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Carter JC, Purcell N, Stewart CH, Pearce GC, Balkin M, Allen KJ. Still a 'boys' club': a qualitative analysis of how gender affects a career in anaesthesia in Australia and Aotearoa New Zealand. Anaesthesia 2024; 79:694-705. [PMID: 38629288 DOI: 10.1111/anae.16281] [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] [Accepted: 02/28/2024] [Indexed: 06/09/2024]
Abstract
Gender inequity remains an issue in anaesthesia despite increasing numbers of women training and achieving fellowship in the speciality. Women are under-represented in all areas of anaesthetic research, academia and leadership. The Gender Equity Subcommittee of the Australian and New Zealand College of Anaesthetists recently conducted a survey asking "Does gender still matter in the pursuit of a career in anaesthesia in 2022?". The survey was distributed to a randomly selected sample of 1225 anaesthetic consultants and completed by 470 respondents (38% response rate) with 793 free-text comments provided. Three overarching themes were identified: gender effects on the career and family interface; women do not fit the mould; and gender equity changes the status quo. Women respondents described a need to make a choice between career and family, which was not described by men, as well as stigmatisation of part-time work, a lack of access to challenging work and negative impacts of parental leave. Women respondents also described a sense of marginalisation within anaesthesia due to a 'boys' club' mentality, a lack of professional respect and insufficient structural supports for women in leadership. This was compounded for women from ethnically and culturally diverse backgrounds. A need for specific strategies to support anaesthetic careers for women was described as well as normalisation of flexibility in workplaces, combined with a broadening of our definition of success to allow people of all genders to experience fulfilment both at home and at work. This study is the first published qualitative data on factors affecting gender equity for anaesthetists in Australia and Aotearoa New Zealand. It highlights the need for further exploration, as well providing a foundation for changes in attitude and structural changes towards advancing gender equity.
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Affiliation(s)
- J C Carter
- Department of Anaesthesia, Austin Health, Melbourne, Australia
- Department of Anaesthesia, Mercy Hospital for Women, Melbourne, Australia
| | - N Purcell
- Department of Anaesthesia, Royal Prince Alfred Hospital, Sydney, Australia
| | - C H Stewart
- Department of Perioperative Medicine and Anaesthesia, Westmead Hospital, Sydney, Australia
| | - G C Pearce
- Department of Anaesthesia and Perioperative Medicine, Te Whatu Ora Waitemata, Auckland, Aotearoa, New Zealand
| | - M Balkin
- Department of Anaesthesia and Pain Medicine, Alfred Health, Melbourne, Australia
| | - K J Allen
- Department of Anaesthesia and Pain Medicine, Royal Melbourne Hospital, Melbourne, Australia
- Department of Critical Care, University of Melbourne, Australia
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2
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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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3
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Attard Montalto A, Mifsud S, Deguara J, Attard Cortis P. Perceived authority gradients among anaesthetic teams in Malta. J Perioper Pract 2024:17504589241232509. [PMID: 38706307 DOI: 10.1177/17504589241232509] [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: 05/07/2024]
Abstract
Over the decades, cases like those of Elaine Bromiley, who passed away after a 'cannot intubate, cannot ventilate' scenario, have prompted deeper analyses of team dynamics and authority gradients. It is thought that a steep authority gradient may have impeded lifesaving communication between members of the anaesthetic team, leading to her death. Using an online questionnaire, we carried out a cross-sectional observational study exploring the perceived authority gradients within anaesthetic teams in the main operating theatres at Mater Dei Hospital, Malta. Nurses were found to experience a steeper authority gradient than anaesthetists. They were less comfortable making suggestions too and also felt like the suggestions they made were less listened to by lead anaesthetists. To a lesser extent, females also experienced a steeper authority gradient. Increasing age and grade were associated with a flatter authority gradient. Further research needs to be carried out to identify the underlying reasons behind the steeper perceived authority gradient affecting nurses. Interventions are being planned to attempt to decrease the perceived authority gradient.
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Affiliation(s)
- Andrew Attard Montalto
- Department of Anaesthesia, Intensive Care & Pain Medicine, Mater Dei Hospital, Msida, Malta
| | - Stephanie Mifsud
- Department of Anaesthesia, Intensive Care & Pain Medicine, Mater Dei Hospital, Msida, Malta
| | - Justin Deguara
- Department of Anaesthesia, Intensive Care & Pain Medicine, Mater Dei Hospital, Msida, Malta
- Department of Nursing, Mater Dei Hospital, Msida, Malta
| | - Petramay Attard Cortis
- Department of Anaesthesia, Intensive Care & Pain Medicine, Mater Dei Hospital, Msida, Malta
- Department of Nursing, Mater Dei Hospital, Msida, Malta
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Weller JM, Mahajan R, Fahey-Williams K, Webster CS. Teamwork matters: team situation awareness to build high-performing healthcare teams, a narrative review. Br J Anaesth 2024; 132:771-778. [PMID: 38310070 DOI: 10.1016/j.bja.2023.12.035] [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: 08/22/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 02/05/2024] Open
Abstract
Healthcare today is the prerogative of teams rather than of individuals. In acute care domains such as anaesthesia, intensive care, and emergency medicine, the work is complex and fast-paced, and the team members are diverse and interdependent. Three decades of research into the behaviours of high-performing teams provides us with clear guidance on team training, demonstrating positive effects on patient safety and staff wellbeing. Here we consider team performance through the lens of situation awareness. Maintaining situation awareness is an absolute requirement for safe and effective patient management. Situation awareness is a dynamic process of perceiving cues in the environment, understanding what they mean, and predicting how the situation may evolve. In the context of acute clinical care, situation awareness can be improved if the whole team actively contributes to monitoring the environment, processing information, and planning next steps. In this narrative review, we explore the concept of situation awareness at the level of the team, the conditions required to maintain team situation awareness, and the relationship between team situation awareness, shared mental models, and team performance. Our ultimate goal is to help clinicians create the conditions required for high-functioning teams, and ultimately improve the safety of clinical care.
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Affiliation(s)
- Jennifer M Weller
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand; Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand.
| | - Ravi Mahajan
- Centre of Excellence in Critical Care, Apollo Hospitals Group, Chennai, India; Department of Anaesthesia and Intensive Care, University of Nottingham, Nottingham, UK
| | - Kathryn Fahey-Williams
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Craig S Webster
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand; Department of Anaesthesiology, School of Medicine, University of Auckland, Auckland, New Zealand
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Lee SE, Seo JK. Effects of nurse managers' inclusive leadership on nurses' psychological safety and innovative work behavior: The moderating role of collectivism. J Nurs Scholarsh 2024. [PMID: 38467584 DOI: 10.1111/jnu.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/02/2024] [Accepted: 02/25/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION In the rapidly evolving healthcare landscape, the capacity to foster innovative work behavior among nurses is increasingly important. This study examined the dynamics between inclusive leadership, psychological safety, collectivism, and innovative work behavior among nurses. DESIGN The study used a cross-sectional, correlational design. METHODS This study utilized data from 730 medical-surgical nurses who provided direct care to patients. Standardized instruments were used to assess key study variables. Statistical analyses, including moderated mediation regressions, were employed to investigate the complex interplay among these variables. RESULTS We found a positive association between inclusive leadership and innovative work behavior, and psychological safety mediated this relationship. Collectivism moderated inclusive leadership's direct relationship with psychological safety and its indirect relationship with innovative work behavior. The results revealed that nurses with lower levels of collectivism were more responsive to their managers' inclusive behaviors, strengthening the relation between inclusive leadership, psychological safety, and innovative work behavior. CONCLUSION Our findings suggest that promoting inclusive leadership behaviors among nurse managers to create a psychologically safe environment can motivate nurses to engage in innovative work behavior. However, it is also important to understand that the effectiveness of leadership may differ depending on the collectivist values of individual nurses. CLINICAL RELEVANCE Nurse managers should adopt inclusive leadership behaviors, such as valuing trust, open communication, and diversity, in order to foster psychological safety and innovative work behavior among nurses.
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Affiliation(s)
- Seung Eun Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| | - J K Seo
- Psychological Science Innovation Institute, Department of Psychology, Yonsei University, Seoul, South Korea
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Jeon H, Kim S, Shon Y. Ethical issues in the operating room: A scoping review. Nurs Ethics 2023:9697330231197704. [PMID: 37769689 DOI: 10.1177/09697330231197704] [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: 10/03/2023]
Abstract
BACKGROUND For the patients receiving care in the operating room, it emphasizes that the ethical behavior and attitude of health professionals should be aligned with patients' basic human rights. Surgical ethics may provide an ethical alternative in a specific operating room context. However, it is unclear how actively research is being conducted in this regard. AIM This study determines the direction of future research by identifying ethical issues experienced in the operating room. METHOD This scoping review is based on the methodological framework suggested by Arksey and O'Malley in 2005. PubMed, CINAHL, EMBASE, WOS, Cochrane, KISS, and KMbase databases were searched from January 2012 to May 2022. Two researchers independently screened the searched articles by reviewing the titles, abstracts, and full texts. Consequently, 19 studies were selected. FINDINGS Five categories were identified: Professional ethics, Organizational ethics, Patients' rights, Patient safety, and Allocating resources. The derived categories covered all the same content as the International Council of Nurses' (ICN) code of ethics, with the exception of one element, that is, global health. CONCLUSIONS This study highlights ethical issues in the operating theatre and emphasizes the need for individual and organizational strategies aligned with the ICN code of ethics. Future research should cover a wider range of issues, employ diverse perspectives and methodologies, and enhance ethical practices to improve understanding and ethical practices in the field.
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Seelandt JC, Boos M, Kolbe M, Kämmer JE. How to enrich team research in healthcare by considering five theoretical perspectives. Front Psychol 2023; 14:1232331. [PMID: 37637888 PMCID: PMC10448055 DOI: 10.3389/fpsyg.2023.1232331] [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] [Received: 05/31/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
The aim of this paper is to inspire team research to apply diverse and unconventional perspectives to study team dynamics and performance in healthcare settings. To illustrate that using multiple perspectives can yield valuable insights, we examine a segment of a team interaction during a heart-surgery, using five distinct interdisciplinary perspectives known from small group research: the psychodynamic, functional, conflict-power-status, temporal, and social identity perspectives. We briefly describe each theoretical perspective, discuss its application to study healthcare teams, and present possible research questions for the segment at hand using the respective perspective. We also highlight the benefits and challenges associated with employing these diverse approaches and explore how they can be integrated to analyze team processes in health care. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses. We also point to further research avenues and highlight the benefits associated with employing these diverse approaches. Finally, we offer our own insights and opinions on the integration of these approaches, as well as the types of data required to conduct such analyses.
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Affiliation(s)
| | - Margarete Boos
- Department of Social and Communication Psychology, Institute for Psychology, University of Göttingen, Göttingen, Germany
| | - Michaela Kolbe
- Simulation Center, University Hospital Zürich, Zürich, Switzerland
- ETH Zurich, Zürich, Switzerland
| | - Juliane E. Kämmer
- Department of Social and Communication Psychology, Institute for Psychology, University of Göttingen, Göttingen, Germany
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Methangkool E. How to be Better Leaders Through Effective Conflict Resolution. J Cardiothorac Vasc Anesth 2023; 37:337-339. [PMID: 36567219 DOI: 10.1053/j.jvca.2022.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Emily Methangkool
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, CA.
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MacLennan K, Minehart RD, Vasco M, Eley VA. Simulation-based training in obstetric anesthesia: an update. Int J Obstet Anesth 2023; 54:103643. [PMID: 36933323 DOI: 10.1016/j.ijoa.2023.103643] [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: 01/18/2023] [Revised: 01/24/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
In this update we explore the current applications of simulation in obstetric anesthesia, describe what is known regarding its impacts on care and consider the different settings in which simulation programs are required. We will introduce practical strategies, such as cognitive aids and communication tools, that can be applied in the obstetric setting and share ways in which a program might apply these tools. Finally, we provide a list of common obstetric emergencies essential for a program's curriculum and common teamwork pitfalls to address within a comprehensive obstetric anesthesia simulation program.
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Affiliation(s)
| | - R D Minehart
- Massachusetts General Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | - M Vasco
- Universidad CES, Medellín, Colombia
| | - V A Eley
- Royal Brisbane and Women's Hospital, Brisbane, Australia; The University of Queensland, Brisbane, Australia.
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Brewster DJ, Butt WW, Gordon LJ, Sarkar MA, Begley JL, Rees CE. Leadership during airway management in the intensive care unit: A video-reflexive ethnography study. Front Med (Lausanne) 2023; 10:1043041. [PMID: 36873881 PMCID: PMC9980339 DOI: 10.3389/fmed.2023.1043041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/25/2023] [Indexed: 02/18/2023] Open
Abstract
Effective leadership is crucial to team performance within the intensive care unit. This novel study aimed to explore how staff members from an intensive care unit conceptualize leadership and what facilitators and barriers to leadership exist within a simulated workplace. It also aimed to identify factors that intersect with their perceptions of leadership. This study was underpinned by interpretivism, and video-reflexive ethnography was chosen as the methodology for the study. The use of both video recording (to capture the complex interactions occurring in the ICU) and team reflexivity allowed repeated analysis of those interactions by the research team. Purposive sampling was used to recruit participants from an ICU in a large tertiary and private hospital in Australia. Simulation groups were designed to replicate the typical clinical teams involved in airway management within the intensive care unit. Twenty staff participated in the four simulation activities (five staff per simulation group). Each group simulated the intubations of three patients with hypoxia and respiratory distress due to severe COVID-19. All 20 participants who completed the study simulations were invited to attend video-reflexivity sessions with their respective group. Twelve of the 20 participants (60%) from the simulations took part in the reflexive sessions. Video-reflexivity sessions (142 min) were transcribed verbatim. Transcripts were then imported into NVivo software for analysis. The five stages of framework analysis were used to conduct thematic analysis of the video-reflexivity focus group sessions, including the development of a coding framework. All transcripts were coded in NVivo. NVivo queries were conducted to explore patterns in the coding. The following key themes regarding participants' conceptualizations of leadership within the intensive care were identified: (1) leadership is both a group/shared process and individualistic/hierarchical; (2) leadership is communication; and (3) gender is a key leadership dimension. Key facilitators identified were: (1) role allocation; (2) trust, respect and staff familiarity; and (3) the use of checklists. Key barriers identified were: (1) noise and (2) personal protective equipment. The impact of socio-materiality on leadership within the intensive care unit is also identified.
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Affiliation(s)
- David J Brewster
- Intensive Care Unit, Cabrini Hospital, Melbourne, VIC, Australia.,Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Warwick W Butt
- Intensive Care Unit, Cabrini Hospital, Melbourne, VIC, Australia.,Royal Children's Hospital, Melbourne, VIC, Australia
| | - Lisi J Gordon
- Centre for Medical Education, School of Medicine, University of Dundee, Dundee, Scotland, United Kingdom
| | - Mahbub A Sarkar
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Jonathan L Begley
- Intensive Care Unit, Cabrini Hospital, Melbourne, VIC, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Charlotte E Rees
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
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Postpartum hemorrhage: The role of simulation. Best Pract Res Clin Anaesthesiol 2022; 36:433-439. [PMID: 36513437 DOI: 10.1016/j.bpa.2022.11.002] [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: 10/17/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
Postpartum hemorrhage (PPH) persists as a leading cause of maternal death worldwide, and in the United States, most maternal deaths due to hemorrhage are deemed preventable. While essential preparations for hemorrhage include protocols and checklists, implementation science has revealed that it is not enough to merely introduce these tools into units. Simulation affords safe opportunities for practice and produces reliable behavior change, and it does not always need to be highly expensive and resource consuming. We review how simulation can be applied to address a unit's vulnerabilities in identifying, managing, and resolving PPH, as well as considerations for crafting a comprehensive simulation program for your unit.
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12
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Raveendran L, McGuire CS, Gazmin S, Beiko D, Martin LJ. The who, what, and how of teamwork research in medical operating rooms: A scoping review. J Interprof Care 2022; 37:504-514. [PMID: 35543316 DOI: 10.1080/13561820.2022.2058917] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite the importance of teamwork in the operating room (OR), teamwork can often be conflated with teamwork components (e.g., communication, cooperation). We reviewed the existing literature pertaining to OR teamwork to understand which teamwork components have been assessed. Following PRISMA guidelines for scoping reviews, 4,233 peer-reviewed studies were identified using MEDLINE and Embase. Eighty-seven studies were included for synthesis and analysis. Using the episodic model of teamwork as an organizing framework, studies were grouped into the following teamwork categories: (a) transition processes (e.g., goal specification), (b) action processes (e.g., coordination), (c) interpersonal processes (e.g., conflict management), (d) emergent states (e.g., psychological safety), or (e) omnibus topics (a combination of higher-order teamwork processes). Results demonstrated that action processes were most frequently explored, followed by transition processes, omnibus topics, emergent states, and interpersonal processes. Although all studies were framed as investigations of teamwork, it is important to highlight that most explored only one or a few constructs under the overarching umbrella of teamwork. We advocate for enhanced specificity with descriptions of OR teamwork, reporting practices pertaining to interprofessional demographics and outcomes, and increased diversity in study design and surgery type to advance understanding of teamwork and its implications.
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Affiliation(s)
| | - Cailie S McGuire
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Stefanie Gazmin
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Darren Beiko
- Department of Urology, Queen's University, Kingston, ON, Canada
| | - Luc J Martin
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
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Grande B, Zalunardo MP, Kolbe M. How to train thoracic anesthesia for residents and consultants? Curr Opin Anaesthesiol 2022; 35:69-74. [PMID: 34889801 DOI: 10.1097/aco.0000000000001080] [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: 11/25/2022]
Abstract
PURPOSE OF REVIEW The training of anesthesiologists in thoracic surgery is a significant challenge. International professional societies usually provide only a case number-based or time-based training concept. There are only a few concepts of simulation trainings in thoracic anesthesia and interprofessional debriefings on a daily basis are rarely applied. In this review, we will show how professional curricula should aim for competence rather than number of cases and why simulation-based training and debriefing should be implemented. RECENT FINDINGS Recent curricula recommend so-called entrustable professional activities (EPAs)as a way out of the dilemma between the number of cases vs. competence. With these EPAs, competence can be mapped and prerequisites defined.Training concepts from simulation in healthcare have so far not explicitly reached anesthesia for thoracic surgery. In addition to mere technical training, combined technical-behavioral training forms have proven to be an effective training targeting the entire team in the context of the actual working environment in the operating theatre. SUMMARY Interdisciplinary and interprofessional learning can take place in simulation trainings and on a daily basis through postevent debriefings. When these debriefings are conducted in a structured way, an improvement in the performance of the entire team can be the result. The basis for these debriefings - as well as for other training approaches - is psychological safety, which should be established and maintained together with all professions involved.
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Affiliation(s)
- Bastian Grande
- University Hospital Zurich, Institute of Anesthesiology, Zurich, Switzerland
- University Hospital Zurich, Simulation Center
- ETH Zurich, Departement of Health Sciences and Technology, Zurich, Switzerland
| | | | - Michaela Kolbe
- University Hospital Zurich, Simulation Center
- ETH Zurich, Departement of Health Sciences and Technology, Zurich, Switzerland
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14
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Social bias, discrimination and inequity in healthcare: mechanisms, implications and recommendations. BJA Educ 2022; 22:131-137. [PMID: 35531078 PMCID: PMC9073302 DOI: 10.1016/j.bjae.2021.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
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15
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Veli Korkmaz A, van Engen ML, Knappert L, Schalk R. About and beyond leading uniqueness and belongingness: A systematic review of inclusive leadership research. HUMAN RESOURCE MANAGEMENT REVIEW 2022. [DOI: 10.1016/j.hrmr.2022.100894] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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16
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Minehart RD, Su HK, Petrozza JC. Teaming: learning, competing, and innovating in the world of reproductive medicine. Fertil Steril 2021; 117:10-14. [PMID: 34924184 DOI: 10.1016/j.fertnstert.2021.11.030] [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: 11/29/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
Healthcare teams must be deliberately cultivated to reach their full potential. Shifting focus from individual performance to a team's collective competence allows for targeted and evidence-based interventions that support teamwork and improve patient outcomes. We reviewed essential concepts drawn from team science and explored the practical applications of teaming. Reproductive endocrinology and infertility healthcare providers play a pivotal role by teaching, modeling, and fostering teaming attitudes and behaviors. Through teaming, we can maximize our teams' ability to learn, innovate, compete with other teams, and thrive in today's healthcare environment.
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Affiliation(s)
- Rebecca D Minehart
- Harvard Medical School, Boston, Massachusetts; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
| | - Henry K Su
- Harvard Medical School, Boston, Massachusetts; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - John C Petrozza
- Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
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Etherington C, Kitto S, Burns JK, Adams TL, Birze A, Britton M, Singh S, Boet S. How gender shapes interprofessional teamwork in the operating room: a qualitative secondary analysis. BMC Health Serv Res 2021; 21:1357. [PMID: 34923992 PMCID: PMC8684702 DOI: 10.1186/s12913-021-07403-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/10/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite substantial implications for healthcare provider practice and patient outcomes, gender has yet to be systematically explored with regard to interprofessional operating room (OR) teamwork. We aimed to explore and describe how gender and additional social identity factors shape experiences and perceptions of teamwork in the OR. METHODS This study was a qualitative secondary analysis of semi-structured interviews with OR team members conducted between November 2018 and July 2019. Participants were recruited across hospitals in Ontario, Canada. We conducted both purposive and snowball sampling until data saturation was reached. Transcripts were analyzed thematically by two independent research team members, moving from open to axial coding. RESULTS Sixty-six interviews of OR healthcare professionals were completed: anesthesia (n=17), nursing (n=19), perfusion (n=2), and surgery (n=26). Traditional gender roles, norms, and stereotypes were perceived and experienced by both women and men, but with different consequences. Both women and men participants described challenges that women face in the OR, such as being perceived negatively for displaying leadership behaviours. Participants also reported that interactions and behaviours vary depending on the team gender composition, and that other social identities, such as age and race, often interact with gender. Nevertheless, participants indicated a belief that the influence of gender in the OR may be modified. CONCLUSIONS The highly gendered reality of the OR creates an environment conducive to breakdowns in communuication and patient safety risks in addition to diminishing team morale, psychological safety, and provider well-being. Consequently, until teamwork interventions adequately account for gender, they are unlikely to be optimally effective or sustainable.
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Affiliation(s)
- Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada
| | - Simon Kitto
- Department of Innovation in Medical Education, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
| | - Joseph K Burns
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Tracey L Adams
- Department of Sociology, Social Science Centre, Western University, London, ON, N6A 5C2, Canada
| | - Arija Birze
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Meghan Britton
- Main Operating Room, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Sukhbir Singh
- Department of Obstetrics, Gynecology & Newborn Care, University of Ottawa, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Sylvain Boet
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, General Campus, 501 Smyth Rd, Critical Care Wing 1401, Ottawa, Ontario, K1H 8L6, Canada.
- Department of Innovation in Medical Education, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.
- Francophone Affairs, Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.
- Faculty of Education, University of Ottawa, 145 Jean-Jacques-Lussier Private, Ottawa, ON, K1N 6N5, Canada.
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18
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Stephenson AL, Diehl AB, Dzubinski LM, McErlean M, Huppertz J, Sidhu M. An Exploration of Gender Bias Affecting Women in Medicine. Adv Health Care Manag 2021; 20:77-95. [PMID: 34779186 DOI: 10.1108/s1474-823120210000020004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Women in medicine face barriers that hinder progress toward top leadership roles, and the industry remains plagued by the grand challenge of gender inequality. The purpose of this study was to explore how subtle and overt gender biases affect women physicians, physician leaders, researchers, and faculty working in academic health sciences environments and to further examine the association of these biases with workplace satisfaction. The study used a convergent mixed methods approach. Sampling from a list of medical schools in the United States, in conjunction with a list of each state's medical society, the authors analyzed the quantitative survey responses of 293 women in medicine. The authors conducted ordinary least squares multiple regression to assess the relationship of gender barriers on workplace satisfaction. Additionally, 132 of the 293 participants provided written open-ended responses that were explored using a qualitative content analysis methodology. The survey results showed that male culture, lack of sponsorship, lack of mentoring, and queen bee syndrome were associated with lower workplace satisfaction. The qualitative results provided illustrations of how participants experienced these biases. These results emphasize the obstacles that women face and highlight the detrimental nature of gender bias in medicine. The authors conclude by presenting concrete recommendations for managers endeavoring to improve the culture of gender equity and inclusivity.
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19
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Abstract
Obstetric anesthesiologists provide care under unique conditions, where frequently unscheduled cases demand flexibility in thinking and acting. And although most obstetric patients may be healthy, they can quickly deteriorate, necessitating rapid team diagnostic and treatment interventions. Examining decision making is a critical step in improving care to these patients. This article reviews evidence-based models of decision making both with individuals and with teams, and presents strategies to improve decision making under any circumstance.
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Affiliation(s)
- Rebecca D Minehart
- Obstetric Anesthesia Division, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRJ 440, Boston, MA 02114, USA.
| | - Daniel Katz
- Department of Anesthesiology, Perioperative & Pain Medicine, The Mount Sinai Hospital, 1 Gustave L. Levy Place, New York City, NY 10029, USA
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20
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Rudolph JW, Pian-Smith MCM, Minehart RD. Setting the stage for speaking up: psychological safety and directing care in acute care collaboration. Br J Anaesth 2021; 128:3-7. [PMID: 34776122 DOI: 10.1016/j.bja.2021.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/12/2021] [Accepted: 09/18/2021] [Indexed: 11/19/2022] Open
Abstract
Managing a safe and efficient anaesthetic induction within a team involves the challenge of when, if, and how to surface, discuss, and implement the best plan on how to proceed. The Lemke and colleagues study in this issue of the British Journal of Anaesthesia is a unique view into real-world conversations that naturally occur in anaesthesia teams in moments of high task and cognitive load, such as induction of anaesthesia. The study spotlights important small moments of physician, nurse, and trainee team coordination. It illuminates key patterns of conversation in naturally occurring anaesthesia teams, and raises important questions about what the speaking up standard should be and the psychological safety-shaping role consultants play in setting the norms for speaking up.
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Affiliation(s)
- Jenny W Rudolph
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Center for Medical Simulation, Boston, MA, USA.
| | - May C M Pian-Smith
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Center for Medical Simulation, Boston, MA, USA
| | - Rebecca D Minehart
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Center for Medical Simulation, Boston, MA, USA
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21
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Webster CS, Taylor S, Weller JM. Cognitive biases in diagnosis and decision making during anaesthesia and intensive care. BJA Educ 2021; 21:420-425. [PMID: 34707887 DOI: 10.1016/j.bjae.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- C S Webster
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - S Taylor
- Auckland City Hospital, Auckland, New Zealand
| | - J M Weller
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand.,Auckland City Hospital, Auckland, New Zealand
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22
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He B, He Q, Sarfraz M. Inclusive Leadership and Subordinates' Pro-Social Rule Breaking in the Workplace: Mediating Role of Self-Efficacy and Moderating Role of Employee Relations Climate. Psychol Res Behav Manag 2021; 14:1691-1706. [PMID: 34703333 PMCID: PMC8524254 DOI: 10.2147/prbm.s333593] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/06/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose Drawing on the Social Information Processing (SIP) theory, the study sought to examine the link between inclusive leadership and employees’ pro-social rule-breaking (PSRB) behavior through the mediating effect of self-efficacy. The study also investigates the moderating role of employee relations climate between inclusive leadership and self-efficacy. Methods The study’s sample size consists of 438 full-time corporate employees at 47 organizations from China. Statistical analysis methods were used for data analysis, such as Pearson’s correlation analysis, confirmatory factor analysis, and multilevel regression analysis. Results The results demonstrated that inclusive leadership positively affects PSRB behavior and self-efficacy. Furthermore, the employee relations climate moderate’s self-efficacy, which mediates the relationship between inclusive leadership and the PSRB behavior of employees. Conclusion This study determines the psychological factors causing PRSB behavior in light of inclusive leadership. In the context of SIP theory, the findings conclude that inclusive leadership fundamentally influences self-efficacy, encouraging employees to exhibit PSRB behavior. Furthermore, this study also explains the mediating and moderating effect of self-efficacy and employment climate, which shape PSRB behavior. Hence, this study contributes to the organizational behavior literature regarding PSRB behavior and inclusive leadership.
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Affiliation(s)
- Bin He
- School of Management, Guangdong University of Technology, Guangzhou, Guangdong, People's Republic of China
| | - Qinqing He
- School of Management, Guangdong University of Technology, Guangzhou, Guangdong, People's Republic of China
| | - Muddassar Sarfraz
- Department of Commerce & Business, Government College University Faisalabad, Layyah Campus, Layyah, 31200, Pakistan
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23
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Lemke R, Burtscher MJ, Seelandt JC, Grande B, Kolbe M. Associations of form and function of speaking up in anaesthesia: a prospective observational study. Br J Anaesth 2021; 127:971-980. [PMID: 34511257 DOI: 10.1016/j.bja.2021.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/29/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Speaking up with concerns in the interest of patient safety has been identified as important for the quality and safety of patient care. The study objectives were to identify how anaesthesia care providers speak up, how their colleagues react to it, whether there is an association among speak up form and reaction, and how this reaction is associated with further speak up. METHODS Data were collected over 3 months at a single centre in Switzerland by observing 49 anaesthesia care providers while performing induction of general anaesthesia in 53 anaesthesia teams. Speaking up and reactions to speaking up were measured by event-based behaviour coding. RESULTS Instances of speaking up were classified as opinion (59.6%), oblique hint (37.2%), inquiry (30.7%), and observation (16.7%). Most speak up occurred as a combination of different forms. Reactions to speak up included short approval (36.5%), elaboration (35.9%), no verbal reaction (26.3%), or rejection (1.28%). Speaking up was implemented in 89.1% of cases. Inquiry was associated with an increased likelihood of recipients discussing the respective issue (odds ratio [OR]=13.6; 95% confidence interval [CI], 5.9-31.5; P<0.0001) and with a decreased likelihood of implementing the speak up during the same induction (OR=0.27; 95% CI, 0.08-0.88; P=0.03). Reacting with elaboration to the first speak up was associated with decreased further speak up during the same induction (relative risk [RR]=0.42; 95% CI, 0.21-0.83; P=0.018). CONCLUSION Our study provides insights into the form and function of speaking up in clinical environments and points to a perceived dilemma of speaking up via questions.
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Affiliation(s)
- Rahel Lemke
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland; Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Michael J Burtscher
- School of Applied Psychology, Zurich University of Applied Sciences, Switzerland; Universtiy of Zurich, Switzerland
| | - Julia C Seelandt
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Bastian Grande
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland; Simulation Centre, University Hospital Zurich, Zurich, Switzerland
| | - Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland; ETH Zurich, Zurich, Switzerland.
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24
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Gill HK, Niederer RL, Danesh-Meyer HV. Gender differences in surgical case volume among ophthalmology trainees. Clin Exp Ophthalmol 2021; 49:664-671. [PMID: 34218497 DOI: 10.1111/ceo.13969] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/27/2021] [Accepted: 07/01/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The number of females in ophthalmology has steadily increased over recent decades. The aim of this study was to evaluate whether there is a difference in procedural volume and cataract surgery between male and female trainees in the Royal Australian and New Zealand College of Ophthalmologists (RANZCO). METHODS A longitudinal retrospective review of de-identified surgical RANZCO trainee logbook data from 2008 to 2020 was undertaken. Data from 241 trainee logbooks were analysed for: location of training, gender, date of commencement of training, maternity/paternity leave status, number of surgeries observed, assisted, supervised and unsupervised. Surgical cases were grouped as: (1) all surgical cases; (2) complete cataract cases and (3) partial cataract cases. RESULTS Among 241 trainees (40.7% females), 197 263 procedures were performed. Total surgical volume was 21.1% lower at 4 years for females (median 665.5 vs. 843.5; p = 0.036). Completed cataract surgery was 21.5% lower at 18 months (median 87.5 vs. 111.5; p = 0.022) and 41.7% lower at 4 years (median 216 vs. 369; p < 0.001). Interrupted training was significantly more common in females (30.6% vs. 0.7%; p < 0.001). However, linear regression analysis did not identify parental leave or duration as a significant predictor for number of completed cataracts (p = 0.206). Complication rate was not different between males and females (p = 0.35). CONCLUSIONS Female trainees completed 41.7% fewer cataract operations at the end of their training compared to male counterparts with the gap widening between years 1 and 4 of training. The current data demonstrates that female and male RANZCO trainees are not receiving equivalent operating experiences.
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Affiliation(s)
- Hannah K Gill
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand
| | - Rachael L Niederer
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand
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25
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Ngai J, Capdeville M, Sumler M, Oakes D. A Call for Diversity: Women and Cardiothoracic Anesthesiology Fellowship Education. J Cardiothorac Vasc Anesth 2021; 36:66-75. [PMID: 34330578 DOI: 10.1053/j.jvca.2021.06.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/11/2021] [Accepted: 06/25/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Jennie Ngai
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Langone Health, New York, NY.
| | - Michelle Capdeville
- Department of Cardiothoracic Anesthesia, Cleveland Clinic Lerner College of Medicine, Anesthesiology Institute, Department of Cardiothoracic Anesthesia-J4, Cleveland Clinic, Cleveland, OH
| | - Michele Sumler
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
| | - Daryl Oakes
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
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26
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Sex and gender differences in anesthesia: Relevant also for perioperative safety? Best Pract Res Clin Anaesthesiol 2020; 35:141-153. [PMID: 33742574 DOI: 10.1016/j.bpa.2020.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/03/2020] [Indexed: 12/20/2022]
Abstract
Sex (a biological determination) and gender (a social construct) are not interchangeable terms and both impact perioperative management and patient safety. Sex and gender differences in clinical phenotypes of chronic illnesses and risk factors for perioperative morbidity and mortality are relevant for preoperative evaluation and optimization. Sex-related differences in physiology, as well as in pharmacokinetics and pharmacodynamics of anesthetic drugs may influence the anesthesia plan, the management of pain, postoperative recovery, adverse effects, patient satisfaction, and outcomes. Further studies are needed to characterize outcome differences between men and women in non-cardiac, cardiac, and transplantation surgery in order to individualize perioperative management and improve patient safety. Transgender patients represent a vulnerable population who need special perioperative care. Gender balance increases team performance and may improve perioperative outcomes.
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27
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Long J, Jowsey T, Garden A, Henderson K, Weller J. The flip side of speaking up: a new model to facilitate positive responses to speaking up in the operating theatre. Br J Anaesth 2020; 125:1099-1106. [PMID: 32943191 DOI: 10.1016/j.bja.2020.08.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/30/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Speaking up is important for patient safety, but only if the concern raised is acknowledged and responded to appropriately. While the power to change the course of events rests with those in charge, research has focussed on supporting those in subordinate positions to speak up. We propose responsibility also rests with senior clinical staff to respond appropriately. We explored the perceptions of senior staff on being spoken up to in the operating theatre (OT), and factors moderating their response. METHODS We undertook interviews and focus groups of fully qualified surgeons, anaesthetists, nurses, and anaesthetic technicians working in OTs across New Zealand. We used grounded theory to analyse and interpret the data. RESULTS With data from 79 participants, we conceptualise three phases in the speaking up interaction: 1) the content of the speaker's message and the tone of delivery; 2) the message interpreted through the receiver's filters, including beliefs on personal fallibility and leadership, respect for the speaker, understanding the challenges of speaking up, and personal cultural and professional norms around communication; and 3) the receiver's subsequent response and its effects on the speaker, the observing OT staff, and patient care. CONCLUSIONS The speaking up interaction can be high stakes for the whole OT team. The receiver response can strengthen team cohesion and function, or cause distress and tension. Our grounded theory uncovers multiple influences on this interaction, with potential for re-framing and optimising the speaker/receiver interaction to improve team function and patient safety.
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Affiliation(s)
- Jennifer Long
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Tanisha Jowsey
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Alexander Garden
- Department of Anaesthesia, Capital and Coast Health, Wellington, New Zealand
| | - Kaylene Henderson
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand; Department of Anaesthesia and Perioperative Care, Auckland City Hospital, Auckland, New Zealand
| | - Jennifer Weller
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand; Department of Anaesthesia and Perioperative Care, Auckland City Hospital, Auckland, New Zealand.
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28
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Barry TM, Janjua H, Cousin-Peterson E, Ottinger M, Kuo PC. WITHDRAWN: Battle of the sexes: The effect of surgeon gender on postoperative in-hospital mortality. Surgery 2020:S0039-6060(20)30533-X. [PMID: 32980167 DOI: 10.1016/j.surg.2020.07.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/24/2022]
Abstract
The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Tara M Barry
- Department of Surgery, University of South Florida, Tampa, FL
| | - Haroon Janjua
- Department of Surgery, University of South Florida, Tampa, FL
| | | | - Mary Ottinger
- Department of Surgery, University of South Florida, Tampa, FL
| | - Paul C Kuo
- Department of Surgery, University of South Florida, Tampa, FL
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29
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Wong CA, Moonesinghe SR, Boer C, Hemmings HC, Hunter JM. Women in anaesthesia, a special issue of the British Journal of Anaesthesia. Br J Anaesth 2020; 124:e40-e43. [PMID: 31973824 DOI: 10.1016/j.bja.2019.12.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 12/31/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Cynthia A Wong
- Department of Anesthesia, University of Iowa, Iowa City, IA, USA.
| | - S Ramani Moonesinghe
- Surgical Outcomes Research Centre, Centre for Perioperative Medicine, University College, London, UK
| | - Christa Boer
- Faculty of Medicine, Department of Anaesthesiology, Amsterdam University Medical Centre, VU University, Amsterdam, the Netherlands
| | - Hugh C Hemmings
- Departments of Anesthesiology and Pharmacology, Weill Cornell Medicine, New York, NY, USA
| | - Jennifer M Hunter
- University of Liverpool, Department of Ageing and Chronic Disease, Liverpool, UK
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