap in fee-for-service claims in Ontario, with women claiming less than men overall and in nearly every specialty. Further work is required to understand the root causes of the gender pay gap.
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Affiliation(s)
- Zamir Merali
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Armaan K Malhotra
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Michael Balas
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Gianni R Lorello
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Alana Flexman
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Tara Kiran
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Christopher D Witiw
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont.
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Durfey SNM, White J, Adashi EY. Pregnancy and Parenting in Medical School: Highlighting the Need for Data and Support. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1259-1262. [PMID: 33570853 DOI: 10.1097/acm.0000000000003988] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
More than 7% of medical students graduate from medical school with at least 1 nonspouse dependent, the majority of whom are likely children. However, there are no national studies on medical students who are parents, and very little is known about what medical schools are doing to support them. A growing literature on the experiences of residents and attending physicians who are parents has neglected to include those of medical students who are parents. It is possible that focusing on research and policy change for residents and attending physicians who are parents without considering medical students may bring about improvements that come too late for many. Further data are needed both on the available policies for students who are parents and on the experiences and needs of these students. Leading national organizations in medical education can help guide medical schools by leveraging their national networks to highlight existing best practices and to foster discussions about how best to support medical students who are parents.
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Affiliation(s)
- Shayla N M Durfey
- S.N.M. Durfey is a first-year resident, Hasbro Children's Hospital, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Jordan White
- J. White is assistant professor of family medicine and medical science, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Eli Y Adashi
- E.Y. Adashi is professor of medical science, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Farid H, Stack-Dunniber H, Molina R, Nosal C, Mendiola M, Hacker M. Discrimination, Microaggressions, and Perceptions of Institutional Response in an Academic Obstetrics and Gynecology Department. Cureus 2021; 13:e15993. [PMID: 34336484 PMCID: PMC8318124 DOI: 10.7759/cureus.15993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Discrimination in the workplace remains a barrier to advancing diversity and inclusion in the physician workforce. This study sought to examine experiences of discrimination, microaggressions, and perceptions of the institution’s response in an academic obstetrics and gynecology department. Method All obstetrics and gynecology faculty, fellows, and residents were invited to complete an anonymous, Institutional Review Board-approved cross-sectional survey from February through June 2019. The survey incorporated questions from multiple validated tools on discrimination, microaggressions, perceptions of the institution’s response, and opportunities for comments. Data are presented as the frequency with percent and were analyzed using Stata (StataCorp, College Station, USA); two of the authors reviewed and deductively coded the qualitative data. Results The response rate was 58% (87/151), with 30% of the respondents identifying as trainees and 75% identifying as female. Thirty respondents (35%) identified as non-Caucasian. Fifty-four respondents (62%) had ever experienced discrimination and 63 (72%) reported ever experiencing microaggressions at work; of those, 14 (22%) experienced microaggressions several times per week. Of the 69 respondents (79%) who experienced microaggressions and/or discrimination, 49 (71%) felt their experiences were due to gender, and 26 (38%) felt that they were due to race/ancestry. Only 41 respondents (59%) felt that the institution was fair to all employees, and 17 (25%) did not believe diversity was managed effectively. Conclusion Most physicians in the department experienced microaggressions or discrimination, with gender or race/ancestry as common inciting factors. A small but notable portion of respondents would prefer the institution to manage diversity differently. These findings merit further investigation about how to address discrimination in academic medicine.
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Affiliation(s)
- Huma Farid
- Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | | | - Rose Molina
- Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Catherine Nosal
- Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Monica Mendiola
- Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Michele Hacker
- Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
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Affiliation(s)
- Erica C Kaye
- From St. Jude Children's Research Hospital, Memphis, TN
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Jones SK, Chan KH, Bourdage JS, Bharwani A. Identifying leadership in medical trainees: evaluation of a competency-based approach. BMJ LEADER 2021; 6:20-29. [DOI: 10.1136/leader-2020-000402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 04/14/2021] [Accepted: 05/04/2021] [Indexed: 11/04/2022]
Abstract
BackgroundAs medical professional roles diversify, it is essential to understand what makes effective medical leaders. This study develops and validates a medical leadership competency framework that can be used to develop and evaluate leaders across all levels of medical organisations.MethodIn Phase One, the authors derived desired leadership traits and behaviours in the medical context from a panel of subject matter experts (SMEs). Traits and behaviours were then combined into multifaceted competencies which were ranked and further refined through evaluation with additional SMEs. In Phase Two, the final seven competencies were evaluated with 181 medical trainees and 167 supervisors between 2017 and 2018 to determine the validity of rapid-form and long-form leadership assessments of medical trainees. Self and supervisor reports of the seven competencies were compared with validated trait and leadership behaviour measures as well as clinical performance evaluations.ResultsThe final seven leadership competencies were: Ethical and Social Responsibility, Civility, Self-Leadership, Team Management, Vision and Strategy, Creativity and Innovation, and Communication and Interpersonal Influence. Results demonstrate initial validity for rapid-form and long-form leadership evaluations; however, perceptions of good leadership may differ between trainees and supervisors. Further, negative leadership behaviours (eg, incivility) are generally not punished by supervisors and some positive leadership behaviours (eg, ethical leadership) were associated with poor leadership and clinical performance evaluations by supervisors. Supervisor perceptions of leadership were significantly driven by trainee scores on social boldness (a facet of extraversion).ConclusionsA multicompetency framework effectively evaluates leadership in medicine. To more effectively reinforcepositive leadership behaviours and discourage negative leadership behaviours in medical students and resident physicians, we recommend that medical educators:: (1) Use validated frameworks to build leadership curriculum and evaluations. (2) Use short-term and long-term assessment tools. (3) Teach assessors how to evaluate leaders and encourage positive leadership behaviours early in training.
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Haslam RE, Collins A, Martin LH, Bassale S, Chen Y, Seideman CA. Perceptions of gender equity in pediatric urology. J Pediatr Urol 2021; 17:406.e1-406.e7. [PMID: 33558178 DOI: 10.1016/j.jpurol.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/08/2021] [Accepted: 01/14/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION/OBJECTIVE Women constitute more than 50% of medical students in the United States. However, only 9.9% of practicing urologists are women, with much fewer numbers in high ranking appointments and positions of leadership. With a growing number of women in pediatric urology, we sought to evaluate how pediatric urologists perceive the climate for women physicians and compare perceptions and experiences of gender equity based on characteristics including gender, practice type, parental status, and years in practice. STUDY DESIGN An IRB approved survey was sent out to the Society of Pediatric Urology (SPU) listserve of active members. We utilized a validated study, the Culture Conducive to Women's Academic Success questionnaire (CCWAS, higher scores indicating better perceived culture toward women). Subcategories (equal access, work-life balance, freedom of gender bias, and leadership support) were also analyzed. A comment section was provided for respondents to include their own experiences. Descriptive statistics were used for demographics and clinical characteristics. Wilcoxon Rank-Sum and Kruskal-Wallace tests were used to compare CCWAS scores between groups. RESULTS A total of 116 practicing physicians returned completed surveys for analysis (response rate, 116/355 (33%) [ n = 41,35.3%] female [n = 75,64.7%] male). There was a statistically significant difference in total CCWAS score between male and female genders, indicating male physicians perceived the culture of their department toward women more positively than their female counterparts (median [ interquartile range] CCWAS score, 208.0 [189.0-228.0] vs 164.0 [136.0-190.3]; P < 0.0001). There was no significant difference in CCWAS scores based on years in practice, parental status, or academic versus private practice. DISCUSSION Limitations of our survey include both participation and non-response bias. Those with strong opinions may have been more likely to respond to the survey. Male respondents comprised 64.7% (n = 75) of overall respondents, representing 25% active male SPU members. Whereas the response rate of active female members of the SPU was 70%. The survey was designed to assess gender equity in academia, and may not be as generalizable to the private practice community. Yet, the differences in perceptions and experiences of gender equity of this study have been noted by studies in other specialties, as well as the 2018 AUA Census report, and may provide insight into the presence and perpetuation of unconscious or systemic biases within medicine. CONCLUSION In this study, male physician perceptions of gender equity were different from those reported by female physicians, suggesting there are gender-based differences in how gender inequities are perceived and experienced.
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Affiliation(s)
- Roxanne E Haslam
- Oregon Health and Science University 3303 SW Bond Avenue, CH10U, Portland, OR, 97239, USA.
| | - Austin Collins
- Biostatistics Shared Resources, Knight Cancer Institute, 2720 SW Moody Avenue, KCRB 4133 Portland, OR, 97201, USA
| | - Leigh H Martin
- Oregon Health and Science University 3303 SW Bond Avenue, CH10U, Portland, OR, 97239, USA
| | - Solange Bassale
- Biostatistics Shared Resources, Knight Cancer Institute, 2720 SW Moody Avenue, KCRB 4133 Portland, OR, 97201, USA
| | - Yiyi Chen
- Biostatistics Shared Resources, Knight Cancer Institute, 2720 SW Moody Avenue, KCRB 4133 Portland, OR, 97201, USA
| | - Casey A Seideman
- Doernbecher Children's Hospital, Oregon Health and Science University, 700 SW Campus Drive, Portland, OR, 97239 USA
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Affiliation(s)
- Michelle Cohen
- Department of Family Medicine (Cohen), Queen's University, Kingston, Ont.; Division of Family Medicine (Cohen), Trenton Memorial Hospital, Trenton, Ont.; Department of Family and Community Medicine (Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Kiran), University of Toronto; MAP Centre for Urban Health Solutions (Kiran), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran), University of Toronto, Toronto, Ont.
| | - Tara Kiran
- Department of Family Medicine (Cohen), Queen's University, Kingston, Ont.; Division of Family Medicine (Cohen), Trenton Memorial Hospital, Trenton, Ont.; Department of Family and Community Medicine (Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Kiran), University of Toronto; MAP Centre for Urban Health Solutions (Kiran), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Kiran), University of Toronto, Toronto, Ont
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Hauw-Berlemont C, Aubron C, Aissaoui N, Bodet-Contentin L, Boissier F, Fartoukh MS, Jourdain M, Le Marec J, Pestel J, Salmon Gandonnière C, Tamion F, Hamzaoui O. Perceived inequity, professional and personal fulfillment by women intensivists in France. Ann Intensive Care 2021; 11:72. [PMID: 33978840 PMCID: PMC8116474 DOI: 10.1186/s13613-021-00860-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/23/2021] [Indexed: 01/05/2023] Open
Abstract
Background The medical workforce has been feminized for the last two decades worldwide. Nonetheless, women remain under-represented among intensivists. We conducted a survey among French women intensivists to assess their professional and personal quality of life and their perception of potential gender discrimination at work. Methods We conducted an observational descriptive study by sending a survey, designed by the group FEMMIR (FEmmes Médecins en Médecine Intensive Réanimation), to women intensivists in France, using primarily the Société de Réanimation de Langue Française (SRLF) mailing list. The questionnaire was also available online between September 2019 and January 2020 and women intensivists were encouraged to answer through email reminders. It pertained to five main domains, including demographic characteristics, work position, workload and clinical/research activities, self-fulfillment scale, perceived discrimination at work and suggested measures to implement. Results Three hundred and seventy-one women responded to the questionnaire, among whom 16% had an academic position. Being a woman intensivist and pregnancy were both considered to increase difficulties in careers’ advancement by 31% and 73% of the respondents, respectively. Almost half of the respondents (46%) quoted their quality of life equal to or lower than 6 on a scale varying from 1 (very bad quality of life) to 10 (excellent quality of life). They were 52% to feel an imbalance between their personal and professional life at the cost of their personal life. Gender discrimination has been experienced by 55% of the respondents while 37% confided having already been subject of bullying or harassment. Opportunities to adjust their work timetable including part-time work, better considerations for pregnant women including increasing the number of intensivists and the systematic replacement during maternity leave, and the respect of the law regarding the paternity leave were suggested as key measures to enable better professional and personal accomplishment by women intensivists. Conclusion In this first large French survey in women intensivists, we pointed out issues felt by women intensivists that included an imbalance between professional and personal life, a perceived loss of opportunity due to the fact of being a woman, frequent reported bullying or harassment and a lack of consideration of the needs related to pregnancy and motherhood.
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Affiliation(s)
- Caroline Hauw-Berlemont
- Médecine Intensive Réanimation, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, Paris, France
| | - Cécile Aubron
- Médecine Intensive Réanimation, Centre Hospitalier Régional Et Universitaire de Brest, Université de La Bretagne Occidentale, Brest, France
| | - Nadia Aissaoui
- Cardiovascular Research Center (PARCC), APHP, Hôpital Européen Georges Pompidou, Université de Paris, INSERM Unit 970, Paris, France
| | - Laetitia Bodet-Contentin
- Médecine Intensive Réanimation, INSERM CIC 1415, CRICS-TriGGERSep Network, CHRU de Tours and methodS in Patient-Centered Outcomes and Health ResEarch (SPHERE), Université de Tours, INSERM UMR 1246, Tours, France
| | - Florence Boissier
- Médecine Intensive Réanimation, Hôpital Universitaire de Poitiers, Poitiers, France.,INSERM CIC 1402 (ALIVE Group), Université de Poitiers, Poitiers, France
| | - Muriel Sarah Fartoukh
- Service de Médecine Intensive Réanimation, Faculté de Médecine Sorbonne, Hôpital Tenon, APHP, and APHP, Sorbonne Université, Paris, France
| | - Mercedes Jourdain
- Médecine Intensive Et Réanimation - CHU de Lille, Lille, France.,Membre de L'unité INSERM U1190 - Recherche Translationnelle Sur Le Diabète, Lille, France
| | - Julien Le Marec
- AP-HP Sorbonne Université, Site Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive - Réanimation, Département R3S; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Julia Pestel
- Diplôme D'étude Spécialisée Médecine Intensive Réanimation (DESMIR), Inter-région Sud-Ouest, France
| | | | - Fabienne Tamion
- Médecine Intensive Et Réanimation, Hôpital Universitaire de Rouen, Rouen, France.,INSERM U1096 EnVi, Université Normandie, UNIROUEN, caen, France
| | - Olfa Hamzaoui
- Université Paris-Saclay, AP-HP, Hôpital Antoine Béclère, Service de réanimation polyvalente, Clamart, France.
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Rogers EA, Moser-Bleil EK, Duffy BL, Gladding S, Wang Q, Mustapha T. Gender Matters: Internal Medicine Resident Perceptions of Gender Bias in Medical Training. J Gen Intern Med 2021; 36:1448-1450. [PMID: 32514898 PMCID: PMC8131430 DOI: 10.1007/s11606-020-05772-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/06/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Elizabeth A Rogers
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
- Program in Health Disparities Research, University of Minnesota, Minneapolis, MN, USA.
| | - E Kendahl Moser-Bleil
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Briar L Duffy
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Sophia Gladding
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Qi Wang
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Taj Mustapha
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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Affiliation(s)
- Shannon M Ruzycki
- Division of General Internal Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Susan Franceschet
- Department of Political Science, University of Calgary, Calgary, Canada
| | - Allison Brown
- Division of General Internal Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Gender pay disparity in anesthesiology. Curr Opin Anaesthesiol 2021; 34:145-148. [PMID: 33606397 DOI: 10.1097/aco.0000000000000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to look at the historical and current gender pay gap in healthcare, specifically in the field of anesthesiology, as well as discuss some of the reasons for the difference in compensation and its consequences. Future aims and directions to bridge the gap will also be explored. RECENT FINDINGS Even though women have achieved equality in terms of admission to medical school and residency programs, disparities still exist in terms of compensation for equal or comparable work. However, institutional initiatives to close the pay gap have achieved success. SUMMARY In order to improve the gender pay inequality, there needs to be continuous efforts on the institutional level for recognition of the disparity, initiation of programs for mentorship and sponsorship for female faculties, and continuous monitoring of the effect of the programs.
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Bhandari S, Jha P, Cooper C, Slawski B. Gender-Based Discrimination and Sexual Harassment Among Academic Internal Medicine Hospitalists. J Hosp Med 2021; 16:84-89. [PMID: 33496657 DOI: 10.12788/jhm.3533] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 09/14/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Gender-based discrimination and sexual harassment, both implicit and overt, have been reported in academic medicine. This study examines experiences of academic hospitalists regarding gender-based discrimination and sexual harassment. METHODS A survey was distributed to Internal Medicine hospitalists at university-based academic institutions in the United States. Questions assessed experiences regarding gender-based discrimination and sexual harassment in their interactions with patients, as well as with other healthcare providers (HCPs). RESULTS Eighteen institutions participated in the survey, resulting in 336 individual responses. Female hospitalists more frequently reported inappropriate touch, sexual remarks, gestures, and suggestive looks by patients compared with male peers both over their careers (P < .001) and in the last 30 days (P < .001). Similarly, females more frequently reported being referred to with inappropriate terms of endearment (eg, "dear," "honey," "sweetheart") by patients both over their careers (P < .001) and in the last 30 days (P < .001). Almost 100% of females reported being mistaken by patients for nonphysician HCPs over their careers, compared with 29% of males (P < .001) (76% vs 10%, in the last 30 days; P < .001). Similarly, females more frequently reported sexual harassment over their careers (P < .05) and being mistaken for nonphysician HCPs by colleagues both over their careers (P < .001) and in the last 30 days (P < .001). Females rated their sense of respect both by patients (P < .001) and colleagues (P < .001) lower than males (P < .001). More females than males reported that gender negatively impacted their career opportunities (P < .001). CONCLUSION This survey demonstrates that gender-based discrimination and sexual harassment are commonly encountered by academic hospitalists, with a significantly higher number of females reporting these experiences.
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Affiliation(s)
- Sanjay Bhandari
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pinky Jha
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Cynthia Cooper
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Barbara Slawski
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Ruzycki SM, Brown A, Bharwani A, Freeman G. Gender-based disparities in medicine: a theoretical framework for understanding opposition to equity and equality. BMJ LEADER 2021. [DOI: 10.1136/leader-2020-000231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jorge A, Bolster M, Fu X, Blumenthal DM, Gross N, Blumenthal KG, Wallace Z. The Association Between Physician Gender and Career Advancement Among Academic Rheumatologists in the United States. Arthritis Rheumatol 2021; 73:168-172. [PMID: 33460296 PMCID: PMC7815955 DOI: 10.1002/art.41492] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 08/11/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the potential association between physician gender and academic advancement among US rheumatologists. METHODS We performed a nationwide, cross-sectional study of all rheumatologists practicing in the US in 2014 using a comprehensive database of all licensed physicians. Among academic rheumatologists, we estimated gender differences in faculty rank, adjusting for differences in physician age, years since residency graduation, publications, National Institutes of Health (NIH) grants, registered clinical trials, and appointment at a top 20 medical school using a multivariate logistic regression model. We also estimated gender differences in leadership positions (i.e., division director and fellowship program director). RESULTS Among 6,125 total practicing rheumatologists, 941 (15%) had academic faculty appointments in 2014. Women academic rheumatologists (41.4%) were younger and had completed residency more recently than men. Women had fewer total publications, publications on which they were the first or last author, and NIH grants. In fully adjusted analyses, women were less likely to be full or associate professors than men, with an adjusted odds ratio (OR) of 0.78 (95% confidence interval [95% CI] 0.62-0.99]). Women in rheumatology had similar odds as men of being a fellowship program director or division director (adjusted OR 0.99 [95% CI 0.69-1.43] and adjusted OR 0.96 [95% CI 0.66-1.41], respectively). CONCLUSION Among academic rheumatologists, women are less likely than men to be full or associate professors but have similar odds of being fellowship program directors or division directors, when adjusting for several factors known to influence faculty promotion. These differences suggest barriers to academic promotion despite representation in leadership positions within rheumatology divisions.
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Affiliation(s)
- April Jorge
- Clinical Epidemiology Program of the Division of Rheumatology, Allergy, and Immunology and Mongan Institute, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Marcy Bolster
- Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Xiaoqing Fu
- Clinical Epidemiology Program of the Division of Rheumatology, Allergy, and Immunology and Mongan Institute, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Daniel M. Blumenthal
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Kimberly G. Blumenthal
- Clinical Epidemiology Program of the Division of Rheumatology, Allergy, and Immunology and Mongan Institute, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Allergy/Immunology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Zachary Wallace
- Clinical Epidemiology Program of the Division of Rheumatology, Allergy, and Immunology and Mongan Institute, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Brown A, Bonneville G, Glaze S. Nevertheless, They Persisted: How Women Experience Gender-Based Discrimination During Postgraduate Surgical Training. JOURNAL OF SURGICAL EDUCATION 2021; 78:17-34. [PMID: 32654996 DOI: 10.1016/j.jsurg.2020.06.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE More women than ever are pursuing surgical specialties despite historical dominance by men. The objective of this study was to examine how surgical residents experience gender-based discrimination during their residency training, including the common sources, settings, and implications of these experiences. DESIGN A sequential explanatory mixed methods design was used to combine results from an initial quantitative survey of surgical residents of all genders at the University of Calgary with qualitative data derived from interviews with surgical residents who identified as women. PARTICIPANTS Thirty-seven surgical residents of all genders completed a survey. Fourteen women completed a one-to-one, semistructured interview. RESULTS Women reported significantly more frequent experiences of gender-based discrimination than men, particularly regarding lack of respect from others, inappropriate jokes or comments, and hostile or humiliating behaviors. Nursing staff and patients were reported as prominent sources of discrimination, and the emergency and operating rooms were the most common settings. The qualitative findings highlighted the additional challenges for women during surgical residency, including navigating the relationships with nursing, having to work "twice as hard" to receive respect from patients and nurses, reports of persistent harassment and bullying, becoming desensitized to mistreatment and discrimination, and the influence of their gender on the quality of their education as well as their well-being. CONCLUSIONS Despite the increasing number of women entering surgical specialties, women surgical residents report frequent and severe experiences of gender-based discrimination during their training, even at an academic institution where over half of residents are women.
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Affiliation(s)
- Allison Brown
- University of Calgary, Cumming School of Medicine, Department of Medicine, Calgary, Alberta, Canada; University of Calgary, Department of Community Health Sciences, Calgary, Alberta, Canada.
| | - Gabrielle Bonneville
- University of Calgary, Department of Obstetrics & Gynecology, Calgary, Alberta, Canada
| | - Sarah Glaze
- University of Calgary, Department of Obstetrics & Gynecology, Calgary, Alberta, Canada; Foothills Medical Centre, Department of Obstetrics of Gynecology, Division of Gynecologic Oncology, Calgary, Alberta, Canada
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Affiliation(s)
| | - Tom Stelfox
- Professor and head, University of Calgary, Calgary, Alta
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Mills G, Ruzycki SM, Sabourin J, Dance E. Experiences of breastfeeding among women residents in Alberta: a cross-sectional survey. Postgrad Med 2020; 133:42-47. [PMID: 32875929 DOI: 10.1080/00325481.2020.1814581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Breastfeeding at work is recommended by pediatric society guidelines and is protected by employment and human rights law in many countries. Despite this, previous studies have found that residents report important structural barriers to breastfeeding at work. METHOD We administered a cross-sectional, electronic, multicenter survey of all women residents in Alberta who were parents in 2017. The study aimed to characterize respondents' experiences of breastfeeding, including duration, goals, barriers, and support from colleagues. RESULTS There were 110 respondents, of whom 53 individuals had breastfed 83 children during residency. While nearly all felt that breastfeeding was important to them, only 69.2% reported meeting their breastfeeding duration goal. Surgical residents were less likely to meet their breastfeeding duration goal than residents in other disciplines (40.0% (n = 6/15) compared to 80.0% of non-surgical (n = 28/35) and 80.0% of family medicine residents (n = 12/15)). Residents reported stopping breastfeeding earlier than they desired due to lack of adequate space (48.7%, n = 19) and lack of time (57.1%, n = 24). Twelve participants (10.9%) reported hearing a derogatory comment from a staff physician about their breastfeeding. CONCLUSIONS Women residents face barriers to breastfeeding at work which require systems-level intervention. Residents from surgical programs may be the most vulnerable to these barriers. Program directors, residency wellness committees, and hospital administrators should prioritize addressing these barriers for women residents returning to work after maternity leave. Examples of interventions that may address these barriers include policies, designation of lactation spaces, and flexible return-to-work schedules.
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Affiliation(s)
- Ginevra Mills
- Department of Obstetrics and Gynecology, Faculty of Medicine, McGill University , Montreal, QC, Canada
| | - Shannon M Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary , Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary , Calgary, Alberta, Canada
| | - Jeanelle Sabourin
- Department of Obstetrics & Gynecology, Faculty of Medicine & Dentistry, University of Alberta , Edmonton, Alberta, Canada
| | - Erica Dance
- Office of Advocacy & Wellbeing, Faculty of Medicine & Dentistry, University of Alberta , Edmonton, Alberta, Canada
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Pope JE. Would a 'Rosendo' by Another Name Smell as Sweet? Gender Disparity in Academic Rank and Publications in Rheumatology. Arthritis Rheumatol 2020; 73:5-8. [PMID: 32852124 DOI: 10.1002/art.41498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/29/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Janet E Pope
- University of Western Ontario and St. Joseph's Health Care London, London, Ontario, Canada
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Kawano-Dourado L, Glassberg MK, Molina-Molina M, Strek ME, Wijsenbeek M, Johannson KA. Gender equity in interstitial lung disease. THE LANCET RESPIRATORY MEDICINE 2020; 8:842-843. [PMID: 32687800 DOI: 10.1016/s2213-2600(20)30310-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Leticia Kawano-Dourado
- Research Institute, Hospital do Coracao, Sao Paulo-SP, 04005-909, Brazil; Pulmonary Division, Heart Institute, Medical School of the University of Sao Paulo, Sao Paulo, Brazil.
| | - Marilyn K Glassberg
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Maria Molina-Molina
- Interstitial Lung Disease Unit, Pulmonary Division, University Hospital of Bellvitge, Barcelona, Spain
| | - Mary E Strek
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Marlies Wijsenbeek
- Erasmus MC, Academic Centre for Interstitial Lung Diseases, Department of Respiratory Medicine, Rotterdam, Netherlands
| | - Kerri A Johannson
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
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Samuel K, Ellicott H. Gender inequality in research: does UK trainee-led research herald an equal future? Br J Anaesth 2020; 124:e77-e78. [DOI: 10.1016/j.bja.2019.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/13/2019] [Accepted: 12/15/2019] [Indexed: 11/29/2022] Open
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