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Jagelaviciute G, Bouwsema M, Walker M, Steer M, Dagnone D, Brennan E. "I am the doctor": gender-based bias within the clinical practice of emergency medicine in Canada-a thematic analysis of physician and trainee interview data. CAN J EMERG MED 2024; 26:249-258. [PMID: 38519829 DOI: 10.1007/s43678-024-00672-w] [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: 08/11/2023] [Accepted: 02/29/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES While women comprise about half of current Canadian medical students and physicians, only 31% of emergency medicine physicians identify as women and women trainees are less likely to express interest in emergency medicine compared to men. Gender-based bias continues to negatively impact the career choice, progress, and well-being of women physicians/trainees. Although instances of gender-based bias are well documented within other medical specialties, there remains a gap in the literature addressing the role of gender specific to the Canadian emergency medicine clinical environment. METHODS Using a qualitative study with a thematic analytical approach, participants were purposively and snowball sampled from a cross-section of centers across Canada and included emergency medicine attending physicians and trainees. A thematic analysis using an inductive and deductive approach was undertaken. All data were double coded to improve study trustworthiness. Descriptive statistics were used to characterize the study population. RESULTS Thirty-four individuals (17 woman-identifying and 17 man-identifying) from 10 different institutions across 4 provinces in Canada participated in the study. Six themes were identified: (1) women experience gender bias in the form of microaggressions; (2) women experience imposter syndrome and question their role in the clinical setting; (3) more women provide patient care to women patients and vulnerable populations; (4) gender-related challenges with family planning and home responsibilities affect work-life balance; (5) allyship and sponsorship are important for the support and development of women physicians and trainees; and (6) women value discussing shared experiences with other women to debrief situations, find mentorship, and share advice. CONCLUSIONS Gender inequity in emergency medicine affects women-identifying providers at all levels of training across Canada. Described experiences support several avenues to implement change against perceived gender bias that is focused on education, policy, and supportive spaces. We encourage institutions to consider these recommendations to achieve gender-equitable conditions in emergency medicine across Canada.
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Affiliation(s)
- Gabriele Jagelaviciute
- Undergraduate Medical Education, Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, ON, Canada.
| | - Melissa Bouwsema
- Department of Emergency Medicine, Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, ON, Canada
| | - Melanie Walker
- Undergraduate Medical Education, Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, ON, Canada
- Department of Emergency Medicine, Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, ON, Canada
- Department of Public Health Sciences, Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, ON, Canada
| | - Molly Steer
- Undergraduate Medical Education, Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, ON, Canada
| | - Damon Dagnone
- Department of Emergency Medicine, Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, ON, Canada
| | - Erin Brennan
- Department of Emergency Medicine, Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, ON, Canada
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Abstract
OBJECTIVE The objective of this study is to systematically synthesize the existing literature on the experiences of motherhood in female surgeons both during surgical training and as staff physicians, to identify knowledge gaps, and to provide recommendations for institutional changes to better support pregnant female surgeons. BACKGROUND There are disproportionately fewer medical students pursuing surgical specialties, as surgery is often seen as incompatible with childbearing and pregnancy. However, no review has summarized the published literature on the collective experiences of female surgeons in navigating motherhood. METHODS Four databases were searched and 1106 abstracts were identified. Forty-two studies were included and a thematic analysis was performed. RESULTS Four themes were identified: path toward motherhood (n=18), realities of motherhood (n=25), medical culture and its impact on career and family life (n=24), and institutional reproductive wellness policies (n=21). Female surgeons are more likely to delay motherhood until after training and have high rates of assisted reproductive technology use. Pregnancy during surgical training is associated with negative perception from peers, pregnancy complications, and scheduling challenges. Maternity leave policies and breastfeeding and childcare facilities are variable and often inadequate. Many female surgeons would agree that greater institutional support would help support women in both their roles as mothers and as surgeons. CONCLUSIONS Both female residents and staff surgeons experience significant and unique barriers before, during, and after motherhood that impact their personal and professional lives. Understanding the unique challenges that mothers face when pursuing surgical specialties is critical to achieving gender equity.
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Kemp A, Garland K, Graham E, Simpson A, Symonette C. Family Planning Among Canadian Plastic Surgeons and Trainees. Plast Surg (Oakv) 2023. [DOI: 10.1177/22925503221151187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: Despite increasing advocacy for family leave policies, few studies have described the current landscape and attitudes around family planning in Canadian plastic surgery. The purpose of this study was to survey Canadian plastic surgeons and trainees to examine their experience with family planning, parental leave, and breastfeeding. Methods: An anonymized survey was distributed to all members of the Canadian Society of Plastic Surgeons and all Canadian Plastic Surgery residents through their program administrators. Survey responses were recorded and analyzed through a customized REDCap™ database. Results were reported using descriptive statistics. Results: A total of 87 plastic surgeons and trainees completed the surgery. We found 72.3% of respondents had children; 67.8% felt their colleagues were supportive of parental leave; 45.6% felt that financial concerns affected their decision to take parental leave; 61.6% felt that their career did not influence the number of children they chose to have; 21.0% accessed fertility services and 9.8% used assisted-reproductive technologies; 80% of respondents who breastfeed felt they did not have enough time to pump at work, however, 79% did not experience any discrimination or criticism for pumping at work. Conclusion: Canadian plastic surgeons most often have children after completing training and choose to take shorter parental leaves as their careers progress. Parental leave and breastfeeding practices in the workplace are reported to have increased support from colleagues compared to previous literature. However, Canadian plastic surgeons continue to struggle with infertility and seek fertility services at rates higher than the general population.
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Affiliation(s)
- Austin Kemp
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Katie Garland
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Division of Plastic and Reconstructive Surgery, Western University, London, ON, Canada
| | - Elise Graham
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Division of Otolaryngology, Western University, London, ON, Canada
| | - Andrew Simpson
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Division of Plastic and Reconstructive Surgery, Western University, London, ON, Canada
| | - Caitlin Symonette
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Division of Plastic and Reconstructive Surgery, Western University, London, ON, Canada
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Siddiqui OM, Savla B, Chowdhary M, McAvoy S, Mishra M. From Beaming Cancer to Beaming Parent: Paternity Leave Experiences in Radiation Oncology. Int J Radiat Oncol Biol Phys 2022; 113:928-933. [DOI: 10.1016/j.ijrobp.2022.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/29/2022] [Accepted: 04/24/2022] [Indexed: 11/26/2022]
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Knaul FM, Arreola-Ornelas H, Essue BM, Nargund RS, García P, Gómez USA, Dhatt R, Calderón-Villarreal A, Yerramilli P, Langer A. The feminization of medicine in Latin America: 'More-the-merrier' will not beget gender equity or strengthen health systems. LANCET REGIONAL HEALTH. AMERICAS 2022; 8:100201. [PMID: 36778730 PMCID: PMC9903642 DOI: 10.1016/j.lana.2022.100201] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This viewpoint addresses the lack of gender diversity in medical leadership in Latin America and the gap in evidence on gender dimensions of the health workforce. While Latin America has experienced a dramatic change in the gender demographic of the medical field, the health sector employment pipeline is rife with entrenched and systemic gender inequities that continue to perpetuate a devaluation of women; ultimately resulting in an under-representation of women in medical leadership. Using data available in the public domain, we describe and critique the trajectory of women in medicine and characterize the magnitude of gender inequity in health system leadership over time and across the region, drawing on historical data from Mexico as an illustrative case. We propose recommendations that stand to disrupt the status quo to more appropriately value women and their representation at the highest levels of decision making for health. We call for adequate measurement of equity in medical leadership as a matter of national, regional, and global priority and propose the establishment of a regional observatory to monitor and evaluate meaningful progress towards gender parity in the health sector as well as in medical leadership.
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Affiliation(s)
- Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA,Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA,Fundación Mexicana Para la Salud, Mexico City, Mexico,Tómatelo a Pecho, Mexico City, Mexico
| | - Héctor Arreola-Ornelas
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA,Fundación Mexicana Para la Salud, Mexico City, Mexico,Tómatelo a Pecho, Mexico City, Mexico,Centro de Investigación en Ciencias de la Salud, Universidad Anáhuac, Mexico City, Mexico
| | - Beverley M. Essue
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA,Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Renu Sara Nargund
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA,Corresponding author.
| | - Patricia García
- Academic Department of Public Health, Administration and Social Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Roopa Dhatt
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA,Women in Global Health, District of Columbia, WA, USA,Division of General Internal Medicine, Department of Medicine, Georgetown University School of Medicine, District of Columbia, WA, USA
| | - Alhelí Calderón-Villarreal
- Global Health Program, University of California San Diego, La Jolla, CA, USA,Universidad Autónoma de Baja California, Tijuana, Baja California, Mexico
| | - Pooja Yerramilli
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Ana Langer
- Department of Global Health and Population, Women and Health Initiative, Harvard TH Chan School of Public Health, Boston, MA, USA
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McIlveen-Brown E, Morris J, Lim R, Johnson K, Byrne A, Bischoff T, Hurley K, Mann M, Menchetti I, Pardhan A, Pham C, Sheppard G, Zia A, Chan TM. Priority strategies to improve gender equity in Canadian emergency medicine: proceedings from the CAEP 2021 Academic Symposium on leadership. CAN J EMERG MED 2022; 24:151-160. [PMID: 35034336 DOI: 10.1007/s43678-021-00245-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/24/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Gender inequities are deeply rooted in our society and have significant negative consequences. Female physicians experience numerous gender-related inequities (e.g., microaggressions, harassment, violence). These inequities have far-reaching consequences on health, well-being and career longevity and may result in the devaluing of various strengths that female emergency physicians bring to the table. This, in turn, has an impact on patient healthcare experience and outcomes. During the 2021 Canadian Association of Emergency Physicians (CAEP) Academic Symposium, a national collaborative sought to understand gender inequities in emergency medicine in Canada. METHODS We used a multistep stakeholder-engagement-based approach (harnessing both quantitative and qualitative methods) to identify and prioritize problems with gender equity in emergency medicine in Canada. Based on expert consultation and literature review, we developed recommendations to effect change for the higher priority problems. We then conducted a nationwide consultation with the Canadian emergency medicine community via online engagement and the CAEP Academic Symposium to ensure that these priority problems and solutions were appropriate for the Canadian context. CONCLUSION Via the above process, 15 recommendations were developed to address five unique problem areas. There is a dearth of research in this important area and we hope this preliminary work will serve as a starting point to fuel further research. To facilitate these scholarly endeavors, we have appended additional documents identifying other key problems with gender equity in emergency medicine in Canada as well as proposed next steps for future research.
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Affiliation(s)
- Emma McIlveen-Brown
- Discipline of Emergency Medicine, Memorial University, 300 Prince Phillip Drive, St. John's, NL, A1B3V6, Canada.
| | - Judy Morris
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Kirsten Johnson
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada
| | | | - Taylor Bischoff
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Miriam Mann
- Stratford General Hospital, Western University, London, ON, Canada
| | - Isabella Menchetti
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alim Pardhan
- Division of Emergency Medicine, Departments of Medicine and Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Chau Pham
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Gillian Sheppard
- Discipline of Emergency Medicine, Memorial University, St. John's, NL, Canada
| | - Ayesha Zia
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Teresa M Chan
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
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