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 Table of Contents  
Year : 2020  |  Volume : 6  |  Issue : 4  |  Page : 337-398

The women in medicine summit: An evolution of empowerment in Chicago, Illinois, October 9 and 10, 2020: Event highlights, scientific abstracts, and dancing with markers

1 Division of Trauma and Critical Care, Northwestern Trauma and Surgical Initiative, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; International Student Surgical Network (InciSioN), Sint-Truiden, Belgium
2 Northwestern University Feinberg School of Medicine, Chicago, IL, USA
3 Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA
4 Division of Hematology and Oncology, University of Illinois Chicago, Chicago, IL, USA

Date of Web Publication24-Dec-2020

Correspondence Address:
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2455-5568.273937

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How to cite this article:
Madani K, Pendergrast T, Sundareshan V, Jain S. The women in medicine summit: An evolution of empowerment in Chicago, Illinois, October 9 and 10, 2020: Event highlights, scientific abstracts, and dancing with markers. Int J Acad Med 2020;6:337-98

How to cite this URL:
Madani K, Pendergrast T, Sundareshan V, Jain S. The women in medicine summit: An evolution of empowerment in Chicago, Illinois, October 9 and 10, 2020: Event highlights, scientific abstracts, and dancing with markers. Int J Acad Med [serial online] 2020 [cited 2023 Jun 5];6:337-98. Available from: https://www.ijam-web.org/text.asp?2020/6/4/337/273937

The inaugural Women in Medicine Summit (WIMS) took place in October 2019. The Conference's goal was to unite women across medical disciplines to discuss, design, and implement solutions to gender inequity and inequality in the profession. The world in which the Second Annual Summit took place was very different. At the time of the Conference (October 9–10, 2020), the novel coronavirus pandemic (COVID-19) had claimed the lives of over 200,000 Americans.[1] Women in medicine are disproportionately affected by the pandemic, they are more likely to be frontline clinicians, the physician pay gap may be exacerbated by COVID-19, with school and day-care closures, women physicians are burdened with increased household and childcare responsibilities, and women's academic productivity is dropping off during the pandemic.[2],[3],[4],[5] Based on these factors, it is more pressing than ever for gender equity advocates to meet and discuss current challenges and design actionable plans to mitigate the impacts of gender inequity in medicine.

In an effort to promote good social distancing practices and ensure the safety of all attendees, the 2020 conference was held virtually. Similar to the inaugural Conference, WIMS took place over 2 days and was preceded by a student preconference held for medical student volunteers. The 2020 student volunteers represented 21 institutions across three countries.

The WIMS Research Committee released a call for abstracts, perspective, and spotlight pieces for submission to be presented at the Conference and published in the International Journal of Academic Medicine. The research committee, consisting of physicians and course directors, reviewed submissions and selected nine original abstracts for presentation during the oral abstract session and 17 for the poster walkthrough. The winning oral and poster presentations were announced at the award ceremony on the final day of the Conference.

Abstract/Research Committee: Vidya Sundareshan, MD, MPH, FACP, FIDSA (Chair), Sheila Dugan, MD, Tochukwu M. Okwuosa, DO, Neelum Aggarwal, MD, Nancy Church, MD, Parul Barry MD, Samantha Wolfe, MD, Margaret Pichardo, MPH (MD, PhD candidate), Nisha Mohindra, MD, Lekshmi Santosh, MD, MA, Ashley Vavra, MD, Tiffany Leung MD, MPH, FACP, FAMIA, Katayoun Madani, MS, MD.

The 2020 WIMS abstract winners:

  1. Best Oral Presentation: Serena Dhaon, BSc, currently working as a clinical assistant with Dr. Vineet Arora and social media intern for the Illinois Medical Professionals Action Collaborative Team (IMPACT) on her abstract: Development of the Illinois Medical Professionals Action Collaborative Team
  2. Best Poster: Tiffany Leung, MD, MPH, FACP, FAMIA, currently an Assistant Professor, Faculty of Health, Medicine and Life Sciences, and PhD candidate, Care and Public health Research Institute, Maastricht University, Maastricht, The Netherlands, on her abstract: Women physicians in transition from early to mid-career.

Conference attendees were equally diverse. The Conference brought 454 women and men in medicine representing numerous disciplines together from eight countries, 35 states, and 160 institutions. New this year was the #HeForShe track, designed specifically for male allies seeking to improve their allyship in the context of gender equity efforts in medicine. Both days of the Conference consisted of plenary sessions, breakout sessions, oral abstract and poster presentations, virtual mentoring for students, trainees, and young faculty, and an award ceremony. Speakers included physicians, lawyers, educators, gender equity researchers, and medical trainees.

Award Committee: Julie Oyler, MD (Chair), Priya Kumthekar, MD, Vidhya Prakash, MD, FACP, FIDSA, Chrissy Babcock, MD, MSc, FACEP, FAAEM, Charu Gupta, MD, Ailda Nika, MD, Tina Sundaram, MD.

The 2020 WIMS #IStandWithHer Award winners:


Winner: Nancy Spector, MD, Tiffany Leung, MD, MPH

Honorable Mention: Archana Shrestha, MD, MS, Narjust Duma, MD, Rache Simmons, MD, Hilary Sanfey, MD


Winner: Peter Pang, MD

Honorable Mention: Mark Shapiro, MD, Gaby Weissman, MD


Winner: Linda Barry, MD

Honorable Mention: Nazineen Kandahari, Katherine LaFaver, MD

Social Media Engagement

Over the 48 h of the Summit, the #WIMStrongerTogether hashtag generated 23.7 million impressions on Twitter and the conference garnered over 45 million impressions overall.

  Preconference, Twitter Chat - October 8, 2020 Top

On the evening before the start of this year's WIMS, two preconference events were held. The first was a conference for student volunteers led by Dr. Ananya Gangopadhyaya. The preconference featured a keynote speech by Dr. Alexandra Mannix of SheMD, an online community of practice for women in medicine, who provided an overview of recent and landmark research about gender inequities in medicine as well as breakout sessions focused on the topics of residency applications and interviewing. This virtual preconference provided an opportunity for students to hear from speakers and engage in smaller breakout sessions, and 4th-year students were able to submit their ERAS applications for review and feedback from faculty. Student volunteers also received training in best practices of social media engagement during virtual conferences.

After the preconference, the Society of Hospital Medicine and WIMS hosted a “Grow Your Network” Twitter chat focused on Gender Equity and not losing ground during this pandemic. The chat garnered 5.49 million impressions on Twitter. The Grow Your Network was the partner event to the following evenings Know Your Network virtual social event that took place as a part of the Summit.

  Day 1: October 9, 2020 Top

On the 1st day of the WIMS, attendees, speakers, and exhibitors were welcomed by Dr. Shikha Jain. She opened the 2-day virtual Summit with data-driven evidence showing the on-going issue of the gender gap in healthcare. She described and the impact the COVID-19 pandemic has had on equity efforts and on widening the inequities and disparities across healthcare systems. She also introduced the “Third Shift,” the concept that much of the equity work that is undertaken is unfunded, underappreciated, completed during “free time” and predominantly completed by those marginalized parties that are most impacted [Exhibit 1].

Each day of the Summit began with a Keynote address. Day 1 Keynote was delivered by Dr. Darilyn Moyer, an infectious disease physician and the Executive Vice President and Chief Executive Officer of the American College of Physicians (ACP) and a visionary in implementing effective gender equity initiatives. Her talk focused on the need to move toward a more JEDI healthcare system (just, equitable, diverse, inclusive) [Exhibit 2]. After the keynote, Dr. Megan Ranney spoke on the necessity of utilizing “New Power” to move toward intentional change [Exhibit 3]. To lead effectively, developing a leadership action plan is essential and Dr. Linda Ginzel led attendees through constructive ways to “Choose Leadership” [Exhibit 4]. Dr. Nancy Spector addressed the “double pandemic” we are currently living through with the COVID-19 pandemic and racial injustice. She focused on the importance of allyship during this tumultuous time [Exhibit 5]. To close the AM sessions, Sarah Alter described the model of developing into a leader.

During the lunch hour, oral abstracts were presented in one virtual room in rapid-fire oral presentations. In parallel, a lunch session led by Drs. Jessi Gold and Arghavan Salles led a session on writing in medicine. Virtual individual mentoring sessions were also on-going during this time with mentors and mentees who had been assigned at the time of registration for the Conference, and a range of specialties and areas of expertise were represented.

Breakout sessions organized throughout the afternoon focused on topics ranging from financial health, cultivating success, advocacy efforts, and navigating through adversity.

In parallel to the Friday breakout sessions, Dr. Tom Varghese and Laurie Baedke, MHA, led the first HeForShe WIMS track. The key takeaway from these sessions was the need for actionable and intentional change from male allies to bring women up to leadership positions. A “holistic” approach for allyship is required including, but not limited to, attitudes, behavior, and willingness to have tough conversations with colleagues.

Attendees came together for a final plenary session led by Retired Lieutenant General Mark Hertling, a session focused on understanding the essential elements of leadership [Exhibit 6]. Dr. Shikha Jain closed day 1 with solutions for how to sponsor, mentor, and utilize innovative strategies to move toward closing the gender gap in healthcare [Exhibit 7]. This was followed by a poster walk with presentation and a virtual zoom networking “Know Your Network” reception with individual breakout rooms for attendees to interact on a more personal level.

  Day 2: October 10, 2020 Top

The 2nd day of the Summit began with opening remarks from Dr. Jain and a deeper dive into the impact implicit bias and microaggressions has had on gender equity efforts [Exhibit 8]. She also described strategies to account for disruptions in productivity during this pandemic utilizing the CV matrix. Dr. Bonnie Mason, an orthopedic surgeon and the Vice President of Diversity and Inclusion for the Accreditation Council for Graduate Medical Education, gave an inspiring and passionate keynote address discussing the necessity of intentionally addressing Diversity Equity and Inclusion initiatives and critically analyzing the performative versus the transformative. The morning continued with a unique topic of finding empowerment through alternative and supplementary opportunities. In the healthcare world, transitions can be challenging, whether the transition is internal and lateral, or transitioning to a new institution. Leaders and pioneers Drs. Vineet Arora and Sandi Lam shared their personal experiences and described strategies for executing a smooth transition plan. In developing into leadership positions, demystifying the process is a key [Exhibit 9]. Dr. Christy Lemak described the steps of leadership growth and competence and the necessity of a cognitive shift to lead effectively [Exhibit 10]. The morning session concluded with Laurie Baedke's powerful message of the importance of taking risks to advance [Exhibit 11].

Breakout sessions organized throughout the afternoon focused on topics ranging from navigating a path to thought leadership, making an impact, developing an elevator pitch, and allyship.

The attendees came together for a final plenary session led by Dr. Omayra Mansfield on the importance of trust for leadership success [Exhibit 12]. The Summit concluded with Dr. Jain inspiring and encouraging attendees to utilize the skills and lessons learned over the 48 h to make intentional personal, professional, and institutional changes to work toward empowering themselves and others over the next year until WIMS 2021 September 24–25 [Exhibit 13].


  Keynote Speakers Top

Darilyn Moyer, MD

Let's Get Loud: Time to Unleash a JEDI Healthcare Workforce

The Tsunami of data regarding systemic disadvantages and barriers to women and others underrepresented in the healthcare workforce is incontrovertible. It is essential that stakeholders in healthcare work together with our patients and communities to correct inequities for our patients and healthcare workforce. Health justice, becoming an antiracist organization, and achieving a diverse, equitable, and inclusive healthcare environment, should be a priority for all medical institutions.

Bonnie Mason, MD

A To Point or a Through Point

Diversity is not a monolith. Building a diverse program begins with a consideration of diversity across experiential (talents and abilities), cognitive (perspectives, experiences, and background), and demographics (culture, religion, race, gender, orientation, language preference, and socioeconomic status). Efforts to bring diversity into medicine must focus on transformative rather than performative change. Targeted interventions to support minoritized trainees yield great success.

  Breakout Sessions Top

[Exhibit 14] and [Exhibit 15] show a summary of the breakout sessions.

Leveraging Twitter to identify physician influencers and drive reputation and rankings, presented by James Sims III

There is a direct correlation between physicians' social media presence and institutional reputation and US News and World Report ranking. A key strategy in improving social media use in an academic center is to identify those physicians already active on social media and have them encourage their colleagues to join them on these applications. Twitter is a great place to start because it is more conversational than other applications.

Financial health for women, presented by Disha Spath, MD

Physicians need $2–3 million to retire. How do they get there? Dr. Spath discussed how many physicians don't have a specific financial plan, especially because many think that they can get away with saving money alone. Dr. Spath touched on the importance of disability insurance, wise investments, slashing debt, and diversifying sources of income.

Cultivating intentional success: Applying the power of a poised voice, presented by Stacy Wood

There are five pivotal attitudes that have the most impact on a woman's life: poised voice, confidence, fear, resilience, and motherhood/caregiver role. Ms. Wood encouraged session attendees to be “resilient and kind to [their] inner voice while approachable, non-apologetic, clear, and concise to [their] external voice.” Self-awareness and taking the time to define goals can help balance the inner and external voices [Exhibit 16].

From grassroots to great change: Starting a women in medicine group from the ground up, presented by Vidhya Prakash, MD, and Najwa Pervin, MD

Drs. Prakash and Pervin shared highlights of the grass-root journey of Southern Illinois University Medicine's Alliance for Women in Medicine and Science (AWIMS). AWIMS engaged both male and female mentors to support the four pillars of their organization: advocacy, awareness, professional development, and support and camaraderie. Leadership buy-in is essential to overcoming barriers to starting a Women in Medicine Group.

Getting involved in a national organization, presented by Neelum Aggarwal, MD

Women are underrepresented in the academic faculty despite equal training. When women are faculty, they earn less than their male peers. Retention of women faculty is also challenging because women are neither equally valued nor compensated, thus limiting earning potential and career advancement. Involvement in national organizations may provide opportunities for sponsorship for women, especially those in the middle of their careers.

Hacking your brain to let the leader emerge, presented by Allison Escalanate, MD

The experience of bias activates the flight or fight response, similar to being physically threatened. This makes the best performance in a leadership role challenging because physicians do their best work when the “social nervous system” is online. Sleep, exercise, friendship, pets, hugs, and play all use this system. When under threat of bias, engage with allies, breathe deep, and speak up, when appropriate [Exhibit 17].

Surgery and ergonomics: Maximizing your capacity, while protecting yourself, presented by Marissa Pentico and Audrey Tsao, MD

The heart of ergonomics is manipulation of your area to suit you. Do not manipulate yourself to fit the environment as this may lead to injury. Other keys to an injury-free surgery career include remaining in a neutral position as much as possible and taking intraoperative breaks as needed. Assessment of shoulder heights (are they similar or different to your assistants) is a good way to assess whether or not you are in a neutral position.

How identity shapes perceptions of wellness, burnout, and balance, presented by Elizabeth Métraux

The key to reducing burnout is about cultivating a community of connections - to patients, peers, and our purpose. Connection can take many forms but often needs to be intentional.

The resolution revolution: Advocacy through engagement-advancing gender parity at the local, regional, and national level, presented by Kathy Tynus MD, FACP, and Joanna Bisgrove, MD

Physicians can create widespread change through healthcare policy advocacy. Through healthcare advocacy efforts, physicians gain leadership skills and learn more about policy and how it affects their individual patients and practices.

Optimizing success with mentoring and sponsoring, presented by Ruth Gotian, PhD, EdD, MS

What is the difference between a role model, a coach, and a sponsor? A role model is someone you want to become, a coach talks to you, a mentor talks with you, and a sponsor talks about you. Women with mentors have an advantage; they have a longer career, more publications, more protected research time, and more money.

Navigating through adversity, presented by Kimberly Manning, MD, and Lawren Wooten, MS

Adversity is a state or instance of serious or continued difficulty or misfortune. Adversity is impossible to avoid in high-stress environments. There are many adverse outcomes of continued adversity, including burnout, errors, and damage to a trainee's self-image and confidence. To address these instances, everyone in medicine must call out adversity like it is, self-reflect, and must work through adversity in real time. Faculty and other leaders must use their power to advocate for change [Exhibit 18].

Cluing into confidence: Developing the confidence to lead, presented by Sarah Unterman, MD

Many women suffer from self-doubt, downplay their accomplishments, and underestimate their abilities. Women in medicine can gain confidence by putting themselves in the middle of the discussion, trying new things and opportunities, being themselves, being honest, and asking the hard questions.

Identifying and overcoming implicit bias, presented by Cheryl Pritlove, PhD, and Elizabeth Métraux

Most discussions about bias take place at the “micro level” of action when, in reality, all levels (micro, macro, meso) need to be addressed in tandem.

Leadership success - our action plan, presented by Sarah Alter

A competent leader develops and empowers individuals and groups, plans strategically, communicates authentically, inspires commitment, and leads change. Barriers to leadership success include problems with relationships, low-risk taking, difficulty managing career, inability to adapt, and narrow functional orientation.

Private practice 101, presented by Krishna Jain, MD

The benefits of private practice include independence and control over care delivery, no internal politics, and more time for family and extracurricular activities. The disadvantages of private practice include start-up and on-going expenses, patient base, on-call, management experience, and no fixed paycheck.

Learn how to make your elevator pitch, presented by Christy Lemak, PhD, FACHE

Women in medicine can actively network their way to a seat at a table when they are prepared to speak about their professional passions. All women should be prepared and practiced in discussing their successes and career goals. Keys to success for an elevator pitch include practicing how to deliver a meaningful autobiography in 30 s, including elements of their personality and how they plan on changing the world [Exhibit 19].

Owning your authority: Building credibility and leveling up in leadership, presented by Laurie Baedke, MHA

Leadership success depends on credibility, confidence, courage, and community and excels with self-awareness and emotional intelligence. To level up in leadership, clarify your brand, align performance to organizational priorities, manage up, telegraph your pass, and curate your circle.

Becoming a woman of impact, presented by Vineet Arora, MD

Becoming a woman of impact is achieved by defining and living a legacy, regardless of the path taken. Dr. Arora encouraged attendees to “lead from where you stand.” To be a woman of impact, women must be present and use their voices to live and advocate for their legacies.

Nonclinical careers/side gigs, presented by Nisha Mehta, MD

Physicians can use “side gigs” to reduce burnout and achieve financial freedom. There needs to be a cultural change in medicine and burnout that allows for new revenue streams outside medicine [Exhibit 20] and [Exhibit 21].

You can have your cake and eat it too, presented by Carlton Galbreath

When negotiating, focus on establishing informational advantage and emotional resonance. Stand tall, channel your most powerful self, and grow your whole pie-your slice will take care of itself.

Making an Illinois Medical Professionals Action Collaborative Team: Advocacy and leaning into the power of the physician mom, presented by Laura Zimmermann, MD, MS, and Eve Bloomgarden, MD

Physician moms, through the IMPACT, have the credibility and compassion to amplify healthcare workers' voices for policy changes and fight the “infodemic” of misinformation. Lift as you rise - amplify, recognize, and support each other.

Speaker training, presented by Rachel Caskey, MD, MAPP

There are several critical considerations for speakers who are preparing a presentation or lecture. Slide design can make or break a speech. Speakers should avoid a lot of background design, choose colors wisely, and space and size text for maximum comprehension. Body language, especially using hands and movement, is engaging if done well and distracting if overdone. Speakers should avoid filler words and make eye contact with the camera or audience as much as possible.

Breaking barriers for diverse women, presented by Niva Lubin-Johnson, MD, FACP

Proper advising, mentorship, and sponsorship for Black women are necessary at all levels: university, medical school, and after residency training. Aside from this type of support, Black women in academic spaces need safety and security to thrive.

HeForShe allyship, presented by David Smith, PhD, and Brad Johnson, PhD

The needle cannot be moved without strong HeForShe allies to move the mission forward. It is essential to link gender equity to leadership and create a culture where can be allies. To do that, it is necessary to reframe gender equity as a leadership issue instead of a “women's issue.”

Turning words into action in 1 min or less, presented by Teri Goudie

Leaders define a future that others cannot see even if they may not fully understand it. Leaders must be masters of hospitality. Because their audience cannot see their vision but can see the leader, it is essential that the leader is trustworthy. The cornerstones of turning words into action are relationships. A presentation is not about delivering messages. It is about giving people an experience that will touch their life in a sustainable way.

  Table of Exhibits Top

Table of Exhibits:

Exhibit 1: Women in Medicine Summit opening 3

Exhibit 2: Time to unleash a JEDI healthcare workforce 4

Exhibit 3: New power 4

Exhibit 4: Choosing leadership 5

Exhibit 5: Allyship, equity collaborative 5

Exhibit 6: Elements of leadership 6

Exhibit 7: Day 1 closing 7

Exhibit 8: Day 2 opening 8

Exhibit 9: Transitioning in leadership 8

Exhibit 10: Physician leadership development 9

Exhibit 11: Risk 9

Exhibit 12: Leadership success 10

Exhibit 13: Women in Medicine Summit 2020 closing 10

Exhibit 14: Day 1 breakout sessions summary 18

Exhibit 15: Day 2 breakout sessions summary 18

Exhibit 16: Breakout session by Stacy Wood 12

Exhibit 17: Hacking your brain to let the leader emerge 13

Exhibit 18: Navigating through adversity 14

Exhibit 19: Learn how to make your elevator pitch 15

Exhibit 20: Empowerment through alternative income streams 16

Exhibit 21: Nonclinical careers continued 16

  Inspirational Spotlight 1 Top


Marin E. Langlieb

Clinical Research Coordinator, Massachusetts General Hospital, Boston, MA, USA

Growing up, it was very clear to me that girls could do anything. I cannot tell you how many bright pink t-shirts I had in the elementary school with “Girl Power” written on them. How proud I was that my high school's freshman AP Bio class was 95% women, and how happy I was that as a pre-med student entering college, I knew that more women than ever before were entering medicine. And then, I wanted to be a surgeon, and those feelings shifted.

It started when I was a sophomore in undergrad, right on the cusp of the #Metoo movement, with a New Yorker cover that depicted an all-female surgical team fully dressed in their scrubs and winged eyeliner, symbols of medicine and femininity. The image made national headlines and inspired many female surgeons to recreate their own versions of the cover. It also inspired me to question why there was still such a dearth of women in surgery and to sift through academic papers, newspaper articles, and testimonies to find out what it was actually like to be a female surgeon.

Some of my findings. Yes, more women are going into medicine, but they are still more likely to be siphoned off into certain specialties.[1] A surprising number of people claim that female surgeons and doctors are not worth the investment as many will work part-time once they have kids. When researchers studied this claim, they found that it was incorrect – female surgeons on average worked the same number of hours as their male colleagues.[2] Yet, despite working similar hours, the researchers also found that female surgeons have lower academic ranks and are more likely to think that having children slowed their career advancement.[2] I began to realize that the lack of women in STEM academic positions was already evident in my own life. Out of all my pre-med bio and chem courses, I had two female professors, each of whom only taught for a half-semester.

A part of me did feel slightly defeated – was the work–life balance of being a surgeon still so much more demanding on women? However, I also found a lot of sources that offered me hope. I read about programs like one in Stanford's Emergency Department that allowed physicians to bank their hours doing extra duties for services such as premade meals and dry cleaning. The program, proposed by Jennifer Raymond, a professor of neurobiology, was met by praise by many in the department.[3] Another article I read compared OB/GYN training to other surgical trainings, both of which have unpredictable and long hours. Yet, while OB/GYN used to be male dominated, the field is now mostly women. These women paved the way for better work–life policies in surgery, such as pushing for formal maternity leave policies.[4] One research article even reported OB/GYN surgeons as having some of the lowest rates of burnout, depression, and work–life conflicts compared to several other surgical specialties.[5] Arguably, having more female surgeons not only is possible but truly also does matter.

Even more meaningful than all of my research was getting to shadow an incredibly accomplished orthopedic surgeon (by that time, I was well aware that orthopedic surgery has one of the lowest percentages of female surgeons). I watched as she commanded the room, teaching the two residents throughout the operation, performing the intricate and complex surgery, and when the operation was over, telling the family the surgery had been successful.

As we sat and talked in the hospital cafeteria after the procedure was finished, I told her some of my findings and how they had intimidated me. She stated while at times juggling her residency and family was difficult, it certainly was not impossible. In fact, she believes it made her a stronger person. As we continued to talk, about half an hour into our conversation, the surgeon apologized and mentioned that she had to go. It was time for her to pick up her son from school.

  References Top

  1. Active Physicians by Sex and Specialty, AAMC; 2017.
  2. Dyrbye LN, Shanafelt TD, Balch CM, Satele D, Sloan J, Freischlag J. Relationship between work-home conflicts and burnout among American surgeons: A comparison by sex. Arch Surg 2011;146:211-7.
  3. Balch CM, Shanafelt TD, Sloan JA, Satele DV, Freischlag JA. Distress and career satisfaction among 14 surgical specialties, comparing academic and private practice settings. Ann Surg 2011;254:558-68.
  4. Schulte B. Time in the Bank: A Stanford Plan to Save Doctors from Burnout. Washington Post; 20 August, 2015.
  5. Rangel EL, Smink DS, Castillo-Angeles M, Kwakye G, Changala M, Haider AH et al. Pregnancy and motherhood during surgical training. JAMA Surg 2018;153:644-52.

  Inspirational Spotlight 2 Top

To My Mentors Who Cared More Than They Needed to: Thank You for Showing Me That There Is No Such Thing as “Caring Too Much”

Dominique Feterman

Department of Medicine, University of Connecticut, Farmington, CT, USA

I cry a lot. Some people would say I cry “too much.” For years, I was made to feel that there was something wrong with me and that crying was not ok, thast I cared too much about everything. Then, I found several mentors who showed me that crying and caring “too much” can be a good thing.

When I was in my last years of medical school, I had to take some time off from school to work, save money, and help my family. Most of my classmates did not have the same worries, so they could not relate. Those were some of the darkest days of my life. My mom had moved to a different country; I was going through a bad breakup; my dad was in the process of forming a new family; and on top of that, I had to temporarily give up my dream of becoming a physician without any assurance that I would be able to return to school and graduate. However, amid all that darkness, I found the one person who would change everything. This person became my first mentor and sponsor; this person showed me that, though a smaller group of people, there are others who also care “too much.” This person was our Surgery Department Director. He learned early in my rotation that I would have to step away from medicine for some time. He expressed his disappointment of me not being able to continue, but he asked me something no attending had ever asked me before: “lease stay in touch.” Hence, I did and he became my very first mentor.

I would e-mail him every couple of months, and he would graciously answer, encouraging me and hoping that I would be able to go back to medical school. When I was finally able to resume medical school, he became my sponsor and advocated for me to get a scholarship. He encouraged me to do research and present at a major conference in the United States (U.S.). However, above all, he taught me (and continues to teach me) valuable lessons that have shaped my becoming the physician I am today. To my first mentor, my sponsor, my role model, thank you for teaching me to have an outstanding work ethic while remaining humble.

A few years later, I graduated (finally!). Inspired by my first mentor, I decided to teach at my medical school. While there, I was fortuitously introduced to who would become my second mentor and second “mom.” She also happened to care too much. She went above and beyond to make sure I had all the resources and support needed to match into residency in the U.S. To my second mom and mentor, my friend, and my cheerleader, thank you for welcoming me into her home and family with arms wide open, for advocating for me, and for teaching me so much more about life.

Right after I matched, I was contacted by my “peer mentor,” a postgraduate year 3 that I had not yet met. When I met her, I immediately liked her and soon we became close friends. To my peer mentor, my friend, my teacher, and my soul sister, I thank her for reminding me of what is important in life and for always listening to me patiently.

To my mentor, who day 1 of intern year, asked me with curiosity where I was from and never forgot; I thank him for making me feel seen when I felt invisible, for trusting me with his academic work and educational material when he retired.

To my mentor who showed me how to be assertive and kind at the same time, thank you for teaching me that we can shatter the glass ceiling if we work together and for inspiring me as a woman in medicine.

To the one who showed me how much she cared about her patients, not just as patients, but as people, remembering details about them at every visit, and making them feel special, thank you for teaching me to do the same with my patients.

To all mentors who cared more than they needed to, thank you for teaching me that there is no such thing as caring “too much.” Your legacy will live on as I try to teach others to care more than is needed to.

  Inspirational Spotlight 3 Top

Improving Staff/Learners' Lactation Experience

Heidi L. Borgwardt, Amy M. Seegmiller Renner

Department of Management Engineering and Consulting, Mayo Clinic, Rochester, MN, USA

Returning to work after giving birth can be challenging, particularly when access to lactation rooms is limited, and supervisors are not always supportive of an individual's decision to breastfeed. The Greater Leadership Opportunities for Women (GLOW) Mayo Employee Resource Group (MERG) – formed to promote, educate, and empower women by breaking down barriers, addressing unconscious bias, and increasing the engagement of women at Mayo Clinic – took on the challenge to increase access to lactation rooms and resources for staff/learners at Mayo Clinic's Rochester, MN Campus.

The GLOW MERG Lactation Workgroup kicked off in August 2018 with a membership representing all three shields – practice, education, and research. This collaborative effort focused initially on understanding the Mayo Clinic lactation policy, the number of lactation rooms on the Rochester Campus, and the legal requirements for lactation rooms. The Workgroup then partnered with Management Engineering and Consulting to conduct a survey of staff/learners on the Rochester Campus who were currently lactating or had been lactating within the last 12 months to understand needs regarding lactation spaces and identify major barriers to pumping. There were 1128 survey respondents, with 68% of respondents working in direct patient care.

Key findings included:

  • 84% of the respondents have had to extend their working hours to use lactation rooms
  • 80% of the respondents report that lack of access to lactation rooms affected their ability to perform their jobs
  • 77% of the respondents always or frequently arrived at a lactation room only to find it occupied.

These findings were used to create recommendations that were circulated for review and approval among institutional department diversity leaders, department chairs, and other staff/learners, with 93 people signing on as proponents. The recommendations also were endorsed by two key enterprise committees.

As a result, two groups were formed in July 2019 to address the identified barriers to lactation success:

  • Rochester Lactation Space and Equipment Subcommittee includes representatives from Education, Research, Environmental Services, Facilities, Human Resources, Information Technology, Room Reservations, and the GLOW MERG and is charged with:

    • Collaborating with the Practice, Research, Education, and Administration space committees in Rochester to advocate for dedicated lactation room spaces commensurate with the needs of staff/learners and contractors
    • Establishing and coordinating innovative lactation space standards
    • Reviewing and responding to opportunities to create new or renovate current spaces for staff lactation
    • Conducting data analysis in support of the planning and implementation of lactation spaces and related equipment
    • Providing standing committee management and accountability for the maintenance of, and operational support for, lactation spaces and equipment.

The subcommittee has begun the process to pilot several multi-stall lactation rooms across the Rochester Campus, although their openings have been delayed to COVID-19. These badge-access rooms will have shared sinks, lockers, and a refrigerator and freezer for staff/learner use. They are also working to identify how the institutional room scheduling system can be used to help staff/learners find available rooms quickly and easily.

  • Human Resources Lactation Workplace Practices Workgroup includes multi-site membership from Practice, Research, Education, Human Resources, and the GLOW MERG and is charged with:

    • Recommending best practice lactation policy and process for re-entry to work/school after the birth of a child. Creating back-to-work/school consults to establish support during pregnancy and manage supervisor and staff/learner expectations
    • Creating and delivering a curriculum for staff/learners and supervisor education and an on-going communications plan
    • Creating a pathway to address noncompliance with policy and practices.

The Workgroup helped revise the Mayo Clinic lactation policy to remove gender-specific language and references to infants since many individuals choose to breastfeed for longer time periods. They have also developed a checklist for supervisors to use as a guide to help staff/learners' transition back to work/school after giving birth and are in the process of developing educational videos and learning modules. The workgroup has also created a page on the external #WeAreMayoClinic website that provides lactation resources, answers to common questions, and location-specific information.

While still ongoing, the amount of progress made to-date on reducing the barriers to pumping and increasing the number of lactation spaces across the Rochester, MN Campus is having a real-time impact on improving the experience of lactating staff/learners at Mayo Clinic.

  Inspirational Spotlight 4 Top

Development of a Women's Leadership Group – Greater Leadership Opportunities for Women Mayo Employee Resource Group

Heidi L. Borgwardt, Amy M. Seegmiller Renner

Department of Management Engineering and Consulting, Mayo Clinic, Rochester, MN, USA

Professional networks and relationships are the foundation of many successful careers. Many of us begin to develop these career-building blocks during our college education, yet what happens after graduation when that sense of connectedness with your network is lost? You join together with colleagues and form an employee resource group (ERG).

Founded in 2015 by four recent university graduates, the Women Inspiring Leadership Development (WILD) Mayo ERG (MERG) was formed to create an inclusive community that connected the needs and interests of women in healthcare and facilitated the professional growth of employees by offering networking, mentoring, and career development resources. Membership was targeted toward women in premanagement and management roles with aspirations for promotion to leadership positions.

In 2017, the WILD MERG combined with the Women in Technology MERG to form the Greater Leadership Opportunities for Women (GLOW) MERG. This new MERG combined two emerging women's leadership groups into one powerhouse group that focused on leadership development, Science, Technology, Engineering and Mathematics (STEM), community outreach, mentoring/coaching, and networking. Led by a governing board consisting of three officers (chair, vice-chair, and secretary), an executive sponsor, and the committee co-leads from each of the five committees – Communications, Events, Membership, STEM, and Community Outreach, this all-volunteer board is responsible for setting the annual strategy for the MERG and coordinating events and activities for members designed to develop leadership knowledge, skills, and attributes. Since its founding, GLOW has delivered over 50 activities for its members that are strategically focused around career planning, networking, mentoring, and navigating the healthcare environment and Mayo Clinic organizational structure. These sessions were carefully developed and delivered through multiple platforms and formats, including TED Talks, book clubs, fireside chats, expert speakers, personal stories, Zoom meetings, and webinars. Postsession surveys were utilized to measure if attendees had learned something new and were subsequently able to apply the skills discussed, with 76% of respondents indicating that they planned to implement some of the tools demonstrated in the session. Most recently, GLOW has developed a podcast – The (G)LOWdown – to share knowledge, lessons learned, and stories from the trenches that shed light on the female leadership experience and engage all genders to promote, educate, and empower female leaders.

A key part of GLOW's community outreach activities is a partnership with the Jeremiah Program, an organization with the goal of bringing families led by single mothers out of poverty – two generations at a time. GLOW has created and delivered educational sessions for Jeremiah Program participants related to professional etiquette, resume writing, and interviewing skills and has provided volunteers to help with other program social activities, such as providing rides to a professional baseball game. A recent call for interest to provide meals for program families resulted in such an overwhelming response that GLOW was also able to donate welcome baskets for program participants as they moved into the Jeremiah Program housing.

GLOW has also moved into policy advocacy, with specific initiatives focused on parental leave, lactation rooms, and engaging men as allies for gender equity. This work has allowed GLOW leadership to expand the visibility of the MERG across the organization and has created multiple opportunities for GLOW to be recognized for its work at the executive levels of Mayo Clinic. This is due in part to the work of GLOW's executive sponsor – a key member of the senior leadership team who helps to guide and drive.

GLOW forward.

GLOW strives to be an inclusive group of all genders throughout Mayo Clinic and since its inception has grown to include over 975 members, with an average year-over-year growth of 53.93%. GLOW was awarded the Mayo Clinic Diversity Champion Award in 2017 and has been asked to share its operating practices with other MERGs across Mayo Clinic on several occasions. GLOW has also engaged in formal and informal mentoring with other MERG groups, including active partnerships with the Lesbian, Gay, Bisexual, Transgender, Intersex, Arab, Iranian Heritage, Chinese, and Somos Latinos MERGs.

The GLOW MERG has been instrumental in raising the profile of MERGs at Mayo Clinic and actively contributes to Mayo Clinic's strategic goals by breaking down barriers, addressing unconscious bias, and increasing the engagement of women at Mayo Clinic. As a result, MERG leaders are now considered to be part of the organization's leadership succession pool and are actively engaged in developing the organization's strategy for 2030.

  Reference Top

  1. Jeremiah Program; 29 July, 2020. Available from: http://jeremiahprogram. org. [Last accessed on 2020 Dec 08].

  Inspirational Spotlight 5 Top

A Lesson in Allyship

Farzanna S. Haffizulla

Department of Internal Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, Florida, USA

My quiet Sundays are often anchored in my memories of growing up in the beautiful Caribbean Islands of Trinidad and Tobago. Every Sunday, as a young child, I woke up to the fragrant, mesmerizing smell of my mother's home-cooked meals. Curried homegrown vegetables, savory fresh seafood and meat dishes, and steaming hot, glistening, and roti flatbreads always punctuated our weekends. My mother, Meharoon, a dedicated Charge Nurse at the San Fernando General Hospital in Trinidad, sacrificed her nights to balance work with family time. Often times, she would take me as a young child to the hospital with her on days that childcare was unavailable. I often snuck away from the nurse's station and explored the hospital. One of my earliest memories during these explorations was seeing so many children tethered to IVs and beeping monitors, and many of them crying with no family in sight. I remember my heart breaking for them as I was enveloped in feeling their suffering. I forced back my tears with wildly imaginative stories that I shared with my new friends. My favorite stories transformed each child into a fearless superhero with infinite powers to heal themselves and others. Seeing their faces light up in happiness for these momentary reprieves from their own pain and discomfort gave me infinite energy to continue my mission. This was a turning point in my life that planted my roots to become a physician.

My mother, Meharoon, was well respected by her peers and was often called upon to act on behalf of the entire medical team in times of grave need. She commanded the respect of all around her but always had the natural ability to empower her team and galvanize their support as aligned with the team's mission. In that setting, I never noticed any gender limitations and always felt that I can do and be anything that I put my mind to.

Immigrating to the US and now, reflecting on my own journey in medicine, I see many differences with regard to gender equity and biases in medicine and science. As a woman of color in medicine, I have faced many prejudices and encountered them at every step of my journey. One of these many instances occurred during my Medical Intensive Care Unit (MICU) rotations as an Internal Medicine resident. I was pregnant with my second daughter, Anisa, and was experiencing preterm labor. The senior resident on my team was an OB/GYN resident. I was initially thrilled to have her expertise just in case it was needed. Those hopeful thoughts were quickly vaporized by shock when she told me point blank that I need to stop faking my preterm labor to minimize my workload. She was intent on making my life difficult. I reminded her that I never asked for a decreased workload, and in fact, I continued to go above and beyond the call of duty. On one occasion, I was doubled over in pain and walked over to the OB unit for a quick fetal monitor check. The male resident called over to my MICU resident and relayed that I was there for any evaluation. All within earshot, I heard her say to him to tell me that I am fine and that I have nothing wrong with me. Without a second thought and despite the clear sizable contractions being recorded from the tocodynamometer strapped to my abdomen, this male resident proceeded to tell me that I was fine and that I should head back to the MICU as soon as possible. I was appalled and knew that I needed help. That afternoon, I wheeled myself on a rolling chair from patient to patient and ensured that I carefully managed each task to avoid harm to my growing baby. I reached out to my male attending and finally shared what I was enduring. He was horrified and took immediate action. My attending was a compassionate physician, father, husband, and immigrant himself. He announced to our team that insensitivity, prejudice, and inhumane behavior are intolerable. He removed this OB/GYN resident from our team and ensured that she engaged in implicit bias and sensitivity training. I felt that my voice was amplified, and that finally, through an intersectional leadership lens, my struggle was understood. I am eternally grateful to this extraordinary attending physician. Shared leadership, allyship, and an intersectional approach are crucial as we strive for gender equity, elimination of discrimination, and the dismantling of racial barriers. Humanism, compassion, and allyship are integral pillars in our quest for equity.

  Inspirational Spotlight 6 Top

>Compassion Is Never a Sign of Weakness

Johanna Vidal-Phelan

University of Pittsburgh Medical Center, Pittsburgh, PA, USA

Recently, I had the solemn opportunity of attending my 93-year-old paternal uncle's funeral. Honoring the life of such a remarkable man, surrounded by my family who will continue to love him dearly, was a special gift. Amid today's increasingly complex world, it is often a challenge to pause, to reflect, to take stock, and to seek moments of clarity. At a simple chapel, alongside family, we collectively and personally said goodbye to a man who marked both my father's life and consequently my life, forever.

My father immigrated from Cuba to the United States in the 1960s to escape Fidel Castro's Communist Government. As a part of the historic Operation Peter Pan, which the U.S. initiated to allow children to seek asylum as refugees initially in Florida and later throughout the country, my father was sent away from everything he knew in Cuba, with no guarantee of ever seeing his parents or his family again. Thankfully, my uncle Santiago was also able to escape and provided for my father while my grandparents stayed behind in Cuba, waiting for their own opportunity to leave. My uncle and aunt took on my teenage father, raising him alongside their own two children, helping to shape him into the man he is today. My father shared a powerful message at my uncle's funeral, poignantly reminding us all that the kindness of one man is everlasting and can transcend generations.

My uncle, having been a lawyer in Cuba, immigrated to the U.S. and became a Spanish teacher. Throughout his career, he demonstrated tenacity, perseverance, and resilience. My father, like my uncle, has lived a life of dedication, hard work, and generosity. My father has always modeled “true grit” and continually encourages my younger sister and me to achieve the highest levels of education and professional experience. Throughout the process of pursuing a career in medicine, completing my residency in pediatrics, and obtaining my healthcare-focused MBA, I have always felt a responsibility to continue the family legacy of determination. My father never asked me to be the smartest student in my class, but he always encouraged me to be the hardest working and most tenacious. He took the time to teach me that life is not only about your I.Q. but also what you do with the level of intelligence you have been blessed with. Hard work, determination, and asking the right questions always help.

As a healthcare leader today, I have the honor and privilege of working with so many talented and exceptionally intelligent individuals. Among the many challenges inherent to the healthcare industry, I am reminded that as a physician leader, compassion goes a long way. It is not a coincidence that recent studies support that allowing physicians the time and encouraging opportunities “to care” improve health outcomes and reduce instance of physician burnout. When patients perceive compassion from physicians, they develop greater trust in the medical profession. Unfortunately, I have also seen how an individual's compassion and kindness may be misinterpreted by others as a sign of weakness. Compassion is not an indication of a leader's vulnerability but rather a differentiator revealing inner strength and confidence. As a physician leader, your team looks up to you whether you are cognitively aware of it or not. Compassion can be contagious that can lead to a positive and flourishing work environment. If you desire a team that shares your vision, priorities, and work ethic, which is effective and high performing, compassion will always be part of the path to true and lasting success.

Physicians need to also demonstrate compassion with each other. The compassion expressed to my family and I in our time of grief will never be forgotten. This personal experience reinforced what I already knew that kindness and compassion need to be valued and encouraged in healthcare. I will not hesitate to go the extra mile for a team that understands and exemplifies the importance of helping others. Compassion is never a sign of weakness, but of greatness.

  Perspective Number 1 Top

Cultivating Courage and Connection

T. Lin, B. Alli1, K. Zeman2, S. Hingle3

Department of Medicine, University of California, San Diego Health Sciences, San Diego, CA (Voluntary Faculty), 1Department of Medicine, Mayo Clinic Alix School of Medicine, Mayo Clinic Arizona, Scottsdale, AZ, 2Medical Corps (FMF/SW), United States Navy, Uniformed Services School of the Health Services, Walter Reed National Military Medical Center, Bethesda, MD, 3Department of Medicine, SIU School of Medicine, Springfield, IL, USA


It lies within all of the hearts of 18 female physicians gathered in a room a few years ago.

Although we did not know each other, we had been convened for our leadership potential and asked to bring diverse perspectives from different regions, specialties, practice settings, and personal situations.

We were there for the Women's Wellness through Equity and Leadership (WEL) program: an innovative collaboration between six leading medical organizations (the American Academy of Pediatrics, American College of Physicians, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, American Psychiatric Association, and the American Hospital Association) and sponsored by The Physicians Foundation.

WEL was created to answer what an intentional investment in mentorship, sponsorship, and networking could do for early to mid-career female physicians. We explored topics within wellness, equity, and leadership development and examined their interconnectedness.

If the extra challenges that female physicians face are openly addressed during the crucial early to mid-career years, would that reduce the leakiness of the pipeline flowing into senior leadership roles?

Would it change our ability to survive the early career challenges and help us better navigate our career paths?

Would we have to choose between making the difference we wanted to in the world and our personal lives?

Is success, self-care, and a sense of well-being a possible combination?

What would we have to do to achieve these things?

And how much would we have to give up to lead?

Which brings us back to the room on that fateful autumn day?

First things first, we needed to face our fears.

Is there a more universal experience as a female physician than feeling fearful?

What united us was also holding us back from learning the answers we sought.

One by one, we gave voice to our fears and raised the “what if” questions.

What if I fail or look foolish?

What if I'm not good, smart, or brave enough?

What if I can't make the difference I want to?

What if I can't keep this up?

What if I disappoint others?

What if I'm not accepted?

What if I'm not loved?

What if the worst things I believe about myself are true?

Fear brought company too: anxiety, insecurity, shame, anger, and guilt.

Looking back, it was an effective way for a group of strangers to come together. Our willingness to be vulnerable allowed us to see how much we had in common with one another.

Next, we utilized tools to claim back our power from any limiting beliefs.

We followed that by defining our dreams, speaking them aloud, and putting them into writing.

As part of that process, we agreed to tell each other the truth and hold each other accountable. We would be honest when we saw someone selling herself short and encourage her to recognize her worth.

Language, presence, and confidence matter.

Through regular virtual and in-person meetings, and much communication in-between, we mentored each other as peers and shared our best practices, especially through setbacks.

Coupled with the highly respected and wise mentors and role models that taught and sponsored us, we became sisters, knowing that we would be stronger if we all rose together.

Over time, we would learn an important lesson: that our fears would never fully dissolve, but they would recede when we gained strength.

Moreover, we needed that strength – as a group and as individuals – for life happened on the way to our goals and dreams.

Career and relationship transitions, increasing roles and responsibilities, childbirth, childcare challenges, separations, deployments, and illnesses, to name a few.

Yet, amazing things also happened within our safe and courageous space. Progress came in fits and starts, but it was real. We pooled our resources. We took chances. Promotions were achieved. Initiatives were launched. Businesses were formed. Collaborations were built. Opportunities were shared.

Teaching each other negotiation skills led to more confidence and much better deals.

Fears about failure and worthiness turned into conversations about imposter syndrome and how it is temporary, and no one is immune.

That realization was a victory in itself.

We also made certain to celebrate and amplify our successes within our circle and beyond.

In doing so, we found ourselves transforming our fears instead of hiding behind them.

Make no mistake, we still experience fear, but we know how to put it in its place now.

Fear is no match for the resilient sisterhood we have built and become.

  Perspective Number 2 Top

Women's Experiences Must Shape Women's Healthcare

Lisa Shah

Department of Hematology and Oncology, Stanford Health Care, Palo Alto, CA

As we celebrate the 100th anniversary of women gaining the right to vote through the 19th amendment, I have been reflecting on both the progress and lack thereof around gender equity for all women. I often say that the one place women and men should not be treated the same is in healthcare. While we absolutely should be achieving equality in the workplace and home, at school and in job searches, and in the media and history books, women have different needs than our male counterparts when it comes to our health.

As a female physician, I remember distinctly my first experience with gender bias. Many of you know exactly what I am referencing – dressed in your white coat clearly labeling you as “Dr.,” the stethoscope draped around your neck, coffee cup in hand indicating your need for a post-call caffeine fix, but the patient still asks “are you my nurse?”

These biases take a different shape in board rooms. Surrounded by suits, everyone knows I am a physician. Now, I am reminded of my gender by watching a male colleague repeat the same point I just made and getting the credit, or being interrupted every third word, or worse still, hearing a male colleague chime in with “I think what you're trying to say is...”

These biases are a part of everyday life for female physicians, and we know that they are a part of the entire healthcare experience for female patients. Women are less likely to receive painkillers when reporting the same pain levels as men. Racial and gender biases contribute to the tragic American maternal mortality crisis. Diseases such as endometriosis that only affect women are grossly understudied and underdiagnosed. The differing symptoms women experience often are not taught to doctors, magnifying inequities in the care setting. Consequently, female patients report feeling dismissed and condescended to by doctors.

The problems are structural as well as clinical. OB-GYN, primary care, mental wellness, and physical therapy are siloed, despite their interdependence. For complete wellness, women must juggle three or more providers, locations, and insurance challenges. This system was never designed to work for women.

As we reflect on 100 years of voting rights and the challenges we still face as female healthcare professionals, we need to be the voice, not the echo. Like many of you, I have dedicated my professional and personal legacy to take my experiences of marginalization and convert them into a meaningful solution – a healthcare delivery model that is 100% centered around women's needs and their lives, dedicated entirely to achieving better healthcare outcomes. Without focusing on the health of women, the millions of things in this world that depend on women will simply fall apart. The onus is on us as leaders to figure this out.

Recently, I have been reading more and more about the reasons why so many things in life were built specifically for men. Cars. Vaccines. Apps. Smartphones. The time is now for this cycle to be broken in healthcare. Women's bodies and health needs are simply not the same as men's; they never will be. Women need a clinical care team that is there to help them become the healthiest version of themselves, not an outdated system designed to care for someone else. Access to this care also needs to be far more convenient than what we have grown accustomed to. Women should be able to intuitively seek help with everything from stress and anxiety to pregnancy and primary care. It should not be too much to ask for this all to be under the same roof or via telemedicine with a care team they know and trust.

These changes are not simply a “beautification” of healthcare. Building a system that integrates women's care needs, training doctors specifically in the unique aspects of women's health, setting standards for compassionate listening, and vastly improving the simplicity of accessing this care will lead to concrete improvements in women's health outcomes.

As the Chief Medical Officer of a national women's health provider, I am so thankful for the opportunity to build a completely new and better healthcare experience for women – one that all women deserve, regardless of age, race, income, or any other factor.

We are living in a time when women's voices, stories, and experiences are finally at the forefront, especially in healthcare. Now is the time for experiences of marginalization to become change that will empower generations of women. While the boundaries continue to exist, we need to continue to set our standards higher.

  Perspective Number 3 Top

Barriers to Breastfeeding in Medical Trainees

Michelle Gyenes

Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland

I was only a few months old when my dad drove me to the nearby hospital. Day after day, I would go on the short journey from my parents' house to the hospital, and after spending some time there, I would head home. I was not sick (quite the contrary): I did this trip for months on end so that I could be breastfed. My mom, a resident at the time, had few other options. I was shocked and disappointed to discover that 28 years later, women face similar barriers.

According to the World Health Organization, the American Academic of Pediatrics, the American College of Obstetricians and Gynecologists, and numerous other organizations, exclusive breastfeeding is recommended for the first 6 months of infancy.[1],[2],[3] However, this recommendation is seldom adhered to by female physicians, particularly residents, who often take shorter maternity leave periods and experience significant barriers to breastfeeding at work.[4] The most recent Global Breastfeeding Scorecard co-created by the UNICEF and the WHO reports that only 11% of countries support their recommendation of 18 weeks of fully paid maternity leave.[5] Notably, the United States is not part of that 11%.

In the limited body of existing research on breastfeeding during postgraduate medical education, the consistent finding was that these difficulties affected almost all mothers. Issues included lack of time for pumping, lack of appropriate facilities, and lack of support from their institutions.[4],[6] It is well established that physician mothers attribute cessation of breastfeeding to work-related factors.[4],[6],[7] While several of these factors are structural and related to time and space, breastfeeding is an often-stigmatized practice.

In 2011, the U.S. Surgeon General cited social norms and embarrassment as two major barriers to breastfeeding.[8] Fear of public shaming and sexualization further propagate existing stigma, preventing women from breastfeeding comfortably and safely.[8] Outside of the United States, public opinion related to breastfeeding is variable. Rates of breastfeeding in the United Kingdom are among the lowest in Europe.[9] Even in Ghana, where breastfeeding in public is a common practice, women report feeling stigmatized and uncomfortable.[10]

Female medical residents often feel as though they have to choose between their career and starting a family; existing stigmas surrounding breastfeeding are just one of the identified barriers.[11] These barriers persist within women's self-concepts, even if their colleagues do not feel as though breastfeeding affects the quality of her work. One study found that while 40% of medical trainees felt that their breastfeeding adversely affected the team, only 10% of co-residents agreed.[4]

There are a growing number of online support groups, both on social media and on personal blogs, that aim to reduce the stigma around breastfeeding, particularly in medical trainees. One example of an organization supporting physician mothers is drmilk.org, an online group with a membership of over 20,000 women in medicine.[12] However, the onus should not be on these working mothers to advocate for themselves.

On a positive note, this issue is being addressed at some residency programs. In 2018, the Accreditation Council for Graduate Medical Education mandated “clean and private facilities for lactation that have refrigeration capabilities, with proximity appropriate for safe patient care.”[13] The American Academy of Family Physicians put out a statement in 2013 outlining the required policies and supports necessary to support the needs of breastfeeding medical trainees, including the creation of lactation facilities, designated protected breast pump time, and facilitating a supportive environment.[14] Although these policies are an excellent and necessary first step, the underlying stigma should also be addressed.

As a medical student, I often hear my classmates and peers discussing their choice of future specialty as well as residency location based on family planning. A simple literature search shows that these conversations are all too common. Often, certain specialties are considered unrealistic based on these parameters. In one survey, 39% of female surgical trainees considered leaving residency during or after pregnancy, and 30% said that they would discourage female medical students from entering a career in surgery.[15] It is not only disappointing but also unacceptable that women, now comprising 51.5% of medical school matriculants in the United States, face such direct barriers to achieving their career and personal goals.[16] I urge postgraduate medical educators in all specialties to commit to supporting their physician mother trainees and take concrete steps toward eliminating the stigma and barriers associated with breastfeeding.

  References Top

  1. Eidelman AI, Schanler RJ. Policy statement: Breastfeeding and the use of human milk. Pediatrics 2012;129:827-41.
  2. World Health Organization. Guideline: Counselling of Women to Improve Breastfeeding Practices. World Health Organization; 2018. Available from: https://www.who.int/publications/i/item/9789241550468. [Last accessed on 2020 Aug 21].
  3. ACOG Committee Opinion No. 756 Summary: Optimizing support for breastfeeding as part of obstetric practice. Obstet Gynecol 2018;132:1086-8.
  4. Ames EG, Burrows HL. Differing experiences with breastfeeding in residency between mothers and coresidents. Breastfeed Med 2019;14:575-9.
  5. World Health Organization, UNICEF. Increasing Commitment to Breastfeeding through Funding and Improved Policies and Programmes: Global Breastfeeding Scorecard. World Health Organization, UNICEF; 2019. Available from: https://www.who.int/nutrition/publications/infantfeeding/global-bf-scorecard-2019/en/. [Last accessed on 2020 Aug 21].
  6. Melnitchouk N, Scully RE, Davids JS. Barriers to breastfeeding for US physicians who are mothers. JAMA Intern Med 2018;178:1130-2.
  7. Sattari M, Levine D, Neal D, Serwint JR. Personal breastfeeding behavior of physician mothers is associated with their clinical breastfeeding advocacy. Breastfeed Med 2013;8:31-7.
  8. U.S. Department of Health and Human Services. The Surgeon General's Call to Action to Support Breast Feeding. U.S. Department of Health and Human Services; 2011.
  9. Earle S. Factors affecting the initiation of breastfeeding: Implications for breastfeeding promotion. Health Promot Int 2002;17:205-14.
  10. Coomson JB, Aryeetey R. Perception and practice of breastfeeding in public in an urban community in Accra, Ghana. Int Breastfeed J 2018;13:18.
  11. Kin C, Yang R, Desai P, Mueller C, Girod S. Female trainees believe that having children will negatively impact their careers: Results of a quantitative survey of trainees at an academic medical center. BMC Med Educ 2018;18:260.
  12. Jones L, Lehmen K. MILK: Mothers Interested in Lactation Knowledge. Available from: https://www.drmilk.org/. [Last accessed on 2020 Aug 21].
  13. Accreditation Council for Graduate Medical Education. ACGME Common Program Requirements (Post-Doctoral Education Program). Accreditation Council for Graduate Medical Education; 2018.
  14. American Academy of Family Physicians. Breastfeeding and Lactation for Medical Trainees. American Academy of Family Physicians; 2019.
  15. Rangel EL, Smink DS, Castillo-Angeles M, Kwakye G, Changala M, Haider AH, et al. Pregnancy and Motherhood during Surgical Training. JAMA Surg 2018;153:644-52.
  16. Association of American Medical Colleges. 2019 FACTS: Applicants and Matriculants Data. Association of American Medical Colleges; 2019.

  Perspective Number 4 Top

First Smiles and Second Opinions

Jennifer L. Lycette

Hematology Oncology, Providence Oncology and Hematology Care Clinic, Seaside, OR

“She didn't even smile.”

This was the startling reply to my open-ended question with which I had learned to start all second-opinion consultations. “What is it that brings you to see me today?”

At their unexpected rejoinder, I became immediately self-conscious of my own facial expression. My smile laid bare. Uncomfortable and exposed to their scrutiny, I did not know how to respond. My face froze, the smile becoming brittle, a shield. For in truth, why should I – or any physician – display a smile if the news is bad? From their words, it was clear that my colleague had not greeted them with one. And that, to them, was the problem.

Second-opinion visits for advanced cancer can be complicated. The patient and their family can attach anger and blame to the first physician who revealed the diagnosis. Hoping, understandably, that the initial oncologist got it wrong.

However, this time, their anger at my colleague seemed to go beyond that.

“She was horrible,” the family continued to say to me. “Just horrible – not even a smile.”

I hoped my still-frozen expression hide my shock and puzzlement while I tried to gather my thoughts. There was nothing remotely horrible about my colleague, far from it. Her academic credentials and experience far outshone mine. If anything, she was the brave one to have the courage to be straight with her patients from the moment she walked into a room. Yet, this patient and their family had eschewed her care and instead come to see me, and all for what?

It would seem, for a smile.

I told myself there was perhaps a layer to their response that came from the normal human denial reaction to bad news. Anger is a common first step on the path of human grief. Yet, when I look back on this situation now, with the hindsight of over a decade of experience since, I cannot help but see something different.

If the first oncologist had been a man and had entered the room with an appropriately somber expression on his face, and then sat down and offered a kind and compassionate presence, all still with a befittingly serious set of his mouth, would these people have been in my examination room for a second opinion? Would they have labeled a man as “horrible” for not having a smile for them? (Or, as seems to be still the fashion in 2020, other misogynistic terms for confident women such as “mean” or “nasty?”) I think the answer is easily no.

As I proceeded with the consultation, a part of my mind asked myself, why did I enter the room with a smile? After all, I knew that I, too, was going to discuss with them the unfortunate, terminal nature of their illness. There was no facial expression that I, or any person, could make that would change that. Hadn't my colleague's choice of not smiling been in actuality the more appropriate approach?

I reviewed the diagnosis with them and explained that I, unfortunately, concurred 100% with my colleague on the expected prognosis and limited treatment options. There was more anger, and then, there were tears, and in the end, they thanked me.

All these years later, I am still not sure if they were thanking me for my professional opinion and expertise or for my smile.

When I think back on it, I wish now that I had not smiled. However, the truth is that it would have been hard for me, not to. I have been socially conditioned to smile, as a woman in our society, since practically birth.[1] When I meet a new patient. When I step into an elevator with a stranger. When I am introduced at a conference.

When I am addressed by my first name instead of my title. When I am mistaken for the nurse instead of the doctor. When I have to repeat myself multiple times at a meeting for my words to be heard. And even, apparently, when I am about to tell a fellow human being the worst news of their life.

I have been thinking a lot about this as I prepare to return to clinical work after taking a leave from practice (dating back before the pandemic). I have been wondering what it will be like to have to deliver life-altering news while wearing a mask, my expression hidden. When no one can see if I smile or not.

Moreover, I realized, perhaps, it will be a small relief. Because maybe, for all of my life, the smile has been the mask.

  Reference Top

  1. Smith RI. The Sexism of Telling Women to Smile. The Atlantic; 4 October, 2016. Available from: https://www.theatlantic.com/notes/2016/10/the-sexism-of-telling-women-to-smile/502826/. [Last accessed on 2020 Aug 20].

  Perspective Number 5 Top

Leadership Development Happens at the Intersection of Formalized Events and Female Bonding

Amy M. Seegmiller Renner, Heidi L. Borgwardt1

Department of Management of Engineering and Consulting, Mayo Clinic College of Medicine and Science, Mayo Clinic, 1Mayo Clinic, Rochester, MN, USA

Reflecting, where have you gained the most amount of growth in your leadership development? Was it from attending formal development events? Or from bonding with other females as you traverse the leadership jungle gym? Or was it a combination of both merging together at a blind intersection that holds enormous potential?

The ability for women and male allies to come together to bolster themselves and others along their leadership journey is essential. Providing a space for this within the healthcare environment is crucial. The utilization of employee resource groups (ERGs) can be a beneficial endeavor that allows employees to come together over a common dimension of diversity.[1] For women wanting to grow in their leadership acumen, an ERG focusing on leadership development can be just the place.

At the Mayo Clinic in Rochester, MN, the Greater Leadership Opportunities for Women Mayo ERG (GLOW MERG) provides the intersection for GLOW members to come together and learn in formal events while also allowing them to bond and share real-life experiences in a safe, informal environment. The often-unseen intersection of learning together in a formal education event and having coffee during an informally hosted chat is the sweet spot where leadership development occurs. The blind intersection can be difficult to see as well as to quantify; however, this is where the practice of applying what you have learned and networking with others can bolster your development overall. The GLOW MERG has recognized this sweet spot and reinforced these development times by hosting monthly formal leadership development events (e.g., interview skills, feedback, and authentic leadership) and monthly informal events (e.g., casual coffee sessions, Yammer discussions, and podcasts).

GLOW members have provided reflections on the importance of these crossroads:

Discussions with GLOW members during the leadership development lectures help shape my perspectives and future applications of the concepts. I have also become more confident in reaching out to other women in executive positions to ask for mentorship.

Each month, there are new and returning GLOW members at coffee. On hearing what others do at Mayo and the departments they work in, I have gained a better appreciation of my skills and strengths – how they benefit me in my role and continuing my career at Mayo.

The action items that I have taken from the noon GLOW talks have been really beneficial to my career planning. I believe that anyone would take away the awareness that building a network is something that you need to do for yourself actively. Finding opportunities to connect through your work role, stretch assignments, and committees outside your day-to-day work is a great way to do that and always emphasized at GLOW events.

I took my time to truly consider what it was I needed first; belonging, professional development, or otherwise. After careful review, I decided on GLOW and could not be happier! This group has provided all that I was searching for and more!

Being involved in a group like GLOW is part of my self-care plan, and I have gained so much in a short amount of time! I truly appreciate the diverse set of members and the welcoming, safe environment to be ourselves, all in an effort for betterment.

My favorite part of being a member of GLOW is acceptance. It did not matter that I was a part of the health system, and it did not matter my position or my experience; all that mattered was my passion for the purpose, which leads to belonging. I am inspired to do my best every day but am slowly allowing myself more learning opportunities to grow and develop, which this group has taught me. I have been able to obtain new professional and personal life skills that I strive to apply each and every day and continuously look to this group to learn more.

These written comments help reinforce the importance of offering formal and informal events to assist GLOW members, with finding their sweet spot and allowing them to traverse leadership development at their time and pace. Ultimately, GLOW will continue to harness the power of this intersection for optimal leadership development.

  Reference Top

  1. Pujo P. 7 Best Practices for Maximizing the Value of Employee Resource Groups (ERGs); 2019. Available from: https://www.affirmity.com/blog/7-best-practices-maximize-value-employee-resource-groups-ergs/. [Last accessed on 2019 Aug 13].

  Perspective Number 6 Top

Women in Medicine: A South Asian Perspective

Maryam Ali Khan, Sarah Nadeem1

Department of Surgery, CMH Lahore Medical College, Lahore, Punjab, 1Department of Internal Medicine and Endocrinology, Aga Khan University, Karachi, Sindh, Pakistan

Home to 1.8 billion people, South Asia boasts an ethnic, linguistic, and socioeconomic diversity unparalleled to any region in the world. However, underneath this rich cultural identity with strong family ties, a deep-rooted patriarchal society pervades beyond borders.

Women constitute 48% of the population; however, with an average remaining gender gap of 34.2%, South Asia is the second-lowest scoring region on global gender gap index.[1],[2]

Gender roles are woven in the fabric of South Asian culture, and nonconformity can have serious repercussions including divorce. Female literacy rates are 64%, which, although improved, still lag in comparison to men at 80%.[3]

Regardless, women have been relentlessly championing, breaking barriers, and triumphing since the first female doctor in South Asia, Dr. Kadambini Ganguly, an Indian doctor under the British Empire.[4]

While, in many countries, attracting women to medicine has been the focus, South Asia has a paradoxically high interest in medicine as a career among females due to respect, prestige, and gender appropriateness associated with women in the role of healers. Female doctors also have better matrimonial prospects.[5]

Despite a high rate of women pursuing medicine, it is not translating into an equitable workforce. Female medical students make up 70% of graduates in Pakistan, 60% in Bangladesh, 51% in India, and 50% in Sri Lanka.[6] However, registered doctors are far lower in comparison. Female representation is vastly absent as we move up the organizational hierarchy of the healthcare sector in hospitals, medical schools, or the Ministry of Health.

Problems that restrict women professionally are shaped by broader sociocultural and organizational issues. While women are encouraged to pursue medical education, career aspirations are largely molded by the wishes of the family, especially husband and in-laws. Stigmatization of night shift and working in remote areas with insufficient security further hinder the retention of these graduates as physicians. Furthermore, women seem to gravitate toward certain “female-friendly” specialties such as obstetrics/gynecology and pediatrics which is not conducive for the needs of the healthcare system.[7]

Women experience gender bias, unequal pay, and harassment with patronizing, gender-stereotyping comments from patients and colleagues at workplace.[8] An average gender pay gap of around 28% exists in the health workforce, and even with occupation and working hours accounted for, the gap remains at 11%.[9]

Despite an apparent disconnect in cultures between the East and the West, the gender stereotypes existing in the field of medicine are largely similar, even if, more widespread. Burden of roles traditionally associated with women such as housework, child-rearing without spousal support end up taking a toll on women forcing them to choose between career and family. Consequently, most end up choosing the latter to uphold the family traditions. Patriarchal culture is not limited to low-income countries with low literacy rate. Married Japanese women in medicine similarly struggle in finding their sense of identity and labeled as inferior physicians among other unmarried female physicians.[10]

While unrealistic to assume a cultural shift to happen overnight, women can be supported in their medical careers through contextually tailored solutions. Gender inequities in healthcare workforce are strongly emphasized in sustainable development goals to achieve universal health coverage. Telemedicine has risen as a potential solution in bridging this gap in addition to addressing the healthcare disparities in inaccessible areas. Sehat Kahani is such one initiative in Pakistan, led by nonpracticing female physicians who have successfully brought back 1500 in the workforce.[11] COVID-19 has demonstrated the essential role of telemedicine in healthcare systems around the world with a huge need to develop it further. In addition, women are essential as the healthcare workforce and shown to lead to a decrease in maternal mortality.[12]

However, more gender-sensitive organizational policies are needed including restructuring postgraduate training to allow flexible working hours, daycare centers, maternity, and paternity leaves.[13] Strong mentorship from female physicians and HeforShe allies is key in navigating these barriers. Women in medicine support groups have shown a positive impact in the US, and things are slowly picking up pace in South Asia. Newly established groups, Women in Global Health and Pakistan Women in Medicine (PWIM), aim to guide national reforms by organizing leadership events, policy, and strategy dialogs. PWIM with over 1000 members is a budding platform connecting female physicians for mentorship and professional growth and advocating for equal inclusion in institutions, conferences, committees, and leadership positions.

Finally, concerns over the feminization of the health workforce need to be replaced by discussion and organized efforts toward mentorship, sponsorship, and scholarship to build a gender-inclusive healthcare sector in South Asia.

  References Top

  1. World Bank. Population, female, South Asia. Available at Population, female - South Asia | Data (worldbank.org). [Last accessed on 2020 Oct 12].
  2. Forum WE. South Asia, Gender Gap Index; 2018.
  3. World Bank. Literacy Rate, South Asia. Available at Literacy rate, adult total (% of people ages 15 and above) - South Asia | Data (worldbank.org). [Last accessed on 2020 Oct 12].
  4. Bhadra M. Indian anthropological association Indian women in medicine: An enquiry since. Indian Anthropol Assoc Stable U 2017;41:17-43.
  5. Masood A. Influence of marriage on Women's participation in medicine: The case of doctor brides of Pakistan. Sex Roles 2019;80:105-22.
  6. Hossain P, Das Gupta R, YarZar P, Salieu Jalloh M, Tasnim N, Afrin A, et al. 'Feminization' of physician workforce in Bangladesh, underlying factors and implications for health system: Insights from a mixed-methods study. PLoS One 2019;14:e0210820.
  7. Mohsin M, Syed J. The missing doctors-an analysis of educated women and female domesticity in Pakistan. Gender Work Organ 2020;27:2. [Doi: 10.1111/gwao.12444].
  8. Manzoor F, Redelmeier DA. Sexism in medical care: “Nurse, can you get me another blanket?” CMAJ 2020;192:E119-20.
  9. Boniol M, McIsaac M, Xu L, Wuliji T, Diallo K, Campbell J. WHO Gender Equity in the Health Workforce: Analysis of 104 Countries. World Health Organization; 2019.
  10. Matsui T, Sato M, Kato Y, Nishigori H. Professional identity formation of female doctors in Japan - gap between the married and unmarried. BMC Med Educ 2019;19:55.
  11. Yusufzai A. Pakistan attracts 700 female doctors back into practice through online service. BMJ 2019;367:l6752.
  12. Ohannessian R, Duong TA, Odone A. Global telemedicine implementation and integration within health systems to fight the COVID-19 pandemic: A call to action. JMIR Public Health Surveill 2020;6:e18810.
  13. Shannon G, Jansen M, Williams K, Cáceres C, Motta A, Odhiambo A, et al. Gender equality in science, medicine, and global health: Where are we at and why does it matter? Lancet 2019;393:560-9.

  Perspective Number 7 Top

Maternity Leave Policies in Graduate Medical Education: How Does the United States Compare Internationally?

Meghana Babu, Heather M. Weinreich1

Medicine, College of Medicine, University of Illinois, 1Department of Otolaryngology, University of Illinois at Chicago, Chicago, IL, USA

Maternity leave remains ambiguous within graduate medical education in the United States. The current system is piecemeal; individual programs set forth guidelines based loosely on government policy and accreditation requirements.[1] As of July 2020, the American Board of Medical Specialties endorsed a 6-week standard leave policy without training extension that remains independent of vacation time or sick leave.[2] How does this proposed schema compare internationally?

Within Canada, female residents are entitled to 17 weeks of maternity leave with the opportunity to take an additional 35 weeks of parental leave.[3] This leave is compensated under Canada's Employment Insurance Program. In addition, each province provides a set of guidelines to ensure safe working conditions for pregnant residents.[3] Despite financial compensation, residents in Canada still face training extension for any maternity leave, as well as the guilt of additional workload on co-residents.[3]

The United Kingdom (UK) faces a decline of interest from medical trainees pursuing surgery.[4] Alternative strategies were implemented to increase recruitment and retention. Junior doctors are allowed 36 weeks of compensated pay as well as 10 “keeping in touch days” during leave.[5] Residents use this to attend conferences and teaching sessions or ease back into clinical work. The prospect of less than full time has gained popularity in the UK.[5] This is a gender–neutral provision with the majority of positions held by junior doctors returning from maternity leave.[5] It allows improved work–life balance at the expense of decreased compensation and a longer training period. Finally, the UK has a well-established system of locum appointments to fill temporarily vacant training slots.[5] There are specific locum appointments for service with tenures.

  References Top

  1. Humphries LS, Lyon S, Garza R, Butz DR, Lemelman B, Park JE, Parental leave policies in graduate medical education: A systematic review. Am J Surg 2017;214:634-9.
  2. American Board of Medical Specialties. ABMS Announces Progressive Leave Policy for Residents and Fellows. PR Newswire: News Distribution, Targeting and Monitoring, Cision PR Newswire; 13 July, 2020.
  3. Having a Family during Residency. Resident Doctors of Canada. Available from: http://www.dol.gov/agencies/whd/fmla. [Last accessed on 2020 Nov 12].
  4. Bartlett J. Addressing the recruitment shortfall in surgery How do we inspire the next generation? Ann Med Surg 2012;25:30-2.
  5. Harris R, McGoldrick C, Mohan H, Derbyshire L, Reilly J, Fitzgerald E. Pregnancy, Maternity Leave and Less than Full time Training During Surgical Training (Issue Brief). Lincoln's Inn Fields, London: Association of Surgeons in Training; 2014. p. 35-43.
  6. Giantini Larsen, Alexandra M. MD, Pories, Susan MD, Parangi, Sareh MD, Robertson, Faith C. MD, MSc, Barriers to Pursing a Career in Surgery, Annals of Surgery: October 9, 2019 - Volume Publish Ahead of Print - Issue - doi: 10.1097/SLA.0000000000003618.
  7. Family and Medical Leave Act. U.S. Department of Labor. Available from: http://www.dol.gov/agencies/whd/fmla. [Last accessed on 2020 Sep 12].
  8. Merchant SJ, Morad Hameed S, Melck AL. Pregnancy among residents enrolled in general surgery: A nationwide survey of attitudes and experiences. Am J Surg 2013;206:605-10.
  9. Shine KI. Preface. On Implementing a National Graduate Medical Education Trust Fund. National Academy Press 2101 Constitution Avenue, N.W. Washington, DC 20418.
  10. Simon AB, Alonzo AA. The demography, career pattern, and motivation of locum tenens physicians in the United States. J Healthcare Manag 2004;49:363-75.
  11. Vogt H, Huntington M. Influence of resident physician “Moonlighting” activities on educational experience and practice choice. South Dakota Med 2015;68:351-5.
  12. Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners: Occupational Outlook Handbook. U.S. Bureau of Labor Statistics, U.S. Bureau of Labor Statistics; 10 April, 2020.
  13. Physician Assistants: Occupational Outlook Handbook. U.S. Bureau of Labor Statistics, U.S. Bureau of Labor Statistics; 10 April, 2020.

  Perspective Number 8 Top

In the Pursuit of Resilience

Yili Zhao

School of Medicine (Medical Student), Graduate School of Management, Weill Cornell Medicine, New York, NY, USA

Building resilience among providers and trainees within medicine has gained traction as a way to combat increasing concerns over physician burnout and mental health. However, resilience, or the ability to recover quickly from stressful situations, has been difficult to quantify and improve, especially as programs targeting mental health in medical providers are still in their infancy. In particular, women in medicine demonstrate lower rates of resiliency and thus endure greater psychological distress during training.[1] Although building resilience is a skill we could all benefit from, the current pursuit of resilience among medical trainees comes with unintended consequences.

Reflecting on our experiences is often taught as a way to improve resilience. In practice, however, between studying for boards and rotating through different services, there is not enough time on the wards for trainees to truly embrace, accept, and process every emotion. I remember that my attempts to bounce back quickly became an exercise in pretending to be Queen Elsa: “Conceal, don't feel, don't let it show.” On one community hospital rotation, I saw one or two patients code every week. However, with each deceased patient immediately being replaced by a new admission, there was no time to feel any grief. The easiest way to move on was to ignore and to try to forget, which is antithetical to resilience itself.

Another danger of rallying behind the slogan of resilience is that the pursuit of medicine can become like a sunk cost. Sunk cost fallacy is the idea that people continue down a path, not because of interest or passion but because of the effort and time they have invested in that pursuit (but cannot get back). It is no secret that the path to becoming a physician is long and difficult. In fact, there was a recent viral Tweet that proclaimed, “I hate this pandemic, if I wanted to waste my early 20s, I would have applied to med[dical] school.”[2] Unfortunately, resilience is often portrayed as a tool to push through hardships in medicine. By expecting trainees to bounce back from every difficult experience, we are distracted from the main question: evaluating if we truly want to pursue medicine or if it is just the momentum of years of hard work and dedication are propelling us forward. If it is the latter, then what does that leave? As a woman, it is even harder to answer that question when the time constraint around building a family is more pressing, and changes to the career trajectory hold other ramifications.

Resiliency teaches individuals to endure adversity, but at what point does the adverse situation itself becomes unacceptable? Recently, one of my classmates worked with a family who refused to accept the fading health of their beloved matriarch and directed their frustrations at her instead. Every day, they flung new, cruel comments at her. She recounted being on the verge of tears after these interactions but needed to pull herself together before reporting back to her attending and facing the rest of her patients. By trying to push through, she was stuck in an unnecessarily stressful situation that no one should have to endure. Her attending eventually noticed their barrage of daily criticisms and stepped in to correct the unacceptable behavior. For women, who are more likely to internalize and self-blame, the focus on resiliency further exacerbates the problem. The same quality that allows us to feel intense empathy for patients also means that we ardently feel the sting of each criticism and setback. In such situations, this shifts the blame to the individual for not being able to handle the situation instead of truly resolving the underlying causes in the environment.[3]

Although students who enter medical school are equally or even better adjusted than their peers, the experiences in medical school can be so unusually traumatic and stressful that medical students lose no time in catching up in terms of mental health problems.[4] Beyond teaching trainees to be resilient, we ought to dedicate more time to improving the conditions in which we work. The people who go into medicine are still people. With the increasing demand for healthcare workers, it is both unfair and unrealistic to expect that everyone in the field will be unflappable in the face of adversity. As we each work individually to become more resilient, we have to recognize that this is only one aspect of the many changes that need to occur to change the fate of mental health within medicine.

  References Top

  1. Jennifer C. Houpy, Wei Wei Lee, James N. Woodruff Amber T. Pincavage (2017) Medical student resilience and stressful clinical events during clinical training, Medical Education Online, 22:1, DOI: 10.1080/10872981.2017.1320187.
  2. Hate This Pandemic, If I Wanted to Waste my Early 20s I Would have Applied to Med Educ Online 2017;22:1320187. 2. Hate This Pandemic, If I Wanted to Waste my Early 20s I Would have Applied to Med School. Twitter; 7 August, 2020. Available from: http://twitter.com/ manlikemazza/status/1291767277151498241.
  3. Evans B, Julian R. Resilient Life: The Art of Living Dangerously. Malden, MA: Polity Press; 2014.
  4. Thompson G, McBride RB, Hosford CC, Halaas G. Resilience among medical students: The role of coping style and social support. Teach Learn Med 2016;28:174-82.

  Perspective Number 9 Top

Quid Pro Quo Harassment in Medicine: A Two-Hit Pattern

Sarah J. Diekman

Department of Occupational and Environmental Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

Early in my medical education, I thought that I would be an oncologist. I was inspired by the doctors who match wits with the cunning and persistent enemy that is cancer. I am not an oncologist, but I believe that my studies of cancer are an important tool for understanding and persisting against the malignancies that plague my specialty of choice: healthcare worker wellness.

This perspective covers a single and narrow problem in healthcare: quid pro quo sexual harassment. This is not an exhaustive evaluation of harassment and discrimination. Rather, if all the systemic problems in healthcare were cancer, quid pro quo is a specific type of cancer, such as pancreatic cancer. It has its own natural history, its own standard of care, and its own solutions.

When people think of sexual harassment, they often think of quid pro quo. This Latin phrase translates to “something for something.”[1] The boss who tells a subordinate to perform sexual favors in exchange for keeping her job is engaging in quid pro quo harassment. It is very important to point out that, although this is often the type of harassment that comes to mind when thinking of sexual harassment in the workplace, it is not the most common type of sexual harassment in medicine. By volume, the most common type of sexual harassment in medicine is gender harassment.[2]

Now looking specifically at the less common, yet too common and devastating form of harassment, quid pro quo. My two-hit theory of quid pro quo in medicine borrows from the two-hit hypothesis of oncology.[3] In my experience as a formal and informal advocate for healthcare workers, I have observed that predators exploit weaknesses in our system to take what they know they are not entitled to take.

Anyone can be sexually harassed. This scenario is not an exhaustive evaluation of harassment. It is a narrow pattern that I have seen and should not be used to diminish the experiences of someone whom it does not apply to. The two-hit scenario concerns me because legally it limits the remedies a victim can seek. Here is the pattern: an early career trainee is not at the top of her class. She may be experiencing one of the many other types of harassment, systematic disadvantage, and/or discrimination. Perhaps, her med school, training program, or hospital is full of stellar geniuses. (If you rank the best doctors of history, one will be the lowest. Ranking can be misleading). No matter the reason, she is struggling to keep her head above water; no one wants to sponsor her because she does not seem like the kind of student, resident, or young attending who will add to the profile of a sponsor, so she is on her own to navigate these waters.

The system is not paying attention to this lack of sponsorship for women.[4] However, there is a force that pays attention to these vulnerabilities. The sexual predators pay attention, and they move on to those who cannot defend themselves. They leverage their position as established reputable professionals against the record of the early professional because they know they will win. They know that no one has been sponsoring this person. They know that this person has been struggling, so it will be easy to strike that second hit. The second hit is the career-ending hit. They know that they can leverage this for what they want: sexual favors. They know that the system for litigating sexual harassment while in residency and early training is complex.[5] The vulnerable professional will be left with the choice to succumb to the demands of the predators or succumb to a life without a career in medicine or STEM.[6] Sometimes, the victims seek the protections of a lawyer; sometimes, they do not. Even if the lawyer can help, it takes years and a huge emotional toll on the early professional.

My experience as an advocate has taught me that it does not have to be this way. As the healthcare community, we can do more to make sure that all early professionals are getting the resources they need to flourish. Our competency evaluation system needs reform. Currently, the system is full of gender and racial inequities.[7] Fair evaluations make a career resilient against the first hit. The first hit puts the competence and career trajectory of the early professional into question. This has legal implications when trying to litigate a future harassment claim. Finally, we need to protect against the second hit by having comprehensive and meaningful plans to address sexual harassment.[8] This means protecting against overt retaliation for reporting which subsequently reduces covert retaliation for reporting.[9] Overall, we need deep systemic change to address all forms of harassment so that professionals can focus on what they came to medicine to do: help patients.

  References Top

  1. Cornell Law, Quid Pro Quo, Information Institute. Available from: https://www.law.cornell.edu/wex/quid_pro_quo. [Last accessed on 2020 Aug 17].
  2. NASEM. Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine. National Academy Press2101 Constitution Avenue, N.W. Washington, DC 20418.
  3. Tomlinson IP, Roylance R, Houlston RS. Two hits revisited again. J Med Genetics 2001;38:81-5.
  4. Lewiss RE, Silver JK, Bernstein CA, Mills AM, Overholser B, Spector ND. Is academic medicine making mid-career women physicians invisible? J Women's Health 2020;29:187-92.
  5. Diekman SJ, Sinha MS. #METOO is reshaping medicine How will the system adapt? J Legal Med 2020;40 Supp1:6-7.
  6. Dartmouth Reaches $14 Million Settlement in Sexual Abuse Lawsuit - The New York Times. Available from: https://www.nytimes.com/2019/08/06/us/dartmouth-sexual-abuse-settlement.html. [Last accessed on 2020 Aug 19].
  7. Ross DA, Boatright D, Nunez-Smith M, Jordan A, Chekroud A, Moore EZ. Differences in words used to describe racial and gender groups in Medical Student Performance Evaluations. PloS One 2017;12:e0181659.
  8. The #TimesUp Movement is Coming to Healthcare. Available from: https://www.fastcompany.com/90313343/the-timesup-movement-is-coming-to-health-care. [Last accessed on 2020 Aug 19].
  9. Binder R, Garcia P, Johnson B, Fuentes-Afflick E. Sexual harassment in medical schools: The challenge of covert retaliation as a barrier to reporting. Acad Med 2018;93:1770-3.

  Perspective Number 10 Top

The View from the Top: reflections of First-Generation Medical Students on the Pre-Med Journey

Maisoon D. Yousif, Amira Abdalla1

Medical Student, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada, 1Medical Student, Faculty of Medicine, The Ohio State University, Columbus, OH, USA

Imagine the medical profession as a castle. It stands tall and glistens atop a mountain, reflecting rays of sunshine off its windows. Those who reach the castle are welcomed in. However, the journey to the top is different for everyone. One side of the hill is steep and rocky, a dangerous trek that requires agility and strength. And yet, many still attempt to do that climb. What they don't know is that the opposite face of this mountain is much less risky. There, a paved road exists, and some drive up to the castle. Both may reach the destination; however, those who navigated the rocky terrain required sustained courage and determination for the longer and more exhausting journey. This is the experience of many first-in-family medical trainees.

Within medicine, many groups are underrepresented. For those who have never seen a doctor they relate to, medicine seems unreachable. These are the students who walk around the mountain, never looking up. It is not due to a lack of interest, just that their attention has never been turned to the option of pursuing medicine.

For the first-generation students who have their hearts set on medicine, it is difficult to know how to start the journey. It is like going on an important trip without a map. Gaining admission to medical school is a balancing act between academic success, research, volunteering, extracurricular activities, and maintaining physical and mental wellness. Not to mention the additional demands of employment, familial responsibilities and socioeconomic struggles may be a part of the experiences of the first-generation students. The application process requires strategy, and first-generation students may not have the social capital, financial stability, or mentorship required in this pursuit. It is difficult to fully describe an experience that encompasses a diverse group of people, but we aim to reflect on our journey before our own admission into medical school as first-generation students.

Aspiring medical students with loved ones – such as parents – who are physicians – benefit on many levels. These students have experience and familiarity with the medical profession, having seen the life of a doctor first-hand. Social capital, familial, and community connections provide opportunities to connect with mentors whose experiences they can learn from. Mentors for these students, both formal and informal, can provide benefits by guiding students, as well as providing research/employment opportunities and information about awards/scholarships. Those with the right connections may have an inside look on the admissions process, having family or friends who had served on admissions committees and as interviewers in the past. These physician parents are then able to mentor and guide their children through the admissions process. Surely, within the limits of ethics and confidentiality, any parent would happily apply lessons they had learned throughout their career to support their child.

With little to no knowledge of strategies to be a competitive applicant, first-generation pre-meds may feel they are running a race that they will inevitably lose. Initiatives such as Community of Support (CoS) at the University of Toronto aim to level the playing field. CoS is a free initiative intended to support underrepresented students at every stage of their pursuit of applying to medical school. It provides access to mentors, one-on-one advising, Medical College Admission Test (MCAT) support, interview preparation, and endless networking opportunities. Alumni of the program are currently medical students, residents, and physicians who continue to give back, for example, by leading workshops or mentoring students. Discovering CoS felt like we had been given a map to navigate the journey. We hope to see greater collaboration on these initiatives within medical education to truly support underrepresented minority students in pursuing a career in medicine and reduce the barriers in doing so. In addition, physicians could and should create space for supporting underrepresented pre-meds.

In medicine, you will be privy to people's most private matters. When you have not lived the experiences that your patients are going through, your capacity to relate is all based on theory. Though being an outlier can make admissions and medical training more difficult, our lived experiences are a blessing in disguise. That unique perspective makes for better physicians who are able to provide culturally safe healthcare environments.

This journey to becoming a physician only starts with admission. Students who possess the desired attributes of a physician, not limited to empathy, work ethic, and leadership, should be equitably supported in their pursuit, regardless of their social capital or parents' employment. On admission to medical school, first-generation medical students are welcomed into the castle. It is now time to face the unknown challenges within.

  Perspective Number 11 Top

When Worlds Collide: the Life of a Parent and Work-from-Home Medical Educator

Heather R. Christensen

Department of Medical Education, University of Cincinnati College of Medicine, Cincinnati, OH, USA

It is after lunch – nearing the middle of the afternoon, and my children are sleeping. For a newly “working-at-home” parent, it is the ideal productivity time, right?

Wrong. Right now, I am sitting down for the first time today, after a 45-min naptime battle with my toddler and my preschooler. I am exhausted. I rest for a brief second and attempt to “shift” into work mode. My brain flickers back-and-forth like two competing radio signals. The static of “home noise” crackles, cutting through work “to-dos.” I see toy trucks flipped over in the hallway, pajamas on the couch that did not make their way to the laundry room, and a manuscript I need to review on the kitchen table. All the while, the crying and screaming I just endured have me frazzled and I, myself, feel like tears could flow at any moment.

Please don't call this “emotional.” It is not a stirring up of mental health issues hindering motivation. It is not an inability to multitask (insert one of the many work-related issues I have addressed today while simultaneously setting up a virtual learning activity and reciting “Llama Llama Red Pajama” to my littlest one, from memory). Moreover, none of what I am experiencing is because my children have no discipline.

It is a recognition of the gravity of circumstance. I am struck with a decision: Should I eat something for the first time since my morning coffee or capitalize on this rare sacred hour to sit down and do “focused” work? Work that I desperately want to do. That I miss doing. I stand at the refrigerator... stare... grab a cheese stick, and open my laptop. I choose work.

Yet, my focus does not come. Trust me, no amount of well-researched “expert advice” regarding a functional home office can fix this. In fact, some of these recommendations feel downright painful. “Join a mid-week virtual meditation.” Sounds spectacular. “For important meetings, put a 'Do Not Disturb' sign on your door.” I could have used that on my 2-h call, after which the playroom looked like an F5-tornado swiftly (certainly not silently) made its way through the space (thank goodness for the “mute” function). My favorite? “Don't allow yourself to be distracted by household chores,” because they dampen productivity. Exactly.

You see, I am not learning to do my ONE job effectively at home. I have picked up a second full-time job. My partner's essential job requires his physical presence at the office, daily. Thus, my once-focused list of career priorities is peppered with (dare I say consumed by) tasks necessary to keep my children educated and occupied (and my house standing). Set up child 1 for Zoom call. Finish converting courses to virtual format. Set out morning snack. Complete IRB application. Feed the dog. Indeed, I am left squeezing work between train-track building, phonics lessons, lunch-making, and handling emotional outbursts. Efficiency remains an unachievable goal that I long for daily.

When my partner returns home, my attention turns to re-crafting lectures and scholarly activity. It also turns to realizations that I am missing time with my complete family unit and that the used-to-be-sacred quality time with my husband will also be filled with more work. It is overwhelming.

I know I am not alone. Moreover, although men may also be fighting this battle, emerging publications highlight a gendered impact of COVID-19 that builds on previously documented disadvantages for women in academia, including promotion and advancement. Articles that do acknowledge the work-from-home burden emphasize “acceptance of” a lack of bandwidth/productivity. While this evokes grace for oneself during a pandemic, it cannot address that I will be evaluated for promotion against faculty in wildly different circumstances, those largely out of my control. Do I have the opportunity to delay my advancement? Of course, I do. Should I have to because of the circumstance that I am in? I do not believe so.

I authentically acknowledge the realities others are facing. I am blessed to have a job I can do from home. I appreciate countless positives, not the least being the gift of being present with my sweet children. Moreover, it is really hard. Not “but”... “and.” Both truths coexist. Parenting requires enormous emotional energy, patience, creativity, and mental space that I otherwise would devote to my career. I am happy to do it. Blessed to do it. Moreover, in times like this pandemic, it requires me to sacrifice other aspects of my life (career included).

That's all. I have time to write. My toddler is awake; it has been 56 min. “Productivity time” is over, and I have to return my attention to my second full-time job.

(Note: I typed this one-handed as my nondominant hand gently rubbed my kindergartener's back. Because although his voice and eyes told me he was tired, he had difficulty resting-missing his own routine. Guess where he goes for comfort? Me. Does it hurt my productivity? Yes. Do I love it? Yes, without a doubt. As I said... it is not a “but” – it is an “and.”)

  References Top

  1. Ferrante MB. Before Breaking the Glass Ceiling, Women Must Climb the Maternal Wall. Forbes, Forbes Magazine; 31 October, 2018. Available from: http://www.forbes.com/sites/marybethferrante/2018/10/31/before-breaking-the-glass-ceiling-women-must-climb-the-maternal-wall/. [Last accessed on 2020 Nov 12].
  2. Kramer J. Women in Science May Suffer Lasting Career Damage from COVID-19. Scientific American, Scientific American; 12 August. 2020.
  3. Jolly S, Griffith KA, DeCastro R, Stewart A, Ubel P, Jagsi R. Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Ann Intern Med 2014;160:344-53.
  4. Jones Y, Durand V, Morton K, Ottolini M, Shaughnessy E, Spector ND, et al. Collateral damage: How COVID-19 is adversely impacting women physicians. J Hosp Med 2020;15:507-9.
  5. Noguchi Y. “8 Tips to Make Working From Home Work for you. NPR, NPR; 15 March, 2020. Available from: http://www.npr.org/2020/03/15/815549926/8-tips-to-make-working-from-home-work-for-you. [Last accessed on 2020 Nov 12].
  6. Friedman S, Westring AF. How Working Parents Can Prepare for Coronavirus Closures.” Harvard Business Review; 14 August, 2020. Available from: http://hbr.org/2020/03/how-working-parents-can-prepare-for-coronavirus-closures. [Last accessed on 2020 Nov 12].

  Perspective Number 12 Top

Forced to Rest

Jillian A. Bybee

Division of Pediatric Critical Care Medicine, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, MI, USA

As Newton's first law states, an object in motion stays in motion with the same speed and direction unless acted upon by an unbalanced force. For most of my life, I was an object in motion. I had one speed (busy) and one direction (become a physician). Eventually, a force knocked me off my path, seemingly out of nowhere. I had ignored the warning signals flashing before me as I sped down the path of medical training. I had nothing left, and I was forced to rest.

At 5 years old, I declared to my parents that I wanted to become a Pediatrician. Although they assumed I would change my mind, I unrelentingly pursued that goal throughout high school and college. I got the grades, racked up extracurriculars, got shadowing experience, worked several jobs, and helped when anyone needed me. I checked the boxes to get into medical school.

Medical school and residency training were no different. If you needed something done, I was there to do it, often at the expense of my own self-care and personal relationships. I joined committees, led projects, gave presentations, and became house staff president. To my peers, it looked like I had it all put together. In reality, my achievement-focused drive stemmed from unrelenting perfectionism and something for which I did not yet have a name: imposter phenomenon. Of course, it would take several more years to put those pieces together.

After residency, I jumped head-first into fellowship training. After a period of acclimation, the familiar pattern emerged: achieve, join, and lead. As my 2nd year of fellowship progressed, my physical health declined due to an injury. Although there was a point, I could barely walk due to pain, I took no time off to rest or recover. I pushed through physical therapy post-call and wore my perfect attendance at work like a badge of honor; I was strong.

All the while, I collected the stresses and traumas of my specialty: Pediatric Critical Care Medicine. I performed procedures, did compressions, led care conferences, and pronounced deaths. Some shifts, I did all of those things. Having no time (or desire) to process my emotions, I pushed them aside, keeping them safely packed away in a box while I sped down my path. With one event, the tightly packed box exploded.

While on call, I admitted a previously healthy patient with what seemed at first to be a common diagnosis. Throughout my shift, he progressively worsened. Within 12 h, he was dead. At the time, his death felt like a personal failure, though the mortality rate for his condition approached 100%. My perfectionism had collided with the reality that nothing is perfect and that there are conditions that medicine cannot cure. I was derailed.

In the following weeks, I was an object at rest. After more than a decade of hurtling through life, I felt stationary while the world zoomed past, continuing at breakneck speed while I was stuck in my new immobility. I was able to be present for clinical shifts but lacked the drive to do my research, go to meetings, or meet deadlines. Eventually, during a meeting with a mentor, it clicked that I needed to process what had happened and what I had been pushing aside for so many years.

Putting myself back together took hard work, introspection, and space. I found a therapist and began to uncover what I had buried. I started meditating to begin feeling what I had not acknowledged. I devoured books, articles, and podcasts of people with struggles like mine. I learned that being vulnerable takes more courage and strength than striving to achieve perfection. I accepted the fundamental truth that real self-care is not selfish. Eventually, I made my way back to myself, this time with boundaries and habits created to protect my well-being.

The practices that originated out of the darkest period of my life comprise the foundation that I come back to when life, inevitably, is difficult. I continue to see a therapist to process the unavoidable traumas of working in medicine. My mindfulness practice allows me to tune into myself, pause, and recharge. These habits enable me to try to be the best (imperfect) version of myself possible at work and in life. In addition, I have the opportunity to help others in medicine learn to care for themselves through speaking about my struggles, teaching, and mentoring. As Anne Lamott said, “Almost everything will work again if you unplug it for a few minutes, including you.”

  Perspective Number 13 Top

Perspective: Maternity Leave Does Not Have to be All about the Baby

Errin Weisman

Family Medicine, Kansas City University, Kansas City, MO, USA

Maternity leave is a great time to bond with your baby. It can also be the best time to re-bond with yourself.

Getting out of the go-go go mindset that often accompanies the medical profession gives you time to sit, reflect, and feel. Are you living your ideal life? What type of work do you want to return to after maternity leave ends?

I am a physician coach and I often get contacted by doctors having epiphanies during maternity leave. Taking a break often sparks new realizations and experiences. I had one mom explain it to me like this:

“Maternity leave was like coming up from the deep end of the swimming pool and getting a breath of fresh air. I was able to go on play dates with other moms. I was able to pick my kids up from school. We were able to do just things I had always wanted to do but could not because of my job. Now, as I am getting ready to go back to the office, I am really fearful of losing this.”

She was worried that going back to the office would mean letting go of those experiences. She wanted to keep being a physician, but she cherished the “normalcy” that she experienced on leave. Her question to me was whether she could have both. To which I responded, “Absolutely.”

Change is always possible, even if it is not always easy. It may take time, and it might be challenging, but creating a fulfilled balance is always worth it.

Creating a life you love

If you are on maternity leave and you are worried about getting back to the office, here are some questions you can ask yourself:

  • What are you loving about life during this time?
  • What things are you ecstatic that you do not have to do while on leave? What are you dreading when you think about going back?
  • What are you excited about going back?

These questions should lead you to understand your needs and boundaries. From these reflections, you can start to form a plan for how to get more of what you want into your life and keep what you do not want out of it.

Maternity leave discrimination

According to JAMA Internal Medicine, nearly one-third of women in a survey including 5000 physician mothers reported experiencing maternal discrimination. The same study showed that maternal discrimination was associated with higher rates of burnout.

That's why it is so important to center and rediscover yourself during maternity leave. Do not wait for your pot to boil over – start taking steps now.

If something at your job was not working before you had a baby, you can bet that it will not work for you while you are trying to keep a tiny human alive. Addressing these problems early and having a game plan for how to handle work–life balance will give you the tools you need to prevent burnout.

Another huge piece of this is learning what support you need around the house to stay sane. The AAMC reported that women spend an average of 8.5 h more housework per week than men.

Do you cherish hour-long talks with your girlfriends? Do you need 30 min to wake up in the morning to feel good? Do not be afraid to talk to your partner about supporting those changes and finding ways to delegate household chores and childcare. Another great option is to outsource those tasks to a professional. You do not have to be a superwoman to be a super great mom.

Your family will thank you later.

The arrival of a new kid brings on a whole wave of new emotions – both good and bad.

As physicians, we learn about postpartum mental health and the importance of “mommy me time.” Moreover, while avoiding depression is vital, “me time” should not stop there. Maternity leave can be a unique opportunity to go from surviving to thriving.

Do not limit the time you spend on yourself. Dream big. Dream past survival.

We should not settle for coming back to work feeling like we need to give up either personal satisfaction or our career goals. There are paths that can create equilibrium between being satisfied at work, with our families, and with ourselves. It sounds crazy, but it is absolutely possible.

Take time during your maternity leave to create that thriving reality. When your kid grows up and sees their mom kicking butt, they are going to thank you.

  Perspective Number 14 Top

How COVID-19 Exposed the Fiction of Physician Mother Flexibility

Tamara Goldberg

Department of Medicine, Mount Sinai Health System, New York, NY, USA

Mid-May New York City. I recall a meeting when my colleagues and I were requested by leadership to please be flexible with last-minute changes as our hospital's COVID-19 caseload decreased and financial pressures mounted. Sounds reasonable, no?

Yet, in the setting of cumulative fatigue and postpeak pandemic uncertainty, this seemingly harmless request triggered feelings of distress and disempowerment. Historically dutiful to such requests, I now was a physician mother thrust into a pandemic climate without an ounce of wiggle room left. Defeated and exhausted, I questioned how I would be able to meet such an expectation.

I have since come to realize that the underlying issue was not one of the individual compliances, but rather, the cumulative career costs for physician mothers like me when we continue to mask the external factors impacting our capacity to be flexible in the first place. Something has to give. And sadly, for many female physicians, it already has....

Indeed, compelling evidence illustrates the disproportionate burden that parenthood places on female physicians compared to their male counterparts.[1],[2],[3],[4] A result is that female physicians not only leave medicine in far greater numbers than their male peers but sadly are doing so at early stages in their career. Given the increasing caregiving demands during COVID-19, such disparities are likely to become exponentially amplified.[5],[6]

I believe that instead of promoting value and recognition, the focus on individual flexibility has actually thwarted our advancement by emphasizing passivity and compliance over problem transparency and solution development. I would posit that the time is ripe to rethink how system flexibility in meeting physicians' needs outside the hospital walls can lead to better support for female physicians and in turn result in increased retention rates. To do so requires focusing on structural changes that would make it not only easy, but advantageous, for organizations to achieve gender equity.

  1. Ensure an explicit commitment to diversity, equity, and inclusion. Prioritize recruitment and retention of underrepresented-in-medicine physicians, including women by empowering Diversity Equity and Inclusion committees to ally directly with decision-makers, hold leadership accountable across the institution, invest in departmental equity initiatives, and advocate for effective training to mitigate implicit bias in recruitment
  2. Institute 12-week paid parental leave policies. A 12-week minimum paid parental leave has consistently been associated with improved health benefits for both parents and children, as well as higher retention rates of female employees. Yet, only 25% of top tier medical schools reported paid faculty leave >8 weeks, and few have clear policies for nonbirth parents[3],[7]
  3. Provide accessible childcare options and emergency back-up childcare. The temporary services that supported frontline provider parents during the COVID-19 peak will require conversion to permanent employer-sponsored childcare solutions
  4. Measure, measure, measure. In addition to objective measures such as pay parity, retention, and equitable gender representation, institutions must survey physicians to explore their lived reality in the workplace. Perceptions matter
  5. Promotion and tenure committees should re-assess traditional productivity metrics during the COVID-19 period. Such committees should actively seek and account for expected alterations in productivity secondary to COVID-19 in the realms of research, teaching, and service[1],[5]
  6. Rethink part-time and flextime work options. Departments should consider alternative work schedule options for physicians which are dually valued as respected pathways to professional growth and promotion.

I trained in an era without duty hours, in which medicine was expected to be your world. However, I am practicing in an era as both a mother and an academic and feel all too intimately the conflicting pressures such a duality pose. As COVID-19 continues unraveling the vulnerabilities of our daily lives, it is time for systems, not physicians, to display flexibility.

  References Top

  1. Arora V MAPP, Shapiro M MD, O'Glasser A, FACP FHM, Charlie Wray DO MS, Shikha Jain MD FACP. Opinion: In the wake of COVID-19, academia needs new solutions to ensure gender equity; 2020. Available from: https://shikhajainmd.com/home/research/. [Last accessed on 2020 Sep 15].
  2. Frank E, Zhao Z, Sen S, Guille C. Gender disparities in work and parental status among early career physicians. JAMA Netw Open 2019;2:e198340.
  3. Health Policy Brief, Paid Family Leave Policies and Population Health, Health Affairs; March, 2019. Available from: https://www.healthaffairs.org/do/10.1377/hpb20190301.484936/full/. [Last accessed on 2020 Nov 12].
  4. Jolly S, Griffith KA, DeCastro R, Stewart A, Ubel P, Jagsi R. Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Ann Int Med 2014;160:344-53.
  5. Malisch JL, Harris BM, Sherrer SM, Lewis KA, Shepherd SL, McCarthy PC, et al, Jennifer Deitloff Proceedings of the National Academy of Sciences 2020, 117:15378-81; DOI: 10.1073/pnas.2010636117.
  6. Pinho-Gomes A. Where are the women? Gender inequalities in COVID-19 research authorship. BMJ Global Health 2020;5:15378-81.
  7. Riano NS, Linos E, Accurso EC, Sung D, Linos E, Simard JF, et al. Paid family and childbearing leave policies at top US medical schools. JAMA 2018;319:611-4.

  Perspective Number 15 Top


Han G. Ngo, Jennifer L. A. Nguyen

Emergency Medicine, School of Medicine, Oakland University, William Beaumont, Rochester Hills, MI, USA

“Phụ nũ không nên theo ngành phẫu thuật” is Vietnamese for “Women should not go into surgery” – that was something our parents believed and wanted us to adopt. Growing up in traditional Asian immigrant families, we were taught that as women, we needed to prioritize having a family over pursuing a rigorous career. With this expectation, we started medical school never considering surgery because doing so would mean taking time away from our “duties.”

As usual, life had other plans for us. During our 1st year of medical school, we fell in love with urology (Jennifer) and interventional radiology (IR, Han) after attending lectures from multiple specialists in these two fields. Although we were conflicted about our growing interest in surgical specialties, it was becoming increasingly clear to us that family medicine or internal medicine was not a good fit after volunteering at local clinics. As we began to figure out how to reconcile our personal interests and our families' expectations, COVID-19 became a global pandemic and our summer internships got canceled.

Ripped from the opportunities to shadow physicians and conduct in-person research, we spent our summer learning more about urology and IR through social media: Instagram, YouTube, webinars, and The Undifferentiated Medical Student podcast. Through these platforms, we listened to female residents and physicians talk about how they have maintained a family outside of their careers and how there are ways to achieve a good work–life balance, such as by opening one's own private practice. These interactions cleared up any doubts that we had been having about the specialties and convinced us to pursue our interests more seriously.

In addition, we looked for summer research opportunities. Most preclinical students are aware that finding a research project is not easy, so how do medical students approach finding one? Our first answer was to cold e-mail doctors but that did not get us anywhere. For weeks, no one replied. E-mails are easy to ignore and it is difficult to discern if a contact is active on e-mail. Not only eager to find research opportunities but also want to work smarter to find them, we got creative and found our answer: Twitter. Bayne and Davies concluded that social media is an effective tool to “capitalize on research collaborations” based on their successful experience with finding research on Twitter.[1] In an effort to not give up on finding research opportunities, we searched up #Urology and #Radiology on Twitter. The goal was to tweet and put our faith in the Twitterverse. The worst that could happen would be if no one replied; however, a couple of hours after our first Tweets, we both received great support from the community, offering not only research opportunities but also mentorships.

We were surprised by those who offered to help either in mentoring or trying to connect us to research opportunities. Since face-to-face meetings are not possible during the pandemic, we spoke with residency program directors, practicing physicians, and residents by phone. Each conversation offered a new viewpoint into our respective fields of interest and how to best prepare ourselves to apply. Jennifer discovered that there are more women in urology than she had previously thought, and 10 out of the 14 Twitter replies were from women. Han was connected with a group of students from other medical schools to collaborate on various IR research projects.

Overall, our shot into the Twitterverse was successful. Although we have not finalized any potential research projects, one thing is for sure – we received mentorship outside of our institution that might prove beneficial when applying to residency programs. In addition, we were able to make new connections, learn more about our interests, and feel more confident in pursuing a career in surgery. Networking can be difficult because there are not many women in these male-dominant fields that we can relate to. However, we hope that more women, like us, will take initiative to search for the right support to realize that good work–life balance is possible depending on how they define it. Moreover, hopefully, in the near future, there will not be such a dichotomy between career and family life for women.

To all medical students out there, shoot your shot! Do not let gender expectations hinder you from exploring a career path. Be creative with the resources around you and make opportunities out of any situation. While we are still young in our careers, perhaps, we will be the #WomenInSurgery that can provide mentorship to a young student 1 day.

  Reference Top

  1. Bayne CE, Davies BJ. Don't Be a luddite: Urologists benefit from social media. Eur Urol Focus 2020;6:430-431

  Perspective Number 16 Top

Self-Compassion for the Overwhelmed Physician Nonmom

Marion Mull McCrary

Internal Medicine, Duke Health, Durham, NC, USA

“You do not have kids – you should have it all together – there is no excuse!”

Have you ever heard such an inconsiderate comment? Who would be so rude to say that to me?

Me, I said that to myself!

I said that to myself when I was stuck in a state of feeling overwhelmed, burned out, and overall, not myself.

I thought that!

As the only female nonmom physician in my group for many years, I would intentionally pick vacations that were not during school breaks, so my partners could be off. I would work Christmas and New Year's weeks because I did not have kids at home. I felt guilty if I was not working or unavailable.

Raising children is one of the biggest responsibilities a person could have in their lifetime. My husband and I ultimately decided not to have children. Did that mean we did not fill that time that others may have spent parenting with nothing? No, we created a full life and a full plate.

I often would think that my classmates and residency mates who had children during those times of our lives had superpowers to be able to do both and do it well.

I was judging myself and felt judged by others who asked me about having children when we were in the office together. Conversations on this topic were often awkward.

When I was burned out, in addition to chastising myself for not being able to have it all together, I was jealous of my male partners who had wives who did not work and in my mind (I am not sure if this was true) had dinner on the table when they got home. I believed that they had someone who took away all the home chores that I was doing in addition to work responsibilities. I joked to my wonderful husband who did a lot for our two-person family that “I needed a wife too.”

I realized years later after lots of thought work, personal development, and self-compassion, that I could decide what I wanted and make changes in my life to pursue that. I learned I was stuck in a thought distortion that “I should” be this, do this, or act this certain way. Some of these thoughts were internally decided “shoulds,” and some were externally, i.e., society decided “shoulds.”

How did I get past my negative self-talk and my thought distortions? – By extending myself a little grace and a little self-compassion. It is often hard for doctors to do this because we have such drive to be perfect, to be right, and to be helpful to others. We need to replace those actions with putting ourselves first and exhibiting self-compassion.

Dr. Kristin Neff describes three components of self-compassion: mindfulness, a shared community, and self-kindness.

  • Mindfulness: being in the present, not judging yourself, knowing how your mind works and how to change it to how you want it to work, knowing yourself, and using your strengths and your values
  • Shared community: finding a group of like-minded and like-hearted doctors and talk to them about how you feel. Do not be ashamed. It is OK to be vulnerable in a safe place. You are not alone. Others have had similar experiences
  • Self-kindness: getting rid of the shame, the “shoulds,” the perfectionism, and the thought that “it is always my fault.” Change your mindset to a positive and growth mindset. Practice self-care.

Hence, now instead of judging myself and having concern if others judge me, I know I can trust my decisions.

Hence, now instead of deferring to “this being the way it is” or “the way it should be,” I make decisions that support me.

Hence, now instead of feeling overwhelmed, burned out, and isolated, I am spending my days the way I want and open about my experience. I want to know and support others who may be where I was.

  Perspective Number 17 Top

COVID Reflections

K. Jadhav

Department of Internal Medicine, University of Missouri- Kansas City School of Medicine, Kansas City, MO, USA

As an academic internist, I am blessed to be able to work with medical students and internal medicine residents. It is whole new teaching, as well as learning experience, for me after working as a hospitalist on my own. I remember wanting to be a doctor ever since I was a kid. It was a long journey from wanting to be a doctor to actually becoming one – especially coming from a nonmedical family. The struggles that I experienced during my residency as an immigrant were helpful in providing lifelong lessons – both with patient experience and growing personally. What I like about my work is that I not only get to care for patients mostly in the outpatient setting but also get to work with the inpatient team and care for the patients admitted in the hospital. Having worked as a hospitalist for 4 years, I love being on inpatient service.

I had a week of inpatient service in March when the COVID pandemic had picked up. It has been a different experience working before and during the pandemic. It was filled with mixed emotions of trying to understand the pathology and manifestations of this new virus as physicians and at the same time answering questions and concerns from patients. Patients were concerned about being in hospital and requesting to be discharged, as soon as possible. Some patients were stable enough to be transferred to another facility, but the formalities to actually get them transferred were a little tedious. We started doing universal masking where all the personal in the hospital would wear mask at all times. That was uncomfortable for few patients. Personally, they felt suffocated by their mask and worried seeing their providers wearing a mask as well. “Am I safe here in the hospital?” “Why does the doctor need to wear a mask?” One of the patients asked our team to talk to her from a distance, so we would not transmit anything to her. Family visit restrictions were difficult for some patients, till we figured out a good way of communicating with their near and dear ones. On the other hand, while providing excellent care to the patients, residents themselves had their family members on their minds. I was proud of all the internal medicine residents but specifically one resident whose family lives in Pacific Coast where COVID was at its peak. He was very calm and composed during his patient care responsibilities. Overall, patients and physicians had their own share of concerns during the initial phase of pandemic.

It was a different experience on service in May. Even though there was no new breakthrough treatment/management protocol change in regard to COVID, there seemed to be less hesitation surrounding the overall situation. Patients were more aware now of the need to be wearing masks at all times, and we were well equipped with means of communicating with their family members. Similarly, residents were getting used to rounding in a new way with social distancing but still collaboratively caring for patients. Most patients went home or to their safe discharge locations; however, not all had that privilege and some tough decisions had to be made. Specifically, one particular patient who was an “undocumented immigrant” with multiple comorbidities complicated hospital course and fluctuating mental status. It was prudent to discuss the goals of care with his family as the patient could not make decisions for himself. I had an amazing resident who facilitated multidisciplinary virtual meeting with the family, along with the interpreter. As challenging as it sounds, it was received very positively and the family expressed their gratitude for helping him return home during his last few days. What struck us the most is that even though he had been sick and had been frequenting the hospital recently, he made something very clear to his family – “He wants to be an organ donor” – his family said. We all looked at each other and tried hard to hide our tears. Social work was able to arrange for home hospice with the help of charity, and the patient was transferred home. We received a note the next day from the social work, stating how thankful the family was to spend some time with the patient at home. Examples like these are what make the branch of medicine a wonderful experience, and I celebrate my childhood dream of becoming a doctor!

  Perspective Number 18 Top

The Unwritten Rules

Alyssa D. Brown

PHD Student, University of Louisville School of Medicine, Louisville, Kentucky, USA

“You could try being less of a bitch.” We were in the student workroom at the rural hospital – taking a brief refuge from the hectic morning. It was the fall of my 3rd year of medical school. The room was not much, a converted supply closet with a couch and a computer. The room was our hiding place to bemoan the rotation. There were just six of us on the rural surgery rotation and only one male student, Austin (Austin is not his real name). I had been paired with Austin, and we rotated with the various surgeons. I never expected him to say anything like this to me. He was just so nice, but I should start from the beginning.

That morning, the attending assailed me for not remembering the replacement rate of potassium for a patient. I was used to a surgeon expecting a lot from me; however, that day, it stung to get reprimanded so early. I had been in the hospital until 2 am for an emergency case, and I had returned to the hospital at 5 am for prerounding. I had barely slept. I wanted so badly to impress the surgeon because I aspired to be a surgeon. Austin and I worked well together. We were seamless on the team; we knew our roles and performed them. In the morning, he had not gotten berated by the attending for his mistake. He, in fact, forgot to check on one of the intensive care unit patients. Austin's mistakes and missteps had been accruing for the entire rotation. It seemed as though the surgeon did not mind when Austin faltered, I was always harangued for seemingly less egregious offenses. I took it in stride, but that day, I decided to ask Austin if he had noticed this difference. All the students were sitting on the couches eating lunch. I asked him, “Do you think the surgeon treats you differently?” I clarified slightly that I did not think he should have gotten yelled at that morning, but it seemed like I got reamed over minor errors, while he was free to make them. He responded that he had not noticed. I was not shocked that he had not even though I hoped he would have. The next thing he said though, stopped me, “You could try being less of a bitch.”

I am rarely silent, but how do I even respond to that? The room fell silent. I felt my face flush, and I fixed my eyes on the floor to prevent the tear forming in the corner of my eye from being seen. It felt like a punch to the gut and the air knocked out of my lungs. No one came to my defense or said anything. It instantly made me feel like I was no longer welcome. He tried to explain it by saying I can be competitive, bossy, and overprotective of my patients. I was running a list of our interactions. Was I a bitch? I always pulled his gown and gloves, I kept him updated on patients, I kept us on track and on time, I covered for his mistakes, and I even offered to split my granola bar from my locker when we missed lunch. This is not to say I was flawless. I can be stern when my concentration is broken. Our personalities were opposite – he was often lost in thought, while I was more intense. I was focused on doing my best for the team and patient.

“You could try being less of a bitch.” This rang in my ears and echoed in my heart. I spiraled; does everyone else see me this way? It was a heady mix of sleep deprivation, anxiety, and malignant thoughts. I felt alone. I felt betrayed that no one stood up for me, and I felt embarrassed.

When the day was finally over, I got in my car and just drove. I had texted a friend, so she expected my call. I fondly referred to her as the brain in our friendship, while she called me the heart. I wear my heart on my sleeve, but she can translate my emotions into words when I fail to. She was on her surgical rotation too. She picked up on the third ring. Her response surprised me, “Alyssa, you are a bitch. It is a good thing. You know what they call a man who is a bitch? A go-getter. The frame is different for women. It has seen as a negative, while in men it is a positive.” I had never thought of it that way. It never crossed my mind that I would be judged by a different standard for being a woman in medicine. It was like I was finally let in on a big secret. As we talked, I realized that there was an extra standard for women in medicine. You had to be: kind, sweet, soft, quiet, not too quiet, know everything but not act as such, look perfect, but nothing too tight or too low cut, be very friendly, do not be too eager to volunteer over a man, put your makeup on in the morning, never come in with wet hair, do not ever complain, do not be sensitive, and never be too confident, and this could continue indefinitely. It is a hefty list all due to gender. It is more than I can ever be. I thought I just had to be empathetic, work hard and be dedicated to the patients. I thought I could be myself.

“You could try being less of a bitch.” After reflecting, I promised myself that moving forward, I was not going to be less of a “bitch” to make someone else feel more comfortable. I want and demand the same respect. I should not be treated differently because I am a woman in medicine, despite the unfortunate reality. Together, we have to start dismantling the thought that there are an extra set of rules for women in medicine. These unwritten rules are not making us better doctors. If I get called a bitch for working hard and caring about the patients, so be it. If that is the case, I will be a bitch.

  Perspective Number 19 Top

The COVID-19 Pandemic and My Academic Career as a Woman Physician

Zarmina Ehsan1,2

1Department of Pulmonary and Sleep Medicine, Children's Mercy- Kansas City, MO, 2Pediatric Pulmonology, University of Missouri- Kansas City School of Medicine, Kansas City, MO, USA

As conference cancellations for major academic meetings that were to be held over the spring and summer started pouring in, I could not help but feel a sinking feeling in my stomach. I had intended to apply for promotion this fall and had worked very hard to stay on track. I had the promotion criteria memorized at this point. With five platform presentations, one workshop to chair and one abstract presentation session to moderate at two separate major academic meetings between April and June, I had surely made it. These were my #lifegoals as a female academic physician. Milestones I had aspired to while attending yearly academic meetings during my training and early career. Well, then, the COVID-19 pandemic happened. As I deleted these upcoming presentations from my CV, the sinking feeling continued.

It is imperative that I apply for promotion this year. I am a woman physician, from an underrepresented racial minority, 4 years out of subspecialty fellowship (two fellowships to be specific) and 2 years into being a new mother. I am terrified of being a statistic and delaying my first ever academic promotion longer than what the average time for a man is.[1] After the birth of my daughter, as my pregnancy haze lifted and I adjusted to my new life as a mother, I was finally able to resume working on my academic portfolio. The period of relative inactivity spanned almost 1 year – I am sure that most academic mothers can attest to this. Furthermore, if you are in academia, you know that 1 year is huge. I got back on track, pushed the pedal on my research activities, started writing manuscripts, and accepted invitations to present at national meetings now that my toddler had become less dependent on me. Fast forward to now, I am due with a second child at the end of the summer, and at 36, I am yet another statistic – the geriatric pregnant woman. The fact that pregnancy places me at the high-risk category for COVID-19-related mortality also crosses my mind, but the fear of not making it to promotion this year is worse. If I do not apply now, it will be at least 2 more years until I am back on track again. I try to explain this to my division chair (a 60-year-old white man). He does not get it. I am not surprised.

Our state has had stay at home orders for over 6 weeks now amid the COVID-19 pandemic. Outpatient clinics are closed, and the sleep laboratory has shut down as well. As with other clinics in the nation, we have started a robust telemedicine program. Time that I previously used for reading sleep studies has now been taken over by clinics. Nevertheless, business is slow. My male colleagues have been pouring research ideas, organizing surveys, and sending out papers for me to proofread. Clearly, this “downtime” has served them well. The statisticians are busier than ever. As faculty take a step back from their life as clinicians, they can focus on academia. This seems like the perfect time to get to work on my long-lost papers in progress. Except I have a toddler to deal with at home and despite being a dual-income household, and having a very caring and involved husband, disparity of household work exists in our home as well (yet another statistic). Women spend almost twice as much time to do household work as men – this also applies to dual-income households including when women are earning more. As women physicians around the world work from home, I wonder about the impact the pandemic has on their research productivity. Single mothers, mothers who are homeschooling their kids, mothers who are supporting husbands through pandemic-related layoffs. Between managing a toddler during the workweek, getting meals prepared, keeping the house in shape, and trying to ramp up our telemedicine program, I cannot seem to find time to reflect on my research and concentrate on reviving old manuscripts. I certainly do not have time to start something new, to avail the COVID-19–associated accelerated peer-review opportunities at leading medical journals or apply for the pandemic-related research funding requests for letters of intent that are flooding my inbox. As I remotely listen in to the third town hall on COVID-19 recovery efforts at our hospital, the sinking feeling in my stomach gets worse. To try and recover from the billions of dollars in lost revenue, our leadership announces efforts to increase clinical productivity and revenue once our hospital resumes business. More clinics during the workweek, evening clinics, and weekend clinics are all on the table. I worry about the impact this will have on the academic physician and the risk it poses to widening the gender gap in academic medicine.[2],[3],[4] The effects of the pandemic will certainly be felt for years to come. No one knows what the new face of medical practice will look like. I certainly need to apply for promotion this fall.

  References Top

  1. The State of Women in Academic Medicine Statistics; 2015-2016. Available from: https://www.aamc.org/data-reports/faculty-institutions/data/state-women-academic-medicine-statistics-2015-2016. [Last accessed on 2020 May 05].
  2. Carr PL, Gunn CM, Kaplan SA, Raj A, Freund KM. Inadequate progress for women in academic medicine: findings from the National Faculty Study. J Womens Health (Larchmt) 2015;24:190-9.
  3. Filardo G, da Graca B, Sass DM, Pollock BD, Smith EB, Martinez MA. Trends and comparison of female first authorship in high impact medical journals: Observational study (1994-2014). BMJ 2016;352:i847.
  4. Kuhlmann E, Ovseiko PV, Kurmeyer C, et al. Closing the gender leadership gap: a multi-centre cross-country comparison of women in management and leadership in academic health centres in the European Union. Hum Resour Health 2017;15:2.

  Perspective Number 20 Top

Cancer Never Stops

Elizabeth B. Jeans

Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA

We sat in his hospital room. Masked in PPE – head to toe – the only visible portion from his perspective was my eyes, which appeared tired with smeared mascara from a long day. The family that would normally be present at these types of meetings had been replaced by a single-old wireless phone that rested on the patient's lap. I pulled a chair close to his hospital bed, trying to normalize these circumstances as much as I could. After introducing myself to the family and trying to understand who all was present, I discussed the findings of his multiple-day hospitalization. “It is cancer,” I said. “It has unfortunately spread diffusely.” I saw the tears swell up in my patient's eyes while the family remained silent. I could only imagine the shock and sadness this news gave them as they sat together in their dining room. After some silence had passed, the conversation furthered as we progressed to discussing prognosis and therapeutic options. For the length of the conversation, the patient remained silent with tears cyclically piling up in his eyes before rolling down his cheek. At the end of our conversation, I listened acutely while his daughter asked if she could call back after I left the room to talk more with him. My heart burned as I sympathized with his daughter who was solely trying to support her father in the only way she knew how. She could not hold him. She could not hug him. She could not be there in one of the largest moments of his life. The patient looked at me and notably wanted me to remain silent as he told her that he was fine and would chat with her another time. Tears swelled up in my eyes as I knew that his efforts were with intent to refrain from being a burden on his family. COVID has impacted many in ways that we could not predict. While our confirmed cases and death rates remain low, the impact of COVID in all aspects of medicine and in fact, all aspects of life, will leave a lasting mark. In this time, it is easy to feel defeated and lose hope for a return of normalcy. A time where a daughter can hug her father as he sits in his intensive care unit bed, finding out that his prognosis is terminal. In these moments, I am thankful for all those that have taken time to go above and beyond for our patients. Aiding in the COVID pandemic stretches far. I am grateful for those working hard on the frontline, but I am also thankful for those who help in alternative ways. We can all help in this pandemic. We can all take the time to realize how this impacts the lives of our patients and takes a few extra minutes out of our days to provide support and empathy for how these days will forever be marked in our patient's minds.

  Perspective Number 21 Top

Vitiligo Superwoman: Rochelle

Katie O'Connell

Medical Student, Eastern Virginia Medical School, Norfolk, Virginia, USA

I met Rochelle on a crisp fall morning at Starbucks almost 2 years ago; her smile and warmth filled the room. She was dressed in a bright purple shirt and matching purple ball cap, with VITILIGO written in big, bold letters. Rochelle is the Virginia vitiligo support group leader under the Vitiligo Friends (VITFriends) national community of support groups. I reached out to her to offer medical student assistance for the group. During our first meeting, Rochelle brought two poster boards that she shared with me and my peers. The poster boards included scores of photographs from the vitiligo events she had hosted and attended over the years. She pointed out Alicia and Perry and many more individuals, now close friends, whom she had met along her journey to spread awareness about vitiligo. Her passion, sincerity, and dedication were contagious. Rochelle developed vitiligo, an autoimmune disease resulting in the destruction of melanocytes, at the age of 25. Her response to the disease was to devote her life to being an incredible advocate for those living with vitiligo. She originally started a support group some 30 years ago. Although it was difficult to get people together in the early days, she began by visiting people living with vitiligo individually – both young and old. Over the years, Rochelle has worked tirelessly to raise awareness and advocate for those affected by vitiligo; she has been featured in many newspapers, local health segments, and talk shows, she was invited to speak on the Geraldo Rivera talk show, she read Vitiligo Doesn't Scare Me, a children's book, to local elementary school children, she participated in advocacy work at both the state and national level, including the Congressional Black Caucus and the American Academy of Dermatology Legislative Conference in Washington D.C., and she spoke to 1st-year medical students in Virginia about her journey living with vitiligo and invited others to share their journey. Rochelle has successfully fought for and won insurance coverage for vitiligo from one payer and has hosted numerous fundraisers to provide vitiligo books to schools and support group members' travel to World Vitiligo Day. Rochelle is a tireless and fearless advocate. She is the kind of person you meet once in a lifetime: bold, inspirational, beautiful, and strong. She brings hope to those who are struggling with a new diagnosis and strength and companionship to those who are afraid and lonely. Her efforts, enabled by love and compassion, have had a positive effect on hundreds of lives. I hope that every medical professional has the opportunity in their career to meet, assist, and learn from a healthcare advocate as noble and effective as Rochelle.

  Perspective Number 22 Top

The Crossroads of SARS-CoV-2 and Health Inequities in the United States

Natasha E. Hongsermeier-Graves

College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA

The majority of an individual's overall health is driven not by healthcare access but by structural and systematic factors, such as demographic inequities and social determinants of health.[1] The recent SARS-CoV-2 pandemic has brought to the forefront longtime health disparities among Black, Brown, Indigenous, and other minority communities.[2] While still lacking, the data available establish that the coronavirus pandemic is hitting these marginalized populations the hardest.[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28] Racism is at the root of these disproportionate effects.

Racial and ethnic minorities receive lower-quality healthcare than Whites, even with the same degree of insurance and ability to pay.[29] Chronic comorbidities that predispose COVID-19 patients to a greater risk of death are more common among African-Americans.[3],[5],[7],[20],[30] This is linked to the allostatic load hypothesis, “weathering,”[31] and the “Slave Health Deficit”[3] – the aftermath of years of discrimination, unequal treatment, and injustices. Populations who have historically experienced discrimination are less likely to own a home[12] and more likely to live in poor, overcrowded housing.[3],[15] Car ownership rates are also lower among marginalized families.[12] Public transportation increases the chance of exposure to SARS-CoV-2, and lack of a car makes drive-up testing sites or other healthcare facilities inaccessible.[2] Restrictive immigration policies may deter immigrants in the country from seeking care for fear of being deported.[22] Millions of marginalized patients are either underinsured[3],[29] or uninsured,[12],[32] often due to holding jobs where coverage is not offered by employers.[3] Many of these jobs are “essential” (food service, transportation, and sanitation)[12],[16] and do not offer paid sick leave[10] or the flexibility to work from home.[3],[12],[26],[33]

Communication barriers further contribute to the disproportionate effects of SARS-CoV-2. This may include a lack of landline or Internet access[15] and language barriers.[8],[24],[29] About 1 in 5 Americans speak a language other than English at home.[34] Aside from hindering direct care, language barriers also result in misinformation or a lack of information – such as the South Dakota meat plant where 40 languages are spoken, but informational COVID-19 pamphlets were only handed out in English.[24] Even where communication is possible, marginalized populations are less likely to trust the information coming from our government or healthcare system, which prevents them from seeking care or following treatment recommendations.[14],[29] The government's credibility has been undermined by victim blaming[20],[35] and a lack of empathy[14] for the disproportionate toll of COVID-19 on non-White populations. The messenger matters, and minority communities, are often not receiving information from people who look like and understand them or from whom they deem as trustworthy.[14] Latinx and Black Americans also have many reasons to distrust healthcare institutions.[4],[14] Mistreatment of socio-politically manufactured racial groups[36] dates back to the 18th century where physicians and scientists created theories of biological inferiority, such as eugenics, to justify the oppression of non-Whites.[37] The Tuskegee syphilis experiment is one horrific example.[38] Even well-intentioned White providers who are not overtly biased typically demonstrate unconscious negative racial attitudes and stereotypes.[29],[39] The resultant distrust may lead to dangerously low vaccination rates if and when a SARS-CoV-2 immunization becomes available, as Black and Brown Americans typically fall at least 10% points behind Whites on flu vaccination rates.[40]

Going forward, national COVID-19 response efforts must focus on a few crucial areas of improvement. All data need to be leveraged to activate communities and put pressure on policymakers to eliminate health disparities and racial discrimination in medicine. Public health information must be communicated to marginalized populations by a credible community leader in a way that considers culture, language, and preferred channel of receiving information. We need to cultivate positive relationships with community leaders to develop their population's capacity and resources to make decisions and take action. We should strive to empower, not over-power. In conclusion, if we are to avoid repeating the same mistakes, a drastic change in our culture and systems will be required. Racism, not a race, creates health disparities. Reducing health disparities creates better health for all Americans. Until will we decide as a society that every human being deserves an equal chance of being healthy, regardless of where they were born, how much wealth their families had, or what color their skin is, Black and Brown people will continue to disproportionately experience higher rates of disease and premature mortality, including from SARS-CoV-2, as they endure the structural racism of America.

  References Top

  1. Fancher T, Lewis J, Gonzalo J, Hammoud M. What Are Social Determinants of Health? American Medical Association Health Systems Science Learning Series. Available from: https://edhub.ama-assn.org/health-systems-science/interactive/17498806. [Last accessed on 2020 Apr 28].
  2. Barr NL, Pez L, Otterbein H, King M. Health Professionals Warn of 'Explosion' of Coronavirus Cases in Minority Communities. POLITICO; Published 06 April, 2020. Available from: https://www.politico.com/news/2020/04/06/coronavirus-demographics-170353. [Last accessed on 2020 Apr 28].
  3. Brooks O. COVID-19 Underscores Wealth and Health Disparities in the African American Community. National Medical Association; Published 08 April, 2020. Available from: https://www.nmanet.org/news/500673/COVID-19-Underscores-Wealth-and-Health-Disparities-in-the-African-American-Community.htm. [Last accessed on 2020 Apr 26].
  4. Maybank A. The Pandemic's Missing Data. The New York Times. Available from: https://www.nytimes.com/2020/04/07/opinion/coronavirus-blacks.html. Published 7 April, 2020. [Last accessed on 2020 Apr 26].
  5. Maybank A. Why Racial and Ethnic Data on COVID-19's Impact is Badly Needed. American Medical Association; Published 8 April, 2020. https://www.ama-assn.org/about/leadership/why-racial-and-ethnic-data-covid-19-s-impact-badly-needed. [Last accessed on 2020 Apr 26].
  6. American Medical Association. States Tracking COVID-19 Race and Ethnicity Data. American Medical Association; Published 24 April, 2020. Available from: https://www.ama-assn.org/delivering-care/health-equity/states-tracking-covid-19-race-and-ethnicity-data. [Last accessed on 2020 Apr 26].
  7. American Medical Association. Top Physician Orgs Urge COVID-19 Mortality Data by Race, Ethnicity. American Medical Association; Published 8 April, 2020. Available from: https://www.ama-assn.org/press-center/press-releases/top-physician-orgs-urge-covid-19-mortality-data-race-ethnicity [Last accessed on 2020 April 27].
  8. Kaplan J. Hospitals Have Left Many COVID-19 Patients Who Don't Speak English Alone, Confused and Without Proper Care. ProPublica; Published 31 March, 2020. Available from: https://www.propublica.org/article/hospitals-have-left-many-covid19-patients-who-dont-speak-english-alone-confused-and-without-proper-care. [Last accessed on 2020 Apr 28].
  9. Robeznieks A. National COVID-19 Patient Data Vital to Fixing Inequity. American Medical Association. Published 24 April, 2020. Available from: https://www.ama-assn.org/delivering-care/health-equity/national-covid-19-patient-data-vital-fixing-inequity. [Last accessed on 2020 Apr 27].
  10. American Medical Association. AMA Announces New COVID-19 Health Equity Resources. American Medical Association; Published 27 April, 2020. Available from: https://www.ama-assn.org/press-center/press-releases/ama-announces-new-covid-19-health-equity-resources. [Last accessed on 2020 Apr 27].
  11. Berg S. Q&A with Oprah Shines Light on COVID-19 Impact on Minorities. American Medical Association; Published 15 April, 2020. Available from: https://www.ama-assn.org/delivering-care/health-equity/qa-oprah-shines-light-covid-19-impact-minorities. [Last accessed on 2020 Apr 27].
  12. Marisol Meraji S, Demby G. Why the Coronavirus Is Hitting Black Communities Hardest. Available from: https://www.npr.org/2020/04/10/832238018/why-the-coronavirus-is-hitting-black-communities-hardest. [Last accessed on 2020 Apr 27].
  13. Marisol Meraji S, Demby G. The News Beyond the COVID Numbers: Coronavirus, Race, And Why It's Important To Track That Data. https://www.npr.org/2020/04/21/840609912/the-news-beyond-the-covid-numbers [Last accessed on 2020 April 27].
  14. Barron-Lopez L. Trump Coronavirus Response Feeds Distrust in Black and Latino Communities. POLITICO; Published Online 21 April, 2020. Available from: https://www.politico.com/news/2020/04/21/race-coronavirus-outreach-197470. [Last accessed on 2020 Apr 27].
  15. Cancryn A. Where Coronavirus Could Find a Refuge: Native American Reservations. POLITICO; Published 28 March, 2020. Available from: https://www.politico.com/news/2020/03/28/native-americans-coronavirus-152579. [Last accessed on 2020 Apr 28].
  16. Diamond D. Public Health Officials Prod Trump's Team for Minority Data. POLITICO; Published 14 April, 2020. Available from: https://www.politico.com/news/2020/04/14/trump-minority-data-coronavirus-185074. [Last accessed on 2020 Apr 28].
  17. Hurst A, Siegel J. Coronavirus: A Lack of Trust And Information In Minority Communities. Available from: http://politi.co/2yX1LHc. [Last accessed on 2020 Apr 28].
  18. King M. Black Doctors Blast “Woefully Anemic” Data on Minority Coronavirus Cases. POLITICO; Published 20 April, 2020. Available from: https://www.politico.com/news/2020/04/20/minority-cases-coronavirus-197203. [Last accessed on 2020 Apr 28].
  19. Simmons-Duffin S. White House: Data on COVID-19 And Race Still Weeks Away. NPR.org; Published 20 April, 2020. Available from: https://www.npr.org/sections/coronavirus-live-updates/2020/04/20/838745546/white-house-data-on-covid-19-and-race-still-weeks-away. [Last accessed on 2020 Apr 28].
  20. Kendi IX. Stop Blaming Black People for Dying of the Coronavirus. The Atlantic; Published 14 April, 2020. Available from: https://www.theatlantic.com/ideas/archive/2020/04/race-and-blame/609946/. [Last accessed on 2020 Apr 28].
  21. Thebault R, Tran AB, Williams V. The Coronavirus Is Infecting and Killing Black Americans at an Alarmingly High Rate. Washington Post; Published 7 April, 2020. Available from: https://www.washingtonpost.com/nation/2020/04/07/coronavirus-is-infecting-killing-black-americans-an-alarmingly-high-rate-post-analysis-shows/. [Last accessed on 2020 Apr 28].
  22. Kendi IX. What the Racial Data Show. The Atlantic; Published 6 April, 2020. Available from: https://www.theatlantic.com/ideas/archive/2020/04/coronavirus-exposing-our-racial-divides/609526/ [Last accessed on 2020 Apr 28].
  23. Acevedo N, Sesin C. Amid coronavirus Spread, Health Advocates Worry Trump's Immigration Policies Put Public at Risk. NBC News; Published 5 March, 2020. Available from: https://www.nbcnews.com/news/latino/amid-coronavirus-spread-health-advocates-worry-trump-s-immigration-policies-n1150241 [Last accessed on 2020 Apr 28].
  24. Siemaszko C. Language Barriers Helped Turn Smithfield Foods Meat Plant into COVID-19 Hotspot. NBC News; Published April 23, 2020. Available from: https://www.nbcnews.com/news/us-news/language-barriers-helped-turn-smithfield-foods-meat-plant-covid-19-n1190736. [Last accessed on 2020 April 28].
  25. Harris P, Maybank A, Wong W, Rios E, Wescott S, Thompson B, Brooks O. Prioritizing Equity: The Experience of Physicians of Color and COVID-19; 2020. Available from: https://www.ama-assn.org/delivering-care/health-equity/prioritizing-equity-experience-physicians-color-and-covid-19. [Last accessed on 2020 Apr 29].
  26. Laurencin CT, McClinton A. The COVID-19 pandemic: A call to action to identify and address racial and ethnic disparities. J Racial Ethn Health Disparities 2020;7:398-402.
  27. Garg S. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 COVID-NET, 14 States, March 1-30, 2020. Centers for Disease Control and Prevention; 2020. Availablr from: https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm. [Last accessed on 2020 May 17].
  28. Wadhera RK, Wadhera P, Gaba P, Figueroa J, Joynt Maddox K, Yeh R, Shen C. Variation in COVID-19 hospitalizations and deaths across New York City Boroughs. JAMA 2020; 2020;323:2192-2195. [Doi: 10.1001/jama.2020.7197].
  29. National Academy of Medicine (formerly the Institute of Medicine). Unequal Treatment: What Healthcare Providers Need to Know About Racial and Ethnic Disparities in Healthcare. National Academy of Sciences, Engineering, and Medicine; 2002. p. 8. Available from: https://www.nap.edu/resource/10260/disparities_providers.pdf. [Last accessed on 2020 Apr 28].
  30. Webb Hooper M, Nápoles AM, Pérez-Stable EJ. COVID-19 and Racial/Ethnic Disparities. JAMA. 2020;323:2466–2467. doi:10.1001/jama.2020.8598.
  31. Geronimus AT, Hicken M, Keene D, Bound J. “Weathering” and age patterns of allostatic load scores among blacks and whites in the United States. Am J Public Health 2006;96:826-33.
  32. Betancourt JR, Maina AW. The institute of medicine report “unequal treatment”: Implications for academic health centers. Mt Sinai J Med 2004;71:314-21.
  33. Workers Who Could Work at Home, Did Work at Home, and Were Paid for Work at Home, by Selected Characteristics, Averages for the Period 2017-2018. U.S. Bureau of Labor Statistics; 2019. Available from: https://www.bls.gov/news.release/flex2.t01.htm. [Last accessed on 2020 May 17].
  34. Shin H, Kominski R. Language Use in the United States: 2007. United States Census Bureau; 2010. Available from: https://www.census.gov/library/publications/2010/acs/acs-12.html. [Last accessed on 2020 Apr 29].
  35. Diamond D. Surgeon General Gets Pushed to Sidelines, Sparking Questions. POLITICO; Published 20 April, 2020. Available from: https://www.politico.com/news/2020/04/20/surgeon-general-coronavirus-197508. [Last accessed on 2020 Apr 28].
  36. Grubbs V. Precision in GFR reporting: Let's stop playing the race card. Clin J Am Soc Nephrol 2020;15:1201-2.
  37. Nieblas-Bedolla E, Christophers B, Nkinsi NT, Schumann PD, Stein E. Changing how race is portrayed in medical education: Recommendations from medical students. Acad Med. 2020;95:1802-6. [Doi: 10.1097/ACM.0000000000003496].
  38. Brown D. 'You've got bad blood': The Horror of the Tuskegee Syphilis Experiment. Washington Post; Published 16 May, 2017. Available from: https://www.washingtonpost.com/news/retropolis/wp/2017/05/16/youve-got-bad-blood-the-horror-of-the-tuskegee-syphilis-experiment/. [Last accessed on 2020 Apr 28].
  39. Milam AJ, Furr-Holden D, Edwards-Johnson J, Webb B, Patton JW, Ezekwemba NC, et al. Are clinicians contributing to excess African American COVID-19 deaths? Unbeknownst to Them, They May Be. Health Equity 2020;4:139-41.
  40. FluVaxView. Flu Vaccination Coverage, United States, 2018-19 Influenza Season. Centers for Disease Control and Prevention; Published 26 September, 2019. Available from: https://www.cdc.gov/flu/fluvaxview/coverage-1819estimates.htm. [Last accessed on 2020 Apr 28].

  Abstract 1: First Place Winner of Women in Medicine Summit Oral Presentation Top

Development and Implementation of Illinois Medical Professionals Action Collaborative Team to Amplify Physician Women and Ally Voices during the COVID-19 Pandemic

Laura J. Zimmermann, Eve D. Bloomgarden1, Ali Khan2, Garth N. Walker3, Amisha Wallia1, Lisa J. Mordell2, Serena R. Dhaon2, Nathan S. Trueger3, Maylyn Martinez2, Shikha Jain4, Vineet M. Arora2

Rush University Medical Center, 1Division of Endocrinology, Northwestern University, 2Department of Medicine, University of Chicago, 3Department of Emergency Medicine, Northwestern University, 4Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL, USA

Introduction: Incorporating the physician perspective is essential to ending the pandemic and advancing the struggle against structural racism and health inequities. Physicians have a duty to promote high-quality information to help public and policymakers address these challenges. Engaging is difficult for frontline physicians during the pandemic, especially for women and those with young children dealing with childcare and remote learning. We, a group of mostly physician moms, formed Illinois Medical Professionals Action Collaborative Team (IMPACT). Through novel partnerships, social and traditional media, and infographics, we aimed to amplify physician voices and facilitate physician engagement in public health messaging and advocacy to stop the spread of COVID-19 and promote racial equity.

Methods: Through social media campaigns, we educated the public on social distancing, mask-wearing, and personal protective practices to safely reopen businesses and schools. By leveraging Facebook groups (Physician Mommies Chicago and the Illinois COVID-19 Medical Collective), we mobilized thousands to sign petitions and letters to policymakers advocating for shelter in place, social distancing, school closings, and masking. Using rapid-cycle document creation/editing on Google Docs and Slack to facilitate rapid discussion, we created multiple timely advocacy letters and op-Eds. We also partnered with other women-led organizations (MaskNowIL, GetMePPEChi, Dear Pandemic, Bump Club, and Beyond) to promote and amplify health expertise on staying safe during the pandemic while also advocating for social justice issues related to structural racism.

Results: Since the start of the pandemic, our team has published over 20 op-Eds in national media, including the Chicago Tribune, Health Affairs, The Hill, Crain's Chicago Business, Physician Weekly Magazine, MsMagazine, and KevinMD. The IMPACT was featured in the Chicago Tribune and on local news networks. Founders were featured on Good Morning America, a recurring Fox 32 segment, and in Forbes Magazine. Our social media campaigns have resulted in Facebook/Twitter/Instagram pages with nearly 1500 followers and posts earning between 1000 and 7000 views on Facebook alone. Successful campaigns included (1) a social distancing hashtag (#6ftApartNotUnder) with >4000 Tweets and with millions of impressions, (2) a Change.org petition with ~10,000 signatures calling for universal masking, (3) a virtual #whitecoatforblacklives march that was Zoom bombed but eventually resulted in over 1M impressions on 1 Tweet alone (2300 engaged) and >3K views on Facebook, (4) an infographic on protesting safely that reached over 7000 on Instagram/Facebook. Through Bump Club and Beyond (nationwide network of >100K moms), we reach over 1500 moms each week on Facebook Live answering questions about staying safe and seeking medical care during the pandemic. We submitted six letters with over 2000 total signatures to Illinois lawmakers advocating for the shelter-in-place, closing schools, PPE supply, and masking. Our letters were used by groups of physician moms in Iowa, Texas, California, and Florida to petition state lawmakers.

Conclusions: Physician moms and allies can organize and strategically leverage social and traditional media to reach thousands, fighting the “infodemic” by amplifying physician voices. The IMPACT has enabled very busy physician parents to organize, advocate, and educate communities about both COVID-19 and advancing racial equity.

  Abstract 2: Second Place Winner of Women in Medicine Summit Oral Presentation Top

Gender-Based Differences in Burnout and Attrition among Physician in Surgery, Obstetrics, and Anesthesia Worldwide: A Scoping Review

Adelina Mazhiqi1,2, Anusha Jayaram1,3, Eliana E. Kim1,4, Dominique Vervoort1,5, Rolvix H. Patterson1,6, Raphael Greving1,7, Leah Gusching1, Lotta Velin1,8, Ellie Moeller1,9, Kathryn Wall1, Jacquelyn A. Corley1,10, Emily Anderson1, Gail Rosseau1,11

1Gender Equity Initiative in Global Surgery, Boston, MA, USA, 2Ängelholm Hospital: Ängelholm, Sweden, 3Tufts University School of Medicine: Boston, MA, USA, 4University of California-San Francisco School of Medicine, CA, USA, 5Johns Hopkins Bloomberg School of Public Health: Baltimore, MD, USA, 6Department of Head and Neck Surgery & Communication Sciences, Duke University Hospital: Durham, NC, USA, 7Justus-Liebig-University School of Medicine: Giessen, Germany, 8Surgery and Public Health, Department of Clinical Sciences Lund, Faculty of Medicine: Lund University, Sweden, 9University of Miami Miller School of Medicine, Miami, FL, USA, 10Duke University Hospital, Durham, NC, USA, 11Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA

Introduction: Burnout is highly prevalent in surgical specialties. It is characterized by emotional exhaustion (EE), depersonalization (DP), and/or reduced personal accomplishment (PA). Burnout is not only associated with reduced career satisfaction but may also lead to attrition and medical errors. Despite 40% of surgeons experiencing burnout, 33% expressing depressive symptoms, and almost 30% reporting poor mental quality of life, burnout among physicians in surgery, obstetrics, and anesthesia (SOA) remains underrecognized worldwide. Women remain underrepresented across surgical specialties globally, but the effect of gender on burnout and attrition is not well understood. Here, we performed a scoping review examining gender-based differences in burnout and attrition among physicians in SOA fields worldwide.

Methods: A scoping review was conducted using the adapted PRISMA-ScR guidelines to describe gender-based differences in burnout and attrition in SOA fields globally. Through predetermined inclusion and exclusion criteria, all English-language articles published by May 1, 2019, were retrieved from PubMed/MEDLINE, World of Science, and Ovid. After screening, 41 articles were included.

Results: Four studies reported women SOA physicians exhibiting higher levels of EE, and three papers found no statistical significance between gender and EE. Three papers reported that men SOA physicians have higher rates of DP than women, one showed similar scores between genders, while another study found lower DP rates among men. One study reported no difference in PA based on gender, and two studies indicated men expressing lower levels than women. [Table 1] depicts included articles concerning the three burnout components. [Table 2] illustrates included papers concerning burnout scores. Eleven papers reported differences between men and women leaving SOA fields. Four studies reported women to be more likely to consider leaving SOA fields than men, with one finding women to be two-to-three times more likely to leave. Common reasons for attrition from SOA fields included work–home conflicts and lack of support, with many citing the need for additional time with friends and family. Two studies showed that being unmarried was significantly associated with SOA physician burnout, while two others showed no effect of marital status on burnout. Women surgeons had worse self-reported work–life balance, greater perceived child-raising responsibility, less satisfaction in partnerships, and more family stress than their men colleagues across three studies. Increased free time was most effective in reducing work stress followed by more staff, flexible working hours, ability to influence scheduling, and increased provider autonomy, as described by one study.

Conclusions: Burnout is prevalent within SOA fields although gender-based differences have yet to be examined. Data within SOA fields suggest that EE is more prevalent among women and that men express higher DP rates. Furthermore, women seem to be more likely to consider leaving SOA fields. To our knowledge, this is the first scoping review describing gender differences in burnout/attrition in SOA fields worldwide. Burnout affects the individual physician and profession, and further, studies are warranted to better understand and address gender differences in burnout/attrition in SOA fields.

  References Top

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  Abstract 3: Third Place Winner of Women in Medicine Summit Oral Presentation Top

Sexual and Gender Harassment and Engagement among U.S. Medical School Faculty

Diana M. Lautenberger, Valerie M. Dandar, Katherine Balas

Academic Affairs, Association of American Medical Colleges, Washington, DC, USA

Introduction: Sexual and gender harassment (SGH) is known to be prevalent in academic medicine, yet few multi-site studies have been conducted, as well as assessed the impact of harassment on workplace engagement. To bridge this gap, the Association of American Medical Colleges (AAMC's) Standpoint Faculty Engagement Survey (SFES) began collecting data from faculty at participating medical schools on the frequency of SGH and perceptions of comfort and confidence with reporting harassment in February 2019. This analysis will explore trends in harassment by different faculty groups and the relationship between harassment and faculty engagement.

Methods: Data for this analysis come from the AAMC's SFES, an optional service offered to member schools, whereby the AAMC administers this faculty engagement survey on behalf of participating medical schools at a time of their choosing. Data for this abstract come from 13 institutions, representing over 8000 faculty, that administered the SFES between February 2019 and May 2020. The SFES's SGH questions ask if and how frequently faculty have experienced any of the five behaviors that commonly define harassment over the past 12 months through interactions with other faculty and staff (e.g., telling of sexist jokes/stories, offensive remarks about one's appearance or sexual activities, offensive or vulgar references to people of a particular gender, condescension or put downs based on gender, and sharing of offensive messages/obscene images based on gender). Demographic data collected from the survey will be used in conjunction with harassment data and measures of global engagement to assess trends in harassment and links with faculty engagement.

Results: Initial findings from 8110 faculty surveyed between February 2019 and May 2020 show that both men and women experience harassment, with approximately 1 in 3 (35%) women reporting at least one incidence of gender harassment in the past year, compared to 1 in 8 (13%) men. Telling of sexist jokes/stories (21%) and puts downs or condescending behaviors based on gender (24%) were the most common types of SGH experienced by women. Rates of harassment increased for women identifying as URM: underrepresented minority LGBT: lesbian, gay, bisexual and transgender, and associate professors. Further, workplace satisfaction was lower and intent to leave was higher among those who experienced harassment compared to those who did not.

Conclusion: This study is unique as it presents data from a larger sample of diverse medical schools on experiences of gender harassment. Analyses confirm the findings of previous studies with smaller sample sizes in that SGH is prevalent in the academic medicine workplace and experienced at higher rates for particular faculty groups, such as women of color. As an initial step to address harassment, institutions can begin by confidentially assessing harassment experiences in their workplace and by implementing educational programs to identify and combat harassment behaviors. In addition to instituting educational programs to assess behaviors themselves, there should be additional steps to create safety and awareness of how to report behaviors when they happen.

  Abstract 4: First Place Winner of Women in Medicine Summit Poster Presentation Top

Women Physicians in Transition

Tiffany I. Leung, Chwen-Yuen Angie Chen1, Tammy Lin2,3, Geneen T. Gin4, Sima S. Pendharkar5, Karen H. Wang6

Faculty, Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands, 1Department of Primary Care and Population Health, Stanford University, Palo Alto, 2Private Practice, Internal Medicine Physician, 3Department of Medicine, University of California San Diego, Health Sciences, San Diego, 4Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, 5Department of Internal Medicine, The Guthrie Clinic, Sayre, PA, 6Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA

Introduction: As women physicians transition through their career, transitioning from early to mid-career often coincides with being in their thirties and forties, when there is often peak potential for imbalance between their professional and personal worlds. The leaky pipeline of women physicians advancing through their careers remains problematic. Focused investigation of important inflection points, or transitions, could contribute important insights to our understanding of gender equity in medical careers. The aims of this study are to learn from narratives of women physicians experiencing this transition and to develop best practices which can serve to support women physicians as they advance through their careers.

Methods: We conducted semi-structured interviews with U.S. women physicians. Eligibility criteria included self-identification as a woman who is in the process of transitioning or who recently transitioned from early to mid-career stage. Purposeful sampling facilitated identification of information-rich cases, with attention to diversity in career pathway, practice setting, specialty, and race/ethnicity. Each participant was offered compensation for their participation. Interviews were audio-recorded and transcribed. Interview questions were open-ended, exploring participants' perceptions of this transition. The study approval was received from the Ethics Review Committee of the Faculty of Health, Medicine, and Life Sciences at Maastricht University; expedited review and approval from Stanford University; and certified as exempt from review from University of California San Diego. Funding was provided by the American Medical Association's Joan F. Giambalvo Fund for the Advancement of Women.

Results: We used an open coding and grounded theory approach to analyze initial interview transcripts. An emerging theme is a tension resulting from finite time divided between demands from a physician career and demands from family needs. In turn, this results in constant boundary control between these life domains that are inextricable and seemingly competing against each other within a finite space: family needs impinge on planned career goals, if the boundary between them is not carefully managed. To remedy this, women sought resources to help them redistribute home responsibilities, freeing themselves to have more time, especially for children.

Women similarly sought resources to help with career advancement, not with regard to time directly, but to first address foundational knowledge gaps about career milestones and how to achieve them. Such resources could be institutional professional development programs and/or relationship-based resources, such as having knowledgeable mentors. Effective mentorship was especially vital, mediating the translation of knowledge into prioritizing professional activities toward a previously unknown time horizon. Thematic saturation has not yet been reached, so additional interviews and iterative analyses are planned.

Conclusions: In this ongoing study, we begin understanding how women identify or activate a career shift and how they marshaled resources and support to navigate barriers they faced. Emerging findings suggest significant and dynamic tension between work–life and family–life domains as women physicians transition from early to mid-career. In short, the early to mid-career transitional phase for women physicians can be career and personally defining. Further investigations of career transitions could offer additional contextual richness in understanding and supporting equitable career transitions.

  Abstract 5: Second Place Winner of Women in Medicine Summit Poster Presentation Top

Testosterone as a Novel Anti-Estrogen Therapy in Lymphangioleiomyomatosis

Masina G. Wright, Cynthia Pappenfus, Thomas Van Der Kloot1

Department of Medicine, University of New Mexico Hospital, Albuquerque, NM, 1Department of Pulmonology, Maine Medical Center, Portland, ME, USA

Introduction: Lymphangioleiomyomatosis (LAM) is a rare disease in which abnormal smooth muscle-like cells proliferate in the lungs, causing progressive cystic/obstructive lung disease and respiratory failure. It is almost exclusively diagnosed in premenopausal ciswomen. Numerous studies have found that estrogens promote LAM cell proliferation, migration, and metastasis, but clinical studies evaluating anti-estrogen-focused therapies have not shown benefit. Recent bench-to-bedside research has identified a role for sirolimus, which has been shown to slow progression of disease, leading to the MILES and MIDAS trials.

Case Presentation: A 39-year-old female with a history of asthma presented with an 18-year history of LAM and symptoms of shortness of breath, chest pain, dyspnea on exertion, and low stamina with subjective cyclical hormonal aggravations. LAM was diagnosed near menarche, and prior exacerbations included a pneumothorax presenting around ovulation/menses. Previous treatments included bilateral pleurodesis. She was on 2 mg of sirolimus daily. As monthly estrogen peaks correlated with exacerbations, our treatment focus was to suppress ovarian estradiol production through supratherapeutic doses of testosterone. Bioidentical hormone therapy was initiated at 5–15 mg of testosterone cypionate subcutaneous per week titrated upward, plus 75 mg of bioidentical progesterone daily. She reported immediate improvement in endurance and resolution of fatigue. Over 18 months, her dyspnea improved, with complete resolution of chest pain. At 3 and 6 months, sirolimus levels returned elevated with elevated cholesterol and hemoglobin. Serial pulmonary function testing demonstrated a decrease in residual volume and total lung capacity, as well as improvement in FEV1 since initiating hormonal therapy. The sirolimus level was able to be halved with sustained improvement in lung function and normalization of cholesterol and hemoglobin. She has minimal menses, correlating with improved disease progression.

Discussion: Research has focused on genetic associations between LAM, tuberous sclerosis, and treatment with the rapamycin complex inhibitor sirolimus. There is no LAM cure with lung transplant indicated in appropriate patients. Mouse models suggest that anti-estrogen therapy may be an effective treatment; however, this affects fertility, sexual health, bone density, and aging. Furthermore, clinical studies in humans have not shown benefit. LAM cells have evidenced progesterone responsiveness, with animal? studies showing both suppression of estradiol activation and/or increased metastasis. Conversely, synthetic progestins have been associated with no benefit, or deterioration of disease when studied in humans. In this patient, bioidentical progesterone was used to stabilize the endometrium from testosterone's aromatization and to prevent uninhibited proliferation in breast tissue. The effects of testosterone in supertherapeutic doses are known from transgender scholarship. This patient experienced a slight change in hair growth/hair loss, heightened endurance, subjectively increased metabolism and muscle mass, decreased body fat, and mild mood changes. She is a self-advocate for nutritional management of estrogen-like lignins with minimal alcohol and no tobacco or recreational drugs. Testosterone with progesterone has suppressed the hypothalamic–pituitary–ovarian axis in this case, with subjective improvement and objective cessation of disease progression. This LAM case suggests that testosterone can sustain the multisystemic benefits of gonadal hormone health while enhancing and preserving lung function and decreasing sirolimus requirements.{Table 3}

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  5. Prizant H, Hammes SR. Minireview: Lymphangioleiomyomatosis (LAM): The “other” steroid-sensitive cancer. Endocrinology 2016;157:3374-83.
  6. Yu J, Astrinidis A, Howard S, Henske EP. Estradiol and tamoxifen stimulate LAM-associated angiomyolipoma cell growth and activate both genomic and nongenomic signaling pathways. Am J Physiol Lung Cell Mol Physiol 2004;286:L694-700.

  Abstract 6: Third Place Winner of Women in Medicine Summit Poster Presentatio Top

Clearing the Path for Early Career Women Faculty: The Early Pathways to Success Conceptual

Sade Spencer, Kait Macheledt1, Jerica Berge1, Rahel Ghebre2

Departments of Pharmacology, 1Family Medicine and Community Health and 2Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, Minneapolis, MN, USA

Introduction: There are key skill sets that can support the success of academic medicine faculty in their academic careers. However, some of the most important skills expand beyond traditional career development and include factors such as peer-to-peer mentoring and connections, financial wellness, and work–life integration. Faculty who identify as women experience unique barriers to building these skill sets.

Methods: The University of Minnesota, Center for Women in Medicine and Science, has developed a yearlong CWIMS-Early Pathways to Success Program aimed at providing gender-specific, interdisciplinary, evidence-based career development for early-stage faculty and faculty who are new to the university. A pilot program launched in the fall 2019, guided by three assumptions and a conceptual framework.

Results: Twelve faculty were selected for the 2019–2020 pilot program cohort. During the pilot program, cohort faculty members successfully collaborated on multiple projects including one publication submission. At program completion, cohort members had identified growth along many domains including confidence in navigating promotion and tenure process, self-advocating, developing mentor/mentee relationship, having work/life balance, and developing leadership skills.

Conclusion: Faculty who identify as women experience unique barriers within academic medicine and science. The CWIMS-Early Pathways to Success Program pilot presents a conceptual framework for creating evidence-base career-development programs that are gender-specific and promote the advancement of women in medicine and science.

  Abstract 7 Top

Experiences of Physician Mothers during the COVID-19 Pandemic Based Upon their Children's Ages

Annie Savka1, Claire Pearson2,3, Anne Messman2, Miriam Levine3, Viviane Kazan2, Teena Chopra4, Diane L. Levine5

1Wayne State University, Detroit, MI, 2Department of Emergency Medicine Wayne State University Detroit, MI2, 3Ascension St. John Medical Center, Tulsa OK, 4Department of Internal Medicine - Infectious Diseases Wayne State University, Detroit, MI, 5Department of Internal Medicine Wayne State University, Detroit, MI, USA

Introduction: Physician mothers must balance family responsibilities with a demanding career. A global survey was sent out to assess physician mothers' experience during the COVID-19 pandemic. This is a subset analysis evaluating the impact of the pandemic on physician mothers with young children.

Methods: From April 27 through May 11, 2020, a convenience sample of physician mothers was surveyed regarding personal preparedness for COVID-19. Surveys were distributed via the Facebook Physician Moms Group and via the authors' personal/professional contacts.

Results: A total of 2177 mothers (80%) had at least one child (but may have had older children) who was elementary-school age or younger (”younger children”) and 714 (26%) mothers had at least one child who was middle- or high-school age (”older children”). The majority of mothers (52%) with older children did not change their schedule during the pandemic versus mothers of younger children (32%). Mothers with younger children were more likely than those with older children to cut back on their hours, 13% versus 9%, respectively. Mothers with older children were more likely to be primarily responsible (48% vs. 18%) or entirely responsible (11% vs. 6%) for helping children with assigned schoolwork compared to those with younger children. Mothers of older children (61%) were more concerned with exposing their spouse/partner to COVID-19 than mothers with younger children (44%), whereas mothers of younger children were more concerned with exposing their parents to COVID-19 (43% vs. 33%), dying from COVID-19 (42% vs. 36%), schooling children from home (30% vs. 17%), and separation from family (27% vs. 21%) compared with mothers of older children. Mothers with older children were more likely to prepare by ensuring adequate supplies of food, cleaning supplies, medications, and toilet paper, as well as preparing financially. Mothers with younger children were more likely than those of older children to feel that the balance between professional and personal responsibilities worsened during the pandemic (49% vs. 31%). Despite this, mothers felt more satisfied with the time they spent with their family and less guilty about not spending time with them during the pandemic [Table 1].

Conclusions: Physician mothers had different concerns depending upon their children's ages. Mothers with younger children were more likely to stop working or change their work schedule and felt that their work/life balance worsened during the pandemic. Mothers with older children were more likely to be primarily or entirely responsible for helping with schoolwork to prepare by obtaining various household supplies. Further analysis of mothers' needs based on the age of the children, the family responsibilities, and the stage they are in their career could provide more guidance for future planning. As more women become physicians, the needs of physician mothers are important considerations for future pandemic preparedness.

  Abstract 8 Top

Sexual Harassment and Reporting for Physicians (SHARE): Using Incident Reporting to Understand the Characteristics, Response, and Impact of Incidents Where Physicians Are Sexually Harassed by Patients

Shirin Hemmat, Elaine Khoong1, Sarah Lisker1, Kristan Olazo1, Anjana E. Sharma2, Christina Mangurian3,Alicia Fernandez1, Urmimala Sarkar1

Departments of Internal Medicine and 3Psychiatry, University of California San Francisco, Departments of 1Medicine and 2Family and Community Medicine, University of California San Francisco at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA

Introduction: Previous studies have shown that a third of physicians encounter sexual harassment from patients, with these rates nearly double for women. Sexual harassment of women in the workplace, including by patients, has been identified as a challenge to the recruitment and advancement of women physicians. The nature of these encounters has not been previously described. Using incident reporting, the objective of this study was to qualitatively characterize encounters where physicians were sexually harassed by patients.

Methods: The anonymous SHARE tool used a web-based questionnaire for physicians to report the incidents of sexual harassment by patients. The questionnaire included structured questions about respondent traits, incident characteristics, individual and institutional response to the incident, and impact on the respondent. Respondents also described the incident in a free text which was coded inductively.

Results: As with all incidents reporting, data collection is on-going. Respondent traits: 52 respondents from 13 states and nine medical specialties initiated the survey. 47 respondents were women. Incident traits: 23 occurred in the outpatient setting, 20 inpatients, and ten in the emergency department. 26 had met the patient on at least one prior incident. Most harassment was verbal (n = 51), which included inappropriate or flirtatious remarks (i.e., commenting on the physician's attractiveness or breast size, asking the physician on a date, or to engage in sexual activity). There were 12 incidents of physical harassment, including inappropriate touching, intimidation, or exposure. Three reported stalking or threats from patients. Physician response: 17 respondents ignored the harassment, 12 addressed the patient directly, 19 told a supervisor or colleague, and 11 formally reported the incident. Many did not formally report because they felt that their experience was not significant enough to report (n = 17). Others feared negative repercussions (n = 9), felt shame about the experience (n = 9), or felt uncertain about the reporting process (n = 18). Institutional/supervisor response: 12 patients were reassigned or dismissed from the clinic, three normalized or minimized the patient's behavior, two addressed the behavior with the patient, two patients were prohibited from seeing trainees, two discouraged formal reporting, and there was one instance of retaliation after reporting. Physician impact: 22 said the incident negatively impacted their mental health, 13 said they withdrew from an aspect of their job or organization as a result of the incident, ten had decreased job satisfaction, and three changed their behavior (dressed differently or took a different route to work).

Conclusion: Sexual harassment of the physicians is common with a wide range of incidents. Many do not formally report despite having negative experiences that impacted their ability to perform their job. When reported, many institutional/supervisor responses were inadequate. The next steps include helping physicians, supervisors, and institutions to better address and prevent incidents of physician sexual harassment by patients.{Table 4}

  Abstract 9 Top

A Content Analysis of Consent Forms for Transgender Adolescents Initiating Pubertal Suppression and Gender-Affirming Medications

Samhita L. Nelamangala, Katherine E. Boguszewski, Julia Taylor

Department of Adolescent Medicine, University of Virginia, Charlottesville, VA, USA

Introduction: Recent clinical guidelines emphasize the importance of protection against harm, involvement of mental health professionals, youth assent, and parental permission for transgender (TG) adolescents, considering pubertal suppression (PS) and gender-affirming hormones (GAHs). The guidelines do not, however, address the process of obtaining minor assent and parental permission or issues that increase the complexity of consenting to PS and GAHs. This study aims to describe and compare informed consent processes across clinical sites providing PS and GAHs. This study is the first to look at variations in consent processes as a step toward refining decision support and informed consent processes that address the specific needs of TG youth and their families.

Methods: As part of a larger, IRB-approved survey about informed consent processes, providers of gender-related care to adolescents uploaded informed consent forms for PS and GAHs. Publicly available consent forms were also found through a web search. We conducted content analysis on all consent forms using quantitative and qualitative methods. Published clinical guidelines and ethical norms from the Endocrine Society[1] and the World Professional Association for Transgender Health[2] for obtaining minor assent and parental permission were used to develop a coding instrument to evaluate form content, tone, and style. Eleven core elements of informed consent were identified and analyzed across all submitted consent forms. Four additional elements were identified and analyzed specifically for GAH consent forms.

Results: Twenty-three consent forms were included in the analysis (seven for pubertal suppression, eight for testosterone, and eight for estrogen). 95% (n = 22) of the consent forms utilized short phrases or bullet points and 65% (n = 15) did not use jargon. Only 50% (n = 4) of the PS consent forms had all 11 core elements, and one included less than half. 81% (n = 13) of GAH consent forms contained between 10 and 15 core elements and 25% (n = 4) had less than 10 of the core elements. Mental health provider involvement was mentioned in 85.7% (n = 6) of PS forms but was only present in 50% (n = 8) of GAH forms. Risks of treatment were included in 100% of forms and explicitly named in 95% (n = 22). However, only 26% (n = 6) of forms explicitly identified impacts of PS or GAHs as benefits. 78.3% (n = 18) of all forms included a signature line for minor assent, while 43.5% (n = 10) explicitly confirmed the minor's understanding and documented agreement with the intended treatment.

Conclusions: There was a great deal of variability in consent forms in regard to their content, style, and inclusion of basic elements of informed consent. While the risks of treatment were well categorized, there was little consistency in the way that benefits were portrayed or defined. A robust discussion or documentation of assent was not uniformly present across the analyzed consent forms. The role of consent forms in fostering minor participation and assent when initiating PS and GAHs needs further clarification and development. Future research should focus on ways to encourage and prioritize active minor assent, thereby improving the health and experience of TG adolescents.

  References Top

  1. Wylie C Hembree, Peggy T Cohen-Kettenis, Louis Gooren, Sabine E Hannema, Walter J Meyer, M Hassan Murad, Stephen M Rosenthal, Joshua D Safer, Vin Tangpricha, Guy G T'Sjoen, Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, 2017;102:3869-3, https://doi.org/10.1210/jc.2017-01658.
  2. World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People. 7th version. World Professional Association for Transgender Health; 2012.

  Abstract 10 Top

Concerns of Physician Mothers at Work during the COVID-19 Pandemic

Ryan Melikian, Claire Pearson1,2, Miriam Levine2, Anne Messman1, Teena Chopra3, Lauren Robb1, Andrea Janis1, Reda Awali3, Diane L. Levine4

Wayne State University: Detroit, MI, 1Department of Emergency Medicine Wayne State University Detroit, MI2, 2Ascension St. John Medical Center: Tulsa OK, 3Wayne State University Department of Internal Medicine - Infectious Diseases: Detroit, MI, 4Wayne State University Department of Internal Medicine: Detroit, MI, USA

Introduction: Physician mothers manage familial and professional obligations which may be exponentially more challenging during a crisis. A global survey was sent out to assess physician moms' experience during this COVID-19 pandemic to better understand the impact on their personal and professional lives.

Methods: From April 27 through May 11, 2020, a convenience sample of physician mothers was surveyed regarding personal preparedness for COVID-19. Surveys were distributed via the Facebook Physician Moms Group and via personal/professional contacts of the authors.

Results: The final analysis included 2709 surveys. All states were represented except Montana and Wyoming; 7% of the respondents were from outside the United States. Majority of the respondents were 30–39 years old (45%), 11–15 years postresidency (30%), Whites (67%), married to a partner of the opposite sex (91%), and had elementary-school–aged children (48%). Twenty-four percent had a spouse with a high-risk job (firefighter, emergency medical technician, etc.) and 32% had a spouse who was also a physician. Over half were practicing in an area they identified as high COVID-19 density, while 50% had personally cared for a person with COVID-19. The majority (60%) prepared for the pandemic. [Table 1] shows their primary professional concerns. Eight of the top 10 concerns were about staff and co-workers. Approximately 6% wrote free-text comments about their biggest professional concerns, which included disruption of services to patients, changes in the standard of care for patients while not being able to see patients as usual, patients foregoing medical care due to fear, and mental health fall out of patients. In addition, there were several concerns about mental health of healthcare workers, the disruption of training and educations of medical students, residents, and fellows with both short- and long-term ramifications and long-term career consequences for those in academic medicine. Almost all (94%) educated themselves about COVID-19, 64% educated themselves about pandemics, and 33% reviewed critical care medicine. Over half (55%) modified their schedule by providing telehealth visits, and 38% worked from home. Approximately 20% did not modify their schedule while 28% limited patient contact. Of note, 12% voluntarily increased their work-hours while 6% were required to increase their hours.

Conclusions: Physician mothers' professional lives were impacted by the COVID-19. Majority prepared for the pandemic and nearly all educated themselves about COVID-19. Concerns for staff and co-workers predominated. This is one of the first studies to explore physician moms' professional experience during the pandemic. Understanding the professional concerns may allow for the development of professional preparedness strategies for physician mothers.

  Abstract 11 Top

Social and Clinical Factors to Consider When Investigating Low Exclusive Breastfeeding Compliance

Jeannel T. Miclat

Biomedical Sciences Department, Philadelphia College of Osteopathic Medicine, Georgia Campus, PA, USA

Introduction: A hospital in a highly populated, metropolitan area in the Southwestern United States currently has an exclusive breastfeeding rate of 42.7%. In an effort to improve patient outcomes, the present study was conducted to understand which mothers and infants were at risk for having low exclusive breastfeeding compliance.

Methods: The study analyzed 5011 mothers and their newborns during the hospital from delivery to discharge between January 1, 2018, and December 31, 2018. The average hospital stay was between 48 and 72 h postpartum. Their charts were compared against 17 different social and clinical factors, which were chosen based on previous literature studies identifying them as possible influencers to breastfeeding outcomes. These factors included social demographics such as mother's age, race, marital status, insurance type, home environment, and prenatal education. The historical clinical factors studied were the mother's history of obstetrics para and gravida, in addition to her history of spontaneous, induced, and para abortion. Finally, the clinical factors during delivery and postpartum that were analyzed were the estimated gestational age at delivery, delivery type, epidural status, maternal complications, placental complications, and postpartum hemorrhage delivery complications. These factors were then compared to the feeding method utilized following delivery until discharge.

Results: Mothers who were single, low socioeconomic status, in their early twenties or late thirties, and on government subsidized insurance were at a higher risk of having low exclusive breastfeeding rates. In addition, those who did not have previous prenatal education or familial support had lower breastfeeding rates than those who did. Mothers who are Caucasian, Native American, African-American, Middle Eastern, Hispanic, Hawaiian, or other Pacific Islanders were at a greater risk of having poor exclusive breastfeeding outcomes. Infants with an estimated gestational age between 31 and 38 weeks at birth or were delivered via cesarean section had the lowest rates of exclusive breastfeeding upon discharge.

Conclusion: On completion of the study, it is recommended that current labor and delivery practices should be reevaluated to decrease complications and increase safety for mother and infant while also providing clinicians the resources to resolve complications quickly. Moreover, there should be continuing education for all clinicians in breastfeeding techniques that include, but not limited to, assisting in the restoration of milk flow and aiding an infant to latch. These skills should be integrated in medical centers' yearly skills competency checks and workshops for all departments that board any child 2 years of age or younger. Finally, breastfeeding support groups should run concurrently with a significant others supporting breastfeeding workshop is recommended to give mothers a layered social support system. Further research should be conducted in the future on how different combinations of the 17 social and clinical factors affect exclusive breastfeeding both positively and negatively.

  Abstract 12 Top

#MeTooInMedicine: A Student-Led Storytelling Initiative to Increase Transparency of and Eliminate Gender-Based Violence in Healthcare

Nazineen Kandahari1, 2, 3, Nilufar Kayhani13, Laura Alberti3,4, Merary Martinez-Cobian3, Meghan O'Brien2,3, Diana Farid3,5, Emily Silverman2,3

1School of Public Health, University of California Berkeley, Berkeley, 2School of Medicine, University of California San Francisco, 3MeTooInMedicine, San Francisco, 4Bay Area Women Against Rape, Oakland, 5Stanford School of Medicine, Stanford, CA, USA

Introduction: Gender-based violence (GBV) is based in unequal power relationships between genders. The institution of medicine has many features that perpetuate GBV, including its historical male dominance, strong hierarchies, lack of accountability from leadership, and culture that tolerates mistreatment. To initiate awareness and culture and policy change, we organized a first-ever event at University of California San Francisco (UCSF) and a nation-wide storytelling initiative to honor people who have experienced GBV in the healthcare institution.

Methods: For our event, we invited medical professionals of all genders to submit their stories via a call for submissions sent to all major medical institutions in the Bay Area, California. With the consent of story submitters, we trained volunteer storytellers to perform the narratives anonymously. We also partnered with a rape crisis center for a training on how to respond when witnessing or experiencing GBV within medical situations. Finally, we worked with an UCSF-designated confidential advocate to organize a forum that demystifies Title IX. We organized the stories, training, and forum into a 1-day conference. We offered psychological support with grounding meditations, on-call therapists, and confidential advocates. At the end, we facilitated a quantitative and qualitative survey of the event's impact on participants' awareness and self-efficacy in situations of GBV. Audience members' responses and the nationwide support prompted project growth. This year, we launched our website and opened the story submission form nationally. We employed a snowball sampling recruitment strategy among numerous medical schools, gender equity advocates, national organizations, and physician bloggers. New stories collected are being used for production into short animated films to be debuted at our second conference. To facilitate healing/processing, participants can opt to be involved in their movie production.

Results: In our first event, of the 51 participants (39% of attendees) who completed the postevent survey, the majority expressed that the conference made them feel more comfortable speaking up for themselves in instances of GBV. Almost all participants expressed that the conference taught them how to respond in future incidents of GBV (94% agreed or strongly agreed). Qualitatively, participants found that the stories validated their personal experiences, with one reporting that they “affirmed the dynamics I have experienced, but that I felt I had to deal with in silence to be good at my job.” In our current iteration, we had 1274 visitors to our website over 6 weeks. Of those, 67% selected to view the story submission page. Thus far, we have collected 28 stories from healthcare professionals in all stages of training. Preliminary analyses demonstrate that a majority of stories detail GBV in the form of verbal harassment. One participant reported a senior clinician asking a physician “What are you working on, babe?” during rotations and another participant reported a supervisor stating “Wow you are like a rabbit” when finding out a female physician was pregnant. Of these stories, 14 chose to not remain anonymous to be involved in production of the short films.

Conclusions: Our initiative reveals that storytelling can raise awareness, enlist institutional accountability, and empower the community to respond to GBV.

  Abstract 13 Top

Gender-Specific Medicine

Basia Chazaro, Raoul Chazaro

BR Patient Health for You, LLC: Baton Rouge, Patient health for you, LLC, New Orleans, Louisiana, USA

Introduction: A female cardiothoracic surgery fellow interested in minimally invasive cardiac and thoracic surgery sought further training. She had previously been trained at Stanford for medical school, the Mayo Clinic for general surgery residency, and University of Washington and Harvard for cardiothoracic surgery.

Methods: During this current fellowship, she felt hurt, deceived by an attending, and was left with awful feeling of never trusting this attending again. She is fighting her fear, by telling her story for others that might experience the same to not feel alone, to band together and seek societal guidance.

Results: A 59-year-old poor Black diabetic woman, with increased body mass index, history of stroke, pain medication use preoperatively, was told she needed an operation for severe aortic valve regurgitation (AVR). Before surgery, in extensive attempts to locate the preoperative echo, the fellow was told by the cardiothoracic surgery to “not worry about it” that he “had looked at it.” This correlated with what the clinic staff told the fellow when she called on two occasions looking for the echo. The attending booked the patient for a mechanical Aortic Valve Replacement. He frequently bragged he had the greatest Relative value units RVUs of any surgeon that year in that institution. After sternotomy, the attending canceled the procedure due to a need for root enlargement. The attending subsequently admitted to the fellow he did not looking at the echo before surgery, which would have revealed echo parameters to decide if truly a root enlargement was necessary, and that it was “all his fault.” At least two other factors support that he had not looked at the echo before surgery, including had a root enlargement been considered, this would have been communicated to the operating room nurses who would have obtained material, such as a bovine pericardial patch, for such enlargement. Second, the attending's reasoning for canceling the operation after sternotomy being the need for root enlargement, the first time, he realized this, further supports never looking at the echo before surgery. The attending was named in a suit but not the fellow. Against her will the attending surgeon and hospital decided to settle for 67k. Also, against her will, they decided to report her to the NPDB, despite not being named.

Conclusion: This case is fraught with disrespect for the patient, patient's family, and fellow. Worlds came crashing down. She had never experienced such unethical behavior by an attending before. The system, including Human resources HR, administration, the surgeon, and malpractice company, was completely unfair protecting the White male billing surgeon in an RVU system over the low female fellow. The NPDB rules need to be revamped. The fellow has written to the secretary of Health and Human Services. Other fellows and attendings have mentioned unfair practices. Thus, the fellow is speaking out as there are likely other fellows/attendings, who have or are in the middle of experiencing a similar unfair situation and likely feel alone. Rather than creating more roadblocks for skilled, empathetic, and ethical clinicians to take care of patients, societal support would be beneficial to establish pathways of fairness.

  Abstract 14 Top

Reducing Barriers to Wellness during COVID-19: The Wellness Concierge Resource Service

Sarah C. Newhall1, Megan E. Furnari1,2

1Medical Student, School of Medicine, Oregon Health and Science University, 2Department of Neonatology, Oregon Health and Science University, Portland, OR, USA

Introduction: The purpose of this study is to evaluate the effectiveness of a wellness call-in hotline as a method to reduce barriers to wellness for hospital workers and students during COVID-19. Women make up the majority of healthcare workers, are the largest portion of frontline workers, and also perform the majority of unpaid labor caring for children, elderly, and other family members. As of April 2020, 73% of COVID-19–positive healthcare workers were women. Better access to resources to ease stress, anxiety, and wellness burdens is an important part of creating a sustainable health workforce during a pandemic and creating space for women in healthcare to do their best work.

Methods: This study looks at the implementation of a wellness phone service to support healthcare workers. A virtual elective was created for clinical phase medical students pulled from rotations during COVID-19. The role of medical students in the creation of this hotline was three-fold: to develop the resource documents for use by hotline operators, to design the script and call logs to be used by the hotline operators, and to serve as the hotline operators. The hotline is designed as a system in which any Oregon Health and Science University (OHSU) employee can call the OHSU operator, ask for the COVID resource line, and be directed to the medical student on-call as the hotline operator. The call was anonymous, student wellness operators asked safety questions to ensure the caller was not in crisis if necessary, and finally, the call focused on the local or national resource that would best serve the healthcare worker. Students tracked information on the unit or department of the caller; their position, benefit status, and employment classification; the time spent with callers; the resources offered; and any follow-up needed based on how much information the caller consented to provide.

Results: Wellness initiatives for employees in healthcare can be vast and difficult to navigate. At the start of the COVID-19 pandemic, OHSU deemed wellness an indispensable part of emergency operations to ensure the mental health and overall well-being of healthcare workers in an uncertain time. In tracking the use of wellness resources and the wellness hotline, we are able to assess which wellness concerns were most prominent among our hospital and research staff along with which groups needed more support.

Conclusions: Results showed that the start of the pandemic concerns was often related to clinical questions as we figured out new operating protocols but then shifted toward concerns around mental health, stress reduction, and financial concerns. One implication for further study is the feasibility and effectiveness to staff and operationalize the call-line as needed when COVID is surging and to then minimize financial and personnel commitment when not needed. Another study could look at overall trends of wellness initiatives started during COVID-19 and the impact on the workforce.

  Abstract 15 Top

Sex Bias in Angiotensin-Converting Enzyme 2 Research

Branka Miličić Stanić, Sydney Maddox, Kathryn Sandberg

Center for the Study of Sex Differences in Health, Aging and Disease, Georgetown University, Washington, DC, USA

Introduction: Angiotensin-converting enzyme 2 (ACE2) has garnered widespread interest as the cellular receptor of SARS-CoV-2, the causative virus of the COVID-19 pandemic. Throughout the world including the United States, men have more severe disease from COVID-19 than women. Thus, understanding how ACE2 is regulated in both sexes could shed light on sex differences in COVID-19 disease severity. To that end, we conducted a systematic review of studies investigating ACE2 in both sexes.

Methods: Searches of OVID and PubMed were conducted in journals through August 20, 2020. All languages were included, and no start date was imposed in the search. We included all original research studies involving primary cells and tissues. Two separate searches were performed before Boolean logic (1) and (2) were applied: (1) (”angiotensin converting enzyme 2” or ACE2 or “ACE 2” or “angiotensin converting enzyme II” or “angiotensin converting enzyme two”) and (2) all mammals except humans.

Results: As of August 20, 2020, more than 2500 original research articles have been published on ACE2 in mammals excluding humans. Most of these studies were conducted in rats (43%) and mice (17%). The vast majority (68%) of these studies on ACE2 used male animals only, while 11% were conducted only in females. Less than 10% compared ACE2 between the sexes and 11% failed to report the sex of the animals studied. Most studies of ACE2 were of protein expression measured by Western blot (60%). Not all studies demonstrated antibody specificity, and we found significant differences in sensitivity and accuracy among antibody suppliers, with ACE2 antibodies from Santa Cruz being the least reliable. Less is known regarding ACE2 enzyme activity (13%) or mRNA (40%) expression. Studies in animal models of gonadal hormone deficiency, diabetes, and hypertension reported differential regulation of ACE2 in the kidney, heart, and adipose tissue, which are the tissues implicated in COVID-19 pathology. The majority of studies reporting sex-specific regulation of ACE2 also demonstrated that ACE2 plays a greater protective role in the female than the male.

Conclusion: There remains a significant male bias in basic science research on ACE2. This bias could result in missed opportunities for drug discovery in COVID-19 therapeutics that ultimately could improve outcomes for men with COVID-19 disease as well as women. Therapeutics that involve ACE2 could have different efficacy in men and women. Therefore, it will be critically important to consider the biological variable of sex not only in research studies investigating mechanisms of ACE2 regulation but also in studies of therapeutics designed to treat COVID-19.

  References Top

  1. Liu J, Ji H, Zheng W, Wu X, Zhu JJ, Arnold AP, et al. Sex differences in renal angiotensin converting enzyme 2 (ACE2) activity are 17beta-oestradiol-dependent and sex chromosome-independent. Biol Sex Diff 2010;1:6.
  2. Ji H, de Souza AMA, Bajaj B, Zheng W, Wu X, Speth RC, Sandberg K. Sex-Specific Modulation of Blood Pressure and the Renin-Angiotensin System by ACE (Angiotensin-Converting Enzyme) 2. Hypertension. 2020;76:478-87. doi: 10.1161/HYPERTENSIONAHA.120.15276. Epub 2020 Jun 22. PMID: 32564694; PMCID: PMC7365573.
  3. De Souza AM, Linares A, Speth RC, Campos GV, Ji H, Chianca D Jr., et al. Severe food restriction activates the central renin angiotensin system. Physiol Rep 2020;8:e14338.

  Abstract 16 Top

How Did Emergency Medicine Physician Mothers Prepare and Cope during the COVID-19 Pandemic?

Lauren Robb, Anne Messman1, Miriam Levine2, Teena Chopra3, Ryan Melikian, Andrea Janis, Diane L. Levine4, Claire Pearson1,2

Departments of 1Emergency Medicine, 3Internal Medicine- Infectious Diseases and 4Internal Medicine, Wayne State University, Detroit, MI, 2Ascension St. John Medical Center, Tulsa, OK, USA

Introduction: Emergency medicine physicians (EMPs) are on the frontlines at all times, including during the pandemic. While many EMPs thrive on the unpredictable, this was pushed to the extreme during the COVID-19 pandemic. This subset analysis aims to evaluate the impact of the COVID-19 pandemic on the lives of EMP mothers.

Methods: From April 27 through May 11, 2020, a convenience sample of physician mothers was surveyed regarding personal and professional preparedness for COVID-19. Surveys were distributed via the Physician Moms Group, an international Facebook group with over 70,000 members from all medical specialties, and via personal contacts and professional organizations.

Results: A total of 194 surveys were completed by EMP mothers [Table 1]. Of the respondents, 54% were aged between 30 and 39 years, 77% were Whites, 12% were Asians, 5% were Black or Hispanic, and 89% were married to opposite sex partners. EMPs had on average 1.6 children, 75% with elementary school-aged children or younger. The United States represented 95% of the responses, with participants hailing from 36 states. Less than half of the EMP mothers felt personally or professionally prepared for COVID-19 (31% and 49%, respectively). EMP mothers were most concerned about exposing their children to COVID-19, more so than about acquiring COVID-19 themselves. 46% bought their own personal protective equipment (PPE), and 38% bought PPE for their family. Respondents' spouses/partners altered their work schedules to provide childcare in 37% of the cases, and mothers altered their own schedule to provide care for their child(ren) 32% of the time. EMP mothers were less likely to feel guilty about not spending time with their families and more likely to express satisfaction with the amount of time they spent with their families during than before the pandemic (41% vs. 57% and 63% vs. 55%, respectively). 72% of the EMP mothers practiced in an area with a high density of COVID-19 patients and 80% cared for COVID-19 patients. The mothers prepared professionally by educating themselves on COVID-19, reviewing critical care medicine, and educating themselves about pandemics. The biggest professional concerns were insufficient PPE for self (53%), staff morale (49%), insufficient PPE for staff (47%), health of staff (46%), and financial challenges (41%).

Conclusions: The data show that EMP mothers prepared for the pandemic by acquiring PPE, altering their work schedules, and self-educating on COVID-19. Mothers were most concerned about exposing their children and parents to COVID-19, more so than exposing themselves. Although EMPs are frontline, less than half of these mothers felt personally or professionally prepared for the pandemic. EMPs are one of the leading specialists during a pandemic, and these results suggest that EMPs may need more preparation for pandemics.

  Abstract 17 Top

Impact of COVID-19 on Physicians Mothers

Andrea Janis1, Claire Pearson1,2, Miriam Levine2, Anne Messman1, Teena Chopra3, Reda Awali3, Lauren Robb, Ryan Melikian, Diane L. Levine4

Departments of 1Emergency Medicine, 3Internal Medicine- Infectious Diseases and 4Internal Medicine, Wayne State University, Detroit, MI, 2Ascension St. John Medical Center, Tulsa, OK, USA

Introduction: The COVID-19 global pandemic has and will continue to shape the lives of healthcare workers. How a pandemic impacts physician mothers is unknown but may have important consequences for pandemic planning in the future. This study evaluates the personal and professional experiences of physician mothers during the COVID-19 pandemic and the impact of the pandemic on the lives of physician mothers.

Methods: A convenience sample of physician mothers or pregnant physicians of any specialty over the age of 18 who responded to a post on Facebook Physician Mothers Group (FPMG), a post/e-mail on a FPMG member's social network, or a personal text message or e-mail. A convenience sample of physician mothers completed an on-line survey posted between April 27 and May 11, 2020. Members were encouraged to repost on social media and share with personal contacts, resulting in a passive snowball sampling effect.

Results: A total of 2709 physician mothers from 48 states, Puerto Rico, and 19 countries, representing more than 25 medical specialties, completed the survey. Most were between 30 and 39 years of age; 67% self-identified as Whites, 17% as Asian, and 4% as African-American. Most had been working for 11–16 years. 91% had a spouse/partner of the opposite sex. Over half were practicing in an area they identified as high COVID-19 density, while 50% had personally cared for a person with COVID-19. Comparing personal concerns among physician mothers who personally prepared for the pandemic with those who were not, the most commonly-listed concern among both groups was exposing their children to COVID-19 with no statistical difference between these groups for this top concern (51% vs. 50%, odds ratio [OR] 0.98, P = 0.78) [Table 1]. Mothers who had personally prepared were significantly more likely to be concerned about disrupted family life (30% vs. 23%, OR 0.71, P < 0.001), schooling children from home (29% vs. 23%, OR 0.76, P = 0.002), and financial hardship (23% vs. 18.5%, OR 0.77, P = 0.007). Regarding professional concerns, mothers who had not personally prepared were more likely to be concerned about lack of PPE for self (44% vs. 39%, OR 0.83, P = 0.01) and health of the department (13% vs. 10%, OR 0.74, P = 0.02). Among both personally prepared and unprepared mothers, the most commonly-listed professional concern was staff morale. Mothers who had professionally prepared for the pandemic were less likely to be concerned about dying from COVID-19 (44% vs. 37%, OR = 0.75, P = 0.001) or about financial hardship (23% vs. 18%, OR = 0.76, P = 0.006).

Conclusions: Differences existed in the concerns of physician mothers based upon whether they had prepared for COVID 19 or not, but health of their children was always physician mothers' top concern. This study is among the first exploring the personal and professional challenges facing physician mothers during a pandemic. Understanding their concerns may facilitate development of support for physician mothers. Further studies are needed to understand the factors impacting preparedness for disasters such as global pandemics.

  Abstract 18 Top

Patient Health Care Disparities in the Surgical Consent Process

Basia Chazaro, Raoul Chazaro

BR Patient Health for You, LLC, Baton Rouge, Patient health for you, LLC, New Orleans, Louisiana, USA

Introduction: Purpose recognition of healthcare disparities (HCDs) is increasingly common in the last year. One such example that has brought it to a forefront is the COVID pandemic health crisis, although I have witnessed the like since kindergarten. One area of HCDs rarely discussed is biases in the cardiac surgical consent process.

Methods: This is the case of a 59-year-old poor Black diabetic female woman with increased body mass index, followed for severe aortic valve regurgitation. She saw a cardiothoracic surgeon in preoperative consultation; however, the surgeon neglected to look at the preoperative echo, to determine many factors related to the aortic valve regurgitation such as aortic annular size, degree or aortic valve regurgitation, location of jet, appearance of leaflets, and assessment of other causes such as aortic annular dilation, aortic sinus dilation, sinotubular dilation, or aortic aneurysm. The patient also was on chronic pain medication preoperatively for chronic back pain. Efforts to reduce her pain medication preoperatively were not addressed, such as counseling or visiting a pain clinic. She also had had a previous stroke and was at risk for bleeding subsequently if on anticoagulants, yet only a mechanical valve was offered.

Results: The patient was not offered any minimally invasive approach that might reduce her postoperative pain or risk of sternal wound infection. She was neither offered aortic valve repair, tissue nor sutureless valve, homograft nor Ross procedure, nor another surgeon who could do those procedures, even within the same institution. A new current echo was also not offered to her as the previous one was 9 months old as well. It was never explained to the patient preoperatively that the attending had not looked at the echo before surgery, although he had mentioned to other staff he had. Despite being the only person who knew this at the time, he was not present for the time out in the operating room. The attending instructed the team to proceed however canceled the procedure after sternotomy, when the attending decided a root enlargement was required, which could have been known preoperatively if the echo were examined. Postoperatively, the attending never told the patient he had not looked at the echo preoperatively.

Conclusion: One form of HCD is differential surgical consent. Consent is a quality issue. Full surgical consent should not depend on gender, race, or economic status. Upholding the Hippocratic Oath and doing no harm are paramount. This also requires institutional and societal commitments to diversity and inclusion for success.

  Abstract 19 Top

Women in Surgery: Identifying Factors Influencing Medical Student Specialty Choice

Heba Elassar, Kristin LeMarbe, Victoria A. Roach1

Departments of Orthopedic Sports Medicine and 1Foundational Medical Studies Oakland University William Beaumont School of Medicine, Rochester, MI, USA

Introduction: While efforts to improve gender equality among US medical graduates have been underway, women remain underrepresented with only 20.7% of surgeons identifying as female as of 2017. Research has identified factors such as lifestyle, duration of training, and experience during the surgical clerkship to be the major influences on students' attitudes toward the field of surgery. This study aims to identify gender disparities in relation to career preferences among medical students and how these differences may relate to ultimate specialty choice.

Methods: A cross-sectional study was conducted by surveying medical students from all grade levels, currently enrolled at a Midwestern Allopathic Medical School. The survey collected demographic data and asked participants to rank items related to lifestyle preferences and career factors that would influence their specialty choice. Two-sample independent t-test was used to compare continuously measured variables, and Chi-square test was used to compare categorical variables.

Results: The survey was distributed to the entire student body; 27% of the students participated (n = 133). Analysis of specialty preferences among male and female participants revealed that female participants were more likely to be interested in nonsurgical specialties (P = 0.0076) and less likely to be interested in highly specialized medical fields (P = 0.0091). Female respondents also placed a greater importance on providing preventive care than male respondents (P = 0.0075) and less of an importance on salary (P = 0.0205). While there were no significant differences among male and female participants in the rating of their surgical clerkship experience as positive or negative (P = 0.0894), female respondents found the surgical clerkship to be less rewarding than their male counterparts (P = 0.0212).

Conclusions: When compared to males, female participants were more interested in nonsurgical specialties, placing a greater value on providing preventive care when choosing a specialty. The additional finding surrounding female respondents' lower interest in highly specialized medical fields can be associated with the coexisting indication of salary potential as a lower priority among females. Given the fact that highly specialized fields with higher salary potentials require more training, it can be suggested that the total length of training is a determinant of specialty choice among female students, though this association was not directly assessed. These gender differences exist among student participants despite no identifiable differences in rating their clerkship experiences. The results suggest a perpetuation of the attitudes toward being a woman in surgery that are potentially sustained by priority differences in lifestyle or duration of training. Early exposure to surgical fields through surgeons who have similar values can serve as an opportunity to educate female students on how a career in surgery can ultimately align with their priorities.

  Abstract 20 Top

COVID-19-Related Healthcare Closures Negatively Affect Patient Health and Postoperative Recovery for Women Greater Than Men

Laurie Hiemstra1,2, Michaela Kopka1,2, Julie-Anne Frayn1, Sarah Kerslake1

1Medical Student, Banff Sport Medicine Foundation, Banff, 2Department of Surgery, University of Calgary, Calgary, Canada

Introduction: To determine how COVID-19–related healthcare closures affect the health, recovery, and access to resources of female and male pre- and post-operative orthopedic sport medicine patients.

Methods: Electronic questionnaires assessing physical health, emotional health, virtual care, and access to resource were distributed to patients whose orthopedic restorative surgeries were postponed, as well as those within 3 months of surgery at the time of the COVID-19 closure. The EQ-5D-3L was included as a quantitative and standardized measure of general health status. Data were descriptively analyzed using means, standard deviations, and qualitative measures. Chi-square test was used to compare the survey responses for women and men (P < 0.05). Unpaired t-test was used to compare the EQ-5D-3L health state scores.

Results: A total of 115 patients whose surgeries were postponed completed the survey (61 female [53%] and 54 [47%] male). Women were more likely than men to report that their symptoms increased due to the COVID-19–related surgical delay 49.2% versus 33.3%, (χ2 [2, N = 200] = 5.9, P = 0.051), including an increase in pain 55.6% versus 45% (χ2 [2, N = 200] = 12.08, P = 0.002). Further, 67.2% of the female patients compared to 57.4% of the male patients reported that the postponement of their surgery would negatively affect their ability to return to work (χ2 n/s). Female patients more frequently described the feelings of anxiety, stress, concern, and general negativity than male patients. Comparison of EQ-5D-3L health state scores revealed no statistically significant differences between female and male patients (P = 0.23). A total of 198 patients within 3 months of restorative orthopedic surgery completed the survey (109 females [55.1%], 89 [44.9%] males). Majority of the patients (69.7%) indicated that COVID-19–related healthcare closures had an overall negative affect on their recovery, with women more likely to report that their recovery was delayed than men 49.5% versus 36% (χ2 [2, N = 200] = 6.27, P = 0.044). Women accessed virtual physiotherapy more often than men (46.8% vs. 34.8%) but also were more likely to report that the lack of in-person physiotherapy negatively impacted their recovery 82.6% versus 61.8% (χ2 [2, N = 200] = 10.0, P = 0.007). Virtual orthopedic follow-up was deemed helpful by 61.3% of the patients. Female patients more frequently reported feelings of anxiety, concern, worry, and frustration due to the COVID-related healthcare closures than males. Comparison of EQ-5D-3L health state scores revealed no statistically significant differences between female and male patients (P = 0.59).{Table 5}

Conclusion: This study demonstrated the significant impact of COVID-19–related healthcare closures on pre- and post-operative orthopedic sport medicine patients and revealed gender-specific differences in the effects of surgical and rehabilitation delays. Female patients identified significantly more pain and psychological symptoms due to delays in surgery. Postoperatively, women were significantly more likely to report feeling delayed in their rehabilitation. However, despite these differences, the EQ-5D-3L health state scores revealed no statistically significant differences between female and male patients.

  Abstract 21 Top

Diversity on the Walls of Indiana University School of Medicine, Terre Haute

Julie M. Vaughan, Meredith C. Campbell

Medical Student, Indiana University School of Medicine, Terre Haute, IN, USA

Introduction: Indiana University School of Medicine (IUSM) had its first graduating class in 1909 and Lillian Mueller, a member of the class, became IUSM's first woman graduate. This year's 1st-year medical class profile includes a gender distribution of 49% women and 51% men. This inclusive nature from the founding of the school to the current times is a positive factor for IUSM, but there is a stark lack of portraits, banners, or attributes to the women physicians and scientists who made a history for IUSM. While IUSM is not alone in this lack of female representation on its walls, the lack of representation has an impact on its student body and faculty.

Methods: At the Terre Haute Campus, hallways and classrooms used by medical students are surveyed to quantify the ratio of men, women, and nonbinary persons represented on the walls. Wall pieces were categorized as paintings, plaques, awards, photographs, or other. Those represented in wall hangings were tallied by gender and by wall piece category, and then calculations were made to determine the gender ratio within each category.

Results: Looking at the overall representation on the wall, 41.8% of those depicted are women. When excluding names on plaques (awards), it remains relatively constant at 41.9%. When removing class photographs, the percentage falls significantly to 15.4%. The only woman depicted, excluding awards and class photographs, is present due to the honor her husband was receiving. It is staggering that no women are present for their contributions to science or medicine.

Conclusions: The goal of this project is to draw attention to the great disparity of representation for women in medicine and academia and to raise awareness of this inequality as IUSM works to improve representation in the future.

  Abstract 22 Top

Incorporation of Latinx Cultural Values in the Treatment for Postpartum Depression

Claudia S. Roldan, Darren E. Zinner

Department of Health, Science, Society, and Policy, Brandeis University, Waltham, MA, USA

Introduction: Pregnancy is both a cultural condition and medical experience. Latinx culture is typically characterized by strong family and community values, high expectations of motherhood, and stigma of mental health. These may be both risk factors and protective forces in pregnancy, specifically in postpartum depression (PPD), with national data, indicating lower prevalence and clinician discussion rates of PPD among Latinxs. The purpose of this study was to explore how Latinx culture influences mothers and how reproductive health care providers respond to the role of culture in pregnancy and PPD in the United States.

Methods: After obtaining Institutional Review Board approval, we conducted qualitative interviews with three different types of women's healthcare providers: doulas (8), midwives (9), and OB-GYNS (7) about their experiences caring for Latinx families. We also asked them about their training, PPD as a medical phenomenon, and their overall experience caring for pregnant mothers. Interviews were transcribed verbatim and analyzed qualitatively.

Results: The qualitative interviews suggest that PPD is a common phenomenon, but there are disparities in screening (i.e., not every facility screens). Providers noted that there are many barriers to care for PPD, including financial, logistical (transportation), other children, stigma, and lack of knowledge of PPD. Our analysis suggests that Latinx culture may promote values and behaviors protective of postpartum depression, such as seeking support from nonmedical establishments via extended family in the postpartum period. Providers also noted high levels of mental health stigma and resistance to care from the traditional medical establishment in the Latinx families they worked with. When asked about cultural competency, some providers opted to “treat everyone the same,” while others, especially providers of color, took deliberate steps to tailor their care for every patient.

Conclusions: Culture is a shaping force in the way Latinx families experience pregnancy and the postpartum period. Nationally reported low clinician discussions of PPD rates among Latinxs might be due to the effect of stigma of PPD and distrust of the medical establishment. Providing individualized care could potentially be a way of meeting cultural needs and requires an open mind and willingness to learn from the patient. Further research is needed to investigate Latinx patient perceptions and experiences of their care for PPD.

  Abstract 23 Top

Exploring Differences in Attitudes toward the Efficacy of Substance Use Disorder Curriculum at the Undergraduate Medical Level: What Role Does Gender Play?

Sabrina E. Dass, Tabitha Moses, Eva Waineo, Mark K. Greenwald

Department of Psychiatry, Wayne State University School of Medicine, Detroit, MI, USA

Introduction: Research has shown that self-assessments help students to reflect and identify gaps in their learning. Prior studies also show that female students underestimate their clinical skills and knowledge compared to their male counterparts. To our knowledge, there is no published research about gender differences specific to substance use disorder (SUD) curriculum. The purpose of this study was to determine whether gender differences exist in medical students' (1) self-assessment of the SUD curriculum at Wayne State University School of Medicine and (2) confidence in appropriately caring for future patients with SUDs.

Methods: Medical students (M1–M4) were invited to complete an online baseline survey containing questions about clinical experiences, knowledge about opioid overdose and naloxone, and attitudes toward patients with opioid use disorder. All students who completed the baseline survey received a 6-month follow-up survey, which included the same questions, and an additional self-assessment of 12 SUD curriculum components scored using a 5-point Likert scale (1 – strongly disagree to 5 –strongly agree).

Results: A total of 256 students completed the baseline survey (59.4% females, 40.2% males), 105 of whom also completed the 6-month follow-up survey (67.6% females, 32.4% males). In the 6-month follow-up survey, we asked medical students to rate various facets of the school's pain and SUD curriculum. We identified gender differences in 7 of 12 statements, with males more likely than females to agree with the following: “I receive all the training I need for treating patients with SUDs in medical school” (P = 0.027); “I know how to assess a patient's risk for SUDs” (P = 0.036); “I know how to identify and describe potential pharmacological and nonpharmacological treatment options for pain management” (P = 0.001); “I understand the difference between all the SUD treatment options” (P = 0.002); “I feel confident in preparing evidence based and patient-centered pain management and SUD treatment plans for patients with acute and chronic pain” (P < 0.001); “I can recognize the risk factors and signs of opioid overdose and correctly administer naloxone” (P = 0.002); “I can recognize signs of SUDs in healthcare professionals and identify ways to help” (P = 0.004). In addition, we asked their thoughts on whether the school should provide naloxone kits to students and those who should bear the cost. Although there was no gender difference in whether students thought that they should receive naloxone kits (67.0% yes, 26.2% maybe), females were more likely than males to suggest students cover less of the cost, i.e., students pay full cost (3.0%, 0%), students pay for a subsidized kit (21.2%, 2.9%), no cost to students (75.8%, 97.1%) for males and females, respectively (χ2 = 11.904, P = 0.003).

Conclusions: We observed gender differences in medical students' opinions of SUD curriculum and their self-reported confidence to identify, manage, and treat patients with SUD. Further investigation into the accuracy of self-assessment and its association with clinical competency in treating patients with SUDs is warranted. As schools continue to expand SUD curriculum, a deeper understanding of the impact of gender may provide insight into gender disparities and inform curriculum development that best meets the needs of all students.

  References Top

Coronavirus Resources Center, Johns Hopkins University and Medicine; 21 October, 2020. Available from: https://coronavirus.jhu.edu/map.html. [Last accessed on 2020 Nov 12].  Back to cited text no. 1
Rouse LP, Nagy-Agren S, Gebhard RE, Bernstein WK. Women physicians: Gender and the medical workplace. J Womens Health (Larchmt) 2020;29:297-309.  Back to cited text no. 2
Jones Y, Durand V, Morton K, Ottolini M, Shaughnessy E, Spector ND, et al, Collateral damage: How COVID-19 is adversely impacting women physicians. J Hosp Med 2020;8;507-9.  Back to cited text no. 3
Alon TM, Doepke M, Olmstead-Rumsey J, Tertilt ML. The Impact of COVID-19 on Gender Equality. NBER Working Paper Series; 2020.  Back to cited text no. 4
Vincent-Lamarre P, Sugimoto CR, Larivière V. The decline of women's research production during the coronavirus pandemic. Nature index. 2020 May 19;19.  Back to cited text no. 5
Arora VM, Wray CM, O'Glasser A, Shapiro M, Jain S. Using the curriculum vitae to promote gender equity during the COVID-19 pandemic. Proc Natl Acad Sci U S A 2020;117:24032.  Back to cited text no. 6
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