Women in Medicine: The Limits of Individualism in Academic Medicine

"I don't know if I can keep doing this": a qualitative investigation of surgeon burnout and opportunities for organization-level improvement

Introduction

Burnout is a pressing issue within surgical environments, bearing considerable consequences for both patients and surgeons alike. Given its prevalence and the unique contextual factors within academic surgical departments, it is critical that efforts are dedicated to understanding this issue. Moreover, active involvement of surgeons in these investigations is critical to ensure viability and uptake of potential strategies in their local setting. Thus, the purpose of this study was to explore surgeons' experiences with burnout and identify strategies to mitigate its drivers at the level of the organization.

Methods

A qualitative case study was conducted by recruiting surgeons for participation in a cross-sectional survey and semi-structured interviews. Data collected were analyzed using reflexive thematic analysis, which was informed by the Areas of Worklife Model.

Results

Overall, 28 unique surgeons participated in this study; 11 surgeons participated in interviews and 22 provided responses through the survey. Significant contributors to burnout identified included difficulties providing adequate care to patients due to limited resources and time available in academic medical centers and the moral injury associated with these challenges. The inequitable remuneration associated with education, administration, and leadership roles as a result of the Fee-For-Service model, as well as issues of gender inequity and the individualistic culture prevalent in surgical specialties were also described as contributing factors. Participants suggested increasing engagement between hospital leadership and staff to ensure surgeons are able to access resources to care for their patients, reforming payment plans and workplace polities to address issues of inequity, and improving workplace social dynamics as strategies for addressing burnout.

Discussion

The high prevalence and negative sequalae of burnout in surgery necessitates the formation of targeted interventions to address this issue. A collaborative approach to developing interventions to improve burnout among surgeons may lead to feasible and sustainable solutions.

Past resources, future envisioning, and present positioning: how women who are medical students at one institution draw upon temporal agency for resistance

While women entering medical school are faced with a patriarchal system, they also enter into a community with other women and the potential for resistance. The purpose of this study is to use the theory of temporal agency to explore how first-year medical students who identify as women draw upon past, future, and present agency to resist the patriarchal system of medicine.The data for this study were drawn from the first year (October 2020-April 2021) of a longitudinal project using narrative inquiry to understand the socialization of women students in undergraduate medical education. Fifteen participants performed two interviews and a series of written reflection prompts about their childhood and medical school experiences, each lasting approximately 45 min.Participants' resistance drew on past resources, recognizing themselves as Other, which contributed to categorically locating themselves as part of a broader resisting community, even outside their institution. They also hypothesized future possibilities as part of resistance, either an ideal future where they would exercise power, or an unchanged one and the hypothetical resolutions they would use to manage it. Finally, they contextualized past and future in the present, identifying problems to make strategic decisions and execute actions.Our creative interweaving of the constructs of temporal agency, communal agency, and resistance allows us to paint a nuanced picture of how these women conceive of themselves as part of a larger group of women amidst the hierarchical, patriarchal structures of medical school while, at times, internalizing these hierarchies.

Exposure of medical students to sexism and sexual harassment and their association with mental health: a cross-sectional study at a Swiss medical school

OBJECTIVES

To assess the self-reported prevalence of sexism and sexual harassment at a Swiss medical school, and to investigate their association with mental health. Research hypotheses were an association between sexism/sexual harassment and poor mental health and a higher prevalence of sexism/sexual harassment in clinical rotations.

DESIGN

Cross-sectional study as a part of ETMED-L project, an ongoing cohort study of interpersonal competences and mental health of medical students.

SETTING

Single-centre Swiss study using an online survey submitted to medical students.

PARTICIPANTS

From 2096 registered students, 1059 were respondents (50.52%). We excluded 26 participants (25 due to wrong answers to attention questions, and 1 who did not answer the sexism exposure question). The final sample (N=1033) included 720 women, 300 men and 13 non-binary people.

MEASURES

Prevalence of self-reported exposure to sexism/sexual harassment. Multivariate regression analyses of association between being targeted by sexism or sexual harassment and mental health (depression, suicidal ideation, anxiety, stress, burnout, substance use and recent mental health consultation). Regression models adjusted for gender, academic year, native language, parental education level, partnership and an extracurricular paid job.

RESULTS

Being targeted by sexism or sexual harassment was reported by 16% of participants with a majority of women (96%). The prevalence increased with clinical work. After adjusting for covariates, we found association between being targeted by sexism/harassment and risk of depression (OR 2.29, 95% CI 1.54 to 3.41, p<0.001), suicidal ideation (B coefficient (B) 0.37, p<0.001) and anxiety (B 3.69, p<0.001), as well as cynicism (B 1.46, p=0.001) and emotional exhaustion (B 0.94, p=0.044) components of burnout, substance use (B 6.51, p<0.001) and a recent mental health consultation (OR 1.78, 95% CI 1.10 to 2.66, p=0.005).

CONCLUSIONS

Sexism and sexual harassment, although less common than usually reported, are behaviours of concern in this medical school and are significantly associated with mental health.

Advice for women considering a career in medicine: A qualitative study of women physicians' perspectives

BACKGROUND

Research has explored the problems that women encounter during a medical career; however, the advice that experienced women physicians would give to women who have not yet entered the field is needed to reveal how the medical work landscape is evolving and to provide real-world narratives to help career seekers make informed choices.

OBJECTIVE

By eliciting women's perspectives on their medical careers by asking them what advice they would give to aspiring women physicians. We aimed to reveal areas for improving career satisfaction of women physicians and to inform those who advise women considering a medical career.

METHODS

In this qualitative study, we used a phenomenological approach to conduct semi-structured one-on-one interviews with 24 women physicians to query the advice they would give to women contemplating a career in medicine.

RESULTS

Thematic analysis of interview transcriptions revealed 10 themes that women physicians communicated as being important to consider before deciding to become a physician. Although some advice had a cautionary tone, encouraging and practical advice was also conveyed. The most abundant themes concerned the centrality of patient care, a passion for practicing medicine, and the importance of planning. Other key topics included family and friends, self-reflection, life balance, finances, ethics, maintaining presence, and two overt cautionary statements.

CONCLUSION

Interviews revealed that meaning and purpose derived from a medical career and maintaining work-life balance are valued by some women physicians. Participants were encouraging in recommending medicine as a career choice for women, while highlighting some challenges.