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 Table of Contents  
Year : 2019  |  Volume : 5  |  Issue : 3  |  Page : 240-301

Inaugural Women in Medicine Summit: An Evolution of Empowerment in Chicago, Illinois, September 20 and 21, 2019: Event Highlights, Scientific Abstracts, and Dancing with Markers

1 Department of Medicine, Rush University Medical Center, Chicago, IL, USA
2 Department of Surgery, Northwestern University, Northwestern Trauma and Surgical Initiative, Northwestern Trauma and Surgical Initiative; St. George's University School of Medicine; Department of Surgery, InciSioN: The International Student Surgical Network, Chicago, IL, USA
3 Department of Surgery, Northwestern University, Northwestern Trauma and Surgical Initiative, Northwestern Trauma and Surgical Initiative; Northwestern University, Feinberg School of Medicine, Chicago, IL, USA

Date of Web Publication24-Dec-2019

Correspondence Address:
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2455-5568.273937

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How to cite this article:
Jain S, Madani KS, Swaroop M. Inaugural Women in Medicine Summit: An Evolution of Empowerment in Chicago, Illinois, September 20 and 21, 2019: Event Highlights, Scientific Abstracts, and Dancing with Markers. Int J Acad Med 2019;5:240-301

How to cite this URL:
Jain S, Madani KS, Swaroop M. Inaugural Women in Medicine Summit: An Evolution of Empowerment in Chicago, Illinois, September 20 and 21, 2019: Event Highlights, Scientific Abstracts, and Dancing with Markers. Int J Acad Med [serial online] 2019 [cited 2023 Jun 9];5:240-301. Available from: https://www.ijam-web.org/text.asp?2019/5/3/240/273937

The Women in Medicine Summit (WIMS) was founded in 2019 as a unification of women in medicine, with the common goal of finding and implementing solutions to gender inequity. The purpose of the WIMS is to educate women on the disparities present in our healthcare system, to provide educational sessions for professional and personal growth and development, and to empower women with evidence-based solutions to ultimately close the gender gap in healthcare.

Breakout sessions and presentations were given by diverse women from various specialties and institutions to deliver evidence-based information and present tools and solutions to be utilized in gauging issues and working toward fixing the system. This continuing medical education (CME) event also provided a forum in which women could brainstorm, across specialties, to formulate questions and answers needed toward changing the system at their home institution to their specialty-specific organizations and at a national and even an international level.

By design, WIMS aims to amplify the lives of women in medicine by bringing together women from across the globe and from multiple disciplines; with attendees from 32 states and the District of Columbia, nationally, representatives globally from Australia, Bangladesh, Canada, Ethiopia, Kenya, Rwanda, and Singapore were present. From Chicago, all the institutions in the city united to work together, amplify together, and empower together. The Conference was memorialized by Lauren Green from Dancing with Markers and each lecture was beautifully documented in real time (refer Figures for each lecture and breakout).

The initial impetus for the WIMS came from the Women in Medicine Symposium founded in 2018 after Dr. Shikha Jain realized a need for a multidisciplinary conference focused on women in healthcare in Chicago. Together with Dr. Mamta Swaroop, the Women in Medicine Symposium at Northwestern University was created with over 200 women physicians in attendance. With the success of this first event and the opportunity to develop a multi-institutional, multi-specialty event with executive sponsorship from Rush University Medical Center, and co-sponsorship from multiple academic and community institutions and organizations from both Chicago and across the nation, the WIMS was intentionally composed. The WIMS hosted 19 top-tier collaborative medical institutions and organizations with more than 425 medical professionals registered. The 2-day conference consisted of plenary sessions, breakout sessions, oral abstract and poster presentations, one-on-one mentoring for students, trainees, and young faculty, an award ceremony, and networking sessions. Speakers included internationally renowned physicians, lawyers, educators, administrators, advocates, scientists, researchers, trainees, students, and thought-leaders globally.

The multi-institutional conference was planned by a steering committee made of physicians from Rush University Medical Center, the University of Chicago, Northwestern Memorial Hospital, Loyola Medical Center, the University of Illinois, John H. Stroger Jr. Hospital of Cook County, Rosalind Franklin University of Medical Science, South Illinois University School of Medicine, Community Hospital, the American Medical Association (AMA), the American Medical Women's Association (AMWA), the Illinois State Medical Society, Chicago Medical Society, American College of Physicians, the American College of Surgeons Women in Surgery, Association of Women Surgeons, 500 Women in Medicine, and the Society for Vascular Surgery. Endorsements from 50 organizations and institutions from multiple disciplines also showcased the support of this innovative and necessary CME event.

The research committee sent out a call for abstracts, perspective, and spotlight pieces for submission to be presented or published in the IJAM. The research committee, consisting of seven physicians, along with both course directors reviewed submissions, and the top nine original abstracts were chosen to be presented during the oral abstract session and others were selected for poster presentation. Three physicians judged the oral abstract sessions and two judged the poster presentations. The top oral and poster presentations were announced at the award ceremony.

Abstract/Research Committee: Parul Barry, MD (Chair), Vidya Sundareshan, MD, Sheila Dugan, MD, Tochukwu M. Okwuosa, DO, Neelum Aggarwal, MD, Nancy Church, MD, Meenakshi Jolly, MD.

The 2019 WIMS abstract winners are given below:

  1. Best Oral Presentation: Deena Kishawi, BSc currently a 4th-year medical student at the Stritch School of Medicine, Loyola University in Chicago, Illinois, for her abstract: Hijab in the Operating Room: How to Address Barriers that Prevent Hijab-Wearing Women from Pursuing Careers in Surgery
  2. Best Poster: Sabrina Dass, BSc currently a 2nd-year medical student at Wayne State University School of Medicine in Detroit, Michigan, for her abstract: Gender Differences in Attitudes toward Substance Use Disorder: Educational Improvements in Addiction Medicine in Detroit, MI.

The Awards Committee sent out a call for submissions for three #IStandwithHer awards. Nominated by their peers, the award winners were selected on their embodiment of the qualities of perseverance, resilience, leadership, and/or allyship. The Awards Committee, consisting of seven physicians, along with both course directors reviewed submissions and the top three candidates were chosen for award with honorable mentions to five individuals for the SheforShe #IStandwithHer award, three individuals for the HeforShe #IStandwithHer awards, and three individuals for the Resilence #IStandwithHer award. The winners were announced at the award ceremony, held on the 2nd day of the WIMS.

Award Committee: Leah Tatebe, MD (Chair), Julie Oyler, MD, Oluwatoyin (Toyin) Adeyemi, MD, Priya Kumthekar, MD, Vidhya Prakash, MD.


Winner: Dara Kass, MD

Honorable Mention: Deborah Burnet, MD, Nancy Spector, MD, Jessica Servey, MD, Vineet Arora, MD, Arghavan Salles, MD.


Winner: Arthur Pancioli, MD

Honorable Mention: Kim A. Williams, MD, Elbert Huang, MD, James Ryan Stewart, DO.


Winner: Colette Mull, MD

Honorable Mention: Maria Artunduaga, MD, Julia Baird, MD, Sarah Diekman, MD.

  Keynote Speakers Top

Julie Silver, MD

A Trailblazing Visionary of Gender Equity

Named a Top Innovator in Medicine in 2012 by The Boston Globe, Dr. Silver is the Associate Chair in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is known for her ground-breaking work on impairment-driven cancer rehabilitation and developed a best practice model for cancer rehabilitation that has been adopted by hundreds of hospitals in the U.S. She has committed to supporting the healthcare workforce and is a nationally recognized expert on inclusion, diversity, and equity. Her work in equity intersects with dissemination and implementation of science as well as with physician burnout. She has spearheaded groundbreaking research and numerous initiatives, such as #WallsDoTalk, #BeEthical, and the #NeedHerScience campaigns and published extensively on the topic in high-impact journals that include the New England Journal of Medicine and multiple Journal of the American Medical Association Network journals. Dr. Silver directs two highly acclaimed annual CME courses at Harvard Medical School: (1) Writing, Publishing, and Social Media for Healthcare Professionals and (2) Career Advancement and Leadership Skills for Women in Healthcare. These courses have trained thousands of physicians and other healthcare leaders throughout the U.S. and internationally.

Pauline Clance, PhD, ABPP

An Innovative Illuminator of the Impostor Phenomenon

The Georgia Author of the Year Award recipient for her 1985 book, The Impostor Phenomenon: Overcoming the Fear that Haunts Your Success. Dr. Pauline Rose Clance, Professor Emerita of Psychology at Georgia State University in Atlanta, Georgia, developed the term Impostor Phenomenon (IP) with Dr. Suzanne Imes and co-authored a founding article in 1978 which led to worldwide research and media interest in the topic. Many studies on the IP have been conducted worldwide, in countries including Holland, Korea, China, Sweden, Iran, India, Egypt, Australia, Canada, and the UK. The Clance IP Scale has been translated for use in several countries, including Japan, Poland, Denmark, and Pakistan. Her original IP book has been translated into Russian, German, French, and Norwegian and is now digitally available on Amazon. Since its conception over 38 years ago, Dr. Clance's IP continues to elicit new professional and academic interest and application each year.

  Day 1: September 20, 2019 Top

On the 1st day of the WIMS, attendees, speakers, and exhibitors were welcomed by Dr. Shikha Jain and Dr. Mamta Swaroop, who started the 2-day Summit with data-driven evidence showing the ongoing issue of the gender gap in healthcare and the importance of conferences, such as this one, in serving toward closing the gap [Exhibit 1].

Each day of the Summit began with a Keynote address. Dr. Julie Silver, an Associate Professor and Associate Chair in the Department of Physical Medicine and Rehabilitation at Harvard Medical School, is a trailblazer in the gender equity space and an internationally recognized leader in the field. Her talk focused on the importance of utilizing evidence-based data to move toward impactful change in the gender disparities that exist in healthcare [Exhibit 2].

After the Keynote, Dr. Dana Corriel spoke on the effectiveness and impact of using social media for advocacy and described ways to create a platform to further work toward gender equity. Historically, women have been tremendous advocates for others; however, when it comes to themselves, it is the exact opposite [Exhibit 3]. Dr. Victoria Medvec shed light on the reasons for this behavior, sharing important strategies on how to be one's own best advocate [Exhibit 4]. Dr. Caprice Greenberg spoke on the importance of focusing on fixing the system and not women [Exhibit 5]. To end the morning sessions, a panel of men and women who have been champions for women and have found strategies men can utilize to be effective allies, shared their experiences and wisdom on a #HeForShe panel. The panel was moderated by Dr. Shikha Jain and medical student Kate Gerull, one of the founders of the 500 Women in Medicine, and the panel included Drs. Thomas Varghese, Julie Silver, Lewis Flint, Howard Liu, Omar Lateef, and Michael Sinha. They discussed the challenges and solutions each of them found, individually and within their institutions, to help women navigate a system that often has barriers in place for their advancement [Exhibit 6].

During the lunch hour, the top oral abstracts were presented in a room with attendees and a panel of judges. In parallel, a lunch session led by Women Writers in Medicine titled, From NEJM to the New York Times: Writing for Publication and Career Advancement, was given [Exhibit 7].

Lunch session focused on writing for publication and career advancement.

Lunch was followed by breakout sessions and individual mentoring sessions. Mentors and mentees had been assigned at the time of registration for the conference, and a range of specialties and areas of expertise were represented.

Breakout sessions organized throughout the afternoon focused on topics ranging from advocacy through engagement and health policy, “faking it till you make it,” work–life integration, financial health, finding leadership styles, sexual harassment, and how to best utilize social media in healthcare.

The day closed with a summary of key points from each breakout session led by Dr. Shikha Jain and was followed by a poster walk with presentation and judging of the posters and a networking reception for everyone in attendance to put their recently learned skills into practice and further solidifying the awareness that one's network is one's net worth.

  Day 2: September 21, 2019 Top

The 2nd day of the Summit began with opening remarks summarizing day 1 from the course directors. An amazing Keynote address was delivered by Dr. Pauline Clance, a Diplomat of the American Board of Professional Psychology. She imparted an insightful lecture about the Imposter Phenomenon (IP). Dr. Clance provided the audience with a “Clance IP Scale,” developed to help individuals determine whether or not they have IP characteristics [Exhibit 8]. Dr. Clance continued the discussion during her breakout session. The morning continued with a panel discussion moderated by Dr. Swaroop and Maren Loe, a medical student and one of the founders of the 500 Women in Medicine, entitled Looking Back to See Our Future: How Far We Have Come including Drs. Michaela West, Patricia Finn, Catherine DeVries, and Dinee Simpson. The panelists shared their narrative and gave leadership advice to the audience [Exhibit 9]. Continuing on the topic of leadership, the panel Leading In: Discover Your Legacy and Becoming a Woman of Impact was delivered by Drs. Vineet Arora, Karen Remley, and Christine Malcolm. They shared the importance of creating a legacy statement and mapping out career goals early. The Director of Healthcare Leadership at Creighton University, Mrs. Laurie Baedke, held her largest coaching session, uniquely tailored for the WIMS, passionately delivered, and perfectly named to close the morning session, Making the Journey Together [Exhibit 10].

Day 2 Keynote speech was delivered by Dr. Pauline Rose Clance on The IP.

Panel Looking Back to See Our Future, How Far We Have Come, a group of distinguished women in medicine talking about lessons learned throughout their careers.

During lunch, Drs. Jain and Swaroop presented the research and IStandWithHer awards to recipients and recognized all the award nominees. Following a lunch break, the afternoon was filled with breakout sessions on topics from advancing the mission of your women's committee and task force, getting involved in a national organization, identifying and overcoming implicit bias, medical student and resident empowerment, navigating a path to becoming a thought leader, communicating in difficult situations, speaker training, the impostor phenomenon to breaking barriers for diverse women.

After Dr. Jain led a final discussion on the breakout sessions, she closed the WIMS with an announcement for the next year WIMS to be held on October 9 and 10, 2020, in Chicago, Illinois, and a promise to continue to work toward fixing the system and improving gender parity, together.



  Breakout Sessions Top

Breakout Session 1: Fake it till you make it: positioning yourself for power

Caprice Greenberg, MD, MPH, FACS

Dr. Greenberg addressed the fallacy that individuals start their careers having all of the abilities needed to succeed [Exhibit 11].

Breakout Session 2: Financial health for women

Treasa Moran

Ms. Moran, a financial advisor, presented simple, noteworthy points on how to build financial stability when such an accomplishment has always been intended for our male counterparts [Exhibit 12].

Breakout Session 3: Finding your way in medicine: Pregnancy, elderly care, family planning

Alison Escalante, MD

Dr. Escalante gave a how to session on striving for work–life integration, rather than work–life balance [Exhibit 12].

Breakout Session 4: Finding your leadership style

Karen J. Nichols DO, MA, MACOI, CS

Dr. Nichols led a session to determine the leadership and communication approach of individuals [Exhibit 13].

Breakout Session 5: How to use social media

Dana Corriel, MD

Dr. Corriel explained how social media is a live organism and the opportunities provided by social media to inform and connect with peers are unparalleled [Exhibit 14].

Breakout Session 6: Sexual harassment

April Walkup, JD; Arghavan Salles, MD, PhD; Jessica Gold MD, MS

The rise in sexual harassment lawsuits since the Me Too movement's birth has come as a surprise to half of the population; the half doing the harassing.

Breakout Session 7: Advocacy through engagement: Advancing health policy at the local, regional, and national level

Michael Sinha MD, JD, MPH; Katherine Tynus MD, FACP

Ideas need action to go from theory to reality. With legislative advocacy, a great gap exists in the knowledge of these methods for those in medicine [Exhibit 12].

Breakout Session 8: Advancing the mission of your women's committee

Sheila Dugan, MD

In her talk, Dr. Dugan discussed steps toward building an institutional movement [Exhibit 15].

Breakout Session 9: Breaking barriers for diverse women

Tochukwu Okwuosa, DO; Monica Vela, MD

Drs. Okwuosa and Vela explored with the group several ways to combat the impact of racism in their session, using Research, Illuminate, Steer, and declare Exigency (RISE) [Exhibit 15].

Breakout Session 10: Skill building: Difficult situations, managing up, coaching

Andrea Kramer JD; Alton B. Harris, JD

Speakers Mrs. Kramer and Mr. Harris provided guidance on overcoming stereotypes and practical and effective techniques to respond to difficult situations women face when interacting with colleagues, staff, and patients and their families [Exhibit 15], [Exhibit 16], [Exhibit 17].

Breakout Session 11: Getting involved in a national organization

Neelum Aggarwal, MD

Dr. Aggarwal actively analyzed the skills needed for leadership development starting with a self-assessment on working in groups and personal strengths to benefit a team [Exhibit 15].

Breakout Session 12: Identifying and overcoming implicit bias

Cheryl Pritlove, PhD; Elizabeth Metraux

Dr. Pritlove and Ms. Metraux examined implicit bias and discussed strategies on how to identify and overcome.

Breakout Session 13: Medical student/resident empowerment

Isobel Marks, MBBS, MA

Ms. Marks, a surgical trainee in London, reviewed the role played by advocacy, engagement, and policy in the empowerment of the female workforce worldwide [Exhibit 15].

Breakout Session 14: Navigating a path to becoming an expert/thought leader

Laurie Baedke, MHA, FACHE, FACMPE

Mrs. Baedke explored in depth what is required to become an expert on a subject [Exhibit 18].

Breakout Session 15: Speaker training

Rachel Caskey, MD, MAPP

Dr. Caskey highlighted the importance of delivery in addition to the content of any presentation. From tone to the body language and font, it all matters when delivering a message [Exhibit 15].


We would like to acknowledge the Rush University Cancer Center for sponsoring the publication of the WIMS submissions in IJAM and Lauren E. Green, Owner, Executive Director of Dancing with Markers whose art memorialized the WIMS. We would like to thank Polly Rossi and her team at Meeting Achievements without whom the WIMS would not have been possible. We would like to recognize the work of her Northwestern Trauma and Surgical Initiative Fellow Katayoun Madani, and her Global Surgery Research Associates, Veronica Velasquez and Liza Vitkovskaya, without whom the pages would be blank and gravity would remain a theory.

If you want to lift yourself up, lift up someone else.

– Booker T. Washington

  Table of Exhibits Top

Exhibit 1: Opening Remarks 3

Exhibit 2: Keynote: Gender Equity 4

Exhibit 3: Social Media for Advocacy 5

Exhibit 4: Negotiation and Self Advocacy 5

Exhibit 5: Stop Fixing Women and Start Fixing the System 6

Exhibit 6: #HeForShe 6

Exhibit 7: From NEJM to the New York Times 7

Exhibit 8: Keynote the Impostor Phenomenon 8

Exhibit 9: Looking Back to See Our Future 9

Exhibit 10: Leading In 9

Exhibit 11: Fake It Till You Make It 10

Exhibit 12: Day 1 Some of the Breakout Sessions 11

Exhibit 13: Finding Your Leadership Style 12

Exhibit 14: How to Use Social Media 12

Exhibit 15: Day 2 Some of the Breakout Sessions 13

Exhibit 16: Coaching Session 14

Exhibit 17: Communicating in Difficult Situations 14

Exhibit 18: Navigating a Path 15

I can clearly recall my thoughts during the conversation my daughter and I had about how men and women were often treated differently. She was telling me about her friend Emma, a girl who had spent the night at our home, made a fort in my daughter's room, and giggled at dinner, who cut off all her hair in solidarity with her friend and namesake who had cancer. As she told me how Emma was treated when she had short hair and people thought she was a boy, I must admit, I was curious to what privilege she was privy. Reflecting on the lives of my best friend Anita, my mother, my aunt, my grandmother all the way to my baby cousin sister, I could consider only the benefits of being a young man. As I began reading of gender socialization in schools, my perspective and reactionary attitude were both simply wrong. We facilitate certain behaviors and encourage particular activities, all the while disciplining and expecting a cadre of distinct expectations from our children. We then hope for equity and equality in the treatment of our daughters.

– Mamta Swaroop, MD FACS

The following piece is written by Emma Hann, currently an eighth grader at Thomas Jefferson Middle School.


E. M. Hann

Thomas Jefferson Middle School, Indiana

I was in the fifth grade when one of my close friends, Emma, lost the battle against cancer. Emma was diagnosed with cancer when we were in the fourth grade. Emma and I hung out after school almost every day before she was taken out of school due to her diagnosis. When she lost the battle against cancer, I was devastated. I decided that I had to do something to help others who had to go through what Emma went through. My school was hosting a St. Baldrick's event to raise funds to help cure childhood cancer. I decided to participate to honor Emma. In just 2 months going door to door and asking family and friends to donate, every chance I could, I raised $2500. Not only was the purpose of St. Baldrick's to raise money, but it was also to donate your hair to cancer patients. I realized that I took my hair for granted while other kids would do anything just to have hair. I knew my hair would grow back, anyway. After I raised as much money as I could, I shaved all of my hair off and donated it to other kids like Emma.

For the first couple of months after shaving my head, people often mistook me for a boy. I noticed that I was treated more harshly by people who thought I was a boy than when I looked more like a girl.

Several times, when a stranger would accidentally bump into me or something like that, they would ignore me without apologizing. However, when I had longer hair, people apologized almost every time that happened.

Sometimes, I would run through a parking lot to get to the car and I never got yelled at for doing it until I shaved my head. It was cold 1 day and I wanted to get the car as quickly as possible, so I ran through the parking lot. A lady saw me running and pulled her car over. She yelled out of her window at me, something like, “Hey bud, you know you're not allowed to run in a parking lot. You should know better than that!” in an unkind, reprimanding manner. I told her I was sorry and she drove away. If that happened to me back when I had long hair, I think she would have been more concerned and understanding.

When I moved to a new state and a new school, no one knew that I used to have long hair. I think some people thought I was a boy and none of the girl classmates really approached me to be friends. I was used to having lots of friends, so this was weird for me. Once they heard my name and knew for sure I was a girl, they became more friendly.

Taking Charge of the Change in Culture

K. S. Madani1, 2, 3, I. H. Marks3,4

1Department of Surgery, Northwestern University, Northwestern Trauma and Surgical Initiative, Chicago, IL, USA, 2St. George's University, School of Medicine, 3InciSioN: the International Student Surgical Network, 4Department of Surgery, North West Thames Foundation School, London, England

Twenty-two years after Elizabeth Blackwell received her medical degree, 14 years after she opened the New York Infirmary for Indigent Women and Children, a functioning training hospital for female medical and nursing students, and 3 years after the establishment of the Women's Medical College of the New York Infirmary, in 1871, the President of American Medical Association, Dr. Alfred Stille, believed women to be morally unfit to practice medicine, claiming them to be ignorant, inexact, untrustworthy, unbusinesslike, lacking in sense and mental perception, and contemptuous of logic.[1]

Much has been achieved and overcome by women in medicine across the globe. The Medical Women's International Association is turning 100 years old this year, and the AMWA will be 104 years old! Today's medical students and trainees are growing up in a time where half of all medical school students in the United States are women, and #ILookLikeASurgeon and #HeForShe are trending topics of discussion on social media.

Yet, we are far from achieving gender equity in medicine and much work remains.

Over 2 days in September 2019, over 400 healthcare professionals from around the world came together for the inaugural WIMS held in Chicago, Illinois. Students and trainees made up not only the audience but also speakers, moderators, coordinators, and volunteers, providing a unique opportunity to not only network with those in attendance but also integrate into the community and play a crucial role in framing the future of the field into which they are entering.

The WIMS featured many expert speakers and two panel discussions. The panel, How Far We Have Come, featured accomplished women leaders sharing their unique experiences and lessons learned from training to practice to their personal lives. Interestingly, many expressed these pearls as a growth process: “As you grow through a career in medicine…” They spoke of the importance of a support system and a community around them, the role of mentors and champions, and the value of self-care.

From a student's and a trainee's perspective, it is always inspiring to learn about the experiences of other women in medicine. To know, others have faced similar, if not more challenging hurdles and prejudice. Yet, they have persevered, which is reassuring. A sense of community and having role models to relate and look up to is crucial for all students and trainees.

It is also imperative to become familiar with the tools and resources to empower students and trainees to identify and overcome biases and hurdles, both internally and externally. Talks and workshops on implicit bias, IPs, and writing for career advancement allowed for us to educate ourselves and take back to our programs what we learned.

Speakers such as Dr. Julie Silver, Dr. Caprice Greenberg, and Dr. Marion Henry beautifully illustrated, with data, the truth and reality of “the GAP” by women in medicine collectively: the gender pays gap, gaps in publication, and gaps in leadership and promotion opportunities. These were all very eye-opening discussions for students and trainees who are making plans for their future careers. The presence of male leaders in medicine who spoke on the #HeforShe, Men Who Champion Women panel further demonstrated the support of leaders in most fields and levels for gender equity in medicine. The speakers on the panel discussed “male privilege” in medicine and how it can be used to amplify women in medicine. They shared various aspects of their role in mentorship of women, especially students and trainees. Moreover, they highlighted the significance of mentoring other men in becoming #HeForShe.

The WIMS created a community to provide support, guidance, and mentorship around gender equity issues and also provided a platform for open discussion of challenges faced by women in medicine, solutions where they exist, and brainstorming for resolutions where they do not. The latter perhaps being the most innovative aspect of this summit as envisioned by the co-founders and co-chairs Dr. Mamta Swaroop's and Dr. Shikha Jain: a conference designed ”to amplify the lives of women in medicine and work towards gender parity in healthcare through: Skill development, Action Plans, Advocacy, Professional Growth, Education, and Inspiration.”

For students and trainees, the WIMS was an excellent educational opportunity and a supportive environment, but it also represented an invaluable place where women and men, students, trainees, early career practitioners, and those years into their careers could come together to individually and collectively take charge of the change in culture necessary to reach gender parity in health care.

  Reference Top

  1. Clevenger MR. From lay practitioner to doctor of medicine: Woman physicians in St. Louis, 1860-1920. Gateway Herit 1987;8:12-21.

  Perspective Number 1 Top

Our Sisters Keepers

I. H. Said Hamdun

Department of Surgery, University of Nairobi, Nairobi, Kenya

Being a woman pursuing a career in medicine is a tough, yet fulfilling path. Women in society, since time immemorial, have always been undermined, especially by men and sadly by women as well. Yet, she always seems to come out fighting and proving all wrong.

Being a woman by itself is tough, with all the household duties and family responsibilities placed on her. One who pursues a career and most importantly a medical one is deemed unfit for family life, saying that she will not have time for her family. Throughout history, women in medicine have had great obstacles to overcome to join medicine, even going to the extent of one pretending to be a man, to follow her medical dream.

These days more women are pursuing their passions. However, despite all the hurdles to get to where we are now, we still face opposition and challenges. Society puts male doctors on a pedestal and considers them better medical practitioners than their female counterparts. This is not or may not be true. Yet, women have to try above and beyond to prove their capabilities. We need to change societies' mentality and put both genders on an equal stand.

Having a womb does not make one less knowledgeable or inferior to the other.

So why does society make it seem so?

Women need to stand together and show society that we can do as much and even better than men. We should mentor each other and lift each other up so that in the long run, we prove our capabilities and overcome the gender disparities evident.

Why are women paid less than men when both do the same work? Or why do men have higher negotiating powers than women? All this should change. This can only be done if we, as women, stick together and advocate for equal rights. According to several reports, there are more women in the world today than men, so what exactly is stopping us from fighting for our rights?

We are the glue that holds families together and the first teachers that men have.

What exactly are we teaching them that they grow up to behave as if they are superior to women?

We should ask ourselves such questions and try to find solutions.

Women undermining other women is yet another problem we encounter. Putting another person down does not make one better than the other. Trying to prove to an intern that as a consultant you know more by belittling them, helps nobody but may create a cycle of pain.

We need to break this chain.

Some doctors put the younger ones through a lot of tough situations claiming that they also went through it or even had it worse does not help the society. One should try to make the teaching period or mentorship better than they had to go through.

This is growth.

Women in medicine already have it tough and are scrutinized by society for every action.

Let us try to support each other and show the world, what men can do women can do better. We are our sisters keepers. When we mentor others, we lead each other to progress. The future is ours, but we need to work together and change societies' mentality to view us just as capable, if not more, than the men. Let us be the physicians we all dreamed of becoming. All are achievable all if we work at it.

  Perspective Number 2 Top

Share Your Passion with the Next Generation – It's worth it!

Julia Alexandra Steinle

The Faculty of Medicine, University of Muenster, Muenster, Germany

”Anything but surgery!” – That is what I used to say when someone asked me which field I wanted to specialize in after medical school. During my training as a paramedic, I had got to know operating theaters with bad-tempered staff, hushing students in the corner of the room in a hostile manner, and making sure all they could see were the shoulders from people senior enough to stand a few centimeters closer to the green cloths. In medical school, I remembered those experiences which had led to my stereotype of the unfriendly, grunting surgeon, who does not care about students or teaching. In addition, male and female lecturers often emphasized how women should not choose surgery anyway as the workload was too hard and there was no place for a family while training to be a surgeon.

And thus, I was convinced that surgery was the last specialty I would go for.

Three years later, after trying to fall in love with internal medicine, pediatrics, anesthesiology, and basic science research, I coincidentally stepped into a Global Surgery Conference. And there, they were surgeons who greeted their fellow humans, surgeons who showed interest in the ideas of others, and surgeons who were eager to pass on their knowledge to the next generation. I have been welcomed into the Global Surgery family by many great mentors, from junior doctors to senior professors, all who have warm-heartedly shared their experiences, ideas, and passion with me. They did not tell me that I should be a surgeon. They equipped me with the skills and confidence to explore my own interests and passion instead of listening to gender or specialty stereotypes. As a result, I learned how much I love the practical work of surgery, how much I enjoy being in operating theaters, and how much I appreciate to learn the details of a surgical procedure or diagnosis. Thus, tossing my stereotype of a surgeon over board, I understood that I can be the kind of surgeon I choose to be.

I am not saying global surgeons are the only humane surgeons and everyone else belongs to the hostile operating theaters. I am not saying Global Surgery is the solution for all students who feel the burden of demotivating stereotypes and discouraging gender roles.

To all medical students, I am saying, find your own passion! Do not let prehistoric training methods or work ethics stop you from following your interests. Keep looking for people who are going the path you would like to go and who are not afraid to share this path with you.

And to all doctors and mentors, I am saying, share your passion! Give students the chance to fall in love with medicine; there is no need to scare them away or make them suffer. Only because in the past women did not become surgeons or radiologists, why should we stop them today? Let's empower everyone to find what they love and follow the path they choose for themselves.

Share your passion with the next generation – it's worth it! My mentors have enabled me to get over inculcated stereotypes, and that is why, when someone now asks me which field I want to specialize in, I reply, “Nothing but surgery!”

  Perspective Number 3 Top

Be the Change

Q. Hussein

Surgeon, HCA Physician Services Group, Bradenton, FL, USA

I could not believe this day had finally come. I was being interviewed at an institution for which I have been heavily recruited. My mind raced as I thought about the journey which had led me to this place. After 5 grueling years of general surgery training, I was board certified and finishing up my surgical critical care fellowship. I had multiple interviews for a trauma surgery position lined up. I was on cloud nine! This, after having five kids while in residency and pregnant with my sixth, as a fellow. “I knew I could do it,” I told myself. Motherhood and surgery are not mutually exclusive!

I was quickly brought down to earth. “You've accomplished nothing over the past 5 years,” the chairman said, as he threw my CV across the table.

My heart sank. I felt disappointed. This was all too familiar. Then, resentment started to boil up. Although most of my previous experiences were predictive, this was different. As a hijab-wearing Muslim woman, “you will never be allowed in an operating room (OR),” was the advice I received in high school. And as a mother, I was told, “you'll never finish this training, and even if you do, you won't be productive.” These were all assumptions based on perceptions of what a surgeon looks like. And although many of these assumptions were accurate, as I have had to create a hijab procedure for the OR in medical school and a maternity leave policy in residency, they were surmountable.

The encounter with this chairman, however, was unlike any other. Not only were the challenges created by my intersectionality belittled, but also my experiences and my reality were denied. The fact that I prioritized having a family over more rigorous academic pursuits was seen as a shortcoming. This was a denunciation of my values. Having trained in the hierarchical field of medicine, especially in surgery, it became an ingrained practice to lend credence to those with authority. Hence, I instinctively lost sight of how proud I was of my achievements moments prior. And I doubted whether I had, in fact, accomplished anything.

This is how imposter syndrome is inflicted on women in medicine.

All the stamina and strength I built up by overcoming all the other obstacles, was not enough to prepare me for this. However, although surgery taught me to respect authority, it encouraged me to question not only authority but also the entire system. As my mind started racing again, it started connecting the dots. Almost every warning I have been given about pursuing surgery has been accurate. I had to actively partake in creating the changes needed for me to fit into a system that was not designed to accommodate me. From creating policies for operating rooms to changing an entire surgery department's policy on pregnant residents, I had to take the first step. Moreover, if I wanted to make any progress in my career, I had to push for the changes I wanted to see.

This was a sad, yet empowering realization. Although it was disheartening to see the lack of effort being put into making the pursuit of surgery more appealing and accommodating to women and underrepresented minorities, it was gratifying to see that we had the power to change the systems.

Hence, instead of accommodating the needs of institutions and trying to fit into their value systems, I decided to approach the rest of my interviews differently. I had my values clearly defined: I love being a wife and a mother. I love to operate and take care of my patients. I openly discussed my family at interviews. Anyone who saw them as a shortcoming or questioned my devotion to surgery because of my motherhood was clearly not aligned with these values and was not a good fit for me. I was eventually recruited by an initially all-male trauma group, and I could not have asked for better colleagues. I no longer allowed anyone else's values to impose on mine.

Bias exists in medicine as demonstrated by a recent study in the Journal of the American Medical Association. Despite the presence of evidence, women's stories and lived experiences continue to be denied. This denial amplifies the imposter syndrome. As many women in medicine will admit, there is nothing surprising about the evidence.

It is time we stop denying reality. It is time we join forces with our male allies and work collaboratively to make and be the changes we want to see.

  Perspective Number 4 Top

Resilience in Residency

C. D. Gordon

Department of Internal Medicine, Oregon Health and Science University, Portland, Oregon

I was 39 weeks pregnant on Match Day, when my partner and I opened our envelopes revealing where we would spend our next few years for residency. About a month later, as my partner and I were several weeks into our new parenting gig and also preparing to move across the country; it had finally sunk in that being new residents and new parents might be more work than expected. Panicking, we phoned our program, asking for permission and assistance for a nontraditional work schedule. One that would allow for each of us to take time off and care for our children, and complete residency over an extended period of time. Graciously, this was arranged; thus, we have been taking turns as primary caregiver at home and primary resident in-house, alternating roles every month. Now, as a postgraduate year 3 in internal medicine, yet in my 6th year of training, I can honestly say that I have no regrets. Although at times it seems I may be in perpetual residency, this arrangement has afforded me the opportunity for reflection, for personal and professional development, and most importantly, for happiness.

Residency programs are placing more and more emphasis on the importance of building resilience into our practice of medicine. Incorporating training on how to develop resilience during residency is one of many institutional responses to the epidemic of physician burnout. As a resident, I have found that my own personal life jacket protecting me from burnout has been the gift of my two children. Despite the challenges of raising young children while working in an emotionally taxing, high-stress work environment, I have found that not only has my experience as a mother helped me to expand my capacity for empathy, love, and especially patience, but it has also allowed me to practice medicine in a way that is both more enjoyable and ultimately more sustainable.

As a self-identified worrywart, I mull over decisions endlessly before making a choice. And then, spend way too much time afterwards, wondering if my decision was correct. This approach can be maladaptive and can lead to difficulty disconnecting from work, thus compromising relationships, quality of sleep, and home life, feeding into a cycle of inadequate self-care, and ultimately negatively impacting work performance. As an intern, I struggled with high anxiety levels and insomnia, worrying constantly about buckling under pressure. Fortunately, with the steadfast support of my partner, family, and residency program, I was able to step back and put my experience into perspective. My challenges at work were universal among residents rather than unique, and with time, they would seem less daunting. More importantly, I learned that my failures and inadequacies were a part of my development yet did not define me as a person. On the contrary, my identity was something more solid and unwavering, something I felt I had control over. I saw myself as a humanitarian, a mother, and a doctor, and the realization that I could be all these things simultaneously was liberating.

Hence, how did my children teach me resilience in residency? Perhaps, it started with their infectious laughter. Their ability to find humor in the simplest thing is impressive as well as adorable. It reminds me that our sense of humor is one of the things that distinguish us as human and has the power to connect complete strangers. When I allow myself to laugh at work, it helps me find common ground with patients and colleagues, thus strengthening these relationships and infusing meaning into my day. Humor also helps us to bounce back from difficult interactions, thereby helping to bring us back into the present moment.

Another essential tenet of childhood is curiosity, a quality that may be lost during training due to fatigue or burnout. Their endless questioning has rekindled my own inquisitiveness as a clinician, reminding me that there are many things in medicine, as in life, which we take for granted without questioning.

Parenting is also a continuous exercise in patience. In addition to learning to wait for my 2-year–old child to zip up his own coat, I have learned to give myself time to adapt to new practice environments and incorporate new knowledge into my practice. By watching my children grow as they learn tasks, I have become more comfortable with my own frustrations as I practice skills and take on new responsibilities.

Throughout my journey of growing as a doctor, my children have kept me grounded, laughing, curious, and patient as I go.

  Perspective Number 5 Top

Young Idealism

V. Chen

Carle Illinois College of Medicine, Illinois, USA

As my classmates and I move toward our futures as practicing physicians, it is impossible to ignore that the social issues debated on the national stage – abortion, gender equality, and racial justice – will impact our practice of medicine. We see the statistics on how heart attacks in women are misdiagnosed at far higher rates than men, read about how Black Americans are made to endure greater pain than their White counterparts. We cannot deny that what we personally believe impacts the decisions we make for our patients.

And yet, when it comes to personal beliefs, we are oddly silent.

Before coming to the Midwest for medical school, I lived mostly in liberal communities on the East and West Coasts. There, everyone seemed proud to voice their opinions if only because we knew we would be met with affirmation. After all, it is easy to be staunchly opinionated when everyone around you holds the same basic views. If my former communities were echo chambers for the like-minded, then what I found in my new medical school was close to the opposite: a staunch resistance to giving any opinion at all.

For many of us, medical school was our first time surrounded by peers who held vastly different political opinions from our own. If ever there was a time when voicing our thoughts might have changed a mind or two, it was now. Yet, we stayed quiet. We did not want to create trouble and did not want to politicize the class dynamic or get labeled as confrontational. Besides, we told ourselves, we needed to prove our worth as scientists before spouting out strong opinions. Being outspoken was a luxury, only the most established in the field could afford.

When we did have to talk about controversial issues, we spoke only in scientific fact: numbers and mechanisms thrown into conversation as if enough hard evidence would spell out the conclusions we were not willing to say. We spoke about abortion in terms of morbidity rates and out-of-pocket costs but never in open dialog about whether it was right or wrong. After all, in the medical community, there is a common belief that science speaks for itself. With this comes the subtle implication that personal opinion cuts down an argument's validity. Perhaps, it is not surprising then that so many people I have met in medicine are only willing to speak about social issues in the language of numbers and hard evidence.

The problem with this is that scientific evidence is rarely an effective rhetorical device on its own, as our colleagues fighting for climate change action have found again and again. Facts and statistics will never be an adequate substitute for value judgment or moral reckoning just as strong conviction without fact cannot hold its ground. The beauty of medicine is that it has never been a purely scientific or purely social discipline, and to insist on treating, it as just one or the other is to miss out on powerful tools we have at our disposal. We can not ignore the social and moral implications of controversial topics such as abortion and transgender rights because we cannot win the fight with the language of science alone.

I have faith that this is changing. It has to change. If we are willing to speak only the language of scientifically polished fact, then we leave a void in the national conversation that someone, likely someone less informed, will be more than happy to swoop in and fill. I am proud of the physicians who made a stand against gun violence and refused to stop talking when told to “stay in their lane.” I am proud of the doctors in my community who stand up for transgender youth even when they are brushed aside by their colleagues. We need more voices like this because in medicine, we see the injustices that affect our patients every single day and we do not say nearly enough about it.

Throughout history, the youth have always been the idealistic ones. Too young to know better, as they say. The problem is that young people in medicine are waiting until they become old and established before they feel safe enough to voice their opinions. We are going to get tired. We are going to get entrenched in our ways as every generation before us has. Hence, maybe it is time that we medical students, the future doctors, step up and fight for the world, we wanted to create when we took the Hippocratic Oath. Leave it to the others to catch up.

  Perspective Number 6 Top

Burnout, Wellness, Resilience: This Is Not as Good as It Gets (There Is a Whole Lot More We Can Do)!

L. Deutsch

Loren Academic Services, Inc., Winnetka, IL, USA

Medical education is concerned about burnout, and there are significantly higher burnout rates than in the general population, higher still among women. Students and residents often suffer in silence, and effective approaches are needed to address burnout. This need is impacted by the culture of silence that often exists in medicine and makes it difficult to openly discuss personal struggles and feelings associated with burnout.

Silence may cause those in difficulty to feel more alone and more isolated, leading to a facade of positivity. This facade can further isolate those most in need and heighten feelings of failure and doubt. Although medicine often contends with failure in the abstract, it remains uncomfortable with discussions about actual failures. Reducing stigma around personal struggles requires listening and empathy. It involves tolerating the ambiguity and having conversations that, at times, can feel uncomfortable or unfathomable.

For more than 25 years, I have consulted in medical education, designing and implementing integrative curriculum (content and process) with evidence-based learning plans in undergraduate medical education and graduate medical education departments. Developing a curriculum that incorporates both content and process, means understanding the basic and clinical sciences, organ systems, and clinical skills development. It means understanding how to engage students and residents in decision-making, problem-solving, and self-reflection so that they can deepen their fund of knowledge, retain high-yield information, and develop the confidence to become doctors.

As a medical educator and clinician, I am increasingly concerned about burnout and its impact on students, residents, and faculty. The implications are myriad and have significance for training, recruiting, retention, tolerance, empathy, and access to healthcare.

Addressing burnout is complex but not impossible. It requires us to understand the systems in which our students and residents learn, the barriers and obstacles they may encounter, and a willingness to openly discuss and hear stories of failure (and success). It involves building an environment of tolerance and trust where it is understood that learning means making mistakes. This point of view includes 25 years of case examples, student and resident narratives, and sample curriculum and strategies with measurable outcomes.

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  Perspective Number 7 Top

Mother's Day: A Subtle Shift in Perspective

P. Kotini-Shah

Department of Emergency Medicine, University of Illinois at Chicago, Chicago, Illinois, USA

With Mother's Day around the corner, I felt myself filling up with anticipation and craving a nice celebration. Then, my spouse told me he wanted to invite his mom as well. I was upset, really upset. I did not want to share the day with her. You see, I already share the day with my mother-in-law for our marriage anniversary (her birthday is the same day).

Could I not have this day to myself? Is that selfish of me? It did seem like it. It is a universal day to celebrate all mothers, was my spouse's argument. It is a generic hallmark holiday, so why not celebrate with others who are mothers? I did see his point, but I did not want to admit it right away. Hence, it got me thinking of why it was so important for me to feel special on this day. Why did I feel that I deserved the attention, the admiration, the affection? I think because I am so attached to my role as a mother. It is a big deal to me. Every decision I make is in some way linked to my role as a mother. My work schedule is customized to best align with my toddlers sleep/wake routine. I try my hardest to schedule my workouts to create the least impact on my children, and for many years, I just flat out neglected myself. It has taken me 6 months to schedule a hair appointment. Who has time for 3 h of color/cut/blowdry?!

However, beyond the superficial and mundane sacrifices, there are plenty of other sacrifices that mothers have had to make and continue to make. One effect of becoming a mother has been the self-imposed “motherhood penalty” in the workplace. I have said no to opportunities that I would have otherwise taken up eagerly. I have become less of a “team player” at work because childcare takes precedence. I have not been able to attend social events because bedtime starts at 7:30 pm for my kids, and unless the event is planned way in advance, I cannot find childcare. These are workplace sacrifices that I am okay with because I want to be with my young children, yet these choices do feel uncomfortable because I am quieting my career-minded, ambitious, “sky is your limit” side to be mommy. This transformation, figuratively and literally, to be “supermom” is hurdled with a wide spectrum of sacrifices, from the small (maybe petty) – to larger ones.

In essence, being a mother embodies the ultimate sacrificial spirit for something greater than yourself. This characteristic is universal. All mothers, all around the world, for centuries have done this. My mother-in-law, in her own ways, has made countless sacrifices too. Perhaps, I should ask her about her story. In the end, I was okay with sharing my Mother's Day this year and share the commonality in our experience as mothers. However, looking ahead, I hope to celebrate Mother's Day not just at home, but alongside my colleagues as well.

I hope that on each Mother's day, men and women, especially those in power, reflect on the sacrifices and challenges of mothers or primary caregivers who are activity trying to balance raising the next generation with productivity at work. In due time, with sustained, deliberate, mindful reflection, open acknowledgment, and recognition, there can be a subtle shift in the systemic engrained biases and perceived competence to ultimately elevate the position of mothers.

  Perspective Number 8 Top

Are We to Blame?

I. H. Said Hamdun

Department of Surgery, University of Nairobi, Nairobi, Kenya

There are low- and middle-income countries (LMICS) countries governed by cultural practices that may undermine women. There are high-income countries (HICS) countries governed by cultural practices that may undermine women.

Many of us struggle to achieve our positions, and yet, despite that, the community, regards male doctors as superior, in both knowledge and skill, even when the woman is higher in rank or post.

Why is this? Why is it throughout history, the woman always comes second to the man?

How is this possible when we, women, are the ones who raise these men?

Are we partly to blame?

What kind of values do we instill in them?

We should ask ourselves many such questions and try to consider the root cause of these issues.

At times, women are their own worst enemies; instead of mentoring younger generations to become great leaders, they fear losing their positions and keep others down or at a position below them, just so they shine and remain in authority.

I would like to be among leaders who lift up the younger generation, imparting knowledge and skills to others, to benefit the entire community. This is possible. Women have so many obstacles to overcome that we all need to be united and encourage each other, be it a woman from a HIC or LMICS, or from any geographical, cultural, or language difference. We can achieve much more when we come together.

I have encountered both good and bad women leaders and the power they possess to either make or break another.

No one benefits from undermining, not matter the circumstances.

When we allow each other to grow, the society will grow with us.

Women are the core of any family. The power they possess affects all members of society, globally.

So, are we partly to blame…

We need to raise our men to respect and value women and their ability to achieve as much as, if not more. We need to inspire, guide, and teach our sons and our daughters.

Let us all act as one community, a global community, and make the world better, together, for all.

If you educate a man, you educate an individual, but if you educate a woman, you educate a whole nation.

– African Proverb

  Perspective Number 9 Top

Pattern Recognition

S. L. Schroth

Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

In medicine, you learn to recognize patterns.

An elderly patient presents with shortness of breath and lower extremity edema – add heart failure to the differential. A young African-American female reports a dry cough and difficulty breathing while walking to work – maybe it is sarcoidosis.

Often, these patterns provide a helpful service, aiding in the assimilation of a tremendous amount of knowledge that must occur as one progresses through medical education and training. The recognition of their existence and subsequent use is often rewarded. Like a ready response when the chief resident on service asks for differential diagnosis for the newly admitted patient, complaining of severe back pain and vomiting. Another correct answer on a UWorld practice test, to get a higher score on a career-defining examination, the USMLE.

However, what happens when the patterns we have learned to recognize are an inaccurate representation of reality?

What happens when we begin accepting patterns portrayed in the media and our social networking sites as fact?

Although I have spent only a mere 2 years as a student in this world of medical education, it is readily apparent I fit into very few of the “typical medical student” patterns. I am a part of a small cohort of dual degree students. I am nontraditional, never considering becoming a physician until after I graduated from college in 2013. And, I am a disabled woman.

Making a statement like, “I am disabled,” typically results in a shift, a turning of the tables so to speak. Now, you must decide how or if this statement changes the way you receive the words written here.

You see, I spent the majority of my life seamlessly fitting into the world around me until a freak accident and falling dead tree changed everything. Abled to disabled and walking to wheeling, I never imagined or realized the patterns that had been deeply engrained in my own mind about the value of my now disabled self-worth. Patterns, I have come to realize, have also been imprinted on my fellow classmates, professors, and future patients.

Paralysis has added an additional label to my demographic identity, just as it has added an additional lens to my view of the world. This lens, while sometimes worn with tears and frustration, has provided clarity and acknowledgment of an earlier perspective I once held. A perspective where implicit bias built on poorly informed patterns ran unencumbered, further propagated by ignorance and “not my problem” thinking. A perspective where individuals with disabilities are not viewed as equals and never will be.

I will forever remember holding onto a closed envelope from the DMV, the weight of which seemed infinitely greater than the blue and white placard it enclosed. A new marker to hang in my vehicle, a new identity to accept, a new reality I was being forced to inhabit. And yet…

My life has continued along its path, albeit a rather different path than my previously intended journey. I certainly have my fair share of struggles, but my accomplishments, many a direct result of my injury, speak for themselves. Outside of pursuing a career as a physician scientist, I race marathons using a racing chair and have qualified for Boston Marathon twice. I have served as Ms. Wheelchair WI and then Ms. Wheelchair America, advocating for persons with disabilities on a national stage. Six years since my injury, I live my life with passion and pride, using my wheels to propel both myself and my goals to fruition.

Our society has come to associate certain patterns with disability – patterns of incompetence and inferiority. An expectation of a life of misery, which is not the reality. In allowing acceptance of these ignorant and fallacious patterns, we create barriers that deter and deprive as doubt and self-loathing shrouds the mind of a newly injured patient or fear takes hold of soon-to-be parents receiving news of an extra chromosome.

As trainees, educators, and physicians we possess a unique ability to impact the lives of others in profoundly influential ways. Recognizing the source and addressing the reliability of the patterns we use to inform our actions and reactions are therefore not only important but also imperative as we interact with countless individuals who possess experiences vastly different from our own.

Patterns exist.

Recognize them for what they truly are, no more and no less.

  Perspective Number 10 Top

Do Not Forget the “Doctor”

S. T. John

University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA

In my first days of medical school, a fellow male classmate nudged me during an introductory lecture and exclaimed, “Over 60% female…can you believe it?” I felt slightly unsettled. I was unsure whether his sentiment was rooted in astonishment, excitement, or revolt. It definitely had a tinge of chauvinism. I gave my classmate the benefit of the doubt and did not ask for clarification. Coming from an all-boy high school, I was never exposed to the barriers women face in academics, let alone the ongoing challenges women face in the world due to discrimination. I tried to stay informed and felt uplifted by stories of women leading scientific breakthroughs, rising to positions as CEOs, and even running for the office of president. After all, it was 2016, and the thought of legitimate prejudice seemed outdated. Nevertheless, that comment stuck with me.

Soon, I was entering the clinical years and the occasion was marked by the traditional White Coat ceremony. On receiving my own coat, I seriously thought about what it represented. It was more than a simple garment or a place to keep pens, notebooks, and references. Simply wearing, it seemed to invoke confidence and respect. I did not understand at that time, however, that for many of my female colleagues, a white coat was not enough. Even when wearing it, they were still frequently asked for clarification on their role.

Recently, I was struck by another inequity when working in our primary care clinic. The male attending physicians are routinely referred to as “Doctor” by both the staff and the patients. This is not true for female attending physicians. I was assigned to a clinic with Dr. Uhlenhake. Over the past year, I realized that several patients called her by her first name, yet she had never directed nor encouraged them to do so. When it came to male physicians, patients never assumed it was okay to address them by their first name. This disparity struck me as very strange. Why did people assume it was ok to call female physicians by their first name but not males? I discussed this with a female colleague who said, “Why are you surprised?” I was blind to an implicit bias that was right in front of me.

Then, 1 day, Dr. Uhlenhake decided to address the issue in real time while I was standing with her in an examination room and a patient called her Molly. Her tone was jovial but serious. She did so tactfully and with grace. Instead of shrugging off the recommendation or getting annoyed, the patient was genuinely surprised at himself and expressed a commitment to change. We all agreed it was important to discuss and we left the room after a hug and handshake, everyone smiling. Afterward, we reviewed this with the other medical students on the team and discussed their experiences and opinions. Dr. Uhlenhake pointed out that as a mentor to female and male trainees, she felt obligated to be a strong role model and act on the moment. Women should be called by the title and degree they have earned. Then, I realized that this problem is not just the burden of my female colleagues. I must be an active ally and correct patients when I see this happen.

To help change the perception of women in medicine, I will need to do more than simply notice the bias and barriers that continue to exist. True reform requires those of us who have privilege in medicine to speak up. It is not about the title. It is about equality. This is why I am committed to stepping up to the plate as I prepare for core rotations. If I hear others refer to female physicians by their first name, I will gently remind them, “Do not forget the Doctor.”

  Perspective Number 11 Top

Pursuing Formal Leadership Education as Female Physicians: Perspective of Two MD/MBA Students

S. Desai

Tufts University School of Medicine, Boston, Massachusetts, USA

When people learn that we are pursuing business degrees during our medical training, they often raise a simple question: “Why are you getting an MBA?” A shared priority of ours is ensuring that our patients receive the best possible care. After scrutinizing our healthcare system, we realized that optimizing patient care may mean tackling issues beyond the scope of caring for individual patients. Patients are negatively affected by systemic issues such as skyrocketing healthcare costs and inadequate healthcare access. Challenges such as physician burnout and growing administrative burden weigh down our colleagues. We chose to actively develop the skills we need to confront these larger issues by pursuing formal leadership and business training in a combined MD and MBA program. We feel more confident in our ability to tackle these challenges and hope to inspire other women in medicine to do the same.

Changing a healthcare system fraught with foundational issues requires diverse perspectives that women in medicine can provide. Unfortunately, there is still a lack of women occupying seats at the leadership table where critical discussions regarding these problems take place.

Gender inequality is a reality in today's healthcare system. Women are still significantly less likely to be promoted to positions in senior healthcare management, with only 33% of current healthcare leadership positions filled by women. Although 40% of physicians are women, only 22% of full professor ranks at academic medical centers are held by females, and only 16% of administrative and departmental leadership positions are filled by women.[1] By receiving formal training in leadership, operations, and management, we feel better equipped to lead future diversity initiatives and to pave the path for other women in healthcare with similar goals. Our medical school, Tufts University School of Medicine in Boston, Massachusetts, has one of the oldest combined MD/MBA programs in the United States. Since 1999, the program has graduated 82 women compared to 230 men. Not a single year has boasted more female graduates than male. Strikingly, during this time, an increasing percentage of women have made up medical school graduates, reaching over 50% in 2017.[2] Despite this, we have not seen any parallel trends in dual degree MD/MBA programs.

Lack of confidence and inadequate support have been cited as barriers to women assuming leadership roles.[3] We actually believe that women interested in leadership are confident, but we also feel that formal MBA training can help women who desire leadership roles channel their ambition within organizations more effectively. Studies have shown that men are more willing to apply for new positions even if they do not meet all of the listed qualifications, while women are more hesitant if they do not meet all the required competencies.[3] Until this changes, an MBA program can provide a woman with the necessary confidence in her qualifications to take on administrative and departmental leadership roles in her healthcare organization and prevent others from questioning her abilities.

Our own experiences in the combined MD/MBA program have helped us develop invaluable technical competencies and further our leadership skills. Classes such as financial accounting and corporate finance will prepare us for future departmental budget meetings and empower us to ask for a seat at the table of organizational steering committees. Courses such as operations management have helped us apply principles taught to us in the classroom to real-world clinical realities. For example, learning about lean six-sigma operational principles in our business class helped us work to decrease patient wait times and increase the efficiency of a urogynecology clinic at our home medical center. In another situation, we applied principles from case studies on training standardization and scalability for growing businesses to revamp the support staff training of a dermatology clinic. By converting the traditional model of nurse-to-nurse apprenticeship into an online, flipped-classroom curriculum, we elevated support staff competency, physician satisfaction, and scaled training resources for a growing practice. These types of measurable accomplishments get people noticed by potential mentors and can buoy women into leadership roles early in their careers.

While there is no recipe for professional success, one of the most cited elements of a successful career is having a mentor. As future physician leaders, we hope to serve as mentors for the next generation of ambitious, empathetic, and confident female physicians who will make meaningful changes in the lives of individual patients and in the healthcare system as a whole.

  References Top

  1. Cox E. Why Aren't More Women in Health Care Leadership Roles?” U.S. News & World Report, U.S. News & World Report; 10 January, 2019. Available from: http://health.usnews.com/health-care/for-better/ articles/2019-01-10/why-arent-more-women-in-health-care-leadership- roles.
  2. More Women Than Men Enrolled in U.S. Medical Schools in 2017. AAMCNews; 18 December, 2017. Available from: http://news.aamc.org/ press-releases/article/applicant-enrollment-2017/.
  3. Boylan J, Dacre J, Gordon H. Addressing women's under-representation in medical leadership. Lancet 2019;393:e14.

  Perspective Number 12 Top

There is Always Time for Birth Control

M. Uhlenhake

Department of Internal Medicine and Pediatrics, The University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA

As a Med-Peds physician, I have a passion for adolescents and young adults. I frequently have conversations about safe sex with patients and coach students and residents on how to do the same. I have come a long way. When I first started talking about sex with patients, I was naive and awkward. The conversation was choppy and did not flow. Now 8 years after residency, I am at ease when discussing this often-taboo topic and frequently tell trainees that the goal is to talk about sex like they talk about baseball or the movies, with the same level of comfort and confidence. The 2017 Youth Risk Behavior Surveillance System results showed that 39.5% of our high school students in 9th–12th grade have had sexual intercourse. More surprising, however, is that among sexually active high school students, 46.2% did not use a condom during their last sexual encounter and 70.6% did not use pills, a patch, a ring, the shot, an IUD, or an implant before sex. These numbers motivate me. I realize we still have a lot of work to do.

We are in the mid of the summertime rush in primary care. Recently, the clinic has been hustling with overbooked schedules. Not long ago, I had an opportunity to practice what I preach to residents and students. I was behind. The morning was taxing with several patients who had very complex psychosocial needs. I met with an adolescent who had numerous concerns including fatigue, chronic headaches, hot flashes, weakness, and abdominal pain. The visit was long and involved a social work consultation. Two hours later, while the nurse was reviewing the discharge paperwork, the patient suddenly requested birth control. The nurse found me in another room and pulled me aside, saying, “Dr. Uhlenhake, now she is requesting birth control!” in a desperate tone. I sighed for a quick moment, simply because others were waiting. Then, I collected myself and returned to the room to prescribe contraception because as I consistently tell learners, “There is always time for birth control!” Teens and young adults need access to contraception in real time. Therefore, we must be adaptable and responsive to address this urgent need.

  Reference Top

  1. Available from: http://www.cdc.gov/healthyyouth/data/yrbs/overview.htm. [Last accessed on 2019 Jul 27].

  Perspective Number 13 Top

Gender Inequity and Burnout Among Physicians: Can Comedy Cure Us?

S. D. Deshmukh

Department of Radiology, Northwestern University, Chicago, IL, USA

Recently, there has been a call to incorporate more humanities into medical school curriculums in an effort to foster culturally-sensitive compassionate doctors with enough resilience to withstand mounting burdens of the profession that have led to an epidemic of physician burnout. And yet, despite recognition of a need for change, the healthcare system continues to forsake its doctors – factual data regarding gender inequity, discrimination, and burnout abounds within the literature.

I have to wonder, if we send these supposedly newly robust fair-minded medical students into a failing system, will they not ultimately succumb to disillusionment?

And, if repeatedly facing disappointment and disenchantment, might they be more susceptible to the very symptoms we are trying to prevent?

To help combat inequity and burnout, we should incorporate humanities into ongoing professional education even after medical school. Medical improv, the burgeoning field of employing improvisational theater (improv) training techniques to improve physician communication, cognition, and teamwork skills, offers a playful yet effective method of promoting inclusion and wellness. Improv was developed in Chicago in the 1920s as a therapeutic games strategy for immigrant and inner-city children. Today, improv is recognized as a form of comedy as well as a means for personal development and career growth.

Improv has been taught at several medical schools to cultivate skills such as active listening, clear information delivery, and mental agility in the setting of unpredictable environments. Through fundamental principles such as “there are no mistakes,” “every team member has equal value and responsibility,” and the famous “yes, and” (agreement/support rather than negation of ideas), improv creates a safe collaborative space with an emphasis on teamwork and acceptance. Improv scenes, where gender, age, race, and even species lines are readily crossed, may shed light on unconscious or implicit bias among participants. Those with a tendency for thoughtfulness and reflection may find themselves learning to be more assertive and commanding, while those with a tendency for self-promotion and dominance may find themselves learning to let go of control and prioritize group success. Improv has something to teach everyone.

Involvement of everyone cannot be overemphasized. In the case of gender discrimination, for instance, well-meaning programs to promote equity are often geared toward women only. Not only do women-specific programs have the potential to place additional time and financial burden on the very participants they intend to benefit, but they may also create an erroneous perception that women are the problem – that women need to be “fixed” through mentoring and training initiatives to develop qualities conventionally attributed to men. Programs that mandate universal participation regardless of gender and approach inequality as a systems (rather than individual) failure will be more successful in truly achieving equity.

As an example, consider an improv exercise where three people (male and female doctors) act out a scene based on spontaneous suggestions of who – “massage therapists!,” what – “lavender-scented oil!,” and where – “Lithuanian spa!” Compeled to speak on the spot, participants delve into a somewhat absurd and hopefully hilarious conversation that will naturally elicit various emotional reactions, conflicts, attitudes, and beliefs. Once the scene has concluded, a debriefing session is held with input from the participants and the “audience” who observed the scene. How did the participants interact? Did someone dominate and if so, how could the others have asserted themselves and what could the dominating person have done to allow equal partaking? Did participants “yes, and” one another in support of each individual's ideas or was there an aura of negation and rebuke? Most importantly, how might the scene – boiled down to a discussion between co-workers – mirror a team meeting among doctors and how can lessons from the exercise be applied to improve communication, solidarity, and equality? By playfully and perhaps surreptitiously addressing issues of discrimination and marginalization, improv offers a novel (and ideally fun) method of fostering inclusion and wellness in any professional setting.

Medical improv has the potential to serve as an innovative tool to combat gender and racial inequity, implicit bias, and burnout as well as continuing medical education for the principles of communication, professionalism, and teamwork. Medical improv and other humanities must be incorporated at all stages of medicine, however, to exert a measurable effect. We cannot rely on the next generation of doctors to save the healthcare system – change is necessary at every level. And if we as physicians do not unite to fight this battle now, then we are sure to 1 day discover that the joke's on us.

  References Top

  1. Hoff G, Hirsch NJ, Means JJ, Streyffeler L. A call to include medical humanities in the curriculum of colleges of osteopathic medicine and in applicant selection. J Am Osteopath Assoc 2014;114:798-804.
  2. Shannon G, Jansen M, Williams K, Cáceres C, Motta A, Odhiambo A, et al. Gender equality in science, medicine, and global health: Where are we at and why does it matter? Lancet 2019;393:560-9.
  3. Lightfoote JB, Deville C, Ma LD, Winkfield KM, Macura KJ. Diversity, inclusion, and representation: It is time to act. J Am Coll Radiol 2016;13:1421-5.
  4. Kang SK, Kaplan S. Working toward gender diversity and inclusion in medicine: Myths and solutions. Lancet 2019;393:579-86.
  5. West CP, Dyrbye LN, Shanafelt TD. Physician burnout: Contributors, consequences and solutions. J Intern Med 2018;283:516-29.
  6. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet 2016;388:2272-81.
  7. Watson K. Perspective: Serious play: Teaching medical skills with improvisational theater techniques. Acad Med 2011;86:1260-5.
  8. Rachel RH, Rian JD, Gregory JK, Bostwick JM, Birk CB, Chalfant L, et al. Telling the patient's story: using theatre training to improve case presentation skills. Medical humanities 2011;37:18-22.
  9. Hoffman A, Utley B, Ciccarone D. Improving medical student communication skills through improvisational theatre. Med Educ 2008;42:537-8.
  10. Shochet R, King J, Levine R, Clever S, Wright S. 'Thinking on my feet': An improvisation course to enhance students' confidence and responsiveness in the medical interview. Educ Prim Care 2013;24:119-24.

  Perspective Number 14 Top

The Bimodal Distribution of Leadership for Women in Academic Medicine

M. Shah, D. Davenport

Department of Emergency Medicine, Rush University, Chicago, IL, USA

From the approximate ages of 18–30 years, females dedicated to the pursuit of medicine often sacrifice love, life, and fertility to accomplish their career goals. While 65% of healthcare workers and the majority of healthcare consumers are women, we make up only 30% of healthcare C-suite teams and 13% of CEOs.[1] This discrepancy is further demonstrated in academia. Despite the fact that women comprise half of the medical student and residency populations, we remain grossly underrepresented in academic leadership. Females represent only 37% of full-time academic physicians.[2]

Today, a woman who decides to transiently work part-time for personal reasons may suffer from bias based on perceptions of part-time physicians. If they choose to return to full-time practice, these misconceptions have many consequences that limit their access to advancement. The existing literature suggests that both part-time faculty and institutional leaders perceive part-time work to be detrimental to academic advancement.[3],[4] Frequently, it is assumed that part-time workers are not dedicated to their institution, lack innovation, or have poor work ethic. As a result, they are rarely considered for opportunities that arise.

However, we argue that there can be a bimodal distribution of leadership for women. There is a large percentage of able women who demonstrate exemplary leadership skills early in their career yet opt to take a detour in their career path to advance their personal priorities. These women do not consequently lose their abilities, yet when they return, they are met with resistance, trying to pry open doors that were slammed shut behind them.

Hence, how can women who choose to be part-time return to leadership when the time is right? First, decisions made in the past for lifestyle or family should not be second guessed. Ultimately, these decisions brought you where you are today and provided valuable lessons and wisdom.

Strong mentorship is key; however, when attempting to restart your career, a single mentor is insufficient. Instead, one should create a “career advisory board” mixed with mentors and sponsors. While females can be strong allies and offer workarounds to maximize work–life balance, the advisory group should include men as well. The “he-for-she” support of a woman returning to leadership can speak volumes. The advisory group should include people who will support, motivate, and inspire you but also hold you accountable. In addition, those interested in research should create a cell of individuals who are also trying to advance their career to rotate as leads on various projects to serve as a support system and to increase publications and individual visibility.

Your mentors may crack open doors, but you need to be proactive. Do not wait for an invitation, instead schedule one-on-ones with leaders with whom you align and maximize these encounters. Even if plagued with imposter syndrome, portray confidence and say yes to any opportunity that presents itself that will help you reach your goals. Finally, you should not fear failure but recognize that missteps are pivot points to achieving success.

Institutions must also be part of the solution. For part-time doctors to be successful, they must not be marginalized. It is well documented that the lack of on-site and emergency childcare options, the tendency for meetings outside of routine work hours, and the absence of part-time promotional tracks have been shown to negatively impact the satisfaction and retention of women faculty.[5] Therefore, transient part-time status may be the only option for some female physicians. Recognizing this, institutions should create a culture that addresses these barriers. Clear and equitable policies for part-time faculty in critical issues such as salary, benefits, malpractice coverage, administrative support, productivity expectations, mentorship and inclusion in scholarly projects should also be revolutionized. As women, we should be included in discussions surrounding institutional programming and solutions. For example, promotion criteria that are proportional to the amount of time a faculty member works will allow for slower but appropriate academic advancement among part-time faculty.[6]

It is our hope that the creation of pathways to success for part-time physicians will allow women to achieve parity with respect to career advancement, professional development, and leadership in academic medicine. Normalizing this bimodal distribution of leadership and supporting the nontraditional professional path will ultimately improve recruitment and retention of female leaders in medicine.

  References Top

  1. Stone T, Miller B, Southerlan E, Raun A. Women in Healthcare Leadership. Oliver Wyman; 2019. Available from: https://www.oliverwyman.com/content/dam/oliver-wyman/ v2/publications/2019/January/WiHC/WiHCL-Report-Final.pdf. [Last accessed on 2019 Jul 18].
  2. Ashley CW. Barriers to success for female physicians in academic medicine. Journal of community hospital internal medicine perspectives 2014;4.3: 24665.
  3. Levinson W, Kaufman K, Bickel J. Part-time faculty in academic medicine: Present status and future challenges. Ann Intern Med 1993;119:220-5.
  4. Socolar RR, Kelman LS. Part-time faculty in academic pediatrics, medicine, family medicine, and surgery: The views of the chairs. Ambul Pediatr 2002;2:406-13.
  5. Strong EA, De Castro R, Sambuco D, Stewart A, Ubel PA, Griffith KA, et al. Work-life balance in academic medicine: Narratives of physician-researchers and their mentors. J Gen Intern Med 2013;28:1596-603.
  6. Levine RB, Mechaber HF. Opting in: Part-time careers in academic medicine. Am J Med 2006;119:450-3.

  Perspective Number 15 Top

My Gas Station Lesson

M. A. Uhlenhake

Department of Internal Medicine and Pediatrics, The University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA

I am a white woman with German-Irish blood who grew up in a middle-class neighborhood in the heart of the Midwest. My father was an insurance claims manager for Allstate, and my mother was a public school teacher. My progressive parents were the first in their families to go to college and made it a priority to expose my siblings and me to a variety of new things.

I am now the grateful mother of two girls. I often think about how my daughters' lives will be different from my own. Growing up, we always had enough but were made conscientious of the week-to-week importance of money. I remain frugal. My daughters were born in the top 1%. They live in a neighborhood with an average income higher than what I was accustomed to experiencing. This, in addition to their skin color, gives them privilege.

Yesterday, at the gas station, I noticed a black mother dutifully followed by her two sons. Smiling and jostling in a brotherly fashion they were content to be near their mom. The scene stirred my motherly instincts. Driving home, I thought about how it would feel to be a black mother with black sons. I already fret too much about my girls. What about her? How often does she lie awake in bed, worrying about her sons? How does she deal with the constant fear that they will be labeled, judged, criticized, or maybe killed because they are black? What if he wears a hoodie? What if he gets pulled over? What if he questions authority? What if he voices his opinion? Will others be afraid of him? I do not believe anyone has been afraid of my girls, and if they were, it would leave me hurt, angry, and confused.

While getting an iced tea in the same gas station, I had noticed a second mom filling up several large containers with ice at the beverage station. I thought, “Wow, that's a lot of ice, why not buy a bag?” Then, I saw her kids standing beside her trying to be patient, rosy-cheeked, sweat on their brows from the hot summer day. I heard her mumble under her breath, “No air conditioning, “ and “It's too hot.” My kids have never known what it is like to be without A/C or heat. They are always comfortable when they sleep.

Finally, on my way to the car, I ran into a Latina nurse that I had previously worked with. We exchanged pleasantries when suddenly she said, “My daughter's dad, he was….deported.” My jaw dropped. This statement seemed to matter-of-factly tumble out of her mouth, but I could see the pain in her eyes. I had no words. I glanced at her daughter who was sitting in the car, oblivious to us. My own in-laws are immigrants and my spouse is an Indian-American, natively born in Emporia, Kansas. My kids, however, will never know the grief of having a parent or relative suddenly deported.

Just a simple stop at the gas station inspired me to dissect my own family's privilege. It is my job to teach my girls what advantages they have received without any effort of their own. Eventually, I hope they fully understand the deeper content in these scenarios. My daughters must understand that their skin color and their socioeconomic status give them an instant head start. I have read parenting books and blogs. I have studied how to feed them, how to put them to bed, how to nurture them, and how to keep them healthy. I have been committed to getting them “kindergarten ready” before they start school, but what about “life ready?” I have not yet found a resource on how to teach privilege to children. Hence, for now, I will start with this simple gas station curriculum and continue one step at a time to develop it as my children grow older and have new life experiences. Imagine the impact if more well to do, women-of-privilege did the same.

  Perspective Number 16 Top

Difficult Decisions

A. J. Eisenberg

Department of Obstetrics and Gynecology, Beaumont Hospital, Dublin, Ireland

I remember the day I met Lily – she was the last patient I saw on a busy day in the office. Even in the darkened ultrasound room, I could see her face light up when I showed her and her husband their tiny baby's “heartbeat” on the screen. “Your baby is the size of a blueberry,” I quipped. Her brown hair bounced around her face as she laughed at my joke. She turned to her husband, “when should we tell everyone?”

At 16 weeks, Lily came in with a list of questions. “I know I am young, but I am interested in the genetic screening test for my baby you told me about last time. I am sure the baby will be fine, but I would rather be prepared if there is a problem.”

The following week, I received her results. “Oh shit!' slipped out of my mouth as I saw the abnormal result. I called her immediately. “Lily, please call me as soon as you get this message.” While waiting, I arranged an ultrasound at the hospital for her.

The specialist at the hospital called the day of the ultrasound. This is never a good sign, I thought when I picked up the phone. “This baby has a large cystic hygroma, already nearly as big as the baby's head. We should really check the baby's chromosomes too.” The combination of this growth and abnormal chromosomes likely meant the baby would not survive.

Once again, I found myself giving Lily more bad news. “To know the full extent of your baby's condition, you need to have an amniocentesis to determine the baby's chromosomes,” I explained over the phone. After a long pause and a deep sigh, she choked out, “I need to talk to my husband and I will call you back,” and then she added, “I think I'm starting to feel the baby move…”

They proceeded with an amniocentesis. The cold winter days waiting for results felt cruel and harsh.

The devastating news came 2 weeks later: the chromosomes were not normal. After attending a meeting with several specialists at the hospital, Lily came to see me. Her face appeared thin, eyes puffy from lack of sleep, and crying. She sat down, looked straight at me, and said, “I need someone to tell me what to do. There were so many doctors at this meeting, telling me everything wrong with my baby, every part of her body abnormal, that her survival was unlikely. I just couldn't hear them after a while. It was so overwhelming.” She paused. “They ended with telling me an abortion was an option.”

I felt my own tears forming, I was afraid for Lily and knew I needed to speak from my heart.

With a shaky voice, I began “From all that we know, the abnormal chromosomes and the cystic hygroma, this baby will not survive. You need to consider the harm that may come to you continuing this pregnancy – the possibility of complications that may lead you to never be able to carry a pregnancy, or worse, lose your life. I think you seriously need to consider terminating this pregnancy.”

She began sobbing. Once she was able to settle herself, she looked at me again and calmly said, “Thank you. No one at that other meeting was straight with me. I just needed an honest answer and I appreciate you giving me that.”

I stared at her chart after she left. What words could I write that would describe the heart-wrenching choice Lily and her husband must make? Simply saying “considering abortion” seemed inhumane. “Voluntary termination of pregnancy?” Who “volunteers” to be in this situation?

That week, Lily scheduled the termination. She went to a specialist because of the difficulty of the procedure.

I hoped they would treat her with kindness and caring.

I hoped someone held her hand as she drifted off to sleep.

I hoped she knew how strong she was.

As an obstetrician, I take care of two patients at once, the mother and the baby. Sometimes, their needs are very different, so different that one may need to sacrifice the other to survive. The burden of choosing, not between good and bad, but worse or less worse, lives with the patient forever.

Now, years later, Lily has two healthy children. Although unspoken, we will always share the memory of her third child.

  Perspective Number 17 Top

On Adversity…

R. A. Fleishman

Department of Neonatal-Perinatal Medicine, St Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA

Hahnemann is closing. And yet, we are here: sitting beside our patients, holding their hands, poring over their laboratories, and defining their diagnoses. We are teaching, we are learning, we are yearning for respect. For years, the walls held rumors. However, they also held us in, held us together in dignity. Patients have died here. Women have lost their children. Children have lost their parents. We – this staff, this hospital – serve at the pleasure of the uninsured, the undocumented, the uncounted.

Across the street from the hospital is a homeless encampment. The tents have multiplied in the last few months. I see women there, when I walk into work, who are pregnant. I see young men, whose mothers must ache, as their sons beg for change at car windows. They drip with sweat and their skin is bronzed with dirt. These humans need care. They are right there, visible to us. And yet, Hahnemann is closing because their care lacks value.

Strangers in the staff elevators hold each other's gaze long enough that, if we were not here together at Hahnemann, right now, would be uncomfortable. There is a laugh as we push buttons and hold doors. This morning, 16 floors gave us time to discuss oregano on cafeteria potatoes. Because, really, what else is there to say? The department of Bioethics sends us all a survey. How has your sense of control over things in life been affected compared to baseline? Has your level of alcohol use been affected? This is all there is to do. Just to note it all, catalog it, and move forward.

Just today, I met families from six countries, from three continents, from every end of Philadelphia. I pulled an iPad on a pole with me on rounds to serve as my interpreter because I do not speak Vietnamese, or Spanish, or Mandarin, or French. I sat beside women, some new mothers, some mothers anew, and met their eyes. My notes read routine newborn care and counseling. This is more than just listening, reflecting. More than seeing the tiny worry in a woman's eyes and knowing, sometimes before she does, what she needs to know about her child. The presence of mind to model impeccable bedside manner for my intern, who has been a doctor less than a week, cannot waver because the hospital is closing. And these women deserve nothing less.

A few weeks ago, a woman came to visit her child in the neonatal ICU at Hahnemann. She was homeless, hungry, and briefly sober. That was also the day a cadre of administrators in tailored suits wandered the building. They spoke with monotoned fact about reduction in services. One of them had the nerve to cringe ever so slightly at the smell of this woman as I wheeled over a chair so that she could hold her child. Never mind the reduction in services; her child's nurses fed her, helped her shower, humanized her.

At every nurse's station, people are planning for what's next. For many nurses, their last job interview was when people thought HIV was a disease just for men. Without a bachelor's in nursing and just a few years shy of retirement, they type their resumes with two fingers for their colleagues to vet. Others rehearse their interviews for each other in the whispered moments between taking vital signs and giving medications, between one operation and the next. Some are welcomed and embraced on a new path with the supportive arms of new coworkers. We need you, this embrace reads. Some meet shame. How could you work there? Others are judged, as if the name of their employer implies a lack of something in them or in their dedication to the care of others, as if they should have known before and somehow not let this befall them. Because those who judge are really saying: we are doctors, we are nurses, we do not lose our jobs. They are wondering: could this ever befall us?

We cannot mitigate or hide from calamity. Our staff will carry Hahnemann forward. All the resilience, all the empathy, all the mentorship in the face of adversity will not be derailed. We will model it with lightness against the dark in the nuanced moments of healthcare. We will hold doors, hold hands, hold heads high. We are here.

  Perspective Number 18 Top

Society for Women in Radiation Oncology: Empowering Women in Radiation Oncology

P. N. Barry, C. Hentz1, A. Albert2, M. Knoll3, K. Doke4, A.H. Masters5, A. Lee6, L. Dover7, L. Puckett8,

C. Goodman9, V. Osborn10, R. Jagsi11

Department of Radiation Oncology, Rush University Medical Center, 1Department of Radiation Oncology, Loyola University Medical Center, Chicago, IL, 2Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, 3Regional Cancer Care Associates, Hackensack, NJ, 4Department of Radiation Oncology, University of Colorado, 5University Radiologists: Springfield, IL, 6Memorial Sloan Kettering Cancer, 7Department of Radiation Oncology, University of Alabama, 8Department of Radiation Oncology, Medical College of Wisconsin, 9Department of Radiation Oncology, Northwestern University, 10Department of Radiation Oncology, Mount Sinai: New York, New York, 11Department of Radiation Oncology, University of Michigan,

Ann Arbor, MI

The Society for Women in Radiation Oncology (SWRO) developed in early 2017 as a forum to connect women in the field. Recent estimates show that women only comprise about one-quarter of radiation oncology physicians and residents.[1],[2] This is despite overall growth in the number of women in medicine: the AAMC issued a press release in 2017 noting the milestone: “More women than men enrolled in US medical schools in 2017.”[3] What is especially concerning is the slow rate of growth of women's participation in certain specialties, including radiation oncology. One study found that female representation for radiation oncology trainees and full-time faculty has increased by only 0.3% per year.[4] Women in medicine face a number of challenges, from unconscious bias to overt discrimination and harassment, along with additional barriers related to society's expectations of a gendered division of domestic labor. In addition to these, women in radiation oncology face additional challenges. For example, women radiation oncology trainees may prefer other women as mentors;[5] at the very least, medical students may need a few senior female role models to envision joining the specialty, and given the small size of the field, many institutions may have very few or no women in such positions.

The SWRO has sought to address many of these concerns using a multipronged approach. First, SWRO has created a popular mentorship program that pairs trainees with women faculty across the country. Face-to-face meet-ups are frequently held at radiation oncology society meetings to facilitate mentoring and networking. In addition, with increased accessibility through technology, members can take advantage of this program electronically throughout the year. Second, SWRO has hosted several popular webinars and interviews. Topics have ranged from social media to career advice, helping women who may not have access to networks or informal connections to reap the rewards of expert information. Third, SWRO ran the wildly popular international social media #WomenWhoCurie campaign. This campaign, which was hosted on Marie Curie's birthday, sought to promote women in radiation oncology and aim for gender parity in the field. #WomenWhoCurie resulted in nearly 3000 tweets and over 1 million impressions, helping to model for young women that radiation oncology is indeed a field that welcomes women and benefits from diversity. Finally, the SWRO has brought to light issues faced by women physicians through its publications and ongoing research activities.

By promoting women in radiation oncology, we at the SWRO hope to increase parity and improve our representation in our field. The importance of diversity and equity in radiation oncology – and their impact on the quality of care, science, and education in the field – cannot be overstated.

  References Top

  1. Association of American Medical Colleges. Data and Reports – Workforce – Data and Analysis – AAMC. Association of American Medical Colleges. Available from: http://www.aamc.org/data/workforce/reports/492560/1-3- chart.html.
  2. Association of American Medical Colleges. Data and Reports – Workforce – Data and Analysis – Association of American Medical Colleges. Available from: http://www.aamc.org/data/workforce/reports/492576/2-2-chart.html.
  3. Association of American Medical Colleges News. More Women Than Men Enrolled in U.S. Medical Schools in 2017. Association of American Medical Colleges News; 18 December, 2017. Available from: http://news.aamc.org/ press-releases/article/applicant-enrollment-2017.
  4. Ahmed AA, Hwang WT, Holliday EB, Chapman CH, Jagsi R, Thomas CR Jr., et al. Female representation in the Academic Oncology Physician workforce: Radiation oncology losing ground to hematology oncology. Int J Radiat Oncol Biol Phys 2017;98:31-3.
  5. Barry PN, Miller KH, Ziegler C, Hertz R, Hanna N, Dragun AE. Factors affecting gender-based experiences for residents in radiation oncology. Int J Radiat Oncol Biol Phys 2016;95:1009-16.

  Perspective Number 19 Top

Purposefully Engaging Gender Social Inequities within and outside Clinical Care as an Index of Performance in Service Delivery

A. O. Fasanmi

Morehouse School of Medicine, Atlanta, Georgia, USA

As a child, I loved thinking of when I will grow up and be a doctor. Most of the doctors I saw growing up were men, and when I became a teenager, I preferred seeing female doctors than male doctors, but there were not many of them available. This thought ignited my journey to becoming a physician. Then, I worked hard and got into medical school and read like crazy, I wanted to specialize in many specialties and at different times; Pediatrics, Community Medicine, Obstetrics and Gynecology, or perhaps Neurology or Neurosurgery. My goal was still to save many lives! I quickly realized that although this was doable, there were many challenges to achieving this dream as a woman, growing up in Africa!

In my years of training and clinical practice, there was no gender sensitivity in addressing the needs of female students and physicians. There were no considerations for the peculiar needs of female doctors; we were forced to share call rooms with male doctors. We were one and the same in the eye of the administrators who of course were mainly men, it was a male-dominated world. The desire to have it all together, be a physician as well as a good mother and spouse took a psychological and physical toll on most of my female colleagues and a great many opted out of clinical practice eventually.

In my years of practice, I realized that access to healthcare was a huge challenge for women and girls in the society I grew up in because women were particularly dependent on men for resources and also bound by sociocultural and religious norms that restricted certain types of independence. Maternal and child mortality was high due to preventable causes, but it was “part of life and women's problem.” Day in, day out, as I took calls and tried to save the lives of women and children, I recognized that some of my patients died due to late presentation with overwhelming preventable complications. It became apparent to me that there was a great need for medical women to do work outside the clinical setting and promote social transformations that will ultimately impact the lives and well-being of women and children.

All around the world, women and children still die, sometimes not because there are no healthcare service delivery points available or they have not received the best clinical care, but they die because they presented late with complications that are preventable. They die because of poor or inability to access care due to certain social norms that are oppressive to women and prevent them from making the right decisions for themselves and their children. They die because of the insensitivities of the societies in which they live.

Although medical advancements have brought great hope to many women, this hope is still dependent on inequitable access to healthcare services due to race, gender, class and geographic location. There is still so much work that needs to be done in transforming our societies to be equitable, just and responsive to the needs of women and children so that they can aspire and reach their full potential regardless of their race, gender, class, and location. Therefore, it is important to purposefully engage gender social inequities within and outside the clinical care setting as an index of performance in service delivery. This is also part of the work we must do as women in medicine.

  Perspective Number 20 Top

Gender Discrimination in Surgery Despite a Critical Mass of Women: the Case of Gynecologic Oncology

S. Temkin1,2

1The Gynecologic Oncology Center, Baltimore, 2Anne Arundel Medical Center, Annapolis, Maryland, USA

Gynecologic oncology (GO) is a unique surgical subspecialty dedicated to the care of women diagnosed with gynecologic cancers. The field developed as a “supersubspecialty” of obstetrics and gynecology (Ob/gyn), and as a result, the provision of GO care includes both surgical and medical management of malignancies of the female reproductive tract. Practitioners complete an Ob/gyn residency followed by a competitive 3–4-year fellowship in GO. Skills learned during fellowship training include both the mastery of radical pelvic and abdominal surgery, including gastrointestinal and genitourinary procedures, and proficiency in chemotherapy prescribing for malignancies of the ovary, uterus, cervix, vagina, and vulva. As cancer surgeons who prescribe chemotherapy, gynecologic oncologists provide cancer care that is holistic, value-based, and person-centered.

The #MeTooMedicine, #TimesUpHealthCare, and #ILookLikeASurgeon campaigns have highlighted the role of implicit bias and gender discrimination in medicine. In 2019, nearly half of the 1200+ gynecologic oncologists in the US and Canada are women; 70% of trainees in the field are women. Critical mass theory applied to gender equity would predict that with more than 30% representation of an under-represented group, in this case women, culture change will follow. Given the large numbers of women in the field, GO should be leading other surgical fields in gender equity – providing an example of gender parity in career advancement and leadership. However, the critical mass of women has not protected gynecologic oncologists from gender bias and sexual harassment. A recent survey gynecologic oncologists reported high rates of sexual harassment; 71% of women in the field reported experiencing sexual harassment.

Gynecologic oncologists are surgeons who typically report within the departments of Ob/gyn. Of the medical specialties, Ob/gyn has the largest proportion of women trainees (83%) and faculty (57%). Women have comprised more than half of Ob/gyn residency graduates for over 20 years. However, the proportion of women in leadership is remarkably similar to those seen in other specialties, and in academic medicine – only 20% of department chairs in Ob/gyn are women. This is far below the expected rates based on the number of women trainees for the length of time that Ob/gyn residents have been mostly women. In Ob/gyn, the specialty within which the subspecialty of gynecologic oncology is housed, attaining a critical mass of women within the field has not been enough to create a successful working environment where women to get paid the same or attain leadership positions at rates similar to men. Women who succeed in female-majority, male-dominated organizations can paradoxically defend the status quo of the male-dominated hierarchy. This “queen-bee phenomenon” can limit an organization's ability to benefit from gender diversity. Paradoxically, the women in power are unlikely to add diversity to the team. Moreover, queen bees can negatively affect the diversity climate as they signal to other women that to be accepted, they need to de-emphasize their gender. Women who are aggressive or agentic (surgical personalities) are rarely successful in a male-dominated environment with queen bee women in the second tier of leadership.

For gynecologic oncologists, these gender dynamics of the Ob/gyn department are compounded by the subspecialty focus of departmental leaders. Not only are Ob/gyn chairs mostly men, but also they are rarely surgeons (they are mostly obstetricians) and only 15% are gynecologic oncologists. Within Ob/gyn departments, this misalignment of leadership (by gender and surgical focus) with the demographics and mission of GO – surgical and medical care of women with cancer – leaves gynecologic oncologists paradoxically over-exposed to gender bias. As women who are surgeons and surgeons who care exclusively for women, gynecologic oncologists must often negotiate for basic surgical needs such as staff, block time, or access to equipment directly with the operating room (because they usually are the highest volume surgeons in our department, and our Chairman is not a surgeon).

The future of GO is going to be a surgical subspeciality, led by women! For GO to remain a successful model of cancer care, the practitioners must be supported in environments free of gender bias. A critical examination of the value of this model of cancer care and support for the field is needed. Ideal reporting structures, organizational infrastructure, and institutional support should be evaluated so that our needs as women surgeons are met and the women patients with gynecologic cancers can be afforded the best possible care.

  Perspective Number 21 Top

But Still, Like Air, I Rise

K. S. S. Hoehn

Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, IL, USA

On November 19, 2018, a shooting occurred at a Chicago Hospital. As it was unfolding, all of us wondered what happened. Everyone said it must be gang related; the violence in the city is spreading. Who would start shooting at a hospital? Only later, did we learn that primary victim was Dr. Tamara O'Neal, an emergency department physician was killed by her ex-fiance. In addition to Dr. O'Neal, a police office and a pharmacist were also murdered in cold blood. Sadly, the police could close the case as just another case of domestic violence. The city could breathe a sigh of relief that it was a targeted shooting, an angry jilted fiance trying to get back at the woman who had the courage to leave him.

Dr. O'Neal was doing everything right; she ended her engagement with a potentially violent partner. People perceive that successful women cannot be victims in relationships, because they can just leave. However, women are at the highest risk of death when they leave a relationship, and the presence of a gun in the home increases the risk of homicide by 500%.[1] 72% of all murder-suicides involve an intimate partner, and 94% of these murder victims are woman.[1] This could never happen to a doctor, right?

One in three women is a victim of intimate partner violence during their lifetime.[2] When I was a medical student looking for a summer project, I spent the summer volunteering at a shelter for battered women. It was there that we watched OJ evading the police, everyone riveted in silence while waiting to see if an abuser would be brought to justice. Never in a million years, did I ever think that I would be in a violent relationship and afraid for my life and those of my children. The thought of my spouse alone with my children even for 15 min was terrifying to me. After my beloved dog died in suspicious circumstances at a gun range, I went on immediate leave to stay home and make sure my children were safe. Despite his violence, the police sided with him, saying it is a man's right to keep unloaded guns on his property.

What is the rate of intimate partner violence among physicians? Due to reticence to report, we do not have reliable numbers.[3] When Dr. Casey Drawert was murdered by her husband, described as a prominent businessman, the world wondered, how could a successful physician woman also be a victim at home?[4] Dr. Choo wrote about how the clash between successful professional lives and turbulent personal lives leads to underreporting among physician women.[4] Sadly, women who leave a batterer are 75% more likely to be killed than if they stay.[5] In 2017, the CDC found that nearly half of all female homicide victims were killed by an intimate partner or their parter's friends and family. The United Nations reports that 50,000 women per year are killed by their intimate partner, which is 137 women per day or 6 women per hour.[7]

Why write about this now? Successful women are not able to go underground and sacrifice their careers to escape a violent relationship. Oftentimes, they are the breadwinner and trying to move and establish custody at the same time. I was asked multiple times a day when interviewing, what will your husband the neurosurgeon do? There was not a graceful way for me to share that I was leaving him. No one asks a man what his spouse will do when they move. The topic of one's spouse should be irrelevant to those hiring, as the person should be judged on her own merits. Less is more is the optimal avenue to move forward, and let the applicant choose what to disclose. This will avoid empowering the abuser by discussing him during interviews.

I am one of the lucky ones, I got out alive. I am grateful for my nanny during my contentious divorce, and her FBI spouse who kept my children at an undisclosed location literally under guard until the movers had gone and we were on our way out of the state. I am grateful to have a job that I love with supportive and nonjudgmental colleagues. I decided to share my story to mitigate the shame associated with intimate partner violence, and let everyone know, as Maya Angelou said, “you may kill me with your hatefulness, but still, like air, I rise.”

You may shoot me with your words,

You may cut me with your eyes,

You may kill me with your hatefulness,

But still, like air, I rise

– Maya Angelou

  Perspective Number 22 Top

The Gig Economy of Global Health: Female Perspectives from the Field

J.E. Manning1,2, S.U. Schwanke Khilji1, 3, 4

1Laboratory of Malaria and Vector Research US Embassy, Phnom Penh, Cambodia, 2National Institute of Allergy and Infectious Diseases and National Institutes of Health, 4Division of Hospital Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA, 3Oregon Health and Science University Global, Bangkok, Thailand

Intensified interest in global health is yielding unprecedented numbers of medical trainees, predominantly female, attempting to forge global health careers.[1],[2] However, academic global health career tracks are ill-defined, and physicians working overseas must assemble training obligations, fieldwork, and academic expectations into a cohesive framework.[3] Meanwhile, the landscape of medicine is transforming alongside the dawning of the “gig economy,” a major shift in the lay concept of labor markets characterized by flexible short-term work enabled by digital platforms.[4] As academic literature begins to explore related generational shifts in workplace values,[5] it is important to frame the experience of women in academic global health (WAGH) within the larger context of the gig economy.

There is no consensus on the definition of the gig economy. Most often, it includes contingent or alternate work arrangements spurred by increasing connectivity and emphasis on work–life balance but at the expense of increased individual risk.[6],,[7],[8] Digital platforms fueled the popularity of “gigging” by decoupling labor from physical location.[9] Paralleling recent gains in the number of women physicians, women engaged in alternate work arrangements increased nearly two-fold from 2005 to 2015 (8.9%–17%).[10],[11] The gig economy's impact on healthcare via online marketplaces and telemedicine opportunities has important consequences for the future practice of medicine, especially for WAGH.[9],[12],[13]

Academic global health bears many similarities to the gig economy: career paths marked by autonomy, entrepreneurialism, and personal risk-taking but at the “tax” of job insecurity, lack of regular benefits, inadequate workplace protection, and portfolio careers.[3],[7],[13] Like all women, WAGH also face gender bias and “baby penalty” during career-building years, incurring additional risks of sexual violence and substandard prenatal or medical care while in the field.[14],[15] In a recent WAGH survey, more than three-quarters of respondents cited inability to achieve work–life balance as the most important reason to leave the global health.[16] Not surprisingly, women hold only 24% of leadership roles in global health academic centers.[2] Academic advancement is a launching point to serve in leadership positions in policy-making consortiums, government, think tanks, and multilateral bodies, suggesting that women drop out of the pipeline by failing to advance in academia.[2],[17],[18] Given precarious funding for traditional academic career pathways, WAGH may be increasingly tempted to abandon academic positions for greater flexibility and earning potential in the gig economy.[19],[20] Unless academic medical centers revolutionize the way that they retain and promote WAGH, we propose that the leaky pipeline of WAGH leaders may worsen in the burgeoning gig economy.

The success of both gig-based businesses and academic global health centers depend on a vibrant culture of workers with diverse skill sets, entrepreneurial drive, and topical expertise. To retain talented WAGH, institutions must take risks to catalyze change as it is often structural discrimination that confers varying degrees of “career capital.”[21] Further, because global health is situated at the crossroads of disciplines, researchers face organizational barriers similar to other physician-innovators pushing multidisciplinary health advances.[3],[22] For future WAGH leaders navigating career advancement, the obstacles to amazing career capital are amplified by organizational gendering processes and working at a distance, leaving women more vulnerable to deserting the pipeline.[21]

Overcoming academic “flexibility stigma” is imperative to retaining women.[21] Companies reliant upon the gig economy transformation have invested heavily in online platforms to facilitate flexibility and working at a distance.[4],[9] All faculty seeking flexibility may benefit from institutional investment into digital platforms to promote remote work routines, which may in turn mitigate WAGH career dropout. Providing access to nontraditional professional development as archived webinars, CME credit for remotely-attended activities, and enhanced video conferencing capabilities are a start. Promotion committees may reconsider the value of multidisciplinary activities, adopted policy documents, and published international guidelines, in addition to peer-reviewed journal publications. Institutional recognition of the value and timelines of nonlinear paths where traditional academic productivity may ebb and flow alongside field and family demands is critical.

We write from the perspective of US-trained WAGH working overseas thanks to supportive institutions, which have made our career choices possible by ensuring stable income, adaptable clinical appointments, and mentorship support. However, we have watched as too many women colleagues have left for the gig economy, often leaving medicine altogether. Under the conviction that WAGH will continue to recede from leadership positions if existing frameworks for compensation, professional obligations, and promotion persist, we call on academic medical institutions committed to global health to actively address the unique risks borne by women in global health – else risk losing more of these potential leaders to an increasingly appealing and innovative health gig economy.

  References Top

  1. Drain PK, Primack A, Hunt DD, Fawzi WW, Holmes KK, Gardner P. Global health in medical education: A call for more training and opportunities. Acad Med 2007;82:226-30.
  2. Downs JA, Reif LK, Hokororo A, Fitzgerald DW. Increasing women in leadership in global health. Acad Med 2014;89:1103-7.
  3. Palazuelos D, Dhillon R. Addressing the “global health tax” and “wild cards”: Practical challenges to building academic careers in global health. Acad Med 2016;91:30-5.
  4. Tran M, Sokas RK. The gig economy and contingent work: An occupational health assessment. J Occup Environ Med 2017;59:e63-e66.
  5. Boysen PG 2nd, Daste L, Northern T. Multigenerational challenges and the future of graduate medical education. Ochsner J 2016;16:101-7.
  6. Maybe the Gig Economy Isn't Reshaping Work After All – The New York Times. Available from: https://www.nytimes.com/2018/06/07/business/economy/work-gig-economy.html. [Last accessed on 2018 Sep 12].
  7. The Growth of the Gig Economy: A Look at American Freelancers. Available from: https://www.businessnewsdaily.com/10359-gig-economy-trends.html. [Last accessed on 2018 Sep 11].
  8. Contingent and Alternative Employment Arrangements Summary. Available from: https://www.bls.gov/news.release/conemp.nr0.htm. [Last accessed on 2018 Sep 11].
  9. Graham M, Hjorth I, Lehdonvirta V. Digital labour and development: Impacts of global digital labour platforms and the gig economy on worker livelihoods. Transfer (Bruss) 2017;23:135-62.
  10. Data – OECD. Available from: http://www.oecd.org/gender/data/women-make-up-most-of-the-health-sector-workers-but-they-are-under-represented-in-high-skilled-jobs.htm. [Last accessed on 2018 Sep 12].
  11. Katz L, Krueger A. The Rise and Nature of Alternative Work Arrangements in the United States, 1995-2015. Cambridge, MA: National Bureau of Economic Research; 2016.
  12. Digital Health Care Revolution | Fortune. Available from: http://fortune.com/2017/04/20/digital-health-revolution/. [Last accessed on 2018 Feb 26].
  13. Healthcare: Gig Economy Hits Telemedicine with Nomad Health | Fortune. Available from: http://fortune.com/2017/11/15/healthcare-telemedicine-nomad/. [Last accessed on 2018 Feb 26].
  14. Barry M, Talib Z, Jowell A, Thompson K, Moyer C, Larson H, et al. A new vision for global health leadership. Lancet 2017;390:2536-7.
  15. Ceder I, Erkut S. Unpredictable Schedules Disproportionately Hurt Women's Careers. Harvard Business Review; 08 January, 2018. Available from: https://hbr.org/2018/01/unpredictable-schedules-disproportionately-hurt-womens-careers. [Last accessed on 2018 Sep 12].
  16. Why do Women Hold Less than 25 Percent of Global Health Leadership Roles? | Devex. Available from: https://www.devex.com/news/why-do-women-hold-less-than-25-percent-of-global-health-leadership-roles-85417. [Last accessed on 2018 Feb 26].
  17. Downs JA, Mathad JS, Reif LK, McNairy ML, Celum C, Boutin-Foster C, et al. The ripple effect: Why promoting female leadership in global health matters. Public Health Action 2016;6:210-1.
  18. Molina R, Boatin A, Farid H, Luckett R, Neo D, Ricciotti H, et al. Creating flexible and sustainable work models for academic obstetrician-gynecologists engaged in global health work. Obstet Gynecol 2017;130:843-51.
  19. Katz IT, Wright AA. Scientific Drought, Golden Eggs, and Global Leadership - Why Trump's NIH Funding Cuts Would Be a Disaster. N Engl J Med 2017;376:1701-4.
  20. The Future of Gig Work is Female. Hyperwallet Payout Platf; 30 August, 2017. Available from: https://www.hyperwallet.com/resources/ecommerce-marketplaces/the-future-of-gig-work-is-female/. [Last accessed on 2018 Sep 11].
  21. Newman C, Chama PK, Mugisha M, Matsiko CW, Oketcho V. Reasons behind current gender imbalances in senior global health roles and the practice and policy changes that can catalyze organizational change. Glob Health Epidemiol Genom 2017;2:e19.
  22. Majmudar MD, Harrington RA, Brown NJ, Graham G, McConnell MV. Clinician innovator: A novel career path in academic medicine a presidentially commissioned article from the American Heart Association. J Am Heart Assoc 2015;4:e001990.

  Perspective Number 23 Top

LMN2: a Leadership Theory Based on the Deconstruction of the Lynch Principles

L. L. Newman

Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

This emerging perspective on leadership theory illustrates six domains of essential merits which provide a framework to dismantle the lynch principles of 1712. It is this instructional set which has led to systematic, methodical oppression of African descendants. It is rooted in racial discrimination but has expanded to encompass discrimination by age and gender.

LMN2 is a new leadership model which could positively impact the inequities in medical academia with regard to advancement into executive leadership roles, incentives and salaries, and rate of promotion. This model is based on the decoupling of what has been perpetuated in the minds for greater than 300 years throughout society from an intellectually driven, purpose-filled approach to the advancement of all people in all facets of industry including, but not limited to medicine.

Love, laughter, modeling the way, meaning (purpose), navigation, and new fashioning constitute LMN2, a new proposal on leadership theory. It portrays a gift of high moral aptitude, while restoring integrity and inspiring hope. LMN2 analyzes the lynch principles and provides a model of deconstruction to emphasize similarities; evokes trust and respect; and promotes confidence and psychological freedom. LMN2 encourages relationships and network for the well-being of humanitarianism through six key elements.

Love is the most important of these elements. Love of humankind, the Earth, family, and education are some examples which may inspire and motivate one in spite of the complicated world that we live in. It is not a common entity within leadership models. Regardless of your work industry, a display of love of your colleagues for who they are and the value they contribute forges positive relationship at work and abroad.

LMN2 proposes a unique way of leading through deconstruction of the lynch principles. Daring to lead differently often requires leading from the outside before attaining an inside executive role. One must be brave and courageous when it is good for the masses, the mind, body, and the soul. Great leaders nurture the most novice of ideas. They can envision beyond the physical scope of the present.

Great leaders are beacons of inspirational hope, exhibit high moral aptitude, and restore integrity to their respective organizations or field of the study. LMN2 harnesses six elements to shine a different light into leadership from a different vantage point. It skillfully lays out the principle and illustrates how each principle serves to provide a different prong to widely deconstruct the lynch principles of 1712. This leadership model provides a new perspective on old problems to embark on the new.

  Perspective Number 24 Top

It Is a Shame We Have Not Changed

S. E. Jolley

Department of Medicine, Section of Pulmonary and Critical Care, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana, USA

It is well known that there is an epidemic of moral injury (poorly termed “burnout”) among physicians in modern medicine. Healthcare systems and medical schools are grappling with increasing numbers of physicians and students suffering psychological sequelae as a result. In addition, the number of physician suicides continues to climb with few signs of an effective, preventative solution. Academia, like medicine, is enduring a similar fate. With ever-dropping NIH pay lines, the academic arena has devolved to a survival-of-the-fittest contest. This hypercompetitive environment is driving talented junior investigators away from biomedical research placing the future of the US research enterprise at risk.

Healthcare systems and universities propose numerous interventions for “burnout.” These interventions focus on building resiliency and promoting self-care and wellness. Medical schools and hospitals rally around resiliency as the key to unlocking the burnout puzzle; however, they systematically ignore and at times even promote resiliency's insidious cousin: shame. Renowned shame researcher, Brene Brown, defines shame as “an intensely painful feeling or experience of believing we are flawed and therefore unworthy of acceptance and belonging.” Unlike guilt when we make a mistake, which may be adaptive for change, shame results from the internalization of blame leading the individual to believe they are the mistake. Shame results in feelings of being trapped, powerlessness, and isolation, and excess shame is linked to worsening self-esteem, addiction, and worsening mental health, including anxiety, depression, and suicide.

Years of shame research suggests that shame is a key driver of maladaptive behaviors that deplete resiliency, promote disconnection, and reduce self-worth. Shame breeds maladaptive perfectionism as a defense mechanism resulting in an ever-evolving list of unachievable expectations. This lack of personal efficacy is a hallmark of “burnout” in physicians. This begets more shame propagating a downward spiral. At the extreme end of this spectrum, this shame spiral devolves into anxiety, depression, and ultimately suicide. This is amplified in women and minority physicians who must perform at a near-perfect level just to maintain equal footing. Luckily, shame researchers note that this is a fixable problem. They argue that individuals and systems can halt this process by giving a name to shame when present, reducing shame triggers, and building a culture of connection to build shame-specific resiliency.

Beyond promoting maladaptive perfectionism, researchers suggest that over time, shame erodes vulnerability. Fear of displaying one's true self for fear of judgment creates a superficial society devoid of true, personal connection. Internet comments, social media posts, and hospital peer reports place physicians on the shame defensive increasing their fear of making mistakes or appearing less than perfect in front of colleagues or patients. Punitive actions for honest mistakes or extreme criticism of physician stylistic choices exacerbate this ever-present sense of judgment. Further, to this day in academic medical centers, our trainees are conditioned to shame with the use of shame-inducing “pimping” as “teachable” moments. Trainees are taught to act out of fear of imperfection and encouraged to continually show their best self. As a means of protection, physicians withdraw from personal connection and individuality contributing to the depersonalization and cynicism that defines burnout. As older physicians become conditioned to this shamed state, they, in turn, promote shame-inducing behaviors with junior physicians creating an unending cycle of abuse.

Although shame triggers are commonplace in medical practice today, they are largely a construct of our own making. We attribute burnout to many causes: a loss of autonomy to hospital systems, increasing technology, and changing practice patterns. However, we rarely talk about the negative culture that exists within medicine today. In place of promoting shame-based tactics, physicians could chose to accept a culture that encourages and promotes vulnerability, individuality, and transparency. They could recognize vulnerability as a sign of strength and a necessary element for human connection. Medical schools could teach trainees to embrace uncertainty while retaining their competence and enhancing empathy deepening connections between physicians and reconnecting us with our patients in a shared humanity. We should stop encouraging physicians to become resilient, while ignoring the ever-present trauma that led to their injury. In combat, soldiers adapt to the environment and situation when a war appears unwinnable. As physicians, we must change the culture of medicine if we really hope to save our colleagues from moral injury. We must let go of shame and embrace vulnerability and imperfection. Can you imagine a shame-free healthcare environment that embraced vulnerability and fostered individuality? I can and I think we and our patients would love it.

  Perspective Number 25 Top

The Power of #MedStudentTwitter for Women Medical Students

B. Christophers, S. Zucker1, P. Kantesaria2

The Weill Cornell/Rockefeller/Memorial Sloan Kettering Tri-Institutional MD-PhD Program, 1Tulane University School of Medicine, New Orleans, Louisiana, 2Rutgers New Jersey Medical School, Newark, New Jersey, USA

Twitter has been described as many things: an echo chamber of gossip, catalyst for misinformation, and home for internet “trolls.” As such, many may be surprised that we are exalting the site as a professional tool, especially for medical students. #MedTwitter is an online community that has bridged connections between medical professionals across geographic and hierarchical boundaries. This acts similarly to professional conferences but without financial barriers. More recently, medical students have started sharing their experience under the hashtag #MedStudentTwitter, a space both cathartic and educational. Twitter acts as an equalizer that gives women who are just entering medicine a constantly updated trove of learning opportunities, a community of female peers and mentors, and a space to share their own thoughts on medicine.

Being active on Twitter puts you in contact with individuals eager to share advice, stories, opportunities, and support. You begin to recognize people and create a network with diverse perspectives and roles that you retweet and reply to, which oftentimes develop into friendships and mentorships. Women on #MedTwitter are constantly acting as sponsors by encouraging students and trainees to pursue professional development opportunities, including conferences, fellowships, scholarships, events, webinars, and awards.

One productive avenue to engage in conversations with physicians and students is through Twitter chats: TOPIC-based discussions that occur at a particular time under a specified hashtag. In fact, all three of us met because we participate in the weekly #WomenInMedicine chat founded by Petra Dolman, MD (@petradMD). Since becoming friends, we have spearheaded a few collaborations between us, including the bi-weekly MedStudentChat (in partnership with fellow medical student Travis Benson). Several popular regular Twitter chats have been founded by women physicians: #SoMeDocs for doctors engaging on social media, #MedHumChat for the medical humanities, and #PWChat for a potpourri of academic topics. The popularity and success of these chats are founded in the connection fostered among participants.

Women in medicine have carved out a community for themselves through the hashtag #GirlMedTwitter. Users include the hashtag to seek guidance on lighter questions (e.g., comfy professional shoes for clinic) and advice on handling heavier issues (e.g., sexual harassment) that disproportionately affect women in medicine. The #GirlMedTwitter hashtag grew into a movement and a nonprofit Girl Med Media, Inc., led by @ClinicalPearl and other women in medicine. Spaces such as #GirlMedTwitter allow women students to tap into collective wisdom broader than those to which they have access at their training institution.

Even with such brevity, many users share compelling, powerful reflections about being women in medicine, encouraging others to engage with this show of humanity. Women students have a supportive space to develop their voice as budding medical professionals. It is also a continuous lesson in professionalism because every post needs to abide by professional and ethical standards. Students join professionals in conversations about current events, using their education to comment on health issues. In the same vein, medical students can highlight patient advocacy issues related to their clinical interests to expand general awareness on these topics.

It can be challenging for women medical students to receive exposure and recognition for their efforts and accomplishments. Twitter is a platform to amplify their work in front of a broader audience. Women in medical school can find ways to start and join the conversation on #MedStudentTwitter that is in line with their experiences and interests and connect with scholars and leaders regardless of location.

#MedTwitter's greatest educational tool is the”tweetorial:” a series of tweets for learners, often drafted by experts in the field, on a wide range of topics as a form of Free Open Access Medical Education (#FOAMed). These tweetorials are concise and straightforward, making use of images, poll questions to test concepts, and references to the most up-to-date data. Through tweetorials, learners connect with passionate educators on topics often considered too niche or too new for students, all for free. Further, regardless of her school's individual hiring practices, women medical students on Twitter get the benefit of learning from diverse teachers.

In diversity and inclusion, a frequently cited statement is “you can't be what you can't see.” Thanks to the power of #MedTwitter, a woman medical student can not only see what she wants to be, but she can also personally connect with those women physicians with shared interests. For the next woman medical student seeking guidance, mentors should ask, “Have you joined Twitter yet?”

  Spotlight Number 1 Top

Thoughts of an Immigrant Physician

J. C. Mejias-Beck

Department of Internal Medicine and Pediatrics, University of Missouri, Kansas City, Missouri, USA

Undocumented: A word that will forever be with me. A word that defines who I am despite now being a United States Citizen. This word is powerful. It has shaped me. It will always be a part of my journey. For a significant portion of my life, my immigration status dictated what I did and the opportunities I had. A small document with a nine-digit number dominated my life. When my family and I left Venezuela, we envisioned better opportunities away from violence, poverty, political coercion, and famine. On moving to the States, we never intended to overstay our visas and ultimately become undocumented.

The journey to my MD has not been easy, and at times, very uncertain. I feel blessed by the fact that I joined a small cohort of individuals who were openly accepted into the medical school class of 2014, which, at that time, were the first with a DACA status. Every step of my medical education was uncertain: from taking the medical school entrance examination, applying to medical schools, applying for financial aid, and even applying to residencies.

I am a Latina physician. I now have a hyphenated last name: Mejias-Beck, with Beck being my married name. My last name is a reflection of my life. It blends my Venezuelan culture with my American life. My patients refer to me as Doctora Mejias, Doctor Beck, or Doctor Mejias-Beck. I connect to each title in a unique way. At times, I find myself trying to fit into three worlds: Hola. Hello. Medicine.

I often look around and feel out of place. I reflect on some of my patients and know they have felt the same. It is hard to describe what being undocumented feels such as the constant fear, anxiety, stress, the unknown, the limits, and the guilt. Without documentation, I was afraid. I was fearful of who I was, what I looked like, how I spoke, and where I came from. I will never forget those emotions and struggles.

Beyond insurance and expense, there are many reasons why undocumented people do not see a doctor. One of the largest barriers is apprehension. My family and I lived through this fear. We only saw a physician when were quite ill. Those of us who work in the medical community must understand how difficult it is for an undocumented patient to show up. Most doctors do not look like us or speak a different language. We are afraid of what might happen when we check into a medical office. We wonder if we will be welcomed or asked for papers. Will we be reported to the government? Is our English good enough?

However, we were also afraid of being misunderstood. I was raised with cold remedies such as Vivaporu al pecho y los pies antes de acostarse (vapor rub to the chest and feet before bed) and miel con cebolla roja (honey and red onion) to treat a cough. What if a physician questions the evidence behind this or asks, “Now why would you do that?” These remedies are deeply rooted and rich in our culture. We believe in them. My own mother was terrified of mal de ojo (evil eye) when we were young. She stuck a moist piece of paper on our forehead to get rid of the hiccups when we were infants. These traditions and belief systems are real to us. We hold them close. While I practice Western traditional medicine, I feel a deep responsibility to my cultural roots. I like to share these traditions with my colleagues in hopes that they become more familiar with my culture and feel more equipped to connect with patients who are like me.

As medicine advances, it will only be as strong as the physicians who lead the way. Taking the Hippocratic Oath is not enough. We must fully commit to serving a diverse population. Physicians should mirror the population they treat. However, the number of Latino medical students and Latino physicians continues to saunter. There are efforts to address this. In the meantime, adequate and up-to-date training on cultural awareness is essential. I am dedicated to teaching others about the journey undocumented patients face, including my own. Understanding the unique challenges of undocumented patients is essential in today's political climate. Creating a safe platform for us to share it is a start.

  Spotlight Number 2 Top

From Bedrest to Balance

L. Santhosh

Department of Medicine, University of California, San Francisco, California, USA

Underwhelmed by the grainy black-and-white images of “baby sister,” my toddler bounced on my husband's knees, while I squinted to try to meet the ultrasonographer's steely gaze. I knew something was wrong: her calipers measured and re-measured the too-tiny bobbing head, and I envied my nonmedical husband's oblivion in that moment. The maternal–fetal–medicine (MFM) doctor finally arrived, with a litany of frightening abbreviations: IUGR, oligo, r/o PTL, and I was wheeled to L and D at 32 weeks. I had planned on working out after the routine ultrasound: a flimsy hospital gown replaced the athleisure, the toddler went home for dinner to keep some semblance of routine, and I received intramuscular betamethasone in case this baby needed to be born today.

The doctors asked concernedly, “You don't have any more inpatient service time, do you?”

”Yeah, but I guess I'll cancel that…”

”YES, definitely cancel it.”

”Okay. But can I still do clinic?”

”What? Clinic?! No!”

How much denial was I in, that my very first question during my admission was whether I could see more patients?

After a few days of being a “reliable” patient, I was given a “choice:” remain inpatient with daily testing until my ultimate To be determined (TBD) delivery date, or discharge home, but return to the hospital daily for monitoring. And so began my weeks of bedrest, a strange purgatory between feeling well enough to work but not being allowed. I was technically an outpatient, <at home and not admitted to the hospital>, but with inpatient admission and an emergency Caesarean-section beckoning, daily. I was an academic physician, yet simultaneously, I was a confused pregnant patient!

New uncertainties filled each day. Should I be nil per os/ nothing by mouth (NPO) just to be safe? How could I even respond to the simple question “When are you due?” Any new ache or pain or discomfort seemed suddenly ominous – another complication or just hypochondria? Horror stories of fellow physician mothers with devastating pregnancy complications intruded my thoughts, and I already knew the data on increased pregnancy complications in physician moms. Between ultrasounds and antenatal testing and pharmacy visits and blood draws, there was hardly any time or energy to tie up my research projects as I adamantly “worked from home.”

As I frantically scheduled phone meetings and answered e-mails, innocent well-meaning comments unintentionally neglected the dichotomy between the fetus and me. How are you feeling? I am fine, but she is not fine at all. You do not even look that big! Thanks… because she is barely getting enough nutrition to grow. Coworkers were unable to understand the nuance of my situation – I could not blame them as I could barely understand myself. They alternated between saying, “Oh how awful! But can you still do this for me by this deadline?”

Strangely, during my bedrest, the abnormalities on my ultrasounds disappeared one by one. MFM fellows and attendings gathered around me and exclaimed, “It's because you're not working!” “TOXIC STRESS!” proclaimed one of my colleagues. How strange and perverse to imagine that my all-encompassing, rewarding job was sucking energy out of me and nutrients out of my fetus.

With the loss of control, I was forced to aggressively triage: no clinic, yes Inbox. No committee meetings where I was replaceable, yes, video-conference into ones when I had something important to say. Decline that book chapter will not be career-changing anyways. Record myself giving a presentation in case I could not deliver it in-person. Submit my Master's thesis early and hope it was “good enough” for graduation. Big-picture career advice meetings with mentors? Those would have to wait. I did not know what was facing me the next day, let alone my 5-year plan.

Fire-fighting mode felt strangely calming. The forced bedrest forced me to slow down and reflect, if not relax. I had no choice but to take it 1 day at a time. In the evenings, instead of glancing at my phone, I would play with my daughter with full attention. Instead of doing work after she went to bed, I would watch a new TV show or go to bed early, knowing a premature newborn could be here momentarily.

During this time of purgatory, my daughter taught me, nay, forced me, to slow down and focus on her, focus on us. She showed me quite literally how family and life are more important than my self-imposed busy-ness. She pulled me from the edge of burnout to instead find balance.

Her name is Jaya, which means victorious. She threatened to come at 32 weeks, and she ended up coming at 37 weeks. In teaching me about balance, she was victorious.

  Spotlight Number 3 Top

What's Left Behind

M. Franckowiak

Jacobs School of Medicine and Biomedical Sciences at University at Buffalo at University at Buffalo--SUNY, Buffalo, New York, USA

The surgeon and the nurses and the surgical techs are trying to find a sponge in the room where I sit and monitoring a patient's anesthesia and vital functions such as heart rate, blood pressure, and respirations.

The surgery began a few hours ago.

There were things taken apart, things removed, things sewn back together.

Part of the time, the lights were off. During that time, the surgeon and the medical student viewed inside of the patient from cameras that projected onto a screen. The cameras insert into the patient at spidery, awkward angles. The incisions are smaller than band aids in this surgery, and they do not generally get put inside the abdominal cavity, where if they were left behind, they could, over a few weeks or months, simmer up an infectious, purulent mess.

Still, the surgical technologist and the circulating nurse must count all the instruments and sponges that were there at the beginning of the case. There is an opening count, a closing count, extra counts if one of them goes on break. It is a simple math. The opening count must match the number that are there at the end of the case. If they do not match, the surgeon might need to order an X-ray to ensure that one of the sponges was not left inside the patient. They might have to search the floor. They might have to reopen the abdomen to retrieve a missing sponge.

Sometimes, they fall on the floor.

  • Occasionally, they get left inside of patients
  • These accidental sponges become a source of complications, mortality, and lawsuits
  • As it turns out, though, every incorrect count has a correct operating room count associated with it on the record.

No surgeon ever leaves a sponge behind inside the abdominal cavity. Not intentionally, anyway. It happens by human error, though, every so often, and not so infrequently, violating the first principle of the Hippocratic Oath: Primum non nocere.

First, do No Harm.

Merriam Webster defines an accident as an unplanned or unforeseen event or circumstance. An alternate definition of an accident is an unfortunate event, resulting especially from carelessness or ignorance. There are infinite ways upon which the human body can come upon unplanned, accidental circumstances. When bodily harm results from these circumstances, the secondary result is called trauma. Of all the accidents that can occur to humans, penetrating abdominal trauma and head injury are two injuries that are likely to cause accidental death. These happen most frequently in motor vehicle accidents and falls.

I cannot remember who the surgeon was in this case.

This scenario has happened literally dozens of times in my career.

Once, at a much later time, a resident told me a story about a surgeon, we worked with, Dr. Tim Jorden, who had left a sponge in a patient. The patient presented to his office with complaints of fever, abdominal pain, and nausea.

The sponge was visible on an X-ray then.

As the story goes, Dr. Jorden had such a good reputation with his patients, and such a calming, soothing voice that I can attest to, that he simply showed the patient the X-ray, the sponge, and he told the patient, “That sponge needs to come out now,” with the emphasis on now. The patient thanked Dr. Jorden profusely. That pretty much ended any worry about litigation proceedings for him.

I cannot remember who the resident was who told me that story.

Memory is funny like that.

You think you remember things one way, or maybe you do not think very much about them at all, but then something happens, and you look back, and you wonder if you missed something critical, like by accident, like a sponge.

Once, when I was on-call in the trauma ICU at Erie County Medical Center in Buffalo New York, I was up very late at night with two other residents who had become my very good friends that month. It is funny how spending 80 h a week with other people make you innately dependent on them for emotional support. I was pregnant at the time with my son, Roman. The baby's father was a surgeon who I had worked with but had not dated for very long. He was not speaking to me, except when he called often during those months to try to get me to have an abortion. He said that no one was going to help me. He said that I had a dead mother. He said that I should not bring a baby into the world if it was not going to have a good life. I guess he thought two doctors could not provide a good enough life. Or maybe he was just thinking selfishly of himself.

Maybe, he was afraid of me exercising my freedom without his permission.

People are funny like that.

It was probably about 2 a.m. that Saturday night in the trauma ICU, but I cannot remember exactly.

Memory is funny like that.

I was adjusting the ventilator on a patient who I swore must have had nine lives. Elmer was over 70 and he had fallen off his Harley, sustaining multiple rib fracture trauma, a small heart attack, and a head injury. Elmer's lungs were filling up with fluid from inflammation. Liana and I were talking about the baby when the attending trauma surgeon, Dr. Timothy Jorden, came into the unit. He looked kind of like Laurence Fishburn from The Matrix. Black sunglasses, slick black suit, slick bald scalp, dark skin, long dark dress coat. Everything about him was mysterious and slick and dark. And his voice. Everyone agreed that it was always so calming, melodious, soft. Looking back, I had put it somewhere between Clint Eastwood. Wait, no, not Clint Eastwood. It was not Jack Nicholson either. Not Morgan Freeman. It is not my memory that fails me here, because I can hear his smooth voice clearly if I try.

It was unique, unforgettable, not easily describable.

Later, sometime in 2011, I was sitting in a case at Buffalo General Hospital (BGH), probably in a gallbladder or an exploratory laparotomy or a hernia repair.

I cannot remember.

Dr. Jorden worked there, too, but mostly, he worked at Erie County Medical Center (ECMC) as a trauma surgeon, fixing up numerous abdominal traumas and vascular traumas and chest traumas. There was no shortage of accidents. People come in shot up the most during the months of June, July, and August. They crash their cars in high-speed accidents more when the weather is nice, usually not on purpose, usually by accident. Mostly, in Buffalo, though, the weather is not too nice. We have a high incidence of seasonal affective disorder, a kind of depression, but I do not remember what month it was when I saw Tim at BGH.

When the weather gets nice, people drive faster, too.

They feel better and less depressed. They go out more.

Sometimes, they veer into someone else's lane. Maybe, they do not stay in their own lane because they are high on drugs. Maybe, the other guy in the other lane is driving a very expensive, massive BMW SUV and the trauma victim is driving a Kia. Or maybe, the guy's lane who they veer into is driving a massive truck like an F450 with tons of momentum and power and their Prius does not stand a chance. How those things go.

I was an attending when I saw Tim then, not a resident.

I was doing okay.

I had had my son on July 4, 2006, Independence Day. It was now 2011. At the end of that case, Dr. Jorden broke surgical scrub and the residents started to close the incision, his meticulous surgical wound. He asked me how I was doing. I said that I was doing well. I noticed that he had lost a lot of weight, and I said that he looked good, asked him how he was doing. He said, in that voice, “You know, not too well, not too well.”

I said, “Oh? Is everything okay?”

I did not know Tim well.

I knew that he had been in the military, if I remember correctly.

There were rumors that he was a Navy Seal. I knew he had a good reputation with his patients. Maybe, he did not get the same respect that the White male doctors who came to work in crisp, pressed suits did, the ones who published a lot, the ones who ran the department. I knew he had an ex-wife. Maybe, he had child support payments like my son's father did now. Maybe, he was an underdog because he had done his residency here before he became an attending and sometimes that seems to make you a resident forever. I did not know Tim well.

I do not remember.

Memory is strange like that.

When you know someone, but not well, and you have to wake up a patient from anesthesia, and there is not a lot of time to go into more detail, you hope with these everyday encounters that the sponge count is accurate, and that you remember things correctly, and that you did not miss anything accidental, like a sponge. How these things go.

Maybe I should have asked Tim more about how he was doing, what was bothering him.

He needed someone to help him, but by accident, no one did.

Not professionally, not personally.

A few years later, on the morning of Wednesday, June 14, 2012, Jorden spoke to his ex-girlfriend, Jacqueline Wisniewski, a nursing student and a single mother of a young boy. Cell phone records later indicated that he had spoken to Wisniewski on the phone for over 15 min. He had been in a relationship with her that had resulted in several domestic violence calls to police and a report to Jorden's fellow employees, but no arrest was made. How these things go.

There was later a rumor that Wisniewski was pregnant then.

I cannot remember exactly.

No reports indicated that Wisniewski owned a handgun.

No reports indicated that she carried any weapons.

No knives, no pepper spray.

Wisniewski was found in the stairwell in the old wing of the building, dead, following abdominal trauma.

Police learned that Jorden entered the D. K. Miller building of the ECMC campus that morning in June, carrying a black bag. He lured the 33-year-old nursing student into a stairwell and shot her four times at blank range with a handgun that was later recovered from his office. A manhunt was initiated for Jorden, a former weapons expert. The hunt included a SWAT team, a K-9 team, and a lockdown of the hospital that contained over 400 patients and more than 2000 employees, students, and visitors. Shortly after Jorden committed the murder, he went to his Lake Erie home around 9.40 a.m. Robots were sent in to search the home, but they did not find the trauma surgeon, Dr. Jorden. Video surveillance at Jorden's home showed him leaving the back door, entering a heavily wooded area. Corrections officers found him dead, wearing scrubs, lying beside a nearby creek that Friday, shot in the head. A.357 magnum was in his right hand. Tim had recently mailed a cashier's check for nearly 40,000 dollars to his brother in Atlanta. He had given a Rolex to a friend, a police officer on disability. I always remembered Tim as a nice guy like that, remembered him taking care of trauma patients in June, July, and August. However, then, you wonder, when you go to count, when you count back the days, you wonder if you missed something critical, and you worry about what's left behind.

  Spotlight Number 4 Top

My Benzodiazepine Journey

C. Huff

Director, Benzodiazepine Information Coalition

”'I wish it need not have happened in my time,' said Frodo.

'So do I,' said Gandalf, 'and so do all who live to see such times. But that is not for them to decide. All we have to decide is what to do with the time that is given us.'”

— J. R. R. Tolkien

As long as I can remember, I wanted to become a doctor. To me, it is the noblest profession – a chance to positively impact the lives of others. However, in 2011, after my daughter was born, I was forced to quit my cardiology practice. I needed major surgery to correct a congenital malformation of my legs. I was devastated – my entire purpose in life was gone. The surgery was brutal, and it took me over a year to rehab. Slowly though, as I recovered, I began to settle into my new role as a stay-at-home mom. I missed my patients, but I had a new, fulfilling purpose.

I had great plans for my daughter's last year of preschool, including special outings and just spending time together. The next year, she would start kindergarten, and I would go back to work. However, my plans were again derailed in August 2015 when I was prescribed Xanax, a benzodiazepine, for insomnia. The drug made me more ill than I could have ever possibly imagined. At first, it was subtle – new anxiety and tremor after 3 weeks' use. I had no idea what was happening – neither did my doctors. I became progressively sicker – my anxiety turned to sheer terror. I could not sleep. I could not breathe. I could not swallow.

Neurological tests were normal, so I was referred for biofeedback for “anxiety.” The psychologist instructed me to stop Xanax for the session. I remember lying on the floor of her office with all my muscles severely contracted, unable to breathe. After taking the missed dose of Xanax, the symptoms melted away. Alarm bells went off: Xanax was causing my illness.

I needed to stop Xanax, but every time, I reduced the dose, I suffered severe withdrawal symptoms. I was not addicted – I had no cravings and never took more than prescribed – yet my body was physically dependent on the drug. I was trapped on the drug and becoming more ill every day.

A psychiatrist helped me switch to Valium (the longer half-life facilitates tapering), and I slowly tapered over a period of 3.25 years. I was disabled the entire time, experiencing 80 different withdrawal symptoms. Basic tasks such as cooking and cleaning were impossible. Some days, I struggled just to get dressed or take a shower. Many days, I was bedbound. I could not care for my beautiful daughter – my heart was broken. I went through a long period of grieving for what was lost. I wish I had never accepted that Xanax prescription, but turning back the clock is impossible.

A quick Google search showed me I was not alone. I was shocked at what I read in the online benzodiazepine support forums. There were thousands of people, like myself, suffering disabling neurological injury from these drugs. Some had symptoms so severe and prolonged that they committed suicide. I was angry. Why had we never been taught about this in our training? Why is this not common knowledge in the medical community?

The more I learned about the scope of this unrecognized problem and interacted with those who suffered, the more I was compelled to take action. I joined Benzodiazepine Information Coalition, a nonprofit that educates about the adverse effects of prescribed benzodiazepines. I began to write openly about my personal story and the benzodiazepine problem. I told my story on NBC Nightly News, and I documented my taper and illness on Twitter. Between being ill and an extreme introvert, this was extremely difficult. However, I set myself aside because this invisible group of sufferers needed an advocate.

I am now 3 months free of Valium. I am finally seeing some improvements in my health but still have a long recovery ahead; the taper took a tremendous toll on my body. I do not know how long it will take to fully recover. What I do know is that, despite my illness, I am going to continue to be the best mom possible. And while I miss cardiology, I will keep fighting for patients who have been harmed by prescribed benzodiazepines. This was not my life plan – nobody would choose this illness – but since this is the hand I was dealt, I am choosing to raise awareness and help others adversely affected by these drugs.

  Spotlight Number 5 Top

Out of the Mouth of Babes

M. E. Maldonado

Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA

My Chair looked crushed as he showed me the letter that he had received from the Accreditation Council on Graduate Medical Education (ACGME). The letter showed the words in b: recommendation–probation.

Soon after I joined the hospital as a green associate program director, we had had our site visit. My Chair was also the internal medicine program director. The ACGME's mission for residency programs had been evolving, and they emphasized oversight and outcomes rather than a prescriptive approach to residency education. The time and effort required of a program director had increased immensely, and it was now clear that one could not be a Chair and program director. He wondered if I had take on the program director's role.

Taking on a program going on probation was not appealing to me, and I asked for time to assess whether we could avoid this adverse outcome.

I met with colleagues in neighboring programs to get their take on residency education. I reviewed notes from an educational meeting I had attended and spoke to my own former program director. He recommended an external consultant to review our program. All of these actions yielded new information, and we realized that we could counter probation. I wrote a response letter that addressed each citation, and we won a 1-year accreditation. At that point, I was ready to become program director. I had had an extensive education about the current state of residency education, what the challenges would be, and what our next steps needed to be.

I am also a parent. I loved the summers because I had found a camp in the city where I worked. My commute was frequently an hour each way, which represented time away from my daughter. Each morning, she and I would drive to the hospital and the camp provided transportation back and forth from my workplace. She had have a terrific day and we spent our evenings trading stories. Our time together during the commute was precious and wonderful.

There is an old saying that our kids learn by our example. I will never forget the day she told me that she thought that the nurses at the clinic were doctors – because they were women.

My daughter was waiting for me in my office the day I met with my Chair to discuss what I had hope would be new salary. She was 10 years old.

My Chair was a colleague and a dear friend. He had already investigated the possibility of a raise and had been turned down. At our meeting, I learned that only my title would change.

Only program directors understand the crushing responsibility of their role. The program director is accountable for the actions of their residents. They must advocate for resources to run the program with integrity, and frequently, they run up against systemic and institutional barriers. They implement curricular innovations, but sometimes, the residents will not bite. They must continually inspire, cajole, mentor, and coach a disparate group of adults and manage the faculty responsible for teaching and evaluating the residents.

No one tells you that you are going to crow with joy when you recruit a group of residents worthy of the profession of medicine, or cry in sorrow if one has not gotten the fellowship they desired or has to be dismissed from the program, or if several residents do not pass the in-training examination. The buck stops with you, and you are fully accountable. I have often felt it was like being president of your own little country.

To say I was disappointed that I would not be getting a salary commiserate with my new role would be an understatement.

”How did it go?” my daughter asked, as we left the hospital.

I told her that I was not going to get a raise.

”Why don't you just ask for what you want, Mama?” she persisted.

The next day, I went back to my Chair who suggested that I meet with the final decision-maker. I got my raise, and it made all the difference in subsequent raises. I had assisted the program in avoiding probation, gained much wisdom, and had sought help from mentors. And yet, before this very moment, in negotiations, I had not learned how to advocate for myself and to realize that no is not the end of the discussion. However, I had taught my daughter the importance of asking for what you want, and she mirrored this back when I needed it the most.

  Spotlight Number 6 Top


A. Ndekezi

Department of Pediatrics, Kibagabaga District Hospital, Kigali, Rwanda

This is a story about a girl from a single family home, dysfunctional in all means possible who arose to achieve her dreams and who is now ready to help better her community and the world at large. Better her community and the world at large, one person at a time.

I am a general practitioner currently in my 2nd year of clinical practice. I was born in Kenya in a normal nuclear family, and I was described to be an active outspoken child. However, around my 4th year came the passing of my father and beginning of chaos in my life.

After 2 years of his passing, my mother was diagnosed as schizophrenic and was no longer able to be the parent figure we needed to have family–financial and emotional stability. We struggled in Kenya for roughly 9 more years and then relocated back to Rwanda when I was roughly 13 years. Those 9 years were full of chaos and physical and verbal abuse from a mentally ill mum. I vividly remember sleeping out on the streets on a night; I vividly remember, as I slept on the street one night, my mum taking off to the neighboring country, Tanzania. And I felt like the world had given up on me and my 4-year-old brother, who slept beside me in the freezing cold. We did not ask neighbors for help because we were taught not to trust anyone. I remember waking up at 4 a.m. in the morning and looking at street children who I had so often looked down on I remember having a eureka moment that these children also had reasons that had them sleeping on the streets. There and then, I vowed to help street children and anyone else who seemed vulnerable because in the back of my mind I always had a tagging feeling that there was more to life than what I was experiencing.

We relocated to Rwanda and life got better because we had family around. I got a scholarship for all of my high school years and that is where I started working with street children, partly as a give back project. This passion continued well into university where I started a group called inspiration. I worked with girls who were formally street kids. I had the opportunity to hear their stories, help them with school work, and also teach them new skills such as dancing and drawing.

I did the above while still in medical school, but I had not unlocked the potential that I had until I met Dr. Zhenya an internist who was working with residents but also worked with undergraduates. The thing is through all I had gone through I did not believe that I had a voice that needed to be heard or that I was brainy enough and this affected my studies. Not believing in oneself is something that hinders girls to pursue science subjects more so in our class of roughly 100 students we were only 30 girls or less.

I interned under Dr. Zhenyas' supervision, and she was patient enough to wait for my answers and specifically wait for me to present my patient and discuss what I had learned. This opened inside me a passion that I did not have before of wanting to share what I had read or my thoughts on the diagnosis of a patient or management plan that I considered to be beneficial.

I henceforth excelled in my studies and I am currently in my 2nd year of clinical practice, but I am continuously trying to learn how to use my voice. I am striving to learn how to share the little I know to learn more. I was able to present my poster presentation in the CUGH conference that happened this past March in Chicago. I was anxious, but because I had set out to share the little I knew, I made it through.

Currently, my schizophrenic mum is healing and is more than proud to find out her illness did not hinder me but propelled me to do my best in this world. I am looking forward to help empower street kids with skills that will help them be independent and make their own jobs and also start an organization that empowers women with enough knowledge to make informed decisions about health issues and their bodies, e.g., contraception usage. The future is bright, and we can only hope to be change we need in our society to make a difference.

  Abstract Number 1: Winner of WIMS Oral Presentation Top

Hijab in the Operating Room: How to Address Barriers that Prevent Hijab-Wearing Women from Pursuing Careers in Surgery

D. Kishawi

Stritch School of Medicine, Loyola University, Chicago, Illinois, USA

Introduction: Surgery is a field that is ever-evolving – though historically has been one that is male dominated. Over the last decade, the number of female medical students and trainees has significantly increased, and now, females make up the majority of medical students. However, the rate of females pursuing surgery and subsurgical specialties has not followed that same trend. Minorities and females are substantially underrepresented in orthopedics, otolaryngology, and neurosurgery, along with other surgical specialties. It is imperative to address the disconnect and to determine ways to increase the diversity of surgical specialties. Specifically, hijab-wearing Muslim women have a difficult time finding a balance between donning compliant religious attire and maintaining modesty, while also complying with hospital and operating room regulations.

Methods: Extensive web search of all the ACGME accredited residency programs in Neurological Surgery, Orthopedic Surgery, and General Surgery in the US listed on the AAMC website. Inclusion criteria included the following: residency program in the US, functioning website of residency program with a list of all current residents along with photographs accompanying each resident name. Once the number of residents wearing hijab was identified, the American College of Surgeons (ACS) was contacted and asked about hijab-wearing women who are members of ACS.

Results: On research of 578 residency programs for the academic year of 2017–2018 in Neurological Surgery, Orthopedic Surgery, and General Surgery, there are nine hijab-wearing women out of 9673 residents (0.09%). Of those, eight general surgery residents and one orthopedic surgery resident wear hijab.

Conclusions: By removing the barriers and hindrances that have prevented hijab-wearing Muslim women from entering surgical fields, a new subset of talent can pursue surgical careers and help contribute to the evolution of the field of surgery. A collection of education materials has been created in efforts to address and remove these barriers; including a video on how to scrub in wearing hijab, along with a detailed plan on how to request and implement accommodations at medical schools and institutions around the US [Figure 1].
Figure 1: A Guide to Hijab in the Operating Room

Click here to view

  Abstract Number 2: Winner of WIMS Poster Presentation Top

Gender Differences in Attitudes toward Substance Use Disorder: Educational Improvements in Addiction Medicine in Detroit, MI

S. E. Dass, T. E. Moses, R. Ramos, J. Chou, M. K. Greenwald, E. Waineo

Wayne State University, School of Medicine, Detroit, MI, USA

Introduction: In 2017, opioid overdose was associated with 2053 deaths in Michigan including 636 deaths in the Detroit area.[1] Accessing treatment for substance use disorder (SUD) remains difficult. Unfortunately, most medical schools do not provide an adequate foundation that equips students to identify and treat SUDs, and few discuss gender differences and socioeconomic determinants in SUD and treatment.[2] Although all specialties work with these patients, only those in psychiatry or addiction medicine fellowships receive specialized SUD education. Improving medical school curricula can translate to better-educated physicians and expand the addiction treatment workforce

Methods: “Detroit versus Addiction” is a Wayne State University School of Medicine (WSUSOM) student-run organization that initiated bridging the gap in SUD training for medical students. For the 2018–2019 academic year, WSUSOM implemented a horizontally integrated curriculum on pain management, SUDs, treatment, and withdrawal. An initial online survey was distributed to medical students as part of a wider initiative on Opioid Overdose Prevention and Response Training (OOPRT). The survey included questions about clinical experiences, knowledge of opioid use disorder (OUD), and attitudes toward patients with SUD.

Results: A total of 251 students (28.7% M1, 25.1% M2, 21.9% M3, and 24.3% M4) completed the survey. Average age was 26.0 ± 2.7 years, 59.4% identified as male, 73.3% as White (23.1% Asian, 4.8% African-American, 3.6% others), and 6% as Hispanic. More males reported knowing someone (or themselves) with a SUD (75.5% male, 55.7% female; χ2 = 10.3, P = 0.001). There were no gender differences in previous clinical experience, knowledge of SUD treatment, or desire to receive training in overdose prevention or SUD treatment. Regarding patients with SUD, there were significant gender differences: Males were more likely to agree with the statements “I prefer not to work with patients with SUDs” (t = 3.07; P = 0.003), “Patients with SUDs irritate me” (t = 3.93; P < 0.001), “Patients with SUDs are particularly difficult to work with” (t = 2.88; P = 0.004), and “Treating patients with SUDs is an ineffective use of medical dollars” (t = 2.50; P = 0.013) than females.

Student-led initiatives created a Buprenorphine Waiver Training program offered to medical students; 76 students volunteered to complete the initial 4-h training hosted by Detroit versus Addiction. Due to the popularity of the voluntary training, it is now required for students on the internal medicine clerkship. OOPRT training is being integrated into the preclinical years for all students. Through methadone dispensing clinics, M1 and M2s can volunteer to assist patients in OUD treatment.

Conclusion: Newly added educational programs will provide opportunities to improve medical students' knowledge of overdose, buprenorphine and naloxone, and confidence in recognizing and managing patients with SUDs. The apparent gender differences in experiences and attitudes toward patients with SUDs suggest a potential avenue for further research and directed training. Student-led initiatives with faculty support can lead to curriculum changes that train a new generation of physicians who are better prepared to treat patients with SUDs.

  References Top

  1. Michigan Department of Health and Human Services. Drug Overdose Deaths in Michigan, 2016-2017. Michigan Department of Health and Human Services; 2019.
  2. McCance-Katz EF, George P, Scott NA, Dollase R, Tunkel AR, McDonald J. Access to treatment for opioid use disorders: Medical student preparation. Am J Addict 2017;26:316-8.

  Abstract Number 3 Top

The Rush Heart Center for Women – Two Big Hearts Project: Design and Baseline Overview

N. T. Aggarwal1,2, L. Dairaghi2, S. Somnay3, J. M. D. Gomez2, A. Agdamag4, A. S. Volgman2

1Rush Alzheimer's Disease Center, 2Rush University Medical Center, Chicago, 3Rush University Medical Center, University of California, Berkeley, IL, 4Rush University Medical Center, University of Minnesota, Minneapolis, MN, USA

Introduction: Cardiovascular disease (CVD) remains the leading cause of mortality for women in the United States, despite advancements in both clinical care and community awareness. In a city as segregated as Chicago, the prevalence of and mortality due to CVD and stroke variy widely across neighborhoods. The current project aims to (1) characterize the cardiovascular health of community-based women across Chicagoland and (2) monitor the health of participants to identify novel cardiovascular risk factors that could improve screening methods for asymptomatic women with CVD.

Methods: To raise awareness of the leading cause of deaths in women in asymptomatic women, the Two Big Hearts Screening Project recruited women across the greater Chicago region to receive cardiac screenings in 2008. In 2008, participants received lipid panel, fasting glucose, electrocardiogram, and transthoracic echocardiogram screenings at Rush University Medical Center. Study participants also completed health surveys regarding demographics, medical history, and healthy lifestyle factors. Atherosclerotic cardiovascular disease (ASCVD) risk scores were calculated based on information collected in these surveys. Participants continue to be monitored for changes in health and cardiovascular outcomes.

Results: There were 355 women who participated in the screening from across Chicago, the surrounding suburbs, and neighboring states. This community-wide project encompassed 146 separate zip codes predominantly in the North and South sides of Chicago. Participants aged from 18 to 89 years at the time of the screening, with an average of 53 ± 13 years. Of the participants, 60% self-identified as Caucasian, 24% as African-American, 7% as Hispanic, and 4% as Asian. Preliminary analyses show that over half of the participants self-reported having at least one cardiac-related condition upon entering the study, and almost 90% of participants reported a family history of at least one of the following: hypertension, high cholesterol, diabetes, strokes, heart attacks, or other heart conditions. Using the pooled cohort equation, ASCVD 10-year risk scores were calculated in 283 women. This revealed that 20.5% of participants had an elevated risk of having a cardiac event of myocardial infarction, stroke, or death, defined as ASCVD 10-year risk scores above 7.5%. The average ASCVD risk scores of the groups were as follows: African-Americans: 7.5%; Asians and Hispanics: 5.7%; and Caucasians 4.6%. A follow-up study was done showing that a baseline ASCVD risk score of >7.5% was associated with 10-year ASCVD outcomes (P = 0.003).

Conclusion: It is well known that CVD does not affect men and women equally, but it affects different races/ethnicities differently as well. Considering that this community-based study has demonstrated to be effective in highlighting CVD characteristics and that city-wide risk of CVD and stroke is known to vary greatly among neighborhoods in Chicago, it will be worthwhile to replicate the program in other racial populations and neighborhoods. Identifying women at high risk is crucial to educate them on how to lower their risk.

  Abstract Number 4 Top

Women Caregivers with Heart Disease: a Pilot Study to Understand the Level of Caregiving Stress and Needs of Women with Heart Disease through the Development of a Cardiology Specific: Caregiving Program to Improve Caregiver Quality of Life and Health

G. Alexander1, S. Chandra1, A. Rao2, A. S. Volgman1, N. T. Aggarwal1,3

1Rush University Medical Center, 2Neurocern, 3Rush Alzheimer's Disease Center, Chicago, IL, USA

Introduction: The stress of caregiving is an underreported health threat for both women and men. Women in particular are most susceptible, with research noting that compared to women who do not provide care, those who do have higher rates of psychiatric morbidity, lower perceived health status, hypertension, poor immune function, and decreased engagement in preventative health behaviors. Relatively little has been reported in the literature regarding how providing care impacts caregivers who have cardiovascular disease. Even less is known regarding what specific resources these caregivers utilize while managing their own chronic disease. This study will look at a diverse group of caregivers, recruited from the Rush Heart Center for Women (RHCW), who have clinically diagnosed cardiovascular disease, to ascertain how caregiving for a loved one with cognitive concern, impacts their own health and quality of life.

Methods: A total of 50 patients (age >50) from four locations (Rush Main Campus, South Loop, River North, and Oak Park) will be enrolled in the study if they indicate that they are caregivers to an older adult with a memory concern. Patients will be contacted by phone, at which time a preintervention survey will be administered with questions regarding well-being, depression, sleep, personality, perception of dementia, family history of dementia, level of caregiver stress, memory concerns, and a brief cognitive test. Following this, the patient will be contacted by a certified dementia education provider from the Alzheimer's Association's (AA) Direct Connect Program, who will give support and share community resources. For patients wanting individualized care, an immediate care consultation with the AA care navigator will be scheduled. This AA intervention program will be provided for up to 6 months. During that time and for up to 1 year, the RHCW will administer follow-up calls (4 weeks/8 weeks/3 months/6 months/12 months) to obtain information related to caregiving stress: cardiac symptoms, disability, pain, decision-making, health literacy, and a review of patient medical history. Patients interested in additional resources will be directed to online caregiving modules from Neurocern (www.neurocern.com). Descriptive statistics will be used to characterize patients on their baseline and postintervention levels of depressive symptoms, anxiety, life satisfaction, perceived stress, social networks, and self-rated health. Laboratory data (lipid panels, HbA1C, ESR, CRP, and electrolytes) and blood pressure at baseline and throughout the study will be obtained through the Electronic medical records (EMR). Analyses will compare change in biomarkers and survey results based on AA Intervention type, Neurocern users, and non-Neurocern users. All data will be stratified based on sex and race/ethnicity.

Results: The data collected in this study will provide valuable information to practicing cardiologists and the dementia care community regarding the impact of caregiving stress to the overall health and well-being of this group of patients.

Conclusion: If this intervention is proven to be beneficial, it could be tailored to reach caregivers being seen by other specialties. Finally, this innovative Cardiology-Caregiving program has the potential to be incorporated into the clinical training of different healthcare providers and improve upon the current educational and technological interventions that exist today.

  Abstract Number 5 Top

Bringing Gender Diversity into Focus: an Intervention in Radiology Residency Recruitment at University Hospitals

K. Salem, L. Walker, D. Kumari, E. Alencherry, N. Faraji, M. Wein, M. Al Natour, R. Jones, C. Patena, H. Marshall, C. Badve, K. Herrmann, C. Kosmas, L. Mehta, D. Plecha, L. Sieck

Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA

Introduction: Diversity and representation in radiology have been a hot button issue lately. While women comprise 50.8% of the US population and the percentage of women matriculating into medical school continues to rise reaching over 50%, female radiology residents only make up 27.8% of diagnostic radiology residents. Underrepresented minorities (URMs) meanwhile make up 30% of the US population, but only 8.3% of trainees in radiology programs. This underrepresentation of females and minority residents has been attributed to a number of factors, including the paucity of exposure to radiology during medical training, the misconception that radiologists do not deliver direct patient care, and unconscious bias during the residency interview process.

Methods: University hospitals/Case Western Reserve University Department of Radiology is an ACGME accredited residency program with 40 total residents over 4 years of training. A review of the past 9 years of residency classes revealed that the program had been performing below national standards in terms of diverse recruitment. Over the past 9 years, females have comprised on average only 18.9% of radiology residents with URMs comprising 0%.

Following several departmental changes in the fall of 2018 including the promotion of a female radiologist to interim co-chairperson, the appointment of the first female associate program director, and advocacy from the female residency academic education coordinator and other departmental leaders, the recruitment process for the class of 2023 was restructured making recruitment of diversity the number one priority. Out of approximately 740 applications received by the program, 198 were from females and 92 were from URMs. A total of 101 candidates were invited to interview, of which 34 were female and 6 were URMs. Before interview season, efforts were made to revamp the residency website, including the addition of a webpage for the Women in Radiology (WIR) interest group to improve the visibility of departmental diversity efforts. Female candidates who were invited to interview also received a welcoming e-mail from the female associate program director introducing them to the WIR group. Female residents were also always present at the preinterview dinners. The introductory presentation on interview day included information about the WIR group as well as work–life information pertinent to all applicants including maternity/paternity leave and location of daycares. Radiology faculty interviewers were also specifically selected to represent the diversity within the department – there were four female radiologist interviewers with at least 1–2 interviewing at every interview session as well as one male URM radiologist. Female or URM applicants were then intentionally matched with female or URM radiology faculty for their interviews.

Results: Match results for the class of 2023 revealed greatly improved resident diversity with the incoming class consisting of 30% female residents and 20% URMs.

Conclusion: We recognize that this can be improved in the future and there is a long way to go to achieve meaningful diversity in the radiology workforce; however, our intervention and small, intentional changes in the recruitment process did indeed demonstrate success in attracting a more diverse group of residents to train at our program.

  Abstract Number 6 Top

Are We Really That Different? A Survey of Male and Female Millennial Medical Student Priorities and Perceptions

K. Hughes, E. Ritz1, T. Beck2, S. B. Glick3, L. Ravindra3

Rush Medical College, Rush University Medical Center, 1Biostatistics Core, Rush Medical College, Rush University Medical Center, 2Internal Medicine Epidemiology Research, Rush University Medical Center, 3Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA

Introduction: There are wide discrepancies in female representation across medical specialties at both the attending and resident physician levels. While there are ample data exploring physician compensation, satisfaction, and burnout across specialties in the US, no recent studies explore specialty choice in the millennial medical student (MMS) population from a gender perspective. We evaluated the preferred specialties of male and female MMS in America and identified potential factors driving their decisions.

Methods: We surveyed allopathic MMS across the US with anticipated graduation dates between 2019 and 2023 [Figure 1]. In addition to basic demographic information, the survey inquired about top three Accreditation Council for Graduate Medical Education (ACGME) residency choices, perception of female representation among specialties, the most important personal and professional factors driving specialty choice, intent to practice full- or part-time, preference for academic versus private practice, and expectation of household responsibilities. Responses on Likert-type items were compared between genders using the Mann–Whitney test.
Figure 1: Survery of millennial medical students' priorities, perceptions, and specialty choices

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Results: A total of 288 MMS completed the survey (173 females, 115 males). Age ranged from 21 to 35 years with no significant difference in mean age between genders (mean ± standard deviation: 25.6 ± 1.96 years [women] vs. 25.5 ± 2.51 years [men], P = 0.727). Internal Medicine and Emergency Medicine were among the top three choices for the overall cohort, for men, and for women [Table 1]. Specialties were categorized as as procedural specialty (PS) or nonprocedural specialty (NPS) [Table 2], 69.9% of men versus 46.2% of women ranked a PS as their intended specialty (P < 0.001). The top three factors driving specialty choice were the same for both men and women: aligning with medical interests, work–life balance, and job security. Other than female representation in specialty, which women ranked as significantly more important than men (P < 0.001), all factors, including ability to have a family, salary potential, schedule flexibility, and leadership opportunities, were ranked similarly by both genders [Figure 2]. Men reported greater intent to work full time than women (P < 0.001). There was no statistically significant difference in desire to work in academic versus private practice settings or with expectations of household duties in a domestic partnership.
Figure 2: Likert plots of selected factors influencing specialty choice

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Table 1: Top 3 intended specialty choices overall and by gender

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Table 2: Categorization of Accreditation Council for Graduate Medical Education residency specialties as primarily procedural specialties versus primarily nonprocedural specialties for the purposes of our study

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Conclusions: Although women have entered medical school in nearly equal numbers to men for the last 20 years, there remain wide discrepancies in female representation across medical specialties. Our study found that this gap may be closing in the millennial generation, as male and female MMS preferences are more aligned than disparate. Using 2017 data from the American Association of Medical Colleges (AAMC), we categorized specialties into primarily PS versus NPS [Table 3] in a similar method as we did for medical student residency choices. Using this categorization, 35.1% of male and 24.5% of active female physicians in the United States practice in a PS. While our results reveal a substantially lower number of women considering a PS compared to male MS, the percentage of women considering a PS in our survey is markedly greater than the percentage of active female physicians practicing in a PS.
Table 3: Categorization of American Association of Medical College medical specialties and subspecialties for active US physicians as primarily procedural versus as primarily nonprocedural

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This research study did not involve human subjects as confirmed by our institutional review board.

  Abstract Number 7 Top

A Survey of Women Physicians: Priorities for Engagement

C. Shoushtari1,2, K. Tynus1,2

1Northwestern University, Feinberg School of Medicine, 2Department of Hospital Medicine, Northwestern Medical Group, Chicago, IL, USA

Introduction: With the advent of the #MeToo and #TimesUpHealthcare movements and a growing awareness of gender disparity in pay and career advancement, many women physicians are seeking opportunities to advance their professional interests. Recognizing this trend, the Illinois State Medical Society created an Ad Hoc Women Physicians Committee to engage women and provide resources to meet their needs. Toward that end, we conducted a survey of female ISMS members to identify their concerns and priorities.

Methods: The survey was conducted between April and May 2019. There were 81 respondents from throughout the state: 42 from Cook County (Chicago area), 9 from Lake/McHenry/DuPage/Will/Kane (collar counties of Chicago), 7 from Sangamon, 5 from Champaign, 6 from Winnebago, 2 from Madison, 2 from Peoria, and 5 from other counties – McLean, Clinton, and Christian

Results: In the survey, women were asked to list their topics of main concern in a free-text format, with multiple responses allowed per respondent. Following is a list of their main concern by order of frequency: pay equity (40%), leadership development (39%), preventing burnout (24%), maternity/paternity leave/childcare support (19%), sexual harassment (14%), reproductive rights (11%), women's health (11%), access to healthcare (8%), financial planning (1%), and human trafficking (1%).

Women also were asked to rank the importance of the following topics on a 4-point scale, with 4 being most important. Their average responses in order of importance are as follows: advocacy (3.52), leadership (3.38), education (3.25), mentorship (3.24), and networking (3.18). When broken down by geographic location, urban/suburban physicians' priorities were advocacy (3.59), education (3.42), leadership (3.31), networking (3.26), and mentorship (3.22). Rural physician's priorities were leadership (3.43), advocacy (3.42), mentorship (3.31), networking (3.17), and education (2.89).

Conclusion: Based on these results, women physicians' needs may vary based on their local needs and access to resources. Healthcare organizations that wish to engage and harness women physicians' growing interest in advancing their gender-based needs may find these results useful in planning educational and social events for women physicians.

  Abstract Number 8 Top

Implementation of Emergency Department Pregnancy Screening at Triage to Address Gender Disparities in Radiology Turn-Around-Time

D. E. Loke, A. M. Farcas, J. S. Ko, L. M. Aluce, V. R. McDonald, A. L. Fant, N. Shakeri

Department of Emergency Medicine, McGaw Medical Center of Northwestern University, Chicago, Illinois, USA

Introduction: There are significant gender disparities in radiology turn-around-time (TAT) and length of stay (LOS) in our emergency department (ED). Compared to age-matched men (AMM), women of childbearing age (WCBA) have longer time to computed tomography (CT) chest/abdomen/pelvis and ED LOS (115 vs. 92 min, P < 0.05; 523 vs. 488 min, P < 0.05, respectively). We hypothesize these disparities relate to delayed pregnancy screening. The goal of this study was to address these disparities by standardizing pregnancy screening in triage.

Methods: A retrospective chart review was performed at a large, urban academic ED from February 1, 2019, to March 31, 2019 after implementation of the study intervention: providing a urine cup at time of triage to all WCBA (ages 12–50). Nursing, ED assistant, and patient education initiatives were used to implement this process. WCBA and AMM who underwent CT chest and/or abdomen/pelvis were included. Patients with CT order placed after CT completion were excluded. The primary outcome was CT TAT (time from order to completion). Secondary outcomes included ED LOS (ED arrival to departure), percentage of WCBA pregnancy tested, and percentage of those tested in triage. The CT TAT and LOS data were analyzed with Student's t-test and Mann–Whitney U-test, while Chi-square test was performed for rate of pregnancy testing pre- and post-intervention.

Results: A total of 1059 patients met inclusion criteria. Ninety-four were excluded for CT order placed after completion (45 WCBA, 49 AMM). Ultimately, 965 patients were analyzed (625 WCBA, 340 AMM). Post-intervention, the average CT TAT was 109 versus 95 min (P < 0.05), while ED LOS was 538 versus 528 min (P = 0.716) for WCBA and AMM, respectively. CT TAT decreased by 6 min (P = 0.066) for WCBA post-intervention but increased by 3 min (P = 0.583) for AMM. ED LOS increased by 15 min for WCBA and by 40 min for AMM (P < 0.05). The percentage of WCBA pregnancy tested increased (49.2%–51.3%, P < 0.05), while percentage done in triage decreased (31.3%–27.8%, P < 0.05).

Conclusion: Overall, there was improvement in CT TAT and rate of pregnancy testing in WCBA postintervention. CT TAT in WCBA improved by 6 min, which approached significance although was still significantly longer than CT TAT in AMM. ED LOS increased for both WCBA and AMM postintervention. However, ED LOS in WCBA approached that of AMM, and there was no longer a significant difference between them. While the percentage of WCBA who were pregnancy tested in the ED significantly increased, fewer WCBA were tested in triage. We hypothesize that this was due to effective education of providers to obtain pregnancy testing any time during the ED stay, as evidenced by the increase in pregnancy testing percentage, and the fact that during the study period, a large portion of patients started to bypass triage due to a new flow process. Future directions of this project include further optimization of pregnancy screening in the ED via a rapid serum qualitative pregnancy test.

  Abstract Number 9 Top

Sex Considerations in Therapeutics: Clinical Trials, Prescribing Practices, and Patient Outcomes

A. Pyzer, R. Ortiz Worthington, M. Maldonado

University of Chicago Medicine, Chicago, Illinois, USA

Introduction: While significant progress has been made in realizing sex and gender equity in healthcare, women still remain disadvantaged with respect to their healthcare interactions and clinical outcomes. We sought to better understand the historical frameworks, which create sex-based disadvantages for female patients in healthcare.

Methods: We performed a literature review of sex and gender bias in therapeutics, which included case series, cohort studies, and perspective pieces. Key search terms included “women,” “sex,” “gender,” “health,” “differences,” and “disparities.” We also interviewed institutional experts in pharmacology and medical history for further direction to key literature. We synthesized our findings into a cycle to explain sex differences in therapeutics.

Results: We present a cycle, which illustrates systematic sex and gender bias throughout clinical research, as depicted in [Figure 1]. Risk of bias begins at the stage of hypothesis generation and research funding, with 69% of NIH-funded principal investigators being men. Gender inequality is perpetuated through biases in clinical trial design, recruitment, and enrollment. In 1977, the FDA restricted women of childbearing age from participating in early stage clinical trials in an effort to protect their offspring from unknown effects, but this has resulted in a paucity of data on drug effects on these populations. In addition, some conditions are difficult to diagnose in women due to “classic” disease presentations being based on male patients. This excludes women in clinical trials for medications related to these diseases. Women are prescribed more medications than men but have more challenges accessing and adhering to therapy. These issues are compounded by differences in pharmacokinetics. Some examples include decreased renal excretion of drugs, disparities in adipose tissue affecting drug distribution, and differences in the CYP metabolic pathways in women. Resultantly, women have higher rates of adverse drug events than men. Male investigators are less likely to clinical trial conduct subgroup analyses by sex. Without adequate data on side effects seen in women, fewer symptoms may be identified as adverse events. Furthermore, submitting adverse events to the FDA online safety reporting portal (SRP) is a confusing and arduous process, which may discourage reporting and introduce further bias due to lack of data. These sources of bias feed into inequities in hypothesis generation. For example, if women do not report a side effect of a therapeutic, then the issue would not be adequately identified, leading to a failure to generate hypothesis-driven research to elucidate the extent of the issue and the mechanism behind it. As such, a cycle of sex-related bias in therapeutics is perpetuated.
Figure 1: The Cycle of Sex-Related Bias in Theraputics

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Conclusions: Women are systematically disadvantaged in their utilization of medical therapeutics due to endemic bias in our healthcare and biomedical research systems. Our proposed cycle of sex-related bias may be used as a framework to recognize the sources of sex-related bias and inequity in prescribing for women, to understand the implications of sex-related bias on adverse events and efficacy, and as a tool to devise the practical steps, we can take to mitigate these biases and improve outcomes for women.

  Abstract Number 10 Top

Crowdfunding for Cancer: Success and Challenges of A Female Physician Organization in Nigeria

C. D. Akwaowo1,2, I. O. Umoh1,3, A. I. Udoh Aniema I1,3, U. Umana1,3, E. Usoroh1,4, E. Ighorodje1,3, E. Attah1,5

1Medical Women's Association of Nigeria, Akwa Ibom State Branch, Departments of 2Community Health and 3Internal Medicine, University of Uyo Teaching Hospital, 5Akwa Ibom State Primary Health Care Development Agency, Uyo, Nigeria, 4KNCV TB Program, Southern Nigeria

Introduction: Crowdfunding is emerging as an innovative method of financing and has been applied in different settings to raise funds for projects. The Medical Women's Association of Nigeria(MWAN) carries out breast and cervical cancer screening activities in over 30 states in Nigeria. MWAN Akwa Ibom State (AKS) branch has been carrying out routine cancer screening monthly for over 15 years. Many of the clients are indigent and cannot afford to pay for the services. MWAN organized fundraising campaigns in 2018 with the goal of supporting these indigent cancer patients. This paper document the experiences, successes, and challenges of the crowdfunding campaigns for cancer and health projects carried out by MWAN AKS branch.

Methods: To raise funds, three activities were organized: World Cancer day in February 4 had two events a cancer walk and a pink charity ball. The October event was the Pink Luncheon. The events were designed as hybrid model for crowdfunding with campaigns shared on online social media platforms, including WhatsApp and the organization's Facebook page. Intensive, repeated, and captivating motivational messaging were carried out, and a cancer-branded, personalized pink T-shirt was perked for the donors.

Results: The campaigns raised over 3.7 million naira (10,136.98 USD) which was substantial considering the economic situation in Nigeria. The funds raised were donated to indigent cancer patients to support their treatment. A postcampaign online survey revealed that 80.6% of the participants rated the cancer walk as excellent while over 93% rated the Pink ball as very good. Over 80% would recommend the events to a friend and would like the events repeated annually. While 92.5% of respondents made the donations because they felt MWAN was raising funds for a good cause, 31.3% made donations because they had friends that had cancer. Over 70% of donations came from friends. About 92.5% of the respondents were willing to donate to future campaigns. Challenges faced during the crowdfunding campaign include an inertia to join the campaign and donate, time constraints between commencing the campaigns and actual fund raising, time to see the people individually, follow-up calls, and need to follow-up redeeming pledges. Despite these, the WhatsApp platform formed for the campaigns has remained a viable and vibrant online community of over 200 members, actively engaged in raising funds for other women helping women projects including recent donation of over 5000 USD to a set of motherless triplets.

Conclusion: With dwindling foreign aid for many programs in Low and Middle Income Countries (LMICs), the application of crowdfunding using social media platforms may provide a valuable source of income for humanitarian projects. However, the campaign content and process need to be well designed to achieve intended outcomes. The policy implications of this emerging concept in low-middle-income settings like Nigeria is the potential for use as an innovative funding mechanism for health projects.

  Abstract Number 11 Top

Assessment of Author Gender in Editorials in a High Impact Factor Oncology Journal

S. Majeed, K. Bannerman, J. K. Silver1, S. Jain

Rush University Medical Center, Chicago, IL, USA, 1Spaulding Rehabilitation Hospital Brigham and Women's/Mass General Health Care

Introduction: There is a large body of research demonstrating women in medicine face barriers in publishing. This may impact their promotion, compensation, and career satisfaction. Many factors likely contribute to publishing disparities among women and men. However, it is reasonable to anticipate equitable representation among authors of editorials and perspective articles as there are many qualified women available to write them. Nevertheless, recent studies have demonstrated disparities in these publication categories in nononcological specialties.

Objective: To examine the gender of authors of editorial type articles in a high impact oncology journal and to determine whether women physicians are equitably represented.

Methods: In this study, we analyzed the gender of authors of editorials published in The Journal of Clinical Oncology (JCO). JCO has an impact factor of 28.245, making it among the top 1% of all journals. The study assessed a 3-year period (January 1, 2016, to December 31, 2018). The first and last author listed on the publication were selected. If only one author was listed, this individual was categorized as first author. We determined the gender of each author by Internet searches of public profiles.

Results: Results were extracted from JCO journals published from 2016 to 2018 and 222 editorial pieces were analyzed. In 2016, there were a total of 101 editorial articles published, and of these, 37% (n = 37) first authors and 30% (n = 30) last authors were women. In 2017, a total of 83 editorial articles were published, with 30% (n = 25) first author and 30% (n = 13) last authors being women. Finally, in 2018, there were 42 editorial articles with 36% (n = 15) first authors and 29% (n = 7) last authors being women. During the 3-year study period, in total, 34.1% of first authors were women. The results were compared to active practicing women in the specialty in 2017. This information was obtained from the American Society for Clinical Oncology (ASCO) State of Cancer Care in America report from 2017. The ASCO data were obtained from the American Medical Association Physician Masterfile and reported 32% of practicing oncologists in the US were women. Thus, the representation of both first and last authors of editorials was higher than women in the specialty.

Conclusion: In this study, we found that the representation of women authors of JCO editorials in the first and last positions during the 3-year analysis period was higher than the reported distribution of oncologists as reported by the ASCO 2017 State of Cancer Care in America report. Editorials are an important part of physicians' and scientists' contributions to medicine, and further research is warranted in the specialty of oncology and beyond.

  Abstract Number 12 Top

Being Beatriz: A Virtual-Reality Depiction of Dementia to Challenge Ageism and Build Empathy Among Medical Students

E. B. Phelps, C. Shaw1, E. Washington1, I. Kats, P. Patel, A. S. Volgman, D. C. Potts2, N. T. Aggarwal

Rush University Medical Center, Chicago, IL, 1Embodied Labs, Los Angeles, CA, 2Cognitive Dynamics Foundation, Tuscaloosa, AL, USA

Introduction: Despite a growing, diversifying population of older adults, medical education often fails to incorporate a focus on building empathy with geriatric patients. This project applies virtual-reality (VR) innovation to a curricular setting to depict age-related conditions and assesses the knowledge of sex and gender that students bring to the VR experience. The pilot vignette portrays a Latina woman, Beatriz, through progressive stages of Alzheimer's disease.

Methods: Rush University students from medical, nursing, and occupational therapy programs were recruited (N = 26, 78% female) and administered four existing measures of empathy, implicit bias, ageism, and knowledge of sex differences in medicine Sex and Gender-based Medical Education (SGME). Participants then engaged in the Beatriz VR modules from Embodied Labs to experience a first-person perspective of dementia. At a later date, participants debriefed the VR experience in interdisciplinary focus groups. Statistics are descriptive on pre- and post-surveys, with qualitative content analysis of focus group data.

Results: Students endorsed a significant positive change in attitudes toward older adults (P = 0.027). Domains of empathy and implicit bias with respect to age did not differ after the VR simulation (P = 0.64; 0.23). Items related to broader understanding of gender and women's/men's health were linked to a baseline knowledge score; students indicated a neutral familiarity of these topics (average item score = 3.5 on 1–5 Likert scale). On teaching sex-specific health topics, a slightly higher coverage of women's health was reported (score = 2.29 vs. 2.59, where 1 = yes, 2 = no, and 3 = not sure). Students reported that their program did not have curricula or classes on SGME (2.17) and disagree on feeling prepared to handle sex and gender differences in health care (1.8). Motifs from focus groups include noted insight from both the patient's inner dialog and the family response to their matriarch's decline. Participants endorsed an appreciation for the reciprocity of disease impact on patients and caregivers. Curiosity about gender roles in both disease and caregiving surfaced as themes across groups: how the caregiver and care partner roles would differ from mother and daughter or father and son.

Conclusions: The data represent a likely developmental trajectory that challenging attitudes precedes cognitive–behavioral change and ultimately informs an entrenched implicit bias. Adapting attitudes via narrative simulations may simply be the first step in attacking ageism and building empathy. Despite their endorsement of the importance of SGME, students feel that their curricular coverage of sex and gender differences in medicine is lacking. Student's curiosity expands beyond medicine to the familial and cultural contexts of disease experience. Ultimately, students are eager to understand gender nuances, and current educational frameworks still have room to accommodate this curiosity. Ongoing research will expand into greater item-level analyses to identify the greatest gaps in SGME and include a more gender-balanced cohort to assess variance among male and female participants. We further aim to optimize and integrate longitudinal age-related modules into medical education and programs addressing caregiver burden in millennial.

  Abstract Number 13 Top

Explaining Higher Disability in Women Compared to Men among the Elderly: The Singapore Chinese Health Study

W. Koh, K.Y. Chua1

Health Services and Systems Research, Duke-NUS Medical School, 1NUS Graduate School for Integrative Sciences and Engineering (NGS), National University of Singapore, Singapore

Introduction: While it has been observed that among older adults, women have more disability than men, the underlying reasons remain unclear. Studies conducted mostly in Western populations have suggested that the higher prevalence of disability in women could be explained by sex-specific differences in social and health-related factors. We examined the reasons for the difference in disability between men and women among elderly Chinese in Singapore.

Methods: The Singapore Chinese Health Study is a population-based prospective cohort of 63,257 middle-aged and older Chinese recruited from 1993 to 1998 in Singapore and followed regularly through interviews and record linkages. We used data from 13,789 participants of this cohort who were of mean age of 74 years (ranging 63–97 years); when they participated in the follow-up, three interviews conducted from 2014 to 2016. Subjects were interviewed for socio-demographic factors and history of physician-diagnosed comorbidities and examined for cognitive impairment, anthropometric measurements, handgrip strength, and timed up-and-go (TUG). During these interviews, participants were also assessed for disability using the Lawton Instrumental Activities of Daily Living (IADL) Scale. The IADL was scored using the summed scores of the polytomous scale, and those who scored more than 8 points were considered to be disabled.

Results: After adjusting for age, compared to men, women were more likely to be disabled, with an odds ratio (OR) (95% confidence interval CI]) of 1.29 (1.20–1.39) for association with disability. This is despite women having a lower prevalence of disabling comorbidities, such as cardiovascular diseases, gout, and chronic lung diseases. After controlling for these comorbidities, the OR (95% CI) for disability in women was 1.38 (1.28–1.48). Higher educational level was associated with lower odds of disability, and the women in our study had a lower level of education compared to men. When we included educational level as a covariate, the OR (95% CI) for women was attenuated to 1.13 (1.05–1.23). Compared to men, the women in our study also had higher prevalence of fractures, arthritis, and central obesity; weaker handgrip strength; and slower TUG. After controlling for these factors, women no longer had higher odds of disability: OR (95% CI) was 0.97 (0.89–1.05). Further adjustment for cognitive impairment did not change the results materially. Furthermore, arthritis and central obesity were associated with odds of disability in women but not in men. Arthritis increased the odds (95% CI) of disability by 37% (22%–54%) in women compared to 5% (−13%–27%) in men (P for interaction = 0.006); and central obesity increased the odds of disability by 27% (13%–41%) in women compared to −5% (−16%–7%) in men (P for interaction < 0.001).

Conclusion: Lower educational level, muscle strength, and physical performance, together with higher prevalence of fractures, arthritis, and central obesity, may explain the greater prevalence of disability in women compared to men among the elderly. While reducing fracture risk and increasing muscle strength and physical performance may reduce disability in the elderly population, disability among older women may be further prevented by control of arthritis and central obesity.

  Abstract Number 14 Top

Are Women Underrepresented as “Influencers” of #MedEd?

K. Dzara

Department of Pediatrics, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA

Introduction: Twitter has been increasingly adopted as part of medical education dissemination and discussion. The hashtag #MedEd is the “gold standard for medical education” information.[1] When a user sends a tweet including the hashtag, it indicates to other users that the tweet is relevant to a particular topic (medical education). Hashtag uses include formal and informal education and teaching, professional development, and networking, as well as sharing, receiving, and discussing news, scientific information, and educational resources.[2],[3] In a recent week, 5875 users sent 11,334 #MedEd tweets, leading to 32,385 million impressions-clear evidence of the hashtag's popularity. Impact metrics such as number of tweets, mentions, and impressions interpret individual users' influence on the hashtag. Recent articles spotlight the growing use of Twitter as a way to translate scholarship written by women or about gender equity in medicine.[4],[5] Concurrently, there has recently been a surge in #WomeninMedicine and #HeForShe tweets; multiple tweet chats, tweetorials, webinars, and conversations have reinforced interest. Twitter is a mechanism to amplify the voices of women in medical education. The study aims include:

  1. To benchmark the gender distribution of #MedEd “influencers”
  2. To determine differences between female and males for three “impact metrics”-number of tweets, mentions, and impressions.

Methods: Data from Twitter and the Symplur Healthcare Hashtag Project were utilized to determine the most influential #MedEd users, from a sample of 5 days monthly for a calendar year (2017–2018, N = 521). Duplicate users were collapsed and organizational users removed; 309 users remained in the sample of influencers. Influencers were manually coded based on gender into female (N = 126; 40.8%), male (N = 176; 57.0%), and other/unknown (N = 7; 2.3%); gender was assigned based on the author's interpretation; all nonbinary or unknown were reviewed by a second coder. Average number of tweets, mentions, and impressions were abstracted for users who were influencers for those metrics. A one-sample t-test was utilized to determine the differences in representation of female and male #MedEd influencer groups. Independent samples t-tests were utilized to determine differences in number of tweets, mentions, or impressions between female and male #MedEd influencer groups. The Partners Healthcare IRB designated the study not human subjects research.

Results: In this sample of #MedEd influencers, there were significantly more males (N = 176; 57.0%) compared to females (N = 126; 40.8%) (t = 2.91; P = 0.004). There were no differences between females and males on average number of tweets (t = 0.403; P = 0.004); mentions (t = 1.02; P = 0.577), and impressions (t = −1.427; P = 0.056) [Table 1].
Table 1: Differences between #MedEd Influencers by Gender

Click here to view

Conclusion: This study benchmarks the gender distribution of #MedEd influencers. These users were more likely to be male than female. However, among influencers, the average number of tweets, mentions, or impressions attained did not vary by gender. Thus, although females are underrepresented as #MedEd influencers, once they cross the threshold of being an influencer, their impact is equivalent to male users. To encourage a more equal gender distribution of #MedEd influencers, female users should be tagged in Twitter initiatives (e.g., #ThrowbackThursday or #Follow Friday) and offered opportunities to demonstrate Twitter leadership (e.g., lead virtual chats or journal clubs).

  References Top

  1. Micieli A, Frank JR, Jalali A. AM last page: A medical educator's guide to #MedEd. Acad Med 2015;90:1176.
  2. Cabrera D, Vartabedian BS, Spinner RJ, Jordan BL, Aase LA, Timimi FK. More than likes and tweets: Creating social media portfolios for academic promotion and tenure. J Grad Med Educ 2017;9:421-5.
  3. Dzara K, Hurtubise L. Re: “Social media and the21st-century scholar: How you can harness social media to amplify your career”. J Am Coll Radiol 2018;15:705.
  4. Cawcutt KA, Erdahl LM, Englander MJ, Radford DM, Oxentenko AS, Girgis L, et al. Use of a coordinated social media strategy to improve dissemination of research and collect solutions related to workforce gender equity. J Womens Health (Larchmt) 2019;28:849-62.
  5. Greenhalgh T. Twitter Women's Tips on Academic Writing: A Female Response to Gioia's Rules of the Game. Journal of Management Inquiry 2019:28.4;484-7.

  Abstract Number 15 Top

Promoting Academic Women through Recognition: Nominations Are Essential

V. G. Press1,2, M. Huisingh-Scheetz1, J. Oyler1

Departments of 1Medicine and 2Pediatrics, University of Chicago, Chicago, IL, USA

Introduction: The majority of academic award recipients across medical specialties have been men. Literature has documented this phenomenon in surgery, anesthesia, emergency medicine, physical medicine and rehabilitation, and neurology. Award recognition is critical to promotion, funding, and attaining status at regional and national levels. Our objective was to evaluate the changes in gender distribution among award recipients at the University of Chicago following a pilot award nomination intervention aiming to increase the proportion of female awardees.

Methods: This was a pre/post-evaluation of the University of Chicago's Women's Committee Sub-Award Committee's effort to increase recognition of deserving women scientists, clinicians, and educators within the Department of Medicine (DOM) and Biological Sciences Division (BSD). We obtained historical lists of DOM and BSD award recipients and examined the gender distribution. We then piloted a nomination intervention that included identifying eligible female nominees for each award and delegating subcommittee members to shepherd each nomination. Assigned subcommittee members facilitated the nominations by identifying appropriate people to write letters of support, drafting letters of support, and obtaining and submitting necessary documents. We determined the average percent of men and women award recipients across all available pre- and post-intervention years and determined whether there was a significant change in the gender distribution using Chi-square tests. To account for national trends decreasing gender disparities, we conducted a sensitivity analysis limiting our preintervention period to the same number of years as the postintervention period (2 years DOM, 3 years BSD).

Results: Historical awardee lists were available from 2006 to 2016 (DOM) and 2011 to 2017 (BSD). Preintervention, 39% (range = 25%–58%) and 38% (range = 18%–57%) of awardees were women in the DOM and BSD, respectively. The intervention was then implemented in 2018 (DOM) and 2017 (BSD). In the 2 and 3 years following the intervention, the percentage of women awardees significantly increased to 56% (range = 25%–50%; P = 0.02) and 56% (range = 55%–65%; P = 0.02), in the DOM and BSD, respectively. A sensitivity analysis comparing the distribution of women among awardees calculated over the 2 (DOM) and 3 (BSD) years preintervention to the 2 and 3 years postintervention distribution was also significant (DOM preintervention: 33%, range 29%–37%, P = 0.045; BSD preintervention: 34%, range = 18%–43%, P = 0.02).

Conclusions: We found that a simple, easily reproduced intervention, which requires few resources, significantly increased the number of deserving women receiving awards both within our Department and our Division. Because we only increased the number of nominated woman and did not implement any interventions with regard to the decision process, it is possible that the low proportion of women awardees before our intervention was due, in part, to qualified women being over looked, perhaps due to implicit bias. It is important to note, however, that implicit bias could still impede deserving women from receiving recognition for other awards, such as those who rely on clinical productivity and/or trainee evaluations. Future work can establish whether interventions can successfully address these factors. Since nomination bias, however, is likely pervasive, other programs, sections, departments, and/or divisions could easily develop low-cost, feasible nominating processes at their institutions.

  Abstract Number 16 Top

Consequences of Long-Term Intimate Partner Violence of South Asian Immigrant Women

A. Shah

Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut, USA

Introduction: Intimate partner violence (IPV) disproportionately affects South Asian immigrant women in the United States as a significant, preventable public health issue. Several health outcomes result from IPV, including acute and chronic health outcomes due to constant mental stress. Barriers to help-seeking for South Asian immigrant women, which include general barriers, barriers specific to immigrant status, and barriers specific to South Asian culture, can be associated with these health outcomes, due to the lack of access and prolonged exposure to stress. This research describes the relationship between barriers to help-seeking, categorized by Bronfenbrenner's ecological systems theory (macrosystem, exosystem, mesosystem, microsystem, and individual levels) and physical, mental, and reproductive health outcomes.

Methods: Data used for the present analysis were collected as a part of the South Asian Women Health and Safety Study. This was a qualitative study, in which 16 semi-structured in-depth interviews and one focus group were conducted with South Asian immigrant survivors of IPV. Participants were recruited using the snowball sampling method.

Results: A high majority of participants indicated barriers at a family level (90%), ranging from normalization of the abuse to complete lack of family support and communication. Another high impact barrier included self-blame (n = 70%). Health outcomes were categorized into the following: mental health, physical health, and reproductive health. Specifying by category, 90% of the participants experienced physical health outcomes, 70% experienced mental health outcomes, and 70% experienced reproductive health outcomes.

Conclusions: Due to the low sample size, it is not possible to make a significant claim regarding a causal pathway. However, the information provided from the participants has given a basis for the specific barriers that exist within this population, for which research and interventions can be conducted. In addition, further research can also be done to understand the direct pathways of IPV-related stress to physical and reproductive health outcomes.

Note: As this was conducted using the data of an overarching study, CORIHS or IRB approval for this particular study was not required.

  Abstract Number 17 Top

Health Determinants of Cardiovascular Outcomes in People Living with HIV Receiving Antiretroviral Therapy in Rwanda: A Study Protocol Rreview

V. Dushimiyimana1,2, M. Twagirumukiza1, B. Kateera3, J. Mucumbitsi3, N. A. B. Ntusi4, J. Condo2,3, S. Callens1

1Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium, 2Medical Research Center Unit, Rwanda Biomedical Center, 3Division of Cardiology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda, 4 Department of Medicine, Cape Town University, Cape Town, South Africa

Introduction: The global burden of cardiovascular diseases (CVDs) in people living with HIV (PLHIV) is well known but less documented in Rwanda, where the expanded access to antiretroviral therapy (ART) has changed the natural history and outcomes of the disease into a manageable chronic condition. At the end of June 2018, the ART services coverage accounted for 189,362 people (83% of all PLHIV). Although this has improved patient prognosis and increased life expectancy, there is evidence that CVD are emerging.

Aim: To investigate the determinants of CVD risk in PLHIV receiving ART.

Methods: We will conduct a prospective longitudinal cohort study (36 months) and assess various predictors and outcomes among a cohort of PLHIV on ART, compared to a cohort of HIV-uninfected individuals. All facilities with HIV and noncommunicable disease clinics that have adequate infrastructure, electronic medical records, and the ability to undertake monitored patient follow-up will be selected for inclusion into the study. PLHIV receiving ART will be recruited randomly from those facilities' database; HIV-uninfected individuals will be recruited randomly from multiple outpatient departments and the surrounding area of selected health facilities.

We will select a sample of 449 PLHIV and 1794 HIV-uninfected individuals considering gender and age and using a proportion of 1:5 to mitigate the potential high rate of lost to follow-up. The analysis will be done using regression models to identify the significant determinants. CVD cases detected will be directly linked to the NCD clinics for the provision of treatment and care.

Results: This is a study protocol review. The study outcome is any cardiovascular event defined by cardiovascular morbidity (elevated blood pressure, abnormal lipid profiles, cardiomyopathy, ischemic heart disease, and stroke) and mortality occurring within the study cohorts. The health determinants of interests include individual medical, biochemical, and immunological characteristics; demographic factors such as social economic status and gender; and cardiovascular risk factors such as metabolic syndrome, diet, and lifestyles.

Conclusion: Knowing the determinants of CVD in PLHIV receiving ART is key for several reasons. This will inform preventive measures, develop innovative strategies for management, help set up comprehensive care, improve the quality of life for this specific population, and provide research-based evidence for policy-makers.

  Abstract Number 18 Top

University Hospitals Cleveland Medical Center Pilot Program Mentoring Young Women into Radiology as a Profession

R. Pham, K. Horn1, J. Shin2, G. Stefanek CNP3, R. Shenk4, H. Gilmore5, S. Hemphill, L. Mehta6, D. Plecha7, L. Sieck7

University Hospitals Cleveland Medical Center, 1Case Western Reserve University, 2Ohio State University, Breast Health Center, 3University Hospitals Cleveland Medical Center, 4Breast Surgery University Hospitals Cleveland Medical Center, 5Anatomic Pathology University Hospitals Cleveland Medical Center, 6Case Western Reserve School of Medicine, 7Department of Radiology University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA

Introduction: There is a significant gender disparity in radiology which has not changed much from the 1960s. In 2013, the American College of Radiology (ACR) created a commission on “Women and Diversity in Radiology” to address this problem. In the ACR's 2019 report on diversity, “Women accounted for 48% of medical school graduates in 2012, for 34% of all academic clinical faculty MDs, and for 29% of radiology faculty.” One solution that might alleviate this problem is to introduce radiology as a medical specialty to young female students early in their professional training, even before medical school. In this way, when these students get to medical school, the early exposure may generate interest in the specialty. This early introduction and resulting increased interest has been termed “increasing the pipeline.”

Methods: The Radiology Department at University Hospitals Cleveland Medical Center (UHCMC) piloted a summer radiology research program hosted by the coordinator for the local women in radiology interest group at UHCMC. Two female summer research assistant volunteers participated in this program. One of the volunteers is a rising sophomore Asian-American college student and the other student is a rising 2nd-year African-American master's student in physiology. The graduate student was previously denied medical school admission and is now in the mid of a master's degree to strengthen her application for medical school. Both students collaborated on a breast imaging research project about ductal carcinoma in-situ (DCIS). This project involved building a database in REDCap (a secure web application for managing databases), creating patient imaging lists, reading and recording pathology reports, and recording the data of the imaging appearance of DCIS interpreted by the two staff breast imagers participating in the study. They met with the UHCMC REDCap informatics manager to get a deeper understanding of the REDCap application and how to use it optimally.

Results: They each created a poster presentation on a unique imaging presentation of a breast cancer patient. Coordinated by a breast imager in partnership with the breast surgery clinic, the students took advantage of local observational experiences including a multidisciplinary medical management meeting of the breast health center, multidisciplinary tumor board, radiology-pathology conference, and grand rounds speakers on radiology topics. They observed breast surgery residents and certified nurse practitioners in the medical breast clinic, and they observed breast imaging and pathology interpretations by radiologists and pathologists. They spoke with medical students and radiology residents to gain a deeper understanding of their worklife. They had a book club discussion on diversity issues in medicine centered around “Black Man in a White Coat” by Dr. Dwayne Tweedy.

Conclusion: The breast center is a great conduit for introducing students to radiology as a profession and also to the multidisciplinary practice of medicine. There are many observational and shadowing experiences through the breast center that are available to introduce students to medicine. The breast imaging section at UHCMC is comprised of solely female faculty and this exposure to the female breast radiologists as well as the many other professional women in breast healthcare (surgeons, pathologists, oncologists, CNPs, sonographers, mammography technologists), makes it an empowering environment for students to observe professional women in action.

  Abstract Number 19 Top

Areas of Need for Women in Medicine: Lessons from Rush Women's Leadership Development Program

M. Jolly, S. A. Dugan, S. E. Lawler, O. Velasquez, J. M. Shlaes

Department of Medicine and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA

Introduction: Gender inequity persists in medicine in varied forms. Rush University Leadership and Learning Academy developed a Women's Leadership Development Program (WLDP) under the guidance of a Leadership development consultant. Herein, we present the results of a baseline survey to explore areas of need as identified by the WLDP participants from a metropolitan academic medical center.

Methods: Forty-one women were nominated by senior leaders to participate based on seniority and/or leadership potential. They were from varied background within the Rush Health Care System. All participants were administered a survey at baseline, with 15 questions pertaining to their readiness in various arenas for transitioning into a leadership role. Each question had 5-Likert style response options, where higher score denoted greater readiness. We obtained mean scores for the responses on each item and identified the items with least scores for potential areas of greater need for future targeted interventions.

Results: Of the 38 women participants, two were vice presidents, eight associate vice presidents, 17 directors, six physician faculty, four faculty managers, and one corporate manager. Mean scores for each item are shown in [Table 1]. For most items, mean scores were >3.5.
Table 1: Mean scores for the survey questionnaire. Red depicts those items with scores <3.5

Click here to view

Of 15 items, six scored <3.5 and were identified as potential areas of need and future intervention. These included “I know how to engage mentors and sponsors at Rush,” “I know how to position myself for advancement at Rush,” “I am skilled at understanding and navigating Rush Policies,” “I have a clear vision of my long term goals and how to get there,” “I proactively seek out and utilize professional feedback,” and “I know how to influence others to advance organizational goals.” Highest scores were for the items “I consistently demonstrate Rush I CARE values” and “I am assertive when the situation calls for it.”

Conclusions: Senior women with leadership potential in Rush Health care setting identify six major areas of need in this survey study. WLDP program is targeted to support the needs and facilitate advancement of skills for leadership readiness and success.

  Abstract Number 20 Top

Rush University Women's Leadership Development Program: Metrics of Success

M. Jolly, S. A. Dugan, S. E. Lawler, O. Velasquez, J. M. Shlaes

Department of Medicine and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA

Introduction: National Faculty Survey identified gender differences in retention, rank, and leadership opportunities for women leaders at Academic Medical Centers (AMC). Herein, we describe the development of Women's Leadership Development Program (WLDP) and the results from the first batch of participants who completed the training.

Methods: Rush Women's Leadership Council (WLC) convened focus groups with university and administrative women leaders regarding perceived gender inequities for leadership positions. This exercise informed dialog with the Rush Senior Leadership Team (SLT) to facilitate a conducive environment for growth of women leaders and charting a WLDP. In collaboration with the AMC leadership academy, a leadership development consultant performed an evidence-based literature review to identify the top nine areas of gender inequity, of which WLC focused on the top six relevant, AMC pertinent modules for our (WLDP) pilot program. A flipped classroom model, with the six modules comprising of a 30-min online and a 90-min face-to-face applied component was selected. A seventh module was subsequently added as a learning integration component. Thirty-eight participants from varied parts of the health care system were nominated from the WLC and vetted through the SLT. Each participant selected an accountability partner to discuss and test their strategies. The modules were optimizing communication skills for effectiveness and executive presence, negotiating essentials, self-promotion and branding, sponsorship, RACI and influencing, organizational savvy/navigating Rush culture, and integration and goal setting. Participants completed pre- and post-WLDP self-assessment surveys with 15 questions on readiness for leadership transition. There were Likert scale five response options, with higher score denoting greater readiness. In addition, the participants provided feedback on the utility of each module in real time. We performed paired t-tests to compare pre- and post-survey responses. Effect size (ES) for the intervention was calculated. P ≤ 0.05 on two-tailed tests was considered statistically significant. Cohen d ≥ 0.7 is considered large ES.

Results: Pre- and post-survey responses for 14 participants are shown in [Table 1]. Participants scored average of <3 on 6/15 questions [Table 1] at baseline, showing specific areas of unmet needs. There were significant improvements noted post-WLDP, with 14/15 items. All the scores exceeded 3.5 post-WLDP. Total mean scores improved from 46.28 to 60.78 (P = 0.002), yielding an effect size of 1.04. Average rating for the seven WLDP modules was 4.55 (out of 5).
Table 1: Comparison of pre and post WLDP survey responses

Click here to view

Conclusions: Specific areas of unmet needs were identified at baseline. The modules were well accepted and appreciated. Following the WLDP, there was a large increase in skills related to leadership training. Next steps include tweaking the modules based on the feedback provided, offering coaching sessions, and tracking career and leadership trajectories of the participants.

  Abstract Number 21 Top

Gender Bias in Student Evaluations of Graduate Medical Education Faculty

A. Riopelle1,2, K. Sable2, B. Adams1,2, A. Buchanan1,2

1Department of Family Medicine, 2Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA

Introduction: Instructor and student evaluations are a current standard practice in the evaluation of performance in higher education. Studies on college students revealed preferentially higher evaluations for male professors as well as a gender bias against female professors even when controlled for teaching quality.[1],[2],[3],[4],[5],[6],[7] Poor evaluations can discourage female faculty and may negatively impact career progress and promotion. Other studies contradict these findings of gender bias.[2],[3] This study was designed to explore whether there is a trend of gender bias in faculty evaluations in health science education. If bias is evident in graduate health sciences, could it be a factor in the disproportionately low number of women in academic medical faculty positions? To address this, anonymous evaluations of faculty instructors from medical students were analyzed and assessed for gender bias. The ratings for male versus female faculty were compared in the small group-teaching environment to determine the presence of gender bias in students' evaluations within Loyola University Chicago Stritch School of Medicine. The study of evaluations from 2014 and 2015 revealed that gender bias favoring men exists in graduate medical education, and therefore, additional qualities of female and male faculty members should be taken into account in assigning faculty positions.

Prior studies of college students show both a preference for male professors as well as a gender bias against female professors.[1],[2],[3],[4],[5],[6],[7] This bias is evident in the form of lower ratings on student evaluations even when teaching quality is equal.[5],[6] Not only can poor evaluations be demoralizing for female faculty, but they can also impede their upward progress and promotion.[8],[9] If gender bias in faculty evaluations is present in health science graduate education, then consideration should be made that this may contribute to the disproportionately low number of women in academic medical faculty positions.

Methods: We compared ratings for male versus female faculty in the small group-teaching environment from the 2014–2015 academic years. A multivariable generalized linear mixed effects model was used to estimate the odds of a higher evaluation score. Random intercepts were allowed for each student to account for their repeated (correlated) evaluations. The proportional odds assumption was assessed using a score statistic.[10]

Results: Students (N = 615) contributed 4229 evaluations to this analysis. Controlling for student sex, medical college admission test (MCAT) score, undergraduate grade point average (GPA), faculty status, faculty race, and student race, male faculty were 1.36 (95% confidence intereval [CI]: 1.12–1.66) times more likely than female faculty to have a higher score on the overall small group evaluation (P = 0.002). Similarly, male students were nominally more likely than female students to give higher scores on the overall small group evaluation (odds ratio = 1.46, 95% CI: 1.01–2.11; P = 0.046).

Conclusion: It is standard practice for students to evaluate their instructors. A gender bias favoring men extends up to the level of graduate medical education. Therefore, given the evidence of gender disparity among professors, additional assets of female faculty members should be taken into account in assigning faculty positions.

  References Top

  1. Basow S. Student evaluations of college professors: When gender matters. J Educ Psychol 1995;87:656-65.
  2. Benton S, Cashin W. Student Ratings of Teaching: A Summary of Research and Literature. The IDEA Center; 2012.
  3. Braga M, Paccagnella M, Pellizzari M. Evaluating students evaluations of professors. Econ Educ Rev 2014;41:71-88.
  4. Doubleday AF, Lee LM. Dissecting the voice: Health professions students' perceptions of instructor age and gender in an online environment and the impact on evaluations for faculty. Anat Sci Educ 2016;9:537-44.
  5. MacNell, Lillian, Driscoll A, Hunt AN. What's in a name: Exposing gender bias in student ratings of teaching. Innovative Higher Education 2015;40.4:291-303.
  6. Taqi HA, Al-Darwish SH, Akbar RS, Al-Gharabali NA. hoosing an English teacher: The influence of gender on the students' choice of language teachers. Engl Lang Teach 2015;8:182-90.
  7. Boring A, Ottoboni K, Stark PB. Student evaluations of teaching (mostly) do not measure teaching effectiveness. ScienceOpen Res 2016:1-11. [Doi: 10.14293/S2199-1006.1.SOR-EDU.AETBZC.v].
  8. Miller J, Chamberlin M. Women are teachers, men are professors: A study of student perceptions. Teach Sociol 2000;28:283-98.
  9. Huston TA. Race and gender bias in higher education: Could faulty course evaluations impede further progress toward parity? Seattle J Soc Justice 2006;4:590-611.
  10. Argresti A. Analysis of Ordinal Categorical Date. 2nd ed. Hoboken, NJ: Wiley; 2010.

Ethical conduct of research

All of the projects published herein underwent required approval Ethics Committee/Institutional Review Board process, as applicable. In addition, the authors/teams were required to follow applicable EQUATOR Network (http://www.equator-network.org/) guidelines during the conduct of research.


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]

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