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Jerath A, Satkunasivam R, Kaneshwaran K, Aminoltejari K, Chang A, MacDonell DSY, Kealey A, Ladowski S, Sarmah A, Flexman AM, Lorello GR, Nabecker S, Coburn N, Conn LG, Klaassen Z, Ranganathan S, Riveros C, McCartney CJL, Detsky AS, Wallis CJD. Association Between Anesthesiologist Sex and Patients' Postoperative Outcomes: A Population-based Cohort Study. Ann Surg 2024; 279:569-574. [PMID: 38264927 DOI: 10.1097/sla.0000000000006217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To examine the association of anesthesiologist sex on postoperative outcomes. BACKGROUND Differences in patient postoperative outcomes exist, depending on whether the primary surgeon is male or female, with better outcomes seen among patients treated by female surgeons. Whether the intraoperative anesthesiologist's sex is associated with differential postoperative patient outcomes is unknown. METHODS We performed a population-based, retrospective cohort study among adult patients undergoing one of 25 common elective or emergent surgical procedures from 2007 to 2019 in Ontario, Canada. We assessed the association between the sex of the intraoperative anesthesiologist and the primary end point of the adverse postoperative outcome, defined as death, readmission, or complication within 30 days after surgery, using generalized estimating equations. RESULTS Among 1,165,711 patients treated by 3006 surgeons and 1477 anesthesiologists, 311,822 (26.7%) received care from a female anesthesiologist and 853,889 (73.3%) from a male anesthesiologist. Overall, 10.8% of patients experienced one or more adverse postoperative outcomes, of whom 1.1% died. Multivariable adjusted rates of the composite primary end point were higher among patients treated by male anesthesiologists (10.6%) compared with female anesthesiologists (10.4%; adjusted odds ratio 1.02, 95% CI: 1.00-1.05, P =0.048). CONCLUSIONS We demonstrated a significant association between sex of the intraoperative anesthesiologist and patient short-term outcomes after surgery in a large cohort study. This study supports the growing literature of improved patient outcomes among female practitioners. The underlying mechanisms of why outcomes differ between male and female physicians remain elusive and require further in-depth study.
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Affiliation(s)
- Angela Jerath
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, TX
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Kirusanthy Kaneshwaran
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Khatereh Aminoltejari
- Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Ashton Chang
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - D Su-Yin MacDonell
- Department of Anesthesiology, St. Paul's Hospital/Providence Health Care, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Alayne Kealey
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephanie Ladowski
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Anita Sarmah
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Alana M Flexman
- Department of Anesthesiology, St. Paul's Hospital/Providence Health Care, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesiology and Pain Management, University Health Network - Toronto Western Hospital, Toronto, ON, Canada
- The Wilson Centre, Toronto General Hospital, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Sabine Nabecker
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesiology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Natalie Coburn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Lesley G Conn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia - Augusta University, Augusta, Georgia, USA
| | | | - Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Colin J L McCartney
- Department of Anesthesia and Pain Medicine, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Allan S Detsky
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher J D Wallis
- Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada
- Department of Surgery, Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
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Lorello GR, Hodwitz K, Issenberg SB, Brydges R. Relinquishing control? Supervisor co-regulation may disrupt students' self-regulated learning during simulation-based training. Adv Health Sci Educ Theory Pract 2024; 29:9-25. [PMID: 37245197 DOI: 10.1007/s10459-023-10244-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Abstract
When uncertain, medical trainees often seek to co-regulate their learning with supervisors and peers. Evidence suggests they may enact self-regulated learning (SRL) strategies differently when engaged in self- versus co-regulated learning (Co-RL). We compared the impacts of SRL and Co-RL on trainees' acquisition, retention, and preparation for future learning (PFL) of cardiac auscultation skills during simulation-based training. In our two-arm, prospective, non-inferiority trial, we randomly assigned first- and second-year medical students to the SRL (N = 16) or Co-RL conditions (N = 16). Across two learning sessions separated by two-weeks, participants practiced and were assessed in diagnosing simulated cardiac murmurs. We examined diagnostic accuracy and learning trace data across sessions, and conducted semi-structured interviews to explore participants' understandings of their underlying choices and learning strategies. SRL participants' outcomes were non-inferior to Co-RL participants on the immediate post-test and retention test, but not on the PFL assessment (i.e., inconclusive). Analyzing interview transcripts (N = 31) generated three themes: perceived utility of initial learning supports for future learning; SRL strategies and sequencing of murmurs; and perceived control over learning across sessions. Co-RL participants regularly described relinquishing control of learning to supervisors and regaining it when on their own. For some trainees, Co-RL seemed to interfere with their situated and future SRL. We posit that transient clinical training sessions, typical in simulation-based and workplace-based settings, may not allow the ideal processes of Co-RL to unfold between supervisor and trainee. Future research must examine how supervisors and trainees can share accountability to develop the shared mental models that underlie effective Co-RL.
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Affiliation(s)
- Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, University Health Network - Toronto Western Hospital, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Wilson Centre for Research in Education, University Health Network, Toronto, ON, Canada
| | - Kathryn Hodwitz
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Room 5-086, 209 Victoria St., Toronto, ON, M5B 1T8, Canada
| | - S Barry Issenberg
- Michael S Gordon Center for Simulation and Innovation in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ryan Brydges
- Wilson Centre for Research in Education, University Health Network, Toronto, ON, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Room 5-086, 209 Victoria St., Toronto, ON, M5B 1T8, Canada.
- Allan Waters Family Simulation Centre, Unity Health Toronto, Toronto, ON, Canada.
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Lorello GR, Kuper A. What's in a name? Internal coherence as a marker of rigour in research. J Clin Anesth 2024; 92:111216. [PMID: 37487864 DOI: 10.1016/j.jclinane.2023.111216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Gianni R Lorello
- Department of Anesthesia and Pain Management, University Health Network - Toronto Western Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; The Wilson Centre, University of Toronto - Toronto General Hospital, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Ayelet Kuper
- The Wilson Centre, University of Toronto - Toronto General Hospital, Toronto, ON, Canada; Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
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Lorello GR, Schrewe B. Unmasking imposter syndrome: individual responsibility or repercussions of systemic oppression? Br J Anaesth 2024; 132:230-233. [PMID: 38242604 DOI: 10.1016/j.bja.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 01/21/2024] Open
Abstract
In contemporary and popular discourse, imposter syndrome is frequently outlined as an individual problem that can be overcome. Rather than the locus of responsibility being placed on the individual, we posit that neoliberal academic institutions contribute to imposter syndrome by (de)legitimising certain forms of knowledge.
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Affiliation(s)
- Gianni R Lorello
- Toronto Western Hospital - University Health Network, Department of Anesthesia and Pain Management, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; The Wilson Centre, Toronto, ON, Canada; Women's College Research Institute, Toronto, ON, Canada.
| | - Brett Schrewe
- Department of Pediatrics & Island Medical Program, Faculty of Medicine, University of British Columbia, Victoria, BC, Canada
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Soussi S, Mehta S, Lorello GR. Equity, diversity, and inclusion in anaesthesia and critical care medicine: consider the various aspects of diversity. Br J Anaesth 2023; 131:e135-e136. [PMID: 37567809 DOI: 10.1016/j.bja.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/06/2023] [Accepted: 07/15/2023] [Indexed: 08/13/2023] Open
Affiliation(s)
- Sabri Soussi
- Department of Anaesthesia and Pain Management, University Health Network - Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Sangeeta Mehta
- Department of Medicine, Sinai Health, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Gianni R Lorello
- Department of Anaesthesia and Pain Management, University Health Network - Toronto Western Hospital, University of Toronto, Toronto, ON, Canada; Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; The Wilson Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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Ladha KS, Lu J, McIsaac DI, van Vlymen JM, Lebovic G, Ehtesham S, Pazmino-Canizares J, Clarke H, Parotto M, Lorello GR, Wijeysundera DN. Peri-Operative Wearables in Elder Recover after Surgery (POWERS) study: a protocol for a multicentre, prospective cohort study to evaluate perioperative activity with postoperative disability in older adults after non-cardiac surgery. BMJ Open 2023; 13:e073612. [PMID: 37770257 PMCID: PMC10546154 DOI: 10.1136/bmjopen-2023-073612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION The ageing population has led to an increasing proportion of surgical patients with greater frailty and comorbidity. Complications and mortality within 30 days of a surgical procedure are often used to evaluate success in the perioperative period however these measures can potentially underestimate a substantial level of morbidity associated with surgery. Personal wearable technologies are now readily available and can offer detailed information on activity intensity, sedentary behaviour and sleeping patterns. These devices may provide important information perioperatively by acting as a non-invasive, and cost-efficient means to risk stratify patients. METHODS AND ANALYSIS The Peri-Operative Wearables in Elder Recover After Surgery (POWERS) study is a multicentre observational study of 200 older adults (≥65 years) having major elective non-cardiac surgery. The objectives are to characterise the association between preoperative and postoperative activity monitor measurements with postoperative disability and recovery, as well as characterise trajectories of activity and sleep in the perioperative period. Activity will be monitored with the ActiGraph GT3X device and measured for 7-day increments, preoperatively, and at 1 week, 1 month and 3 months postoperatively. Disability will be assessed using the WHO Disability Assessment Schedule 2.0 assessed at 1 week, 1 month and 3 months postoperatively. ETHICS AND DISSEMINATION The POWERS study received research ethics board approval at all participating sites on 1 August 2019 (REB # 19-121 (CTO 1849)). Renewal was granted on 19 May 2022.
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Affiliation(s)
- Karim S Ladha
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Justin Lu
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Janet M van Vlymen
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Gerald Lebovic
- Applied Health Research Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Sahar Ehtesham
- Applied Health Research Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Hance Clarke
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Pain Research Unit, University Health Network, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
| | - Matteo Parotto
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
| | - Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
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Hrynyk N, Peel JK, Grace D, Lajoie J, Ng-Kamstra J, Kuper A, Carter M, Lorello GR. Queer(ing) medical spaces: queer theory as a framework for transformative social change in anesthesiology and critical care medicine. Can J Anaesth 2023; 70:950-962. [PMID: 37217735 DOI: 10.1007/s12630-023-02449-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 08/02/2022] [Accepted: 09/15/2022] [Indexed: 05/24/2023] Open
Abstract
Queer theory is a disruptive lens that can be adopted by researchers, educators, clinicians, and administrators to effect transformative social change. It offers opportunities for anesthesiologists, critical care physicians, and medical practitioners to more broadly understand what it means to think queerly and how queering anesthesiology and critical care medicine spaces improves workplace culture and patient outcomes. This article grapples with the cis-heteronormative medical gaze and queer people's apprehensions of violence in medical settings to offer new ways of thinking about structural changes needed in medicine, medical language, and the dehumanizing application of medical modes of care. Using a series of clinical vignettes, this article outlines the historical context underlying queer peoples' distrust of medicine, a primer in queer theory, and an understanding of how to begin to "queer" medical spaces using this critical framework.
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Affiliation(s)
- Nicholas Hrynyk
- Department of Philosophy, History, and Politics, Thompson Rivers University, Kamloops, BC, Canada
| | - John K Peel
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jason Lajoie
- Department of English, University of Waterloo, Waterloo, ON, Canada
| | - Joshua Ng-Kamstra
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
- Department of Surgery, The Queen's Medical Center, Honolulu, HI, USA
| | - Ayelet Kuper
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- The Wilson Centre, University of Toronto, Toronto General Hospital, Toronto, ON, Canada
| | - Mic Carter
- The Creative School, Toronto Metropolitan University, Toronto, ON, Canada
| | - Gianni R Lorello
- The Wilson Centre, University Health Network - University of Toronto, Toronto, ON, Canada.
- Department of Anesthesia and Pain Management, University Health Network - Toronto Western Hospital, Toronto, ON, Canada.
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
- University Health Network-Toronto Western Hospital, 399 Bathurst Avenue, McL 2-405, Toronto, ON, M5T 2S8, Canada.
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Heybati K, Flexman AM, Lorello GR, Mehta S. Outcomes of COVID-19 manuscripts submitted to the Canadian Journal of Anesthesia: a retrospective audit of author gender and person of colour status. Can J Anaesth 2023; 70:988-994. [PMID: 37188835 PMCID: PMC10184964 DOI: 10.1007/s12630-023-02455-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 05/17/2023] Open
Abstract
PURPOSE We aimed to evaluate the representation of women and persons of colour (POC) authors of COVID-19 manuscripts submitted to, accepted in, and rejected from the Journal and to evaluate trends in their representation during the pandemic. METHODS All COVID-19 manuscripts submitted to the Journal between 1 February 2020 and 30 April 2021 were included. Manuscript data were retrieved from Editorial Manager, and gender and POC status were obtained through: 1) e-mail communication with corresponding authors; 2) e-mail queries to other coauthors; 3) NamSor software, and 4) Internet searches. The data were described using percentages and summary statistics. A two-sample test of proportions was used for comparisons and trends were analyzed with linear regression. RESULTS We identified 314 manuscripts (1,555 authors), 95 (461 authors) of which were accepted for publication. Of all authors, 515 (33%) were women, and women were the lead and senior authors of 101 (32%) and 69 (23%) manuscripts, respectively. There were no differences in women's representation as authors between accepted and rejected manuscripts. Overall, 923/1,555 (59%) authors were identified as POC, with a significantly lower proportion of POC authors among accepted vs rejected manuscripts (41%, 188/461 vs 67%, 735/1,094; difference, -26%; 95% CI, -32 to -21; P < 0.001). We did not observe significant trends in the proportion of women and POC authors over the study period. CONCLUSION The proportion of women authors of COVID-19 manuscripts was lower than men's representation. Further research is required to determine the factors that account for the higher proportion of POC authors across rejected manuscripts.
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Affiliation(s)
- Kiyan Heybati
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alana M Flexman
- Department of Anesthesia and the Centre for Health Evaluation and Outcomes, St. Paul's Hospital/Providence Health Care, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto Western Hospital, Toronto, ON, Canada
- The Wilson Centre, University of Toronto, Toronto General Hospital, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Sangeeta Mehta
- Department of Medicine, Sinai Health System, Toronto, ON, Canada.
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
- Mount Sinai Hospital, 600 University Ave, Suite 18-216, Toronto, ON, M5G 1X5, Canada.
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Lorello GR, Hawryluck L. Like patients, practitioners are not cases: (re)humanizing the "case" report. Can J Anaesth 2023; 70:1113-1114. [PMID: 37165133 PMCID: PMC10171904 DOI: 10.1007/s12630-023-02471-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 05/12/2023] Open
Affiliation(s)
- Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Anesthesia and Pain Management, University Health Network - Toronto Western Hospital, Toronto, ON, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
- The Wilson Centre, University Health Network - University of Toronto, Toronto, ON, Canada.
| | - Laura Hawryluck
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Critical Care Medicine, University Health Network - Toronto Western Hospital, Toronto, ON, Canada
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Casas Lopez C, Lorello GR, Kim C, Liu E, Flexman AM. Current status of Equity, Diversity, and Inclusion in Canadian departments of anesthesiology: a national survey and quality improvement audit. Can J Anaesth 2023; 70:1094-1096. [PMID: 37173566 DOI: 10.1007/s12630-023-02467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 05/15/2023] Open
Affiliation(s)
- Catalina Casas Lopez
- Department of Anesthesiology and Perioperative Medicine, London Health Sciences Centre and St. Joseph's Health Care, University of Western Ontario, London, ON, Canada.
| | - Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, University Health Network- Toronto Western Hospital, Toronto, ON, Canada
- The Wilson Centre, Toronto General Hospital, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Clara Kim
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Eric Liu
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Alana M Flexman
- Department of Anesthesia, St. Paul's Hospital/Providence Health Care, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcomes Sciences, St. Paul's Hospital, Vancouver, BC, Canada
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Potter E, Sivagurunathan M, Armstrong K, Barker LC, Du Mont J, Lorello GR, Millman A, Urbach DR, Krakowsky Y. Patient reported symptoms and adverse outcomes seen in Canada's first vaginoplasty postoperative care clinic. Neurourol Urodyn 2023; 42:523-529. [PMID: 36630152 DOI: 10.1002/nau.25132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Vaginoplasty is a relatively common gender-affirming surgery with approximately 200 Ontarians seeking this surgery annually. Although Ontario now offers vaginoplasty in province, the capacity is not meeting demand; the majority of trans and gender-diverse patients continue to seek vaginoplasty out of province. Out-of-province surgery presents a barrier to accessing postsurgical follow-up care leaving most patients to seek support from their primary care providers or providers with little experience in gender-affirming surgery. OBJECTIVE To provide an account of the common postoperative care needs and neovaginal concerns of Ontarians who underwent penile inversion vaginoplasty out of province and presented for care at a gender-affirming surgery postoperative care clinic. DESIGN, SETTINGS, AND PARTICIPANTS A retrospective chart review of the first 80 patients presenting to a gender-affirming surgery postoperative care clinic who had undergone vaginoplasty at an outside surgical center was performed. Descriptive analyses were performed for all variables. RESULTS The sample consisted of 80 individuals with the mean age of 39 years (19-73). Most patients had surgery at another surgical center in Canada (76.3%). Many patients (22.5%) accessed care in the first 3 months after surgery, with the majority (55%) seeking care within the first perioperative year. Most patients (61.3%) were seen for more than one visit and presented with more than two symptoms or concerns. Common patient-reported symptoms during clinical visit included pain (53.8%), dilation concerns (46.3%), and surgical site/vaginal bleeding (42.5%). Sexual function concerns were also common (33.8%) with anorgasmia (11.3%) and dyspareunia (11.3%) being the most frequent complications. The most common adverse outcomes identified by health care providers included hypergranulation (38.8%), urinary dysfunction (18.8%), and wound healing issues (12.5%). CONCLUSIONS AND RELEVANCE Findings from chart review offer valuable insights into the postoperative needs and neovaginal concerns of Ontarians who have had vaginoplasty out of province. This study demonstrates the need for routine postoperative care in patients undergoing vaginoplasty. Patients experience numerous symptoms and concerns that often correlate with clinical findings and require multiple follow-up appointments. Health care providers may benefit from further education on the more common nonsurgical issues identified in this study.
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Affiliation(s)
- Emery Potter
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Kathleen Armstrong
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Lucy C Barker
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Janice Du Mont
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gianni R Lorello
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia and Pain Management, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada.,The Wilson Centre, University Health Network, Toronto, Ontario, Canada
| | - Alexandra Millman
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Transition Related Surgery Program, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David R Urbach
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Transition Related Surgery Program, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, Women's College Hospital, Toronto, Ontario, Canada
| | - Yonah Krakowsky
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Transition Related Surgery Program, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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12
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Hung PSP, Byeon AG, Noorani A, Walker MR, Lorello GR, Hodaie M. Sex differences in patient journeys to diagnosis, referral, and surgical treatment of trigeminal neuralgia: implications for equitable care. J Neurosurg 2022:1-9. [PMID: 36585864 DOI: 10.3171/2022.11.jns221191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/17/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Trigeminal neuralgia (TN) is an orofacial pain disorder that is more prevalent in females than males. Although an increasing number of studies point to sex differences in chronic pain, how sex impacts TN patients' journeys to care has not been previously addressed. This study sought to investigate sex differences in patients' journeys to diagnosis, referral, and treatment of TN within a large national context. METHODS Patients with classic TN (n = 100; 50 females and 50 males) were randomly selected through chart reviews at the largest surgical treatment center for TN in Canada for a cross-sectional study. Statistical tests, including Welch's t-test, the chi-square test, Pearson's correlations, and analyses of covariance, were conducted with Python. RESULTS Key discrepancies between sexes in access to care were identified. Females had a significantly longer referral time interval (average 53.2 months vs 20.4 months, median 27.5 months vs 11.0 months, p = 0.018) and total time interval (average 121.1 months vs 67.8 months, median 78.0 months vs 45.2 months, p = 0.018) than males, despite reporting higher pain intensity at referral. Although medically intolerant patients had a significantly shorter referral time interval than medically tolerant patients (average 13.0 months vs 41.0 months, median 6.0 months vs 17.0 months, p < 0.001), medically tolerant females had a significantly longer referral time interval than medically tolerant males (average 59.9 months vs 21.7 months, median 30.0 months vs 12.0 months, p = 0.017). No statistically significant differences were detected between the sexes for diagnostic time interval (average 63.3 months vs 43.0 months, median 24.0 months vs 24.0 months, p = 0.263) or treatment time interval (average 4.6 months vs 4.7 months, median 4.0 months vs 3.0 months, p = 0.986). CONCLUSIONS Critical sex differences in patients' journeys to TN surgical treatment were identified, with females enduring considerably longer referral timelines and expressing significantly greater pain intensity than males at referral. Taken together, our findings suggest the presence of unconscious bias and discrimination against females and highlight the need for expediting TN treatment referral for female TN patients.
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Affiliation(s)
| | - Alana G Byeon
- 1Institute of Medical Science, University of Toronto, Ontario, Canada
| | - Alborz Noorani
- 1Institute of Medical Science, University of Toronto, Ontario, Canada
- 2MD Program, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Matthew R Walker
- 3Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Gianni R Lorello
- 4Department of Anesthesia and Pain Management, University Health Network-Toronto Western Hospital, Toronto, Ontario, Canada
- 5Department of Anesthesiology and Pain Medicine, University of Toronto, Ontario, Canada
- 6The Wilson Centre, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada
- 7Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- 1Institute of Medical Science, University of Toronto, Ontario, Canada
- 3Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- 8Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada; and
- 9Division of Neurosurgery, Krembil Brain Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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13
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Silver JK, Booth GS, Chatterjee A, Crusto CA, El-Sayed N, Fleming TK, Gavini N, Golden SH, Jacobs JW, Jagsi R, Larson AR, Liu HY, Lorello GR, Muir R, Shim RS, Spector ND, Stanford FC, Verduzco-Gutierrez M, Zafonte RD. Organizations in science and medicine must hold each other accountable for discriminatory practices. Cell 2022; 185:3073-3078. [PMID: 35985283 PMCID: PMC9924297 DOI: 10.1016/j.cell.2022.06.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/14/2022] [Accepted: 06/22/2022] [Indexed: 01/24/2023]
Abstract
Many organizations persist in working with others that engage in known, remediable structural discrimination. We name this practice interorganizational structural discrimination (ISD) and argue it is a pivotal contributor to inequities in science and medicine. We urge organizations to leverage their relationships and demand progress from collaborators.
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Affiliation(s)
- Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
| | - Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Archana Chatterjee
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Cindy A Crusto
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Nuha El-Sayed
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Talya K Fleming
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute at Hackensack Meridian Health, Edison, NJ, USA
| | - Nara Gavini
- Massachusetts General Hospital Institute of Health Professions, Charlestown Navy Yard, Boston, MA, USA
| | - Sherita Hill Golden
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Reshma Jagsi
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Allison R Larson
- Department of Dermatology, Georgetown University School of Medicine and MedStar Health, Washington, DC, USA
| | - Howard Y Liu
- Department of Psychiatry, University of Nebraska Medical School, Omaha, NE, USA
| | - Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronoto, ON, Canada
| | - Roshell Muir
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Ruth S Shim
- Department of Psychiatry and Behavioral Sciences, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Nancy D Spector
- Department of Pediatrics, Executive Leadership in Academic Medicine®, Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
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14
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Peel JK, Flexman AM, Cygler J, Kirkham KR, Lorello GR. Standing out or fitting in: A latent projective content analysis of discrimination of women and 2SLGBTQ+ anesthesiologists and providers. J Clin Anesth 2022; 80:110884. [PMID: 35597003 DOI: 10.1016/j.jclinane.2022.110884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Discrimination toward sex and gender minority anesthesiologists and anesthesia trainees exists. Potential reasons for this discrimination are unclear and incompletely characterized. This study sought to better understand what discrimination looks like for sex and gender minorities in anesthesiology and the culture within anesthesiology that allows this discrimination to occur. MATERIALS AND METHODS With institutional research ethics board approval and informed consent, we performed a qualitative analysis of free-text responses from a previously-published internet-based cross-sectional survey distributed to Canadian anesthesiology residents, fellows, and staff. The purpose of this survey was to characterize intersections between respondent gender or sexuality with experiences of discrimination in the workplace. Separate analysis of qualitative and quantitative components of this survey was planned a priori, and the quantitative component was published elsewhere. Free-text responses were independently coded by two researchers and subsequently synthesized into emerging themes using latent projective content analysis sensitized by Butler's theory of performativity. RESULTS Out of 490 free-text responses from 171 respondents [140 (81.9%) identifying as heterosexual], two themes emerged: i) fitting in: performativity reinforcing the status quo, and ii) standing out: performativity as a means of disruptive social change. Power structures were observed to favour individuals who "fit in" with the normative performances of gender and/or sexuality. DISCUSSION Our study illuminates how individuals whose performances of gender and sexuality "fit in" with those expected normative performances reinforce a workplace culture that advantages them, whereas individuals whose performances of gender and sexuality "stand out" disproportionately experience discrimination. The dismantling of bias and discrimination in the anesthesiology workplace requires individuals (a) who are empowered within their workplace because they "fit in" with the majority; (b) who recognize discrimination toward communities of their peers and/or colleagues; and (c) who actively choose to "stand out".
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Affiliation(s)
- John K Peel
- University of Toronto, Department of Anesthesiology and Pain Medicine, Toronto, ON, Canada
| | - Alana M Flexman
- The University of British Columbia, Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver, BC, Canada
| | - Jeremy Cygler
- University of Toronto, Department of Medicine, Toronto, ON, Canada
| | - Kyle R Kirkham
- University of Toronto, Department of Anesthesiology and Pain Medicine, Toronto, ON, Canada; University Health Network - Toronto Western Hospital, Department of Anesthesia and Pain Management, Toronto, ON, Canada
| | - Gianni R Lorello
- University of Toronto, Department of Anesthesiology and Pain Medicine, Toronto, ON, Canada; University Health Network - Toronto Western Hospital, Department of Anesthesia and Pain Management, Toronto, ON, Canada; The Wilson Centre, University Health Network, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
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15
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Verduzco-Gutierrez M, Katz NB, Fleming TK, Silver EM, Hunter TL, El Sayed N, Escalon MX, Lorello GR, Silver JK. Author Diversity on Clinical Practice Guideline Committees. Am J Phys Med Rehabil 2022; 101:493-503. [PMID: 34775456 DOI: 10.1097/phm.0000000000001932] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Reports have demonstrated that women overall and women physicians, in particular, are underrepresented as authors of clinical practice guidelines. This analysis used publicly available information to explore the diversity of rehabilitation-related clinical practice guideline authors by gender, race, and ethnicity. Primary analysis identified authors' gender, race, ethnicity, and visible minority status. Two sets were analyzed: (1) clinical practice guidelines by Department of Veterans Affairs (VA) categorized as "Rehabilitation" or "Pain" (n = 7; VA clinical practice guidelines) and (2) a set (n = 10) published in the United States (US) from 2019 to 2021 that were selected because of low numbers of inclusion at less than 20% women authors. Key findings include that among physician authors, both the VA and US clinical practice guidelines underrepresented women (15 [24.2%] and 27 [16.7%], respectively) and those coded as a racial or ethnic minority were particularly underrepresented. Notably, women authors overall were equally represented (92 [50.0%]) in the VA clinical practice guidelines. The US clinical practice guidelines had women authors who were underrepresented (36 [19.0%]). Secondary analysis of the entire set of VA clinical practice guidelines (n = 21) found gaps in diversity-related content. Clinical practice guidelines have far-reaching health and economic impacts, and addressing disparities in the diversity of author teams and/or gaps in diversity-related content is of paramount importance.
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Affiliation(s)
- Monica Verduzco-Gutierrez
- From the Department of Rehabilitation Medicine, Joe R. and Teresa Lozano Long School of Medicine at UT Health San Antonio, San Antonio, Texas (MV-G); Department of Internal Medicine, Mount Auburn Hospital, Cambridge, Massachusetts (NBK); JFK Johnson Rehabilitation Institute at Hackensack Meridian Health, Edison, New Jersey (TKF); Department of Physical Medicine and Rehabilitation, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey (TKF); Department of Physical Medicine and Rehabilitation, Hackensack Meridian School of Medicine, Nutley, New Jersey (TKF); Department of Psychology, Integrative Neuroscience, University of Chicago, Chicago, Illinois (EMS); Department of Internal Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California (TLH); Joslin Diabetes Center, Boston, Massachusetts (NES); Department of Medicine, Harvard Medical School, Boston, Massachusetts (NES); Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York (MXE); Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada (GRL); Department of Anesthesia and Pain Management, Toronto Western Hospital-University Health Network, Toronto, Ontario, Canada (GRL); The Wilson Centre, University Health Network, Toronto, Ontario, Canada (GRL); Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada (GRL); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (JKS); Massachusetts General Hospital, Boston, Massachusetts (JKS); Brigham and Women's Hospital, Boston, Massachusetts (JKS); and Spaulding Rehabilitation Hospital, Boston, Massachusetts (JKS)
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16
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Sivagurunathan M, Du Mont J, Armstrong K, Englesakis M, Krakowsky Y, Lorello GR, Potter E, Smith A, Urbach DR. Protocol for a scoping review on transition-related surgery procedures, outcome measures and access to care. BMJ Open 2022; 12:e054781. [PMID: 35487523 PMCID: PMC9052047 DOI: 10.1136/bmjopen-2021-054781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Transgender and gender diverse (TGD) individuals often identify with a gender different to the one assigned at birth. Transition is a term used to describe the process TGD individuals take to live as their true gender. Surgery can be a very important aspect of care for members of TGD communities. Transition-related surgery (TRS) refers to many different types of surgeries completed to meet a TGD individual's gender-related goals. While various systematic reviews have attempted to synthesise the existing peer-reviewed literature around aspects of TRS, there are few scoping reviews in this area. Our scoping review aims to address this gap through providing an up-to-date overview of the TRS literature in order to provide an overarching view of the topic. METHOD AND ANALYSIS This review will follow the methods outlined by the Joanna Briggs Institute's methodology for scoping reviews and will be reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. A search of nine scientific databases resulted in 20 062 potential articles. After removing duplicates, articles will be screened for inclusion using Covidence. Data extraction and synthesis will be carried out using NVivo and reviewed by team members. ETHICS AND DISSEMINATION As this study is a scoping review of the existing literature, no ethics review is required. The findings from this review will be disseminated through multiple pathways including open access publication, submission to conferences, social media and Listservs. The findings of the study will also be readily available to clinicians, organizations, interest groups, and policy-makers.
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Affiliation(s)
| | - Janice Du Mont
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Kathleen Armstrong
- Women's College Hospital, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | | | - Gianni R Lorello
- Women's College Hospital, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, University Health Network - Toronto Western Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Emery Potter
- Women's College Hospital, Toronto, Ontario, Canada
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17
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MacKinnon KR, Lefkowitz A, Lorello GR, Schrewe B, Soklaridis S, Kuper A. Recognizing and renaming in obstetrics: How do we take better care with language? Obstet Med 2021; 14:201-203. [PMID: 34880931 DOI: 10.1177/1753495x211060191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Ariel Lefkowitz
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Brett Schrewe
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | | | - Ayelet Kuper
- Wilson Centre for Research in Education, University Health Network/University of Toronto, Toronto, Canada
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18
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Merali Z, Malhotra AK, Balas M, Lorello GR, Flexman A, Kiran T, Witiw CD. Gender-based differences in physician payments within the fee-for-service system in Ontario: a retrospective, cross-sectional study. CMAJ 2021; 193:E1584-E1591. [PMID: 34663601 PMCID: PMC8547248 DOI: 10.1503/cmaj.210437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Differences in physician income by gender have been described in numerous jurisdictions, but few studies have looked at a Canadian cohort with adjustment for confounders. In this study, we aimed to understand differences in fee-for-service payments to men and women physicians in Ontario. Methods: We conducted a cross-sectional analysis of all Ontario physicians who submitted claims to the Ontario Health Insurance Plan (OHIP) in 2017. For each physician, we gathered demographic information from the College of Physicians and Surgeons of Ontario registry. We compared differences in physician claims between men and women in the entire cohort and within each specialty using multivariable linear regressions, controlling for length of practice, specialty and practice location. Results: We identified a cohort of 30 167 physicians who submitted claims to OHIP in 2017, including 17 992 men and 12 175 women. When controlling for confounding variables in a linear mixed-effects regression model, annual physician claims were $93 930 (95% confidence interval $88 434 to $99 431) higher for men than for women. Women claimed 74% as much as men when adjusting for covariates. This discrepancy was present in nearly all specialty categories. Men claimed more than women throughout their careers, with the greatest gap 10–15 years into practice. Interpretation: We found a gender gap in fee-for-service claims in Ontario, with women claiming less than men overall and in nearly every specialty. Further work is required to understand the root causes of the gender pay gap.
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Affiliation(s)
- Zamir Merali
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Armaan K Malhotra
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Michael Balas
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Gianni R Lorello
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Alana Flexman
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Tara Kiran
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont
| | - Christopher D Witiw
- Division of Neurosurgery (Merali, Malhotra, Balas), Department of Surgery, and Department of Anesthesiology and Pain Medicine (Lorello), University of Toronto; Department of Anesthesia and Pain Medicine (Lorello), Toronto Western Hospital - University Health Network, Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Flexman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Kiran), St. Michael's Hospital, University of Toronto; Institute of Health Policy, Management and Evaluation (Kiran, Witiw), University of Toronto; Division of Neurosurgery (Witiw), Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ont.
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19
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Lorello GR, Flexman AM. Authorship of Women in Neuroanesthesia and Neurocritical Care: Publish or Perish? J Neurosurg Anesthesiol 2021; 33:283-284. [PMID: 34267155 DOI: 10.1097/ana.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto
- Department of Anesthesia and Pain Management, Toronto Western Hospital-University Health Network
- The Wilson Centre, University Health Network
- Women's College Research Institute, Women's College Hospital, Toronto, ON
| | - Alana M Flexman
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia
- Department of Anesthesia, St. Paul's Hospital, Vancouver, BC, Canada
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20
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Roque RA, O'Reilly-Shah V, Lorello GR, Adams T, Cladis F. Transgender patient care: a prospective survey of pediatric anesthesiologist attitudes and knowledge. Can J Anaesth 2021; 68:1723-1726. [PMID: 34405355 DOI: 10.1007/s12630-021-02089-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Remigio A Roque
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
| | - Vikas O'Reilly-Shah
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Management, University Health Network - Toronto Western Hospital, Toronto, ON, Canada.,The Wilson Centre, University Health Network, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Trevor Adams
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Franklyn Cladis
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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21
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Aggarwal A, Panayi AC, Lorello GR, Silver JK. Letter to the Editor: How Do Medical Students Perceive Diversity in Orthopaedic Surgery, and How Do Their Perceptions Change After an Orthopaedic Clinical Rotation? Clin Orthop Relat Res 2021; 479:1626-1627. [PMID: 33856396 PMCID: PMC8208404 DOI: 10.1097/corr.0000000000001762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Ayushi Aggarwal
- Harvard Medical School and University of Maryland School of Medicine, Baltimore, MD, USA
| | - Adriana C. Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Gianni R. Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto Western Hospital – University Health Network, Toronto, ON, Canada
| | - Julie K. Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts General Hospital, Brigham and Women’s Hospital, and Spaulding Rehabilitation Hospital, Boston, MA, USA
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Lorello GR, Silver JK, Flores LE, Larson AR, McCarthy K, Odonkor CA, Flexman AM. Diversity of residency applicants to anaesthesiology and other specialties in the USA from 2014 to 2019. Br J Anaesth 2021; 127:e27-e30. [PMID: 34045063 DOI: 10.1016/j.bja.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; The Wilson Centre, Toronto General Hospital, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA; Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Laura E Flores
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Kristian McCarthy
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Charles A Odonkor
- Department of Orthopaedics and Rehabilitation, Division of Physiatry, Yale New Haven Hospital, New Haven, CT, USA
| | - Alana M Flexman
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada; Department of Anesthesiology, St Paul's Hospital/Providence Health Care, Vancouver, BC, Canada
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Silver EM, Flores LE, Muir R, Padilla KE, Salinas M, Lorello GR. Letter to the Editor on "Investigating faculty assessment of anesthesia trainees and the failing-to-fail phenomenon: a randomized controlled trial". Can J Anaesth 2021; 68:1300-1301. [PMID: 34031805 DOI: 10.1007/s12630-021-02029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Emily M Silver
- Department of Psychology, University of Chicago, Chicago, IL, USA
| | - Laura E Flores
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Roshell Muir
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Kathleen E Padilla
- School of Criminology and Criminal Justice, Arizona State University, Phoenix, AZ, USA
| | - Manisha Salinas
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Jacksonville, FL, USA
| | - Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada. .,Department of Anesthesia and Pain Management, University Health Network - Toronto Western Hospital, Toronto, ON, Canada. .,The Wilson Centre, University Health Network, Toronto, ON, Canada. .,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
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Peel JK, Flexman AM, Kirkham KR, Lorello GR. Gender and sexuality-based discrimination in anesthesiology within Canada: a cross-sectional survey. Can J Anaesth 2021; 68:1263-1265. [PMID: 33890238 DOI: 10.1007/s12630-021-01997-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/27/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- John K Peel
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Alana M Flexman
- Department of Anesthesiology, Pharmacology &Therapeutics, The University of British Columbia, Vancouver, BC, Canada.,Department of Anesthesia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Kyle R Kirkham
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Management, Toronto Western Hospital - University Health Network, Toronto, ON, Canada
| | - Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada. .,Department of Anesthesia and Pain Management, Toronto Western Hospital - University Health Network, Toronto, ON, Canada. .,The Wilson Centre, University Health Network, Toronto, ON, Canada. .,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
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Flexman AM, Shillcutt SK, Davies S, Lorello GR. Current status and solutions for gender equity in anaesthesia research. Anaesthesia 2021; 76 Suppl 4:32-38. [PMID: 33682100 DOI: 10.1111/anae.15361] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 11/24/2022]
Abstract
Despite increasing numbers of women entering anaesthesia, they remain persistently under-represented within academic anaesthesia and research. Gender discordance is seen across multiple aspects of research, including authorship, editorship, peer review, grant receipt, speaking and leading. Women are also under-represented at higher faculty ranks and in department chair positions. These inequities are further magnified for women with intersectional identities, such as those who identify as Black, indigenous and women of colour. Several barriers to participation in research have been identified to date, including a disproportionate amount of family responsibilities, a disproportionate burden of clinical service, gender bias, sexual harassment and the gender pay gap. Several strategies to improve gender equity have been proposed. Increasing access to formal mentorship of women in academic medicine is frequently cited and has been used by healthcare institutions and medical societies. Senior faculty and leaders must also be conscious of including women in sponsorship and networking opportunities. Institutions should provide support for parents of all genders, including supportive parental leave policies and flexible work models. Women should also be materially supported to attend formal educational conferences targeted for women, aimed at improving networking, peer support and professional development. Finally, leaders must display a clear intolerance for sexual harassment and discrimination to drive culture change. Peers and leaders alike, of all genders, can act as upstanders and speak up on behalf of targets of discrimination, both in the moment or after the fact. Gender inequities have persisted for far too long and can no longer be ignored. Diversifying the anaesthesia research community is essential to the future of the field.
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Affiliation(s)
- A M Flexman
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - S K Shillcutt
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - S Davies
- Trinity College, Cambridge University, Cambridge, UK
| | - G R Lorello
- Department of Anesthesiology and Pain Medicine, University Health Network and University of Toronto, Toronto, ON, Canada
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Lorello GR, Kuper A, Soklaridis S, Schrewe B. How discourses of gender equity during COVID-19 become exclusionary: Lessons from parenthood. J Eval Clin Pract 2021; 27:9-11. [PMID: 33150668 DOI: 10.1111/jep.13509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Gianni R Lorello
- Department of Anesthesia and Pain Medicine, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,The Wilson Centre, University Health Network/University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Toronto, Ontario, Canada
| | - Ayelet Kuper
- The Wilson Centre, University Health Network/University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sophie Soklaridis
- The Wilson Centre, University Health Network/University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Brett Schrewe
- Department of Pediatrics, The University of British Columbia, Victoria, Canada
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27
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Paton M, Naidu T, Wyatt TR, Oni O, Lorello GR, Najeeb U, Feilchenfeld Z, Waterman SJ, Whitehead CR, Kuper A. Dismantling the master's house: new ways of knowing for equity and social justice in health professions education. Adv Health Sci Educ Theory Pract 2020; 25:1107-1126. [PMID: 33136279 PMCID: PMC7605342 DOI: 10.1007/s10459-020-10006-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/21/2020] [Indexed: 05/19/2023]
Abstract
Health professions education (HPE) is built on a structural foundation of modernity based on Eurocentric epistemologies. This foundation privileges certain forms of evidence and ways of knowing and is implicated in how dominant models of HPE curricula and healthcare practice position concepts of knowledge, equity, and social justice. This invited perspectives paper frames this contemporary HPE as the "Master's House", utilizing a term referenced from the writings of Audre Lorde. It examines the theoretical underpinnings of the "Master's House" through the frame of Quijano's concept of the Colonial Matrix of Power (employing examples of coloniality, race, and sex/gender). It concludes by exploring possibilities for how these Eurocentric structures may be dismantled, with reflection and discussion on the implications and opportunities of this work in praxis.
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Affiliation(s)
- Morag Paton
- Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, 6th Floor, Toronto, ON M5G 1V7 Canada
- Department of Leadership, Higher and Adult Education, Ontario Institute for Studies in Education, University of Toronto, Toronto, Canada
| | - Thirusha Naidu
- Behavioural Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Tasha R. Wyatt
- The Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Oluwasemipe Oni
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Gianni R. Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital - University Health Network, Toronto, Canada
- The Wilson Centre, University Health Network/University of Toronto, Toronto, Canada
| | - Umberin Najeeb
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Zac Feilchenfeld
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Stephanie J. Waterman
- Department of Leadership, Higher, and Adult Education, Centre for the Study of Canadian and International Higher Education, Ontario Institute for Studies in Education, University of Toronto, Toronto, Canada
| | - Cynthia R. Whitehead
- The Wilson Centre, University Health Network/University of Toronto, Toronto, Canada
- Family and Community Medicine, Women’s College Hospital, Toronto, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ayelet Kuper
- The Wilson Centre, University Health Network/University of Toronto, Toronto, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
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28
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Peel JK, Lorello GR. Equity, diversity, and inclusion code of conduct for anesthesiology departments. Can J Anaesth 2020; 68:268-269. [PMID: 33170452 DOI: 10.1007/s12630-020-01851-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- John K Peel
- Department of Anesthesiology and Pain Medicine, The University of Toronto, Toronto, ON, Canada
| | - Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, The University of Toronto, Toronto, ON, Canada. .,University Health Network, Toronto Western Hospital - Department of Anesthesia and Pain Medicine, Toronto, ON, Canada. .,The Wilson Centre, Toronto, ON, Canada. .,Women's College Research Institute, Toronto, ON, Canada.
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Lorello GR, Silver JK, Moineau G, McCarthy K, Flexman AM. Trends in Representation of Female Applicants and Matriculants in Canadian Residency Programs Across Specialties, 1995 to 2019. JAMA Netw Open 2020; 3:e2027938. [PMID: 33231640 PMCID: PMC7686870 DOI: 10.1001/jamanetworkopen.2020.27938] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE Disparities in representation between sexes have been shown at multiple career stages in medicine despite increasing representation in the overall physician workforce. OBJECTIVE To assess sex representation of applicants to the Canadian R-1 entry match for postgraduate training programs from 1995 to 2019, comparing distribution between different specialties as well as applied vs matched applicants. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis of aggregate data provided by the Canadian Resident Matching Service between 1995 and 2019 analyzed aggregate data for the Canadian R-1 residency match from 1995 through 2019. EXPOSURES Applicant sex as reported in the Canadian Resident Matching Service database. MAIN OUTCOMES AND MEASURES The sex representation of applicants was compared and the longitudinal trends in sex representation were analyzed by specialty between 1995 and 2019. The sex representation of overall applicants to the Canadian R-1 entry match were compared with matched applicants, and both were stratified by specialty. RESULTS A total of 48 424 applicants were identified (26 407 [54.5%] female applicants), of which 41 037 were matched applicants. Using specialty groupings, female applicants were most highly represented in obstetrics and gynecology (1776 of 2090 [85.0%]) and least represented in radiology (658 of 2055 [32.0%]). Within individual subspecialties, female applicants had the lowest representation in neurosurgery (90 of 394 [22.8%]). While female applicants represented an increasing proportion of the overall applicant population between 1995 and 2019 (z = 2.71; P = .007), significant increases were seen in some, but not all, individual specialties. Differences by sex were found among Canadian medical graduate match rates to their top-ranked specialty: female applicants had a lower likelihood of being rejected for family medicine (rejection of male applicants: OR, 0.46; 95% CI, 0.39-0.54; P < .001) and psychiatry (OR, 0.59; 95% CI, 0.46-0.76; P < .001) and were more likely to be rejected for all-encompassing surgery (acceptance of male applicants: OR, 1.19; 95% CI, 1.10-1.28; P < .001). CONCLUSIONS AND RELEVANCE Increasing representation of female residency applicants over time was seen in some, but not all, medical specialties in Canada, and sex-based differences in successful match rates were observed in some specialties. The reasons for these disparities require further investigation for corrective strategies to be identified.
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Affiliation(s)
- Gianni R. Lorello
- Department of Anesthesia and Pain Medicine, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Ontario, Canada
- The Wilson Centre, Toronto, Ontario, Canada
- Women’s College Research Institute, Toronto, Ontario, Canada
| | - Julie K. Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston
- Brigham and Women’s Hospital, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Genviève Moineau
- Emergency Medicine, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ontario, Canada
- Association of Faculties of Medicine of Canada, Ottawa, Ontario, Canada
| | | | - Alana M. Flexman
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
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Maxwell C, Lorello GR. Équité, diversité et inclusion dans les départements d'obstétrique, de gynécologie et de santé reproductive. Journal of Obstetrics and Gynaecology Canada 2020; 42:936-938. [DOI: 10.1016/j.jogc.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lorello GR, Cil T, Flexman AM. Women anesthesiologists' journeys to academic leadership: a constructivist grounded theory-inspired study. Can J Anaesth 2020; 67:1130-1139. [PMID: 32514695 DOI: 10.1007/s12630-020-01735-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/11/2020] [Accepted: 06/02/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Women continue to be underrepresented in academic anesthesiology, especially in leadership positions. Possible reasons for this gender disparity include family responsibilities, inadequate mentorship, lack of desire for leadership, the leaky pipeline effect (i.e., attrition of women physicians over the course of their career trajectories), and discrimination. Our objective was to understand the lived experiences of Canadian anesthesiologists in leadership positions. METHODS In this constructivist grounded theory-inspired study, we used purposeful sampling to identify women anesthesiologists in leadership positions at one Canadian institution. Each participant underwent a one-on-one semi-structured interview of 40-60 min in length, sampling until theoretical saturation was reached. We included questions about the participant's practice setting, influences on their career, and advice the participant would provide to other women in leadership. We used an iterative approach to theoretical sampling and data analysis. The audio-recorded semi-structured interviews were transcribed and coded. NVivo12 was used for open and axial coding, and cross-referencing. RESULTS Eight women anesthesiologists were recruited and interviewed. Our iterative process identified four interconnected themes: difficulty internalizing a leadership identity, identifying systemic barriers and biases, dissonance between agentic traits and communal social gender roles, and mentorship as shaping lived experiences. Participants consistently expressed experiencing discrimination, articulated barriers related to family responsibilities and ingrained societal expectations, and discussed how typical leadership traits are applied differently to women and men. Women perceived themselves as more compassionate and communicative than men. Despite these traits, these women have expressed barriers to obtaining mentorship. CONCLUSION We identified consistent interconnected themes among the experiences of our sample of women anesthesiologists in academic leadership and found that academic anesthesiology is a gendered profession as experienced by these women leaders. Further research should focus on strategies to remove barriers to participation in academic anesthesiology for women.
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Affiliation(s)
- Gianni R Lorello
- Toronto Western Hospital, University Health Network - Department of Anesthesiology and Pain Medicine, Toronto, ON, Canada. .,Department of Anesthesiology and Pain Medicine, The University of Toronto, Toronto, ON, Canada. .,The Wilson Centre, Toronto, ON, Canada.
| | - Tulin Cil
- The Wilson Centre, Toronto, ON, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Department of Surgery, Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Alana M Flexman
- Vancouver General Hospital - Department of Anesthesiology, Vancouver, BC, Canada.,Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada
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Lorello GR. Leading progress: the role of the chief diversity officer in anesthesiology departments. Can J Anaesth 2020; 67:612-614. [DOI: 10.1007/s12630-019-01530-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022] Open
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Lorello GR, Parmar A, Flexman AM. Representation of women amongst speakers at the Canadian Anesthesiologists' Society annual meeting: a retrospective analysis from 2007 to 2019. Can J Anaesth 2020; 67:430-436. [PMID: 31691254 DOI: 10.1007/s12630-019-01524-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/08/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Despite an increase in the proportion of women entering the field of anesthesiology, women remain underrepresented in academic and leadership positions. Speaking at national and international conferences is an important component of academic visibility and promotion. To date, the gender representation of speakers at the Canadian Anesthesiologists' Society (CAS) annual meeting has not been examined. METHODS We conducted a retrospective analysis of the representation of women amongst speakers at the CAS annual meeting between 2007 and 2019, inclusively. We also examined the representation of women in different subspecialty subject area symposia at each CAS annual meeting, and the gender composition of meeting symposia panels (i.e., groups of two or more speakers in a session) at the meeting. RESULTS Overall, 28.5% (358/1,256) of speaker slots included women, similar to their representation in Canadian clinical anesthesiology over the study period (26.7%), and increasing significantly over the study period. Women were more highly represented as obstetric anesthesia speakers at the CAS annual meetings, with lower representation in cardiothoracic anesthesia, transplant anesthesia, and critical care symposia. Of the 311 meeting symposia, 146 (46%) were composed of all men speakers. CONCLUSION The representation of women speakers at the CAS annual meeting was similar to the representation of women in the anesthesiology workforce in Canada over the study period. Gender representation varied widely by subspecialty symposia, subject area, and women were absent from nearly half of all symposia at the CAS annual meetings, which are potential areas of future investigation and intervention.
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Affiliation(s)
- Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
- Department of Anesthesia, The University of Toronto, Toronto, ON, Canada.
- The Wilson Centre, Toronto, ON, Canada.
- Toronto Western Hospital, University Health Network, 399 Bathurst Avenue, McL 2-405, Toronto, ON, M5T 2S8, Canada.
| | - Arun Parmar
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Alana M Flexman
- Department of Anesthesiology, Vancouver General Hospital, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada
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Bosco L, Lorello GR, Flexman AM, Hastie MJ. Women in anaesthesia: a scoping review. Br J Anaesth 2020; 124:e134-e147. [PMID: 31983412 DOI: 10.1016/j.bja.2019.12.021] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022] Open
Abstract
Despite an increase in the proportion of women anaesthesiologists over time, women remain under-represented in academic and leadership positions, honour awards, and academic promotion. Current literature has identified several reasons for the observed gender disparity in anaesthesiology leadership and faculty positions, including unsupportive work environments, lack of mentorship, personal choices, childcare responsibilities, and active discrimination against women. A scoping review design was selected to examine the nature and extent of available research. Our review provides an overview of the literature that explores gender issues in anaesthesiology, identifies gaps in the literature, and appraises effective strategies to improve gender equity in anaesthesiology. We searched PubMed, MEDLINE, and EMBASE up to July 2019, and included 30 studies for analysis. Most reports used retrospective or survey methodologies. The review shows that women anaesthesiologists face gender biases in the work environment, are under-represented in various positions of leadership or influence, and as authors. Work-life demands may impose a challenge. Motivation and interest in career advancement of women anaesthesiologists have not been well studied. Several strategies have been proposed, ranging from an individual to administrative level, which may help anaesthesiologists achieve equal representation of women in the field.
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Affiliation(s)
- Laura Bosco
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Postgraduate Medical Education, Toronto, ON, Canada
| | - Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, Toronto Western Hospital - University Health Network, Toronto, ON, Canada; The Wilson Centre, University Health Network, Toronto, ON, Canada.
| | - Alana M Flexman
- Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Maya J Hastie
- Department of Anesthesiology, Columbia University, New York, NY, USA
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Ng SL, Kangasjarvi E, Lorello GR, Nemoy L, Brydges R. 'There shouldn't be anything wrong with not knowing': epistemologies in simulation. Med Educ 2019; 53:1049-1059. [PMID: 31418455 DOI: 10.1111/medu.13928] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/09/2019] [Accepted: 06/11/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Medical education embraces simulation-based education (SBE). However, key SBE features purported to support learning, such as learner safety and learning through experience and error, may not align with the dominant culture of medicine, in which portraying confidence and certainty about one's knowledge prevails. Misaligned conceptions about knowledge and learning may produce unintended negative effects, including the suboptimal implementation of SBE, which could consequently compromise SBE and its outcomes. METHODS To uncover the epistemological beliefs of students experiencing SBE, we conducted a theory-informed analysis of interviews with 24 pre-clerkship medical students following their participation in an SBE training study. Our analysis borrowed from coding methods common in constructivist grounded theory and used Hofer and Pintrich's four dimensions of epistemology as sensitising concepts. RESULTS Participants subscribed to a dominant view of knowledge as consisting of concrete facts, derived from external sources. By contrast, they described but did not prioritise a conception of building their own knowledge through different learning experiences. Participants positioned experts (i.e. teaching faculty members) as the ultimate knowledge validators through their presence and feedback. Participants also noted that faculty staff could counter medicine's pressures to perform with certainty and confidence at all times by instead embodying and modelling an authentic appreciation of learning through experiences, errors and discovery. CONCLUSIONS Medicine's tendency to idealise the objective pursuit of singular truths may compromise the purported culture of SBE as a space for learning many wide-ranging aspects of medicine, including how and when to innovate and deviate from norms. Explicit attempts to bridge the epistemological beliefs of medicine and SBE may better enable the realisation of safe experiential learning. Faculty members are positioned to play key roles in enabling this bridging.
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Affiliation(s)
- Stella L Ng
- Centre for Faculty Development, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Emilia Kangasjarvi
- Centre for Faculty Development, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital - University Health Network, Toronto, Ontario, Canada
- Department of Anesthesia, Faculty of Medicine, Toronto, Ontario, Canada
| | - Lori Nemoy
- Allan Waters Family Simulation Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ryan Brydges
- Allan Waters Family Simulation Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Bennitz J, Simons M, Lorello GR. Arteriovenous fistula and high output cardiac failure in a double lung transplant patient. BMJ Case Rep 2019; 12:12/8/e229776. [PMID: 31466976 DOI: 10.1136/bcr-2019-229776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a case of a high cardiac output (CO) arteriovenous fistula (AVF) with pulmonary hypertension (PH) post-double lung transplant presenting for AVF occlusion. The patient presented with a CO of 9.83 L/min, pulmonary artery pressures of 64/16, inferior vena cava dilatation and an AVF between the left common iliac artery and vein. Given her anaesthetic considerations, we elected to proceed with local anaesthesia and sedation. Trial balloon occlusion resulted in an increase in blood pressure and a headache that resolved with balloon deflation. Successful final occlusion with an endovascular stent was completed without adverse events. PH is a complex pathophysiology with the potential for catastrophic decompensation. Anaesthesiologists must consider a patient's comorbidities and the procedure to safely administer anaesthesia without complications.
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Affiliation(s)
- Joshua Bennitz
- Department of Anesthesiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Martin Simons
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Gianni R Lorello
- Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Lorello GR, Parmar A, Flexman AM. Representation of women on the editorial board of the Canadian Journal of Anesthesia: a retrospective analysis from 1954 to 2018. Can J Anaesth 2019; 66:989-990. [PMID: 31037587 DOI: 10.1007/s12630-019-01378-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, University Health Network, Toronto, ON, Canada.
- Department of Anesthesia, The University of Toronto, Toronto, ON, Canada.
- The Wilson Centre, Toronto, ON, Canada.
| | - Arun Parmar
- Department of Anesthesiology and Pain Medicine, University Health Network, Toronto, ON, Canada
| | - Alana M Flexman
- Department of Anesthesiology, Vancouver General Hospital, Vancouver, BC, Canada
- Department of Anesthesiology and Perioperative Care, The University of British Columbia, Vancouver, BC, Canada
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Lorello GR, Flexman AM. Is it time for #UsToo in the medical profession? CMAJ 2019; 191:E480. [DOI: 10.1503/cmaj.71814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Lorello GR, Flexman AM. 75 years of leadership in the Canadian Anesthesiologists' Society: a gender analysis. Can J Anaesth 2019; 66:843-844. [PMID: 30941672 DOI: 10.1007/s12630-019-01359-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Gianni R Lorello
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada. .,Toronto Western Hospital, University Health Network, Toronto, ON, Canada. .,The Wilson Centre, University Health Network, Toronto, ON, Canada.
| | - Alana M Flexman
- Vancouver General Hospital - Department of Anesthesiology, Vancouver, BC, Canada.,Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada
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Lorello GR, Flexman AM. Potential gender remuneration gaps in anesthesiology. Can J Anaesth 2019; 66:470-471. [PMID: 30460605 DOI: 10.1007/s12630-018-1259-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 11/13/2018] [Accepted: 11/13/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Gianni R Lorello
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada. .,Toronto Western Hospital, University Health Network, Toronto, ON, Canada. .,The Wilson Centre, University Health Network, Toronto, ON, Canada.
| | - Alana M Flexman
- Department of Anesthesiology, Vancouver General Hospital, Vancouver, BC, Canada.,Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada
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Flexman AM, Parmar A, Lorello GR. Representation of female authors in the Canadian Journal of Anesthesia: a retrospective analysis of articles between 1954 and 2017. Can J Anaesth 2019; 66:495-502. [PMID: 30805906 DOI: 10.1007/s12630-019-01328-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/28/2018] [Accepted: 12/01/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Females remain under-represented in academic anesthesiology. Our objectives were to investigate gender differences over time in the first and last authors of published articles as well as corresponding citation rates in the Canadian Journal of Anesthesia (CJA). METHODS We conducted a cross-sectional, retrospective analysis of first and last authors' gender from editorials and original articles published in the CJA in a sample of one calendar year of each decade between 1954 to 2017. We analyzed the relationships between author gender, year of publication, article type, and number of citations. RESULTS Out of 639 articles identified, 542 (85%) were original investigations and 97 (15%) were editorials. Where gender could be confidently identified, the majority (461/571, 81%) of first authors were male. Although there was an increase in the proportion of female first authors over time, this increase was outpaced by the overall increase in female anesthesiologists in Canada. Original articles received more citations and were more likely to have a female first author than editorial articles were. An original article with a female first author resulted in 0.34 (95% confidence interval, 0.28 to 0.39; P < 0.001) more citations per article than a male first author when adjusting for year of publication. CONCLUSIONS Our study shows that, despite a slow increase over time, female authors are under-represented relative to male authors in the CJA and relative to the changing demographics of anesthesiologists in Canada. The reasons for this disparity are multifactorial and further research is needed to identify effective solutions.
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Affiliation(s)
- Alana M Flexman
- Department of Anesthesiology, Vancouver General Hospital, Vancouver, BC, Canada.,Department of Anesthesiology and Perioperative Care, The University of British Columbia, Vancouver, BC, Canada
| | - Arun Parmar
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, 399 Bathurst Avenue, McL 2-405, Toronto, ON, M5T 2S8, Canada
| | - Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, 399 Bathurst Avenue, McL 2-405, Toronto, ON, M5T 2S8, Canada. .,Department of Anesthesia, The University of Toronto, Toronto, ON, Canada. .,The Wilson Centre, Toronto, ON, Canada.
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Plyley T, Cory J, Lorello GR, Flexman AM. A survey of mentor gender preferences amongst anesthesiology residents at the University of British Columbia. Can J Anaesth 2018; 66:342-343. [PMID: 30484164 DOI: 10.1007/s12630-018-1260-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Tyler Plyley
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Julia Cory
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Department of Anesthesia, The University of Toronto, Toronto, ON, Canada.,The Wilson Centre, Toronto, ON, Canada
| | - Alana M Flexman
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada. .,Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, Vancouver, BC, Canada.
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Lorello GR, Legault MC, Rakić B, Bisgaard K, Pezacki JP. Synthesis and bioorthogonal coupling chemistry of a novel cyclopentenone-containing unnatural tyrosine analogue. Bioorg Chem 2008; 36:105-11. [DOI: 10.1016/j.bioorg.2007.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 12/13/2007] [Accepted: 12/27/2007] [Indexed: 10/22/2022]
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Costello F, Coupland S, Hodge W, Lorello GR, Koroluk J, Pan YI, Freedman MS, Zackon DH, Kardon RH. Quantifying axonal loss after optic neuritis with optical coherence tomography. Ann Neurol 2006; 59:963-9. [PMID: 16718705 DOI: 10.1002/ana.20851] [Citation(s) in RCA: 448] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine to what degree changes in retinal nerve fiber layer (RNFL) thickness after optic neuritis (ON) correlate with either visual recovery or impairment. METHODS ON can cause visible defects within the RNFL, which can be quantified using optical coherence tomography (OCT). It may be possible to predict visual recovery by measuring RNFL loss after ON. Fifty-four patients underwent repeated evaluations with optical coherence tomography and standardized ophthalmic testing after ON. Regression analyses were used to determine the relationship between RNFL thickness and visual function. RESULTS Thinning of the RNFL was seen in the majority of patients (74%), and it tended to occur within 3 to 6 months of ON. The average RNFL value was thinner (p<0.0001) in the affected (78 microm) compared with the unaffected eye (100 microm). Patients with incomplete visual recovery demonstrated greater RNFL loss after ON. Regression analyses demonstrated a threshold of RNFL thickness (75 microm), below which RNFL measurements predicted persistent visual dysfunction. INTERPRETATION Determination of RNFL thickness may predict visual recovery after ON, and lower RNFL values correlate with impaired visual function. Optical coherence tomography may have a potential role as a surrogate marker for axonal integrity within the optic nerve among patients with ON.
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Abstract
Antifreeze glycoproteins (AFGPs) have many potential applications ranging from the cryopreservation and hypothermic storage of tissues and organs to the preservation of various frozen food products. Since supplying native AFGP for these applications is a labor-intensive and costly process, the rational design and synthesis of functional AFGP analogues is a very attractive alternative. While structure-function studies have implicated specific structural motifs as essential for antifreeze activity in AFGP, the relationship between solution conformation and antifreeze activity is poorly understood. Toward this end, we have analyzed AFGP8 in aqueous solutions using dynamic light scattering (DLS) and circular dichroism (CD). Our results indicate that AFGP8 forms discrete aggregates in solution. These aggregates are predominantly composed of dimers that form at solution concentrations greater than 20 mM. CD spectroscopy indicates that the preferred solution conformation of AFGP8 is consistent with that of random coil. However, significant beta-sheet and alpha-helix character is observed in more concentrated solutions, indicating that these glycopeptides are highly flexible in solution. Aggregation appears to have a minimal effect on the overall solution conformation. Thermal hysteresis (TH) activity of the aggregated solutions is much higher than that of less concentrated solutions that do not form aggregates. While cooperative functioning between lower and higher molecular weight AFGPs has been reported, this is the first instance where cooperative functioning in lower molecular weight AFGPs has been observed.
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Affiliation(s)
- Vincent R Bouvet
- Department of Chemistry, 10 Marie Curie, University of Ottawa, Ottawa, Ontario, Canada K1N 6N5
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