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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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2
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Bhaumik D, Schlesinger MJ. How exposure to patient narratives affects stereotyped choices of primary care clinicians. PLoS One 2023; 18:e0295243. [PMID: 38060553 PMCID: PMC10703228 DOI: 10.1371/journal.pone.0295243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
In this paper, we examine whether patient narratives alter the impact of stereotyping on choice of primary care clinicians: in this case, the common presumption that female doctors will be more attentive to empathic relationships with patients. 1052 individuals were selected from a nationally representative Internet panel to participate in a survey experiment. Participants were given performance data about 12 fictitious primary care physicians, including a randomized set of narrative feedback from patients. We compared the choice of clinician made by participants who value bedside manner and were exposed to narratives in the experiment, compared to those valuing bedside manner who had not had this exposure. We estimated multivariate logistic regressions to assess whether exposure to patient comments that "disrupt" stereotypes influenced choice of physicians. Participants who saw patient comments and had previously reported caring about bedside manner had a 67% higher odds of choosing a female physician than those participants that did not see a patient comments, controlling for the content of the narratives themselves. When participants were exposed to patient comments that disrupt gendered stereotypes, they had a 40% lower odds of choosing a female physician. Simple exposure to patient narratives that do not clearly disrupt gendered stereotypes increased the likelihood of choosing a female clinician by priming attention to relational aspects of care. However, when the content of a sufficient proportion of patient comments runs counter stereotypes, even a minority of narratives is sufficient to disrupt gendered-expectations and alter choices.
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Affiliation(s)
- Deepon Bhaumik
- Department of Health Policy and Management, Yale University, New Haven, Connecticut, United States of America
| | - Mark J. Schlesinger
- Department of Health Policy and Management, Yale University, New Haven, Connecticut, United States of America
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3
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Xu AL, Humbyrd CJ, De Mattos CBR, LaPorte D. The Importance of Perceived Barriers to Women Entering and Advancing in Orthopaedic Surgery in the US and Beyond. World J Surg 2023; 47:3051-3059. [PMID: 37735223 DOI: 10.1007/s00268-023-07165-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Global perceptions of barriers to women in orthopaedics have not been assessed. The purpose of this study was to determine the importance of international barriers to women entering and advancing within orthopaedic surgery. METHODS An anonymous, online survey was distributed to women medical students, trainees, and practicing surgeons via Women in Orthopaedics Worldwide, the "Women in Ortho" Facebook page, and individual programmes. Participants were asked to rate perceived barriers to (1) pursuing training and (2) career advancement on a scale of 1-5, with 5 being the most important and relative to other barriers. Descriptive statistics and univariate analyses were employed. RESULTS The survey yielded 237 US (84.0%) and 45 international (16.0%) respondents. Per entering orthopaedic surgery, the most important barriers were male-dominated culture, lack of a strong women mentor, and lack of female representation at home institution. Compared with the US surgeons/trainees, international respondents cited greater societal disapproval (2.8 ± 1.2 vs. 3.4 ± 1.3, P = 0.01). Medical students assigned less importance to lack of exposure, more to lack of resources for creating competitive applications (P < 0.05). Regarding career advancement, lack of women leadership, family responsibilities, and gender-biased selection for promotion were the most important. International surgeons/trainees noted greater concern for societal disapproval (3.5 ± 1.5 vs. 2.6 ± 1.3, P = 0.003) and were more likely to rank sexual harassment in their top three (17.6 vs. 4.2%, P = 0.02). CONCLUSION While notable differences exist, there is striking similarity across countries and position levels in perceived barriers to women entering and advancing in orthopaedic surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Amy L Xu
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA.
| | - Casey J Humbyrd
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Dawn LaPorte
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA
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4
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He ZW, Wang C, Li Y, Danzeng A, Liu FB, Zhu Y, Shi JY, Ciren P, Yuan XY, Wu CX, Lan RH, Zhang BH. The state of female hepato-pancreato-biliary (HPB) surgeons in China: see us in operation theater with great prospects. HPB (Oxford) 2023; 25:1402-1410. [PMID: 37543474 DOI: 10.1016/j.hpb.2023.07.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/02/2023] [Accepted: 07/12/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE This study aims to investigate the proportion and distribution of female HPB surgeons in China, describe their current status, and analyze the possible barriers and challenges in their careers. METHOD Tertiary hospitals with the division of HPB in mainland China in 2021 were enrolled and surgeon demographic information was collected through the review of official websites and/or telephone interviews. RESULTS The majority of female HPB surgeons (72.92%) were located in the first or second-tier cities in mainland China, with an increasing number of new female HPB surgeons entering the field annually, particularly after 2005 (from 27 to 52 per 5 years). Despite no significant difference in academic backgrounds, female HPB surgeons initiated their careers at an earlier age and took a longer time to obtain chief titles (P < 0.05). Interestingly, female HPB surgeons performed laparoscopic complex HPB cases at a similar rate (95.42%) to their male counterparts and were more likely to specialize in endoscopic surgery (P = 0.021), with a similar ratio of obtaining administrative positions. CONCLUSION Minimally invasive surgery may provide females with unprecedented opportunities in the HPB surgery field. However, despite the increasing numbers of female HPB surgeons, the proportion remains low in China.
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Affiliation(s)
- Zheng-Wei He
- Hepatic Surgery Center, Institute of Hepato-pancreato-biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Chao Wang
- Hepatic Surgery Center, Institute of Hepato-pancreato-biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yong Li
- Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Awang Danzeng
- Hepatic Surgery Center, Institute of Hepato-pancreato-biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fu-Bin Liu
- Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Yuan Zhu
- School of Automation, China University of Geosciences, Wuhan, 430074, China
| | - Jia-Yu Shi
- Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Pingcuo Ciren
- Hepatic Surgery Center, Institute of Hepato-pancreato-biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao-Yin Yuan
- Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Cheng-Xian Wu
- Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Run-Hu Lan
- Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China
| | - Bin-Hao Zhang
- Hepatic Surgery Center, Institute of Hepato-pancreato-biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Division of Hepato-pancreato-biliary Surgery, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, 430064, China.
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5
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Ononuju UC, Morgan JB, Ode GE. The Role of Inclusion in Increasing Diversity and Retention Across Surgical Residencies: a Literature Review. Curr Rev Musculoskelet Med 2023; 16:557-562. [PMID: 37715927 PMCID: PMC10587044 DOI: 10.1007/s12178-023-09866-8] [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] [Accepted: 08/21/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE OF REVIEW Across surgical specialties, residencies are incentivized to improve program diversity, most often through recruitment of underrepresented minority (URM), women, LGBTQ, and disabled applicants. However, residency attrition remains high in these groups, highlighting the need for specific inclusion initiatives to improve retention and support for these cohorts. A better understanding of previous efforts at retention is paramount. This paper reviews the existing literature on inclusion and retention efforts in surgical residencies. RECENT FINDINGS A literature search was conducted using PubMed Central. Published articles were filtered based on date (2018-2023) and relevancy. Articles were evaluated holistically and focused on methods in increasing diversity and inclusion in residency retention. Through formal literature review focusing on pertinent research topic terms (i.e., inclusion, diversity, residency, surgery, retention), efforts that included inclusion initiatives, improving residency retention, and diversifying leadership were overarching themes. In recent years, there have been marked strides and improvements in encouraging resident diversity and inclusion. However, more widespread efforts with proven efficacy are needed in order to improve residency retention and to increase and maintain diversity in leadership in surgery.
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Affiliation(s)
- Ucheze C. Ononuju
- Department of Orthopaedic Surgery, Wellstar Kennestone Regional Medical Center, Marietta, GA USA
| | - Jakara B. Morgan
- School of Medicine, University of South Carolina-Greenville, Greenville, SC USA
| | - Gabriella E. Ode
- Sports Medicine Institute, Hospital For Special Surgery, New York City, NY USA
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6
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Ellingsen DM, Isenburg K, Jung C, Lee J, Gerber J, Mawla I, Sclocco R, Grahl A, Anzolin A, Edwards RR, Kelley JM, Kirsch I, Kaptchuk TJ, Napadow V. Brain-to-brain mechanisms underlying pain empathy and social modulation of pain in the patient-clinician interaction. Proc Natl Acad Sci U S A 2023; 120:e2212910120. [PMID: 37339198 PMCID: PMC10293846 DOI: 10.1073/pnas.2212910120] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/25/2023] [Indexed: 06/22/2023] Open
Abstract
Social interactions such as the patient-clinician encounter can influence pain, but the underlying dynamic interbrain processes are unclear. Here, we investigated the dynamic brain processes supporting social modulation of pain by assessing simultaneous brain activity (fMRI hyperscanning) from chronic pain patients and clinicians during video-based live interaction. Patients received painful and nonpainful pressure stimuli either with a supportive clinician present (Dyadic) or in isolation (Solo). In half of the dyads, clinicians performed a clinical consultation and intake with the patient prior to hyperscanning (Clinical Interaction), which increased self-reported therapeutic alliance. For the other half, patient-clinician hyperscanning was completed without prior clinical interaction (No Interaction). Patients reported lower pain intensity in the Dyadic, relative to the Solo, condition. In Clinical Interaction dyads relative to No Interaction, patients evaluated their clinicians as better able to understand their pain, and clinicians were more accurate when estimating patients' pain levels. In Clinical Interaction dyads, compared to No Interaction, patients showed stronger activation of the dorsolateral and ventrolateral prefrontal cortex (dlPFC and vlPFC) and primary (S1) and secondary (S2) somatosensory areas (Dyadic-Solo contrast), and clinicians showed increased dynamic dlPFC concordance with patients' S2 activity during pain. Furthermore, the strength of S2-dlPFC concordance was positively correlated with self-reported therapeutic alliance. These findings support that empathy and supportive care can reduce pain intensity and shed light on the brain processes underpinning social modulation of pain in patient-clinician interactions. Our findings further suggest that clinicians' dlPFC concordance with patients' somatosensory processing during pain can be boosted by increasing therapeutic alliance.
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Affiliation(s)
- Dan-Mikael Ellingsen
- Department of Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo0372, Norway
- Department of Psychology, Pedagogy and Law, School of Health Sciences, Kristiania University College, Oslo0107, Norway
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
| | - Kylie Isenburg
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
| | - Changjin Jung
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
- KM Research Science Division, Korea Institute of Oriental Medicine, Daejeon461-24, Republic of Korea
| | - Jeungchan Lee
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA02129
| | - Jessica Gerber
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
| | - Ishtiaq Mawla
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
| | - Roberta Sclocco
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA02129
- Department of Radiology, Logan University, Chesterfield, MO63017
| | - Arvina Grahl
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA02129
| | - Alessandra Anzolin
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA02129
| | - Robert R. Edwards
- Department of Anesthesiology, Brigham and Women’s Hospital, Boston, MA02115
| | - John M. Kelley
- School of Social Sciences, Communication, and Humanities, Endicott College, Beverley, MA02115
- Program in Placebo Studies & Therapeutic Encounter, Harvard Medical School, Boston, MA02215
| | - Irving Kirsch
- Program in Placebo Studies & Therapeutic Encounter, Harvard Medical School, Boston, MA02215
| | - Ted J. Kaptchuk
- Program in Placebo Studies & Therapeutic Encounter, Harvard Medical School, Boston, MA02215
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Massa, chusetts General Hospital, Harvard Medical School, Charlestown, MA02129
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA02129
- Department of Radiology, Logan University, Chesterfield, MO63017
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Wang Y, Liu C, Wang P. Patient satisfaction impact indicators from a psychosocial perspective. Front Public Health 2023; 11:1103819. [PMID: 36908420 PMCID: PMC9992178 DOI: 10.3389/fpubh.2023.1103819] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023] Open
Abstract
Background Patient satisfaction plays an important role in improving patient behavior from care, reducing healthcare costs, and improving outcomes. However, since patient satisfaction is a multidimensional concept, it remains unclear which factors are the key indicators of patient satisfaction. The purpose of this study was to verify whether and how patients' psychosocial perceptions of physicians influenced patient satisfaction. Method In China, 2,256 patients were surveyed on stereotypes of physicians, institutional trust, humanized perception, and communication skills, as well as patient expectations and patient satisfaction. The data were analyzed using structural equation modeling. Results Stereotypes, institutional trust, and humanized perception have an indirect effect on patient satisfaction through communication, and patient expectations have a direct effect on patient satisfaction. Conclusions "Patient-centered" communication is the key to improving patient satisfaction, while positive stereotypes at the societal level, standardization of organizational institutions, expression of the doctor's view of humanity in the doctor-patient interaction, and reasonable guidance of patient expectations are important for improving patient satisfaction.
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Affiliation(s)
- Yao Wang
- College of Education, Lanzhou City University, Lanzhou, China
| | - Chenchen Liu
- Department of Psychology, Shanghai Normal University, Shanghai, China
| | - Pei Wang
- School of Teacher Education, Honghe University, Mengzi, China.,Faculty of Education, East China Normal University, Shanghai, China
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Su F, Wang Y, Wu Q, Wang PJ, Chang X. The Influence of Stereotypes on Trust in Doctors from Patients' Perspective: The Mediating Role of Communication. Psychol Res Behav Manag 2022; 15:3663-3671. [PMID: 36544911 PMCID: PMC9762404 DOI: 10.2147/prbm.s389202] [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] [Received: 09/08/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose To investigate the relationship among patients' stereotypes of doctors, effectiveness of doctors' communication skills evaluated by patients, and patients' trust in doctors. Patients and Methods A cross-sectional survey with a total of 3289 patients from 103 hospitals in eastern, central and western China was conducted. Results There were strong correlations among patients' stereotypes, patients' evaluation on doctors' communication skills, and patients' trust (r = 0.50-0.67, p < 0.01 for all). Patients' trust was predicted by patients' stereotypes directly (β = 0.32, 95% CI: 0.27-0.37) and indirectly (β = 0.19, 95% CI: 0.16-0.23) through patients' evaluation on doctors' communication skills. Conclusion Both patients' stereotypes and patients' evaluation on doctors' communication skills have predictive effects on patients' trust. Patients' stereotypes are not only a direct predictor of patients' trust but also an indirect predictor via doctors' communication skills as a mediator. This national survey underlines the significance of patients' stereotypes, and emphasizes the importance of developing doctors' communication skills on patients' trust. In order to build a more trustful doctor-patient relationship, there should be a joint effort at social and individual level to reinforce positive impression and suppress negative stereotypes of doctors. As far as communication skills are concerned, doctors are encouraged to use helpful verbal and nonverbal techniques that benefit their profession impression management.
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Affiliation(s)
- Fan Su
- School of Foreign Languages, Tongji University, Shanghai, People’s Republic of China
| | - Yao Wang
- Faculty of Education, East China Normal University, Shanghai, People’s Republic of China
| | - Qing Wu
- Faculty of Education, East China Normal University, Shanghai, People’s Republic of China
| | - Pei-Juan Wang
- School of Foreign Languages, Tongji University, Shanghai, People’s Republic of China
| | - Xin Chang
- School of Foreign Languages, Tongji University, Shanghai, People’s Republic of China,Correspondence: Xin Chang, School of Foreign Languages, Tongji University, Shanghai, 200092, People’s Republic of China, Email
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Rutjens BT, Niehoff E, Heine SJ. The (im-)moral scientist? Measurement and framing effects shape the association between scientists and immorality. PLoS One 2022; 17:e0274379. [PMID: 36190951 PMCID: PMC9529126 DOI: 10.1371/journal.pone.0274379] [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: 05/20/2021] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
Recent years have not only seen growing public distrust in science, but also in the people conducting science. Yet, attitudes toward scientists remain largely unexplored, and the limited body of literature that exists points to an interesting ambivalence. While survey data suggest scientists to be positively evaluated (e.g., respected and trusted), research has found scientists to be perceived as capable of immoral behavior. We report two experiments aimed at identifying what contributes to this ambivalence through systematic investigations of stereotypical perceptions of scientists. In these studies, we particularly focus on two potential sources of inconsistencies in previous work: divergent operationalizations of morality (measurement effects), and different specifications of the broad group of scientists (framing effects). Results show that scientists are generally perceived as more likely to violate binding as opposed to individualizing moral foundations, and that they deviate from control groups more strongly on the latter. The extent to which different morality measures reflect the differentiation between binding and individualizing moral foundations at least partially accounts for previous contradictory findings. Moreover, the results indicate large variation in perceptions of different types of scientists: people hold more positive attitudes toward university-affiliated scientists as compared to industry-affiliated scientists, with perceptions of the 'typical scientist' more closely resembling the latter. Taken together, the findings have important academic ramifications for science skepticism, morality, and stereotyping research as well as valuable practical implications for successful science communication.
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Affiliation(s)
- Bastiaan T. Rutjens
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
- * E-mail:
| | - Esther Niehoff
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Steven J. Heine
- Department of Psychology, University of British Columbia, Vancouver, Canada
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10
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Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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11
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Jolbäck P, Rogmark C, Bedeschi Rego De Mattos C, Chen AF, Nauclér E, Tsikandylakis G. The Influence of Surgeon Sex on Adverse Events Following Primary Total Hip Arthroplasty: A Register-Based Study of 11,993 Procedures and 200 Surgeons in Swedish Public Hospitals. J Bone Joint Surg Am 2022; 104:1327-1333. [PMID: 35867715 DOI: 10.2106/jbjs.21.00744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stereotypes may prevail, but little is known about the influence that the sex of an orthopaedic surgeon may have on outcomes. In a recently published study, there were no differences in the rate of adverse events following total hip arthroplasties (THAs) performed by female or male orthopaedic surgeons. The objective of the present study was to investigate whether there was any difference in adverse events within 90 days following a primary THA performed by either a male or female surgeon in Sweden. METHODS A retrospective study was performed to evaluate primary THAs performed for osteoarthritis between 2008 and 2016 at 10 hospitals in western Sweden. Local hospital data were linked with the Swedish Hip Arthroplasty Register (SHAR) and with a regional patient register. Data collected from local hospitals and the SHAR included surgeon-related information (e.g., sex, annual volume, and level of training) and patient-related information (e.g., age, sex, and Elixhauser comorbidity index). Adverse events were retrieved from the regional patient register. The definition of adverse events followed the SHAR definition of adverse events. Mixed models were used to investigate the impact of surgeon sex on adverse events. RESULTS A total of 11,993 primary THAs were performed by 200 surgeons, of whom 17.5% were women. The proportions of adverse events within 90 days were similar for female (6%) and male (7%) surgeons. No association was found between surgeon sex and adverse events (adjusted odds ratio, 0.72; 95% confidence interval, 0.52 to 1.00) when all surgeons (both attendings and residents) were included in the analysis. A sensitivity analysis that included attendings only yielded similar results (adjusted odds ratio, 0.88; 95% confidence interval, 0.60 to 1.29). CONCLUSIONS Despite a small tendency toward lower rates of adverse events at 90 days after THAs performed by female surgeons, there was no significant association between surgeon sex and the risk of adverse events following THA. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Per Jolbäck
- Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Skaraborg Hospital, Skövde, Sweden
| | - Cecilia Rogmark
- Swedish Arthroplasty Register, Gothenburg, Sweden.,Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö/Lund, Sweden
| | | | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emma Nauclér
- Swedish Arthroplasty Register, Gothenburg, Sweden
| | - Georgios Tsikandylakis
- Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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12
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Galhotra S, Smith RB, Norton T, Mahnert ND. The surgical gender gap: the impact of surgeon gender in medicine and gynecologic surgery. Curr Opin Obstet Gynecol 2022; 34:256-261. [PMID: 35895969 DOI: 10.1097/gco.0000000000000788] [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: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the current literature evaluating the effect of surgeon gender on patient outcomes and satisfaction, and the impact of gender bias on female surgeons. RECENT FINDINGS The proportion of female physicians has increased in recent years, especially in Obstetrics and Gynecology. Recent literature assessing this impact supports equivalent or superior medical and surgical outcomes for women surgeons and physicians. It also reveals superior counseling and communication styles as perceived by patients. However, women in medicine receive lower patient ratings in competence, medical knowledge, and technical skills despite the existing evidence. Additionally, female physicians experience pay inequality, limited advancement opportunities, higher prevalence of microaggressions, and higher rates of burnout. SUMMARY Recognition of gender bias is essential to correcting this issue and improving the negative impact it has on female physicians, our patients, and the field of women's health.
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Affiliation(s)
- Sheena Galhotra
- Banner University Medical Center Phoenix, University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA
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Cheng W, Lin SY, Fan YH, Chen SW. Retrospective study of the differences in patient characteristics and revenue between male and female surgeons in Taiwan. Sci Rep 2021; 11:23744. [PMID: 34887512 PMCID: PMC8660838 DOI: 10.1038/s41598-021-03289-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/30/2021] [Indexed: 11/09/2022] Open
Abstract
Surgery is traditionally a male-dominated field, and gender differences exist despite the growing numbers of female surgeons. A handful of studies have evaluated the condition in Asian societies. We aimed to examine the difference between female and male surgeons in urology, general surgery, and gynecology by analyzing a nationwide, population-based database. We identified surgeons with a clinical experience of six to thirteen years between 1995 to 2013 from the National Health Insurance Research Database. We collected patient numbers and revenue per month in outpatient and inpatient care, as well as monthly numbers of surgeries conducted by female and male surgeons in urology, general surgery, and gynecology, for analysis. Original student’s t-test and wilcoxon rank sum test was used to compare the differences between female and male surgeons, and p values less than 0.05 were considered statistically significant. Female urologists and general surgeons had a significantly higher ratio of female patients in Taiwan. Female urologists had patient numbers, revenues, and numbers of surgeries comparable to male urologists. In contrast, female general surgeons had significantly less involvement in outpatient and inpatient care and had low monthly revenues. Female general surgeons contradictorily performed more oncological surgeries per month than males. However, the difference in numbers of oncological surgeries was not significant after excluding breast cancer surgeries. Female gynecologists had a similar amount of outpatients and outpatient revenue but significantly less inpatient care and numbers of surgeries per month. A gender-based gap exists among surgeons in Taiwan. The gap between females and males appeared narrower in urology than in general surgery and gynecology. Management of diseases related to female sex organs, including breast, were more common among female surgeons. Efforts should be made to decrease gender stereotypes, to ensure that patients receive the best care regardless of the sex of the surgeons.
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Affiliation(s)
- Weiming Cheng
- Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan.,Program in Molecular Medicine, School of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Biopharmaceutical Science, School of Life Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Urology, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shu-Yi Lin
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Yu-Hua Fan
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Program in Molecular Medicine, School of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Sheng-Wen Chen
- Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan. .,Urological Center, No.87, Tongde Road, Nangang District, Taipei, 11556, Taiwan.
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14
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Bunzli S. CORR Insights®: Clinician Facial Expression of Emotion Corresponds with Patient Mindset. Clin Orthop Relat Res 2021; 479:1924-1926. [PMID: 33835101 PMCID: PMC8373543 DOI: 10.1097/corr.0000000000001744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/03/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Samantha Bunzli
- Research Associate, The University of Melbourne, Department of Surgery, St Vincent's Hospital, Melbourne, Australia
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15
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Silva FCS, Cerqueira MMBDF, Mercês MCD, Magella FMS, Ruivo BBC, von Rautenfeld M, Aras R. Demographic and professional profile of Brazilian women in vascular surgery: final results. J Vasc Bras 2021; 20:e20210062. [PMID: 34456986 PMCID: PMC8366404 DOI: 10.1590/1677-5449.210062] [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] [Received: 04/25/2021] [Accepted: 06/13/2021] [Indexed: 11/22/2022] Open
Abstract
Background Gender diversity in health teams is associated with better productivity. As women’s participation in surgery has been growing, it is important to improve knowledge about the elements that guide their professional development. Objectives The aim of this study was to outline the demographic and professional features of female vascular surgeons in Brazil. Methods A cross-sectional study was designed, in which a questionnaire was made available online for 60 days. Invitations to participate were distributed by institutional e-mail sent from the Brazilian Society of Angiology and Vascular Surgery (SBACV) to associate women surgeons. Results are presented as numbers and percentages. Odds ratios and chi-square tests were used for analysis. Results From a total of 810 invitations sent out, 281 questionnaires were completed. The most prevalent age groups were 25-35 years (n = 115) and 36-45 years (n = 114). Among those who worked exclusively in the private sector, 79.8% had at least one board certification (OR: 0.76, 95% CI: 0.65-0.89; p = 0.001). Regarding workload distribution, 64.4% and 34.2% reported that they spend more time in the clinic and hospital, respectively. Respondents with more years of experience reported a predominance of office practice (p = 0.002). Although 67.3% (n = 189) had published scientific papers, 68% (n = 191) had never held leadership roles. Conclusions The study respondents consisted of highly qualified women surgeons with respect to training, certification, and scientific engagement, but they remain underrepresented in professional management positions. Surgical societies and health institutions should act to promote inclusive and diverse leadership.
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Affiliation(s)
| | | | | | | | | | | | - Roque Aras
- Universidade Federal da Bahia - UFBA, Salvador, BA, Brasil
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16
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Donohoe CL, Mohan HM. Pregnancy, parenthood and second-generation bias: women in surgery. Br J Surg 2021; 108:1-2. [PMID: 33640909 DOI: 10.1093/bjs/znaa014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 11/12/2022]
Affiliation(s)
- C L Donohoe
- National Centre for Oesophageal and Gastric Cancer, Trinity St James' Cancer Institute, St James' Hospital, Dublin, Ireland
| | - H M Mohan
- National Centre for Oesophageal and Gastric Cancer, Trinity St James' Cancer Institute, St James' Hospital, Dublin, Ireland.,Department of Colorectal surgery, St Vincent's University Hospital, Dublin, Ireland
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17
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Pradeep T, Melachuri S, Arun S, Ravipati A, Wang S, Zhang M, Errera MH, Fu R. Trends in Anti-VEGF Injection Medicare Part B Claims among Male and Female Ophthalmologists from 2012-2016. Semin Ophthalmol 2021; 36:628-632. [PMID: 33678125 DOI: 10.1080/08820538.2021.1890797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Compared to male ophthalmologists, female ophthalmologists have significantly reduced salaries, fewer faculty roles and authored publications, garnered less federal research funding, and achieved less editorial advancement. We aimed to use the most recently available Centers for Medicare and Medicaid Services data to characterize trends and differences in anti-VEGF reimbursements coded for by male and female ophthalmologists.Methods: We used Medicare Fee-For Service Provider Utilization and Payment Data: Part B Provider public use files for 2012-2016 to quantify service and reimbursement patterns for anti-VEGF injections between male and female ophthalmologists. Five outcome variables were studied: number of providers, average Medicare payment amount, total payment, number of services, and number of Medicare beneficiaries.Results: Number of services performed per female provider was 71.2% that of a male ophthalmologist in 2012, and this percentage did not change from 2012 to 2016 (95%CI [0.63, 0.804], [0.984, 1.04], respectively). Female providers had 76.1% of beneficiaries as males in 2012, and this percentage stayed constant throughout the years (95%CI [0.69, 0.84] and [0.99, 1.03], respectively). The total payment difference between female and males was $102,175 per provider in 2012, and this gap widened by $18,292 yearly (95% CI [-162599.17, -41760.47], [-33060.35, -3524.38], respectively).Conclusion: While male and female providers saw considerable increases in aflibercept services and payments in the 5-year period, the gap between male and female reimbursements widened significantly. Moving forward, analysis of large-scale Medicare datasets provides a tangible report card on how effective our attitudes and policies are in cultivating equal opportunity.
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Affiliation(s)
- Tejus Pradeep
- Johns Hopkins School of Medicine.,Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Samyuktha Melachuri
- Department of Ophthalmology, University of Washington, Seattle, WA, USA.,University of Pittsburgh, Pittsburgh, PA, USA
| | - Siddharth Arun
- Johns Hopkins School of Medicine.,Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Advaitaa Ravipati
- Johns Hopkins School of Medicine.,Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Serena Wang
- Johns Hopkins School of Medicine.,Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Matthew Zhang
- Johns Hopkins School of Medicine.,Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Marie Helene Errera
- Department of Ophthalmology, University of Washington, Seattle, WA, USA.,University of Pittsburgh, Pittsburgh, PA, USA
| | - Roxana Fu
- Johns Hopkins School of Medicine.,Department of Ophthalmology, University of Washington, Seattle, WA, USA.,University of Pittsburgh, Pittsburgh, PA, USA
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18
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Olson S, McAlpine H, Cain SA, Mitchell R, Olsson G, Drummond KJ. Editorial. International women leaders in neurosurgery: past, present, and what the future must look like. Neurosurg Focus 2021; 50:E2. [PMID: 33789238 DOI: 10.3171/2020.12.focus20949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sarah Olson
- 1Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, Queensland
| | - Heidi McAlpine
- 2Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, Victoria
| | - Sarah A Cain
- 2Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, Victoria
| | - Ruth Mitchell
- 3Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria.,4Walter and Eliza Hall Institute for Medical Research, Parkville, Victoria; and
| | - Gemma Olsson
- 5Department of Neurosurgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Katharine J Drummond
- 2Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, Victoria.,3Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria
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19
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Martinez KA, Keenan K, Rastogi R, Roufael J, Fletcher A, Rood MN, Rothberg MB. The Association Between Physician Race/Ethnicity and Patient Satisfaction: an Exploration in Direct to Consumer Telemedicine. J Gen Intern Med 2020; 35:2600-2606. [PMID: 32632788 PMCID: PMC7459065 DOI: 10.1007/s11606-020-06005-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patient satisfaction measures have important implications for physicians. Patient bias against non-White physicians may impact physician satisfaction ratings, but this has not been widely studied. OBJECTIVE To assess differences in patient satisfaction by physician race/ethnicity. DESIGN A cross-sectional observational study. PARTICIPANTS Patients seeking care on a large nationwide direct to consumer telemedicine platform between July 2016 and July 2018 and their physicians. MAIN MEASURES Patient satisfaction was ascertained immediately following the encounter on scales of 1 to 5 stars and scored two ways: (1) top-box satisfaction (5 stars versus fewer) and (2) dissatisfaction (2 or fewer stars versus 3 or more). To approximate the information patients would use to make assumptions about physician race/ethnicity, four reviewers classified physicians into categories based on physician name and photo. These included White American, Black American, South Asian, Middle Eastern, Hispanic, and East Asian. Mixed effects logistic regression was used to assess differences in patient top-box satisfaction and patient dissatisfaction by physician race/ethnicity, controlling for patient characteristics, prescription receipt, physician specialty, and whether the physician trained in the USA versus internationally. KEY RESULTS The sample included 119,016 encounters with 390 physicians. Sixty percent were White American, 14% South Asian, 7% Black American, 7% Hispanic, 6% Middle Eastern, and 6% East Asian. Encounters with South Asian physicians (aOR 0.70; 95% CI 0.54-0.91) and East Asian physicians (aOR 0.72; 95% CI 0.53-0.99) were significantly less likely than those with White American physicians to result in top-box satisfaction. Compared to encounters with White American physicians, those with Black American physicians (aOR 1.72; 95% CI 1.12-2.64), South Asian physicians (aOR 1.77; 95% CI 1.23-2.56), and East Asian physicians (aOR 2.10; 95% CI 1.38-3.20) were more likely to result in patient dissatisfaction. CONCLUSIONS In our study, patients reported lower satisfaction with some groups of non-White American physicians, which may have implications for their compensation, professional reputation, and job satisfaction.
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Affiliation(s)
- Kathryn A Martinez
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Ave, G10, Cleveland, OH, 44195, USA.
| | - Kaitlin Keenan
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Radhika Rastogi
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Joud Roufael
- Kent State University College of Public Health, Kent, OH, USA
| | - Adrianne Fletcher
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Mark N Rood
- Department of Family Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Ave, G10, Cleveland, OH, 44195, USA
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20
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Cultural Barriers for Women in Surgery: How Thick is the Glass Ceiling? An Analysis from a Low Middle-Income Country. World J Surg 2020; 44:2870-2878. [PMID: 32372142 DOI: 10.1007/s00268-020-05544-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study aimed to highlight cultural barriers faced by surgeons pursuing a surgical career faced by surgeons at a tertiary care hospital in Pakistan. As more females opt for a surgical career, barriers faced by female surgeons are becoming increasingly evident, many of which are rooted in cultural norms. In Pakistan, a predominantly Muslim-majority, low middle-income country, certain societal expectations add additionally complexity and challenges to existing cultural barriers. METHODS A cross-sectional survey was administered via e-mail to the full-time faculty and trainees in the Department of Surgery at the Aga Khan University Hospital, Karachi, Pakistan, from July 2019 to November 2019. RESULTS In total, 100 participants were included in this study, with the majority being residents (55.6%) and consultants (33.3%). 71.9% of female surgeons felt that cultural barriers towards a surgical career existed for their gender, as compared to 25.4% of male surgeons (p < 0.001). 40.6% of females reported having been discouraged by family/close friends from pursuing surgery, as compared to only 9.0% of males (p < 0.001). Moreover, a greater percentage of females surgeons were responsible for household cooking, cleaning and laundry, as compared to male surgeons (all p < 0.001). Lastly, 71.4% of female surgeons felt that having children had hindered their surgical career, as compared to 4.8% of males (p < 0001). CONCLUSION Our study shows that significant cultural barriers exist for females pursuing a surgical career in our setting. Findings such as these emphasize the need for policy makers to work towards overcoming cultural barriers.
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21
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Newman C, Templeton K, Chin EL. Inequity and Women Physicians: Time to Change Millennia of Societal Beliefs. Perm J 2020; 24:1-6. [PMID: 33482936 DOI: 10.7812/tpp/20.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Gender inequities date back thousands of years, with women expected to be caregivers at home and men expected to be leaders with occupations outside the home. In more recent history, women have trained in various professions, including medicine. Although the number of female physicians has risen consistently over the past several decades and half of US medical students now are women, gender inequities persist and are due, at least in part, to implicit (unconscious) biases held by doctors, other health care professionals, and patients and their families. Implicit biases negatively affect women in their medical careers and contribute to slower advancement, less favorable evaluations, underrepresentation in leadership positions, fewer invited lectures, lower salaries, impostor syndrome, and burnout. Despite efforts to address gender biases, studies in academic medical centers indicate no major change over a 20-year span. Management of implicit gender bias at the organizational level is imperative. Strategies include implicit bias training for doctors and other staff; development of a transparent and equitable compensation plan; and transparent processes for promotion and hiring, mentorship, and sponsorship of women physicians for grand rounds, lectureships, committees, leadership positions, and awards. Achievement of equity for women physicians requires effort and ultimately a culture change. Gender equity in the medical profession will lead to improved physician wellness, retention of women physicians, and improved access to and quality of health care.
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Affiliation(s)
- Connie Newman
- Division of Endocrinology and Metabolism, Department of Medicine, New York University Grossman School of Medicine, New York, NY.,Past President, American Medical Women's Association, Schaumburg, IL
| | - Kim Templeton
- Past President, American Medical Women's Association, Schaumburg, IL.,Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Eliza Lo Chin
- American Women's Association, Schaumburg, IL, and University of California, San Fransisco, San Fransisco, CA
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22
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The contribution of patients' presurgery perceptions of surgeon attributes to the experience of trust and pain during third molar surgery. Pain Rep 2019; 4:e754. [PMID: 31583364 PMCID: PMC6749897 DOI: 10.1097/pr9.0000000000000754] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/03/2019] [Accepted: 04/11/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Patients' feeling of trust in their surgeon may modulate the experience of pain during surgery. However, factors that contribute to patients' experience of trust during surgery remain underexamined. The current study examined the contribution of patients' impressions of surgeons' warmth and competence to their experience of trust and pain during wisdom tooth extractions. Methods: Patients (N = 135, 47% female) scheduled for a wisdom tooth extraction reported their current distress and impressions of their surgeon's warmth and competence after a brief introduction to their surgeon immediately before surgery. Immediately after their surgery, patients reported their experience of trust (feeling safe and in good hands) and pain during surgery. Path analyses modeled perceptions of surgeon warmth, competence, and their interaction as predictors of patients' experiences of trust and pain during surgery. Results: Higher perceived surgeon competence, but not warmth, predicted the experience of higher trust and lower pain during surgery. Perceived competence interacted with perceived warmth such that the competence–trust relationship was only significant at moderate to high levels of perceived surgeon warmth and failed to reach significance at lower levels of perceived surgeon warmth. Conclusion: These results indicate that patients feel greater trust in surgeons who are perceived as higher in competence and warmth, underscoring the importance of impression management in surgical care.
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23
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Evans SB, Cain D, Kapur A, Brown D, Pawlicki T. Why Smart Oncology Clinicians do Dumb Things: A Review of Cognitive Bias in Radiation Oncology. Pract Radiat Oncol 2019; 9:e347-e355. [PMID: 30905730 DOI: 10.1016/j.prro.2019.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
This review will discuss the (perhaps biased) way in which smart oncologists think, biases they can identify, and potential strategies to minimize the impact of bias. It is critical to understand cognitive bias as a significant risk (recognized by the Joint Commission) associated with patient safety, and cognitive bias has been implicated in major radiotherapy incidents. The way in which we think are reviewed, covering both System 1 and system 2 processes of thinking, as well as behavioral economics concepts (prospect theory, expected utility theory). Predisposing factors to cognitive error are explained, with exploration of the groupings of person factors, patient factors, and system factors which can influence the quality of our decision-making. Other factors found to influence decision making are also discussed (rudeness, repeated decision making, hunger, personal attitudes). The review goes on to discuss cognitive bias in the clinic and in workplace interactions (including recruitment), with practical examples provided of each bias. Finally, the review covers strategies to combat cognitive bias, including summarize aloud, crowd wisdom, prospective hindsight, and joint evaluation. More definitive ways to mitigate bias are desirable.
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Affiliation(s)
- Suzanne B Evans
- Yale University School of Medicine, Department of Therapeutic Radiology, New Haven, Connecticut.
| | - Daylian Cain
- Yale University School of Management, New Haven, Connecticut
| | - Ajay Kapur
- Northwell Health, Department of Radiation Medicine, New Hyde Park, New York
| | - Derek Brown
- University of California San Diego, Department of Radiation Oncology, San Diego, California
| | - Todd Pawlicki
- University of California San Diego, Department of Radiation Oncology, San Diego, California
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