CONFERENCE ABSTRACTS AND REPORTS
Year : 2021 | Volume
: 7 | Issue : 4 | Page : 307--357
Proceedings of the third annual women in medicine summit: An evolution of empowerment 2021
Deborah Rupert1, Beatrix Thompson2, Michelle Fernando3, Marah Kays4, Parul Barry5, Shikha Jain6,
1 Medical Scientist Training Program, Stony Brook University, Stony Brook, NY, USA
2 Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT, USA
3 California Northstate University College of Medicine, Elk Grove, CA, USA
4 Kansas City University, Kansas City, MO, USA
5 Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, PA, USA
6 Division of Hematology and Oncology, University of Illinois Chicago, Chicago, IL, USA
|How to cite this article:|
Rupert D, Thompson B, Fernando M, Kays M, Barry P, Jain S. Proceedings of the third annual women in medicine summit: An evolution of empowerment 2021.Int J Acad Med 2021;7:307-357
|How to cite this URL:|
Rupert D, Thompson B, Fernando M, Kays M, Barry P, Jain S. Proceedings of the third annual women in medicine summit: An evolution of empowerment 2021. Int J Acad Med [serial online] 2021 [cited 2022 Dec 4 ];7:307-357
Available from: https://www.ijam-web.org/text.asp?2021/7/4/307/333412
For the third consecutive year, the Illinois-based nonprofit organization Women in Medicine® (WIM) hosted its annual Summit to spotlight leading voices of women in medicine and their allies in the fight for gender equity in healthcare and healthcare leadership. The annual theme of the conference is an Evolution of Empowerment, with this year focused on “Finding Your Voice.” As in prior years, abstracts were solicited from self-identified healthcare workers across the globe in the following categories: perspectives, inspirational spotlights, data-driven findings. Submissions were reviewed and scored by members of the WIM Abstract Committee and selected for presentation orally and in poster format. All accepted abstracts are published herein. The WIM Scientific Committee also selected Abstract Award Winners for notable submissions, announced herein.
As was the case for the 2020 summit, the proceedings were once again held virtually due to the on-going COVID-19 pandemic. Much of the conference focused on the disproportionate consequences of the pandemic on women in healthcare over the last two years as well as examples in which women healthcare leaders successfully harnessed their skill sets to effect change. In addition, in response to piecemeal policies provided by healthcare institutions to support women employees in the wake of the COVID-19, WIM leadership also asked attendees to provide their input via an anonymous survey as to what support systems worked well and which fell short over the past two years. The results are anticipated to speak to common mechanisms by which the healthcare sector as a whole can better retain women.
The conference continues to engage a diverse audience; leading and rising voices in the gender equity in healthcare space were present from nearly all of the top U.S. hospitals and educational institutions across the nation from Massachusetts General Hospital in Boston to the Cleveland Clinic in Akron, Ohio to the University of California San Francisco and Northwestern Memorial Hospital in Chicago. International counterparts hailed from Australia, Bangladesh, Brazil, Canada, Egypt, Iraq, Ireland, India, Malaysia, the Netherlands, New Zealand, and Pakistan. In keeping with the overarching mission of WIM, the conference continues to successfully unite women and their allies across institutions, organizations, specialties, and geographical regions.
As in prior years, the summit conference consisted of a pre-conference aimed predominantly at medical students, and two days of seminar-style, evidenced-based talks (September 24th and 25th). After the preconference, the Society of Hospital Medicine and WIMS hosted the “Grow Your Network” twitter chat focused on finding your voice. The chat garnered 4.43 million impressions on twitter. The Grow Your Network was the partner event for the Know Your Network virtual social event that took place as a part of the Summit.
Newly released this year, as announced during the summit, was the WIM Speakers Bureau; a curated platform for women in medicine all over the world to represent themselves and their expertise. The Speakers Bureau aims to directly addresses the gender gap in invited professional speaking opportunities, keynote addresses, media appearances, where women in medicine are inappropriately underrepresented. This initiative will build a database of women healthcare workers and connect those individuals to speaking and consulting opportunities.
Finally, a number of resources were provided to attendees including Continuing Medical Education (CME) credit for practicing physicians, informational hands-out documenting key take-aways from seminars, and live Dancing with Markers graphic art summaries. High yield take-home points and toolsets from WIM faculty were also published in a free downloadable WIM Compendium for attendees and others to review.
Abstract/Research Committee Members: Dr. Parul Barry of the University of Pittsburgh (Committee Chair), Dr. Neelum Aggarwal, Ms. Johanna Balas, Ms. Shiva Barforoshi of Chicago Medical School, Christine Bestvina of the University of Chicago, Dr. Rakhee Bhayani of Washington University in St. Louis, Ms. Christina Brown of Rush Medical College, Dr. Tiffany Leung of Maastricht University in the Netherlands, Dr. Yun Rose Li of Eisenhower Medical Center, Ms. Margaret Pichardo of Howard University, Dr. Susan Pories of Mount Auburn Hospital, Dr. Lekshmi Santhosh of the University of California San Francisco, Dr. Vidya Sundareshan of Southern Illinois University, Dr. Ashley Vavra of Northwestern Medicine, and Dr. Anna Volerman of the University of Chicago.
The 2021 WIMS Abstract Awards contain two categories and were presented to the following individuals this year:
Oral Abstract Award Winner: Dr. Jayne Rice for her talk entitled Imposter syndrome among minority medical student who are underrepresented in medicine
Poster Abstract Award Winner: Ms. Joowon Choi for her poster entitled Factors affecting female plastic surgeons' decision to pursue and maintain an academic career
Awards Committee Members: Dr. Julie Oyler of the University of Chicago (Chair of the Committee), Dr. Christine Bestvina of the University of Chicago, Dr. Charu Gupta of the Northshore Hospital system, Dr. Karen Ho of Northwestern University, Dr. Priya Kumthekar of Northwestern University, Dr. Tina Sundaram of Rush University, and Dr. Akshra Verma of Southern Illinois University.
The #IStandWithHer Awards contain several categories and were presented to the following individuals this year:
#HeForShe Award Winner
Dr. Mark Shapiro of Santa Rosa Memorial Hospital in California
In addition, honorable mentions in this category were noted for:
Dr. Charlie Wray of the San Francisco Veterans Affairs Medical Center
Dr. Alim Pardhan of the Division of Emergency Medicine at McMaster University in Hamilton, Ontario, Canada
#SheForShe Award Winners
Mid-Career Winners: Dr. Daryl Oakes of the Department of Cardiac Anesthesiology at Stanford University
In addition, honorable mentions in this category were noted for:
Dr. H. Barrette Fromme of the Department of Pediatric Hospital Medicine at the University of Chicago, Chicago, IL, USA
Dr. Sima Patel of the Department of Neurology at the University of Minnesota
Late Career Winners: Dr. Julie Silver of the Department of Physical Medicine and Rehabilitation at Harvard Medical School and Dr. Reshma Jagsi of the Department of Radiation Oncology at the University of Michigan
In addition, honorable mentions in this category were noted for:
Dr. Ruth Gotian of the Department of Anesthesiology at Weill Cornell
#Resilience Award Winners
Dr. Maya Vijayaraghavan of the Department of Medicine at the University of California San Francisco
In addition, honorable mentions in this category were noted for:
Dr. Amy Holthouser of the Department of Pediatrics at the University of Louisville
Dr. Manisha Sharma, Senior Medical Director of the Community Health Group in California
Conference Social Media Engagement
The 2021 summit spurred outstanding engagement on social media from physicians and trainees around the world. The WIM organization is associated with two unique hashtags which were developed in 2019 and which continue to unite key stakeholder in the healthcare-social media space: specifically, #WIMStrongerTogether and #WIMSummit.
During the week of the conference (from September 17th to September 28th) the #WIMStrongerTogether hashtag generated 33.07 million impressions resulting from its use in over 4,900 tweets sent by over 800 conference participants. Similarly, the #WIMSummit tag over this period generated 12.67 million impressions from its use in 1,707 tweets that were sent by over 400 participants. The two hashtags together generated 45.74 million impressions during the conference week. The vast majority of this activity stemmed from the pre-conference (held Thursday September 23rd) and two conference days (September 24th and 25th); collectively accounting for 30.06 million impressions and over 4,000 tweets during this 72-hour period.
The 2021 pre-conference for medical student attendees was held the evening of September 23rd. Dr. Shikha Jain, Dr. Ani Gangopadhyaya, Dr. Neelum Aggarwal, and Ms. Christine Brown welcomed trainees to the session. The pre-conference featured a keynote address from Drs. Brittani James and Brandi Jackson [Exhibit 1].
In addition, students were provided breakout sessions focused on:
Research and advocacy, specifically highlighting features of quality mentorship and sponsorship when entering this space, led by Ms. Tricia Pendergrast, Dr. Joanna Bisgrove, Dr. Katherine Tynus, and Dr. Neelum Aggarwal [Exhibit 2]Tools for successfully navigating third year clinical clerkships and residency applications, led by Drs. Ana Mauro, Euna Chi, and Brandi Jackson [Exhibit 3]Addressing illness and caretaker burdens as trainees, led by Dr. Brittani James and Ani Gangopadhyaya.
Residents and young faculty mentorship session
The Preconference also offered residents and early faculty the inspiring opportunity to obtain one-on-one mentoring with a host of several well-known and established physicians including Kimberly D. Manning, MD; Helen Burstin, MD, MPH, MACP; Andrea A. Pappalardo, MD, FAAAAI, FACAAI; Krishna Jain, MD; Stephanie Hartselle, MD; Julie Oyler; MD; Joanna Turner Bisgrove, MD, FAAFP; Laura Desveaux, PhD; Mark Shapiro, MD; Pamela L. Kunz, MD; Suzanne Koven, MD; and Disha Spath, MD.
Mentees were matched to mentors based on their respective interests and career goals. Anjana Pillai, MD, FAASLD, Associate Professor of Medicine at the University of Chicago Medicine, and Marah Kays, medical student at Kansas City University, introduced the session and outlined the structure of the session which concluded with a thirty minute-long question and answer panel discussion with Assistant Professor at Rush University Dr. Joanna Turner Bisgrove, Professor of Medicine at Emory University School of Medicine Dr. Kimberly D. Manning, internal medicine physician and founder and CEO of The Frugal Physician Dr. Disha Spath, and host of Explore The Space Podcast Dr. Mark Shapiro. Dr. Anjana Pillai moderated this discussion with live submitted questions from attendees.
Day 1: September 24, 2021
Exhibit 5: Leading in a Crisis. Drs. Shikha Jain and Helen Burstin's introductory Welcome and Keynote on day 1 of the Women in Medicine Summit, empowering attendees to lead with their strengths.
Dr. Shikha Jain, medical oncologist, founder and President of the Women in Medicine® nonprofit, and Chair of the Women in Medicine Summit, welcomed attendees, exhibitors, and speakers to the 2021 Summit. She encouraged individuals to sign up for the multiple CME Longitudinal Leadership Programs offered for women and male allies, and the Women in Medicine® Speaker's Bureau. Dr. Jain emphasized her awe and appreciation for women in healthcare everywhere who have risen up to address the challenges posed by the global COVID-19 pandemic. She touched on the large gap between those matriculating into medical school and those being promoted into leadership positions. COVID-19 has exacerbated these gender inequities in a multitude of ways: women make up the majority of frontline workers and are more vulnerable to pandemic-related economic effects, negative career impacts, and fatigue. She then described the concept of the “4th Shift” for Women in Medicine and the importance of allies (#HeforShe) to the goal of gender equity. Dr. Jain ended her talk with an inspiring call for collaboration, collective action.
The first keynote address of the summit was delivered by Helen Burstin, MD, MPH, Executive Vice President and CEO of the Council for Medical Specialty Societies [Exhibit 5]. She began Friday's first session with a keynote about gender and leadership during a crisis. She presented data on gender differences in leadership effectiveness during the COVID-19 pandemic, which underscored how women performed better as leaders in a crisis but are often thwarted by “glass ceilings”. To counter these leadership inequities and intersectional issues of race and gender, she encouraged intentional mentorship and sponsorship, institutional policies and processes, and providing more opportunities for women to step up and lead.
Next Dr. Ngozi Ezike, Director of the Illinois Department of Public Health, highlighted her inspiring, optimistic reflections on leading through a crisis [Exhibit 6]. She shared the importance of continuing efforts to enact social change and becoming comfortable with discomfort and uncertainty. She shared with attendees three lessons from her career: teamwork and loyalty are paramount to achieving these goals. She noted silver linings exist in even the darkest of storms, and that seeking out trusted advisors is essential for navigating challenging journeys.
Employing the analogy of athletic training, Dr. Monica Verduzco-Gutierrez, academic physiatrist, and Chair of the Department of Rehabilitation Medicine at the Long School of Medicine at University of Texas Health San Antonio, shared her personal path towards becoming a leader in medicine [Exhibit 7]. She outlined how to develop core leadership skills and outline a path towards success, the role of bias in organizational systems and leadership trajectories, the value of strategic partnerships, and how to use one's passions to create research opportunities.
In the second session, Tanya Menon, PhD, Professor of Management and Human Resources at Fisher College of Business at Ohio State University, outlined crucial negotiation strategies and methods to advocate and negotiate for oneself [Exhibit 8]. She outlined mental models such as finding common ground, asking questions to explore nuances, understanding one's goals, and combating the win/lose framework often viewed in negotiation techniques.
Next, Kimberly Manning, MD, FACP, Professor of Medicine at Emory University School of Medicine, spoke to the power of narrative medicine as a teaching tool [Exhibit 9]. She underscored, using patient stories, the power of narratives to change the way we think, highlight bias, stereotypes, disparities, and injustice, and show us what books and journals cannot. In particular, she emphasized the importance of telling the stories of women and historically excluded people who may have been left out of the narrative.
Breakout session 1
The five breakout rooms offered attendees the opportunity to attend sessions in a more intimate environment and introduced methods of honing one's skills in social media, journalism and public speaking, financial health, policy-making, and medical marketing. Kelly Cawcutt, MD, MS, Assistant Professor in the University of Nebraska Department of Internal Medicine, outlined how social media can be used to revolutionize medicine, providing opportunities for one to network, educate, collaborate, advocate, and promote, as well as build a personal brand [Exhibit 10]. Although there are risks to engagement on social media, its benefits to professional development when utilized with a mission are extensive. Teri Goudie, Founder and CEO of Goudie Media and former ABC News journalist, spoke to the art of turning words into action through intentional, impactful communication techniques and the power of a simple story. Disha Spath, MD, a primary care physician based in New York, outlined strategies for optimal financial health for women, including disability insurance, life insurance, and estate planning. She also taught how to set up an emergency fund, implement debt-mitigation strategies, and build assets through investing. Drs. Kathy Tynus, Internal Medicine Specialist in Chicago, and Joanna Bisgrove, family physician and assistant professor of family medicine at Rush University Medical Center in Chicago, Illinois, explained the close links between policy and healthcare and the benefits of healthcare advocacy. In the fifth breakout session with Andrea Paul, MD, physician entrepreneur, consultant, and expert in medical marketing, Dr. Paul outlined how to effectively market ideas, including pitching to journalists, publishing your own content, search engine optimization, and entering competitions to promote your cause. She also emphasized the importance of social media platforms and audio marketing when building a company or brand.
Breakout session 2
The second set of breakout sessions for the day were similarly informative and inspiring. Mark Shapiro, MD, underscored the importance of amplifying others with intention. Amplification and collaboration are inseparable and can occur both in person and on social media. Lieutenant General Mark Hertling, former U.S. Army officer and developer of the Florida Hospital organization's Physician Leadership Development course, offered strategies to emerge more resilient after facing crises. Drawing parallels between combat and experiences in the recent COVID-19 pandemic, Hertling emphasized the importance of teamwork, planning, assessing one's mental, physical, and emotional state, and analyzing and renewing critical interpersonal and team relationships. Dr. Ruth Gotian, Chief Learning Officer and Assistant Professor of Education in Anesthesiology at Weill Cornell Medicine, defined the “Success Factor” for peak performance. Dr. Gotian outlined four common elements of high achievers: intrinsic motivation, perseverance, strong foundations, and continuous learning. She also underscored the importance of cultivating a team of mentors and setting goals according to your passions and strengths. Neelum Aggarwal, MD, Associate Professor in the Rush Medical College Department of Neurological Sciences, encouraged attendees to get involved in a national organization to develop leadership skills and maximize impact through social media.
The fifth breakout session was led by Dr. Susan Pories, head of the Media and Medicine Program at Harvard Medical School. Her work, prioritizing visual thinking strategies, enhances medical education through the integration of arts and sciences, re-introducing humanity to the profession and humanizing physicians [Exhibit 11].
Breakout session 3
The third breakout session for the day brought new insight into storytelling, navigating toxic work environments, how to be anything without being everything, transitioning into leadership, and building a virtual playbook. Suzanne Koven, MD, primary care physician and writer in residence at Massachusetts General Hospital, spoke to the great history of storytelling in medicine and the benefits it can provide to physicians today. Dr. Koven emphasized that physicians can use storytelling to relieve stress, amplify voices, and advance legislative/cultural change. Pamela Kunz, MD, Director of the Center for Gastrointestinal Cancers at Smilow Cancer Hospital and Yale Cancer Center, defined a toxic work environment and identified who experiences harassment in medicine [Exhibit 12]. Dr. Kunz equates an equitable workplace with equitable patient care. She proposed a REACH method for navigating a toxic work environment that includes: Researching your field through the lens of gender equity, Educating yourself, Advocating, Connecting, and Healing. The third breakout session was led by Stephanie Hartselle, MD, Clinical Associate Professor of Psychiatry and Human Behavior at Brown University. Dr. Hartselle defined the terms “overcontrol” and “undercontrol” and encouraged self-assessment work to determine which camp participants fell into. She then described how radically open dialectical behavioral therapy can help physicians to feel joy in their daily lives through practicing flexibility, urge resistance, mindfulness, and acceptance.
The fourth breakout session was centered on leadership and was led by Monica Verduzco-Gutierrez, MD, who emphasized cultivating an outward mindset and following intuition while transitioning into a leadership position as a physician. She advised that the management of transitions should begin with a listening tour, followed by identifying change, and finally networking the movement. Dr. Verduzco-Gutierrez recommended that physician leaders develop a personal brand, advocate for others, and create a leadership philosophy.
The fifth breakout session focusing on digital medicine was led by Maj. Regan A. Stiegmann, DO, MPH, FACLM, double board-certified Active-Duty Flight Surgeon in the United States Air Force, Brian D. Schwartz, PhD, MLIS, Associate Professor of Medical Humanities, Director of Library Services, Paige M. Nahod, BS, OMS II, and Samantha Santora, BA, OMS II. They defined the new field of digital medicine and outlined the pairing of medicine with technological advancement to address gender inequities in both fields. Dr. Stiegmann, Dr. Schwartz, Paige M. Nahod, and Samantha Santora then introduced the “Getting Women Up to the Chalkboard: A Digital Medicine Playbook” they created to aid women in gaining knowledge in the field of digital medicine.
Day one concluded with a fireside chat with Vineet Arora, MD, MAPP, Herbert T. Abelson Professor of Medicine and Dean for Medical Education at the University of Chicago Medicine, Pritzker School of Medicine and Lucy Kalanithi, MD, Clinical Associate Professor of Medicine at Stanford University and closing remarks from Dr. Shikha Jain [Exhibit 13]. Dr. Kalanithi openly discussed her journey through processing suffering in the wake of her husband's death. Dr. Arora discussed infertility and the struggles women face both privately and publicly.
Dr. Jain closed the first day of the conference with highlights from the Summit. She emphasized how to effectively lift others as we rise through prioritizing, delegating, motivating, setting others up for success, and utilizing objective reviews. Dr. Jain expanded on mentorship vs. sponsorship by explaining the “Mentor Sponsor Continuum” demonstrating that being a sponsor and a mentor are not mutually exclusive. She then shared that the most successful leaders have more diverse contacts they can reach out to, highlighting the importance of a varied network.
The closing session was followed by a poster walk with presentation, and a virtual zoom networking “Know Your Network” reception with individual breakout rooms for attendees to interact on a more personal level.
Day 2: September 25, 2021
Dr. Shikha Jain welcomed again the speakers, attendees, and exhibitors to the second day of the WIMS summit. She described “Imposter Phenomenon” and the cycle of implicit bias and burnout that perpetuates it. She also expanded on the immediate challenges that COVID-19 introduced for women in medicine. Dr. Jain offered potential solutions, including tenure clock extensions, deliberate mentorship, and sponsorship, and utilizing your CV.
The keynote address was delivered by Dr. Brittani James and Dr. Brandi Jackson and addressed structural inequities and systemic racism that directly impacts our workforce and patient care delivery [Exhibit 14]. They described their journeys into medicine as young black women and their reflections on racism in medicine as physicians providing care to Chicago's underserved and uninsured.
Julie Freischlag, MD, FACS, FRCSEd, DFSVS, CEO of Wake Forest Baptist Health and Dean of Wake Forest School of Medicine, gave an empowering talk on breaking glass ceilings [Exhibit 15]. She shared her experiences being the only woman in leadership groups and inspired others to be authentic and trustworthy leaders. She views challenges as gifts and believes following one's fears can lead to true braveness in breaking down barriers.
Allison Escalante, MD, Professor of Pediatrics at Rush University, advised how to take leadership to the next level by sharing techniques to employ our human biology to become better leaders [Exhibit 16]. Dr. Escalante introduced the “Sigh, See, Start” method prior to meetings to encourages those around to feel safe and listened to; creating an environment that facilitates leadership.
Nancy Spector, MD, Associate Dean for Faculty Development at Drexel University College of Medicine, opened session five discussing the invisibility phenomenon for women in medicine in mid-career [Exhibit 17]. She shared data showing the decreased number of leadership positions, speaking opportunities, amplification of work, and lead authorship for women in medicine. She then defined the “broken rung,” which describes women's progress being limited by initial promotion to management, rather than the traditional metaphor of a glass ceiling. Dr. Spector concluded her talk by recommending a top-down approach from leaders paired with intersectionality to combat this phenomenon.
Laurie Baedke, MHS, FACHE, FACMP, Director of Healthcare Leadership Programs at Creighton University, led a talk on resilience and establishing boundaries to protect well-being. She outlined the five elements of well-being: career, physical, social, financial, and community, while sharing the well-being gender gap in the United States. Laurie recommended organized resilience through practice and habits, which can help take advantage of challenges to find success.
Breakout lunch 6
Breakout sessions over lunch included topics ranging from using writing as an advocacy tool, social media for women in medicine, and takeaways from the inaugural WIMS inclusive leadership lab for men. Arghavan Salles, MD, PhD and Jessica Gold, MD, MS, led the first breakout session devoted to writing. Dr. Salles and Dr. Gold started out the session sharing publications examples that successfully incorporated personal narratives. When writing a piece, they suggested to be as authentic as possible, identifying both your mission and perspective, and being intentional about your audience and outlet. Vineet Arora, MD, MAPP, and Mark Shapiro, MD led the second breakout session centering on social media and its place as a component of professional life.
Dr. Shapiro and Dr. Arora discussed the opportunity social media can provide physicians to build their personal brand and lift others up in the process. They recommend those new to social media start slowly to build up their platform as a credible platform for information. The prevalence and how to combat social media harassment was also discussed and how to navigate representing both your personal and professional identity.
The final breakout session was led by Brad Johnson, PhD, Professor of Psychology at the United States Naval Academy and David Smith, PhD, co-author of Good Guys: How Men Can Be Better Allies for Women in the Workplace. Several members of the inaugural Inclusive Leadership Lab joined the panel, including Dean W. Felsher, MD, PhD, and Erik Wallace, MD, FACP, that was focused on engaging male leaders in gender equity [Exhibit 19]. They opened their session introducing the WIMS Inclusive Leadership Lab and its main objectives and by defining three different types of allyship: interpersonal, public, and systemic. The nature of allyship as a journey was reiterated along with ideas on how men can support their female colleagues through speaking up, possessing a growth-oriented mindset, and modeling behaviors that increase gender equity.
Breakout session 4
After lunch, the fourth set of breakout sessions consisted of seven concurrent discussions on a diverse set of topics surrounding leadership, advocacy, and asset protection. Eve Bloomgarden, MD, and Laura Zimmerman, MD, MS, FACP, co-founders of the Illinois Medical Professionals Action Collaborative Team (IMPACT) led a session on how they leveraged social and traditional media to combat misinformation and effectively distribute COVID-19 vaccines in Chicago. Sandeep Basran, JD, an attorney in Chicago, Illinois specializing in asset protection for medical professionals, led a session in which he advised physicians on how to reach out to an attorney and start the often emotional process of asset protection and estate planning as soon as possible to minimize the cost and challenges of an unplanned estate. Laurie Baedke, MHS, FACHE, FACMP, Director of Healthcare Leadership Programs at Creighton University, led a session on leveraging transitions in one's career to refine focus by clarifying one's vision and values and setting Specific, Measurable, Achievable, Relevant, Time bound (SMART) goals. Alison Escalante, MD, led a session detailing practical habits and skills to use as a leader, including projecting confidence through word choice, social cues, inflection, and self-compassion. Laura Desveaux, PhD, PT, Founder & Executive Director of Women Who Lead, led a session on bridging the gap between knowledge and action by defining one's target, effectively allocating one's time, articulating one's plan, mitigating threats, and leveraging fresh starts. Anuradha R. Bhama, MD, colorectal surgeon at the Cleveland Clinic, led a session on how to pursue wellness in the face of an endless to-do list by eliminating unnecessary negativity, recognizing toxic positivity, and recognizing and limiting cognitive distortions through the CBT technique of cognitive reframing [Exhibit 20]. Stacy Wood, founder of Through the Woods Consulting, led a session on creating intentional success by honestly defining, clarifying, and protecting one's vision and exuding confidence and leadership by developing one's voice.
Breakout session 5
The six breakout sessions during the fifth session included practical guides to promoting and supporting as well as protecting yourself across several different angles. Avital O'Glasser, MD, FACP, FHM, Associate Professor and Hospitalist at the Oregon Health & Science University School of Medicine, offered tips for maintaining your CV and bio, which included expanding the definition of “scholarship” and employing strategies to make maintenance as convenient and simple as possible. Viktorya Vilk, Program Director of Digital Safety & Free Expression at PEN America, and Wendy Davidson, Senior Trainer at the nonprofit organization Hollaback, led a session on combating online harassment through bystander intervention techniques. Tricia Pendergrast, medical student at the Feinberg School of Medicine, led a session on maximizing social media engagement at academic conferences, including how to live-tweet, structure tweets, and curate your Twitter bios [Exhibit 4]. Marissa Pentico, MS, OT/L, CPE, Ergonomics Coordinator at Duke University and Health System, and orthopaedic surgeon Audrey Tsao, MD, led a session on implementing ergonomics as a surgeon. Vineet Arora, MD, MAPP, and Alice Chen, MD, Professor of Clinical Medicine at the UCSF School of Medicine, led a conversation on entering into advocacy at any stage in one's healthcare career [Exhibit 21]. Krishna Jain, MD, Chief Executive Officer at National Surgical Ventures, spoke to strategies when facing and after facing a lawsuit, along with strategies to prevent lawsuits and protect oneself.
Breakout session 6
Brad Johnson, PhD, and David Smith, PhD, led a #HeForShe discussion about male allyship and how men in medicine can support and advocate for women both publicly and in the workplace [Exhibit 22]. Julie Oyler, MD, Associate Program Director of the University of Chicago Internal Medicine Residency Program, led a session on how to change the culture in your organization or institution through detailing her experience creating and leading a women's committee at her institution. Christy Lemak, PhD, FACHE, Professor and Chair of Health Services and Administration at the University of Alabama at Birmingham, led a session on creating an elevator pitch for yourself. Mildred Olivier, MD, BS, FACS, Professor of Ophthalmology at Chicago Medical School/Rosalind Franklin University of Medicine and Science, curated a series of sessions on navigating the nuances of each specialty. The first on internal medicine was led by Dr. Annabelle Volgman, co-founder, and medical director of the Rush Heart Center for Women, and Avital O'Glasser, MD. The second session on obstetrics and gynecology was led by Nancy Church, MD, FACOG, FAMWA and the third session on surgery was led by Ana LoDuca, MD. The fourth and final session on pediatrics was led by Myrtis Sullivan, MD, MPH.
The last day of the conference concluded with a keynote address by Dr. Nisha Mehta, MD, on changing the female physician experience [Exhibit 23]. Dr. Shikha Jain opened by asking attendees to share their key takeaways from the conference. Attendees contributed takeaways such as, “the importance of amplifying not only your voice but others' voices,” “recognizing women more in the institution,” “advocate and talk to your peers about what matters to you as a doctor and as a person,” “your message is a gift to the world; take your voice and use it in a way that encourages others to listen to you,” and do “not be afraid to become an advocate for what is important to us women.” Dr. Jain then introduced Dr. Nisha Mehta, the final keynote speaker of the conference.
Dr. Mehta, radiologist and founder of Physician Side Gigs, the largest physician-only Facebook community in the country, discussed how although 51% of matriculants into medical schools are women, “40% of women physicians go part-time or leave medicine altogether within six years of completing their residencies.” Her first piece of advice is for women physicians to reflect on their desires and come up with creative solutions before assuming that the physician lifestyle is incompatible with their goals, in the same way that Dr. Mehta has been able to integrate both clinical medicine and advocacy into her life as a physician. Her second piece of advice is for women physicians to unapologetically tell their stories and ask for accommodations to change the culture and sustainability of medicine, which must change to address physician burnout and the physician shortage. Dr. Mehta concluded with a question-and-answer portion, where she emphasized more to tell stories to help navigate uncomfortable conversations and have creative solutions to integrate other things into your life that are important to you.
Dr. Shikha Jain concluded the conference by announcing the top social media influencers under the #WIMStrongerTogether tag on Twitter, thank-yous, and lessons learned from the conference, including amplifying your voice as well as others', and the importance of investing in yourself.
List of Conference Related Graphics and Exhibits
Exhibit 1: Student Pre-Conference Welcome and Keynote 3
Exhibit 2: Getting Involved in Research & Advocacy 3
Exhibit 3: How to Succeed in Clerkships and Applying to Residency 4
Exhibit 4: Best Practices for Live Tweeting a Conference 4
Exhibit 5: Leading in a Crisis 5
Exhibit 6: Leading Through a Crisis 5
Exhibit 7: On Becoming a Chair 5
Exhibit 8: Negotiate for Yourself 5
Exhibit 9: Power of Narrative 6
Exhibit 10: Using Social Media to Revolutionize Medicine 6
Exhibit 11: Incorporating the Arts into Medical School 7
Exhibit 12: Navigating a Toxic Work Environment 7
Exhibit 13: Keynote Fireside Chat and Day 1 Closing Remarks 8
Exhibit 14: Day 2 Welcome 8
Exhibit 15: Breaking Glass Ceilings and Leading Through Adversity 8
Exhibit 16: Taking Your Leadership to the Next Level 8
Exhibit 17: The Invisibility Factor 9
Exhibit 18: No Thank You 9
Exhibit 19: How to Engage Male Leaders in Gender Equity 10
Exhibit 20: The Pursuit of Wellness 10
Exhibit 21: Advocacy at Any Stage of Your Career 11
Exhibit 22: Cultivating #HeForShe Allies 11
Exhibit 23: Changing the Female Physician Experience 11
Inspirational Perspective Number 2
Gender Equity and the Imperative of Trainee Engagement
Astha Thakkar1, Tamara Goldberg2
1Montefiore Medical Center, New York, 2Department of Medicine, Mount Sinai Morningside-West, New York, USA
In the past few years, as women have begun to represent an increasingly larger percentage of the physician workforce, as well as the majority of medical student trainees, much has come to light regarding gender disparities in the profession. Indeed, substantial evidence has shown that compared to male physicians, women in medicine face significant inequities in compensation, higher rates of burnout and depression, maternal discrimination, decreased advancement into academic leadership positions and high rates of gender and sexual harassment. Attesting to this urgency, both the American College of Physicians and the American Medical Association published position papers calling for organizational commitment toward promoting gender equity. While such statements importantly set the stage for systems change, it will be equally vital to develop ground-up initiatives to drive the gender equity movement from within organizations. Such efforts necessitate engagement not only at the faculty level but at the trainee level as well.
Residency training represents a formative period of growth for physicians during which professional identity is shaped, lifelong practice habits are established, and the culture of an institution is inculcated. Indeed, it is during this time that Graduate Medical Education (GME) programs play a key role in equipping their trainees with the skill-set to practice in today's healthcare landscape. We believe that a critical component of this aim must be to prepare residents to address and mitigate gender disparities in the profession. Importantly, certain gender equity concerns may be particularly heightened during this period including; disparities in burnout/depression, restrictive parental leave policies, gender bias in performance evaluations and letters of recommendation, increased rates of perceived sexual harassment, challenges of nurse-physician dynamics, and difficulty finding mentors. While several programs may have existing forums for gender equity discussions, the literature in this space is scarce.
As a high-yield, low effort first step toward local awareness of gender disparities during training, we propose that GME programs prioritize the creation of women-in-medicine/gender-equity-in-medicine discussions for residents. Such groups can serve as a feasible forum to create awareness of gender equity issues, identify unmet concerns of trainees, provide a platform to discuss potential solutions, promote wellness, develop community, and practice career advancement skills-all of which are vital for both trainees and faculty leading them.
The Women In Medicine resident interest group (WIM) at our program offers an example of how local efforts to address gender equity can serve the needs of trainees and programs. WIM is a resident-led, faculty-supported group established six years ago that convenes monthly. A chief resident organizes the monthly meetings and recruits resident presenters and faculty facilitators for each session. All efforts are made to schedule talks during the time of year when they may be most applicable for trainees. For example, summer sessions might focus on impostor syndrome or seeking mentorship, while spring sessions may focus on the art of self-promotion and effective interviewing strategies. Once a topic is chosen, the resident meets with the chief resident and/or faculty who provides guidance for the presentation structure.
Over the past six years, our session content has included: skills sessions (i.e. negotiating strategies, self-promotion, mastering the elevator pitch, the art of saying “no”, and contract negotiation), equity update talks (i.e. pay transparency, parental leave, and the status of women in academic medicine), moderated panel discussions (women physicians in leadership), facilitated support sessions (sexual harassment and microaggressions, male allyship, managing parenthood as a trainee, coping with transitions, navigating nurse-physician dynamics, mentorship, and finding your voice in the #MeToo era), and networking events.
The group has successfully developed a consistent, safe space for dialogue, raised awareness of gender equity among trainees, maintained a varied and gender diverse audience at each session, provided tangible skills for career development and has even expanded to include trainees in other departments. In addition to the above, this group has helped foster strong relationships between trainees and faculty, providing an opportunity to connect outside of the formal workplace environment.
In conclusion, we call for GME programs to support and prioritize a consistent and continuous forum for gender equity discussions for trainees. Such groups could be the starting point from which trainees learn to support one another, generate meaningful discussions about gender disparities, develop career-advancing skills, engage with leaders within their organization, and become the propellers of change within the institution.
Dr. Astha Thakkar was a former Chief Resident at Mount Sinai Morningside-West Internal Medicine Residency Program.
Inspirational Perspective Number 4
Relative Value Unit Robot or Healthcare Hero
Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA
The concept of a Relative Value Unit (RVU) is something I was not taught in medical school. But once I began my career in academic medicine, how much impact these three little letters have on physician's lives became increasingly clear. Formally, an RVU is the system which insurers use to “define the value of a service or procedure relative to all services and procedures''. Translated by those of us who provide clinical care - an RVU is an arbitrary value, which ultimately deems how “valuable” or “productive” a physician is to any institution.
This year, like many hospitals, our institution began COVID related pay cuts to physicians. Our pay cut “plan” was not universal but determined by the prior year's total RVUs. I happened to take maternity leave in the prior year, so my salary took a hit that my male partner's did not. In other words - I was financially penalized for having a child. My experience is just one example of how one policy can have significant unintended consequences. While people take medical leave for various reasons, a pay practice that financially penalizes faculty for taking leave will always disproportionately impact women.
After months of putting myself and my family at risk, by continuing to provide time sensitive reproductive healthcare to women throughout the pandemic - my hospital administration said thank you with a decrease in salary. By way of an arbitrary mathematical formula my relative value was deemed to be lower than my male counterpart.
As a female obstetrician and gynecologic surgeon, I have chosen to work with and for women. I have dedicated my life to caring for women and giving them agency to control their own lives. Yet, I have experienced the sting of sexism and gender discrimination throughout my entire educational and professional career. I've been overlooked for leadership positions and promotions. I've been repeatedly addressed by my first name and my male colleagues as “Doctor”. I've been measured by how I appear in scrubs, not how I perform surgically in them. I've been put down and dismissed and had my ideas stolen and endured sexist comments from male colleagues. I've been told not to pursue surgical specialties because they are not “family friendly.”
These micro and macro aggressions have accumulated over time and have shaped my identity and my career trajectory. While advocating for my patients at every level and channeling my energy and passion for gender equality into patient care, I have forgotten to advocate for myself. I allowed these experiences to creep so far into my subconscious that on some level, I actually started to believe I am worth less than a man.
My family was financially harmed by losing money, but the psychological damage cut much deeper. As I drive into the hospital, seeing signs thanking healthcare “heroes”, I am angered at the empty gratitude these signs represent. The t-shirts and water bottles telling us, “We are all in this together”, are meaningless when our leaders treat us as a number in a spreadsheet. We are cogs in a wheel of a broken system that cares more about RVUs than the actual humans who produce them. It is infuriating to be called a “healthcare hero”, while simultaneously being treated like an RVU robot. Pay cuts to physicians who kept coming to work during a pandemic are demoralizing. Inequitable pay cuts that punish women for parenting pour salt in the wound.
The evidence that gender discrimination in medicine exists is abundant. The appetite for change among those in leadership is not. If those in leadership positions continue to invalidate these very real experiences with pay discrimination and gender bias, our system will not change. Until our male colleagues realize that equal pay does not equal less for them, but that gender equity is good for all of us – the inequities will perpetuate. But more importantly, until we actually believe we are equals - we can never make meaningful change.
Only four years into my first job as an attending, and I am already “burning out”. I'm stuck between an impossible decision – speak out and potentially ruin my career, or stay quiet and abandon the very principles that drove me into this profession. After years of staying quiet, it is time to advocate for my relative value. It's time to start believing in our collective value as women physicians - because it's priceless. Equity in the physician workforce will take time, it will be hard work - but we can at least start by speaking our truths.
Inspirational Perspective Number 5
Scheduling Meetings to be Respectful of #WomenInMedicine: Tips for Leaders
Department of Hematology, Mayo Clinic, Rochester, Minnesota, USA
Meetings are an obligatory way to connect with our peers regarding essential issues such as optimizing clinical care, dealing with administrative issues, and planning for future changes within our practices. However, meetings may also pose excessive and sometimes overwhelming demands on our time. Women in medicine may be particularly vulnerable to multi-pronged demands related both to our work as physicians and also our additional commitments to caregiving, household tasks, and other “non-medical” duties., Women in medicine experience more dissatisfaction with work-life integration than their male counterparts, and leaders should be particularly mindful to avoid imposing additional burdens and stress on their female team members. I have several suggestions for leaders to keep this in mind when scheduling meetings:
Avoid scheduling recurring meetings at the same time of day/day of the week
Meetings are often scheduled for a recurring day/time (”first Tuesday of every month at 5 PM”). However, since not only meetings but also conflicts with those meetings are “recurring events,” if a meeting is always conducted at the same time, some invitees will never be able to attend. I suggest that leaders rotate scheduling between different times of day (morning, noon hour, evening) and days of the week. This maximizes chances that an attendee with a conflict with a certain day/time will be able to attend at least some of the meetings.
Schedule meetings during “just before” or “just after” times of day
Early morning or late evening meetings are likely to be challenging for physicians with families. For example, early-morning meetings may conflict with child care arrangements (daycare dropoff, nanny arrival time, etc.) and evening meetings may conflict with family meals or bedtime. I suggest that leaders schedule meetings “just before” the start of the workday (i.e. 7:45-8:30) or “just after” the end (i.e. 4:45-5:30), which may allow attendees to make minor scheduling arrangements to allow participation (ask a caretaker to come 15 minutes earlier, arrange for a 30-minute later daycare pickup, etc.). This is much less intrusive than arranging for full child or elder care coverage during a previously uncovered period of time.
Limit meeting duration
In my opinion, with good pre-planning and effective leadership, most 60-minute meetings can be completed in 45 minutes and most 30-minute meetings can be completed in 20-25 minutes. I recommend curtailing meeting length to these durations, accompanied by an agenda sent out at least two days prior to the meeting with 2-3 clear “talking points” and 1-2 goals. If a 45-minute meeting is approaching the 35-minute mark, the leader can step in and state, “let's take our last 10 minutes and focus on our goals for the meeting and how we can accomplish them in the remaining time.”
Offer alternatives to in-person participation
The COVID-19 era has demonstrated that virtual meetings are a viable alternative to in-person meetings. While many organizations have returned to in-person meetings, I recommend that all meetings should continue to have a virtual participation option. This allows those with physical conflicts that do not take 100% “mental engagement” (daycare dropoff, meal preparation, etc.) to participate at least in part. Additionally, I recommend that leaders send out a brief post-meeting summary with 2-3 “main points” along with a request for engagement with at least one follow-up item (”we discussed this new protocol during the meeting; please review these 3 main points and then vote yes or no to adopting it”). This will increase engagement rather than simply sending out a lengthy and non-engaging document entitled “minutes.”
I hope that these are relatively straightforward, actionable, and helpful suggestions to leaders as they schedule team meetings. All leaders must respect women in medicine and one way to demonstrate this respect is to avoid undue meeting demands. We all struggle with work-life integration and reducing the stress of meeting attendance in ways that respect challenges often faced by women in medicine is essential.
Jolly S, Griffith KA, DeCastro R, et al. Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Ann Intern Med 2014;160(5):344-53.Strong EA, DeCastro R, Sambuco D et al. Work-life balance in academic medicine: narratives of physician-researchers and their mentors. J Gen Intern Med 2013;28(12):1596-603.Marshall AL, Dyrbye LN, Shanafelt TD, et al. Disparities in Burnout and Satisfaction with Work-Life Integration in U.S. Physicians by Gender and Practice Setting. Acad Med 2020;95(9):1435-43.
Inspirational Perspective Number 10
Perks of A Pandemic: Reclaiming Women's Power
Sondos Al Sad
The Ohio State University, Columbus, Ohio, USA
Thanks to the “mutant” common cold virus that has challenged our resilience and exposed our flaws like nothing else. We have witnessed “the taboos” getting liberated into our public court; everyone now is talking about religion, politics, and sex. Many of such public matters revealed our unhealed wounds and accelerated the growth in brains and pains.
In such turmoil, we must reclaim ownership of our minds, and admit that there is no mindFULLness when our perspectives are hostages of unilateral narratives! We were equally unprepared, yet the impact showed enormous disparities.
Necessities, forcefully, regained their rank back, after a prolonged immersion in standardization where one coat is expected to fit all. I realized that diversity, plurality, equity, and inclusivity are competing interests with mass production, deeply rooted misogyny, and colonial hierarchy, and this conflict has sadly taxed us many losses.
I lost many dear faces, and with every loss, a piece of my heart changed! I had to experience the change in my professional character and personal psych, deprived of intellectual solidarity and camaraderie in my workspace, while grasping the reality of how cruel the healthcare industry is.
As a mother, I got exhausted fighting for a space in my career when I have gracefully earned my degrees! Unsurprisingly working mothers carried the heavy lift of the inequities in the healthcare exchange, yet disappointing, and astonishing how we let such oblivious transgression become an occupational norm?! There was a point where I was rooming my own patients, scheduling patients, providing social services, and chasing staff to assist in clinical procedures while managing a household and homeschooling, only to see trivial tasks -that had nothing to do with clinical decision making - ungratefully added to my list.
Moreover, when we fall at any intersection of the demographics, it further complicates our burdens. As a visibly Muslim minoritized working immigrant mother, my experiences were often ridiculed and invalidated.
I stretched my resilience so thin that the same old irritating questions seemed belittling to my colossal efforts to make ends meet. Gratefully, my ability to articulate the agony heightened and I chose to boldly respond.
”I do not know how you do this?” This is often an interjectional question that may have good intentions but reflects a diminutive image of our discernable management skills. When someone asks you that question; coach them to change it to “how can I help you do your job comfortably.”
”We are understaffed, why don't you do it yourself?” I am certain we all had some of this, and it is more likely to be said to a female MD than not. My answer has become; “the whole world is understaffed, so be nice to those who showed up!”
”We can't do telehealth forever, and we need to accommodate patients” , this is an oxymoron! Telehealth has evidently proven that work environments can change in a blink to keep the bills. I encourage you to negate the status quo for the sake of mental wellness. Historically, we forced environmental change to fit people's needs, rather than change people to fit outdated healthcare delivery tools.
”We have always done it this way,” a reply I commonly get whenever I suggest an innovative or transformative change to clinical practice. We have to challenge this concrete thinking of “our way or no way” with a persevering growth mindset. Do not shy away from sharing your content, and lead by unlearning old habits yourself. Beware that the preconceived cynicism has served many egos and wickedly consolidated the procrastination to educate ourselves about “the others” potential.
Most importantly, our resurrection is strongly tied to how much compassion we earn towards those who suffered our complacency for long, the largest of whom are women! Radical empathy must be a main ingredient in our healing potion, we lost more people to our habitual apathy than we had to COVID-19. Fellow sisters, stand up for each other.
To my fellow colleagues in medicine, life is too short to live it at a discounted rate, so please be kind to yourself and unconditionally practice intellectual solidarity with EVERYONE! We own our characters, and everything else is rental. To the women who reclaimed their power in a system that was not designed to gracefully embrace their womanhood, I am so proud of you!
Inspirational Perspective Number 13
Hearing the unheard
Bowling Green, OH, USA
I am 11.5 years old. I have recently been diagnosed with Hashimoto's thyroiditis, sicca, and chronic hives. Autoimmune diseases are difficult to diagnose, and they disproportionately affect women. I noticed some interesting patterns when my parents were trying to find answers about what was happening to me:
Some medical professionals felt that my symptoms were nothing more than allergies, and they did not seem interested in diving deeperMany spoke only to my mother and I felt like simply a spectator to my own healthOne nurse practitioner, who had initially dismissed my mom and I, behaved like a different, more respectful person when my father came to the next appointment.
Women, children, and others without power such as minority populations often face these kinds of experiences. As a result, they may not receive the care that they need.
This is not simply a challenge that I have faced when communicating with medical professionals. Among my own relatives, people made assumptions about my health and what I could do because my disease is invisible. Some of these statements felt hurtful. So, I worked on communicating clearly with these relatives to help them understand what I am going through and how to best to interact with me.
I developed a few simple questions that could help people around me (my relatives, teachers, and medical professionals) communicate with me. I noticed that my parents were always filling out forms before my appointments. These usually focused on my physical symptoms. I think that a different kind of questionnaire would benefit people whose voices are often unheard, giving them a way to express their needs. The questions I developed focus on kids, but such questions could apply to anyone. It is a simple index card with the following statements for a patient to fill in:
It makes me sad if you say:
It makes me mad if you say:
It makes me anxious if you say:
It makes me calm if you say:
It bothers me if you:
I need you to help me:
I appreciate it when you:
I have had over 50 appointments this year at the best hospitals and I have never seen a tool like this. There are three reasons why this tool could be helpful in-patient interactions. First, it highlights the things that can help and hurt in communication. Even though medical professionals (and teachers and relatives) might want to help, they could accidentally say things that upset someone else. You can reduce that by asking people how they want to be spoken to. Second, it helps patients have some control of a situation where they often don't feel power. This is especially important for women, minorities, and children who are so often unheard. Third, we could study how different people want to be treated at these difficult times and gather more information about communicating with patients.
This is an idea that I am passionate about. If there are any medical professionals who would like to test it in their hospitals and see if it can improve patient interactions, please let me know ([email protected]).
Inspirational Perspective Number 19
Inspirational Spotlight: The Duma Lab
Department of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
During a national committee meeting a few months ago, a private chat message popped up, “Hey! It's great to see you here!”
Such was our first interaction. I was familiar with Dr. Narjust Duma's work through Twitter and prior American Society for Clinical Oncology (ASCO) meetings and knew of her as the co-founder of the Latinas in Medicine community and a champion for gender equity. I was surprised, however, that she knew me!
Later that afternoon, she sent me a direct message on Twitter, “I would love to discuss a potential project with you if you have time.”
I had struggled to find a mentor during my training. Despite multiple attempts, everyone I had reached out to was either too busy or had a different scope of interests. As a third-year hematology oncology fellow interested in pursuing an academic career, it was difficult to navigate this landscape without a mentor and/or sponsor. I had resigned myself to doing the best that I can but admittedly felt a pang of jealousy when I heard others discuss how enriching mentorship relationships were. I was in the middle of my job hunt as well and keenly felt the loss of having a guiding mentor throughout that process.
Dr. Duma was warm and kind during our very first phone call and immediately made me feel like I belong. It was the first time someone had reached out to ask me if I would like to “write with them”. That was our very first collaboration – a book chapter focused on cancer care in the United States. Later, she invited me to join one of her lab meetings. It struck me the effort and organization that it must take to mentor more than twenty junior trainees and to obtain appropriate funding and provide oversight for their scholarly work. The research focus was what had always interested me: social justice, and gender and ethnic inequities in academic medicine. For the first time in many years, I felt at “home” amidst a community of like-minded individuals. Everyone celebrated each other's milestones and amplified their successes. Opportunities for potential funding and grant applications were shared. Collaborations and authorships were fair. Rather than toxic competitiveness, that often prevails unfortunately in many academic settings, our motto is always that of supporting and empowering one another.
We lead by example. Dr. Duma chooses to devote time selflessly in promoting others and investing in their career growth. Because of that, we pay it forward and serve as mentors ourselves to junior trainees, who join the lab under our guidance. Because Dr. Duma chooses to be vulnerable and discusses issues related to mental health and the impact of isolation on worsening depression in trainees, as evident by her ASCO Voices presentation “My White Coat Doesn't Fit”, we also feel empowered in having those honest conversations that encourages others to reach forward and to feel less alone. Because Dr. Duma embraces her authentic self, without apologies, and challenges the status quo of the “white, cis, hetero male” being the standard in academic medicine, we also feel emboldened to do the same.
Today, our lab continues to grow to include more members nationally and globally. There are ongoing collaborations with various academic centers and prominent researchers. There are opportunities for growth and reflection. But, most importantly, there is a prevailing sense of community and belonging after many of us had struggled with a lack of mentorship and support for a long time. Many women and underrepresented in medicine continue to flock out of academia due to significant micro and macroaggressions and inequities. Our community aims to empower and support those of us who chose this path because it is imperative that we change the status quo.
During the most recent Annual ASCO Meeting, we created our #DumaLab twitter hashtag to promote and amplify each other's work during the meeting. The hashtag was one of the top trending hashtags thanks to the efforts of our group. A personalized mug with the Duma Lab logo was gifted to lab members and collaborators with a shared mindset. The message is loud and clear: there are different career paths in academia, and social justice research, previously often dismissed as inferior, is increasingly being recognized as essential. Furthermore, voices of those underrepresented in medicine will be amplified and will continue to reach a wider audience and reshape the “traditional” face of academic medicine.
Inspirational Perspective Number 26
Covid-19: A Young Doctor's Perspective
Ahmedabad Municipal Corporation Medical Education Trust Medical College, Ahmedabad, India
2020 was a year I was really looking forward to. The final year of my medical school experience, I was embarking onto the internship period. I was excited to get hands-on experience in the hospital and find my footing. The whispers of “corona” had already begun to surface while I was still on my first month of rotation in the internal medicine department. As the cases started to increase, lockdowns were being imposed and restrictions were put in place. The government and the civic body announced hospitals to set up Covid-19-specific wards and then, all the interns were assigned to Covid-19 duty.
All of a sudden, we were catapulted into a situation which was still largely unknown and was still being grasped and researched by the medical experts. So many aspects of the Covid-19 remained unexplained and I, as an intern began my journey as a doctor during a pandemic. Every day, I was sent to a different part of the city to conduct Covid-19 tests and collect swabs. The initial days of the duty were some of the hardest. I was learning ways to protect myself, trying to find good quality masks, donning and doffing of PPE (personal protective equipment) kits, and how to prevent contaminating my house when I came back from duty. The scorching summer heat beat down on me, but I pushed on. It was a challenge to move or even breathe in the poor-quality PPE and once the PPE was donned, we would spend hours in the sun doing tests, unable to drink water, holding our bathroom breaks, on the brink of dehydration completely drenched in sweat. I remember a particular day where I nearly collapsed due to the added pain of my periods.
As duty continued, I was exposed to Covid-19 patients every day. Living with my parents, who are both high risk with comorbidities of Diabetes and Hypertension, I was terrified of contracting the virus and somehow spreading it to my family. So, I made the decision to self isolate when at home as a precaution. I had all my meals in my room, did my laundry separately and absolutely refused to let anyone to enter my room. There was a constant feeling of dread and anxiousness. I felt like I had completely withdrawn from my family, but they always had my back and supported me during these times.
Juggling 12-hour hospital department duties and Covid-19 duties was extremely taxing on my mental and physical health. Hours of wearing gloves and constant need to wash my hands, sanitize and clean every surface left my hands exceedingly dry with my skin peeling.
Each day posed a new challenge. With normalcy shattered and everything put on hold, many plans derailed. The schedule I had set for myself was entirely ruined, exams were postponed. So many things concerning the future remained uncertain and nerve wracking. Every passing day we try to adjust to the 'new normal' hoping it becomes a little less daunting. But even in these hard times I was still learning something new every day. I got to see unique cases at the hospital, run tests, help patients.
I have seen people who absolutely disregard the rules and act selfishly. But what left an impact was the humanity in dire times; I have seen complete strangers help each other, be it offering water or lemonade to tired frontline workers or finding hospital beds and oxygen availability for the critically ill during the deadly waves of this pandemic. These small acts of kindness not only illustrate the spirit of humanity but act as pieces of motivation amidst the fear and grief.
I am grateful to all the healthcare workers spending sleepless nights helping patients staying away from their own families. I am appreciative of all the frontline workers, cleaners, sanitation workers, restaurant workers, delivery agents, and grocery store staff for making our lives somewhat easier in this global health crisis. No one would come out of this pandemic unscathed. But what I have learned is to take life one day at a time.
Inspirational Perspective Number 35
Physician Re-entry -- For Love
Maastricht University, Maastricht, the Netherlands
The American Medical Association defines physician re-entry as “a return to clinical practice in the discipline in which one has been trained or certified following an extended period of clinical inactivity not resulting from discipline or impairment.” My circumstances fit the definition.
During a unique career transition, I returned to a period of full-time clinical work that revealed clear signals marking my re-entry. As a fully trained general internal medicine physician in the U.S., I had intended to re-license and practice in-person clinical medicine in the Netherlands.
I moved voor de liefde, aor for love (of a partner), as the Dutch like to say when inquiring about why people migrate to the lowlands. I quickly discovered after arrival that I am a rare breed of physician as an American vying for a Dutch medical license: according to a published research article, only three North Americans (including U.S. and Canada) of 176 non-Dutch physicians who completed licensing procedures from 2005-2015. While the influx of non-U.S. physicians into the U.S. (as international medical graduates, or IMGs) is known, there is no surveillance of the efflux.
As my journey began, I already knew language mastery was step one. Even though the Netherlands has a very high rate of bilingual (actually, multilingual) speakers, including English, among member countries of the European Union, physicians are required to learn the native language to the required Common European Framework of Reference for Languages (CEFR) level C1 of proficiency before embarking on further physician professional recognition procedures. For perspective, a native speaker's CEFR level is C2, the highest level of proficiency. My adult brain's neuroplasticity for language learning is nowhere near that of my teenage brain in high school Spanish classes.
Beyond language proficiency, additional examinations are required: after the initial language exam, the remaining exams parallel the USMLE Step 1, 2CS, and 2CK exams rather closely. As virtually all IMGs, and every other physician re-entrant, may already know, sitting for exams in a native language during that intensive time of study during medical school is quite different than doing so after practicing one's profession; returning to the basics can frequently be a high bar to re-realize one's dream of doctoring. Doing so in a learned language as an adult is forever etched in my career -- and life -- achievements.
During a period of required clinical work under supervision, for the first time, I considered that I fit the definition of a so-called physician re-entrant. I encountered all of the AMA-listed barriers to licensing, including lack of information about re-entry, lack of consistency in licensure, financial costs, lack of information on the re-entry process and certainly more. There was no guidebook or program to help with re-entry, only a checklist of documents to supply, tests to take, and forms to fill. Regarding the practice environment, clinical practice guidelines, norms, and scope differ even within the same specialty because of a variety of health systems, social support systems, and population health factors. In my case, primary care general internal medicine in the U.S. is exceptional compared to other countries.
Four-and-a-half years, thousands of euros, and one pandemic later, professional recognition as a physician is within reach, yet internal medicine specialty recognition remains uncertain. Additional residency training may be required because of differences between European and American internal medicine training programs' duration. Being a physician re-entrant indicates a growth mindset and both a commitment to lifelong professional and personal learning. Five years ago, I would never have believed being in this place mentally and physically. I carry a deep well of gratitude for the mentors and sponsors across global networks who promote my growth, which is non-traditional and perpetually non-linear. I look forward to the journeys ahead - and will always do so voor de liefde, or for the love of my profession.
American Medical Association. Fact Sheet on Physician Re-Entry. Available from: https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/med-ed-products/physician-reentry-facts_0.pdf. [Last accessed on 2021 Jul 08].Kooij L, Davidse W, Postma CT. Resultaten van 10 jaar toetsing van artsen met een buitenlands diploma (Results from 10 years of testing of physicians with a foreign diploma). Ned Tijdschr Geneeskd 2017;161:D1603.Leung TI, Biskup E, DeWitt D. Facilitating credentialing and engagement of international physician-migrants during the COVID-19 crisis and beyond. Rural Remote Health 2020;20:6027.
Inspirational Perspective Number 42
The Potential of a Student Chapter for Women In Surgery
Joana Letícia Spadoa, Bruna Oliveira Trindade, Gabriela Rangel Brandão, Júlia Iaroseski, Sarah Bueno Motter
Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
Many of us got into medical school with an interest in pursuing a career in surgery. However, we observe a low women's presence when we get in contact with this field during college. For example, we have very few women as professors of surgery in our classes. This reflects the Brazilian scenario, in which women are the minority in most surgical specialties., With that, being a surgeon seemed a challenging possibility to us when considering a medical specialty.
Then, inspired by our interest in surgery, we gathered a group of female medical students and founded a Student Chapter of the Association of Women Surgeons (AWS) in our university.
From the beginning of our Chapter, we tried to create, maintain, and expand a network of medical students, surgical residents, and surgeons. We have promoted events about the career in surgery aiming to approach our colleagues and the surgeons of our locality. Through informal talks, our guests shared the daily life in surgery, from the motivation to be a surgeon to the challenges and the rewards of it. We believe it is crucial to generate the role models of women surgeons we lack in our graduation path. With that, we are giving the first steps to establish a mentorship culture in our place. Now we have a small community of women interested in surgery from different study stages and the feedback of all people involved has been very positive.
Besides our local community, the Chapter allowed us to integrate a worldwide network of people interested in surgery. We have regular meetings with other Latin America chapters, where we develop activities to improve the Chapters in our continent. Moreover, being affiliated with the AWS gave us the opportunity to get in contact with women surgeons from all over the world and to participate in many activities promoted by this association.
Furthermore, our Chapter was a great booster of our academic development, so that scientific research is one of our pillars. First, we establish a culture of searching and discussing the scientific literature about women in surgery. Beyond that, we tried to investigate the reality of women surgeons in our country, which allowed us to elaborate on many pieces of research and whole manuscripts that we sent to national and international scientific events and journals about the theme, like the present work. Thereby, now we have a better understanding of the surgical scenario for women in our country, which stimulates us to constantly research more about the theme.
In addition, being in coordination positions of the Chapter has provided us an opportunity to train leadership and team management skills. We had to learn to work as a group, align different expectations, assume roles and responsibilities, in order to reach our goals. We have an internal structure led by a president and a vice-president and organized in specific sectors (scientific, secretariat, treasury, marketing), which are occupied according to the abilities and preferences of our members. Respect and partnership are strongly stimulated, aiming for individual and collective development. It is valid to mention that our Chapter was founded and until now has worked totally online, but we already have a strong group connection. Thus, it has been an excellent preparation for our profession, in which we will be part of a multidisciplinary team and possibly assume leadership positions.
Also, it is important to mention the contribution of social media to our foundation, growth, and maintenance. Our channels on different platforms gave us many possibilities. We do regular posts and stories on Instagram, in which we interact with our local community and share interesting topics about surgery and women in surgery, as historical facts, inspirational people, surgical techniques, suggestions of materials, divulgation of scientific events, etc. We are also present on Twitter where we interact with people from all over the world sharing our content. Then, especially these days when the contacts are online-based, social media gives us unlimited and enriching connections.
If in many moment surgery didn't seem a career to us, now we feel encouraged and inspired to be a surgeon. Our Chapter has provided us an opportunity to integrate a network of women interested in surgery, to research the Brazilian surgical scenario, and to learn about leadership and team management. Since the beginning, the learning was huge and we are excited about the upcoming challenges. Therefore, it is always very rewarding to contribute to a group that encourages women in surgery and medicine as well.
Scheffer M. et al., Demografia Médica no Brasil 2020. São Paulo, SP: FMUSP, CFM, 2020. 312 p. ISBN: 978-65-00-12370-8. file:///Users/deborahrupert/Downloads/DemografiaMedica2020_9DEZ.pdf. [Last accessed on 2021 Aug 03].Women representation in academic and leadership positions in surgery in Brazil. Association of Women Surgeons. Medical School Chapters. Web. Available from: https://www.womensurgeons.org/page/Chapters. [Last accessed on 2021 Aug 03].
Oral Number 7
The Sticky Surgical Floor: An Analysis of Publications by Women Authors in Vascular Surgery Journals
Anna Alaska Pendleton1, Alexandra Buda2, Deena El-Gabri3, Elizabeth Miranda4, Alexis Bowder5, Anahita Dua1
1Deparment of Vascular Surgery, Massachusetts General Hospital, Boston, Massachusetts, 2University of Rochester School of Medicine, Rochester, New York, 3University of Wisconsin-Madison Medical School, Madison, Wisconsin, 4Department of Vascular Surgery, University of Southern California, Los Angeles, California, 5Department of Surgery, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
Objectives: This bibliometric analysis evaluated authorship trends by gender in the three highest impact factor vascular surgery journals.
Methods: PubMed was searched for articles published in the European Journal of Vascular and Endovascular Surgery, the Journal of Vascular Surgery, and Annals of Vascular Surgery from 2015-2019. A web-based application used predictive algorithms to classify first and last author names as male or female.
Results: A total of 6,457 articles were analyzed, with first author gender predicted with >90% confidence in 83% (4889/5796) and last author gender in 88% (5078/5796). Overall, 25% (1223/4889) of articles had women first authors, and 10% (501/5078) had women last authors. From 2015-2019, there was a slight increase in the proportion of articles written by women first authors (p = 0.001), but no increase in the proportion of articles written by women last authors (p = 0.204). The proportion of articles written by women last authors was lower than the proportion of active women vascular surgeons in 2015 (8% articles vs. 11% surgeons, p = 0.015), 2017 (9% of articles vs. 13% surgeons, p < 0.001), and 2019 (11% of articles vs. 15% surgeons, p < 0.001). A woman last author was associated with 1.45 higher odds of having a woman first author (95%CI 1.17-1.79, p = 0.001).
Conclusions: Over the last five years, there has been no significant increase in women last authors among top-tier vascular surgery journals. Women remain under-represented as senior authors. Nonetheless, women last authors are more likely to publish with women first authors, indicating the importance of women-led mentorship in achieving publication gender equity.
Oral Number 8
A Prospective Characterization of Near-Peer and Faculty Mentoring Relationships for Female Medical Students
Catherine Young Han1, Sabrina Pan2, Ruth Gotian3, Yoon Kang4
1Department of Pediatrics, Weill Cornell Medicine, New York, NY, 2Weill Cornell Medicine, New York, NY, 3Department of Anesthesiology, Weill Cornell Medicine, New York, NY, 4Department of Medicine, Weill Cornell Medicine, New York, NY
Objectives: Currently, the literature on medical school mentoring is focused on faculty mentorship, with limited information on near-peer mentorship, especially amongst female students. This study aimed to examine a tiered mentorship program consisting of near-peer students and faculty in order to characterize the expectations and perceived barriers of each type of mentorship as well as how they may complement one another for first year female medical students.
Methods: We conducted semi-structured focus groups of first-year female medical students who were participants in a pre-established Women in Medicine mentoring group at a large academic medical center. Interviews lasted approximately 1 hour and were recorded and transcribed.
We used a qualitative constant comparative method to affix codes to the data within the transcripts and then collapsed the codes into larger themes. To achieve inter-rater reliability, two researchers coded transcripts independently prior to consensus of the codes and themes which were finalized into a codebook.
Results: Two focus groups were conducted with n = 10 participants. The three recurrent themes were (1) qualities of an ideal mentor, including shared experience and communication (2) outcomes of an ideal mentoring relationship, including gaining knowledge and empowerment and (3) barriers to mentorship, including gender-specific barriers, hierarchical power imbalances, and COVID-19-related challenges [Table 1]. Regarding qualities of ideal near-peer and faculty mentors, students were more likely to describe their communications with near-peers as casual and with faculty as formal. Participants emphasized approachability as being an important factor in their ideal faculty mentorships with much greater frequency than they did for near-peer mentorship. Ideal outcomes of near-peer and faculty relationships were described as providing knowledge, reassurance, and networking for their mentees (specifically facilitating introductions). Near-peer mentors were more likely to offer knowledge on coursework and extracurricular activities while faculty mentors offered knowledge on specialty-specific expertise and family life. Participants also described faculty mentors as providing empowerment and academic deliverables (i.e., letters of recommendation, publications), while near-peer mentors were more likely to provide guidance on navigating the learning environment (i.e., hidden curriculum, approaches to specific clinical services). Increased time constraints were identified as barriers to both faculty and near-peer mentorships. For near-peer mentors, however, these barriers were primarily a function of the limited longitudinality of relationships, as upperclassmen graduated. Barriers specific to faculty involved hierarchy and consequential student perceptions such as wasting mentor time or fear of demonstrating knowledge gaps. On a gender-specific level, mentees also noted both explicit or implicit sexism as an obstacle to mentorship, solely with faculty mentors. The COVID-19 pandemic posed additional barriers to all mentoring relationships through loss of community-building and communication methods.
Conclusions: First-year female medical students regarded faculty mentors as more important for empowerment and networking, but faced more barriers to this type of mentorship such as hierarchy, time constraints, and gender-specific perceptions when compared to near-peer mentorship. Near-peers specifically provided more knowledge on navigating the system. A combination of both near-peer and faculty mentors may serve to more fully support the needs of mentees.
Oral Number 9
Unconscious Bias in Speaker Introductions at a National Vascular Surgery Meeting: The Impact of Speaker and Moderator Demographics
Ashley Vavra1, Courtney Furlough1, Andres Guerra1, Katherine Hekman1, Taehwan Yoo1, Narjust Duma2, Camille Stewart3, Jeniann Yi3
1Department of Vascular Surgery, Northwestern University, Chicago, Illinois, 2Department of Medicine, University of Wisconsin, Madison, Wisconsin, 3Department of Surgery, University of Colorado, Aurora, Colorado, USA
Objectives: Unconscious bias based on attributes such as race and gender contributes to disparities in academic medicine. Previous work has demonstrated that this can manifest in the form of address used during speaker introductions in formal academic settings. Recognition of bias is an essential first step towards addressing it. To examine the potential for bias within vascular surgery, we examined speaker introductions at the Society of Vascular Surgeons Annual Meeting to determine whether such variations in address exist.
Methods: An observational study was performed of speaker introductions from the 2019 Vascular Annual Meeting video archives. Of note, no additional years were available for study. Presentations by non-physicians were excluded. A total of 6 reviewers participated and 2 reviewers independently assessed each video. Professional title with either full name or last name was considered a professional address. Race, gender, title and region of practice were identified for speaker and moderator. Univariate and multivariate logistic regression analyses were performed to identify significant associations with speaker and moderator characteristics and form of address used.
Results: Of 744 talks evaluated, 336 met inclusion criteria. Whereas moderators were more likely to have a more senior title, both speakers and moderators were similar with regards to gender and race distribution [Table 1]. Non-professional address was more common when the speaker was a trainee (OR 3.15, p = 0.043) and when the moderator identified as white vs. non-white (OR 2.45, p = 0.027). Speaker race, moderator rank, and speaker/moderator geographic region and gender did not significantly impact the form of address used for speaker introduction.
Conclusions: Unconscious bias in vascular surgery exists as evidenced by differential speaker introductions at the Vascular Annual Meeting. Specifically, non-professional address was more common when the speaker was less senior in title and when the moderator was identified as white race. Gender was not a significant factor, yet this may reflect the limited sample of female meeting participants that is an additional reflection of systemic disparities. Further work must be undertaken to acknowledge these inequities and actively address these unconscious biases.
Oral Number 22
Imposter Syndrome among Minority Medical Students Who Are Underrepresented in Medicine
Jayne Rice1, Beverlin Rosario-Williams2, Francois Williams3, Alden Landry4
1Department of Vascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, 2The Graduate Center, City University of New York, New York City, New York, 3Department of Psychiatiry, Baylor College of Medicine, Houston, Texas, 4Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
Objectives: Impostor syndrome (IS) is prevalent in medical professionals. However, little is known about the prevalence of IS among medical trainees and those who are underrepresented in medicine (UiM). Even less is known about the experiences of UiM students at predominantly white institutions (PWIs) and historically black colleges/universities (HBCUs) relative to their non-UiM peers. The purpose of this study was to investigate differences in impostor syndrome among UiM and non-UiM medical students at a PWI and a HBCU. We additionally explored gender differences in impostor syndrome among UiM and non-UiM students at both institutions.
Methods: Medical students (N = 284) at a PWI (N = 187, 107 (58%) women) and a HBCU (N = 97, 60 (62%) women), completed an anonymous, online two-part survey. In part one, students provided demographic information, and in part two, students completed the Clance Impostor Phenomenon Scale, a 20-item self-report questionnaire that assessed feelings of inadequacy and self-doubt surrounding intelligence, success, achievements, and one's inability to accept praise/recognition. Based on the student's score, the level of IS was measured and placed into one of four levels: few IS feelings, moderate IS feelings, frequent IS feelings, or intense IS feelings. We conducted a series of chi-square tests, independent sample t-tests, and analysis of variance to test the main aim of the study.
Results: The response rate was 22% and 25% at the PWI and HBCU, respectively. Overall, 97% of students reported moderate to intense feelings of IS, and women were 2.2 times more likely than men to report frequent or intense feelings of IS (63.5% vs 50.5%, p = 0.03). Students at PWI were 3.9 times more likely to report frequent or intense IS than HBCU students (66.7% vs. 42.1%, p < 0.01). In addition, UiM students at PWI were 2.3 times more likely to report frequent or intense IS compared to UiM students at HBCU (66.7% vs. 42.9%, p = 0.02) [Figure 2]. As shown in [Figure 1], a two-way interaction emerged, revealing UiM women scored higher on impostor syndrome than UiM men at the PWI and the HBCU, which was not observed among non-UiM students.
Conclusions: Impostor syndrome is informed by gender, UiM status, as well as environmental context. Efforts to provide supportive professional development for medical students should be directed towards understanding and combatting this phenomenon at this critical juncture of their medical career.
Oral Number 24
Female Trainee Parents in Medical and Procedural Specialties Experience Disproportionate Stress Burdens
Eleanor Sharp1, Kristina Nicholson2, Blake Gibson3, Daniel Glaser4, Maia Taft1, Traci Kazmerski5
1Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, 2Department of Surgery, University of Pittsburgh Medical Center, 3Department of Psychiatry, University of Pittsburgh Medical Center, 4Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, 5Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
Objectives: Demanding schedules and unpredictable work hours are inherent to medical training, making work-life balance difficult for all physician trainees. However, female trainees face unique stressors as they often navigate pregnancy, childbirth, and breastfeeding during medical training. We investigated the experiences and concerns of physician trainees in medical and procedural specialties and identified factors associated with higher parental stress. We hypothesized that female trainees have higher levels of parental stress than male trainees.
Methods: We performed an anonymous, web-based survey of all residents and fellows across a single large academic institution (n = 1719) in April 2021 to assess physician trainee experiences related to parental leave, breastfeeding, and childcare. We used the Parental Stress Scale (PSS) to identify factors associated with increased parental stress. We analyzed results using chi-square tests, two-tailed t-tests, and linear regression as appropriate.
Results: A total of 497 respondents (62% female, 29% response rate) participated. The median PSS score was 41 (IQR 36 – 49); there was no significant difference between male and female trainees (43.1 vs 44.9, p = 0.38). Half of all respondents reported being parents (p = 0.788). Women took longer parental leaves than men (mean 7.4 vs 2.3 weeks, p < 0.001). Over one-third of women reported that they either will be required or anticipate being required to extend training due to parental leave (36% vs 13% of men, p = 0.009). While leave duration was similar for women in medical vs. procedural specialties (p = 0.25), women in medical specialties were significantly more likely to report anticipating the need to extend their training (43% vs. 26% in procedural specialties, p = 0.034). Out of 100 mothers, 83% were actively breastfeeding or had breastfed at their current training program. Breastfeeding was associated with significantly higher PSS scores compared to non-breastfeeding women (46.7 vs. 38.3, p = 0.02). Additionally, lack of perceived program or institutional support for breastfeeding was associated with significantly increased stress (p < 0.001). While trainees in procedural specialties perceived equal breastfeeding support from their programs compared to medical trainees (p = 0.294), they were more likely to report that difficulty finding time and space to pump impacted their achievement of breastfeeding goals (p = 0.01).
Conclusions: As the proportion of women graduating from medical school has increased, and in the context of broader societal shifts, more attention has been given to policies supporting new parents in medical and procedural training programs. However, our results suggest that female trainees continue to experience disproportionate stress burdens, particularly in domains of parental leave and breastfeeding support. While a multi-institutional study is needed to prioritize needs of trainee parents and design appropriate supports, our use of a validated survey instrument to assess parental stress is novel and our results have important implications for institutional policies to promote gender equity.
Oral Number 29
The Association of Burnout and Recommendations Regarding COVID-19 Masking and Social Distancing in a Sample of Largely Physician Mothers
1Allison Mobley, Hannah 2Getachew-Smith, 3Marla Clayman, 1Lisa Mordell, 1Serena Dhaon, 4Shikha Jain, 1Vineet Arora
1Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois 2Department of Communication Studies, Northwestern University School of Communication, Evanston, Illinois, 3Department of Health Communication, Northwestern University Feinberg School of Medicine, Chicago, Illinois, 4Division of Hematology and Oncology, University of Illinois College of Medicine, Chicago, Illinois, USA
Background: Although non-pharmaceutical interventions (NPIs), such as masking and social distancing, have been essential to managing the COVID-19 pandemic, they have also been controversial due to changing guidance, politicization, and misinformation. Healthcare professionals (HCPs) and mothers are trusted messengers of health information. The pandemic is associated with high rates of HCP burnout and has placed high burdens on women HCPs. This study aimed to describe HCPs beliefs and behaviors regarding communication about COVID-19 NPIs and the relationship between communication about NPIs and burnout.
Methods: An online survey was conducted with Illinois HCPs recruited via private electronic channels (e.g., Facebook group of physician mothers) between December 2020-February 2021. The survey included factorial vignettes to assess a participant's comfort and likelihood of discussing NPIs varying by setting, patient's perception of COVID-19's severity, and type of NPI. Likert scales were used to measure normative beliefs, behavioral beliefs (belief expectations), likelihood, comfort with, and frequency of communication about NPIs.The Mini-Z burnout scale was used to measure HCP burnout. Direct COVID-19 specialities were defined as Emergency Medicine, Infectious Disease, or Critical Care. Data were analyzed in STATA with non-parametric tests.
Results: Among the 144 responses included in the analysis, 53% practiced in a suburban/rural area, 49% in a primary care setting, and 16% in direct COVID-19 specialties. While 93% of respondents strongly agreed it is important to discuss NPIs with patients, only 46% strongly believed these discussions would make a difference in patient behavior. Respondents felt significantly more likely to and comfortable talking to patients versus neighbors about NPIs, and with patients worried about COVID-19 versus those thinking it is overblown. Contrary to our hypothesis, HCPs reported greater comfort and likelihood of discussing masks versus social distancing. 57% of respondents reported feelings of burnout. Burnout was significantly higher in HCPs practicing in sub-specialities versus primary care or direct COVID-19 specialities (59% vs. 39%, p = 0.03) and in suburban/rural areas versus urban (55% vs. 30%, p < 0.01). HCPs who reported burnout were less likely to agree with the importance of discussing NPIs with patients (86% vs. 98%, p < 0.01), less likely to report that most of their colleagues have these discussions (40% vs. 60%, p = 0.01) and burnout was associated with a significantly lower frequency of always discussing masking (32% vs. 52%, p = 0.02).
Conclusions: In a sample of predominantly physician mothers, nearly all HCPs held strong normative beliefs about the importance of discussing NPIs. Behavioral beliefs about the impact of these discussions were much lower. A majority of our sample reported burnout, and HCPs experiencing burnout were less likely to value or have discussions about NPIs. This raises concern for the impact of burnout on HCP response to COVID-19, particularly given the new changing guidance around masking. As other data suggests women HCPs face higher rates of burnout, these implications must be considered. Efforts to support those experiencing burnout and empower them to communicate about COVID-19 mitigation strategies are imperative to effectively respond to the pandemic.
ORAL NUMBER 32
Social Media, Technology Access and Oncology: Where Do Patients Seek and Share Health Information?
1Eric Freeman, 1Folasade Odeniyi, 2Darshilmukesh Patel, 1Mary Pasquinelli, 1Shikha Jain
1Department of Pulmonology and Medical Oncology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, 2Division of Hematology and Oncology, University of Illinois at Chicago, Illinois, USA
Objectives: The use of social media has grown substantially over the last decade. Social media in healthcare has many benefits, such as the dissemination of health information, health promotion, and recruitment of clinical study participants. Little is known about patient preferences for social media platforms, particularly among minority populations. The aim of the survey is to assess general social media usage, preferences for health information sharing among patients diagnosed with cancer.
Methods: Between March 2021 to June 2021, a brief 16-item survey adapted from the National Cancer Institute's (NCI) Health Information National Trends Survey (HINTS) was sent via e-mail to patients scheduled for a visit to an outpatient cancer center. To capture patients who may not have Internet access, surveys were also administered in person.
Results: Surveys were sent to 1,713 patients, 307 completed the questionnaire. Participants utilize several information sources: their doctor or healthcare provider (89.3%), Internet search engine (71%), brochures and pamphlets (40.7%), a healthcare non-profit (39.7%), books (33.6%), family (30.9%), hospital website (30.6%), a friend or co-worker (16.9%), television (13.4%), and magazines (12.4%). There was an association between the use of Internet search engine and age (X2 = 8.32; p = 0.004), salary (X2 = 10.0; p = 0.018), and education (X2 = 24.3; p = 0.001). There was also an association between education and the use of brochures and pamphlets (X2 = 16.5; p = 0.021), hospital website (X2 = 15.2; p = 0.034), podcasts (X2 = 12.6; p = .003), and medical journals (X2 = 27.9; p < .001). When respondents were asked to choose just one source, 67.4% chose their doctor or health care provider, while 21.8% chose Internet search engine. The majority of participants have access to a smartphone with Internet (77.2%), a home desktop or laptop with Internet (62.5%), Tablet with Internet (61.2%). Notably, 25.7% of respondents did not have a mobile phone with Internet or a data plan. A majority (64.7%) of respondents have a social media platform. There was an association between having a social media platform and age (X2 = 18.7, p < .001) and gender (Fisher's p = .001). When asked about which social media platform respondents use, the top 10 platforms include: Facebook (61.9%), YouTube (48.9%), Instagram (28.9%), Snapchat (15.3%), Twitter (14.6%), Linkedin (13.4%), Pinterest (13.4%), Tiktok (11.7%), GroupMe (3.9%), and Reddit (2.9%). Respondents primarily used Facebook (22.5%), YouTube (21.5%), Instagram (8.1%), Pinterest (4.9%), and Twitter (3.9%) to receive health information. Respondents primarily used Facebook (17.6%), Instagram (4.2%), YouTube (4.2%), Twitter (1.9%), and GroupMe (1.6%) to share health information. Virtually, none of the participants (94.5%) reported using social media to share health information with a medical professional.
Conclusion: Knowledge of where and how patient access health information is important to ensure that patients are well informed, have access to accurate information and are able to share with their healthcare team to promote care. Future studies should further explore the utility of social media platforms to support oncology patients and their families.
Oral Number 36
Investigating Gender Differences and COVID-19: Impacts on Work-Family and Family-Work Conflicts and Well-being
Kait C. Macheledt1, Nissrine Nakib2, Samantha J. Barker3, Snigdha Pusalavidyasagar4, Jerica M. Berge1
1Department of Family Medicine and Community Health, Center for Women in Medicine and Science, University of Minnesota Medical School, 2Departments of Urology and 3Radiology, University of Minnesota Medical School, 4Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
Objectives: Emerging research shows capacity for the COVID-19 pandemic to have persisting, adverse outcomes on well-being for healthcare workers including burnout, anxiety, depression, increased substance dependence, and PTSD.,,,,, One important dimension not robustly investigated, but anecdotally discussed, is the experience of conflict between work and family. Prior to COVID-19, research demonstrated that medical professionals (e.g. physicians, nurses) experience greater Work-Family Conflict (WFC)., defined as the experience of conflict in which job demands, time, and strain interfere with performing family-related responsibilities. Gender-differences have been evident among medical professionals, in both WFC and Family-Work Conflict (FWC), defined as the conflict in which family interferes with job-related responsibilities. Conflicts between work and family can impact both institutional (e.g. retention) and individual (e.g. stress, depression, anxiety) metrics of wellbeing.,,, This study aims to understand WFC and FWC occurrences during the COVID-19 pandemic among medical professionals with special consideration for gender-differences.
Methods: A cross-sectional survey was administered through email to University of Minnesota health sciences faculty over the months of April-June 2021. The survey used validated measures including Work-Family/Family-Work Conflict Scale. Additional questions included such things as personal demographics (gender, race, caregiver status etc.), academic demographics (school, rank, track, % effort allocations etc.), scholarly productivity, clinical productivity, wellness, stress, and foreseeable benefits of change in working conditions. The associations between gender (e.g. men/women) and WFC, FWC, caregiver status, and faculty rank were examined using the chi-square test for proportions, linear regression, and mediation analysis.
Results: The majority of faculty (n = 292) survey respondents were from the Medical School (80%), Assistant Professors (47%), and identified as being White/European-American (76%). The gender distribution of survey respondents included 35% men, 62% women, and <1% non-binary. Across the gender binary, representation of women and men was similar across faculty track and percent effort allocation (e.g. Research/Scholarship, Clinical, Administrative, and Service). Statistical analysis showed gender was associated with WFC (women 5.03 vs. men 4.62, difference = 0.41 [95% CI 0.03–0.78], P = 0.03) and FWC (3.81 vs. 3.24, 0.57 [0.15–0.98], P = 0.008), with women having greater scores on both scales. Within our study population, caregiver status and faculty rank were each associated with both gender (P = 0.001 and P = 0.01) and conflict score (WFC: P = 0.0004 and P = 0.008; FWC: P < 0.0001 and P = 0.001). Mediation analysis showed that caregiver status and faculty rank each act as partial mediators of the relationship between gender and conflict score, indicating that these mediators explain some, but not all, of the gender-WFC/FWC association (pre-adjustment gender difference: WFC 0.41, FWC 0.57; post-adjustment gender difference: WFC 0.19, FWC 0.16).
Conclusions: The COVID-19 pandemic has exacerbated conflicts between work and family with a capacity to have persistent, adverse effects of institutional and individual metrics of wellbeing. This study provides evidence of important gender-differences in the experience of conflicts between work and family during COVID-19 among medical professionals.
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Oral Number 39
The Missing Doctors: Understanding Why Women Doctors Quit Medical Practice in Pakistan
Usama Waqar1, Shaheer Ahmed2, Russell Seth Martins1, Daniyal Ali Khan1, Rana Muhammad Ahmed Mudabbir1, Samreen Jawaid3, Mahim Malik1, Syeda Sadia Fatima1
1Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University, 2Islamabad Medical and Dental College, Islamabad, Pakistan, 3Dow Medical College, Karachi, Pakistan
Objectives: Women doctors are an integral part of the healthcare delivery workforce globally. In Pakistan, the number of women choosing the medical profession has increased in the last decade, with 80-85% of all medical students being women. However, according to estimates from the Pakistan Medical & Dental Council (PMDC), the proportion of women doctors in the healthcare delivery workforce remains under 50%. This study aimed to assess the factors contributing to this attrition among women doctors and explore potential interventions that can mitigate this attrition rate.
Methods: A nationwide cross-sectional survey was conducted between December 2019 to December 2020 in collaboration with the Association of Women Surgeons of Pakistan. Women doctors licensed by the PMDC and who were residing in Pakistan were included in this study, irrespective of whether they were practicing or not at the time of the survey. An anonymous questionnaire was dispatched to over 100 medical colleges and hospitals in Pakistan and disseminated via several social media forums (Facebook, Twitter, and Instagram). Baseline characteristics and reasons to pursue medicine were assessed for all respondents. In addition, the questionnaire explored alternative career options and reasons that had led to discontinuation of medical practice for women who discontinued practice for a period of >1 year. Furthermore, all respondents were asked about potential interventions that can alleviate the attrition rate among women doctors in Pakistan.
Descriptive statistics were reported, and baseline characteristics were compared among women who were practicing medicine and those who had discontinued medical practice using Chi-square tests or Fisher's Exact tests. All tests were two-sided with p < 0.05 considered threshold for statistical significance.
Results: A total of 662 women doctors responded to the survey; 31.6% had discontinued medical practice while the remaining were practicing at the time of the survey. Most respondents belonged to the 25-34 years age group. Only 24.9% [52 of 209] women doctors who had discontinued medical practice pursued alternative careers, with academic medicine and community health sciences being the most common pursued options respectively.
Women doctors who were married vs single, those who graduated in 2001-2010 vs in 2011-2020, and those who were from Sindh vs Punjab were more likely to discontinue practice (p < 0.001). Overall, the most pertinent reasons that had led to discontinuation of medical practice included inability to simultaneously manage motherhood/childcare, lack of daycare facilities at work, medical workplace being unsupportive of motherhood, inability to simultaneously manage household responsibilities, and limited maternity leaves [Table 1]. A majority of respondents believed that flexible working hours, daycare facilities, and weekly work hour limits were necessary to alleviate the attrition rate among women doctors [Table 2].
Conclusions: Discontinuation of medical practice by women doctors has a devastating impact on the healthcare delivery system, particularly in Pakistan where it adversely affects the health seeking behavior among women due to socioreligious norms. Addressing the need for flexible working hours, daycare facilities, and work hour limits is warranted so that women doctors can continue their medical practice while simultaneously managing motherhood and personal life responsibilities.
Oral Number 47
Using Social Media to Address Vaccine Hesitancy and Vaccine Access During the COVID-19 Pandemic: Amplifying Physician Women and Ally Voices
Jack Dokhanchi1, Serena Dhaon2, Shikha Jain3, Laura Zimmermann4, Eve Bloomgarden5, Halleh Akbarnia6, Tejal Shah5, Hannah Getachew-Smith7, Vineet Arora8
1University of Illinois at Urbana, Champaign, Urbana, 2Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, 3Division of Hematology and Oncology, University of Illinois College of Medicine at Chicago, Chiago, Illinois 4Department of Preventative Medicine Rush Medical College, Chicago, Illinois, 5Division of Endocrinology, Metabolism, and Metabolic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, 6Advocate Condell Medical Center, Libertyville, Illinois, 7Department of Communication Studies, Northwestern University, Chicago, Illinois, 8Department of Medicine, The University of Chicago Pritzker School of Medicine, Chicago, USA
Objectives: Social media can be leveraged to disseminate public health messaging and promote equity. Although trusted by the public, many health care workers (HCWs), especially women, do not engage on social media for fear of harassment and because they are busy balancing increasing professional and personal obligations during the COVID-19 pandemic. Illinois Medical Professionals Action Collaborative Team (IMPACT) was formed in March 2020 by physician mothers in Illinois to amplify HCW voices during the COVID-19 pandemic. IMPACT used social media to (1) identify and address vaccine mis/disinformation, (2) identify and address inequities in vaccine access, and (3) facilitate health care worker advocacy (universal masking in schools).
Methods: To address vaccine mis/disinformation, we used closed Facebook groups in Chicago and Illinois to collect data on common COVID-19 myths reported by HCW. Other strategies to combat vaccine mis/disinformation included (1) creating and amplifying seven “debunking” infographics in English and Spanish and (2) partnering with the national organization Bump Club and Beyond to hold live Q&A sessions on social media with mothers and families. By networking with Facebook groups (e.g., Chicago Vaccine Hunters), we identified a lack of access to vaccines for seniors and community-based HCWs. Two clearinghouses with resources to schedule a vaccine and scheduling tips were created to help improve vaccine access for HCWs and the public. We also created a HCW volunteer registry to staff vaccination events throughout the Chicago-land area. By partnering with health systems and community organizations, such as Chicago Vaccine Angels, IMPACT was able to assist in setting up and staffing vaccine clinics and an in-home vaccination program throughout Illinois. When many Illinois school districts made masking in school optional, we wrote a letter to the Illinois governor and produced a Change.org petition calling for universal masking in schools. Members of IMPACT also circulated the letter and petition for signatures on social media.
Results: The top vaccine myths reported among HCW (N = 120, primarily women) included concerns of infertility and worries of safety given rapid vaccine development. Our COVID-19 Myth Debunkers infographics were shared over 730 times for >197K impressions (as of 8/6/2021). In addition, we produced more than 15 live Q&A sessions on social media that reached over 1000 people per session, and our clearinghouses have reached >2oK people. To date, we have registered >700 HCW and >1000 non-HCW volunteers for over 300 COVID-19 vaccination events that led to ~100K vaccinations. Finally, our letter was signed by >370 HCW, and our petition for masking in schools generated over 32K signatures.
Conclusions: HCWs can strategically leverage social media to identify public health challenges, such as vaccine mis/disinformation, inequities in vaccine access, and gaps in public health policy. Additionally, HCWs can use social media to formulate and execute real-time solutions by amplifying public health messaging, connecting people to resources (vaccines and volunteers), and facilitating physician advocacy.
Poster Number 3
Exploring the 'Black Box' Surrounding Female Surgeons' Experiences with Impostor Phenomenon
Jennifer McCall1, Zoe Hutchison1, Jessica Pudwell1, Afra Mehwish2, Jamie Pyper1, Romy Nitsch1
1Department of Obsterics and Gynecology, Queen's University, Kingston, 2Department of Management, University of Guelph, Guelph, Canada
Objectives: This project aims to characterize the extent and nature of Impostor Phenomenon (IP) among female surgeons in Canada. It seeks to identify when IP first affects female surgeons, what the trajectory of IP is over a career, and how IP manifests on female surgeons' professional practices.
Methods: Female-identified people in Canada who have completed a surgical residency and currently or most recently practiced in Canada were invited to complete an online survey. Distribution was by targeted promotion on social media and direct contact via an email list compiled from professional association and institution directories. The survey consisted of the Clance Impostor Phenomenon Scale (CIPS), several Likert-scale questions designed by the study investigators, and demographics. CIPS is a cross-culturally validated, internally reliable 20-item scale.
Results: 387 participants met inclusion criteria. Median CIPS score was 68 [IQR 53-76], which correlates to high impostorism [[Table 1]. Female surgeons CIPS Scores]. Experience of self-doubt was reported as often true or very true by 179 (46.3%) of respondents in their academic research and 122 (31.5%) in the operating room. 107 (27.7%) of respondents have been hesitant to take on a leadership role due to self-doubt. 11 (2.8%) have given up operating due to self-doubt [[Table 2]. IP experiences by degree of IP]. Most participants experienced self-doubt for the first time before medical school.
Conclusions: IP is experienced by many female surgeons, and they consider IP an influential factor in their professional lives. By understanding how IP affects female surgeons in Canada, this study contributes to scientific knowledge that can advance gender equity in medicine.
Poster Number 6
Factors Affecting Female Plastic Surgeons' Decision to Pursue and Maintain an Academic Career
Joowon Choi1, Wendy Chen2, Aditi Kanth3, Meera Reghunathan4, Katerina Gallus5, Marita Martiney6
1Virginia Tech Carilion School of Medicine, Roanoke, Virginia, 2Division of Plastic Surgery,Department of Orthopedic Surgery, University of California, Los Angeles, California, 3Craniofacial Center, Medical City Children's Hospital, Dallas, Texas,4Division of Plastic Surgery Department of Surgery, University of California, San Diego, California, 5Private Practice, Restore San Diego, San Diego, California, 6Actalent, Princeton, New Jersey, USA
Introduction: Plastic surgery has seen notable growth in female trainees in the past decade, but female representation in academia continues to lag. The purpose of this study is to systematically identify factors associated with the decision to pursue an academic career in female plastic surgeons.
Methods: Twenty-two female plastic surgeons were selected based on experience, region, race, and practice type. Virtual interviews examining training experience, first job selection, and workplace culture were conducted. Responses were anonymized and reported in aggregate.
Results: Of the 22 women interviewed, 7 were in academia, 8 were in private practice, and 7 left academia for private practice. More women in academia identified strong female mentorship as a strong influencing factor for entering plastic surgery than women in private practice (42.8% vs. 14.2%). Practice content was more important to those going into academia (30% vs. 12.5%), while supportive environment and location were more important to those in private practice. Women who left academia cited perceived gender inequity (85.7%) followed by lack of flexibility (71.4%) as reasons for leaving. Satisfaction with current workplace culture is highest in those in private practice as compared to those in academia (87% vs. 33%, p = 0.014).
Conclusion: Our qualitative analysis suggests that the factors influencing why female plastic surgeons leave academia are multifactorial, including practice content, geography, mentorship, workplace culture, and perception of gender equity. This rich qualitative data is currently being used to design a validated survey tool to further elucidate factors contributing to women leaving academia and propose meaningful solutions.
Poster Number 11
Primary Care Providers' Experiences Treating Low Back Pain
Sondos Al Sad, Amanda Start
The Ohio State University, Columbus, Ohio, USA
Objectives: To explore primary care provider (PCP) experiences and practice patterns regarding low back pain (LBP) in females compared to males in the United States.
Methods: We used a cross-sectional study design, data was collected anonymously using a 27-item online survey sent periodically via email to PCPs working in Ohio. We had 58 responses for analysis, data was analyzed using bivariate and multivariate analyses.
Results: Almost 9 out of 10 responding clinicians reported experiencing LBP. PCPs were not in agreement that LBP is different in women than men. Clinicians with women's health, osteopathic, or sport's medicine background were more likely to agree that LBP is different in women than in men. PCPs were more likely to counsel female patients about pelvic floor exercises, however their intake of present pelvic symptoms in LBP female patients is suboptimal. PCPs were more likely to counsel females for home chores than males which is aligned with perceived traditional gender roles amongst PCPs.
Conclusion: There may be a knowledge gap amongst PCPs towards impact of biological sex on LBP and a bias towards gender roles when counseling patients for home chores or occupational tasks. Further investigation of this knowledge gap and counseling approaches, is recommended to better bridge the disparity.
Poster Number 15
How Does Patient Gender Influence Surgeon Understanding of Patient Preference for Hip Or Knee Osteoarthritis Treatment?
Mahima Mangla1, Kathrene Valentine2, Ha Vo2, Karen Sepucha2
1New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, 2Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
Objectives: Published literature on treatment of hip and knee osteoarthritis (OA) has found differences in treatment based on gender. For example, referral to specialty care and recommendation for surgery are both offered less often to women than men. The purpose of our study is to explore how demographic factors including gender can influence the following: (1) how often surgeons both ask and understand their patients' preferences for OA treatment as well as (2) patient visit satisfaction with the surgical consultation.
Methods: This is an exploratory, secondary data analysis comparing patients' treatment preferences for OA and how often surgeons ask and correctly understand their patients' preferences. This study was nested in a larger randomized controlled trial comparing the effectiveness of two different decision aids for hip and knee OA. Patients shared their preferences before (pre-visit) and after (post-visit) their surgical consultations along with their overall visit satisfaction. Surgeons reported what they thought their patients preferred after the visit. Surgeons' perceptions were compared with patient responses to determine if there was preference matching between patient and surgeon. We explored how patient gender influenced preference elicitation and preference matching. Also we examined how demographic factors including gender, race, and health literacy influenced patient-reported visit satisfaction.
Results: There were 204 patient responses with a corresponding surgeon report. The patient responders were on average, 64 years old, 60% female, 71% had knee OA, 91% were White non-Hispanic, and 69% had high health literacy. Overall, patients' preferences matched with the surgeon report more after the visit (79%) as compared to before the visit (56.2%), p < .001.
Surgeons were less likely to have a preference match with women compared to men (75% female vs. 87% male, p = 0.11). The majority of women and men reported that their surgeon elicited their preference for treatment (80% women vs. 85% men, p = 0.56). Patient satisfaction with the visit was lower for women compared to men (p = 0.021). Overall we found patients tended to be more satisfied with the visit if they were male, white, or had higher literacy (p< 0.024).
Conclusions: Generally, we found that patients' preferences matched more with the surgeons' perception of patient preference after the visit. Similarities in preference elicitation frequency and patient-clinician preference matching for men and women is encouraging. Further work to understand why women had less visit satisfaction is warranted. Perhaps examining what is covered in the conversation between surgeons and male and female patients may elucidate important factors influencing treatment selection and patient satisfaction with both their visit and outcomes. Routine implementation of shared decision making may help address any deficits in orthopedic care for women.
Poster Number 16
Geographic Variation in Gender Diversity at US Otolaryngology Programs
Rishabh Sehra, Deesha Desai, Carl Snyderman
Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Objectives: Otolaryngology has historically been dominated by white males, with under-representation of women relative to the general population and other medical specialties. Factors that contribute to diversity of training programs are poorly understood. Here, we relay current gender equality numbers among faculty and residents at all US otolaryngology programs, and correlate the latter numbers with the program's geographical location, political results of the associated county and state in the 2020 election, and the metropolitan population size of the associated city from 2019 US census data. Furthermore, we correlate gender equality numbers among current residents with existing faculty. Ultimately, we aim to discover which factors drive the disparities in gender equality among various ENT programs across the country.
Methods: Gender equality numbers (# of male and female faculty, and # of male and female residents) were collected for 115 accredited ENT programs across the US from department websites. To be considered a faculty member, the individual must have a MD, PhD, MBBS, DDS, or DMD degree. Audiologists and speech pathologists were excluded with no such exclusion criteria for residents. For each individual program, the associated geographical location was listed as per the US Census Bureau's four statistical regions and nine divisions. With regards to politics, 2020 presidential election results for each program's associated county and state were listed as either blue (democrat) or red (republican). Finally, resident population figures from the 2019 US Census data were included for each program's associated city.
Results: Geographically speaking, while the South (region), West South Central division has both the lowest median female:male faculty and resident ratios at 0.27 with a IQR of 0.43 and 0.43 with a IQR of 0.52, respectively, no single division has both the highest median female:male faculty and resident ratio numbers. For the 2020 presidential election, female/male faculty ratio was higher for democratic counties (median of 0.37 with IQR of 0.34) as compared to republican counties (median of 0.20 with IQR of 0.56), and democratic states (median of 0.40 with IQR of 0.37) as compared to republican states (median of 0.28 with IQR of 0.28). Likewise, female/male resident ratio was higher for democratic counties (median of 0.67 with IQR of 0.60) as compared to republican counties (median of 0.63 with IQR of 0.63), and democratic states (median of 0.67 with IQR of .67) as compared to republican states (median of 0.48 with IQR of 0.50). Finally, only weak correlations were found between a program city's metropolitan population size and female faculty and resident diversity numbers.
Conclusions: While no single geographical division displays the strongest ENT gender equality figures, ENT programs in the South, West South Central division display both the lowest female faculty and resident equality numbers. As hypothesized, ENT programs in democratic counties and states possessed stronger female diversity equality numbers as compared to republican counties and states. Finally, the results show that strong ENT faculty gender equality numbers don't necessarily correlate with strong ENT resident gender equality numbers.
Poster Number 17
Solutions to Common Personal and Professional Struggles: Stories from Women Pediatric Hospitalists
Behnoosh Afghani1,2, Cynthia Castiglioni3,4
1Department of Pediatrics, UC Irvine School of Medicine, 2Department of Pediatrics, Children's Health Orange County Hospital, Orange, California, 3Department of Hospital-Based Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 4Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Objective: To delineate specific strategies or solutions that women in pediatric hospital medicine (PHM) have used to successfully address struggles experienced in their career.
Methods: We distributed a survey via the AAP Section on Hospital Medicine Listserv asking members to share stories about their personal and professional barriers, as well as any success stories or solutions. In this report, we will focus on the solutions.
Results: Of 124 respondents, 109 were women and of those, 39 provided a success story. The most common themes related to success stories or solutions with excerpt examples are as follows:
Support from colleagues, peer or family (N = 14)
My hospitalist group was wonderful in covering shifts for me after my son became ill until my own mental state recovered sufficiently that I could return to productive workPeer and family support has been the most helpful. So, I was really on the edge of becoming completely “de-railed”. A large part of what saved me were my nurses, they “breathed me” back to life”…We also have a women providers special interest group…building a network of other colleagues who have the same challenges had really helped me. I've learned how to have 3 alternative childcare providers and how to find balanceWas able to negotiate salary increase to make up for more expensive benefits. Strategy was to have more than one person asking for the same thing with data.
Allyship with organization leaders and sponsorship (N = 7)
I tried my best to use my position and voice to be an ally… so that the burden does not lie on the Black students and trainees and attendings to educate their colleagues… it has opened the door to more conversations…I have advocated for and sponsored a number of female trainees and colleagues. I continue to alert people of ways we can build more inclusive environmentsIdentifying an advocate & ally in the administration has helpedOur hospital leadership has been quite active in engaging our physicians in frequent “check ins” to see how everyone is copingWe have met with our CEO and head of HR to try to explain what it's like to be a woman physician at our institution and told our stories.
Change in career or work schedule (N = 7)
When one door closed another opened and I found other opportunities to practice in a way that I preferred--that allowed me a lifestyle I preferredI was fortunate to transition out of my private practice which was abusive to me in many waysSwitching from full-time academics to part-time private practice was the first good move I made
Other less common themes included stories related to intrinsic motivating factors, prioritizing values and increasing awareness about the challenges.
Conclusion: The most common strategies used by women in PHM to overcome barriers included obtaining support from colleagues, family and peers, forming allies with hospital leaders, gaining sponsorship by senior colleagues, and making career changes to fit personal needs.
Poster Number 18
Is There a Difference in Surgical Technique and Outcomes of Breast Conserving Surgery By Surgeon Gender?
1Anees Chagpar, 2Edward Levine, 3Victor Haddad, 4Andrew Fenton, 5Jukes Namm, 3Carlos Garcia-Cantu, MD, 2Akiko Chiba, 6Melissa Lazar, 7David Ollila, 2Marissa Howard-McNatt, 4Mary Murray, 8Laura Walters, 9Elisabeth Dupont, 5Naveenraj Solomon, 5Sharon Lum
1Department of Surgery, Yale University, New Haven, Connecticut, 2Department of Surgical Oncology, Wake Forest University, Winston-Salem, North Carolina, 3Department of Surgery, Doctors Hospital at Renaissance, Edinburg, Texas, 4Department of General Surgery, Cleveland Clinic, Akron, Ohio, 5Department of Surgery, Loma Linda University, Loma Linda, California, 6Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, 7Division of Surgical Oncology, University of North Carolina, Chapel Hill, North Carolina,8Department of Pathology, Beaumont Hospital, Troy, Michigan,9Breast Health Services, Watson Clinic, Lakeland, Florida, USA
Background: The impact of surgeon gender on various parameters of surgical techniques and outcomes for breast cancer patients undergoing breast conserving surgery is poorly understood.
Methods: Two randomized controlled trials, involving 10 centers and 29 surgeons across the United States, were conducted between 2011 and 2015. The trials accrued 631 Stage 0-3 breast cancer patients undergoing breast conserving surgery who were randomized to either resection of cavity shave margins or not after surgeons had performed their best partial mastectomy. We evaluated the impact of surgeon gender on (a) the use of oncoplastic surgery/complex closure, (b) the volume of tissue removed and initial margin status prior to randomization, (c) rate of post-operative seromas and hematomas, and (d) patient-reported cosmetic outcome at one year between female and male surgeons.
Results: Of the 29 surgeons involved in the trials, 13 (44.8%) were women. Female surgeons accrued 421 (66.7%) of the 631 patients in the trials. The initial margin positivity rate among these patients was slightly lower than for patients treated by their male counterparts (34.0% vs. 41.4%, p = 0.079). Female surgeons were more likely to have used oncoplastic surgery or complex closure to treat their patients (26.8% vs. 11.9%, p < 0.001), but the median volume of tissue resected per patient prior to randomization was no different from that of their male colleagues (69.75 cm3 vs. 75.18 cm3, respectively, p = 0.149). The rates of post-operative seromas (0.5% vs. 1.0%, p = 0.600) and hematomas (0.7% vs. 1.0%, p = 0.663) were no different between female and male surgeons, respectively. In addition, of the 298 patients who reported their cosmetic outcome at one-year postoperatively, the proportion who felt their results were excellent did not vary between female and male surgeons (38.1% vs. 36.4%, respectively, p = 0.695).
Conclusion: While female surgeons use more oncoplastic techniques in breast conserving surgery than their male counterparts, overall results are similar between the two genders.
Poster Number 20
A Fellow's Resilience in Asking for Advice When Communication Goes Awry
Barbara Robinson1, Raoul Chazaro2
1East Carolina Heart Institute, Greenville, North Carolina, 2Northwest Hospital in Arlington Heights, IL, USA
Purpose: Wellness is an important component of top performance as recently seen in Olympics also much required in medicine. Team dynamics and truthful communication are critical for wellness, patient care and for preoperative attending-fellow briefings. It is standard for this fellow, trained at Stanford, Mayo Clinic, University of Washington and Brigham and Women's Hospital, Harvard and is known for being highly ethical and to communicate with the attending at least the night before and morning of surgery. She fell prey to unethical communication and did not recognize it in process.
Methods: The cardiothoracic attending following the patient for severe AR over the last two years. The fellow examined all workup noting no echo available for a patient undergoing an aortic valve replacement the following day. There were two previous reports of severe AR, the last from 9 months prior. Coronaries were normal on catheterization and a left ventricular pullback only was performed, with no known evidence of aortic stenosis by echo, yet no aortic root study was performed to examine the degree of AR. The fellow communicated with the clinic twice to obtain the echo. She was told the cardiologist and CT Surgeon were looking at it together, which she believed. She called a second time to obtain the echo, but it could not be found, which she believed.
Results: The clinic nurse said the attending said he had the echo and had examined it, which she believed. On evening rounds the night before, the fellow discussed the case with the attending and asked if she could see the echo. He told her he had looked at it with cardiology in the clinic, which she believed, and that the echo showed severe AR, which she believed and “not too worry about it”. This made the fellow feel small. The fellow believed the attending had the echo, had looked at the echo and that it was severe AR. The echo was also from an outside lab and was over 9 months ago. No new echo was ordered. Previously when the fellow asked the attending if inhouse echo could be obtained the answer was no. In the morning, she discussed the case with the attending again. At timeout the fellow discussed with the anesthesiologist. Timeout was performed and the case commenced. Later the anesthesiologist returned to the room and stated it was moderate AR. Initially the cardiothoracic surgical attending canceled the case for moderate AR. Then once the annulus size was measured intraoperatively and found to be small, cancelation was for need for root enlargement which could have been known on preoperative echo.
Conclusion: This case causes much stress in the fellow due to communication issues resulting in loss of trust and course of action for the patient and she works on resilience. The attending after the case stated he never looked at the preoperative echo. One assumes communication with one's colleagues is truthful about a patient. Meetings such as these, may provide opportunity for analyzing human factors and allow open discussions.
Poster Number 21
An Analysis Exploring Gender among Urologists in Top Doctor Magazine Lists
Elizabeth J. Adams1, Marne M. Louters2, Simone Thavaseelan3, Stephanie J. Kielb1
1Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, 2Department of Urology, University of Michigan, Ann Arbor, Michigan, 3Division of Urology, Brown University School of Medicine, Providence, Rhode Island, USA
Objectives: To understand gender trends in urology 'Top Doctor' lists, we analyzed regional magazines. Top Doctor lists found in magazines are often published annually, with variable methodologies and criteria for the award. Healthcare research companies creating these lists report provisions in place to minimize bias including the inability for physicians to pay for their inclusion, yet their inclusion methodology is not published. As the percentage of women practicing urology has slowly reached 10.3% of urologists as of 2020, we sought to evaluate whether these lists reflect a contemporary distribution of urologists, to determine if there are regional differences in Top Doctor list gender composition, and to describe similarities and differences among female and male Top Doctors.
Methods: All magazines with a urology, pediatric urology, and/or urogynecology Top Doctor list comprised of physicians with formal urologic training that were published between January 1, 2020 and June 22, 2021 using Castle Connolly Medical Ltd. were included in this study. Castle Connolly Medical Ltd. is a healthcare research company that creates the majority of these Top Doctor lists. Information surrounding physician gender, education, current affiliation, and award history was obtained from institution physician profiles and the Castle Connolly website. A weighted average for patient rating scores was calculated for urologists with 20+ ratings between Healthgrades and Vitals. The regional categories used were South, Northeast, Midwest, and West. Chi square tests, independent t-tests, ANOVA, and descriptive statistics were generated using Microsoft Excel.
Results: A total of 494 urologists awarded 'Top Doctor' from 25 magazines were analyzed. Of the 494 urologists, 42 (8.50%) were women, with female urologists comprising a range of 0-27.8% in each magazine list. Seven magazines (28.0%) included zero female urologists in their Top Doctor lists and eight (32.0%) included one woman on their list. By region, female urologists were represented more often in Western states' Top Doctor Lists (15.1%) in comparison to the Northeast, South, or Midwest (7.97%, 7.84%, 5.41% respectively). Average percent of female urologists per magazine list did not significantly vary across regions (ANOVA). Female urologists more often completed a clinical fellowship compared to their male counterparts (66.7%, 55.1% respectively). Female Top Urologists were significantly more likely to complete a female pelvic medicine and reproductive surgery (FPMRS) fellowship than their male counterparts (p < 0.001, chi square), with 50% of women who completed a fellowship doing so in FPMRS vs. 7.8% for men. The most common fellowships completed by male urologists were urologic oncology (36.3% of fellowships completed), pediatric urology (22.3%), and endourology (19.5%). Male urologists began being honored as a Top Doctor with as little as 1 year of clinical practice compared to at least 6 years in practice for female urologists. Weighted average patient ratings were similar among female and male urologists (4.02, 4.12/5.00 respectively).
Conclusions: Fewer female urologists were awarded Top Doctor status than anticipated based on the percentage of practicing female urologists, especially in the Northeast, South, and Midwest. Top female urologists were more likely to complete a clinical fellowship, with FPMRS being the most common.
Poster Number 23
Pre-Exposure Prophylaxis Awareness and Use among Cisgender Women at a Sexually Transmitted Disease Clinic, 2017-2019
Genoviva Sowemimo-Coker, Alex Zanowick-Marr, Alexi Almonte, Philip Chan
Department of Medicine, Brown University, Providence, Rhode Island, USA
Background: Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV transmission. However, PrEP use and awareness among cisgender women (cis-women) in the United States despite accounting has been low. We determined current levels of PrEP awareness and use among cis-women in a high-risk setting.
Setting: The Rhode Island Sexually Transmitted Infections (STI) Clinic from 2017 to 2019.
Methods: Demographic and behavioral characteristics of HIV-negative, cis-women who presented to the Clinic and who met Centers for Disease Control and Prevention (CDC) indications were included in this analysis. In a logistic regression analysis, PrEP awareness among cis-women was compared to cisgender men who have sex with men (MSM).
Results: Among 2,100 HIV-negative cis-women, 256 met indications for PrEP. PrEP awareness was significantly lower among Hispanic/Latina cis-women [16.3%; adjusted odds ratio (AOR): 0.490, 95% confidence interval (CI): 0.364 to 0.659] and non-Hispanic black cis-women (20.2%; AOR: 0.638, 95% CI: 0.485 to 0.839) relative to non-Hispanic white cis-women (28.5%) [Table 1]. MSM had significantly greater PrEP awareness (83.7; AOR: 18.153, 95% CI: 15.637 to 21.86) than cis-women (22.0%) [Table 2]. Only 12 women reported PrEP use between 2017 and 2019.
Conclusions: Despite accounting for 16% of all new HIV infections in the United States, PrEP awareness and use remains low among cis-gender women and especially women of color. There is a critical need for public health professionals and health care providers to encourage women to better understand their risk of HIV, and subsequently increase PrEP awareness and use among cis-women at risk for HIV.
Poster Number 25
Work-Life Balance Examined in Female Military Physicians
Joscelyn Hodge1, Kristen Wells2
1Department of Public Health Sciences, Madigan Army Medical Center, JBLM, McChord, Washington, 2University of Virginia, Charlottesville, Virginia, USA
Objectives: Female military physicians (FMP) are a unique population of medical professionals in regards to maintaining a work-life balance (WLB) amidst their commitments to family, patients, and military. Female physicians compose a significant proportion of the civilian and military workforce, but they tend to bear more household responsibilities and be more distressed by work-family conflict. Military physicians are unique in that they have a dual commitment to their country and patients. As officers, they are responsible for overseeing others within their chain of command. Additionally, during childrearing and other time-intensive life circumstances, they are still eligible to deploy and are unable to reduce their work hours. In summation, the lives of FMPs are the intersect of multiple long-term commitments. They and their families have had to adapt to meet life's demands. Medical WLB research would benefit by characterizing how FMPs have managed their WLB and cultivated job satisfaction, in hopes of demonstrating how high-achieving professionals can integrate facets of their lives in a sustainable way.
Methods: The University of Virginia IRB for the Social and Behavioral Sciences approved this study. The research team phone-interviewed 25 FMPs via a semi-structured interview format during summer 2017 and spring 2020. The interview questions centered around five main themes: work patterns, career planning, significant other's relationship and roles, deployments and relocations, and WLB. For the qualitative analysis, we listened to the interviews again, notated each interviewee's response to questions, and distilled common themes for each type of response.
Results: The 25 participants had a diverse set of responses to the above five categories, but the most surprising results were in the category of the significant other's roles. In 80% of interviews, the participant noted the need for flexibility in at least one person's career. In regards to career coordination, the aggregate data showed that 72% of significant others made sacrificial career choices, compared to 44% of FMPs. Interestingly, regarding household responsibilities, the FMP did the majority in only 32% of homes, split the responsibilities in 28%, and did the minority in 40%.
Conclusions: This qualitative study shows the large role of the significant other in the career of the FMP. In this study population, significant others do make career sacrifices and attend to more home responsibilities, differing with typical female stereotypes. The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government. The investigators have adhered to the policies for protection of human subjects as prescribed in 45 CFR 46.
Poster Number 27
What Applicants Want on Otolaryngology Residency Program Websites: A Gender-Based Analysis
Alyssa Reese1, Lauren DiNardo1, Michele Carr2
1Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, 2Department of Otolaryngology – Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA
Objectives: The purpose of this study is to determine what prospective residency applicants want to see on otolaryngology residency program websites and to discover whether differences exist based on the gender of the applicant.
Methods: A 45 item survey was given to fourth-year medical students applying to otolaryngology, re-applicants applying to otolaryngology, and first-year otolaryngology residents that had recently matched into a residency program. Data collected included each participant's age, gender, race, current status in school/residency program, and their type of medical degree (MD or DO). Respondents were also asked to specify if their institution had a home otolaryngology residency program. Participants were then asked to mark the components listed that they wished to see. Components were separated into five categories: Application/Selection Criteria, Employment Aspects, Program Features, Social/Community, and Faculty/Contact Information. Lastly, respondents were given an open textbox to write any other characteristics that they wished to see. The survey was distributed in a virtual format through Google Forms. A link to the survey was given at the University at Buffalo ENT Chautauqua, sent to ENT program directors with requests to forward to residents, and posted on otomatch.com. Frequencies were calculated and non-parametric analyses, including Mann-Whitney and Kruskal Wallis tests, were performed when appropriate. P < .05 was considered statistically significant.
Results: 89 surveys were collected. 43 (48.3%) of the survey respondents were male and 45 (50.6%) were female. 59 (66.3%) participants were 26-30 years old. 54 (60.7%) participants were fourth-year medical students, 31 (34.8%) were first-year residents, and 4 (4.5%) were re-applicants. 57 (64.0%) of the participants were Caucasian, 25 (28.1%) were Asian, 4 (4.5%) were African American/Black, and 2 (2.2%) were Hispanic. 83 (93.3%) of the participants held an MD or were MD candidates, and 76.4% had a home otolaryngology residency program. 88 (99%) wanted to see the intern year schedule online, and 87 (97.8%) wanted to see a current resident list with photos. Men were more likely to indicate that they wanted to see a message from the chair of the department. 25 (58.1%) of the men wanted a message from the chair, while only 13 (28.9%) of the women indicated interest (p = .006). There was also a statistically significant difference between the male and female interest in a message from the program director; 31 (72.1%) of the men expressed interest, compared to 21 (46.7%) of the women (p = .016). 20 (44.4%) of the female participants wanted to see more information about the arts and humanities, compared to 8 (18.6%) of male participants (p = 0.010). There were no significant differences in gender preferences for any other criteria listed, including family medical emergency policies, maternity/paternity leave policies, and child care access.
Conclusions: Overall, males and females wanted to see similar items on otolaryngology program websites. Further research is needed to understand gender-based differences in reasons for certain criteria to be listed, and to determine if otolaryngology residency program websites currently have an equitable representation of criteria that applicants of all genders are seeking.
Poster Number 28
Would You Get a Second Opinion? How Gender Impacts Decision-Making in Pediatric Otolaryngology Practice: A Pilot Study
Lauren DiNardo1, Alyssa Reese1, Michele Carr2
1Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York. USA 2Department of Otolaryngology – Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA
Objectives: Our study aims to understand what role gender plays in a parent's decision to seek a second opinion for their child's medical care after speaking to a pediatric otolaryngologist. Specifically, we are looking to see if the gender of the physician or the gender of the parent will impact the parent's choice.
Methods: In June and July of 2021, parents of pediatric (0-18 years) otolaryngology patients in an academic practice completed a survey. The survey consisted of 2 scenarios, based on American Academy of Otolaryngology guidelines, accompanied by a physician's picture next to the case. Questions followed asking how the parent would respond to the hypothetical medical advice given by the physician. Parents had the options of following the pediatric otolaryngologist's advice, going back to their regular family doctor for their opinion, getting a second opinion from another otolaryngologist, or doing nothing. There were 13 different physician images, including one control (no picture). The surveys were double randomized, based on physician image and case 1 versus 2, and there were 169 options in which the parent could receive. Surveys were handed out at random. Demographic data collected included gender, age, race, education level, and age of youngest child. Data was analyzed using Mann-Whitney or Kruskal-Wallis tests when appropriate. P < 0.05 was considered statistically significant. Power analysis of the accrued sample size showed that there was a 91% chance of detecting a difference of 30% between 2 comparison groups.
Results: We collected survey data from 165 (76.4%) females and 51 (23.6%) males. Participants were most commonly in the 30-49 years age range (n = 178, 82.4%). Despite the differences in age, race, and gender of each of the doctors that were listed as part of the case scenarios, there were no significant differences between what the participant would do next and the different characteristics of each pictured doctor. There were also no significant differences between the genders when looking at how the participants answered “what to do next” after the scenarios. In the first scenario, 103 females (64.4%) and 30 males (60%) chose to follow the doctor's advice, and in the second, 89 females (57.1%) and 32 males (68.1%) chose to follow the doctor's advice.
Conclusion: Gender of the physician and gender of a parent played no role in the parent's decision to seek a second opinion for their child's medical care after speaking to a pediatric otolaryngologist. Future research will pinpoint the role of matching genders between parent and physician and the effect of age combined with gender on decisions to seek second opinions.
Poster Number 30
Gender Differences on Discrimination on Medical Appointments: How is Brazil going?
Bruna Oliveira Trindade, Candida Mozzaquatro de Assis Brasil, Danna Gomes Mateus, Joana Letícia Spadoa, Ana Luíza Kolling Konopka, Amanda Vieira Alves
Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
Objectives: The Constitution of the Federative Republic of Brazil and the Code of Medical Ethics says that there is no subjective right to interrupt treatment or to plead conscientious objection when the refusal characterizes discrimination. Therefore, practice any distinction, exclusion, restriction, or preference related to gender, race, social class, or even sexuality with the intention to nullify, impair or restrict the recognition of rights of individuals or groups characterizes direct discrimination. We aim to analyze the wide prevalence of these many kinds of discrimination on medical appointments in a Brazilian national survey.
Methods: The information was obtained from the DATASUS (Brazilian online platform of health), specifically in the National Search of Health from 2013. In this search, people (18 years old or more) were enquired about medical appointments, being one of the questions the evaluation of the presence of discrimination in different categories presented in [Table 1]. The confidence interval used α = 0.05.
Results: The results are summarized in [Table 1]. In a wide perspective, when questioned about discrimination on medical appointments of any type, 10.59% of the Brazilians responded that they felt discriminated against. However, in the case of women, this number was higher, achieving 11.59% and for men, the percentage was actually 9.46%. In the specifics types of discrimination, the number significantly dropped in comparison to the previous variable. Nevertheless, in almost all categories (seven out of nine), women had a superior percentage of personal discriminations perception when compared to men. The specifics categories that had the higher percentage of discrimination were associated with social class (6.09% for women and 4.95% for men) and money problems (5.92% for women and 5.47% for men). Besides that, those same categories presented the top two significant gender percentage differences. The less frequent type of discrimination was related to sexual orientation and this was one of the two categories that men felt more discriminated against than women.
Conclusions: We know that Brazil has a long way to go to reduce the occurrence of discrimination. Although the significant differences are small, an association was found between feeling discriminated against and being a woman. This association is even more expressive when considering social class and income. Only in the categories related to sexual orientation and occupation did men feel more discriminated against than women. More research is needed to improve the quality of health care for populations most vulnerable to prejudice, which should include policies that promote equity.
Leivas PG, et al. Sobre a recusa de tratamento médico em razão da filiação política ou ideológica do paciente. (Regarding the refusal of medical treatment based on political or ideological affilation of the patient). Rev AJURIS 2020;47:267-82.
Poster Number 31
Impact of COVID-19 in Colorectal Cancer Diagnosis in Brazil: Are There Gender Differences?
Bruna Oliveira Trindade, Júlia Iaroseski, Sarah Bueno Motter, Gabriela Rangel Brandão, Joana Letícia Spadoa
Federal University of Health Sciences, Porto Alegre, Brazil
Objectives: In Brazil, the 2020 estimation of colorectal cancer incidence, according to primary tumor location, was the second-highest among all tumors (except non-melanoma skin) in men and women. However, it is not well known how COVID-19's restrictions impacted the Brazilian public health system and its population served by the Brazilian Unified Health System (SUS). Other studies point out that pandemic has impacted the detection and management of colorectal cancer., Therefore, we aim to assess if there were differences in colorectal cancer diagnosis in SUS, between men and women, during this period compared with previous years.
Methods: We have compiled the data available from the “Oncology Dashboard” on the DataSUS platform that holds information about all populations served by SUS. We analyzed the number of colorectal cancer diagnoses and their respective staging, from 2017 to 2020. We stratified data by gender using available categories: women and men. Statistically, we performed a linear regression and chi-square test.
Results: During the analyzed period (2017 to 2020), there were a total of 99,121 diagnoses of colorectal cancer [Table 1], being 50.14% of women patients. There were 31,693 cases in 2020, presenting an overall increase of 7.77% compared to 2019 despite the pandemic scenario during 2020 in Brazil. When evaluated by gender, women showed an increase of 1.62% and men of 3.94%. Through the linear regression to each gender since 2017, it was possible to estimate the expected total number of diagnoses in 2020, being 19,609.33 to women (ANOVA F = 0.035 and R2 = 0.997) and 18,897.67 to men (ANOVA F = 0.061 and R2 = 0.991). Comparing the real number of diagnoses to the estimated number, the COVID-19 caused a negative difference of 6,814 in total colorectal cancer diagnoses cases. The diagnosis deficit was significantly higher in women, representing 3,775.33 possibly missing diagnoses in the women category compared to 3,038.67 in men (p < 0.001). Comparing both gender categories, cancer staging in the diagnosis was equivalent in 2019 and 2020 [Table 2].
Conclusions: While the COVID-19 pandemic had overwhelmed the whole Brazilian public health system, cancer screening programs had also suffered a negative impact. Overall both men and women could have had fewer colorectal cancer diagnoses in 2020 compared with the cases expected for the year. However, the burden was heavier for women compared to men, with more missing cases. Furthermore, this scenario of missing diagnoses brings the alert that future patients may arrive at the health system with advanced stages of the disease.
Institute of Cancer (INCA). Estatísticas de Câncer; June 10, 2021. Available from: https://www.inca.gov.br/numeros-de-cancer. Accessed on/before: 8/6/21Morris EJ, et al. Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: A population-based study. Lancet Gastroenterol Hepatol 2021;6:199-208.Kadakuntla A, Wang T, Medgyesy K, Rrapi E, Litynski J, Adynski G, et al. Colorectal cancer screening in the COVID-19 era. World J Gastrointest Oncol 2021;13:238-51.
Poster Number 34
COVID-19 Impacts on a Midwest Academic Health System: Considerations for Gender Equity and Strengthening Health Systems
Sade Spencer1, Kait C. Macheledt2, Rebekah Pratt3, Rahel G. Ghebre4, Snigdha Pusalavidyasagar5, Sima Patel6, Sophie A. L. Watson7, Jerica M. Berge8
1Department of Pharmacology, University of Minnesota Medical School, Minneapolis, Minnesota, 2Department of Family Medicine and Community Health, Center for Women in Medicine and Science University of Minnesota Medical School, Minneapolis, Minnesota, 3Department of Family Medicine and Community Health University of Minnesota Medical School, Minneapolis, Minnesota, 4Department of Obstetrics, Gynecology and Women's Health University of Minnesota Medical School, Minneapolis, Minnesota, 5Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine University of Minnesota Medical School, Minneapolis, Minnesota, 6Department of Neurology University of Minnesota Medical School, Minneapolis, Minnesota, 7Center for Women in Medicine and Science University of Minnesota, Medical School, Minneapolis, Minnesota, 8Center for Women in Medicine and Science Department of Family Medicine and Community Health University of Minnesota Medical School, Minneapolis, Minnesota, USA
Objectives: As a result of the COVID-19 pandemic, academic health systems are undergoing a transformation with varying degrees of impact on individuals across different social identities1-7. Increases in telemedicine, remote working, virtual medical education and COVID-19-related funding are a few examples of factors impacting work. Transformation of health systems in response to internal and external pressures (e.g. COVID-19, financial stringency, calls to increase racial and gender equity8) requires attention to local contexts, active anticipation of unintended consequences of system changes, and engagement of key stakeholders through transparent use of data for ongoing problem-solving and adaptation9-10. Through a gender equity framework, we aim to explore and understand the presence of gender differences across multiple domains including work productivity and psychosocial stress/well-being (i.e. coping, autonomy, depression, mood, and emotion) among health service faculty in our Midwest academic health system.
Methods: A diverse group of women faculty members and one student collaborator met regularly between May 2020-January 2021 to develop a cross-sectional survey mechanism in line with survey development best practices. Multiple stakeholder groups (e.g. international COVID-19 stress research study Principal Investigators; Office of Faculty Affairs; Office of Diversity, Equity and Inclusion; Wellbeing Working Group; Center for Women in Medicine and Science) were also convened for feedback during survey development. The cross-sectional survey was administered through email to University of Minnesota health systems faculty (i.e. Medical School, School of Public Health, College of Pharmacy, School of Nursing, College of Veterinary Medicine) over the months of April-June 2021. The survey included validated measures (as available) and consisted of approximately 60 qualitative and quantitative questions including sociodemographics (gender, race, etc.), academic characteristics (school, rank, track, % effort allocations etc.), scholarly productivity, wellness, stress, foreseeable benefits of change in working conditions, etc.
Results: Faculty (n= 292) survey respondents were mostly from the Medical School (80%), Assistant Professors (47%), and identified as being White or European American (76%). The gender distribution of survey respondents included 35% Men, 62% Women, <1% Non-Binary, 1% who preferred to self-describe their gender. Across the gender binary, representation of women and men was similar across faculty track and percent effort distribution (e.g. Research/Scholarship, Clinical, Administrative and Service). Preliminary analysis showed both similarities and differences between women and men across multiple self-report domains including productivity, supervisor assessment of productivity, work load, wellness, stress, and COVID-19 related leadership/collaborations.
Conclusions: Through a gender equity framework, this study provides insights into the impacts of COVID-19 on the faculty healthcare workforce. We demonstrate both similarities and differences in experiences of men and women faculty across multiple domains with national relevance. Such findings will be important to consider as healthcare leaders start to build a stronger, more resilient health system in response to COVID-19 system changes.
Blumenthal D, Fowler EJ, Abrams M, Collins SR. COVID-19 – Implications for the health care system.” New England Journal of Medicine, vol. 383, no. 15, Massachusetts Medical Society, Oct. 2020, pp. 1483–88. Taylor and Francis+NEJM, doi:10.1056/NEJMsb2021088.Dwyer ML, Alt M, Brooks JV, Katz H, Poje AB. Burnout and compassion satisfaction: Survey findings of healthcare employee wellness during COVID-19 pandemic using ProQOL.” Kansas Journal of Medicine, 2021:14, pp. 121–27. PubMed Central, doi:10.17161/kjm.vol1415171.Krukowski RA, Jagsi R, Cardel MI. Academic productivity differences by gender and child age in science, technology, engineering, mathematics, and medicine faculty during the COVID-19 pandemic.” Journal of Women's Health 2002;30:pp. 341-47. PubMed, doi:10.1089/jwh.2020.8710.Matulevicius SA, Kho KA, Reisch J, Yin H. Academic medicine faculty perceptions of work-life balance before and since the COVID-19 pandemic.” JAMA Network Open, 2021;4:6 p. e2113539. PubMed Central, doi:10.1001/jamanetworkopen.2021.13539.National Academies of Sciences, Engineering. The Impact of COVID-19 on the Careers of Women in Academic Sciences, Engineering, and Medicine. 2021. www.nap.edu, doi:10.17226/26061.Robinson LJ, Engelson BJ, Hayes SN. Who is caring for health care workers' families amid COVID-19?” Academic Medicine, 2021;1. Ovid MEDLINE(R), doi:10.1097/ACM.0000000000004022.Woerner A, Chick JF, Monroe EJ, Ingraham CR, Pereira K, Lee E, et al. Interventional radiology in the coronavirus disease 2019 pandemic: Impact on practices and wellbeing.” Academic Radiology, 2021. PubMed Central, doi:10.1016/j.acra.2021.05.025.Geerts JM, Kinnair D, Taheri P, Abraham A, Ahn J, Atun R, et al. Guidance for health care leaders during the recovery stage of the COVID-19 pandemic
A Consensus Statement.” JAMA Network Open, 2021;4, p. e2120295. DOI.org (Crossref), doi:10.1001/jamanetworkopen.2021.20295.Paina, Ligia, and David H. Peters. “Understanding Pathways for Scaling up Health Services through the Lens of Complex Adaptive Systems.” Health Policy and Planning, 2012;27, pp. 365–73. Silverchair, doi:10.1093/heapol/czr054.Bloland P, Simone P, Burkholder B, Slutsker L, De Cock KM. The role of public health institutions in global health system strengthening efforts: The US CDC's Perspective.” PLoS Medicine, 2012;9, p. e1001199. PubMed, doi:10.1371/journal.pmed.1001199.
Poster Number 38
Gender Disparity in Twitter Verification Status of Physician-Held Handle
Deborah Rupert1, Kanan Shah2, Avital O'Glasser3, Jillian Tsai4, Miriam Knoll5, Michael Schiml6, Narjust Duma7, Shikha Jain8, Fumiko Chino4
1Medical Scientists Training Program, Stony Brook University, Stony Brook, New York, 2Integris Health, Edmond, Oklahoma,3Oregon Health and Science University, Portland, Oregon,4Department of Radiology Oncology, Memorial Sloan Kettering, Cancer Center, New York, New York,5Advanced Radiation Oncology Services, Montefiore Hospital, New York, New York,6Case Western Reserve University, Cleveland, Ohio,7Cancer Care Equity Program, Dana-Farber Cancer Institute, Boston, Massachusetts, 8Department of Hematology and Oncology, University of Illinois at Chicago, Chicago, Illinois
Use of social media, particularly Twitter, among healthcare workers (HCWs) has grown in recent years. This use encompasses a range of purposes including, interacting with colleagues in a non-regionally restricted manner, amplifying professional developments, and broadcasting scientific communication to the public. Yet social media is a tool that is only as good as the ability of the user to garner a following i.e., build a platform. For HCWs with prominent online presence, part of doing so is achieving verification status. Per Twitter, verification of an account “lets people know that an account of public interest is authentic.” Verification is a symbol not just of authenticity but of authority, especially when account holders engage with the public or popular news media as sources of health information. Thus, verification among HCWs differentiates 'trusted' voices and has significantly implications for professional opportunities present to verified account holders. The degree to which women and Black, indigenous, and other people of color (BIPOC) HCWs benefit from social media use is unknown. Here, we investigate the gender and nationalities of verified, HCW-held Twitter accounts. We took a cross-sectional sampling (n = 757) of verified twitter accounts held by self-identified physicians following a push by the Twitter platform (Fall of 2020) to verify more HCW in the face of the COVID-19 pandemic. Accounts were manually reviewed by two independent coders as to the identity of the account holders, the perceive gender and the nationality/region associated with the account holder. We confirmed this dataset reflects 98% of the current verified twitter accounts held by self-identified physicians as of May 2021. We found that verified twitter account held by men physicians reached significantly more people (”followers”) than those held by women physicians. However, these accounts did not vary significantly in the size of the peer groups they chose to engage with, i.e., the number of accounts they chose to follow (”following”). We also found that accounts held by physicians that were located internationally had 2x fewer followers than those held by physicians based in the United States. Finally, we found an interactive affect in the relationship between the gender of the verified physician account holders and the nationality of those holders on follower counts; multiple comparison testing revealed this affect was driven by the difference between verified US-based male physician and verified internationally-based female physician accounts. These findings suggest that among Twitter verified accounts, the identity of the account holders as it pertains to gender and nationality, affects the audience size reached. That is, among verified physician accounts, some voices remain louder than others.
Poster Number 40
Why Women in Medicine Often Discontinue Practice in Pakistan: Perspectives from Women Medical Students
Usama Waqar1, Daniyal Ali Khan1, Russell Seth Martins1, Shaheer Ahmed2, Rana Muhammad Ahmed Mudabbir1, Samreen Jawaid3, Mahim Malik1, Syeda Sadia Fatima1
1Aga Khan University, Karachi, Pakistan, 2Islamabad Medical & Dental College, Islamabad, Pakistan, 3Dow Medical College, Karachi, Pakistan
Objectives: Despite the pivotal role of women in medicine, there is an emerging concern in Pakistan that women doctors often discontinue medical practice following graduation. According to a study in 2018, 80-85% of all medical students were women. However, the proportion of women doctors in the medical workforce in Pakistan remains under 50%. This study explores the future plans of women medical students to practice medicine as well as their perceptions regarding the factors that can lead to discontinuation of practice by some women doctors and the interventions that can alleviate this attrition rate.
Methods: A nationwide cross-sectional survey was conducted between December 2019 to December 2020 in collaboration with the Association of Women Surgeons of Pakistan. Women enrolled in the Bachelor of Medicine and Bachelor of Surgery (MBBS) Program at a Pakistani institution accredited with the Pakistan Medical & Dental Council (PMDC) were eligible. An anonymous electronic questionnaire was dispatched to over 100 medical colleges and hospitals in Pakistan and disseminated it via several social media forums (Facebook, Twitter, and Instagram). Chi-square tests or Fisher's Exact tests were used to compare demographic characteristics among women medical students who intended to practice and those who were undecided or did not intend to practice medicine. All tests were two-sided with p < 0.05 considered threshold for statistical significance.
Results: A total of 1,245 women medical students responded to the survey; 93.8% intended to practice medicine after their graduation while the rest were either undecided or did not intend to practice. Most women who were undecided or did not intend to practice medicine were from public medical colleges [p = 0.013; [Table 1]]. Overall, the most important perceived reasons that lead to discontinuation of medical practice by some women doctors were inability to simultaneously manage motherhood/childcare, discouragement by in-laws, inability to simultaneously manage household responsibilities, and discouragement by partner/spouse, respectively [Table 2]. An overwhelming majority of respondents (45.6%) believed that flexible working hours were needed to alleviate this attrition, while other proposed interventions included weekly work hour limits (8.9%), daycare facilities (7.8%), and harassment/mistreatment reporting systems (7.1%).
Conclusions: Women medical students represent the future of Pakistani healthcare delivery system, and their discontinuation of medical practice can have damaging consequences on an already under-resourced health system. This is a clarion call for all stakeholders, including hospital administrations and governmental policymakers, to address the necessity for flexible working hours and other highlighted needs. This can potentially mitigate the attrition rate among women medical students following their graduation.
Poster Number 41
Impact of the COVID-19 Pandemic on Breast Cancer Screening in Brazil
Joana Letícia Spadoa, Amanda Vieira Alves, Ana Luíza Kolling Konopka, Bruna Oliveira Trindade, Candida Mozzaquatro de Assis Brasil, Danna Gomes Mateus
Federal University of Health Sciences, Porto Alegre, Brazil
Objectives: Breast cancer is the most common type of cancer amongst women and the main cause of death from cancer in women globally. Mammograms are a useful tool for screening and early diagnosis of the disease and are recommended for women aged 50 to 69 every two years in Brazil. However, the COVID-19 pandemic has caused a reduction in diagnostic procedures in general, which may have an impact on cancer screening. Therefore, we aim to analyze the impact of the COVID-19 pandemic on the main screening method of breast cancer in Brazil.
Methods: We collected data from the Brazilian public health system database (DATASUS) about bilateral mammograms for screening between January 2019 to June 2021 in Brazil and we analyzed the annual and monthly data, in absolute and relative numbers.
Results: In 2019, 3,836,313 bilateral mammograms for screening were performed in Brazil. In 2020, 2,245,264 mammograms were performed, representing a reduction of 41.47% compared to the previous year. The monthly average of these procedures was 319,693 in 2019 and 187,105 in 2020. As seen in [Graph 1] and [Table 1], the most expressive reduction of mammograms occurred from April to September of 2020 and the lowest number of mammograms occurred in May of 2020 with 58,937 mammograms - a reduction of 81.17% compared to the same month in 2019. Analyzing the numbers in 2021, 1,310,233 mammograms were performed from January to June of the present year (months with data available so far). In the same period of the last couple of years, 1,037,649 mammograms were performed from January to June of 2020, and 1,826,636 were performed from January to June of 2019.
Conclusions: From 2019 to 2020, about 1 million fewer bilateral mammograms for screening were performed in Brazil, with a 41.47% of reduction in these procedures, which occurred mainly during the months of the “first wave” of the COVID-19 pandemic in Brazil. Besides that, from January to June of 2021 it was also seen a great difference in the number of mammograms when compared with the same period of 2019. However, this difference in 2021 is smaller than the one seen in the same period of 2020 showing that the pre-COVID numbers of mammograms may be starting to be reestablished. Notwithstanding, the 2020 numbers represent a worrying scenario once it could culminate in a bigger amount of late diagnostics with worse prognostic for the patients and more costs for the public health system. Therefore, it is essential to make efforts towards speeding up the process of performing indicated mammograms that were not made previously because of COVID-19 and guaranteeing access to these procedures as breast cancer is a crucial issue for women's health globally.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209-49.José Alencar Gomes da Silva National Cancer Institute. Guidelines for the Early Detection of Breast Cancer in Brazil; 2015. Available from: https://www.inca.gov.br/publicacoes/livros/diretrizes-para-deteccao-precoce-do-cancer-de-mama-no-brasil. [Last accessed on 2021 Aug 04].Soran A, Gimbel M, Diego E. Breast cancer diagnosis, treatment and follow-up during COVID-19 pandemic. Eur J Breast Health 2020;16:86-8.
Poster Number 43
Evaluation of the Impact of the UC San Francisco Women in Leadership Development Program
Francine Castillo, Bridget Keenan, Margaret Gilbreth, Lekshmi Santhosh
Department of Medicine, University of California, San Francisco, California, USA
Objectives: Despite women comprising the majority of medical students, gender disparities remain at the highest levels of leadership in academic medicine, such as Full Professors, Chiefs, Chairs or Deans. This “leaky pipeline” could be due to lack of self-identification for leadership opportunities, lack of effective mentorship, and gender bias. Leadership courses by national organizations have focused on women faculty development but a gap in support for women trainees in graduate medical education still exists. Recognizing this need, the UCSF Women in Leadership Development (UCSF WILD) program was developed as a program for self-identified women graduate medical education trainees. The longitudinal curriculum aimed to address public speaking skills, improved work-life integration, and effective mentorship throughout the span of the academic year. The objective of this study was to quantitatively and qualitatively analyze the reach and impact of this novel program.
Methods: The UCSF WILD program curriculum was developed after the performance of a needs assessment that identified leadership-related learning goals. Program evaluation was performed via a mixed-methods approach including surveys and structured focus groups that were conducted in the 2019-2020 and 2020-2021 program cycles. Session specific surveys were collected with Qualtrics after each event, with Likert scale style questions assessing attendees' level of confidence in material discussed in each individual session. Focus groups were conducted virtually, with transcription from Rev. Directed content analysis was used to code transcribed responses. Dedoose and Microsoft Excel softwares were used for analyses.
Results: 157 and 76 trainees attended at least one seminar in the 2019-2020 and 2020-2021 programs. Attendees represented 34 specialty and subspecialty departments. 39.7% were residents, 11.2% chief residents, 42.7% fellows, and 6.5% other. 2.3% identified as African-American, 32.4% Asian, 48.9% Caucasian, 6.8% Hispanic, 5.0% other, 3.2% as greater than one category, and 1.4% preferred not to state. Surveys indicate 98% of attendees in our ongoing series met at least one of each session's objectives. Focus groups highlighted program impact. Qualitative analysis highlighted the domains of community, leadership skills, mentorship, and empowerment. Participants emphasized the trainee-exclusive focus and structured leadership curriculum. Prominent themes included the safe space fostered by the program and attendees being near-peers facing similar challenges within and outside the workplace. Other themes included feeling equipped and empowered by the skills taught in each session. Participants emphasized the need for improved accessibility and challenges of in-person workshops given the multi-site nature of our institution and varying schedules among trainees.
Conclusions: Gender disparities persist in the field of medicine. Factors that perpetuate these are complex, but leadership development programs provide an opportunity to empower women to develop skills that can facilitate advancement within academia. Although long-standing programs have targeted early faculty, we provide evidence that women graduate medical education trainees benefit from leadership development programs. Further development and dissemination of leadership programs aiming to address the learning needs of women trainees are warranted.
Poster Number 44
Impact of the COVID-19 Pandemic on Infectious Disease Physician Mothers
Miriam Levine1,2, Teena Chopra2, Claire Pearson1,2, Anne Messman2, Diane Levine2
1Department of Internal Medicine, Ascension St. John Hospital, Detriot, Michigan, 2Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
Objective: The COVID-19 pandemic may have uniquely impacted Infectious Disease (ID) physicians given their heavy involvement in direct patient care and policy making. Physician mothers have the additional stressors of balancing personal and professional responsibilities. This study evaluated the impact of the COVID-19 pandemic upon ID physician mothers.
Methods: An online survey was developed addressing the impact of COVID-19. Quantitative data for the ID subspecialist subset are reported. The survey was open from April 27-May 11, 2020. A survey link was posted on the Physician Mom Group Facebook page. Study authors recruited additional participants, and anyone could share the link. Inclusion criteria were self-selected physician mothers/expectant mothers over age 18.
Results: Most respondents (60/76, 79%) were 30-49 years old, married or opposite-sex partnered (65/76, 85.53%), from the US (66/76, 86.8%), with at least one child at home (63/76, 92.1%) -- primarily elementary school-aged (29/76, 38.2%) and 2 years-preschool (26/76, 34.2.2%). The majority were either white (44/76, 57.9%) or Asian (30.3%). Respondents prepared by ensuring adequate stores of food (54/76, 71.1%), toilet paper (39/76, 51.3%), cleaning supplies, and medications (30/76, 39.5%, for both). Only 13/76 (17.1%) made no preparations. Almost all educated themselves about COVID-19 (71/76, 93.4%) and many about pandemics (43/76, 56.6%). Some ordered additional PPE for clinical sites (20/76, 26.3%). Only 2/76 (2.6%) did not prepare professionally. Top personal concerns were exposing a spouse/partner (37/76, 48.7%) or one's children (32/76, 42.1%) to COVID-19, and acquiring or dying from COVID-19 (26/76, 34.2% for each). Top professional concerns were policymaking (36/76, 47.3%), insufficient PPE for staff (33/76, 43.4%), and staff morale (29/76, 38.2%). Nearly all respondents (63/76, 83.9%) modified professional schedules. Half increased hours, 26/76 (34.2%) voluntarily and 13/76 (17.1%) by requirement. This is as compared with only 18% of the total 2709 respondents from all medical specialties. Other adjustments included telemedicine (33/76, 43.4%) and working remotely (20/76, 26.3%). Home life was often disrupted (44/76, 57.9%), and children's behavior sometimes worsened (17/76, 27%). Spouses/partners and respondents altered work schedules almost equally to provide childcare (19/109, 17.4%; vs 17/109, 15.6%). Half (38/76, 50%) felt social distancing allowed for more quality family time, and guilt about not spending time with family decreased from 50/76 (65.8%) pre-pandemic to 44/76 (57.9%), though 57/76 (75%) noted worsening personal-professional balance. Despite the COVID-19 pandemic, 61/76 (80.2%) did not regret a career in medicine, and 64/76 (84.2%) did not regret subspecializing in ID.
Conclusions: ID physician mothers prepared for the pandemic both personally and professionally and were concerned about their loved ones and their staff. Personal-professional balance and family life were disrupted for many. Despite this, most respondents were still glad to practice in their chosen field.
Poster Number 45
How did OB/GYN Physician Mothers Prepare and Cope during the Beginning of the COVID-19 Pandemic?
Annie Savka1, Miriam Levine1,2, Diane Levine1, Viviane Kazan2, Anne Messman1, Teena Chopra1, Claire Pearson1,2
1Department of Internal Medicine, Wayne State University, Detriot, Michigan, 2Department of Emergency Medicine, Ascension St. John Hospital, Detroit, Michigan, USA
Objectives: Physician mothers must balance family responsibilities with a demanding career. These mothers may experience unique stressors, have been shown to be more dissatisfied with their work-life balance, and are at higher risk for work-family conflict than their male counterparts. Obstetrics/gynecology (OB/GYN) physician mothers had a unique set of challenges during a pandemic. While OB/GYN's already have to prepare for the unpredictable, especially during childbirth, the COVID-19 pandemic brought many new questions and issues to light. This preplanned subset analysis evaluates the impact of the COVID-19 pandemic on the lives of OB/GYN mothers.
Methods: From April 27th through May 11th, 2020, a convenience sample of physician mothers was surveyed regarding personal and professional preparedness for COVID-19. Surveys were distributed via the Physician Moms Group, an international Facebook group with over 70,000 members from all medical specialties, and via personal contacts and professional organizations.
Results: 260 surveys were completed by OB/GYN mothers [Table 1]. Of the respondents, 46% were between the age of 30-39 years old, 42% between 40-49 years old, 75% were white, 13% were Asian, 5% were Black or Hispanic, and 92% were married to opposite sex partners. Most had elementary school-aged children (19%) or younger (28%). The United States represented 95% of responses, with 41 states represented. 33% of respondents agreed they were personally prepared for the local impact of the COVID-19 pandemic, and 34% agreed they were professionally prepared. Prior to the pandemic, 37% shared domestic obligations, while 43% did more than others at home. At the beginning of the pandemic there was minimal change, 36% shared responsibilities and 41% did more. Many mothers were partially responsible for children's school work (41%), while 16% were primarily responsible and 8% were entirely responsible. At the start of the pandemic about 50% did not have to change their schedule for their children, 26% worked in part at home and ~15% cut back. However, 29% of respondents felt the pandemic improved personal-professional life balance, 36% felt it had worsened.. On the other hand, the proportion of respondents reporting they were satisfied with the amount of time they spent with family increased from 42% pre-pandemic to 71% during the pandemic, and guilt about not spending time with family decreased from 65% to 33% of respondents. Although 10% wished they had not gone into medicine as a result of the pandemic, almost none regretted going into OB/GYN.
Conclusions: Less than half of OB/GYN mothers were personally or professionally prepared for the pandemic. OB/GYN mothers reported less guilt about the amount of time spent with family but at the same time some described a worsening work-life balance though without major change in household division of labor Further analysis of the challenges OB/GYN mothers face could provide more guidance on which strategies could improve the quality of work-life balance and lessen the stress on these physicians.
Poster Number 46
Gender Differences in Patient Safety Attitudes of Medical Students
Christina Brown1, Sanket Aggarwal1, Laura M. Seske2, Shobha L. Rao2
1Rush Medical College, Chicago, Illinois, 2Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
Objectives: The purpose of this study is to assess how perceptions of patient safety in medical students can be related to gender. Addressing these differences can be a crucial component to ensuring a safe patient environment and empowering all medical students early in their medical career to speak up about patient safety.
Methods: Third-year medical students at a tertiary medical center were surveyed at the beginning and end of a didactic session focused on patient safety. Of the 84 participants, 35 identified as female, 46 identified as female, 1 identified as non-binary, and 2 declined to respond. Respondents self-reported their confidence levels utilizing a Likert scale rating (1 being strongly disagree and 5 being strongly agree) on vocalizing patient safety errors to peers, residents, and attending physicians. Additionally, they were asked how important learning patient safety was during medical school. Score ratings were averaged between genders. Data analysis using one-tailed t-test calculations was used to determine response differences between genders.
Results: Participants rated their level of patient safety training as Limited (only in the pre-clerkship curriculum), Moderate (additional education through medical school activities), and Significant (additional education outside of medical school). More females reported Limited experiences compared to males (21 and 17 respectively). More males reported Moderate and Significant experiences compared to females (14 and 29 respectively). When asked if learning patient safety was important for medical school, findings indicated the average rating was 4.5/5.0 overall with a nonsignificant difference between genders (p = 0.18). Participants also rated their comfort in identifying patient safety errors with average score 3.5/5.0 overall with nonsignificant difference between genders (p = 0.053). Confidence ratings between females and males in speaking up about patient safety errors to peers (3.8/5.0 and 3.7/5.0, respectively, p = 0.39), residents (3.1/5.0 and 3.7/5.0, respectively, p = 0.004), and attendings (2.7/5.0 and 3.2/5.0, respectively, p = 0.02).
Conclusions: All students surveyed recognized the importance of learning patient safety. However, female students indicated significantly lower self-reported confidence in approaching residents and attendings regarding patient safety errors. It is important to assess gender differences in attitudes and confidence about patient safety to target “just culture” barriers and optimize patient outcomes. With female students rating lower confidence in speaking up about errors, we plan further research to explore why there is a gender gap. Possibilities could include lack of empowerment, lack of education, or lack of clinical exposure. Limitations include response bias regarding the social desirability of knowing patient safety is important in medicine. Sample size represented about half of the third-year medical student class from only one medical school. Patient safety attitudes in medical students show there is collective understanding of its importance in the clinical environment. It is crucial to recognize the differences in comfort levels between male and female students in vocalizing safety errors. Empowering women in medicine and promoting a “just culture”, starting in medical school, can greatly ameliorate patient safety.
Financial support and sponsorship
The Third Annual Women in Medicine Summit was supported by the following benefactors: American Medical Women's Association, Basran Law, Bristol Myers Squibb, Coalition for Physician Well-Being, Genentech, Healio, Illinois State Medical Society, Natera, Oak Street Health, Society of Hospital Medicine, Tempus, ThinkMedium, Toucan, University of Chicago Medicine, University of Illinois Cancer Center, Women in White Coats.
Conflicts of interest
Authors of this report were actively involved in the planning of the 2021 Women in Medicine Summit.
Ethical conduct of research
All of the abstracts and case reports included herein were required to follow applicable EQUATOR Network (http://www.equator-network.org/) guidelines prior to acceptance for presentation at the 2021 WIM Summit. This includes approval by Institutional Review Board / Ethics Committee and patient consent declaration for case reports or series. Verification of the above pre-requisites was performed by the 2021 WIM Summit Planning Committee.