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Kim G, Lodha S, Wein L, Fahs L, Allen A, Rathinavelu J, Sharma P, Fekrat S. Evaluating the Impact of Gender, Race, and Training Year on Internal Medicine Residents' Experiences Across the United States. Perm J 2024; 28:107-116. [PMID: 39192722 PMCID: PMC11404644 DOI: 10.7812/tpp/24.085] [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] [Indexed: 08/29/2024]
Abstract
INTRODUCTION Prior studies have highlighted experiences of bias within resident training based on trainees' gender and race and high rates of burnout. However, few studies have addressed the intersection between bias and wellness for residents in internal medicine (IM) programs. This study explores how race, gender, and training year affect IM residents' bias experiences and well-being. METHODS An anonymous survey with questions evaluating demographics and resident experiences of bias and perceptions of wellness and self-efficacy was distributed to 596 IM programs across the United States. Sixty-nine programs sent out the survey to their IM residents. Respondents to the survey included 176 residents. Descriptive analyses and χ2 tests were performed. RESULTS Responses demonstrated that gender and race impacted residents' experiences with bias and misidentification. Eighty-eight percent of women compared to 1% of men, and 89% of Black residents compared to 3% of White residents reported being misidentified as a nonphysician due to gender and race, respectively. Degrees to which residents felt they were thriving in residency, experiencing burnout, and utilizing their strengths varied significantly by gender. Residents' self-perceived burnout levels were associated with being misidentified as not being a physician due to race. Experiences with bias also increased significantly with training year. DISCUSSION This study provides important insights into the impact of gender, race/ethnicity, and training year on IM residents' experiences with bias and self-perception. CONCLUSION The findings emphasize the need for structural changes within IM residency programs to reduce experiences of bias and to better cultivate the wellness of residents.
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Affiliation(s)
- Grace Kim
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Shweta Lodha
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Lulu Wein
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Lily Fahs
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Ariana Allen
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Jay Rathinavelu
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Poonam Sharma
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sharon Fekrat
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
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Moin H, Majeed S, Zahra T, Zafar S, Nadeem A, Majeed S. Assessing the impact of jigsaw technique for cooperative learning in undergraduate medical education: merits, challenges, and forward prospects. BMC MEDICAL EDUCATION 2024; 24:853. [PMID: 39112972 PMCID: PMC11308412 DOI: 10.1186/s12909-024-05831-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Jigsaw method is a structured cooperative-learning technique that lays the groundwork towards achieving collective competence, which forms the core of effective clinical practice. It promotes deep learning and effectively enhances team-work among students, hence creating a more inclusive environment. OBJECTIVE Present study was designed to introduce jigsaw model of cooperative learning to early-year undergraduate medical students, measure its effectiveness on their academic performance, and evaluate the perspectives of both students and faculty members regarding the same. METHODS It was a mixed method research, involving eighty second-year undergraduate medical students. The jigsaw cooperative learning approach was introduced in two themes within neurosciences module. Students were divided into two equal groups, with one group experiencing typical small-group discussions (SGDs) in first theme and other group exposed to jigsaw approach. The groups were then reversed for second theme. Following the activity, an assessment comprising multiple-choice-questions was conducted to evaluate the impact of jigsaw technique on students' academic performance, with scores from both groups compared. Student perspectives were gathered through self-designed and validated questionnaire, while faculty perceptions were obtained through focus group discussions. Quantitative data were analyzed using SPSS v22, while thematic analysis was performed for qualitative data. RESULTS The students of jigsaw group displayed significantly higher median assessment score percentage compared to control group (p = 0.003). Moreover, a significantly greater number of students achieved scores ≥ 60% in jigsaw group compared to control group (p = 0.006). The questionnaire responses indicated a favorable perception of this technique among students, in terms of acceptance, positive interdependence, improvement of interpersonal skills, and comparison with typical SGDs. This technique was also well-perceived within the educational context by faculty members. CONCLUSION The jigsaw method is associated with higher levels of academic performance among students when compared to typical small-group discussion. The students and faculty perceived this technique to be an effective cooperative learning strategy in terms of enhanced student engagement, active participation, and a sense of inclusivity.
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Affiliation(s)
- Hira Moin
- Department of Physiology, NUST School of Health Science, National University of Sciences and Technology (NUST), Islamabad, 44000, Pakistan.
| | - Sadaf Majeed
- Department of Biomedical Sciences, Dubai Medical College for Girls, Dubai, United Arab Emirates
| | - Tatheer Zahra
- Department of Anatomy, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Sarim Zafar
- Department of Physiology, NUST School of Health Science, National University of Sciences and Technology (NUST), Islamabad, 44000, Pakistan
| | - Amna Nadeem
- Department of Physiology, CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan
| | - Sidra Majeed
- Department of Medical Education, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
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Chen JH, Gardner AK. Going Above and Beyond With SJTs: Impact of Applicant Characteristics on Open Response SJT Participation. JOURNAL OF SURGICAL EDUCATION 2024; 81:1024-1033. [PMID: 38839439 DOI: 10.1016/j.jsurg.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Situational judgment tests (SJT) have gained popularity as a standardized assessment of nontechnical competencies for applicants to medical school and residency. SJT formats range from rating the effectiveness of potential response options to solely open response. We investigated differences in test-taking patterns between responders and nonresponders to optional open response SJT questions during the application process. METHODS This was a prospective multi-institutional study of general surgery applicants to seven residency programs. Applicants completed a 32-item SJT designed to measure ten core competencies: adaptability, attention to detail, communication, dependability, feedback receptivity, integrity, professionalism, resilience, self-directed learning, and team orientation. Each SJT item included an optional, nonscored, open response space for applicants to provide a behavioral response if they desired. Trends in applicant gender, race, ethnicity, medical school ranking, and USMLE scores were examined between the responder versus nonresponder group. RESULTS In total, 1491 general surgery applicants were invited to complete the surgery-specific SJT. Of these, 1454 (97.5%) candidates completed the assessment and 1177 (78.9%) provided additional responses to at least one of the 32 SJT scenario sets. There were no differences in overall SJT performance, USMLE scores (Step 1: 235, SD 14, Step 2: 250, SD 11), race and/or ethnicity between the responder and nonresponder groups. Responders were more likely to be from a top 25 medical school (p < 0.05) compared to the nonresponder group. Among applicants who completed any open response questions, women completed a significantly higher number of questions compared to men (7.21 vs 6.07, p = 0.003). The number of open responses provided correlated with higher scores on SJT items measuring dependability (r = 0.07, p = 0.007). CONCLUSIONS SJT design and format has the potential to impact test-taker response patterns. SJT developers and adopters should ensure test format and design have no unintended consequences prior to implementation.
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Affiliation(s)
- Jennifer H Chen
- Baylor College of Medicine, Department of Surgery, Houston, TX, USA.
| | - Aimee K Gardner
- University of Colorado School of Medicine, Department of Surgery, Aurora, CO, USA; SurgWise, Houston, TX
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Gilbert SR, Torrez T, Jardaly AH, Templeton KJ, Ode GE, Coe K, Patt JC, Schenker ML, McGwin G, Ponce BA. A Shadow of Doubt: Is There Implicit Bias Among Orthopaedic Surgery Faculty and Residents Regarding Race and Gender? Clin Orthop Relat Res 2024; 482:1145-1155. [PMID: 38214651 PMCID: PMC11219165 DOI: 10.1097/corr.0000000000002933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/27/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Orthopaedic surgery continues to be one of the least diverse medical specialties. Recently, increasing emphasis has been placed on improving diversity in the medical field, which includes the need to better understand existing biases. Despite this, only about 6% of orthopaedic surgeons are women and 0.3% are Black. Addressing diversity, in part, requires a better understanding of existing biases. Most universities and residency programs have statements and policies against discrimination that seek to eliminate explicit biases. However, unconscious biases might negatively impact the selection, training, and career advancement of women and minorities who are underrepresented in orthopaedic surgery. Although this is difficult to measure, the Implicit Association Test (IAT) by Project Implicit might be useful to identify and measure levels of unconscious bias among orthopaedic surgeons, providing opportunities for additional interventions to improve diversity in this field. QUESTIONS/PURPOSES (1) Do orthopaedic surgeons demonstrate implicit biases related to race and gender roles? (2) Are certain demographic characteristics (age, gender, race or ethnicity, or geographic location) or program characteristics (geographic location or size of program) associated with the presence of implicit biases? (3) Do the implicit biases of orthopaedic surgeons differ from those of other healthcare providers or the general population? METHODS A cross-sectional study of implicit bias among orthopaedic surgeons was performed using the IAT from Project Implicit. The IAT is a computerized test that measures the time required to associate words or pictures with attributes, with faster or slower response times suggesting the ease or difficulty of associating the items. Although concerns have been raised recently about the validity and utility of the IAT, we believed it was the right study instrument to help identify the slight hesitation that can imply differences between inclusion and exclusion of a person. We used two IATs, one for Black and White race and one for gender, career, and family roles. We invited a consortium of researchers from United States and Canadian orthopaedic residency programs. Researchers at 34 programs agreed to distribute the invitation via email to their faculty, residents, and fellows for a total of 1484 invitees. Twenty-eight percent (419) of orthopaedic surgeons and trainees completed the survey. The respondents were 45% (186) residents, 55% (228) faculty, and one fellow. To evaluate response biases, the respondent population was compared with that of the American Academy of Orthopaedic Surgeons census. Responses were reported as D-scores based on response times for associations. D-scores were categorized as showing strong (≥ 0.65), moderate (≥ 0.35 to < 0.65), or slight (≥ 0.15 to < 0.35) associations. For a frame of reference, orthopaedic surgeons' mean IAT scores were compared with historical scores of other self-identified healthcare providers and that of the general population. Mean D-scores were analyzed with the Kruskal-Wallis test to determine whether demographic characteristics were associated with differences in D-scores. Bonferroni correction was applied, and p values less than 0.0056 were considered statistically significant. RESULTS Overall, the mean IAT D-scores of orthopaedic surgeons indicated a slight preference for White people (0.29 ± 0.4) and a slight association of men with career (0.24 ± 0.3), with a normal distribution. Hence, most respondents' scores indicated slight preferences, but strong preferences for White race were noted in 27% (112 of 419) of respondents. There was a strong association of women with family and home and an association of men with work or career in 14% (60 of 419). These preferences generally did not correlate with the demographic, geographic, and program variables that were analyzed, except for a stronger association of women with family and home among women respondents. There were no differences in race IAT D-scores between orthopaedic surgeons and other healthcare providers and the general population. Gender-career IAT D-scores associating women with family and home were slightly lower among orthopaedic surgeons (0.24 ± 0.3) than among the general population (0.32 ± 0.4; p < 0.001) and other healthcare professionals (0.34 ± 0.4; p < 0.001). All of these values are in the slight preference range. CONCLUSION Orthopaedic surgeons demonstrated slight preferences for White people, and there was a tendency to associate women with career and family on IATs, regardless of demographic and program characteristics, similar to others in healthcare and the general population. Given the similarity of scores with those in other, more diverse areas of medicine, unconscious biases alone do not explain the relative lack of diversity in orthopaedic surgery. CLINICAL RELEVANCE Implicit biases only explain a small portion of the lack of progress in improving diversity, equity, inclusion, and belonging in our workforce and resolving healthcare disparities. Other causes including explicit biases, an unwelcoming culture, and perceptions of our specialty should be examined. Remedies including engagement of students and mentorship throughout training and early career should be sought.
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Affiliation(s)
- Shawn R. Gilbert
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy Torrez
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Achraf H. Jardaly
- Department of Orthopedic Surgery, The Hughston Foundation/Hughston Clinic, Columbus, GA, USA
- Department of Orthopedic Surgery, St. Louis University, St. Louis, MO, USA
| | - Kimberly J. Templeton
- Department of Orthopedic Surgery, The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Kelsie Coe
- Department of Orthopaedic Surgery, Carolinas Medical Center - Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Joshua C. Patt
- Department of Orthopaedic Surgery, Carolinas Medical Center - Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Mara L. Schenker
- Deprtmant of Orthopedic Surgery, Emory University, Atlanta, GA, USA
| | - Gerald McGwin
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brent A. Ponce
- Department of Orthopedic Surgery, The Hughston Foundation/Hughston Clinic, Columbus, GA, USA
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Morimoto T, Kobayashi T, Yamauchi K, Nagamine S, Sekiguchi M, Tsukamoto M, Yoshihara T, Hirata H, Tanaka S, Mawatari M. How long will it take to reach the gender diversity goal for orthopaedics in Japan? J Orthop Sci 2024; 29:1140-1144. [PMID: 37308331 DOI: 10.1016/j.jos.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/19/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND In Japan, orthopaedics is one of the medical fields with the lowest proportion of women. This study analyses the change in gender diversity over the past decade and estimates the time required to achieve the 30% gender diversity goal, according to the critical mass in Japan in 2020. METHODS We investigated the demographic composition of orthopaedic surgeons in 2020 by age group, the gender ratio of the main clinical fields from 2010 to 2020, and estimated the time required for the bottom 10 (i.e., least diverse) medical departments in Japan to reach the proportion of 30% women. We used simple linear regression analyses to clarify the number of years. RESULTS In 2020, the population pyramid of orthopaedic surgeons showed that those in their 50s were the largest component with 24.1%, followed by those in their 40s and 30s with 22.3% and 19.4%, respectively. The percentage of women orthopaedic surgeons increased slightly from 4.1% in 2010 to 5.7% in 2020. This means that to achieve the proportion of 30% women at the current annual increase rate, orthopaedics would require up to 160 years, cardiovascular 149 years, and neurosurgery 135 years. CONCLUSION Contrary to the recent increase in the number of women physicians, there has been only a slight increase in the number of women orthopaedic surgeons over the past decade. Moreover, the number of young male orthopaedic surgeons has decreased. As current orthopaedic surgeons age and retire, Japan will soon face an overall shortage of orthopaedic surgeons. Issues that must still be addressed in Japanese orthopaedics include educating men and women about gender diversity and bias, changing stereotypes about surgical lifestyles, improving work-life balance, and diligent and collaborative efforts at both the individual and community levels.
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Affiliation(s)
- Tadatsugu Morimoto
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan.
| | - Takaomi Kobayashi
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Kazuyo Yamauchi
- Department of Department of Community-Oriented Medical Education, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satomi Nagamine
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan.
| | - Miho Sekiguchi
- Department of Orthopedic Surgery, Faculty of Medicine, Fukusima Medical University School of Medicine, Fukushima, Japan
| | - Masatsugu Tsukamoto
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Tomohito Yoshihara
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Hirohito Hirata
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Shiori Tanaka
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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Wu L, Chen KB. Examining the Effects of Gender Transfer in Virtual Reality on Implicit Gender Bias. HUMAN FACTORS 2024; 66:1504-1519. [PMID: 36574504 DOI: 10.1177/00187208221145264] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To investigate the effect of gender transfer in virtual reality on implicit gender bias. BACKGROUND Gender bias is a type of discrimination based on gender, which can lead to increased self-doubt and decreased self-esteem. Sexual harassment is a hostile form of gender bias that can cause anxiety, depression, and significant mental health issues. Virtual reality (VR) has been employed to help make people become aware of their biases and change their attitudes regarding gender, race, and age. METHODS Forty participants were embodied in avatars of different genders and experienced sexual harassment scenarios in VR. A gender Implicit Association Test (IAT) was administered before and after the experience. RESULTS There was a statistically significant main effect of participant gender (F (1,36) = 10.67, p = .002, partial η2 = .23) on ΔIAT, where males and females reported a decrease (M = -.12, SD = .24) and an increase (M = .10, SD = .25) in IAT scores, respectively. A statistically significant two-way interaction between gender transfer and participant gender was revealed (F (1,36) = 6.32, p = .02, partial η2 = .15). There was a significant simple effect of gender transfer for male participants (F (1,36) = 8.70, p = .006, partial η2 = .19). CONCLUSIONS Implicit gender bias can be modified, at least temporarily, through embodiment in VR. Gender transfer through embodiment while encountering different sexual harassment scenarios helped reduce implicit gender bias. There was a tendency for individuals to increase bias for the gender of the avatar in which they embodied. APPLICATIONS The current research provided promising evidence that a virtual environment system may be used as a potential training tool to improve implicit gender bias.
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Affiliation(s)
- Linfeng Wu
- North Carolina State University, Raleigh, North Carolina, USA
| | - Karen B Chen
- North Carolina State University, Raleigh, North Carolina, USA
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Alexander J, Rajagopalan D, Ramtin S, Ngoue M, Ring D, Adams J. Surgeon Implicit Association of Women With Supportive Roles in Medicine. J Am Acad Orthop Surg 2024; 32:e26-e32. [PMID: 37678842 DOI: 10.5435/jaaos-d-23-00082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 06/23/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND In a previous study, we documented patient implicit bias that surgeons are men. As a next step, we tested the implicit bias of surgeons that women in medicine have leading (chair, surgeon) or supporting roles (medical assistant, physician assistant). QUESTIONS/PURPOSE (1) What is the relationship between the implicit associations and expressed beliefs of surgeons regarding women as leaders in medicine? (2) Are there factors associated with surgeon implicit association and explicit preference regarding the roles of women in medicine? METHODS A total of 102 musculoskeletal surgeon members of the Science of Variation Group (88 men and 12 women) completed an implicit association test (IAT) of implicit bias regarding sex and lead/support roles in medicine and a questionnaire that addressed respondent demographics and explicit preference regarding women's roles. The IAT consisted of seven rounds with five rounds used for teaching and two rounds for evaluation. RESULTS On average, there was an implicit association of women with supportive roles (D-score: -48; SD 4.7; P < 0.001). The mean explicit preference was for women in leadership roles (median: 73; interquartile ranges: 23 to 128; P < 0.001). There was a correlation between greater explicit preference for women in a leading role and greater implicit bias toward women in a supporting role (ρ = 0.40; P < 0.001). Women surgeons and shoulder and elbow specialists had less implicit bias that women have supporting roles. CONCLUSION The observation that musculoskeletal surgeons have an explicit preference for women in leading roles in medicine but an implicit bias that they have supporting roles-more so among men surgeons-documents the gap between expressed opinions and ingrained mental processing that is the legacy of the traditional "roles" of women in medicine and surgery. To resolve this gap, we will need to be intentional about promotion of and emersion in experiences where the leader is a woman. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jeremiah Alexander
- From the The University of Texas Dell Medical School, Austin, TX (Alexander, Rajagopalan, Ramtin, Ngoue, and Ring), and the Department of Orthopaedic Surgery, University of Tennessee College of Medicine-Chattanooga, Erlanger Orthopaedic Institute, Chattanooga, TN (Adams)
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Liu HY, Larson AR, Strong SA, Parekh R, Gautam M, Flores LE, Silver JK. Workforce Diversity, Equity, and Inclusion: A Crucial Component of Professionalism in Psychiatry. Child Adolesc Psychiatr Clin N Am 2024; 33:17-32. [PMID: 37981333 DOI: 10.1016/j.chc.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Documented disparities have profoundly impacted the training and careers of physicians from socially and historically marginalized groups, including women, people with disabilities, people who identify with racial and ethnic minority groups, and the lesbian, gay, bisexual, transgender, and queer or questioning+ community. Professionalism is a core component of medical training and practice, yet a focus on workforce diversity, equity, and inclusion is often absent. This report aims to encourage the adoption of workforce diversity, equity, and inclusion as a crucial component of professionalism, with an emphasis on the field of psychiatry.
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Affiliation(s)
- Howard Y Liu
- University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE 68198-5578, USA.
| | - Allison R Larson
- Georgetown University, MedStar Washington Hospital Center, 5530 Wisconsin Ave, Suite 660, Chevy Chase, MD 20815, USA
| | - Sheritta A Strong
- University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE 68198-5578, USA
| | - Ranna Parekh
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Mamta Gautam
- Psychosocial Oncology Program, The Ottawa Hospital Cancer Center, TOH General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Laura E Flores
- College of Allied Health Professions, University of Nebraska Medical Center, 984035 Nebraska Medical Center, Omaha, NE 68198-4035, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
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Watters A, Cummins J, Roche B. How to Build and How not to Build an Implicit Measure in Behavior Analysis: A case Study Using the Function Acquisition Speed Test. Perspect Behav Sci 2023; 46:459-492. [PMID: 38144551 PMCID: PMC10733251 DOI: 10.1007/s40614-023-00387-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 12/26/2023] Open
Abstract
This article provides a comprehensive overview of the development of a behavior-analytic alternative to the popular implicit association test (IAT), namely, the function acquisition speed test (FAST). The IAT appears, prima facia, to indirectly assess participants' learning histories with regard to the categorization of stimuli. However, its origin within cognitive psychology has rendered it replete with mentalism, conceptual ambiguity, statistical arbitrariness, and confounding procedural artifacts. The most popular behavioral alternative to the IAT, the widely used implicit relational assessment procedure (IRAP), has inherited many of these concerning artifacts. In this article, we present a behavior-analytic critique of both the IAT and IRAP, and argue that a behavior-analytic approach to implicit measures must have stimulus control front and center in its analysis. We then outline a series of early research studies that provided the basis for a potentially superior procedure within our field. We go on to outline how this early research was harnessed in stepwise research, guided by a strict adherence to traditional behavior-analytic methods for the analysis of stimulus relations, to increasingly modify a test format fit for the behavior analyst interested in assessing stimulus relatedness.
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Ausman SE, Mara KC, Brown CS, Epps KL, Kooda K, Mendez J, Rivera CG. CLinician and patient characteristics effect on Antimicrobial Stewardship Interventions (CLASI) study. Infect Control Hosp Epidemiol 2023; 44:2002-2008. [PMID: 37222155 DOI: 10.1017/ice.2023.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To determine whether the gender of clinicians making antimicrobial stewardship recommendations has an impact on intervention acceptance rate. DESIGN A retrospective, multivariable analysis of antimicrobial stewardship prospective audit and feedback outcomes. SETTING A multisite healthcare system including Mayo Clinic Rochester (MN), Mayo Clinic Arizona, Mayo Clinic Florida and 17 health-system hospital sites, where prospective audit and feedback is performed and documented within an electronic tool embedded in the medical record. PARTICIPANTS The study included 143 Mayo Clinic clinicians (84 cisfemales and 59 cismales). METHODS Outcomes were analyzed from July 1, 2017, to June 30, 2022, for intervention rates, communication methods, and intervention acceptance by clinician gender, profession, patient age, and intensive care unit (ICU) status of patient. RESULTS Of 81,927 rules, 71,729 rules met study inclusion. There were 18,175 (25%) rules associated with an intervention. Most of the rules were reviewed by pharmacists (86.2%) and stewardship staff (85.5%). Of 10,363 interventions with an outcome documented, 8,829 (85.2%) were accepted and 1,534 (14.8%) were rejected. Female clinicians had 6,782 (86.5%) of 7,843 interventions accepted, and male clinicians had 2,047 (81.2%) of 2,520 interventions accepted (P = .19). Female patients had more interventions than male patients (female vs male: 25.9% vs 24.9%; OR, 1.04; 95% CI, 1.02-1.08; P = .001). Patients in the ICU had a significantly lower intervention acceptance rate (ICU vs non-ICU: 78.2% vs 86.7%; OR, 0.56; 95% CI, 0.45-0.7; P < .001). CONCLUSIONS Female and male clinicians were equally effective at prospective audit and feedback in a multisite antimicrobial stewardship program. Patients in the ICU were less likely to have stewardship interventions accepted.
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Affiliation(s)
- Sara E Ausman
- Department of Pharmacy, Mayo Clinic Health System, Eau Claire, Wisconsin
| | - Kristin C Mara
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | | | - Kevin L Epps
- Department of Pharmacy, Mayo Clinic, Jacksonville, Florida
| | - Kirstin Kooda
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota
| | - Julio Mendez
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida
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Tameling JF, Lohöfener M, Bereznai J, Tran TPA, Ritter M, Boos M. Extent and types of gender-based discrimination against female medical students and physicians at five university hospitals in Germany - results of an online survey. GMS JOURNAL FOR MEDICAL EDUCATION 2023; 40:Doc66. [PMID: 38125897 PMCID: PMC10728668 DOI: 10.3205/zma001648] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 08/15/2023] [Accepted: 09/12/2023] [Indexed: 12/23/2023]
Abstract
Objective There is a gap in research on gender-based discrimination (GBD) in medical education and practice in Germany. This study therefore examines the extent and forms of GBD among female medical students and physicians in Germany. Causes, consequences and possible interventions of GBD are discussed. Methods Female medical students (n=235) and female physicians (n=157) from five university hospitals in northern Germany were asked about their personal experiences with GBD in an online survey on self-efficacy expectations and individual perceptions of the "glass ceiling effect" using an open-ended question regarding their own experiences with GBD. The answers were analyzed by content analysis using inductive category formation and relative category frequencies. Results From both interviewed groups, approximately 75% each reported having experienced GBD. Their experiences fell into five main categories: sexual harassment with subcategories of verbal and physical, discrimination based on existing/possible motherhood with subcategories of structural and verbal, direct preference for men, direct neglect of women, and derogatory treatment based on gender. Conclusion The study contributes to filling the aforementioned research gap. At the hospitals studied, GBD is a common phenomenon among both female medical students and physicians, manifesting itself in multiple forms. Transferability of the results beyond the hospitals studied to all of Germany seems plausible. Much is known about the causes, consequences and effective countermeasures against GBD. Those responsible for training and employers in hospitals should fulfill their responsibility by implementing measures from the set of empirically evaluated interventions.
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Affiliation(s)
- Jan-Filip Tameling
- Georg-August University Göttingen, Georg Elias Müller Institute for Psychology, Department of Social and Communication Psychology, Göttingen, Germany
| | - Mareike Lohöfener
- Georg-August University Göttingen, Georg Elias Müller Institute for Psychology, Department of Social and Communication Psychology, Göttingen, Germany
| | - Judith Bereznai
- Georg-August University Göttingen, Georg Elias Müller Institute for Psychology, Department of Social and Communication Psychology, Göttingen, Germany
| | - Thi Phuong Anh Tran
- Georg-August University Göttingen, Georg Elias Müller Institute for Psychology, Department of Social and Communication Psychology, Göttingen, Germany
| | - Marie Ritter
- Georg-August University Göttingen, Georg Elias Müller Institute for Psychology, Department of Social and Communication Psychology, Göttingen, Germany
| | - Margarete Boos
- Georg-August University Göttingen, Georg Elias Müller Institute for Psychology, Department of Social and Communication Psychology, Göttingen, Germany
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Brewer A, Nelson L, Mueller AS, Ewert R, O’Connor DM, Dayal A, Arora VM. Gender and Inconsistent Evaluations: A Mixed-methods Analysis of Feedback for Emergency Medicine Residents. West J Emerg Med 2023; 24:847-854. [PMID: 37788024 PMCID: PMC10527837 DOI: 10.5811/westjem.58153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 04/23/2023] [Accepted: 05/25/2023] [Indexed: 10/04/2023] Open
Abstract
Objectives: Prior research has demonstrated that men and women emergency medicine (EM) residents receive similar numerical evaluations at the beginning of residency, but that women receive significantly lower scores than men in their final year. To better understand the emergence of this gender gap in evaluations we examined discrepancies between numerical scores and the sentiment of attached textual comments. Methods: This multicenter, longitudinal, retrospective cohort study took place at four geographically diverse academic EM training programs across the United States from July 1, 2013-July 1, 2015 using a real-time, mobile-based, direct-observation evaluation tool. We used complementary quantitative and qualitative methods to analyze 11,845 combined numerical and textual evaluations made by 151 attending physicians (94 men and 57 women) during real-time, direct observations of 202 residents (135 men and 67 women). Results: Numerical scores were more strongly positively correlated with positive sentiment of the textual comment for men (r = 0.38, P < 0.001) compared to women (r = -0.26, P < 0.04); more strongly negatively correlated with mixed (r = -0.39, P < 0.001) and negative (r = -0.46, P < 0.001) sentiment for men compared to women (r = -0.13, P < 0.28) for mixed sentiment (r = -0.22, P < 0.08) for negative; and women were around 11% more likely to receive positive comments alongside lower scores, and negative or mixed comments alongside higher scores. Additionally, on average, men received slightly more positive comments in postgraduate year (PGY)-3 than in PGY-1 and fewer mixed and negative comments, while women received fewer positive and negative comments in PGY-3 than PGY-1 and almost the same number of mixed comments. Conclusion: Women EM residents received more inconsistent evaluations than men EM residents at two levels: 1) inconsistency between numerical scores and sentiment of textual comments; and 2) inconsistency in the expected career trajectory of improvement over time. These findings reveal gender inequality in how attendings evaluate residents and suggest that attendings should be trained to provide all residents with feedback that is clear, consistent, and helpful, regardless of resident gender.
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Affiliation(s)
- Alexandra Brewer
- University of Southern California: Los Angeles, Department of Sociology, Los Angeles, California
| | - Laura Nelson
- University of British Columbia, Department of Sociology, Vancouver, British Columbia, Canada
| | - Anna S. Mueller
- Indiana University, Department of Sociology, Bloomington, Indiana
| | | | - Daniel M. O’Connor
- Massachusetts General Brigham Wentworth-Douglass Hospital, Dermatology and Skin Health, Dover, New Hampshire
| | | | - Vineet M. Arora
- University of Chicago, Pritzker School of Medicine, Chicago, Illinois
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Conner SM, Choi N, Fuller J, Daya S, Barish P, Rennke S, Harrison JD, Narayana S. Trainee Autonomy and Supervision in the Modern Clinical Learning Environment: A Mixed-Methods Study of Faculty and Trainee Perspectives. RESEARCH SQUARE 2023:rs.3.rs-2982838. [PMID: 37333324 PMCID: PMC10275050 DOI: 10.21203/rs.3.rs-2982838/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background Balancing autonomy and supervision during medical residency is important for trainee development while ensuring patient safety. In the modern clinical learning environment, tension exists when this balance is skewed. This study aimed to understand the current and ideal states of autonomy and supervision, then describe the factors that contribute to imbalance from both trainee and attending perspectives. Methods A mixed-methods design included surveys and focus groups of trainees and attendings at three institutionally affiliated hospitals between May 2019-June 2020. Survey responses were compared using chi-square tests or Fisher's exact tests. Open-ended survey and focus group questions were analyzed using thematic analysis. Results Surveys were sent to 182 trainees and 208 attendings; 76 trainees (42%) and 101 attendings (49%) completed the survey. Fourteen trainees (8%) and 32 attendings (32%) participated in focus groups. Trainees perceived the current culture to be significantly more autonomous than attendings; both groups described an "ideal" culture as more autonomous than the current state. Focus group analysis revealed five core contributors to the balance of autonomy and supervision: attending-, trainee-, patient-, interpersonal-, and institutional-related factors. These factors were found to be dynamic and interactive with each other. Additionally, we identified a cultural shift in how the modern inpatient environment is impacted by increased hospitalist attending supervision and emphasis on patient safety and health system improvement initiatives. Conclusions Trainees and attendings agree that the clinical learning environment should favor resident autonomy and that the current environment does not achieve the ideal balance. There are several factors contributing to autonomy and supervision, including attending-, resident-, patient-, interpersonal-, and institutional-related. These factors are complex, multifaceted, and dynamic. Cultural shifts towards supervision by primarily hospitalist attendings and increased attending accountability for patient safety and systems improvement outcomes further impacts trainee autonomy.
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Olson EM, Sanborn DM, Dyster TG, Kelm DJ, Murray SG, Santhosh L, DesJardin JT. Gender Disparities in Critical Care Procedure Training of Internal Medicine Residents. ATS Sch 2023; 4:164-176. [PMID: 37538076 PMCID: PMC10394715 DOI: 10.34197/ats-scholar.2022-0025oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 12/22/2022] [Indexed: 08/05/2023] Open
Abstract
Background Procedural training is a required competency in internal medicine (IM) residency, yet limited data exist on residents' experience of procedural training. Objectives We sought to understand how gender impacts access to procedural training among IM residents. Methods A mixed-methods, explanatory sequential study was performed. Procedure volume for IM residents between 2016 and 2020 was assessed at two large academic residencies (Program A and Program B: 399 residents and 4,020 procedures). Procedural rates and actual versus expected procedure volume by gender were compared, with separate analyses by clinical environment (intensive care unit [ICU] or structured procedural service). Semistructured gender-congruent focus groups were conducted. Topics included identity formation as a proceduralist and the resident procedural learning experience, including perceived gender bias in procedure allocation. Results Compared with men, women residents performed disproportionately fewer ICU procedures per month at Program A (1.4 vs. 2.7; P < 0.05) but not at Program B (0.36 vs. 0.54; P = 0.23). At Program A, women performed only 47% of ICU procedures, significantly fewer than the 54% they were expected to perform on the basis of their time on ICU rotations (P < 0.001). For equal gender distribution of procedural volume at Program A, 11% of the procedures performed by men would have needed to have been performed by women instead. Gender was not associated with differences in the Program A structured procedural service (53% observed vs. 52% expected; P = 0.935), Program B structured procedural service (40% observed vs. 43% expected; P = 0.174), or in Program B ICUs (33% observed vs. 34% expected; P = 0.656). Focus group analysis identified that women from both residencies perceived that assertiveness was required for procedural training in unstructured learning environments. Residents felt that gender influenced access to procedural opportunities, ability to self-advocate for procedural experience, identity formation as a proceduralist, and confidence in acquiring procedural skills. Conclusion Gender disparities in access to procedural training during ICU rotations were seen at one institution but not another. There were ubiquitous perceptions that assertiveness was important to access procedural opportunities. We hypothesize that structured allocation of procedures would mitigate disparities by allowing all residents to access procedural training regardless of self-advocacy. Residency programs should adopt structured procedural training programs to counteract inequities.
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Affiliation(s)
| | | | | | - Diana J. Kelm
- Department of Medicine and
- Division of Pulmonary and Critical Care,
Mayo Clinic, Rochester, Minnesota
| | - Sara G. Murray
- Department of Medicine
- Division of Hospital Medicine, and
| | | | - Jacqueline T. DesJardin
- Department of Medicine
- Division of Cardiology, University of
California San Francisco, San Francisco, California
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15
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Marquini GV, de Oliveira LM, Takano CC, Dias MM, Silva EV, Nunes ABA, Bella ZIKDJD, Sartori MGF. Feminization of science: female pioneering in the healthcare area. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20221009. [PMID: 37194902 PMCID: PMC10185045 DOI: 10.1590/1806-9282.20221009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/11/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Gisele Vissoci Marquini
- Universidade Federal de São Paulo, Department of Gynecology, Urogynecology and Vaginal Surgery Sector – São Paulo (SP), Brazil
| | - Letícia Maria de Oliveira
- Universidade Federal de São Paulo, Department of Gynecology, Urogynecology and Vaginal Surgery Sector – São Paulo (SP), Brazil
| | - Claudia Cristina Takano
- Universidade Federal de São Paulo, Department of Gynecology, Urogynecology and Vaginal Surgery Sector – São Paulo (SP), Brazil
| | - Marcia Maria Dias
- Universidade Federal de São Paulo, Department of Gynecology, Urogynecology and Vaginal Surgery Sector – São Paulo (SP), Brazil
| | - Eduarda Vilela Silva
- Universidade Federal de Uberlândia, Academic of the Medicine Course – Uberlândia (MG), Brazil
| | | | | | - Marair Gracio Ferreira Sartori
- Universidade Federal de São Paulo, Department of Gynecology, Urogynecology and Vaginal Surgery Sector – São Paulo (SP), Brazil
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16
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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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Abstract
Background Hysteroscopy is the gold standard for evaluating intrauterine pathology. The majority of physicians currently perform hysteroscopy in the operating room. Lack of training has been cited as a barrier to performing office hysteroscopy; however, resident training in office hysteroscopy has not yet been evaluated. Methods A prospective cross-sectional survey was performed. A validated 17 question survey tool was sent to 297 program directors of Accreditation Council for Graduate Medical Education accredited obstetrics and gynecology residency programs for distribution to their residents. The survey utilized a Likert scale to assess resident interest in learning office hysteroscopy, satisfaction in training, and perceived self-efficacy to perform office hysteroscopy independently upon graduation. Results Two hundred and ninety-three obstetrics and gynecology residents responded. Of the respondents, 26.3% reported receiving training in office hysteroscopy. There was no statistically significant difference in training among postgraduate years or program regions. A greater proportion of male residents received training when compared to female residents (42.9% vs. 24.2%, p = 0.019). Ninety-four percent of residents reported interest in learning office hysteroscopy. Satisfaction with hysteroscopy training in the operating room versus the office was 91.1% vs. 11.3% respectively. Of the fourth-year residents, 17.4% felt they could perform office hysteroscopy independently upon graduation and 14.5% reported feeling comfortable performing the procedure. Conclusions Residency training in office hysteroscopy is lacking and residents are unprepared to perform the procedure after graduation. Enhanced residency training in office hysteroscopy would likely improve resident comfort and ability to perform office hysteroscopy in practice.
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Affiliation(s)
- Lindsey Michel
- Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, CT. (all authors)
| | - Scott Chudnoff
- Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, CT. (all authors)
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY. (Dr. Chudnoff)
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Filiberto AC, Abbott KL, Shickel B, George BC, Cochran AL, Sarosi GA, Upchurch GR, Loftus TJ. Resident Operative Autonomy and Attending Verbal Feedback Differ by Resident and Attending Gender. ANNALS OF SURGERY OPEN 2023; 4:e256. [PMID: 37600892 PMCID: PMC10431433 DOI: 10.1097/as9.0000000000000256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/02/2023] [Indexed: 02/05/2023] Open
Abstract
Objectives This study tests the null hypotheses that overall sentiment and gendered words in verbal feedback and resident operative autonomy relative to performance are similar for female and male residents. Background Female and male surgical residents may experience training differently, affecting the quality of learning and graduated autonomy. Methods A longitudinal, observational study using a Society for Improving Medical Professional Learning collaborative dataset describing resident and attending evaluations of resident operative performance and autonomy and recordings of verbal feedback from attendings from surgical procedures performed at 54 US general surgery residency training programs from 2016 to 2021. Overall sentiment, adjectives, and gendered words in verbal feedback were quantified by natural language processing. Resident operative autonomy and performance, as evaluated by attendings, were reported on 5-point ordinal scales. Performance-adjusted autonomy was calculated as autonomy minus performance. Results The final dataset included objective assessments and dictated feedback for 2683 surgical procedures. Sentiment scores were higher for female residents (95 [interquartile range (IQR), 4-100] vs 86 [IQR 2-100]; P < 0.001). Gendered words were present in a greater proportion of dictations for female residents (29% vs 25%; P = 0.04) due to male attendings disproportionately using male-associated words in feedback for female residents (28% vs 23%; P = 0.01). Overall, attendings reported that male residents received greater performance-adjusted autonomy compared with female residents (P < 0.001). Conclusions Sentiment and gendered words in verbal feedback and performance-adjusted operative autonomy differed for female and male general surgery residents. These findings suggest a need to ensure that trainees are given appropriate and equitable operative autonomy and feedback.
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Affiliation(s)
- Amanda C. Filiberto
- From the Department of Surgery, University of Florida Health, Gainesville, FL
| | - Kenneth L. Abbott
- From the Department of Surgery, University of Florida Health, Gainesville, FL
| | - Benjamin Shickel
- Department of Medicine, University of Florida Health, Gainesville, FL
| | - Brian C. George
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI
| | - Amalia L. Cochran
- From the Department of Surgery, University of Florida Health, Gainesville, FL
| | - George A. Sarosi
- From the Department of Surgery, University of Florida Health, Gainesville, FL
| | - Gilbert R. Upchurch
- From the Department of Surgery, University of Florida Health, Gainesville, FL
| | - Tyler J. Loftus
- From the Department of Surgery, University of Florida Health, Gainesville, FL
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Lee MJ, Nho WY, Jung H, Cho JW, Seo JS, Lee HM, Cho KH, Kim YJ, Kim JK. High prevalence of depression and sleep-wake disorders among female emergency medicine residents in South Korea. Ann Med 2022; 54:846-855. [PMID: 35348012 PMCID: PMC8967212 DOI: 10.1080/07853890.2022.2053568] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Depression and sleep-wake disorders are recognized as one of the major problems among emergency physicians. While depression is more common in females than in males, the associated factors linking depression and sleep-wake disorders in emergency physicians, particularly females, remain unknown. OBJECTIVE To analyze the prevalence of depression and sleep-wake problems among emergency medicine (EM) residents in South Korea and to identify the gender differences and situations that adversely predispose female residents to mental health problems. METHODS We conducted a cross-sectional analysis using the data collected from the 2019 National EM Residents Wellness Survey targeting all of 630 EM residents in South Korea. The survey included variables potentially influencing depression and sleep-wake problems, such as personal characteristics, work-related stress, and extrinsic environment. Information regarding medical conditions, depression, job stress, and sleep deprivation was obtained using the self-administered Patient Health Questionnaire (PHQ-9), the Apgar Wellness Score (AWS), and the Epworth Sleepiness Scale (ESS). We analyzed the data using IBM SPSS Statistics version 25 and MedCalc version 17. RESULTS A total of 384 residents participated in the survey. Overall, 27.5% of the EM residents met the criteria for at least moderate depression and 36.9% of the EM residents had sleep-related problems. We found that difficulty in trading the shift schedule and frequent night shifts was associated with depression (p = .001, p = .005; respectively). Female residents demonstrated an increased risk of depression and sleepiness compared to their male counterparts (odds ratio [OR] 1.95, OR 1.81; respectively). In addition, logistic regression analysis revealed significant differences by gender in depression with regards to flexibility of trading shifts (p = .005), level of training in the emergency medical centre (p = .035), and frequent night shifts (p = .010). CONCLUSIONS Approximately, one-third of EM residents report depression and sleep-wake problems, with female residents showing a higher risk than male residents. Several risk factors were identified, and future strategies should be aimed to address these issues to improve the training environment and overall wellbeing of EM residents.KEY MESSAGESThe prevalence of depression and sleep-related problems were, respectively, 1.95 and 1.81 times higher in female residents compared to their male colleagues.The associated risk factors for depression were flexibility of shift trade, level of training in the emergency medical centre, and frequency of night shifts.Improving the training environment and facilities, as well as offering more flexible duty trading options can provide potential opportunities to reduce the risk.
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Affiliation(s)
- Mi Jin Lee
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Woo Young Nho
- Department of Emergency Medicine, CHA Gumi Medical Center, CHA University, Gumi, South Korea
| | - Haewon Jung
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jae Wan Cho
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jun Seok Seo
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Seoul, South Korea
| | - Hyung Min Lee
- Department of Emergency Medicine, Kyung Hee Medical Center, Kyung Hee University, Seoul, South Korea
| | - Kwang Hyun Cho
- Department of Emergency Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Yun Jeong Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jong Kun Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
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Mavis SC, Caruso CG, Dyess NF, Carr CB, Gerberi D, Dadiz R. Implicit Bias Training in Health Professions Education: A Scoping Review. MEDICAL SCIENCE EDUCATOR 2022; 32:1541-1552. [PMID: 36532396 PMCID: PMC9755456 DOI: 10.1007/s40670-022-01673-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 06/17/2023]
Abstract
There is a recurrent call for effective implicit bias (IB) education within health professions education (HPE). We aimed to explore the state of IB education within HPE for clinical learners and IB educators using the Arksey and O'Malley scoping review framework. Thirty publications variable in curricular design met inclusion criteria. No studies assessed learner outcomes at the level of Miller's "shows" or "does" nor reported program evaluation outcomes at the level of Kirkpatrick's "behavior" or "results." Rigorous, theory-guided studies assessing behavioral change, patient care delivery, and patient outcomes are needed to move the field of IB education forward within HPE. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-022-01673-z.
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Affiliation(s)
- Stephanie C. Mavis
- Department of Pediatric and Adolescent Medicine, Division of Neonatal Medicine at Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Catherine G. Caruso
- Department of Pediatrics, Oregon Health and Science University, Portland, OR USA
| | - Nicolle F. Dyess
- Department of Pediatrics, Division of Neonatal Medicine at the University of Colorado, Aurora, CO USA
| | - Cara Beth Carr
- Department of Pediatrics, Division of Neonatology at University Hospitals Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH USA
| | - Dana Gerberi
- Mayo Clinic College of Medicine and Science, Rochester, MN USA
| | - Rita Dadiz
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY USA
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21
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Alzahrani F, Al-Mansour K, Alarifi G, Alyahya S, AlMehaizie N, Almoaibed H. Estimating Implicit and Explicit Gender Leadership Bias among Primary Healthcare Professionals in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15871. [PMID: 36497943 PMCID: PMC9739734 DOI: 10.3390/ijerph192315871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Women have become more influential and powerful; however, implicit bias continues to plague organizations when it comes to women in leadership positions. This study examines the implicit and explicit biases that favor men as leaders among Saudi Arabian primary healthcare professionals. (2) Methods: A secure, web-based survey was administered to primary healthcare professionals. The survey included questions about leadership as well as an Implicit Association Test (IAT) for implicit gender bias. (3) Results: Out of 690 eligible, 448 respondents completed the survey, representing a response rate of 65%. Male residents had a mean IAT score of 0.27 (SD 0.31) and females 0.12 (SD 0.29), both favoring males in leadership roles, and the difference was statistically significant. There was a significant association between gender and gender IAT. In the explicit bias, gender, education, gender of the current manager, and being manager were associated with the gender explicit bias. Explicit bias favoring males in leadership roles was associated with increased implicit bias favoring males in leadership roles. (4) Conclusions: This study found that explicit and implicit gender bias is present among primary healthcare professionals favoring men in leadership positions held by both men and women.
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Affiliation(s)
- Fahad Alzahrani
- Clinical and Hospital Pharmacy Department, College of Pharmacy, Taibah University, Madinah 42353, Saudi Arabia
| | - Khalid Al-Mansour
- Department of Studies and Research, King Abdulaziz Center for National Dialogue, Riyadh 13312, Saudi Arabia
| | - Ghadah Alarifi
- College of Business Administration, Princess Nourah bint Abdulrahman University, Riyadh 11564, Saudi Arabia
| | - Saad Alyahya
- Riyadh Third Health Cluster, Ministry of Health, Riyadh 11622, Saudi Arabia
| | - Nasser AlMehaizie
- Department of Studies and Research, King Abdulaziz Center for National Dialogue, Riyadh 13312, Saudi Arabia
| | - Hanaa Almoaibed
- King Faisal Center for Research and Islamic Studies, Riyadh 12212, Saudi Arabia
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22
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Gibney R, Cantwell C, Toohey S, Boysen-Osborn M, Wiechmann W, Saadat S, Allen A, Wray A. Gender Evaluation and Numeric Distribution in Emergency Medicine Residencies (GENDER): A Retrospective Analysis of Gender Ratios Among Residents and Residency Directors from 2014-2017. West J Emerg Med 2022; 23:886-889. [DOI: 10.5811/westjem.2022.7.54678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 07/28/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction: While females make up more than half of medical school matriculants, they only comprise about one third of emergency medicine (EM) residents. We examined EM residency cohorts with entering years of 2014–2017 to estimate the ratio of males to females among residents and program leadership to determine what correlation existed, if any, between program leadership and residency gender distributions.
Methods: We identified 171 accredited EM residency programs in the United States with resident cohorts entering between 2014-2017 with publicly available data that were included in the study. The number of male and female residents and program directors were counted. We then confirmed the counts by contacting the programs directly to confirm accuracy of the data collected from program websites.
Results: Within the included 171 programs, the overall male to female EM resident ratio was 1.78:1. Individual program ratios ranged from 0.85-8.0. Only eight programs (5.6%) had a female-predominant ratio. Among program directors, the overall male to female ratio was 2.17:1. TThe gender of the program director did not have a statistically significant correlation with the male to female ratio among its residents (P = .93).
Conclusion: Within 171 residency programs across the US with entering cohorts between 2014-2017, the average male to female ratio among residents is nearly 2:1. No significant correlation exists between the gender distribution among a program’s leadership and its residents.
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Affiliation(s)
- Ryan Gibney
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Christina Cantwell
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Shannon Toohey
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Megan Boysen-Osborn
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Warren Wiechmann
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Soheil Saadat
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Angela Allen
- University of North Carolina, Department of Emergency Medicine, Chapel Hill, North Carolina
| | - Alisa Wray
- University of California, Irvine, Department of Emergency Medicine, Orange, California
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Linguistic Differences by Gender in Letters of Recommendation for Female Pelvic Medicine and Reconstructive Surgery Fellowship Applicants From 2010 to 2020. Female Pelvic Med Reconstr Surg 2022; 28:705-712. [PMID: 35703286 DOI: 10.1097/spv.0000000000001220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Linguistic differences suggestive of gender bias have been detected in letters of recommendation (LOR) for female and male residency and fellowship program applicants within multiple medical specialties. OBJECTIVE The aim of the study was to determine whether linguistic differences exist in LOR for female and male physicians applying to female pelvic medicine and reconstructive surgery (FPMRS) fellowship. STUDY DESIGN A retrospective analysis of FPMRS fellowship applications submitted to a university-affiliated academic center from 2010 to 2020 was performed. Linguistic Inquiry and Word Count, a text analysis software, was used to characterize the linguistic content of letters. Multivariable analysis was used to compare letter characteristics with applicant and letter writer demographics. RESULTS Of 306 applications reviewed, 221 (72.2%) applicants were female and 85 (27.8%) were male. Of the 1,062 letters analyzed, 457 (43.0%) were written by female letter writers, 586 (55.2%) by males, and 19 (1.8%) were a combination. Multivariable analysis controlling for race, Step 1 score, and letter writer gender demonstrated more frequent use of affiliation words for female applicants compared with males (3.1% ± 0.3 vs. 2.9% ± 0.3, P = 0.02). No additional differences were noted in average letter length or all other linguistic categories analyzed. Multiple differences were detected between writing styles of female and male letter writers, including average letter length, use of multiple word categories, and use of communal (relationship-oriented) language. Data were stratified into 2-year periods and no longitudinal trends in linguistic differences were detected. CONCLUSIONS No linguistic differences, suggestive of gender bias, were found between female and male applicants to FPMRS fellowship.
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Tiedt K, Webber S, Babal J, Nackers KAM, Allen A, Nacht CL, Coller RJ, Eickhoff J, Sklansky DJ, Kieren M, Shadman KA, Kelly MM. Gender Difference in Teaching Evaluation Scores of Pediatric Faculty. Acad Pediatr 2022; 23:564-568. [PMID: 35914732 DOI: 10.1016/j.acap.2022.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/07/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate associations between faculty gender and milestone-based teaching assessment scores assigned by residents. METHODS We performed a retrospective cohort study of milestone-based clinical teaching assessments of pediatric faculty completed by pediatric residents at a mid-sized residency program from July 2016 to June 2019. Assessments included 3 domains (Clinical Interactions, Teaching Skills, Role Modeling/Professionalism) comprised of a total of 11 sub-competency items. We used multilevel logistic regression accounting for repeat measures and clustering to evaluate associations between faculty gender and assessment scores in the 1) top quartile, 2) bottom quartile, or 3) top-box (highest score). Findings were adjusted for faculty rank and academic track, and resident year and gender. RESULTS Over 3 years, 2889 assessments of 104 faculty were performed by 91 residents. Between assessments of women and men faculty, there were no significant differences in the odds of receiving a score in the top quartile for the 3 domains (Clinical aOR 0.99, P = .86; Teaching aOR 0.99, P = .93; Role Modeling aOR 0.87, P = .089). However, assessments of women were more likely to receive a score in the bottom quartile in both Teaching (aOR 1.23, P = .019) and Role Modeling (aOR 1.26, P = .008). Assessments of women also had lower odds of receiving the highest score in 6 of 11 sub-competencies. CONCLUSION Results suggest that gender bias may play a role in resident assessments of pediatric faculty. Future studies are needed to determine if findings are replicated in other settings and to identify opportunities to reduce the gender gap in pediatric academic medicine.
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Affiliation(s)
- Kristin Tiedt
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Sarah Webber
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Jessica Babal
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Kirstin A M Nackers
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Ann Allen
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Carrie L Nacht
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Ryan J Coller
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Jens Eickhoff
- Departments of Biostatistics (J Eickhoff), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Daniel J Sklansky
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Madeline Kieren
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Kristin A Shadman
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Michelle M Kelly
- Departments of Pediatrics (K Tiedt, S Webber, J Babal, KAM Nackers, A Allen, CL Nacht, RJ Coller, DJ Sklansky, M Kieren, KA Shadman, and MM Kelly), University of Wisconsin School of Medicine and Public Health, Madison, Wis
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Tappy E, Pan E, Verma D, Wang A, Brown LS, Chang S, Florian-Rodriguez M. Linguistic Differences by Gender in Letters of Recommendation for Minimally Invasive Gynecologic Surgery Fellowship Applicants. JOURNAL OF SURGICAL EDUCATION 2022; 79:928-934. [PMID: 35249843 DOI: 10.1016/j.jsurg.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Various surgical specialties have reported gender bias in letters of recommendation (LOR). We aimed to determine if linguistic differences exist in LOR for female and male physicians applying to Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS). DESIGN Retrospective cohort study including application cycles 2019 and 2020. SETTING Academic university hospital. PARTICIPANTS FMIGS applicants. RESULTS Applicant demographic and baseline data included age, race, gender, geographical region of residency training, Step 1 and 2 scores, number of research and volunteer activities, Alpha Omega Alpha and Gold Humanism status and number of LOR, as well as the gender and academic rank of the letter writer. The Linguistic Inquiry and Word Count software, a validated text analysis program, was used to characterize LOR linguistic content. A total of 118 applications, including 391 letters, were analyzed. Seventy-six (64.4%) applicants were female and 42 (35.6%) were male. Most female applicants were white (46% vs. 36%, p = 0.04), had Alpha Omega Alpha status (13% vs. 0%, p = 0.01), higher Step 2 scores (239.7 vs. 230.4, p < 0.01), and more service activities (7.7 vs. 4.7, p < 0.01), compared to male applicants. Male applicants were more likely to graduate from international medical schools (45% vs. 16%, p < 0.01). Female authors wrote 159 LOR, and male authors wrote 232. Following multivariable analysis controlling for race, Step 1 score and letter writer gender, no significant differences in average LOR word count for female and male applicants (406.7 ± 24.2 words vs. 340.1 ± 35.4 words), or differences in Linguistic Inquiry and Word Count linguistic categories existed. CONCLUSIONS Although Baseline differences were noted between female and male FMIGS applicants, no differences in LOR length or linguistic categories were noted. These results likely reflect the impact of female predominance and increased efforts to address gender bias within Obstetrics and Gynecology.
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Affiliation(s)
- Erryn Tappy
- UT Southwestern Medical Center, Dallas, Texas.
| | - Evelyn Pan
- UT Southwestern Medical Center, Dallas, Texas
| | | | - Angela Wang
- UT Southwestern Medical Center, Dallas, Texas
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Liu HY, Larson AR, Strong SA, Parekh R, Gautam M, Flores LE, Silver JK. Workforce Diversity, Equity, and Inclusion: A Crucial Component of Professionalism in Psychiatry. Psychiatr Clin North Am 2022; 45:243-258. [PMID: 35680240 DOI: 10.1016/j.psc.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Documented disparities have profoundly impacted the training and careers of physicians from socially and historically marginalized groups, including women, people with disabilities, people who identify with racial and ethnic minority groups, and the lesbian, gay, bisexual, transgender, and queer or questioning+ community. Professionalism is a core component of medical training and practice, yet a focus on workforce diversity, equity, and inclusion is often absent. This report aims to encourage the adoption of workforce diversity, equity, and inclusion as a crucial component of professionalism, with an emphasis on the field of psychiatry.
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Affiliation(s)
- Howard Y Liu
- University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE 68198-5578, USA.
| | - Allison R Larson
- Georgetown University, MedStar Washington Hospital Center, 5530 Wisconsin Ave, Suite 660, Chevy Chase, MD 20815, USA
| | - Sheritta A Strong
- University of Nebraska Medical Center, 985578 Nebraska Medical Center, Omaha, NE 68198-5578, USA
| | - Ranna Parekh
- American College of Cardiology, 2400 N Street NW, Washington, DC 20037, USA
| | - Mamta Gautam
- Psychosocial Oncology Program, The Ottawa Hospital Cancer Center, TOH General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Laura E Flores
- College of Allied Health Professions, University of Nebraska Medical Center, 984035 Nebraska Medical Center, Omaha, NE 68198-4035, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
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Bennett S, Newman-Griffis DR, Beach MC, Gross M. Digital Scarlet Letters: Sexually Transmitted Infections in the Electronic Medical Record. Sex Transm Dis 2022; 49:e70-e74. [PMID: 34772894 PMCID: PMC9272463 DOI: 10.1097/olq.0000000000001581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The harms of implicit bias in clinical settings are acknowledged but poorly understood and difficult to overcome. We discuss how structural components of electronic medical record (EMR) user interfaces may contribute to sex and gender-based discrimination against patients via constant, duplicative presentation of stigmatizing sexually transmitted infection (STI) data irrespective of clinical significance. Via comparison with symbolism and representative quotes in Hawthorne's 1850 novel The Scarlet Letter, we propose a metaphor to examine how EMRs function as a platform for moral judgment, which may display an indelible "scarlet letter" for pregnant patients with STI history. We consider whether current depictions of STIs in EMRs are structurally unjust and may contribute to biased treatment by directing attention to violations of hegemonic sex/gender norms regarding sexual behavior and thus triggering moral judgments of maternal fitness. We conclude with recommendations for how to address these challenges to improve ethical stewardship of sensitive sexual/reproductive health data.
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Affiliation(s)
- Sarah Bennett
- Department of Obstetrics and Gynecology, Magee Womens Hospital, University of Pittsburgh Medical Center
| | | | | | - Marielle Gross
- Department of Obstetrics and Gynecology, Magee Womens Hospital, University of Pittsburgh Medical Center
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Hansen M, Harrod T, Bahr N, Schoonover A, Adams K, Kornegay J, Stenson A, Ng V, Plitt J, Cooper D, Scott N, Chinai S, Johnson J, Conlon LW, Salva C, Caretta-Weyer H, Huynh T, Jones D, Jorda K, Lo J, Mayersak R, Paré E, Hughes K, Ahmed R, Patel S, Tsao S, Wang E, Ogburn T, Guise JM. The Effects of Leadership Curricula With and Without Implicit Bias Training on Graduate Medical Education: A Multicenter Randomized Trial. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:696-703. [PMID: 34966032 DOI: 10.1097/acm.0000000000004573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To determine whether a brief leadership curriculum including high-fidelity simulation can improve leadership skills among resident physicians. METHOD This was a double-blind, randomized controlled trial among obstetrics-gynecology and emergency medicine (EM) residents across 5 academic medical centers from different geographic areas of the United States, 2015-2017. Participants were assigned to 1 of 3 study arms: the Leadership Education Advanced During Simulation (LEADS) curriculum, a shortened Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) curriculum, or as active controls (no leadership curriculum). Active controls were recruited from a separate site and not randomized to limit any unintentional introduction of materials from leadership curricula. The LEADS curriculum was developed in partnership with the Council on Resident Education in Obstetrics and Gynecology and Council of Residency Directors in Emergency Medicine as a novel way to provide a leadership toolkit. Both LEADS and the abbreviated TeamSTEPPS were designed as six 10-minute interactive web-based modules.The primary outcome of interest was the leadership performance score from the validated Clinical Teamwork Scale instrument measured during standardized high-fidelity simulation scenarios. Secondary outcomes were 9 key components of leadership from the detailed leadership evaluation measured on 5-point Likert scales. Both outcomes were rated by a blinded clinical video reviewer. RESULTS One hundred ten obstetrics-gynecology and EM residents participated in this 2-year trial. Participants in both LEADS and TeamSTEPPS had statistically significant improvement in leadership scores from "average" to "good" ranges both immediately and at the 6-month follow-up, while controls remained unchanged in the "average" category throughout the study. There were no differences between LEADS and TeamSTEPPS curricula with respect to the primary outcome. CONCLUSIONS Residents who participated in a brief structured leadership training intervention had improved leadership skills that were maintained at 6-month follow-up.
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Affiliation(s)
- Matt Hansen
- M. Hansen is associate professor of emergency medicine and pediatrics, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Tabria Harrod
- T. Harrod is senior research associate, Department of Obstetrics and Gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Nathan Bahr
- N. Bahr is senior research associate, Department of Obstetrics and Gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Amanda Schoonover
- A. Schoonover is senior research assistant, Department of Obstetrics and Gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Karen Adams
- K. Adams is professor of obstetrics and gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Josh Kornegay
- J. Kornegay is associate professor of emergency medicine, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Amy Stenson
- A. Stenson is associate professor of obstetrics and gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Vivienne Ng
- V. Ng is assistant professor of emergency medicine, The University of Arizona College of Medicine, Tucson, Arizona
| | - Jennifer Plitt
- J. Plitt is assistant clinical professor of emergency medicine, The University of Arizona College of Medicine, Tucson, Arizona
| | - Dylan Cooper
- D. Cooper is professor of clinical emergency medicine, Indiana University School of Medicine, Bloomington, Indiana
| | - Nicole Scott
- N. Scott is assistant professor of clinical obstetrics and gynecology, Indiana University School of Medicine, Bloomington, Indiana
| | - Sneha Chinai
- S. Chinai is assistant professor of emergency medicine, University of Massachusetts Chan Medical School, Boston, Massachusetts
| | - Julia Johnson
- J. Johnson is professor of obstetrics and gynecology, University of Massachusetts Chan Medical School, Boston, Massachusetts
| | - Lauren Weinberger Conlon
- L.W. Conlon is assistant professor of emergency medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Catherine Salva
- C. Salva is associate professor of clinical obstetrics and gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Holly Caretta-Weyer
- H. Caretta-Weyer is assistant director, Emergency Medicine Residency Program, Stanford University School of Medicine, Stanford, California
| | - Trang Huynh
- T. Huynh is associate professor of pediatrics, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - David Jones
- D. Jones is associate professor of emergency medicine, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Katherine Jorda
- K. Jorda is assistant professor of obstetrics and gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Jamie Lo
- J. Lo is assistant professor of obstetrics and gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Ryanne Mayersak
- R. Mayersak is assistant professor of emergency medicine, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Emmanuelle Paré
- E. Paré is associate professor of obstetrics and gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Kate Hughes
- K. Hughes is assistant professor of emergency medicine, The University of Arizona College of Medicine, Tucson, Arizona
| | - Rami Ahmed
- R. Ahmed is professor of emergency medicine, Indiana University School of Medicine, Bloomington, Indiana
| | - Soha Patel
- S. Patel is assistant professor of obstetrics and gynecology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Suzana Tsao
- S. Tsao is associate professor of emergency medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eileen Wang
- E. Wang is professor of obstetrics and gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tony Ogburn
- T. Ogburn is professor and chair of obstetrics and gynecology, University of Texas Rio Grande Valley School of Medicine, Edinburgh, Texas
| | - Jeanne-Marie Guise
- J.-M. Guise is professor of obstetrics and gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
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Creating work environments where people of all genders in gynecologic oncology can thrive: An SGO evidence-based review. Gynecol Oncol 2022; 164:473-480. [PMID: 35000796 PMCID: PMC9465952 DOI: 10.1016/j.ygyno.2021.12.032] [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: 10/29/2021] [Revised: 12/14/2021] [Accepted: 12/27/2021] [Indexed: 01/10/2023]
Abstract
Equality, equity, and parity in the workplace are necessary to optimize patient care across all aspects of medicine. Gender-based inequities remain an obstacle to quality of care, including within the now majority women subspecialty of gynecologic oncology. The results of the 2020 SGO State of the Society Survey prompted this evidence-based review. Evidence related to relevant aspects of the clinical care model by which women with malignancies are cared for is summarized. Recommendations are made that include ways to create work environments where all members of a gynecologic oncology clinical care team, regardless of gender, can thrive. These recommendations aim to improve equality and equity within the specialty and, in doing so, elevate the care that our patients receive.
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Hochstrasser SR, Amacher SA, Tschan F, Semmer NK, Becker C, Metzger K, Hunziker S, Marsch S. Gender-focused training improves leadership of female medical students: A randomised trial. MEDICAL EDUCATION 2022; 56:321-330. [PMID: 34473373 PMCID: PMC9291895 DOI: 10.1111/medu.14658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/16/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Recent research suggests that the gender of health care providers may affect their medical performance. This trial investigated (1) the effects of the gender composition of resuscitation teams on leadership behaviour of first responders and (2) the effects of a brief gender-specific instruction on leadership behaviour of female first responders. METHODS This prospective randomised single-blinded trial, carried out between 2008 and 2016, included 364 fourth-year medical students of two Swiss universities. One hundred and eighty-two teams of two students each were confronted with a simulated cardiac arrest, occurring in the presence of a first responder while a second responder is summoned to help. The effect of gender composition was assessed by comparing all possible gender-combinations of first and second responders. The gender-specific instruction focused on the importance of leadership, gender differences in self-esteem and leadership, acknowledgement of unease while leading, professional role, and mission statement to lead was delivered orally for 10 min by a staff physician and tested by randomising female first responders to the intervention group or the control group. The primary outcome, based on ratings of video-recorded performance, was the first responders' percentage contribution to their teams' leadership statements and critical treatment decision making. RESULTS Female first responders contributed significantly less to leadership statements (53% vs. 76%; P = 0.001) and critical decisions (57% vs. 76%; P = 0.018) than male first responders. For critical treatment decisions, this effect was more pronounced (P = 0.007) when the second responder was male. The gender-specific intervention significantly increased female first responder's contribution to leadership statements (P = 0.024) and critical treatment decisions (P = 0.034). CONCLUSIONS Female first responders contributed less to their rescue teams' leadership and critical decision making than their male colleagues. A brief gender-specific leadership instruction was effective in improving female medical students' leadership behaviours.
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Affiliation(s)
- Seraina Rahel Hochstrasser
- Intensive CareUniversity Hospital BaselBaselSwitzerland
- Medical Communication, Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
| | - Simon Adrian Amacher
- Intensive CareUniversity Hospital BaselBaselSwitzerland
- Medical Communication, Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
| | - Franziska Tschan
- Department of PsychologyUniversity of NeuchatelNeuchatelSwitzerland
| | | | - Christoph Becker
- Medical Communication, Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
| | - Kerstin Metzger
- Medical Communication, Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
| | - Sabina Hunziker
- Medical Communication, Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
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Gender-Based Linguistic Analysis of Pediatric Clinical Faculty Evaluations. Acad Pediatr 2022; 22:324-331. [PMID: 34923143 DOI: 10.1016/j.acap.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/02/2021] [Accepted: 12/09/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Gendered stereotypes are embedded in the culture of medicine. Women are stereotypically expected to act collaboratively and less assertively, while men are expected to act with authority and power. Whether gender-biased language is expressed in academic pediatric teaching evaluations is unknown. OBJECTIVE Determine whether stereotypic gender-based linguistic differences exist in resident evaluations of pediatric faculty. METHODS We performed a retrospective cross-sectional study of clinical faculty evaluations by pediatric residents in a single program from July 2016 to June 2019. Using Linguistic Inquiry and Word Count, responses to 2 open-ended questions were analyzed for stereotypic language. Categories were reported as a percent of total words written. Comparisons between gender groups were conducted using nonparametric Wilcoxon rank sum tests. Rates of word use within each category were analyzed using logistic regression where faculty and resident gender were included as predictor variables. RESULTS A total of 6436 free-text responses from 3218 unique evaluations were included. As hypothesized, evaluations of women faculty were less likely than those of men to include certain agentic language like power (odds ratio [OR] 0.9, P < .001) and insight (OR 0.9, P < .001), and research words (OR 0.6, P = .003). As expected, evaluations of women were more likely to include grindstone words, like "hardworking" (OR 1.2, P = .012). Contrary to our hypothesis, women received fewer teaching words like "mentor" (OR 0.9, P = .048) and communal words like "friendly" (OR 0.6, P = .001). CONCLUSION Certain stereotypic language was demonstrated in clinical teaching evaluations of pediatric faculty. These findings should be further examined to improve gender inequities in academic pediatrics.
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Gender Equity in Gynecologic Surgery: Lessons from History, Strengthening the Future. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00307-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Salminen LE, Tubi MA, Bright J, Thomopoulos SI, Wieand A, Thompson PM. Sex is a defining feature of neuroimaging phenotypes in major brain disorders. Hum Brain Mapp 2022; 43:500-542. [PMID: 33949018 PMCID: PMC8805690 DOI: 10.1002/hbm.25438] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/12/2022] Open
Abstract
Sex is a biological variable that contributes to individual variability in brain structure and behavior. Neuroimaging studies of population-based samples have identified normative differences in brain structure between males and females, many of which are exacerbated in psychiatric and neurological conditions. Still, sex differences in MRI outcomes are understudied, particularly in clinical samples with known sex differences in disease risk, prevalence, and expression of clinical symptoms. Here we review the existing literature on sex differences in adult brain structure in normative samples and in 14 distinct psychiatric and neurological disorders. We discuss commonalities and sources of variance in study designs, analysis procedures, disease subtype effects, and the impact of these factors on MRI interpretation. Lastly, we identify key problems in the neuroimaging literature on sex differences and offer potential recommendations to address current barriers and optimize rigor and reproducibility. In particular, we emphasize the importance of large-scale neuroimaging initiatives such as the Enhancing NeuroImaging Genetics through Meta-Analyses consortium, the UK Biobank, Human Connectome Project, and others to provide unprecedented power to evaluate sex-specific phenotypes in major brain diseases.
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Affiliation(s)
- Lauren E. Salminen
- Imaging Genetics CenterMark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - Meral A. Tubi
- Imaging Genetics CenterMark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - Joanna Bright
- Imaging Genetics CenterMark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - Sophia I. Thomopoulos
- Imaging Genetics CenterMark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - Alyssa Wieand
- Imaging Genetics CenterMark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - Paul M. Thompson
- Imaging Genetics CenterMark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
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Ouyang K, Huang IA, Wagner JP, Wu J, Chen F, Quach C, Donahue TR, Hines OJ, Hiatt JR, Tillou A. Persistence of Gender Bias Over Four Decades of Surgical Training. JOURNAL OF SURGICAL EDUCATION 2021; 78:1868-1877. [PMID: 34294569 DOI: 10.1016/j.jsurg.2021.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/03/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Female surgeons face gender-specific obstacles during residency training, yet longitudinal data on gender bias experienced by female surgery residents are lacking. We aimed to investigate the evolution of gender bias, identify obstacles experienced by female general surgery residents, and discuss approaches to supporting female surgeons during residency training. METHODS Between August 2019 and January 2021, we conducted a retrospective cohort study using structured telephone interviews of female graduates of the UCLA General Surgery Residency training program. Responses of early graduates (1981-2009) were compared with those of recent graduates (2010-2020). Quantitative data were compared with Fisher's exact tests and Chi-squared tests. Interview responses were reviewed to catalog gender bias, obstacles experienced by female surgeons, and advice offered to training programs to address women's concerns. RESULTS Of 61 female surgery residency graduates, 37 (61%) participated. Compared to early graduates (N = 20), recent graduates (N = 17) were significantly more likely to pursue fellowship training (100% vs. 65%, p < 0.01) and have children before or during residency (65% vs. 25%, p = 0.02). A substantial proportion in each cohort experienced some form of gender bias (71% vs. 85%, p = 0.43). Compared to early graduates, recent graduates were significantly less likely to report experiencing explicit gender bias (12% vs. 50%, p = 0.02) but equally likely to report implicit gender bias (71% vs. 55%, p = 0.50). Female graduates across the decades advocated for specific measures to champion work-life balance in residency (51%), strengthen female mentorship (49%), increase childcare support (41%), and promote women into leadership positions (32%). CONCLUSIONS While having children during residency has become more common and accepted over the decades, female surgery residents continue to experience implicit gender bias in the workplace. Female surgeons advocate for targeted interventions to establish systems for parental leave, address gender bias, and strengthen female mentorship.
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Affiliation(s)
- Kelsey Ouyang
- Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - Ivy A Huang
- Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - Justin P Wagner
- Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - James Wu
- Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - Formosa Chen
- Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - Chi Quach
- Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - Timothy R Donahue
- Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - O Joe Hines
- Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - Jonathan R Hiatt
- Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - Areti Tillou
- Department of Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California.
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Diaz DA, Suneja G, Jagsi R, Barry P, Thomas CR, Deville C, Winkfield K, Siker M, Bott-Kothari T. Mitigating Implicit Bias in Radiation Oncology. Adv Radiat Oncol 2021; 6:100738. [PMID: 34381930 PMCID: PMC8339323 DOI: 10.1016/j.adro.2021.100738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 11/30/2022] Open
Abstract
Implicit bias is one of the most insidious and least recognizable mechanisms that can cause inequity and disparities. There is increasing evidence that both implicit and explicit biases have a negative effect on patient outcomes and patient-physician relationships. Given the impact of Implicit bias, a joint session between ASTROs Committee on Health Equity, Diversity, and Inclusion and the National Cancer Institute (the ASTRO-National Cancer Institute Diversity Symposium) was held during the American Society of Radiation Oncology (ASTRO) 2020 Annual Meeting, to address the effect of implicit bias in radiation oncology through real life and synthesized hypothetical scenario discussions. Given the value of this session to the radiation oncology community, the scenarios and discussion are summarized in this manuscript. Our goal is to heighten awareness of the multiple settings in which implicit bias can occur as well as discuss resources to address bias.
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Affiliation(s)
| | - Gita Suneja
- Department of Radiation Oncology University of Utah, Salt Lake city, Utah
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Parul Barry
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Charles R. Thomas
- Department of Radiation Oncology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Curtiland Deville
- The Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karen Winkfield
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Malika Siker
- Department of Radiation Oncology Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Terri Bott-Kothari
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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Foster N, Price M, Bettger JP, Goodwin CR, Erickson M. Objective Test Scores Throughout Orthopedic Surgery Residency Suggest Disparities in Training Experience. JOURNAL OF SURGICAL EDUCATION 2021; 78:1400-1405. [PMID: 33454284 DOI: 10.1016/j.jsurg.2021.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
Diversifying clinical residencies, particularly in fields that are historically dominated by majority male (M/M) cohorts, is critical to improve both the training experiences of residents and the overall physician workforce. Orthopedic surgery in particular has low numbers of females and under-represented minorities (F/URM) at all levels of training and practice. Despite efforts to increase its diversity, this field has become more homogeneous in recent years. To highlight potential barriers and disparate training environments that may contribute to this dynamic, we present 25 years' worth of institutional data on standardized exam performance throughout residency. We report that despite starting residency with standardized exam scores that were comparable to their M/M peers, F/URM orthopedic surgery residents performed progressively worse on Orthopaedic In-service Training Exams throughout residency and had lower first pass rates on the American Board of Orthopedic Surgery Part 1. Given these findings, we propose that disparate performance on standardized test scores throughout residency could identify trainees that may have different experiences that negatively impact their exam performance. Shedding light on these underlying disparities provides opportunities to find meaningful and sustained ways to develop a culture of diversity and inclusion. It may also allow for other programs to identify similar patterns within their training programs. Overall, we propose monitoring test performance on standardized exams throughout orthopedic surgery residency to identify potential disparities in training experience; further, we acknowledge that interventions to mitigate these disparities require a broad, systems wide approach and a firm institutional commitment to reducing bias and working toward sustainable change.
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Affiliation(s)
| | - Meghan Price
- Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, North Carolina
| | - Janet Prvu Bettger
- Department of Orthopedic Surgery, Division of Spine, Duke University Medical Center, Durham, North Carolina
| | - C Rory Goodwin
- Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, North Carolina
| | - Melissa Erickson
- Department of Orthopedic Surgery, Division of Spine, Duke University Medical Center, Durham, North Carolina.
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Zuckerbraun NS, Levasseur K, Kou M, Rose JA, Roskind CG, Vu T, Baghdassarian A, Leonard K, Shabanova V, Langhan ML. Gender Differences Among Milestone Assessments in a National Sample of Pediatric Emergency Medicine Fellowship Programs. AEM EDUCATION AND TRAINING 2021; 5:e10543. [PMID: 34099991 PMCID: PMC8166301 DOI: 10.1002/aet2.10543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/12/2020] [Accepted: 09/30/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND Understanding gender gaps in trainee evaluations is critical because these may ultimately determine the duration of training. Currently, no studies describe the influence of gender on the evaluation of pediatric emergency medicine (PEM) fellows. OBJECTIVE The objective of our study was to compare milestone scores of female versus male PEM fellows. METHODS This is a multicenter retrospective cohort study of a national sample of PEM fellows from July 2014 to June 2018. Accreditation Council for Medical Education (ACGME) subcompetencies are scored on a 5-point scale and span six domains: patient care (PC), medical knowledge, systems-based practice, practice-based learning and improvement, professionalism, and interpersonal and communication skills (ICS). Summative assessments of the 23 PEM subcompetencies are assigned by each program's clinical competency committee and submitted semiannually for each fellow. Program directors voluntarily provided deidentified ACGME milestone reports. Demographics including sex, program region, and type of residency were collected. Descriptive analysis of milestones was performed for each year of fellowship. Multivariate analyses evaluated the difference in scores by sex for each of the subcompetencies. RESULTS Forty-eight geographically diverse programs participated, yielding data for 639 fellows (66% of all PEM fellows nationally); sex was recorded for 604 fellows, of whom 67% were female. When comparing the mean milestone scores in each of the six domains, there were no differences by sex in any year of training. When comparing scores within each of the 23 subcompetencies and correcting the significance level for comparison of multiple milestones, the scores for PC3 and ICS2 were significantly, albeit not meaningfully, higher for females. CONCLUSION In a national sample of PEM fellows, we found no major differences in milestone scores between females and males.
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Affiliation(s)
- Noel S. Zuckerbraun
- From theUPMC Children’s Hospital of Pittsburgh/University of Pittsburgh School of MedicinePittsburghPAUSA
| | - Kelly Levasseur
- theBeaumont Children’s Hospital/Oakland University William Beaumont School of MedicineRoyal OakMIUSA
| | - Maybelle Kou
- theInova Children’s Hospital/VCU School of MedicineFalls ChurchVAUSA
| | - Jerri A. Rose
- theRainbow Babies & Children’s Hospital/Case Western Reserve University School of MedicineClevelandOHUSA
| | | | - Tien Vu
- theChildren’s Hospital Colorado/University of Colorado School of MedicineDenverCOUSA
| | - Aline Baghdassarian
- theChildren’s Hospital of Richmond at VCU/Virginia Commonwealth University School of MedicineRichmondVAUSA
| | - Kathryn Leonard
- Washington University in St. Louis School of MedicineSt. LouisMOUSA
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Ware AD, Flax LW, White MJ. Strategies to Enhance Diversity, Equity, and Inclusion in Pathology Training Programs: A Comprehensive Review of the Literature. Arch Pathol Lab Med 2021; 145:1071-1080. [PMID: 34015822 DOI: 10.5858/arpa.2020-0595-ra] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Like many medical specialties, pathology faces the ongoing challenge of effectively enriching diversity, equity, and inclusion within training programs and the field as a whole. This issue is furthered by a decline in US medical student interest in the field of pathology, possibly attributable to increasingly limited pathology exposure during medical school and medical student perceptions about careers in pathology. OBJECTIVE.— To review the literature to identify the challenges to diversity, equity, and inclusion in pathology, with an emphasis on the pathology trainee pipeline. To evaluate the medical education literature from other medical specialties for diversity and inclusion-focused studies and initiatives, and determine the outcomes and/or approaches relevant for pathology training programs. DATA SOURCES.— A literature review was completed by a search of the PubMed database, as well as a similar general Google search. Additional resources, including the Web sites of the Association of American Medical Colleges, the Electronic Residency Application Service, and the National Resident Matching Program, were used. CONCLUSIONS.— Many strategies exist to increase diversity and encourage an inclusive and equitable training environment, and many of these strategies may be applied to the field of pathology. Interventions such as increasing exposure to the field, using a holistic application review process, and addressing implicit biases have been shown to promote diversity, equity, and inclusion in many medical specialties. In addition, increasing access to elective and pipeline programs may help to bolster medical student interest in careers in pathology.
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Affiliation(s)
- Alisha D Ware
- From the Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland (Ware, White)
| | | | - Marissa J White
- From the Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland (Ware, White)
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Kramer M, Heyligers IC, Könings KD. Implicit gender-career bias in postgraduate medical training still exists, mainly in residents and in females. BMC MEDICAL EDUCATION 2021; 21:253. [PMID: 33933035 PMCID: PMC8088689 DOI: 10.1186/s12909-021-02694-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 04/19/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND More and more female residents enter postgraduate medical training (PGMT). Meanwhile, women are still underrepresented in academic medicine, in leadership positions and in most surgical specialties. This suggests that female residents' career development may still be negatively impacted by subtle, often unconscious stereotype associations regarding gender and career-ambition, called implicit gender-career bias. This study explored the existence and strength of implicit gender-career bias in doctors who currently work in PGMT, i.e. in attending physicians who act as clinical trainers and in their residents. METHODS We tested implicit gender-career bias in doctors working in PGMT by means of an online questionnaire and an online Implicit Association Test (IAT). We used standard IAT analysis to calculate participants' IAT D scores, which indicate the direction and strength of bias. Linear regression analyses were used to test whether the strength of bias was related to gender, position (resident or clinical trainer) or specialty (non-surgical or surgical specialty). RESULTS The mean IAT D score among 403 participants significantly differed from zero (D-score = 0.36 (SD = 0.39), indicating bias associating male with career and female with family. Stronger gender-career bias was found in women (βfemale =0 .11; CI 0.02; 0.19; p = 0.01) and in residents (βresident 0.12; CI 0.01; 0.23; p = 0.03). CONCLUSIONS This study may provide a solid basis for explicitly addressing implicit gender-career bias in PGMT. The general understanding in the medical field is that gender bias is strongest among male doctors' in male-dominated surgical specialties. Contrary to this view, this study demonstrated that the strongest bias is held by females themselves and by residents, independently of their specialty. Apparently, the influx of female doctors in the medical field has not yet reduced implicit gender-career bias in the next generation of doctors, i.e. in today's residents, and in females.
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Affiliation(s)
- Maud Kramer
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Centre, Heerlen, The Netherlands.
| | - Ide C Heyligers
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Karen D Könings
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Adams MA. Don't fix the women, fix the system: recognizing and addressing implicit gender bias in gastroenterology training and practice. Gastrointest Endosc 2021; 93:1057-1059. [PMID: 33685625 DOI: 10.1016/j.gie.2020.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/17/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Megan A Adams
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA; Division of Gastroenterology, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA; Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
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Champagne-Langabeer T, Hedges AL. Physician gender as a source of implicit bias affecting clinical decision-making processes: a scoping review. BMC MEDICAL EDUCATION 2021; 21:171. [PMID: 33740973 PMCID: PMC7980423 DOI: 10.1186/s12909-021-02601-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/08/2021] [Indexed: 05/02/2023]
Abstract
BACKGROUND The demographic profile of practicing physicians is changing as more female medical students are graduating and practicing in the field. While the education received may not differ by gender, studies have shown that physician practice outcomes vary by provider gender. Various factors could contribute to these differences, including culture and explicit biases which may lead to implicit bias. This study aims to identify the available evidence of gender-based implicit bias throughout the delivery process of medicine. METHODS This scoping review evaluated published literature within the PubMed, Ovid MEDLINE, PsychINFO, Web of Science, and BioMed Central databases pertaining to physician's gender as a factor in the delivery of medicine. Arksey and O'Malley's six-stage methodology was used as a framework and reported using the updated Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Searches occurred between May 2020 and June 2020, and the timeframe was not limited. Included articles had gender as a factor in the delivery of medicine and implicit bias. Articles were excluded if they did not include the gender of the physician. After screening by reviewers and a medical librarian, study characteristics were charted and analyzed. RESULTS The initial search resulted in 2420 records. After screening, 162 of the records were selected based on title and keyword relevance. After additional screening, 15 records were ultimately included in the review based on full-text evaluation. Records were organized into sub-topics post hoc focused on clinical qualities, diagnostics, treatment, and outcomes. CONCLUSION This scoping review found that gender-based implicit bias may be inadvertently acquired from culture and education. Although implicit bias is highly researched, much of the current literature focuses on the gender of the patient. This study found important gaps in the available literature regarding race and gender of the physician. Further studies could explore outcome differences between recent graduates and career physicians, for both female and male physicians.
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Affiliation(s)
- Tiffany Champagne-Langabeer
- School of Biomedical Informatics, The University of Texas Health Science Center, 7000 Fannin Street, Suite 600, Houston, TX, USA.
| | - Andrew L Hedges
- School of Biomedical Informatics, The University of Texas Health Science Center, 7000 Fannin Street, Suite 600, Houston, TX, USA
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Abstract
Implicit or unconscious bias is commonly proposed to be responsible for women’s underrepresentation in academia. The aim of this scoping review was to identify and discuss the evidence supporting this proposition. Publications about unconscious/implicit gender bias in academia indexed in Scopus or psycInfo up to February 2020 were identified. More than half were published in the period 2018–2020. Studies reporting empirical data were scrutinized for data, as well as analyses showing an association of a measure of implicit or unconscious bias and lesser employment or career opportunities in academia for women than for men. No studies reported empirical evidence as thus defined. Reviews of unconscious bias identified via informal searches referred exclusively to studies that did not self-identify as addressing unconscious bias. Reinterpretations and misrepresentations of studies were common in these reviews. More empirical evidence about unconscious gender bias in academia is needed. With the present state of knowledge, caution should be exercised when interpreting data about gender gaps in academia. Ascribing observed gender gaps to unconscious bias is unsupported by the scientific literature.
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Current state of Grand Rounds in U.S. pathology training programs. Ann Diagn Pathol 2020; 46:151484. [PMID: 32172216 DOI: 10.1016/j.anndiagpath.2020.151484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/21/2022]
Abstract
Grand Rounds are held with variable frequency in many academic pathology departments, but their exact goal is uncertain, and the type of subjects covered, and presenters have not been studied. We aimed to gather information about the current state of pathology grand rounds (PGR). We identified all US pathology residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and searched their websites for information regarding PGR, extracting data on their existence, frequency and timing. For a representative subgroup of institutions from all US regions and program sizes, we tabulated the 2017-2018 PGR titles and presenters (gender, degree(s), resident/fellow, faculty academic rank). We found that 71 of 142 (50%) ACGME-accredited programs had PGR, more often in programs with >12 residents (53/88, 60%). PGR were scheduled most commonly weekly, on Thursdays, and at noon. We analyzed 1019 PGR presentations from 41 institutions located in 26 US states. Among the 1105 presenters, 183 (16.56%) were trainees, 74 (6.7%) were non-academic, and 848 (76.7%) were faculty, 559 male and 289 female (M/F = 1.93). M/F ratio increased with academic rank, from 1.0 (117/115) for assistant, to 2.0 (135/68) for associate, and 2.9 (307/106) for full professors. Topics covered by PGR belonged to anatomic pathology (357), clinical pathology (209), research (184) or other medical or surgical specialties (149). Our study suggests that trainees are a major intended audience of pathology grand round. Unfortunately, there is a gender gap among pathology grand round presenters that widens with increasing academic rank of presenters.
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