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Mossanen JC, Schmidt M, Brücken A, Thommes M, Marx G, Sopka S. Short-time mentoring - enhancing female medical students' intentions toward surgical careers. MEDICAL EDUCATION ONLINE 2024; 29:2347767. [PMID: 38696113 PMCID: PMC11067559 DOI: 10.1080/10872981.2024.2347767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Women pursuing a career in surgery or related disciplines are still in the minority, despite the fact that women compose at least half of the medical student population in most Western countries. Thus, recruiting and retaining female surgeons remains an important challenge to meet the need for surgeons and increase the quality of care. The participations were female medical students between their third and fifth academic year. In this study, we applied the well-established psychological theory of planned behavior (TPB) which suggests that the intention to perform a behavior (e.g. pursuing a career in surgery) is the most critical and immediate predictor of performing the behavior. We investigated whether a two-part short-mentoring seminar significantly increases students' intention to pursue a career in a surgical or related specialty after graduation. METHOD The mentoring and role-model seminar was conducted at 2 days for 90 minutes by six inspiring female role models with a remarkable career in surgical or related disciplines. Participants (N = 57) filled in an online survey before (T0) and after the seminar (T1). A pre-post comparison of central TPB concept attitude towards the behavior, 2) occupational self-efficacy and 3) social norm) was conducted using a paired sampled t-test. A follow-up survey was administered 12 months later (T2). RESULTS The mentoring seminar positively impacted female students' attitude towards a career in a surgical specialty. Female students reported a significantly increased positive attitude (p < .001) and significantly higher self-efficacy expectations (p < .001) towards a surgical career after participating in the mentoring seminar. Regarding their career intention after the seminar, female students declared a significantly higher intention to pursue a career in a surgical specialty after graduating (p < .001) and this effect seems to be sustainable after 1 year. CONCLUSION For the first time we could show that short-mentoring and demonstrating role models in a seminar surrounding has a significant impact on female medical student decision´s to pursue a career in a surgery speciality. This concept may be a practical and efficient concept to refine the gender disparity in surgery and related disciplines.
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Affiliation(s)
- J. C. Mossanen
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | - M. Schmidt
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
- AIXTRA – Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - A. Brücken
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | - M. Thommes
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
- AIXTRA – Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - G. Marx
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | - S. Sopka
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
- AIXTRA – Competence Center for Training and Patient Safety, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Trudzinski FC, Athanasiou C, Eberhardt R, Michels-Zetsche JD, Schellenberg M, Eichinger M, Polke M, Kahnert K, Herth FJF, Kreuter M, Kontogianni K. The influence of the interventionalist's sex on the outcome and complications of transbronchial lung cryobiopsy. Respir Med 2024; 233:107772. [PMID: 39142597 DOI: 10.1016/j.rmed.2024.107772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 07/31/2024] [Accepted: 08/10/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND To date there are no data on sex aspects evaluating outcomes of interventional pneumology (IP). Our aim was to investigate sex differences in transbronchial lung cryobiopsy (TBLC) outcomes in the diagnosis of interstitial lung disease (ILD). METHODS All consecutive (TBLC)s performed for ILD evaluation between Nov 17 and Dec 21 at a tertiary referral center for ILDs and IP were analyzed. The indication for the procedure was determined by a multidisciplinary discussion (MDD). Final results including bronchoalveolar lavage (BAL) and histology were discussed in a 2nd MDD and outcomes and procedure related complications were assessed. RESULTS TBLC was performed in 406 patients (38.4 % female/67.8 years/FVC 76.8 %). Among 32 interventionalists, 16 females performed 53 % of interventions. Females had longer procedure times (29.9 vs. 26.6 min, p = 0.046), used fluoroscopy more often (76.7 vs. 50.3 %, p < 0.001) and obtained more samples (3.6 vs. 3.2, p = 0.021) than their male counterparts. No difference was found for major bleeding or pneumothorax. MDD was able to conclude on a diagnosis in 88.4 % of interventions performed by women and in 78.5 % performed by men (p = 0.010). In a multivariate analysis, female gender (OR 1.93) and lower FVC% values (OR 0.98) were significantly associated with diagnostic yield, whereas the number of biopsies, professional experience, use of fluoroscopy or antiplatelet drugs were not relevant. CONCLUSION The results of this study strengthen the role of women in endoscopy and may help to motivate women to pursue a career in IP.
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Affiliation(s)
- Franziska C Trudzinski
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.
| | - Christos Athanasiou
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Ralf Eberhardt
- Asklepios Hospital Barmbek, Pneumology and Internal Intensive Care Medicine, Hamburg, Germany
| | - Julia D Michels-Zetsche
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Mavi Schellenberg
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Monika Eichinger
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital of Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Germany
| | - Markus Polke
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Kathrin Kahnert
- Department of Internal Medicine V, LMU University Hospital, LMU Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany; MediCenter, Hartstr. 52, 82110, Germering, Germany
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Michael Kreuter
- Mainz Center for Pulmonary Medicine, Departments of Pneumology, Mainz University Medical Center and of Pulmonary, Critical Care & Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany
| | - Konstantina Kontogianni
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
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Zhang G, Wang L, Wang X. Cultural distance, gender and praise in peer review. Account Res 2024:1-26. [PMID: 39362649 DOI: 10.1080/08989621.2024.2409310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 09/23/2024] [Indexed: 10/05/2024]
Abstract
Background: Understanding review comments holds significant importance within the realm of scientific discourse. This study aims to conduct an empirical analysis of factors associated with praise in peer review.Methods: The study involved manual labeling of "praise" in 952 review comments drawn from 301 articles published in the British Medical Journal, followed by regression analysis.Results: The study reveals that authors tend to receive longer praise when they share a cultural proximity with the reviewers. Additionally, it is observed that female reviewers are more inclined to provide praiseConclusions: In summary, these discoveries contribute valuable insights for the development of a constructive peer review process and the establishment of a more inclusive research culture.
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Affiliation(s)
- Guangyao Zhang
- School of Public Administration and Policy, Dalian University of Technology, Dalian, China
- WISE Lab, Institute of Science of Science and S&T Management, Dalian University of Technology, Dalian, China
- UNU-MERIT, Maastricht University, Maastricht, The Netherlands
| | - Lili Wang
- UNU-MERIT, Maastricht University, Maastricht, The Netherlands
| | - Xianwen Wang
- School of Public Administration and Policy, Dalian University of Technology, Dalian, China
- WISE Lab, Institute of Science of Science and S&T Management, Dalian University of Technology, Dalian, China
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Silvestre J, Van Nortwick SS. The Evolution of Parental Leave Policies During Surgical Training in the US. JAMA Surg 2024; 159:1213-1214. [PMID: 39110426 DOI: 10.1001/jamasurg.2024.1514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
Abstract
This article discusses the ACGME requirement that sponsoring institutions of postgraduate medical training provide trainees with at least 6 weeks of paid parental leave throughout their training period.
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Affiliation(s)
- Jason Silvestre
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Silvestre J, Rivas GA, Ravinsky RA, Kang JD, Wu HH, Lawrence JP, Reitman CA. Sex diversity in spine surgery fellowship training: analysis of recent trends and program characteristics associated with increased diversity. Spine J 2024:S1529-9430(24)00984-7. [PMID: 39276869 DOI: 10.1016/j.spinee.2024.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 08/20/2024] [Accepted: 08/24/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND CONTEXT Sex diversity in the spine surgery workforce remains limited. Accelerated efforts to recruit more female trainees into spine surgery fellowship training may help promote diversity and inclusion in the emerging spine surgery workforce. PURPOSE This study assessed the representation of female trainees in spine surgery fellowship training and program factors associated with greater sex diversity among fellows. STUDY DESIGN/SETTING This was a cross-sectional analysis of spine surgery fellows in the United States during the 2016-2017 to 2022-2023 academic years. PATIENT SAMPLE N/A. OUTCOME MEASURES Representation (%) and participation-to-prevalence ratios (PPRs) defined as the participation of female trainees in spine surgery fellowship training divided by the prevalence of female trainees in previous training cohorts. PPR values <0.8 indicated underrepresentation. METHODS Sex diversity was assessed among spine surgery faculty, spine surgery fellows, orthopaedic surgery residents, neurosurgery residents, and allopathic medical students. Fellowship program characteristics associated with increased sex diversity were calculated with chi square tests. RESULTS There were 693 spine surgery fellows and 41 were female (5.9%). Sex diversity in spine surgery fellowship training decreased over the study period (6.4% vs. 4.1%, p=.025). Female trainee representation in spine surgery fellowship training was less than that in orthopaedic surgery residency (14.2%, PPR=0.42), neurosurgery residency (17.1%, PPR=0.35), and allopathic medical school (47.6%, PPR=0.12) training (p<.001). There were 508 faculty at 78 spine surgery fellowships and 25 were female (4.9%). There were 3 female fellowship program directors (3.8%). Fellowship program characteristics associated with increased sex diversity included the presence of female faculty (p=.020). Additional program characteristics including geographic region, accreditation status, number of faculty and fellows were not associated with sex diversity (p>.05). CONCLUSIONS Female representation in spine surgery fellowship training decreased over the study period and remains underrepresented relative to earlier stages of medical and surgical training. There was a positive association between female faculty and increased sex diversity among fellows. Greater efforts are needed to create training environments that promote diversity, equity, and inclusion in spine surgery fellowship training.
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Affiliation(s)
- Jason Silvestre
- Department of Orthopaedics and Physical Medicine & Rehabilitation, Medical University of South Carolina, Charleston, SC, USA.
| | - Gabriella A Rivas
- Department of Orthopaedics and Physical Medicine & Rehabilitation, Medical University of South Carolina, Charleston, SC, USA
| | - Robert A Ravinsky
- Department of Orthopaedics and Physical Medicine & Rehabilitation, Medical University of South Carolina, Charleston, SC, USA
| | - James D Kang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Hao Hua Wu
- Department of Orthopaedic Surgery, University of California Irvine, Irvine, CA, USA
| | - James P Lawrence
- Department of Orthopaedics and Physical Medicine & Rehabilitation, Medical University of South Carolina, Charleston, SC, USA
| | - Charles A Reitman
- Department of Orthopaedics and Physical Medicine & Rehabilitation, Medical University of South Carolina, Charleston, SC, USA
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Heybati K, Satkunasivam R, Aminoltejari K, Thomas HS, Salles A, Coburn N, Wright FC, Gotlib Conn L, Luckenbaugh AN, Ranganathan S, Riveros C, McCartney C, Armstrong K, Bass B, Detsky AS, Jerath A, Wallis CJD. Association Between Surgeon Sex and Days Alive at Home Following Surgery: A Population-Based Cohort Study. ANNALS OF SURGERY OPEN 2024; 5:e477. [PMID: 39310349 PMCID: PMC11415092 DOI: 10.1097/as9.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/27/2024] [Indexed: 09/25/2024] Open
Abstract
Objective The objective of this study was to measure potential associations between surgeon sex and number of days alive and at home (DAH). Background Patients treated by female surgeons appear to have lower rates of mortality, complications, readmissions, and healthcare costs when compared with male surgeons. DAH is a validated measure, shown to better capture the patient experience of postoperative recovery. Methods We conducted a retrospective study of adults (≥18 years of age) undergoing common surgeries between January 01, 2007 and December 31, 2019 in Ontario, Canada. The outcome measures were the number of DAH within 30-, 90-, and 365-days. The data was summarized using descriptive statistics and adjusted using multivariable generalized estimating equations. Results During the study period, 1,165,711 individuals were included, of which 61.9% (N = 721,575) were female. Those managed by a female surgeon experienced a higher mean number of DAH when compared with male surgeons at 365 days (351.7 vs. 342.1 days; P < 0.001) and at each earlier time point. This remained consistent following adjustment for covariates, with patients of female surgeons experiencing a higher number of DAH at all time points, including at 365 days (343.2 [339.5-347.1] vs. 339.4 [335.9-343.0] days). Multivariable regression modeling revealed that patients of male surgeons had a significantly lower number of DAH versus female surgeons. Conclusions Patients of female surgeons experienced a higher number of DAH when compared with those treated by male surgeons at all time points. More time spent at home after surgery may in turn lower costs of care, resource utilization, and potentially improve quality of life. Further studies are needed to examine these findings across other care contexts.
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Affiliation(s)
- Kiyan Heybati
- From the Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN
| | - Raj Satkunasivam
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station Texas, TX
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Khatereh Aminoltejari
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Hannah S. Thomas
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Arghavan Salles
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Natalie Coburn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Frances C. Wright
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Lesley Gotlib Conn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Amy N. Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX
| | - Colin McCartney
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Kathleen Armstrong
- Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Barbara Bass
- George Washington University, School of Medicine and Health Sciences, WA
| | - Allan S. Detsky
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Angela Jerath
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher J. D. Wallis
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
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Masterson Creber R, Eslami S, Gaudino M. Improving diversity in cardiac surgery clinical trials with ROMA:Women as an exemplar. Curr Opin Cardiol 2024; 39:426-430. [PMID: 38935044 DOI: 10.1097/hco.0000000000001162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW To describe methods to improve representation of women in cardiac surgery clinical trials. RECENT FINDINGS Cardiovascular disease risk among women is high. Historically, women have been excluded from cardiac surgery trials, in part due to restrictive inclusion criteria. Surgical outcomes, specifically after coronary artery bypass grafting, are consistently worse among female patients, and these outcomes have not improved over the last decade. Addressing treatment effects and clinical benefit among women requires accurate representation in cardiovascular surgery trials. ROMA:Women, is the first cardiac surgery trial to focus solely on women, with the goal of addressing underrepresentation. Through utilizing specific strategies, ROMA:Women is a promising first step in advancing health equity. SUMMARY Strategies to ensure effective recruitment and representation among women in cardiac surgery clinical trials, such as tailored eligibility criteria and comprehensive strategies to improve communication and increase trust, are two of many potential approaches to address the structural barriers to female representation in cardiac surgery clinical trials. To date, ROMA:Women is an example of a trial that has shown extraordinary preliminary success enrolling women. Designing trials exclusively for women is one strategy to improve the diversity of clinical trial participation.
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Affiliation(s)
| | - Sarah Eslami
- Columbia University School of Nursing, Columbia University Irving Medical Center
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
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Takahashi S, Yamaji K, Kohsaka S, Hayashida K, Sato J, Tsukahara R, Honye J, Amano T, Kozuma K. Gender Disparities in Japanese Interventional Cardiology: Outcomes of Female Operators in Percutaneous Coronary Interventions. JACC. ASIA 2024; 4:674-683. [PMID: 39371622 PMCID: PMC11450856 DOI: 10.1016/j.jacasi.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 06/18/2024] [Accepted: 07/08/2024] [Indexed: 10/08/2024]
Abstract
Background Gender disparity remains a significant global concern in interventional cardiology, and there is a lack of extensive research examining the outcomes of percutaneous coronary interventions (PCIs) performed by female interventionalists. Objectives The aim of this study was to examine the practice patterns and outcomes of PCIs conducted by female interventionalists in Japan. Methods This retrospective observational study analyzed data from the Japanese Percutaneous Coronary Intervention registry between January 2019 and December 2021. The primary endpoint was in-hospital mortality and the secondary endpoint was the success rate of PCIs. Results A total of 447 female operators (7.3% of all operators) performed 35,211 PCIs (5.3%) during the study period. Female doctors treated a higher percentage of patients with ST-segment elevation myocardial infarction compared with their male counterparts (20.2% vs 17.7%; P = 0.001), whereas male doctors were more likely to perform PCIs for left main disease (4.9% vs 5.9%; P < 0.001) and lesions treated with rotational atherectomy (3.5% vs 4.9%; P < 0.001). The success rate of PCIs was higher for female interventionalists (97.8% vs 97.2%; P < 0.001). After conducting a risk-adjusted analysis, we found no significant difference in in-hospital mortality (adjusted OR: 0.896; 95% CI: 0.78-1.03; P = 0.12), or procedural complications associated with the operator's gender. Conclusions Overall, female operators exhibited outcomes similar to their male counterparts in terms of adjusted procedural outcomes, and higher crude success rate in certain subgroups. These findings emphasize gender disparities and stress the need to increase gender diversity in interventional cardiology.
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Affiliation(s)
- Saeko Takahashi
- Department of Cardiology, Shonan Oiso Hospital, Oiso, Japan
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kyohei Yamaji
- Department of Cardiology, Kyoto University, Kyoto, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kyoko Hayashida
- Administration Department, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo, Japan
| | - Junko Sato
- Administration Department, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo, Japan
| | - Reiko Tsukahara
- Department of Cardiology, Tokyo General Hospital, Tokyo, Japan
| | - Junko Honye
- Department of Cardiology, Kikuna Memorial Hospital, Yokohama, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - J-PCI Registry Investigators
- Department of Cardiology, Shonan Oiso Hospital, Oiso, Japan
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
- Department of Cardiology, Kyoto University, Kyoto, Japan
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- Administration Department, Japanese Association of Cardiovascular Intervention and Therapeutics, Tokyo, Japan
- Department of Cardiology, Tokyo General Hospital, Tokyo, Japan
- Department of Cardiology, Kikuna Memorial Hospital, Yokohama, Japan
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
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Lorello GR, Flexman AM. A matter of life and death: physician gender and patient outcomes after surgery. Br J Anaesth 2024; 133:479-482. [PMID: 38965014 DOI: 10.1016/j.bja.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 07/06/2024] Open
Abstract
Accumulating evidence supports an effect of physician gender (or sex, a surrogate used in many studies) on important patient outcomes such as death, complications, and hospital length of stay. Recent studies suggest that these effects result from the gender diversity of the team rather than individual physician gender. Here, we reflect on the potential mechanisms of an effect of physician gender on patient outcomes.
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Affiliation(s)
- Gianni R Lorello
- Department of Anesthesia and Pain Management, University Health Network, Toronto Western Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; The Wilson Centre, Toronto, ON, Canada; Women's College Research Institute, Toronto, ON, Canada
| | - Alana M Flexman
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada; Department of Anesthesia, Providence Health Care, St. Paul's Hospital, Vancouver, BC, Canada; Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, BC, Canada.
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Hamilton KM, Bakhit R, Schneyer R, Levin G, Milad M, Truong M, Wright KN, Siedhoff MT, Meyer R. Race, Ethnicity, and Sex Representation Trends Among Minimally Invasive Gynecologic Surgery Fellowship Trainees and Graduates. J Minim Invasive Gynecol 2024; 31:761-768. [PMID: 38772438 DOI: 10.1016/j.jmig.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/23/2024]
Abstract
STUDY OBJECTIVE To study the race, ethnicity, and sex representation and annual trends of AAGL FMIGS fellows and graduates. DESIGN A retrospective cross-sectional study. SETTING AAMC databases were queried for demographic information between 2011 and 2023. PATIENTS/SUBJECTS AAGL FMIGS fellows and graduates. INTERVENTIONS N/A MEASUREMENTS AND MAIN RESULTS: Descriptive statistical analysis and the actual-to-expected (AE) ratio of each race, ethnicity, and sex were performed. AE ratio was calculated by dividing the 13-year average actual percentage of FMIGS trainees and graduates by the expected percentage based demographics of OBGYN residents and the US general population. 477 fellows graduated or were in training between 2011 and 2023; race and ethnicity information was obtained for 347 (72.7%) individuals, and sex information was available for 409 (85.7%). Representation of females ranged from 66.7% in 2017 to 93.3% in 2022. There was a significantly increasing slope for the representation of females (+1.3% per year; 95% CI 0.00-0.03; p = .027). Compared to their distribution among US OBGYN residents, White fellows' representation was lower [AE ratio, 95% CI 0.60 (0.44-0.81)] and of Asian fellows was higher [AE ratio, 95% CI 2.17 (1.47-3.21)]. Female fellows' representation was lower than expected [AE ratio, 95% CI 0.68 (0.48-0.96)] compared to their distribution among US OBGYN residents. Compared to the general US population, White fellows [AE ratio, 95% CI 0.65 (0.48-0.87)] and Hispanic fellows [AE ratio, 95% CI 0.53 (0.34-0.83)] representation was lower. Asian fellows' representation was higher compared to the general US population [AE ratio, 95% CI 5.87 (3.48-9.88)]. CONCLUSION White and Hispanic fellows' representation was lower than expected, while Asian fellows' representation was higher in AAGL-accredited FMIGS programs. Female representation increased throughout the years, but overall, female fellows' representation was lower than expected compared to their distribution among OBGYN residents. These findings may help develop equitable recruitment strategies for FMIGS programs and reduce health disparities within complex gynecology.
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Affiliation(s)
- Kacey M Hamilton
- Department of Obstetrics and Gynecology (Hamilton, Schneyer, Truong, Wright, Siedhoff), Cedars Sinai Medical Center, Los Angeles, California.
| | - Rhiana Bakhit
- University of California (Bakhit), Riverside School of Medicine, Riverside, California
| | - Rebecca Schneyer
- Department of Obstetrics and Gynecology (Hamilton, Schneyer, Truong, Wright, Siedhoff), Cedars Sinai Medical Center, Los Angeles, California
| | - Gabriel Levin
- Lady Davis Institute for Cancer Research (Levin), Jewish General Hospital, McGill University, Quebec, Canada
| | - Magdy Milad
- Department of Obstetrics and Gynecology (Milad), Northwestern Medicine, Chicago, Illinois
| | - Mireille Truong
- Department of Obstetrics and Gynecology (Hamilton, Schneyer, Truong, Wright, Siedhoff), Cedars Sinai Medical Center, Los Angeles, California
| | - Kelly N Wright
- Department of Obstetrics and Gynecology (Hamilton, Schneyer, Truong, Wright, Siedhoff), Cedars Sinai Medical Center, Los Angeles, California
| | - Matthew T Siedhoff
- Department of Obstetrics and Gynecology (Hamilton, Schneyer, Truong, Wright, Siedhoff), Cedars Sinai Medical Center, Los Angeles, California
| | - Raanan Meyer
- Department of Obstetrics and Gynecology (Hamilton, Schneyer, Truong, Wright, Siedhoff), Cedars Sinai Medical Center, Los Angeles, California; The Dr. Pinchas Bornstein Talpiot Medical Leadership Program (Meyer), Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
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11
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Butz F, Müller-Debus CF, Mogl MT. [Gender medicine: endocrine and neuroendocrine diseases : Implications for surgery and perioperative management]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:736-741. [PMID: 39102037 DOI: 10.1007/s00104-024-02140-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 08/06/2024]
Abstract
Gender medicine is also becoming increasingly more important in the field of surgery of endocrine and neuroendocrine diseases. Gender differences in the incidence, symptoms and disease progression are common to all (neuro)endocrine diseases. Understanding these special features, which include socioeconomic aspects as well as different anatomical and biological factors, is essential for the selection of optimal diagnostics and treatment but in some cases further scientific research is required. To date, there is a paucity of gender-specific recommendations in established guideline recommendations. There is an enormous potential in all areas of endocrine surgery to take advantage of differences between men and women in the diagnostics, surgical treatment and perioperative management. Individualized approaches could lead to improved surgical outcomes, reduced perioperative complications and improved follow-up.
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Affiliation(s)
- Frederike Butz
- Chirurgische Klinik Campus Charité Mitte, Campus Virchow-Klinikum, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Charlotte Friederieke Müller-Debus
- Chirurgische Klinik Campus Charité Mitte, Campus Virchow-Klinikum, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Martina T Mogl
- Chirurgische Klinik Campus Charité Mitte, Campus Virchow-Klinikum, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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Scali ST, Columbo JA, Hawn MT, Mitchell EL, Neal D, Wong SL, Huber TS, Upchurch GR, Stone DH. Association of Surgeon Self-Reported Gender and Surgical Outcomes in Current US Practice. Ann Surg 2024; 280:480-490. [PMID: 38994583 DOI: 10.1097/sla.0000000000006404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
OBJECTIVE This study aimed to evaluate the association of surgeon self-reported gender on clinical outcomes in contemporary US surgical practice. BACKGROUND Previous research has suggested that there are potentially improved surgical outcomes for female surgeons, yet the underlying causal path for this association remains unclear. METHODS Using the Vizient Clinical Database(2016-2021), 39 operations categorized by the CDC's National Healthcare Safety Network were analyzed. The surgeon self-reported gender as the primary exposure. The primary outcome was a composite of in-hospital death, complications, and/or 30-day readmission. Multivariable logistic regression and propensity score matching were used for risk adjustment. RESULTS The analysis included 4,882,784 patients operated on by 11,955 female surgeons (33% of surgeons performing 21% of procedures) and 23,799 male surgeons (67% of surgeons performing 79% of procedures). Female surgeons were younger (45±9 vs males-53±11 y; P <0.0001) and had lower operative volumes. Unadjusted incidence of the primary outcome was 13.6%(10.7%-female surgeons, 14.3%-male surgeons; P <0.0001). After propensity matching, the primary outcome occurred in 13.0% of patients [12.9%-female, 13.0%-male; OR (M vs. F)=1.02, 95% CI: 1.01-1.03; P =0.001), with female surgeons having small statistical associations with lower mortality and complication rates but not readmissions. Procedure-specific analyses revealed inconsistent or no surgeon-gender associations. CONCLUSIONS In the largest analysis to date, surgeon self-reported gender had a small statistical, clinically marginal correlation with postoperative outcomes. The variation across surgical specialties and procedures suggests that the association with surgeon gender is unlikely causal for the observed differences in outcomes. Patients should be reassured that surgeon gender alone does not have a clinically meaningful impact on their outcome.
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Affiliation(s)
- Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville
| | - Jesse A Columbo
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Mary T Hawn
- Department of Surgery, Stanford University, Palo Alto, CA
| | - Erica L Mitchell
- Division of Vascular Surgery, University of Tennessee Health & Science Center, Memphis, TN
| | - Dan Neal
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville
| | | | - Thomas S Huber
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville
| | - Gilbert R Upchurch
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville
- Department of Surgery, University of Florida, Gainesville, FL
| | - David H Stone
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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13
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Olds A, Hirji S, Castillo-Angeles M, Kane L, Romano J, Herrington C, Rangel E. Family Planning in Cardiothoracic Surgery: A Comparison Between Male and Female Surgeons. Ann Thorac Surg 2024; 118:720-727. [PMID: 38878951 DOI: 10.1016/j.athoracsur.2024.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 05/07/2024] [Accepted: 05/28/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Although work-family balance impacts specialty selection for medical students of both sexes, pregnancy and childbearing experiences are unique to women. Cardiothoracic surgery, with low female representation, must prioritize these issues to support women entering the field. This study compared family planning experiences between male and female cardiothoracic surgeons. METHODS An anonymous, self-administered questionnaire was distributed to cardiothoracic trainees and surgeons from January to June 2023. Descriptive data were collected on family planning perceptions, assisted reproductive technology use, number of children, and pregnancy characteristics (maternal age, complications, miscarriage). Male surgeons reported pregnancy outcomes of their childbearing partners. RESULTS Of 378 participants, 45.77% were women, and mean age was 44.40 ± 11.59 years. Compared with male surgeons, female surgeons were more often deterred from pursuing cardiothoracic surgery due to a desire to have children (41.62% vs 22.93%, P = .004), more often used assisted reproductive technology (32.37% vs 15.12%, P < .001), had fewer children (1.92 vs 2.48, P < .001), and had fewer children than desired (40.81% vs 25.14%, P < .001). Compared with partners of male surgeons, female surgeons were older at first live birth (34 vs 32 years, P < .001). Among female surgeons, 73 (42.40%) experienced 155 miscarriages, and 54 (74%) reported taking 0 days off from work after miscarriage. CONCLUSIONS The path to parenthood varies significantly by sex for cardiothoracic surgeons, with women more likely to be deterred from the profession by perceived challenges. Policies that promote work-family integration, support maternal-fetal health, and provide support following fetal loss are needed.
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Affiliation(s)
- Anna Olds
- Division of Cardiothoracic Surgery, Department of Surgery, University of Southern California, Los Angeles, California; Heart Institute, Children's Hospital of Los Angeles, Los Angeles, California.
| | - Sameer Hirji
- Division of Cardiothoracic Surgery, Department of Surgery, Brigham and Women's, Boston, Massachusetts
| | - Manuel Castillo-Angeles
- Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lauren Kane
- Division of Pediatric Cardiac Surgery, Department of Surgery, John's Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Jennifer Romano
- Section of Pediatric Cardiac Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Cynthia Herrington
- Division of Cardiothoracic Surgery, Department of Surgery, University of Southern California, Los Angeles, California; Heart Institute, Children's Hospital of Los Angeles, Los Angeles, California
| | - Erika Rangel
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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14
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Enofe N, Tompkins A, Cooke DT, Freeman K, DiMaio JM, Merrill W, Erkmen CP. A Report of Salaries of Academic Cardiothoracic Surgeons Based on Race and Ethnicity. Ann Thorac Surg 2024; 118:569-578. [PMID: 38723883 DOI: 10.1016/j.athoracsur.2024.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/29/2024] [Accepted: 03/26/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Diversity in the physician workforce improves patient care, physician well-being, and innovation. Workforce diversity is dependent on fair compensation that is unbiased by race or ethnicity. The purpose of this study was to determine whether a disparity of representation and salary on the basis of race or ethnicity exists in academic cardiothoracic surgery. METHODS Study investigators performed a cross-sectional analysis of data collected by the Accreditation Council of Graduate Medical Education (ACGME) and the Association of American Medical Colleges (AAMC) faculty data for US medical school faculty 2021 and 2022. Salary data were not available if an academic rank and race or ethnicity had fewer than 6 cardiothoracic surgeons. Study investigators performed a descriptive analysis of the number of faculty and compared median and mean salaries according to academic rank using a paired t test. RESULTS Of the 758 academic cardiothoracic surgeons, 64.9% were White, 25.2% were Asian, 3.3% were Black or African American, 4.9% were Hispanic or Latino, and 1.7% were of other race or ethnicity. Cardiothoracic surgeons at the academic rank of professor were 74.6% White, 17.7% Asian, 3.4% Black or African American, 3.9% Hispanic or Latino, and 0.4% other races. Asian faculty earned 89% to 171%, Black or African American faculty earned 59% to 94%, and Hispanic or Latino faculty earned 84% to 165% of the median salary earned by White faculty. Black or African American faculty consistently and significantly (P = .002) earned lower median salaries compared with White faculty at each academic rank measured. CONCLUSIONS The academic cardiothoracic surgery workforce lacks diversity, especially at the highest academic ranks. Salary equity among races or ethnicities is complex, requiring additional study. However, Black or African American cardiothoracic surgeons experience low representation and salary disparity at every academic rank measured.
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Affiliation(s)
- Nosayaba Enofe
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Anastasiia Tompkins
- Center for Asian Health, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - David T Cooke
- Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, California
| | - Kirsten Freeman
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - J Michael DiMaio
- Department of Cardiothoracic Surgery, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - Walter Merrill
- Department of Cardiac Surgery, Vanderbilt University Hospital, Nashville, Tennessee
| | - Cherie P Erkmen
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pennsylvania; Center for Asian Health, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
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Klotz LV, Deissner H, Eichhorn F. [Gender medicine in lung diseases]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:730-735. [PMID: 39090448 DOI: 10.1007/s00104-024-02141-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 08/04/2024]
Abstract
Gender-specific differences in the diagnostics and treatment must be considered for various lung diseases. In the case of pneumothorax, in addition to differences in etiology there are also relevant differences in treatment and recurrence rates between men and women. For example, to achieve low recurrence rates catamenial pneumothorax requires interdisciplinary collaboration with gynecology. The incidence of lung cancer has equalized in recent years and in addition, various gender-specific prognostic factors have become relevant. Several meta-analyses have identified female gender as a positive prognostic factor for lung cancer, in addition to the higher prevalence of various driver mutations in women. In current trials of multimodal treatment for lung cancer, gender differences in tolerability and patient outcome are already apparent. In subgroup analyses better event-free survival was observed in women, although immune-mediated adverse events were more common in women.
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Affiliation(s)
- Laura V Klotz
- Klinik für Thoraxchirurgie, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
- Thoraxklinik, Universitätsklinikum Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Deutschland.
| | - Henrike Deissner
- Klinik für Thoraxchirurgie, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Florian Eichhorn
- Klinik für Thoraxchirurgie, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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von Wedel D, Redaelli S, Wachtendorf LJ, Ahrens E, Rudolph MI, Shay D, Chiarella LS, Suleiman A, Munoz-Acuna R, Ashrafian S, Seibold EL, Woloszynek S, Chen G, Talmor D, Banner-Goodspeed V, Eikermann M, Oriol NE, Schaefer MS. Association of anaesthesia provider sex with perioperative complications: a two-centre retrospective cohort study. Br J Anaesth 2024; 133:628-636. [PMID: 38926028 DOI: 10.1016/j.bja.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Previous studies suggested that surgeon sex is associated with differential patient outcomes. Whether this also applies to anaesthesia providers is unclear. We hypothesised that female sex of the primary anaesthesia provider is associated with lower risk of perioperative complications. METHODS The first case for all adult patients undergoing anaesthesia care between 2008 and 2022 at two academic healthcare networks in the USA was included in this retrospective cohort study. The primary exposure was the sex of the anaesthesia provider who spent the most time in the operating theatre during the case. The primary outcome was intraoperative complications, defined as hypotension (mean arterial blood pressure <55 mm Hg for ≥5 cumulative minutes) or hypoxaemia (oxygen saturation <90% for >2 consecutive minutes). The co-primary outcome was 30-day adverse postoperative events (including complications, readmission, and mortality). Analyses were adjusted for a priori defined confounders. RESULTS Among 364,429 included patients, 57,550 (15.8%) experienced intraoperative complications and 55,168 (15.1%) experienced adverse postoperative events. Care by female compared with male anaesthesia providers was associated with lower risk of intraoperative complications (adjusted odds ratio [aOR] 0.95, 95% confidence interval [CI] 0.94-0.97, P<0.001), which was magnified among non-trainees (aOR 0.84, 95% CI 0.82-0.87, P-for-interaction<0.001). Anaesthesia provider sex was not associated with the composite of adverse postoperative events (aOR 1.00, 95% CI 0.98-1.02, P=0.88). CONCLUSIONS Care by a female anaesthesia provider was associated with a lower risk of intraoperative complications, which was magnified among non-trainees. Future studies should investigate underlying mechanisms.
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Affiliation(s)
- Dario von Wedel
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Simone Redaelli
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Luca J Wachtendorf
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elena Ahrens
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Maíra I Rudolph
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; Department for Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Denys Shay
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Laetitia S Chiarella
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Aiman Suleiman
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Anesthesia and Intensive Care, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Ricardo Munoz-Acuna
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sarah Ashrafian
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Eva-Lotte Seibold
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephen Woloszynek
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Guanqing Chen
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Valerie Banner-Goodspeed
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; Department for Anesthesiology and Intensive Care Medicine, University of Duisburg-Essen, Essen, Germany
| | - Nancy E Oriol
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Maximilian S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Düsseldorf University Hospital, Düsseldorf, Germany.
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Murray L, Ni Mhuircheartaigh J. Female interns are not choosing radiology as a career-national survey providing insights into gender imbalance. Eur Radiol 2024:10.1007/s00330-024-10943-w. [PMID: 39174655 DOI: 10.1007/s00330-024-10943-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/05/2024] [Accepted: 06/18/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVES Women are under-represented in Radiology, both globally and in Ireland. An annual review of the medical workforce in Ireland for the year 2021-2022 revealed that although the overall gender breakdown of trainees is similar, with 56% female and 44% male trainees, certain specialities have disproportionate numbers of a given gender. Females only account for 38% of Irish Radiology trainees, one of the lowest of all the specialties. The cause for this disparity is likely multifactorial, but a lack of interest in applying for Radiology training by female doctors is a possible cause. The objectives of this study were to identify specific factors that attract or deter intern doctors from considering a career in Radiology and to identify underlying gender-specific differences. MATERIALS AND METHODS Anonymous online surveys were distributed to 50% of the intern population in Ireland between May and June 2022. The survey included questions on demographics, prior radiology exposure, and dedicated multiple-choice questions for those either considering or not considering radiology, which were subdivided into potentially influencing factors. RESULTS Two-hundred-seven interns responded giving a response rate of 48.3%, which totalled almost 25% of the interns in Ireland. For those interns considering radiology, significantly more male interns (n = 24/67, 35.8%) are considering radiology compared with females (n = 26/139, 18.71%), (p < 0.009). Significantly more females were deterred by the perception of radiology as a male-based speciality (p < 0.004). CONCLUSION Significantly fewer females are considering radiology, deterred by physics knowledge, use of technology, and, significantly, by the perception of radiology as a male-dominated speciality. CLINICAL RELEVANCE STATEMENT This survey highlights important reasons that female interns are deterred from radiology. It will help direct future medical training and doctor recruitment policies, with a view to addressing the ongoing gender disparity in the Irish radiology workforce. KEY POINTS Women are under-represented in the Irish and global Radiology workforce. Female interns are dissuaded from Radiology as a career by their perception of Radiology as male-dominated. This survey will shape medical training and doctor recruitment policies to improve gender diversity in radiology.
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Affiliation(s)
- Lorraine Murray
- Department of Radiology, University of Limerick & University Hospital Limerick, Limerick, Co.Limerick, Ireland.
| | - Jennifer Ni Mhuircheartaigh
- Department of Radiology, University of Limerick & University Hospital Limerick, Limerick, Co.Limerick, Ireland
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Segovia F, Jewell JA, Marcinak J, Russin H, Cazares P. Assessment of Navy Provider Knowledge of Women's Mental Health Services, Treatment Practices, and Training. Mil Med 2024; 189:832-841. [PMID: 39160871 DOI: 10.1093/milmed/usae303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/28/2024] [Accepted: 06/03/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION As female active duty populations increase in all military environments, it is critical that women's health be addressed in a comprehensive manner. The study's results will be utilized to assist Navy health care leaders in addressing female force readiness policies, treatment gaps, and training specific to women's mental health. MATERIALS AND METHODS In total, 212 active duty participants were recruited from the Navy's mental health specialties. The survey was hosted on the U.S. Government's MAX.gov survey website and received Institutional Review Board and Survey Review Board approval per Navy and Defense Health Agency requirements. Participants recorded their experiences with various patient presentations using Likert scale assessments, indicated their comfort in prescribing medication to patients with 11 distinct presenting concerns, and responded to six questions regarding their training and clinical experience in the field of women's mental health. RESULTS Differences were noted for provider gender, treatment setting, patient sex, provider rank, and years of independent practice. Female providers were more likely than males to report that their female patients presented with 15 of the 21 measured issues. Providers located at MTFs were significantly more likely than providers in operational billets to report female patients presenting with certain conditions and reported being more comfortable prescribing medication. Eighty percent of respondents authorized to prescribe medicine rated themselves as very or extremely comfortable prescribing medications to their patients for all specified conditions except two: women who are breastfeeding and women who are pregnant. Senior officers reported the most comfort prescribing medication to women who are planning to become pregnant and women who have experienced perinatal loss. Only a minority of providers (20%, female; 33%, males) reported receiving women's mental health education during their training. Of those who did receive training, it was limited to post-partum and pregnancy. Most participants (93%) agreed that women's mental health should be incorporated into training programs for military providers. CONCLUSIONS This exploratory study highlights that provider variables impact assessment and treatment of and for patients. The study highlights the interplay of gender, treatment setting, experiences, and level of comfort are associated with provider assessment of presenting concerns. The authors hope this study will help in prioritizing women's mental health practices, mental health training, and research, and in informing policy and decision-making.
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Affiliation(s)
- Francine Segovia
- Naval Medical Readiness and Training Command Guam, Agana Heights, Guam 96910
| | | | | | - Hannah Russin
- Department of Behavioral Health, Fort Liberty, Ft. Liberty NC 28310, USA
| | - Paulette Cazares
- Naval Medical Readiness and Training Command San Diego, San Diego, CA 92134, USA
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Peacock M, Drumm B, Klein P, Raymond J, Huo X, Chen Y, Abdalkader M, Schonewille WJ, Liu X, Hu W, Li C, Ji X, Alemseged F, Liu L, Siegler JE, Nagel S, Strbian D, Sacco S, Yaghi S, Qureshi MM, Fischer U, Aguiar de Sousa D, Yamagami H, Michel P, Puetz V, Mujanovic A, Marto JP, Kristoffersen ES, Sandset EC, Demeestere J, Hanning U, Novakovic R, Kenmuir C, Agid R, Romoli M, Diana F, Lobotesis K, Roi D, Masoud HE, Ma A, Zhu Y, Sang H, Sun D, Ton MD, Raynald, Li F, Nasreldein A, Jesser J, Kaesmacher J, Weyland CS, Meyer L, Yeo LLL, Yang Q, Thomalla G, Yang P, Poli S, Campbell BCV, Qureshi AI, Chen HS, Zaidat OO, Qiu Z, Nogueira RG, Jovin TG, Miao Z, Nguyen TN, Banerjee S. Basilar artery occlusion management: An international survey of gender influence on management. Interv Neuroradiol 2024:15910199241265590. [PMID: 39140366 DOI: 10.1177/15910199241265590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The superiority of endovascular thrombectomy (EVT) over medical management was not established in two early basilar artery occlusion (BAO) randomized controlled trials. Despite this, many clinicians recommended EVT for acute BAO under certain circumstances. This paper aims to compare physicians' diagnostic and management strategies of BAO according to gender. METHODS From January to March 2022 an international survey was conducted regarding management strategies in acute BAO. We compared responses between clinicians by identifying gender. Questions were designed to examine clinical and imaging parameters influencing management of patients with BAO. RESULTS Among the 1245 respondents from 73 countries, 311 (25.0%) identified as female. This figure was 13.6% amongst interventionists. Geographically, female respondents were lowest in Asia (14.5%) and North America (23.9%). The proportion of respondents identifying as female was consistent regardless of their years of experience. Female respondents were more likely to choose time of onset as time of first estimated stroke like symptom (48.0% vs. 38.5%, p < .01), were less likely to favor thrombectomy in the V4 segment of vertebrobasilar artery occlusions (31.5% vs. 43.3%, p < .01), and were less likely to find it acceptable to enroll all patients who met trial criteria in the standard medical treatment arm of a clinical trial (41.2% vs. 47.0%, p = .01). Male respondents were more likely to agree that thrombolysis would not alter their decision on proceeding with EVT (93.7% vs. 88.3%, p < .01). CONCLUSIONS Female clinicians appear to be significantly underrepresented in stroke medicine. This is most pronounced amongst interventionists and in Asia. Although male and female opinions were closely aligned on many aspects of BAO management, differences in opinion were observed in a number of significant areas which influence decision making.
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Affiliation(s)
- Meabh Peacock
- Department of Stroke Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Brian Drumm
- Department of Stroke Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
- Department of Stroke Medicine, Chelsea and Westminster NHS Trust, London, UK
| | - Piers Klein
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jean Raymond
- Department of Radiology, Interventional Neuroradiology Division, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada
| | - Xiaochuan Huo
- Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Yimin Chen
- Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | - Xinfeng Liu
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Wei Hu
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | | | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Beijing, China
| | - Fana Alemseged
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Liping Liu
- Neurology, Beijing Tiantan Hospital, Beijing, China
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Shadi Yaghi
- Department of Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Muhammad M Qureshi
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Urs Fischer
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Neurology, Basel University Hospital, University of Basel, Basel, Switzerland
| | - Diana Aguiar de Sousa
- Stroke Center, Lisbon Central University Hospital and Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization, Osaka National Hospital, Japan
| | - Patrik Michel
- Stroke Center, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Volker Puetz
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Dresden Neurovascular Center, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Adnan Mujanovic
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway and Department of General Practice, University of Oslo, Oslo, Norway
| | - Else C Sandset
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway
- The Norwegian Air Ambulance, Oslo, Norway
| | - Jelle Demeestere
- Neurology Department, Leuven University Hospital, Leuven, Belgium
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robin Novakovic
- Department of Neurology and Radiology, UT Southwestern, Dallas, TX, USA
| | | | - Ronit Agid
- Division of Interventional Neuroradiology, Toronto Western Hospital, JDMI, UHN, University of Toronto, Toronto, Canada
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
| | - Francesco Diana
- Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Kyriakos Lobotesis
- Interventional Neuroradiology Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Dylan Roi
- Interventional Neuroradiology Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Hesham E Masoud
- Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Alice Ma
- Department of Neurosurgery, Royal North Shore Hospital, Sydney, Australia
| | - Yuyou Zhu
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Hongfei Sang
- Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dapeng Sun
- Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Mai Duy Ton
- Stroke Center, Bach Mai Hospital, Hanoi Medical University, Hanoi, Vietnam
- Faculty of Stroke and Cerebrovascular Disease, VNU-University of Medicine and Pharmacy, Hanoi, Vietnam
| | - Raynald
- Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Ahmed Nasreldein
- Neurology, Assiut University Hospitals, Assiut University, Assiut, Egypt
| | - Jessica Jesser
- Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | | | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Leonard L L Yeo
- Division of Neurology, Department of Medicine, National University Hospital, Singapore and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pengfei Yang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Sven Poli
- Department of Neurology, University of Tuebingen, Tübingen, Germany
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Osama O Zaidat
- Neuroscience and Stroke Program, Bon Secours Mercy Health St Vincent Hospital, Toledo, USA
| | - Zhongming Qiu
- Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
| | - Raul G Nogueira
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tudor G Jovin
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Zhongrong Miao
- Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Thanh N Nguyen
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Soma Banerjee
- Department of Stroke Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
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20
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Guzikevits M, Gordon-Hecker T, Rekhtman D, Salameh S, Israel S, Shayo M, Gozal D, Perry A, Gileles-Hillel A, Choshen-Hillel S. Sex bias in pain management decisions. Proc Natl Acad Sci U S A 2024; 121:e2401331121. [PMID: 39102546 PMCID: PMC11331074 DOI: 10.1073/pnas.2401331121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 07/02/2024] [Indexed: 08/07/2024] Open
Abstract
In the pursuit of mental and physical health, effective pain management stands as a cornerstone. Here, we examine a potential sex bias in pain management. Leveraging insights from psychological research showing that females' pain is stereotypically judged as less intense than males' pain, we hypothesize that there may be tangible differences in pain management decisions based on patients' sex. Our investigation spans emergency department (ED) datasets from two countries, including discharge notes of patients arriving with pain complaints (N = 21,851). Across these datasets, a consistent sex disparity emerges. Female patients are less likely to be prescribed pain-relief medications compared to males, and this disparity persists even after adjusting for patients' reported pain scores and numerous patient, physician, and ED variables. This disparity extends across medical practitioners, with both male and female physicians prescribing less pain-relief medications to females than to males. Additional analyses reveal that female patients' pain scores are 10% less likely to be recorded by nurses, and female patients spend an additional 30 min in the ED compared to male patients. A controlled experiment employing clinical vignettes reinforces our hypothesis, showing that nurses (N = 109) judge pain of female patients to be less intense than that of males. We argue that the findings reflect an undertreatment of female patients' pain. We discuss the troubling societal and medical implications of females' pain being overlooked and call for policy interventions to ensure equal pain treatment.
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Affiliation(s)
- Mika Guzikevits
- Hebrew University Business School, Hebrew University of Jerusalem, Jerusalem9190501, Israel
- Federmann Center for the Study of Rationality, Hebrew University of Jerusalem, Jerusalem9190401, Israel
| | - Tom Gordon-Hecker
- Department of Business Administration, Ben-Gurion University of the Negev, Be’er-Sheva8410501, Israel
| | - David Rekhtman
- The Department of Emergency Medicine, Hadassah Medical Center, Jerusalem9112001, Israel
| | - Shaden Salameh
- The Department of Emergency Medicine, Hadassah Medical Center, Jerusalem9112001, Israel
| | - Salomon Israel
- Psychology department, Hebrew University of Jerusalem, Jerusalem9190501, Israel
| | - Moses Shayo
- Federmann Center for the Study of Rationality, Hebrew University of Jerusalem, Jerusalem9190401, Israel
- Economics department, Hebrew University of Jerusalem, Jerusalem9190501, Israel
| | - David Gozal
- The University of Missouri School of Medicine, Columbia, MO65201
- Joan C. Edwards School of Medicine, Marshall University, Huntington, WV25701
| | - Anat Perry
- Psychology department, Hebrew University of Jerusalem, Jerusalem9190501, Israel
| | - Alex Gileles-Hillel
- Pediatric Pulmonology Unit, Department of Pediatrics, Hadassah Medical Center, Jerusalem9112001, Israel
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem9112102, Israel
| | - Shoham Choshen-Hillel
- Hebrew University Business School, Hebrew University of Jerusalem, Jerusalem9190501, Israel
- Federmann Center for the Study of Rationality, Hebrew University of Jerusalem, Jerusalem9190401, Israel
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21
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Abelleyra Lastoria DA, Casey L, Beni R, Papanastasiou AV, Kamyab AA, Devetzis K, Scott CEH, Hing CB. Gender diversity in the National Joint Registry. Bone Jt Open 2024; 5:637-643. [PMID: 39103162 PMCID: PMC11300044 DOI: 10.1302/2633-1462.58.bjo-2024-0059.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2024] Open
Abstract
Aims Our primary aim was to establish the proportion of female orthopaedic consultants who perform arthroplasty via cases submitted to the National Joint Registry (NJR), which covers England, Wales, Northern Ireland, the Isle of Man, and Guernsey. Secondary aims included comparing time since specialist registration, private practice participation, and number of hospitals worked in between male and female surgeons. Methods Publicly available data from the NJR was extracted on the types of arthroplasty performed by each surgeon, and the number of procedures of each type undertaken. Each surgeon was cross-referenced with the General Medical Council (GMC) website, using GMC number to extract surgeon demographic data. These included sex, region of practice, and dates of full and specialist registration. Results Of 2,895 surgeons contributing to the NJR in 2023, 102 (4%) were female. The highest proportions of female surgeons were among those who performed elbow (n = 25; 5%), shoulder (n = 24; 4%), and ankle (n = 8; 4%) arthroplasty. Hip (n = 66; 3%) and knee arthroplasty (n = 39; 2%) had the lowest female representation. Female surgeons had been practising for a median of 10.4 years since specialist registration compared to 13.7 years for males (p < 0.001). Northern Ireland was the region with the highest proportion of female arthroplasty surgeons (8%). A greater proportion of male surgeons worked in private practice (63% vs 24%; p < 0.001) and in multiple hospitals (74% vs 40%; p < 0.001). Conclusion Only 4% of surgeons currently contributing cases to the NJR are female, with the highest proportion performing elbow arthroplasty (5%). Female orthopaedic surgeons in the NJR are earlier in their careers than male surgeons, and are less involved in private practice. There is a wide geographical variation in the proportion of female arthroplasty surgeons.
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Affiliation(s)
| | - Laura Casey
- St George’s University Hospitals NHS Foundation Trust, London, UK
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22
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Silvestre J, Ahn J, Dehghan N, Gitajn IL, Slobogean GP, Harris MB. Analysis of the diversity pipeline for the orthopedic trauma surgeon workforce in the United States. Injury 2024; 55:111695. [PMID: 38959676 DOI: 10.1016/j.injury.2024.111695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/23/2024] [Accepted: 06/19/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION There is a lack of research on the state of racial, ethnic, and gender diversity in the emerging orthopedic trauma workforce. The purpose of this study was to analyze the training pathway for diverse candidates in orthopedic trauma as it relates to race, ethnicity, and sex. METHODS Self-reported demographic data were compared among allopathic medical students, orthopedic surgery residents, orthopedic trauma fellows, and the general population in the United States (2013-2022). Race categories consisted of White, Asian, Black, and Native American/Alaskan Native (NA/AN), and Native Hawaiian/Pacific Islander (NH/PI). Ethnicity categories were Hispanic/Latino or non-Hispanic/Latino. Sex categories were male and female. Representation was calculated at each stage of accredited training. Participation-to-prevalence ratios (PPRs) quantified the equitable representation of demographic groups in the emerging orthopedic trauma workforce relative to the US population. PPR thresholds were used to classify representation as overrepresented (PPR > 1.2), equitable (PPR = 0.8-1.2), and underrepresented (PPR < 0.8). RESULTS Relative to medical school and orthopedic surgery residency, fewer female (48.5 % vs 16.7 % vs 18.7 %, P < 0.001), Hispanic (6.1 % vs 4.5 % vs 2.6 %, P < 0.001), Black (6.9 % vs 5.0 % vs 3.1 %, P < 0.001), and Asian (24.0 % vs 14.3 % vs 12.2 %, P < 0.001) trainees existed in orthopedic trauma fellowship training. In contrast, more male (51.5 % vs 83.3 % vs 81.3 %, P < 0.001) and White (62.8 % vs 79.1 % vs 84.0 %, P < 0.001) trainees existed in orthopedic trauma fellowship relative to earlier training stages. There were zero NA/AN or NH/PI trainees in orthopedic trauma (PPR = 0). Relative to the US population, Hispanic (PPR = 0.14), Black (PPR = 0.25), and female (PPR = 0.37) trainees were underrepresented in orthopedic trauma. In contrast, Asian (PPR = 2.04), male (PPR = 1.64), and White (PPR = 1.36) trainees were overrepresented in orthopedic trauma. CONCLUSION Women, racial, and ethnic minorities are underrepresented in the emerging orthopedic trauma workforce relative to the US population, and earlier stages of training. Targeted recruitment and guided mentorship of these groups may lead to greater interest, engagement, and diversity in orthopedic trauma.
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Affiliation(s)
- Jason Silvestre
- Medical University of South Carolina, Charleston, SC, United States.
| | - Jaimo Ahn
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Niloofar Dehghan
- University of Arizona College of Medicine Phoenix, Phoenix, AZ, United States
| | - Ida L Gitajn
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
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23
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Figueroa ML, Hiemstra LA. How do we treat our male and female patients? - A primer on gender-based health care inequities. J ISAKOS 2024; 9:774-780. [PMID: 38604569 DOI: 10.1016/j.jisako.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
Health is a fundamental human right, yet disparities in healthcare, based on gender, persist for women. These inequities stem from a patriarchal society that has regarded men as the default standard, leading to women being treated merely as smaller men. Contributing to these disparities are the gender stereotypes that pervade our society. Women possess differences in anatomy, physiology, psychology and social experience than men. To achieve health equity, it is vital to understand and be open to consider and evaluate these aspects in each individual patient. This requires an understanding of our own biases and a commitment to valuing diversity in both patient and caregiver. Improving equity and diversity throughout all aspects of the medical system will be necessary to provide optimal patient care for all.
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24
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Ospel JM, Diprose WK, Ganesh A, Martins S, Nguyen T, Psychogios M, Mansour O, Al-Ajlan F, Yang P, Pandian J, Gopinathan A, Sandset EC, Kennedy J, Volders D, Fahed R, Tjoumakaris S, Bhogal P, Kurz M, Yavagal D, Inoa V, Hill MD, Goyal M. Challenges to Widespread Implementation of Stroke Thrombectomy. Stroke 2024; 55:2173-2183. [PMID: 38979609 DOI: 10.1161/strokeaha.124.045889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Endovascular treatment (EVT) for acute ischemic stroke is one of the most efficacious and effective treatments in medicine, yet globally, its implementation remains limited. Patterns of EVT underutilization exist in virtually any health care system and range from a complete lack of access to selective undertreatment of certain patient subgroups. In this review, we outline different patterns of EVT underutilization and possible causes. We discuss common challenges and bottlenecks that are encountered by physicians, patients, and other stakeholders when trying to establish and expand EVT services in different scenarios and possible pathways to overcome these challenges. Lastly, we discuss the importance of implementation research studies, strategic partnerships, and advocacy efforts to mitigate EVT underutilization.
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Affiliation(s)
- Johanna Maria Ospel
- Department of Diagnostic Imaging (J.M.O., M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Clinical Neurosciences (J.M.O., W.K.D., A. Ganesh, M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - William K Diprose
- Department of Clinical Neurosciences (J.M.O., W.K.D., A. Ganesh, M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Aravind Ganesh
- Department of Clinical Neurosciences (J.M.O., W.K.D., A. Ganesh, M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Sheila Martins
- Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil (S.M.)
| | - Thanh Nguyen
- Departments of Radiology and Neurology, Boston Medical Center, MA (T.N.)
| | - Marios Psychogios
- Department of Neuroradiology, University Hospital Basel, Switzerland (M.P.)
| | - Ossama Mansour
- Alexandria Faculty of Medicine, Department of Neurology, Alexandria University, Egypt (O.M.)
| | - Fahad Al-Ajlan
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia (F.A.-A.)
| | - Pengfei Yang
- Department of Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (P.Y.)
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College and Hospital, Vellore, India (J.P.)
| | - Anil Gopinathan
- Division of Interventional Radiology, Department of Diagnostic Imaging, National University Health System, Singapore (A. Gopinathan)
| | | | - James Kennedy
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom (J.K.)
| | - David Volders
- Department of Radiology, Dalhousie University, Halifax, Canada (D.V.)
| | - Robert Fahed
- Division Neurology, Department of Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada (R.F.)
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA (S.T.)
| | - Pervinder Bhogal
- Department of Neuroradiology, The Royal London Hospital, Barts NHS Trust, United Kingdom (P.B.)
| | - Martin Kurz
- Department of Neurology, Stavanger University Hospital, Norway (M.K.)
| | - Dileep Yavagal
- Department of Neurology, University of Miami Miller School of Medicine, FL (D.Y.)
| | - Violiza Inoa
- Department of Neurology, University of Tennessee Health Science Center, Memphis (V.I.)
| | - Michael D Hill
- Department of Diagnostic Imaging (J.M.O., M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Clinical Neurosciences (J.M.O., W.K.D., A. Ganesh, M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Mayank Goyal
- Department of Diagnostic Imaging (J.M.O., M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Clinical Neurosciences (J.M.O., W.K.D., A. Ganesh, M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada
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25
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Lacava L, Freitas FLD, Borgomoni GB, Silva PGMDBE, Nakazone MA, Campagnucci VP, Tiveron MG, Lisboa LA, Jatene FB, Mejia OAV. More Hospital Complications in Women after Cabg Even for Reduced Surgical Times: Call to Action for Equity in Quality Improvement. Arq Bras Cardiol 2024; 121:e20240012. [PMID: 39166552 PMCID: PMC11341165 DOI: 10.36660/abc.20240012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/24/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Analyses of extensive registries indicate adverse outcomes for women undergoing coronary artery bypass grafting (CABG) surgery, while randomized studies often lack representativeness. OBJECTIVE To compare adjusted hospital outcomes between men and women undergoing CABG. METHODS From July 2017 to June 2019, 3991 patients underwent primary isolated CABG, both electively and urgently, in 5 hospitals in the state of São Paulo, Brazil. To mitigate demographic differences between men and women, populations were adjusted using propensity score matching (PSM). The outcomes considered for analysis were those used by the STS Adult Database. The analyses were performed using R software, with a significance set at p<0.05. RESULTS After PSM (1:1), each group included 1089 patients. Regarding intraoperative variables, men exhibited longer cardiopulmonary bypass (CPB) time (p<0.001), surgical time (p<0.001), a higher number of distal anastomoses (p<0.001), and increased use of arterial grafts. Regarding outcomes, women had a higher incidence of deep sternal wound infection (p=0.006), prolonged Intensive Care Unit stay (p=0.002), increased need for an intra-aortic balloon pump (p=0.04), higher blood transfusion rates (p<0.001), higher 30-day hospital readmission rates after surgery (p=0.002) and higher mortality rate (p=0.03). CONCLUSIONS Although men had longer CPB times, a greater number of arterial grafts, and a greater number of distal anastomoses, immediate results after CABG were poorer in women.
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Affiliation(s)
- Leonardo Lacava
- Hospital Regional São Paulo, Xanxerê, SC - Brasil
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Fabiane Letícia de Freitas
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Gabrielle Barbosa Borgomoni
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | | | | | | | | | - Luiz Augusto Lisboa
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Fabio Biscegli Jatene
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
| | - Omar Asdrúbal Vilca Mejia
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil
- Hospital Samaritano Paulista, São Paulo, SP - Brasil
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Breuner C, Moore E, Walsh E, Hilman S, Mitzel J, Thomas A, Walker-Harding L. Amplifying Their Voice: Inclusive Healthcare Provider Perspectives to Improve Advancement, Resilience, and Retention. Cureus 2024; 16:e66028. [PMID: 39221340 PMCID: PMC11366397 DOI: 10.7759/cureus.66028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Addressing the issues of workplace advancement, resilience, and retention within medicine is crucial for creating a culture of equity, respect, and inclusivity especially towards women and nonbinary (WNB) providers including advanced practice providers (APPs), most notably those from marginalized groups. This also directly impacts healthcare quality, patient outcomes, and overall patient and employee satisfaction. The purpose of this study was to amplify the voices on challenges faced by WNB providers within a pediatric academic healthcare organization, to rank workplace interventions addressing advancement, resilience, and retention highlighting urgency towards addressing these issues, and, lastly, to provide suggestions on how to improve inclusivity. METHODS Participants were self-identified WNB providers employed by a pediatric healthcare organization and its affiliated medical university. An eligibility screener was completed by 150 qualified respondents, and 40 WNBs actually participated in study interviews. Interviews were conducted using a semi-structured interview guide to rank interventions targeted at improving equity, with time allotted for interviewees to discuss their personal lives and how individual circumstances impacted their professional experiences. RESULTS WNB providers called for efficient workflows and reducing uncompensated job demands. Support for family responsibilities, flexible financial/compensation models, and improved job resources all were endorsed similarly. Participants ranked direct supervisor and leader support substantially lower than other interventions. Conclusions: Career mentorship and academic support for WNB individuals are recognized interventions for advancement and retention but were not ranked as top priorities. Respondents focused on personal supports as they relate to family, job resources, and flexible compensation models. Future studies should focus on implementing realistic expectations and structures that support whole lives including professional ambitions, time with family, personal pursuits, and self-care.
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Affiliation(s)
- Cora Breuner
- Adolescent Medicine, Seattle Children's Hospital, Seattle, USA
| | - Emily Moore
- Pediatric Cardiology, Seattle Children's Hospital, Seattle, USA
| | - Elaine Walsh
- Pediatrics, Seattle Children's Hospital, Seattle, USA
| | | | - Julia Mitzel
- Pediatrics, Seattle Children's Hospital, Seattle, USA
| | - Anita Thomas
- Pediatrics, Seattle Children's Hospital, Seattle, USA
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Driscoll AM, Suresh R, Popa G, Berglund L, Azer A, Hed H, Duan Y, Chu A, McGrath A. Do educational interventions reduce the gender gap in communication skills?- a systematic review. BMC MEDICAL EDUCATION 2024; 24:827. [PMID: 39085838 PMCID: PMC11293108 DOI: 10.1186/s12909-024-05773-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/12/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Efficient doctor-patient communication is essential for improving patient care. The impact of educational interventions on the communication skills of male and female students has not been systematically reviewed. The aim of this review is to identify interventions used to improve communication skills in medical curricula and investigate their effectiveness in improving the communication skills of male and female medical students. METHODS A systematic review of the literature was conducted using the PRISMA guidelines. Inclusion criteria were as follows: used intervention strategies aiming to improve communication skills, participants were medical students, and studies were primary research studies, systematic reviews, or meta-analyses. RESULTS 2913 articles were identified based on search terms. After title, abstract, and full-text review, 58 studies were included with interventions consisting of Training or Drama Courses, Curriculum-Integrated, Patient Learning Courses, and Community-Based Learning Courses. 69% of articles reported improved communication skills for both genders equally, 28% for women more than men, and 3% for men more than women. 16 of the 58 articles reported numerical data regarding communication skills pre-and post-intervention. Analysis revealed that post-intervention scores are significantly greater than pre-intervention scores for both male (p < 0.001) and female students (p < 0.001). While the post-test scores of male students were significantly lower than that of female students (p = 0.01), there is no significant difference between genders for the benefits, or difference between post-intervention and pre-intervention scores (p = 0.15), suggesting that both genders benefited equally. CONCLUSION Implementation of communication training into medical education leads to improvement in communication skills of medical students, irrespective of gender. No specific interventions benefitting male students have been identified from published literature, suggesting need of further studies to explore the phenomenon of gender gap in communication skills and how to minimize the differences between male and female students.
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Affiliation(s)
- Alexis M Driscoll
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, 07103, USA
| | - Rohan Suresh
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, 07103, USA
| | - George Popa
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, 07103, USA
| | - Leif Berglund
- Department of Clinical Sciences, Umeå university, Umeå, Sweden
| | - Amanda Azer
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, 07103, USA
| | - Helen Hed
- Umeå University Library, Umeå, Sweden
| | - Yajie Duan
- Department of Statistics, Rutgers University, New Brunswick, NJ, 08901, USA
| | - Alice Chu
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, 07103, USA
| | - Aleksandra McGrath
- Department of Clinical Sciences, Umeå university, Umeå, Sweden.
- Department of Surgical and Perioperative Sciences, Umeå university, Umeå, Sweden.
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Itoh T. Just Because the Acute Myocardial Infarction Patient Is Simply Elderly, or Is There Something Else? - We Need to Acknowledge Sex Differences. Circ J 2024; 88:1208-1210. [PMID: 37952971 DOI: 10.1253/circj.cj-23-0755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Affiliation(s)
- Tomonori Itoh
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University
- Division of Community Medicine, Department of Medical Education, Iwate Medical University
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Doenst T, Faerber G. Challenge-skill balance in cardiac surgery: an attempt to explain sex-related differences in coronary surgery. Eur Heart J 2024; 45:2545-2547. [PMID: 38860698 DOI: 10.1093/eurheartj/ehae350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Am Klinikum 1, D-07747 Jena, Germany
| | - Gloria Faerber
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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Joshi A, Kim A, Hsu N, Aiyer A, Thompson JM. A Comparison of Demographic Diversity Between Orthopaedic Surgery Residents and ACGME Foot and Ankle Fellows From 2007 to 2022. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241263056. [PMID: 39086379 PMCID: PMC11289798 DOI: 10.1177/24730114241263056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024] Open
Abstract
Background Academic medicine emphasizes the need to recruit a diverse workforce in graduate medical education. Orthopaedic surgery residency has demonstrated efforts to model program compositions with evolving US demographics. However, it remains unclear whether orthopaedic fellowships, particularly foot and ankle, also reflect these efforts. Methods Using the publicly available Accreditation Council for Graduate Medical Education (ACGME) Data Resource Book, a census of the gender and racial/ethnic identities of orthopaedic foot and ankle fellows, as well as active orthopaedic surgery residents, were compiled from 2007 to 2022. Linear trend analysis was conducted to evaluate the trends of orthopaedic residents and foot and ankle fellows, with a Pearson correlation for comparison. Results Prior analysis demonstrated no significant change in sex and ethnic diversity of fellows from 2006 to 2015. The majority of foot and ankle fellows were White (31%-69%) and male (63%-88%). Linear analysis demonstrated growing diversity in female and non-White active orthopaedic surgery residents. Similarly, there was an increasing number of female foot and ankle fellows (0%-38%) reflective of the trend in orthopaedic residency (12%-20%); however, there was no significant change among racial/ethnic identities. Pearson correlation analysis between the trend of orthopaedic residency residents and foot and ankle fellows suggests moderate correlation among female, Asian, and "Unknown" racial/ethnic categories. Conclusion The proportion of foot and ankle female fellows in ACGME-accredited fellowships has matched or exceeded the percentage of female orthopaedic residents. Despite increased diversity of orthopaedic surgery residents over the past 2 decades, ACGME-accredited foot and ankle fellowships do not yet reflect similar trends among racial/ethnic minorities. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Aditya Joshi
- Department of Orthopaedic Surgery, Johns Hopkins University Schools of Medicine, Baltimore, MD, USA
| | - Andrew Kim
- Department of Orthopaedic Surgery, Johns Hopkins University Schools of Medicine, Baltimore, MD, USA
| | - Nigel Hsu
- Department of Orthopaedic Surgery, Johns Hopkins University Schools of Medicine, Baltimore, MD, USA
| | - Amiethab Aiyer
- Department of Orthopaedic Surgery, Johns Hopkins University Schools of Medicine, Baltimore, MD, USA
| | - John M. Thompson
- Department of Orthopaedic Surgery, Johns Hopkins University Schools of Medicine, Baltimore, MD, USA
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Carnovale B, Choudhary A, Lavadi RS, Hamilton DK, Agarwal N. Letter to the Editor Regarding: "Neurosurgical Outcomes Among Non-English Speakers: A Systematic Review and a Framework for Future Research". World Neurosurg 2024; 187:272. [PMID: 38970192 DOI: 10.1016/j.wneu.2024.03.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 07/08/2024]
Affiliation(s)
- Ben Carnovale
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Aditi Choudhary
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Neurological Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
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Rambachan A, Joshi M, Auerbach AD, Fang MC. Sex concordance between physicians and patients and discharge opioid prescribing. J Hosp Med 2024; 19:605-609. [PMID: 38721898 PMCID: PMC11222022 DOI: 10.1002/jhm.13389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 07/04/2024]
Abstract
Inpatient pain management is challenging for clinicians and inequities are prevalent. We examined sex concordance between physicians and patients to determine if discordance was associated with disparate opioid prescribing on hospital discharge. We examined 15,339 hospitalizations from 2013 to 2021. Adjusting for patient, clinical, and hospitalization-level characteristics, we calculated the odds of a patient receiving an opioid on discharge and the days of opioids prescribed across all hospitalizations and for patients admitted with a common pain diagnosis. We did not find an overall association between physician-patient sex concordance and discharge opioid prescriptions. Compared to concordant sex pairs, patients in discordant pairs were not significantly less likely to receive an opioid prescription (odds ratio: 1.04; 95% confidence interval [CI]: 0.95, 1.15) and did not receive significantly fewer days of opioids (2.1 fewer days of opioids; 95% CI: -4.4, 0.4). Better understanding relationships between physician and patient characteristics is essential to achieve more equitable prescribing.
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Affiliation(s)
- Aksharananda Rambachan
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, California
| | - Mihir Joshi
- Santa Clara Valley Medical Center, San Jose, California
| | - Andrew D. Auerbach
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, California
| | - Margaret C. Fang
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, California
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Dejenie R, Fannon EE, Persky J, Gaeta E, Soufi K, Howard B, Stadeli KM, Godoy LA. Dissecting Diversity: A Comprehensive Look at the Present Landscape and Future Challenges in Surgical Specialties. JOURNAL OF SURGICAL EDUCATION 2024; 81:1004-1011. [PMID: 38760190 DOI: 10.1016/j.jsurg.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/20/2024] [Accepted: 04/03/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND As the US demographic evolves, surgical fields must adapt to ensure equitable healthcare. Healthcare disparities notably affect minority populations, with communities of color often facing physician shortages and higher rates of diseases such as coronary disease, stroke, and cancer. Research shows that minority physicians significantly improve patient satisfaction and outcomes in underserved communities, highlighting the need for increased physician diversity to enhance cultural competency and patient centered care. Data from the Association of American Medical Colleges (AAMC) reveals minimal increases in underrepresented minorities (URM) in surgical residency and academic careers over the past thirty-six years, with little change URM applicants and matriculants in the nine surgical specialties recognized by the American College of Surgeons from 2010 to 2018. OBJECTIVE This review aims to critically evaluate the current landscape of racial and gender diversity in six out of the nine defined surgical specialties (general surgery, plastic surgery, neurosurgery, orthopedic surgery, cardiothoracic surgery, and vascular surgery) in the US. DESIGN We conducted a comprehensive literature review to assess of the state of diversity within surgical specialties in the United States. By analyzing the benefits of diversity in surgical fields, evaluating the effectiveness of various diversity programs and initiatives, examining the comparative diversity between surgical subspecialties, and assessing the impact of diversity on patient outcomes, our aim is to highlight the critical importance of enhancing diversity in surgical fields. RESULTS While nuances in representation and diversity vary across surgical specialties, all fields persistently exhibit underrepresentation of certain racial/ethnic groups and persistent gender disparities. These disparities manifest throughout various phases, including in residency, and in the recruitment and retention of URM individuals in surgery and surgical subspecialties. While interventions over the past decade have contributed to improving diversity in surgical fields, significant disparities persist. Limitations include the time required for recent interventions to show significant impacts and the inability of established interventions to eliminate disparities. CONCLUSIONS Despite the clear benefits, diversity within surgical specialties remains an uphill battle. Addressing the diversity gap in surgical fields is crucial for improving patient outcomes, healthcare access, and workplace environments, requiring strategies such as targeted recruitment, mentorship programs, and addressing systemic biases. This review highlights the undeniable imperative for change and serve a call to action.
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Affiliation(s)
- Rebeka Dejenie
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
| | - Elise Eh Fannon
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA; David Grant Medical Center. Department of Surgery. 101 Bodin Cir, Fairfield, California 94533, USA.
| | - Julia Persky
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
| | - Emmanuel Gaeta
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
| | - Khadija Soufi
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
| | - Brian Howard
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
| | - Kathryn M Stadeli
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
| | - Luis A Godoy
- University of California, Davis Medical Center. Department of Surgery. 4301 X St, Sacramento, California 95817, USA
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Khan MMM, Munir MM, Woldesenbet S, Khalil M, Altaf A, Rashid Z, Pawlik TM. Association of surgeon's sex, and surgeon-patient dyad with financial outcomes among patients undergoing cancer surgery. J Surg Oncol 2024. [PMID: 38941176 DOI: 10.1002/jso.27752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 06/06/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND AND OBJECTIVES Surgeon sex has been associated with perioperative clinical outcomes among patients undergoing oncologic surgery. There may be variations in financial outcomes relative to the surgeon-patient dyad. We sought to define the association of surgeon's sex with perioperative financial outcomes following cancer surgery. METHODS Patients who underwent resection of lung, breast, hepato-pancreato-biliary (HPB), or colorectal cancer between 2014 and 2021 were identified from the Medicare Standard Analytic Files. A generalized linear model with gamma regression was utilized to characterize the association between sex concordance and expenditures. RESULTS Among 207,935 Medicare beneficiaries (breast: n = 14,753, 7.1%, lung: n = 59,644, 28.7%, HPB: n = 23,400, 11.3%, colorectal: n = 110,118, 53.0%), 87.8% (n = 182,643) and 12.2% (n = 25,292) of patients were treated by male and female surgeons, respectively. On multivariable analysis, female surgeon sex was associated with slightly reduced index expenditures (mean difference -$353, 95%CI -$580, -$126; p = 0.003). However, there were no differences in 90-day post-discharge inpatient (mean difference -$-225, 95%CI -$570, -$121; p = 0.205) and total expenditures (mean difference $133, 95%CI -$279, $545; p = 0.525). CONCLUSIONS There was minor risk-adjusted variation in perioperative expenditures relative to surgeon sex. To improve perioperative financial outcomes, a diverse surgical workforce with respect to patient and surgeon sex is warranted.
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Affiliation(s)
- Muhammad Muntazir Mehdi Khan
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Muhammad M Munir
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Selamawit Woldesenbet
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Mujtaba Khalil
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Abdullah Altaf
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Zayed Rashid
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
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Stuart CM, Mott NM, Mungo AH, Meguid RA, Mitchell JD, Randhawa SK, Rove JY, David EA. Representation of women among cardiothoracic surgery editorial boards: Trends over the past 2 decades. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00537-3. [PMID: 38942139 DOI: 10.1016/j.jtcvs.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/29/2024] [Accepted: 06/17/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE The objective of this study was to examine representation of women on the editorial boards of cardiothoracic surgery-focused journals over the past 2 decades to identify changes over time compared with women cardiothoracic surgeon and trainee representation, and to highlight additional opportunities for improvement. METHODS The editorial boards of 2 high-impact cardiothoracic surgery journals were reviewed from 2000 to 2023. Data on editorial board positions, including editors-in-chief, associate/deputy editors, feature editors, and general members of the editorial board were abstracted. The proportion of women editors was assessed. Data were compared with publicly available information from the Association of American Medical Colleges on physician specialty by sex. RESULTS Of 3460 editorial positions, 332 (9.6%) were held by women. Women occupied 2.2% (1 out of 45) of editor-in-chief positions, 13.2% (78 out of 592) of senior editor positions, 11.5% (33 out of 287) of feature editor positions, and 8.3% (221 out of 2663) of general editorial board positions. The proportion of women holding any editorial board position significantly increased from 2.4% in 2000 to 18.2% in 2023 (P = .01). Overall, editorial board representation increased at a rate of 0.7% ± 1.3% per year, not significantly different from the growth of practicing women cardiothoracic surgeons at 0.3% ± 0.5% per year (P = .584). DISCUSSION Representation of women on the editorial boards of cardiothoracic surgery-focused journals has increased commensurate with the increasing proportion of practicing women cardiothoracic surgeons, although remains at 16%. Work remains to continue the recruitment of women to cardiothoracic surgery as well as to identify the key elements that can support them in positions of leadership.
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Affiliation(s)
- Christina M Stuart
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo.
| | - Nicole M Mott
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo
| | - Alison H Mungo
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - Robert A Meguid
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colo
| | - John D Mitchell
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - Simran K Randhawa
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - Jessica Y Rove
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
| | - Elizabeth A David
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colo
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Benyamein P, Sheahan L, Becker M, Ewing E, Bajaj A, Gallus K, Gosman A. A Work in Progress: Women's Status in the Plastic Surgery Workforce and Recommendations for Success. Aesthet Surg J 2024:sjae121. [PMID: 38913350 DOI: 10.1093/asj/sjae121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Only 20% of the current plastic surgery workforce is female, but since 2022, most matched applicants in integrated plastic surgery programs have been women. This study aimed to examine current practice models among female plastic surgeons, including those outside of academia, as the field continues to evolve. OBJECTIVES This study surveyed female plastic surgeons in different practice models to elicit perspectives, career path advice, characterize/project trends, and provide recommendations for success. METHODS A 37-question survey focusing on demographics, practice models, career paths, desire for practice changes and advice for women trainees was emailed to 1342 members of the American Society of Plastic Surgeons and The Aesthetic Society. Chi square analyses compared practice type characteristics (academia, employed roles, private practice), at a significance level of 0.05. RESULTS Response rate was 53%. Most respondents were age 35-45, in solo practice, trained via traditional pathways, without fellowships, and lacked female mentors. Private practice surgeons were very satisfied in their career, employed surgeons were moderately satisfied and academic surgeons were mildly satisfied. Academic surgeons reported a higher number of working hours (>60) and cases per month (20-30) than employed or private practice surgeons. Recommendations for success included seeking female mentorship, enhancing business skills and building a social media platform during training. CONCLUSIONS Results highlight the importance of female mentorship, acquiring business skills, and indicate private practice leads to greater career satisfaction. Training programs should consider accounting for these factors to better promote women's success and improve equity in academic practice.
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Affiliation(s)
- Paige Benyamein
- Division of Plastic Surgery, Department of Surgery, University of California San Diego, San Diego, CA
| | - Lucy Sheahan
- Division of Plastic Surgery, Department of Surgery, University of California San Diego, San Diego, CA
| | - Miriam Becker
- University of California San Diego, School of Medicine, San Diego, CA
| | - Emily Ewing
- University of Alabama, Department of Psychology, Birmingham, AL
| | | | | | - Amanda Gosman
- Division of Plastic Surgery, Department of Surgery, University of California San Diego, San Diego, CA
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Wagner CM, Ibrahim AM. Sex Disparities After Coronary Artery Bypass Grafting and Hospital Quality. JAMA Netw Open 2024; 7:e2414354. [PMID: 38861261 PMCID: PMC11167499 DOI: 10.1001/jamanetworkopen.2024.14354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/14/2024] [Indexed: 06/12/2024] Open
Abstract
Importance Concern has been raised about persistent sex disparities after coronary artery bypass grafting, with female patients having higher mortality. However, whether these disparities persist across hospitals of different qualities is unknown. Objective To evaluate sex disparities in 30-day mortality after coronary artery bypass grafting across high- and low-quality hospitals. Design, Setting, and Participants This cross-sectional, retrospective cohort study evaluated Medicare beneficiaries undergoing coronary artery bypass grafting between October 1, 2015, and March 31, 2020. Data analysis was performed from July 1, 2023, to December 1, 2023. Exposures The primary exposures were hospital quality and sex. For hospital quality, hospitals were placed into rank order by their overall risk-adjusted mortality rate and divided into quintiles. Main Outcome and Measures Risk-adjusted 30-day mortality using a logistic regression model accounting for patient factors, including sex, age, comorbidities, elective vs unplanned admission, number of bypass grafts, use of arterial graft, and year of surgery. Results A total of 444 855 beneficiaries (mean [SD] age, 71.5 [7.5] years; 120 333 [27.1%] female and 324 522 [72.9%] male) were studied. Compared with male beneficiaries, female beneficiaries were more likely to have an unplanned admission (66 425 [55.2%] vs 157 895 [48.7%], P < .001) and receive care at low-quality (vs high-quality) hospitals (odds ratio, 1.26; 95% CI, 1.23-1.29; P < .001). Overall, risk-adjusted female mortality was 4.24% (95% CI, 4.20%-4.27%), and male mortality was 2.75% (95% CI, 2.75%-2.77%), with an absolute difference of 1.48 (95% CI, 1.45-1.51) percentage points (P < .001). At the highest-quality hospitals, male mortality was 1.57% (95% CI, 1.56%-1.59%), and female mortality was 2.58% (95% CI, 2.54%-2.62%), with an absolute difference of 1.01 (95% CI, 0.97-1.04) percentage points (P < .001). At the lowest-quality hospitals, male mortality was 4.94% (95% CI, 4.88%-5.01%), and female mortality was 7.02% (95% CI, 6.90%-7.13%), with an absolute difference of 2.07 (95% CI, 1.95-2.19) percentage points (P < .001). Female beneficiaries receiving care at low-quality hospitals had a higher mortality than male beneficiaries receiving care at the high-quality hospitals (7.02% vs 1.57%, P < .001). Conclusions and Relevance In this cohort study of Medicare beneficiaries undergoing coronary artery bypass grafting, female beneficiaries were more likely to receive care at low-quality hospitals, where the sex disparity in mortality was double that of high-quality hospitals. Quality improvement targeting low-quality hospitals as well as equitable referral of female beneficiaries to higher-quality hospitals may narrow the sex disparity after coronary artery bypass grafting.
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Affiliation(s)
- Catherine M. Wagner
- National Clinician Scholar’s Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, Michigan Medicine, Ann Arbor
| | - Andrew M. Ibrahim
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, Michigan Medicine, Ann Arbor
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Nair K. Inciting Change Through Professional Mentorship. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:e25. [PMID: 37903322 DOI: 10.1097/acm.0000000000005511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Affiliation(s)
- Kasthuri Nair
- Medical student, Emory University School of Medicine, Atlanta, Georgia; ; ORCID: https://orcid.org/0000-0002-2602-9683
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Vervoort D, Afzal AM, Ruiz GZL, Mutema C, Wijeysundera HC, Ouzounian M, Fremes SE. Barriers to Access to Cardiac Surgery: Canadian Situation and Global Context. Can J Cardiol 2024; 40:1110-1122. [PMID: 37977275 DOI: 10.1016/j.cjca.2023.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023] Open
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Cardiovascular care spans primary, secondary, and tertiary prevention and care, whereby tertiary care is particularly prone to disparities in care. Challenges in access to care especially affect low- and middle-income countries (LMICs), however, multiple barriers also exist and persist across high-income countries. Canada is lauded for its universal health coverage but is faced with health care system challenges and substantial geographic barriers. Canada possesses 203 active cardiac surgeons, or 5.02 per million population, ranging from 3.70 per million in Newfoundland and Labrador to 7.48 in Nova Scotia. As such, Canada possesses fewer cardiac surgeons per million population than the average among high-income countries (7.15 per million), albeit more than the global average (1.64 per million) and far higher than the low-income country average (0.04 per million). In Canada, adult cardiac surgeons are active across 32 cardiac centres, representing 0.79 cardiac centres per million population, which is just above the global average (0.73 per million). In addition to centre and workforce variations, barriers to care exist in the form of waiting times, sociodemographic characteristics, insufficient virtual care infrastructure and electronic health record interoperability, and health care governance fragmentation. Meanwhile, Canada has highly favourable surgical outcomes, well established postacute cardiac care infrastructure, considerable spending on health, robust health administrative data, and effective health technology assessment agencies, which provides a foundation for continued improvements in care. In this narrative review, we describe successes and challenges surrounding access to cardiac surgery in Canada and globally.
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Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Abdul Muqtader Afzal
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Gabriela Zamunaro Lopes Ruiz
- Division of Cardiovascular Surgery, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Chileshe Mutema
- Division of Cardiothoracic Surgery, National Heart Hospital, Lusaka, Zambia
| | - Harindra C Wijeysundera
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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40
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Temkin SM, Salles A, Barr E, Leggett CB, Reznick JS, Wong MS. "Women's work": Gender and the physician workforce. Soc Sci Med 2024; 351 Suppl 1:116556. [PMID: 38825379 DOI: 10.1016/j.socscimed.2023.116556] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 06/04/2024]
Abstract
Historically, the physician professional identity and the organizational structure of Western medicine have been defined by masculine norms such as authority and assertiveness. The past five decades have seen a rapid shift in the demographics of attendees as medical schools, with equal numbers of women and men matriculants for nearly twenty years. Gender as a social, cultural, and structural variable continues to influence the physician workforce. The entry of women into medicine, has had far reaching effects on the expectations of patients, the interactions of physicians with other members of the healthcare team, and the delivery of care. Redefining the culture of medicine to accommodate the diversity of the modern workforce may benefit all physician and improve the delivery of healthcare.
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Affiliation(s)
- Sarah M Temkin
- NIH Office of Research on Women's Health, Bethesda, MD, USA.
| | - Arghavan Salles
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Elizabeth Barr
- NIH Office of Research on Women's Health, Bethesda, MD, USA
| | - Cecilia B Leggett
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jeffrey S Reznick
- National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
| | - Melissa S Wong
- NIH Office of Research on Women's Health, Bethesda, MD, USA; Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Rashid Z, Munir MM, Woldesenbet S, Tsilimigras DI, Khalil M, Khan MMM, Resende V, Dillhoff M, Ejaz A, Pawlik TM. Care fragmentation in hepatopancreatic surgery and postoperative outcomes. Surgery 2024; 175:1562-1569. [PMID: 38565495 DOI: 10.1016/j.surg.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/07/2024] [Accepted: 02/23/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Practice fragmentation in surgery may be associated with poor quality of care. We sought to define the association between fragmented practice and outcomes in hepatopancreatic surgery relative to surgeon volume and sex. METHODS Medicare beneficiaries who underwent hepatopancreatic surgery between 2016 and 2021 were identified. Multivariable analysis was performed to determine provider sex-based differences in the rate of fragmented practice relative to the achievement of a textbook outcome and health care expenditures after adjusting for procedure-specific case volume. RESULTS Among 37,416 patients, almost one-half were female (n = 18,333, 49.0%) with the majority treated by male surgeons (n = 33,697, 90.8%). Female surgeons were more likely to have a greater rate of fragmented practice (females: n = 242, 84.9% vs males: n = 1,487, 78.4%, P = .003; odds ratio 2.66, 95% confidence interval 2.33-3.03, P < .001). Patients treated by high rate of fragmented practice surgeons had increased odds of postoperative complications (odds ratio 1.40, 95% confidence interval 1.28-1.54), extended length-of-stay (odds ratio 1.52, 95% confidence interval 1.38-1.68), 90-day-mortality (odds ratio 1.49, 95% confidence interval 1.28-1.72), and lower odds of achieving a textbook outcome (odds ratio 0.76, 95% confidence interval 0.71-0.83). This association persisted independent of surgeon-specific volume (textbook outcome, high vs low rate of fragmented practice: high-volume surgeon, odds ratio 0.53, 95% confidence interval 0.31-0.91, P = .021 vs. low-volume surgeon, odds ratio 0.76, 95% confidence interval 0.69-0.82, P < .001). Among patients treated by male surgeons, a high rate of fragmented practice was associated with reduced odds of achieving a textbook outcome (male surgeons: odds ratio 0.76, 95% confidence interval 0.70-0.82, P < .001; female surgeons: odds ratio 0.81, 95% confidence interval 0.63-1.05, P = .110). Treatment by surgeons with higher fragmented practice was associated with higher expenditures (index expenditure: percentage difference 9.87, 95% confidence interval, 7.42-12.36; P < .05). CONCLUSION A high rate of fragmented practice adversely affected postoperative outcomes and healthcare expenditures even among high-volume surgeons with the impact varying based on surgeon sex.
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Affiliation(s)
- Zayed Rashid
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH. http://www.twitter.com/ZRashidMD
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH. http://www.twitter.com/musaabmunir
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH. http://www.twitter.com/DTsilimigras
| | - Mujtaba Khalil
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH. http://www.twitter.com/Mujtabakhalil
| | - Muhammad Muntazir Mehdi Khan
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH. http://www.twitter.com/Muntazirmehdik
| | - Vivian Resende
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH; Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil. http://www.twitter.com/vivianresende6
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH. http://www.twitter.com/mary_dillhoff
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH. http://www.twitter.com/AEjaz85
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
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Clark M, Kerslake S, Bøe B, Hiemstra LA. Being a woman and an orthopaedic surgeon-A primer on the challenges we face. J ISAKOS 2024; 9:449-456. [PMID: 38777119 DOI: 10.1016/j.jisako.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
A higher number of women are graduating from medical schools than men, yet orthopedic surgery continues to register the lowest proportion of female surgeons and residents of the surgical specialties. This trend is observed not only in North America but also globally. The presence of a more diverse workforce has been shown to lead to improved patient outcomes, enhanced efficiencies, and overall wellness within healthcare systems and would be of benefit to the orthopedic surgery profession. This primer aims to provide surgeons and leaders with evidence-based insights into diversity, equity, and equality, as well as define barriers and potential solutions pertaining to women in orthopedic surgery.
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Affiliation(s)
- Marcia Clark
- Department of Surgery, University of Calgary, North Tower Foothills Medicine Centre, 1403 29th St. NW, Calgary, Alberta, T2N 2T9, Canada.
| | - Sarah Kerslake
- Department of Surgery, University of Calgary, North Tower Foothills Medicine Centre, 1403 29th St. NW, Calgary, Alberta, T2N 2T9, Canada.
| | - Berte Bøe
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
| | - Laurie A Hiemstra
- Department of Surgery, University of Calgary, North Tower Foothills Medicine Centre, 1403 29th St. NW, Calgary, Alberta, T2N 2T9, Canada; Banff Sport Medicine Foundation, PO Box 1300, Banff, Alberta, T1L 1B3, Canada.
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43
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Wu M, Card EB, Sussman JH, Villavisanis DF, Massenburg BB, Ng JJ, Romeo DJ, Swanson JW, Taylor JA, Low DW. Crowdsourcing the Impact of Illustration in Cleft Surgery Education. Cleft Palate Craniofac J 2024:10556656241257101. [PMID: 38778755 DOI: 10.1177/10556656241257101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE This study aimed to (1) assess layperson preferences for how surgical information is presented; (2) evaluate how the format of visual information relates to layperson comfort with undergoing surgery, perceptions of surgeon character traits, and beliefs about artistic skill impacting plastic surgery practice; and (3) identify sociodemographic characteristics associated with these outcomes. DESIGN A survey was developed in which one of five standardized sets of information depicting a unilateral cleft lip repair was presented as (1) text alone, (2) quick sketches, (3) simple drawings, (4) detailed illustrations, or (5) photographs. SETTING Online crowdsourcing platform. PARTICIPANTS Raters aged 18 years and older from the United States. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) After viewing the surgical information, participants answered three sets of Likert scale questions. Ratings were averaged to produce three composite scores assessing (1) comfort with undergoing surgery (2) perceptions of surgeon character traits, and (3) beliefs about plastic surgery and artistry. RESULTS Four hundred seventy-nine participants were included. Surgeon character traits score was highest among participants who viewed detailed illustrations at 4.46 ± 0.59, followed by photographs at 4.43 ± 0.54, text alone at 4.28 ± 0.59, simple drawings at 4.17 ± 0.67, and quick sketches at 4.17 ± 0.71 (p = 0.0014). Participants who viewed detailed illustrations rated surgical comfort score and plastic surgery and artistry score highest, although differences did not achieve statistical significance. CONCLUSIONS Viewing detailed cleft lip repair illustrations was significantly associated with positive perceptions of surgeon character traits. Our data help to contextualize methods of communication and education valued by the public when seeking cleft care.
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Affiliation(s)
- Meagan Wu
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elizabeth B Card
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jonathan H Sussman
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dillan F Villavisanis
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Benjamin B Massenburg
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jinggang J Ng
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dominic J Romeo
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jordan W Swanson
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jesse A Taylor
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David W Low
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Harik L, Yamamoto K, Kimura T, Rong LQ, Vogel B, Mehran R, Bairey-Merz CN, Gaudino M. Patient-physician sex concordance and outcomes in cardiovascular disease: a systematic review. Eur Heart J 2024; 45:1505-1511. [PMID: 38551446 PMCID: PMC11075930 DOI: 10.1093/eurheartj/ehae121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 05/09/2024] Open
Abstract
The sex disparity in outcomes of patients with cardiovascular disease is well-described and has persisted across recent decades. While there have been several proposed mechanisms to explain this disparity, there are limited data on female patient-physician sex concordance and its association with outcomes. The authors review the existing literature on the relationship between patient-physician sex concordance and clinical outcomes in patients with cardiovascular disease, the evidence of a benefit in clinical outcomes with female patient-physician sex concordance, and the possible drivers of such a benefit and highlight directions for future study.
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Affiliation(s)
- Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, USA
| | - Ko Yamamoto
- Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
| | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Birgit Vogel
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - C Noel Bairey-Merz
- Barbara Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai, Los Angeles, CA, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, USA
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Hallet J, Sutradhar R, Flexman A, McIsaac DI, Carrier FM, Turgeon AF, McCartney C, Chan WC, Coburn N, Eskander A, Jerath A, Perez d’Empaire P, Lorello G. Association between anaesthesia-surgery team sex diversity and major morbidity. Br J Surg 2024; 111:znae097. [PMID: 38747328 PMCID: PMC11094651 DOI: 10.1093/bjs/znae097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Team diversity is recognized not only as an equity issue but also a catalyst for improved performance through diversity in knowledge and practices. However, team diversity data in healthcare are limited and it is not known whether it may affect outcomes in surgery. This study examined the association between anaesthesia-surgery team sex diversity and postoperative outcomes. METHODS This was a population-based retrospective cohort study of adults undergoing major inpatient procedures between 2009 and 2019. The exposure was the hospital percentage of female anaesthetists and surgeons in the year of surgery. The outcome was 90-day major morbidity. Restricted cubic splines were used to identify a clinically meaningful dichotomization of team sex diversity, with over 35% female anaesthetists and surgeons representing higher diversity. The association with outcomes was examined using multivariable logistic regression. RESULTS Of 709 899 index operations performed at 88 hospitals, 90-day major morbidity occurred in 14.4%. The median proportion of female anaesthetists and surgeons was 28 (interquartile range 25-31)% per hospital per year. Care in hospitals with higher sex diversity (over 35% female) was associated with reduced odds of 90-day major morbidity (OR 0.97, 95% c.i. 0.95 to 0.99; P = 0.02) after adjustment. The magnitude of this association was greater for patients treated by female anaesthetists (OR 0.92, 0.88 to 0.97; P = 0.002) and female surgeons (OR 0.83, 0.76 to 0.90; P < 0.001). CONCLUSION Care in hospitals with greater anaesthesia-surgery team sex diversity was associated with better postoperative outcomes. Care in a hospital reaching a critical mass with over 35% female anaesthetists and surgeons, representing higher team sex-diversity, was associated with a 3% lower odds of 90-day major morbidity.
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Affiliation(s)
- Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Cancer Program, ICES, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Cancer Program, ICES, Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Alana Flexman
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Anesthesiology, St Paul’s Hospital/Providence Health Care, Vancouver, British Columbia, Canada
| | - Daniel I McIsaac
- Departments of Anesthesiology and Pain Medicine, University of Ottawa and Ottawa Hospital, Ottawa, Ontario, Canada
| | - François M Carrier
- Carrefour de l’innovation et santé des populations, Centre de recherche du CHUM, and Department of Anesthesiology and Division of Critical Care, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada
- Population Health and Optimal Health Practices Research Unit, Trauma–Emergency–Critical Care Medicine, CHU de Québec–Université Laval Research Centre, Université Laval, Québec City, Québec, Canada
| | - Colin McCartney
- Department of Anesthesiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wing C Chan
- Cancer Program, ICES, Toronto, Ontario, Canada
| | - Natalie Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Cancer Program, ICES, Toronto, Ontario, Canada
| | - Antoine Eskander
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Cancer Program, ICES, Toronto, Ontario, Canada
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Angela Jerath
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Cancer Program, ICES, Toronto, Ontario, Canada
- Department of Anesthesiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Pablo Perez d’Empaire
- Department of Anesthesiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gianni Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Wilson Centre, University Health Network, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
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Miyawaki A, Jena AB, Rotenstein LS, Tsugawa Y. Comparison of Hospital Mortality and Readmission Rates by Physician and Patient Sex. Ann Intern Med 2024; 177:598-608. [PMID: 38648639 DOI: 10.7326/m23-3163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Little is known as to whether the effects of physician sex on patients' clinical outcomes vary by patient sex. OBJECTIVE To examine whether the association between physician sex and hospital outcomes varied between female and male patients hospitalized with medical conditions. DESIGN Retrospective observational study. SETTING Medicare claims data. PATIENTS 20% random sample of Medicare fee-for-service beneficiaries hospitalized with medical conditions during 2016 to 2019 and treated by hospitalists. MEASUREMENTS The primary outcomes were patients' 30-day mortality and readmission rates, adjusted for patient and physician characteristics and hospital-level averages of exposures (effectively comparing physicians within the same hospital). RESULTS Of 458 108 female and 318 819 male patients, 142 465 (31.1%) and 97 500 (30.6%) were treated by female physicians, respectively. Both female and male patients had a lower patient mortality when treated by female physicians; however, the benefit of receiving care from female physicians was larger for female patients than for male patients (difference-in-differences, -0.16 percentage points [pp] [95% CI, -0.42 to 0.10 pp]). For female patients, the difference between female and male physicians was large and clinically meaningful (adjusted mortality rates, 8.15% vs. 8.38%; average marginal effect [AME], -0.24 pp [CI, -0.41 to -0.07 pp]). For male patients, an important difference between female and male physicians could be ruled out (10.15% vs. 10.23%; AME, -0.08 pp [CI, -0.29 to 0.14 pp]). The pattern was similar for patients' readmission rates. LIMITATION The findings may not be generalizable to younger populations. CONCLUSION The findings indicate that patients have lower mortality and readmission rates when treated by female physicians, and the benefit of receiving treatments from female physicians is larger for female patients than for male patients. PRIMARY FUNDING SOURCE Gregory Annenberg Weingarten, GRoW @ Annenberg.
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Affiliation(s)
- Atsushi Miyawaki
- Department of Health Services Research and Department of Public Health, Graduate School of Medicine, and Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan (A.M.)
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Department of Medicine, Massachusetts General Hospital, Boston, and National Bureau of Economic Research, Cambridge, Massachusetts (A.B.J.)
| | - Lisa S Rotenstein
- Divisions of General Internal Medicine and Clinical Informatics, University of California at San Francisco, San Francisco, California, and Center for Physician Experience and Practice Excellence, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts (L.S.R.)
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California (Y.T.)
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Morimoto T, Kobayashi T, Fukuda M, Hirata H, Otani K, Sekiguchi M, Yamauchi K, Tsukamoto M, Nagamine S, Haro H. Comparison of Gender Diversity Among Spine Surgeons in the Japanese Society for Spine Surgery and Related Research and the Neurospinal Society of Japan: A Descriptive Study Through Secondary Analysis of Aggregated Data. Cureus 2024; 16:e61152. [PMID: 38803408 PMCID: PMC11129104 DOI: 10.7759/cureus.61152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
STUDY DESIGN This was a descriptive study through secondary analysis of aggregated data. PURPOSE This study aimed to describe changes in women's membership in the Japanese Society for Spine Surgery and Related Research (JSSR) for orthopedic surgery and the Neurospinal Society of Japan (NSJ) for neurosurgery over the past decade and make predictions for the future. OVERVIEW OF LITERATURE Although the ratio of women physicians in the field of spine surgery is known to be low worldwide, there is a lack of detailed surveys in Japan. METHODS We sent emails to the JSSR and NSJ secretariats to verify membership information (gender and age) from 2013 to 2022. Using ordinary least squares, we projected the years it would take for the JSSR and NSJ to achieve a gender diversity ratio of 30%. RESULTS In 2013, the percentage of women in JSSR and NSJ was 2.3% and 2.7%, respectively. However, after 2018, the percentage of women in NSJ will be higher than in JSSR, rising to 2.7% in JSSR and 4.7% in NSJ by 2022. It would require 101 years for the NSJ and more than 1,000 years for the JSSR to realize 30% gender diversity. CONCLUSIONS JSSR and NSJ have low percentages of women. Improving gender diversity is an important issue for both societies, and they may collaborate on finding a good solution. Both the JSSR and NSJ societies need to actively address gender diversity and become more attractively represented in society for the next generation of spine surgeons.
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Affiliation(s)
| | | | - Miyuki Fukuda
- Neurological Surgery, Shin-Aikai Spine Center, Katano Hospital, Katano, JPN
| | | | - Koji Otani
- Orthopedic Surgery, Fukushima Medical University, Fukushima, JPN
| | - Miho Sekiguchi
- Orthopedic Surgery, Fukushima Medical University, Fukushima, JPN
| | - Kazuyo Yamauchi
- Community-Oriented Medical Education, Graduate School of Medicine, Chiba University, Chiba, JPN
| | | | | | - Hirotaka Haro
- Orthopedic Surgery, University of Yamanashi, Chuo, JPN
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Saka N, Chiang CM, Ogawa T, Pendleton AA, Tsuihiji K, Nomura K, Watanabe Y, Bhandari M. Trend of female first authorship in Journal of Orthopaedic Science, the official journal of the Japanese orthopaedic association from 2001 to 2021: An observational study. J Orthop Sci 2024; 29:914-920. [PMID: 36964116 DOI: 10.1016/j.jos.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Women are underrepresented in orthopaedic surgery, especially in Japan. Authorship is associated with representation and career advancement, but the academic representation of women in Japanese orthopaedic surgery has not been elucidated. This study aimed to elucidate the proportion of female first authorship and its associating factors, as well as trends in the Journal of Orthopaedic Science (JOS), the official journal of the Japanese Orthopaedic Association. METHODS The study reviewed original articles published in JOS from 2002 to 2021 using data from PubMed on March 16, 2022. The gender of the first and last authors was determined using genderize. io, an online gender detection tool and manual search. The study used multivariable logistic regression to identify the factors associated with female first authorship and visualized the trend of predicted probability using restricted cubic spline curve. RESULTS Among 2272 original articles, 148 (6.5%) and 79 (3.5%) had female first and last authors, respectively. Compared with 2002-2006, female first authorship significantly increased in 2012-2016 (adjusted odds ratio [aOR], 2.04; 95% confidence interval [CI], 1.09-4.05; p = 0.03) and 2017-2021 (aOR, 2.72; 95% CI, 1.46-5.276; p = 0.002). Affiliation with an institution in Japan (aOR, 0.51; 95% CI, 0.35-0.74; p < 0.001) and affiliation in orthopaedics (aOR, 0.16; 95% CI, 0.11-0.23; p < 0.001) were negatively associated with female first authorship. Around 2020, the trend showed a gradual then rapid increase in women with non-orthopaedic affiliations. Only a very small increase was observed in women with an orthopaedic affiliation. CONCLUSIONS Female first authorship in JOS has been increasing. However, the proportion of female authors remains low. Authors outside of Japan and not affiliated with orthopaedics largely affect female authorship statistics. The results indicate the persistent gender gap in the academic representation of women in Japanese orthopaedic publications.
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Affiliation(s)
- Natsumi Saka
- Department of Health Research Methods, Evidence & Impact, McMaster University, Ontario, Canada; Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.
| | - Chi-Ming Chiang
- Department of Orthopaedics, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Takahisa Ogawa
- Department of Orthopaedics, Tokyo Medical and Dental University, Tokyo, Japan; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Anna Alaska Pendleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, USA
| | - Kanako Tsuihiji
- Trauma and Reconstruction Center, Shin-Yurigaoka General Hospital, Kanagawa, Japan
| | - Kyoko Nomura
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshinobu Watanabe
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Mohit Bhandari
- Department of Health Research Methods, Evidence & Impact, McMaster University, Ontario, Canada; Division of Orthopedic Surgery, McMaster University, Ontario, Canada.
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49
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Bisset CN, Moug SJ, Oliphant R, Dames N, Parson S, Cleland J. Influencing factors in surgical decision-making: a qualitative analysis of colorectal surgeons' experiences of postoperative complications. Colorectal Dis 2024; 26:987-993. [PMID: 38485203 DOI: 10.1111/codi.16943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/25/2024] [Accepted: 02/21/2024] [Indexed: 05/26/2024]
Abstract
AIM When making anastomotic decisions in rectal cancer surgery, surgeons must consider the risk of anastomotic leakage, which bears implications for the patient's quality of life, cancer recurrence and, potentially, death. The aim of this study was to investigate the views of colorectal surgeons on how their individual attributes (e.g. experience, personality traits) may influence their decision-making and experience of complications. METHOD This qualitative study used individual interviews for data collection. Purposive sampling was used to invite certified UK-based colorectal surgeons to participate. Participants were recruited until ongoing data review indicated no new codes were generated, suggesting data sufficiency. Data were analysed thematically following Braun and Clarke's six-step framework. RESULTS Seventeen colorectal surgeons (eight female, nine male) participated. Two key themes with relevant subthemes were identified: (1) personal attributes influencing variation in decision-making (e.g. demographics, personality) and (2) the influence of complications on decision-making. Surgeons described variation in the management of complications based upon their personal attributes, which included factors such as gender, experience and subspeciality interests. Surgeons described the detrimental impact of anastomotic leakage on their mental and physical health. Experience of anastomotic leakage influences future decision-making and is associated with changes in practice even when a technical error is not identified. CONCLUSION Colorectal surgeons consider anastomotic leaks to be personal 'failures', which has a negative impact on surgeon welfare. Better understanding of how surgeons make difficult decisions, and how surgeons respond to and learn from complications, is necessary to identify 'personalized' methods of supporting surgeons at all career stages, which may improve patient outcomes.
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Affiliation(s)
- Carly N Bisset
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK
- University of Aberdeen, Aberdeen, UK
| | - Susan J Moug
- Department of General Surgery, Royal Alexandra Hospital, Paisley, UK
- Department of General Surgery, Golden Jubilee University National Hospital, Clydebank, UK
- University of Glasgow, Glasgow, UK
| | - Raymond Oliphant
- University of Aberdeen, Aberdeen, UK
- Department of Colorectal Surgery, Raigmore Hospital, Inverness, UK
| | - Nicola Dames
- Association of Coloproctology of Great Britain & Ireland Patient Liaison Group, Oxford, UK
| | | | - Jennifer Cleland
- Medical Education Research and Scholarship Unit, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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50
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Shields MM, Worlton TJ. Invited Commentary: Women Surgeons: Forged by the Sea. J Am Coll Surg 2024; 238:820-822. [PMID: 38629696 DOI: 10.1097/xcs.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
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