Mentoring Relationships and Gender Inequities in Academic Medicine: Findings From a Multi-Institutional Qualitative Study

Medical Student Perceptions of the Barriers to Entering Orthopaedic Surgery Differ by Gender

BACKGROUND

The value of gender representation has been increasingly recognised in medicine, yet women represent only 13.6% of orthopaedic surgeons in Canada. The primary objective of this study was to determine barriers identified by medical students considering pursuing a career in orthopaedic surgery. The secondary objective was to assess for gender-based differences in barriers identified by medical students.

METHODS

A cross-sectional mixed-methods survey was distributed to final-year students at a Canadian medical school. Descriptive analyses were calculated for the study population and gender subgroups. To compare responses between gender subgroups, chi-square or Fisher's exact tests were employed for binary data, and non-parametric Mann-Whitney U tests for ordinal data. Open-text responses were reviewed for descriptions of students' experiences in orthopaedics.

RESULTS

Sixty-four medical students participated, representing a response rate of 59.3%. Male culture and the need for physical strength were identified as strong barriers to pursuing a career in orthopaedics. Additionally, women reported less exposure (p = 0.003), disproportionate constraints (i.e., scrutiny of performance based on gender, p = 0.001), less mentorship (p = 0.028), more concerns about verbal (p < 0.001) and sexual abuse (p = 0.013), and higher rates of direct discouragement from pursuing orthopaedics than men (p = 0.035). Open-text responses indicated that orthopaedics was not considered welcoming to all medical students.

CONCLUSIONS

This study is the first to characterise medical student perceptions of barriers to gender equity in orthopaedic surgery in Canada. Fostering a more equitable environment will necessitate a paradigm shift in the educational framework toward orthopaedic surgery.

What if we consider research teams as teams?

Research teams are an important means by which knowledge is generated in Health Professions Education (HPE). Although funding agencies encourage the formation of interdisciplinary and interprofessional research teams, we know little about how our interdisciplinary and interprofessional research teams are functioning, nor how best to ensure their success. Indeed, while HPE Scholarship Units and research environments have been the object of study, little work has been focused on research teams themselves. In this article, the authors propose that research teams should be studied as unique instantiations of teams where several individuals work together towards a common goal. Considering research teams as a team can encourage attention to how effective teams are built, supported, and celebrated, it can acknowledge that competent individuals may form incompetent teams, and it opens important avenues for future research. Turning our attention to better understanding how and when research teams thrive should support the development of more effective teams; resulting in reduced waste and redundancy, better mobilization of team members' time and skills, and enhanced knowledge generation. Considering research teams as teams, encourages an understanding that these teams require care, commitment, and effort to sustain them, and it acknowledges that pursuing research in a team context is both a collaborative and a social endeavour.

You've Got A Friendtor in Me: Innovations in Peer Mentoring for Mid-Career Palliative Care Clinicians

Introduction: Mentoring is crucial to professional success, but little is known about the professional development needs of mid-career hospice and palliative medicine (HPM) clinicians. Methods: An interprofessional "friendtor" group of five HPM clinicians from three academic medical centers met monthly and for a year-end focus group. A thematic analysis was used to develop a coding structure and identify overarching themes from these discussions. Results: Several themes emerged that highlight the importance of peer support when navigating major life decisions, boundary-setting, and non-clinical practice challenges, celebrating friendtors' personal and professional milestones, and having a productive space for shared academic pursuits. Discussion: Given the challenges and vulnerabilities the field of HPM is experiencing with workforce sustainability and burnout, the importance of developing supports outside of traditional mentorship paradigms is a valuable area of focus. Our work suggests that a friendtorship model may be an effective tool for sustaining mid-career HPM clinicians.

Together but separate: a longitudinal study of how spatial context shapes the formation of social ties of women medical students

Developing and maintaining connections with others, or what we refer to as the formation of social ties, may strengthen medical students' sense of belonging in medical school. Social ties play a particularly important role for women medical students as the medical field remains largely dominated by masculine norms. However, forming social ties remains challenging for women in medicine. This study used the COVID-19 pandemic to examine how women medical students navigated the spatial contexts of medical school to form social ties. Using longitudinal qualitative research and narrative inquiry, it describes how 17 women medical students formed social ties during the early stages of COVID-19. Beginning in fall 2020, during the initial two-years of medical school, the participants (1) described how personal ties were deterred from forming in early experiences of medical school; (2) shared experiences that promoted a sense of community bonding during middle and later periods; and (3) expressed limitations of access to the formation of professional ties throughout their initial 2-years. This study has important implications for understanding ways spatial contexts, access to physical connections, and the mental and emotional barriers or pathways play roles in social tie formation for women medical students and how longitudinal qualitative research can narrate these changes through time.

Gender and Mentorship in Military Medicine: A Survey Study

INTRODUCTION

Mentorship is essential for professional development and advancement within the military. In civilian medicine, the intersection between gender and mentorship holds important implications for research opportunities, academic success, and career progression. However, the intersection of gender and mentorship has not yet been explored within the field of military medicine. The purpose of this study, therefore, was to investigate the role of gender in mentorship within the field of military medicine.

MATERIALS AND METHODS

We investigated gender and mentorship within military medicine by developing and distributing a 16-item Likert survey to active-duty military physicians. We used the Chi-squared test of independence and the independent samples t-test to examine the role of gender in mentorship among the 16 questions.

RESULTS

The male respondents reported more same-gender mentors than females (male [M]: 61.9% vs. female [F]: 33.0%), whereas the female respondents had significantly more mentors of the opposite gender than males (M: 12.4% vs. F: 47.3%). A higher proportion of males indicated no preference compared to females. Conversely, a significant preference for a same-sex mentor was expressed by female respondents compared to male respondents (M: 5.2% vs. F: 30.1%). In contrast, female respondents considered having a mentor more important than their male counterparts (t(206) = -2.26, P = .012, F: 3.86 vs. M: 3.57). Both male and female respondents had significantly more female mentees ($\chi _{\left( 1 \right)}^2$ = 12.92, P < .001, Cramer's V = 0.254).

CONCLUSIONS

While the female participants in our study preferred female mentors, the male participants had more same-gender mentors than the female participants. In addition, more females reported that they did not have the time to be mentored. Our results, therefore, suggest that training males to be better mentors to females and providing accessible mentorship training to females may promote equitable career development within military medicine.

You Can't Be What You Can't See: The Progression of Women in Otolaryngology-Head and Neck Surgery

Objective: To examine trends in the gender composition of residents and faculty in Otolaryngology-Head and Neck Surgery residency programs in the United States and to investigate the correlation between women's representation in leadership positions and the proportion of women faculty and residents. Methods: A literature review was first performed to analyze trends in the gender composition of residents and faculty in Otolaryngology-Head and Neck Surgery (OHNS) residency programs. Current residency programs were then identified using the Electronic Residency Application Service 2023 Participating Specialties and Programs website. The following data was collected from each program website: gender of associated medical school dean, gender of department chair, gender of residency program director, and total number and gender of fellowship directors, faculty, and residents. Wilcoxon rank sum test and Fischer's exact test were used to analyze relationships between the number of women in leadership positions and the proportion of women faculty and residents. Results: An increase in the number of women chairs, residency program directors, residents, and faculty over the past decade is documented across published literature. One hundred twenty-three current academic residency programs were identified. Women accounted for 42%, 30%, 27%, and 8% of current residents, residency program directors, faculty, and department chairs, respectively. Department chair gender was significantly correlated with number of women faculty (P = .01). Any women in a leadership position were correlated with a statistically significant increase in median percent of women faculty (P = .006). Conclusion: Further understanding of how the mentorship of women promotes gender equity is necessary to promote gender diversity in OHNS.

Mentoring as a complex adaptive system - a systematic scoping review of prevailing mentoring theories in medical education

BACKGROUND

Effective mentorship is an important component of medical education with benefits to all stakeholders. In recent years, conceptualization of mentorship has gone beyond the traditional dyadic experienced mentor-novice mentee relationship to include group and peer mentoring. Existing theories of mentorship do not recognize mentoring's personalized, evolving, goal-driven, and context-specific nature. Evidencing the limitations of traditional cause-and-effect concepts, the purpose of this review was to systematically search the literature to determine if mentoring can be viewed as a complex adaptive system (CAS).

METHODS

A systematic scoping review using Krishna's Systematic Evidence-Based Approach was employed to study medical student and resident accounts of mentoring and CAS in general internal medicine and related subspecialties in articles published between 1 January 2000 and 31 December 2023 in PubMed, Embase, PsycINFO, ERIC, Google Scholar, and Scopus databases. The included articles underwent thematic and content analysis, with the themes identified and combined to create domains, which framed the discussion.

RESULTS

Of 5,704 abstracts reviewed, 134 full-text articles were evaluated, and 216 articles were included. The domains described how mentoring relationships and mentoring approaches embody characteristics of CAS and that mentorship often behaves as a community of practice (CoP). Mentoring's CAS-like features are displayed through CoPs, with distinct boundaries, a spiral mentoring trajectory, and longitudinal mentoring support and assessment processes.

CONCLUSION

Recognizing mentorship as a CAS demands the rethinking of the design, support, assessment, and oversight of mentorship and the role of mentors. Further study is required to better assess the mentoring process and to provide optimal training and support to mentors.

A Systematic Review of Gender Disparity in the Authorship of Clinical Trials and Clinical Practice Guidelines in Various Medicine Subspecialties

Authorship in clinical trials and clinical practice guidelines is considered prestigious and is associated with broader peer recognition. This systematic review investigated female representation among studies reporting authorship trends in clinical trials or clinical practice guidelines in different medicine subspecialties. Our search strategy yielded 836 articles, of which 30 met the inclusion criteria. Our findings indicate that females are severely underrepresented in authorship of clinical trials and clinical practice guidelines. Although the proportions of females may have improved in the past decade, the gains are marginal. Notably, studies in this domain predominantly focus on first/last authorship positions, and whether females are underrepresented in other positions as collaborative partners is currently unknown. Also, authorship trends in clinical trials or clinical practice guidelines of most medicine subspecialties besides cardiovascular medicine remain under-researched. Hence, standardizing the methodology for studying gender disparity in research output for comparative analysis between different subspecialties is as urgent as addressing the gender disparity in authorship.

Challenges, coping and support during student placement abroad: A qualitative study

BACKGROUND

During placements abroad, healthcare students are confronted with different personal and professional challenges, related to participation in practice. This study investigates when and how students respond to such challenges, and which coping and support mechanisms students use to overcome these.

METHODS

Twenty-five international students shared their experiences about physiotherapy placement in The Netherlands. Using a critical incident technique, we asked participants to recall events where participation was affected by an unforeseen situation, in or outside the clinic. Further, we explored students' strategies of seeking support within their social network to overcome individual challenges. Two researchers applied thematic analysis to the interview data, following an iterative approach. Team discussions supported focused direction of data collection and analysis, before conceptualizing results.

RESULTS

Participants described a wide range of challenges. The scope and impact level of challenges varied widely, including intercultural differences, language barriers and inappropriate behaviour in the workplace, students' personal context and wellbeing. Mechanisms employed by students to overcome these challenges depended on the type of event (personal or professional), making purposeful use of their available network.

CONCLUSION

Students involve clinical staff, peers, family and friends during placement abroad, to make deliberate use of their support network to overcome challenges in participation, whereas the academic network remains distant. Findings may help reflect on the roles and responsibilities of academic staff and other professionals involved with placements abroad. Healthcare programmes should ensure support before, during and after placement is within students' reach.

Demographic and Academic Productivity Trends Among American Head & Neck Society Fellows Over a 20-Year Period

Importance

Historical data reveal that, compared with women, men are more likely to pursue a head and neck surgical oncology fellowship, but little is known about possible gender differences in academic productivity.

Objective

To assess demographic trends and academic productivity among American Head & Neck Society (AHNS) fellowship graduates.

Design, Setting, and Participants

This cross-sectional study used electronically published data from the AHNS on fellowship graduates in the US and Canada from July 1, 1997, to June 30, 2022. Scopus was used to extract h-indices for each graduate.

Exposure

Scholarly activity.

Main Outcomes and Measures

Main outcomes were changes in demographic characteristics and academic productivity among AHNS graduates over time. Data analysis included effect size, η2, and 95% CIs.

Results

A total of 691 AHNS fellowship graduates (525 men [76%] and 166 women [24%]) were included. Over the study period, there was an increase in the number of programs offering a fellowship (η2, 0.84; 95% CI, 0.68-0.89) and an increase in the absolute number of women who completed training (η2, 0.66; 95% CI, 0.38-0.78). Among early-career graduates pursuing an academic career, there was a small difference in the median h-index scores between men and women (median difference, 1.0; 95% CI, -1.1 to 3.1); however, among midcareer and late-career graduates, there was a large difference in the median h-index scores (midcareer graduates: median difference, 4.0; 95% CI, 1.2-6.8; late-career graduates: median difference, 6.0; 95% CI, 1.0-10.9). A higher percentage of women pursued academic positions compared with men (106 of 162 [65.4%] vs 293 of 525 [55.8%]; difference, 9.6%; 95% CI, -5.3% to 12.3%).

Conclusions and Relevance

This cross-sectional study suggests that women in head and neck surgery begin their careers with high levels of academic productivity. However, over time, a divergence in academic productivity between men and women begins to develop. These data argue for research to identify possible reasons for this observed divergence in academic productivity and, where possible, develop enhanced early faculty development opportunities for women to promote their academic productivity, promotion, and advancement into leadership positions.

Wondering If I'd Get There Quicker If I Was a Man: Factors Contributing to Delayed Academic Advancement of Women in Infectious Diseases

Background

Gender inequities in academic advancement persist in many specialties, including Infectious Diseases (ID). Prior studies of advancement disparities have been predominantly quantitative, utilizing large physician databases or surveys. We used qualitative methods to explore ID physicians' experiences and beliefs about causes and ways to mitigate gender inequities in advancement.

Methods

We conducted semistructured focus group discussions with academic ID physicians in the United States at IDWeek 2019 to explore perceived barriers and facilitators to academic advancement. Participants were assigned to focus groups based on their academic rank and gender. We analyzed focus group transcripts using content analysis to summarize emergent themes.

Results

We convened 3 women-only focus groups (1 for instructors/assistant professors, 1 for associate professors, and 1 for full professors) and 1 men-only focus group of full professors (total N = 50). Our analyses identified several major themes on barriers to equitable academic advancement, including (1) interpersonal and institutional gender bias, (2) difficulty balancing the demands of family life with work life, and (3) gender differences in negotiation strategies.

Conclusions

Barriers to gender equity in academic advancement are myriad and enduring and span the professional and personal lives of ID physicians. In addition to swift enactment of policy changes directed at critical issues such as ending workplace harassment and ensuring adequate parental leaves for birth and nonbirth parents, leaders in academic medicine must shine a bright light on biases within the system at large and within themselves to correct these disparities with the urgency required.

Implementing a Social Determinants of Health Curriculum in Undergraduate Medical Education: A Qualitative Analysis of Faculty Experience

PURPOSE

Following shifts that broadened the medical profession's conceptualization of the underlying drivers of health, medical schools are required to integrate curricula on health disparities and the social context of medicine into undergraduate medical education. Although previous research has focused on student experiences and outcomes in these curricula, less attention has been paid to the experiences of the physician-faculty involved. This study aimed to capture faculty insights to improve understanding of the challenges and opportunities of implementing this curricular reform.

METHOD

In-depth, semistructured interviews were conducted with 10 faculty members at one U.S. medical school in spring 2019 to capture their experiences designing and teaching a new curriculum related to the social determinants of health and health disparities. Study design, including interview guide development, was informed by the critical pedagogy perspective and social constructionist approaches to curriculum implementation. With the use of a constructivist grounded theory approach, interview transcripts were analyzed using open, thematic, and axial coding techniques. Primary themes were categorized as professional, organizational, interactional, or intrapersonal and organized into the final model.

RESULTS

Participants processed their experiences at 4 concentric levels: professional, organizational, interactional, and intrapersonal. Faculty generally embraced the movement to incorporate more discussion of social context as a driver of health outcomes. However, they struggled with the shortcomings of their training and navigating structural constraints within their school when developing and delivering content. When confronted with these limitations, faculty experienced unexpected tension in the classroom setting that catalyzed self-reflection and reconstruction of their teaching approach.

CONCLUSIONS

Findings highlight the challenges that faculty encounter when integrating social determinants of health and related curricula into undergraduate medical education. They also speak to the need for a broader conceptualization of relevant expertise and have implications for how medical schools select, train, and support medical educators in this work.

A Woman's Place Is in Theatre, but Are Theatres Designed with Women in Mind? A Systematic Review of Ergonomics for Women in Surgery

BACKGROUND

Literature regarding ergonomic protocols for surgery is lacking, and there is a paucity of information on how this impacts on gender differences with regards to the barriers faced by women in surgery.

METHODS

This article reviews current literature addressing women in surgery and ergonomics through a systematic search including the Web of Science, Scopus, and PubMed databases.

RESULTS

Searches retrieved 425 items, and after a thorough evaluation for inclusion, 15 studies were examined-predominantly surveys (n = 9) and originating from the USA (n = 9). Identified ergonomic challenges included the general shorter height and smaller glove size of women. Furthermore, women experienced more musculoskeletal pain than men, potentially because the size and design of theatre tools are designed for male and tall individuals, highlighting an unconscious gender bias still pervading the surgical field.

CONCLUSIONS

As more women enter medicine and pursue surgical careers, it is essential to foster a culture of diversity and inclusion in theatre to develop more ergonomic environments.

Gender Equity in Science and Medicine: Breaking the Impasse

Women comprise half of the scientific and medical workforce, yet still hold a minority of leadership positions. Here I discuss the barriers to gender equity and offer a new approach to address the problem.