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 Table of Contents  
Year : 2022  |  Volume : 8  |  Issue : 4  |  Page : 221-320

Conference proceedings: Fourth annual women in medicine summit: An evolution of empowerment 2022

1 Kansas City University, Kansas City, MO, USA
2 University of California, Berkeley, Berkeley, CA, USA
3 St. George's University of Medicine, Grenada
4 Medical Scientist Training Program, Stony Brook University, Stony Brook, NY, USA
5 Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, PA, USA
6 Division of Hematology and Oncology, University of Illinois Chicago, Chicago, IL, USA

Date of Web Publication28-Dec-2022

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

DOI: 10.4103/2455-5568.365559

Rights and Permissions

How to cite this article:
Kays MN, Fernando M, Abdelrahman M, Rupert DD, Barry P, Jain S. Conference proceedings: Fourth annual women in medicine summit: An evolution of empowerment 2022. Int J Acad Med 2022;8:221-320

How to cite this URL:
Kays MN, Fernando M, Abdelrahman M, Rupert DD, Barry P, Jain S. Conference proceedings: Fourth annual women in medicine summit: An evolution of empowerment 2022. Int J Acad Med [serial online] 2022 [cited 2023 Feb 7];8:221-320. Available from: https://www.ijam-web.org/text.asp?2022/8/4/221/365559

Opening Statements

Women In Medicine® (WIM), a 501(c)(3) nonprofit, hosted its annual Summit for the fourth consecutive year, an event where women in medicine and their allies come together. The focus of this summit is to identify barriers women in medicine face and create action plans that can be executed at both the local and national level to address and combat gender inequity in medicine. The summit this year was held in-person (with a virtual option) and took place over two days with a seminar style pre-conference taking place for medical students the day prior.

The Women in Medicine Summit this year hosted over 350 medical professionals, with 50 states, and 74 countries being represented. The eight committees were composed of members from 28 different institutions and organizations and 40 faculty speakers from diverse professions led 25 breakout sessions. On social media, the event garnered 67.89 impressions on Twitter with 9,898 engagements, 11,262 Tweets, which averages out to an average of 309 Tweets per hour.

As in the previous years, the Abstracts and Research Committee, led by Dr. Parul Barry, called for abstract submissions with a focus on gender equity from the following research categories: COVID-19, Social/Behavioral Health, Gender Specific Medicine, Global Health, Case Reports, Clinical, and Basic Sciences. Inspirational and Perspective pieces were also considered. The Abstracts and Research Committee then scored the submissions and selected abstracts for poster and abstract presentations at the WIM Summit, all accepted abstracts are published within this document. The Abstracts and Research Committee then selected abstract award winners from the poster and abstract presentations based on the criteria of innovation, approach, future potential, and impact on the field.

Abstracts and Research Committee Members: This year the committee was led by Chair Dr. Parul Barry of the University of Pittsburgh and Student Lead Ms. Mysa Abdelrahman of St. George's University. 2022 Committee Members were Dr. Neelum Aggarwal of Rush Medical College, Ms. Johanna Balas, Ms. Shiva Barforoshi of Chicago Medical School, Dr. Christine Bestvina of the University of Chicago, Dr. Rakhee Bhayani of Washington University in St. Louis, Ms. Christina Brown of Rush Medical College, Ms. Michelle Fernando-Kammalage, Dr. Tiffany Leung of Maastricht University in the Netherlands, Dr. Yun Rose Li of Eisenhower Medical Center, Dr. Susan Pories of Mount Auburn Hospital, Dr. Lekshmi Santhosh of the University of California San Francisco, Dr. Vidya Sundareshan of Southern Illinois University, Dr. Ashley Vavra of Northwestern Medicine, and Dr. Anna Volerman of the University of Chicago.

The 2022 WIMS Abstract Awards were presented to the following individuals:

Oral Abstract Award Winner:

Ms. Lucki Word for her talk entitled Gender Differences in Parental Leave Usage at a Major United States Urban Institute

Poster Abstract Award Winner:

Ms. Claire Schenken for her poster entitled The Future (of ABMS Member Boards) Is Female

Awards Committee: The committee was led by Dr. Charu Gupta of the Northshore Hospital system and Associated LeadDr. Julie Oyler of the University of Chicago. 2022 Committee Members wereDr. Oluwatoyin M. Adeyemi of Rush Medical College, Dr. Rosalinda Alvarado of Rush Medical College, Dr. Karen Ho of Northwestern University, Dr. Priya Kumthekar of Northwestern University, Dr. Monika Pitzele of Sinai Health System, Dr. Asha N. Shenoi of the University of Kentucky, Dr. Tina Sundaram of Rush University, and Dr. Akshra Verma of Southern Illinois University.

The #IStandWithHer Awards were presented to the following individuals:

#He/Xe/They ForShe Award Winner:

Dr. Garrett S. Booth, Associate Professor of Pathology, Microbiology, and Immunology at Vanderbilt University Medical Center

Honorable mentions in this category were noted for:

Dr. Sachin H. Jain, President & CEO, SCAN Group and Health Plan, Adjunct Professor of Medicine, Stanford University, Senior Associate Dean for Undergraduate Medical Education

#SheForShe Award Winners:

Dr. Sumita B. Khatri, Director, Asthma Center, Professor and Vice Chair, Respiratory Institute, Cleveland Clinic

Honorable mentions in this category were noted for:

Dr. Susan Thompson Hingle, Professor of Medicine, Associate Dean for Human and Organizational Potential, Director of Professional Develop, Department of Medicine SIU School of Medicine

#Trailblazer Award Winners:

Dr. Ariana L. Gianakos, Orthopedic Surgeon, Massachusetts General Hospital

Honorable mentions in this category were noted for:

Dr. Regan A. Steigmann, Director of the Digital Health Track, Rocky Vista University

#Resilience Award Winners:

Dr. Chwen-Yuen Angie Chen, Clinical Associate Professor and Medical Director, Stanford University

Honorable mentions in this category were noted for:

Dr. Romy Jill Block-Posner, Division Chief of Endocrinology and Metabolism at NorthShore University Health Systems

List of Conference Related Graphics and Exhibits

Exhibit 1: Student Pre-Conference Keynote

Exhibit 2: Best Practices for Conference Twitter Engagement

Exhibit 3: Management of Microaggressions

Exhibit 4: Reproductive Life Planning

Exhibit 5: Welcome and Keynote, Who do you think you are?

Exhibit 6: Your Dream Career on Your Terms

Exhibit 7: Leading an Ongoing Crisis: Transitioning from Crisis Mode to Leading in It

Exhibit 8: Negotiating for Yourself

Exhibit 9: Getting Men on Board

Exhibit 10: Chaos, COVID, and Connection: Leveraging Media to Convey Reliable Medical Content

Exhibit 11: Me, Myself, and I…Hate Updating my C.V. Reclaiming the Professional Document

Exhibit 12: Creating Your Own WIM Group

Exhibit 13: Closing Address Day 1: Building Power and Solidarity for Social Justice

Exhibit 14: Nocturnists Dinner

Exhibit 15: Welcome and Keynote for Day 2

Exhibit 16: Physicians as Community Organizers: Allyship and Social Capital at Work

Exhibit 17: Mentor, Coach, Lead to Peak Performance

Exhibit 18: Spilling the Tea and All About “Resiliency”

Exhibit 19: Navigating the Whisper Network: Safeguarding your Reputation, Overcoming Labels, and Controlling the Narrative

Exhibit 20: Using Social Media for Good: Tweetopoiesis

Exhibit 21: Closing Address for Day 2


The student pre-conference this year was a collaboration between the non-profit IGNITE and Women in Medicine. Dr. Shikha Jain, board-certified hematology and oncology physician, founder and chair of the Women in Medicine Summit and Dr. Molly Kraus, Vice Chair Committee for Women in Anesthesia, American Society of Anesthesiologists and board-certified anesthesiologist at Mayo Clinic Arizona, opened the day by welcoming the medical students and introducing IGNITE. Dr. Vineet Arora then gave the keynote address “The Dean's List: Life Lessons from my Journey” in which she described her path in medicine and her current position as the Dean for Medical Education at the University of Chicago [Exhibit 1].

Tricia Rae Pendergrast, medical student at Northwestern University Feinberg School of Medicine and co-founder of GetMePPEChicago and Dr. Jessie Allan, pediatric hospitalist for Palo Alto Medical Foundation and Adjunct Clinical Associate Professor at Stanford University School of Medicine, led a session on “Best Practices for Conference Twitter Engagement” to help prepare attendees for the WIM Summit the following day [Exhibit 2]. They provided tips and tricks for building a professional brand on Twitter.

The breakout sessions for the student pre-conference included a session titled “Management of Microaggressions” was led by Dr. Molly Kraus and a session on how to find mentorship and sponsorship was led by Dr. Shikha Jain and Dr. Neelum Aggarwal, cognitive neurologist, clinical trialist, and researcher in the field of population health and aging [Exhibit 3]. A session on reproductive planning led by Dr. Ariela Marshall, Director of the Women's Hemostasis and Thrombosis Program, Associate Program Director of the Non-Malignant Hematology, Hematology/Oncology Fellowship Program, and Associate Professor of Clinical Medicine at the University of Pennsylvania and Dr. Julia Files, board certified Internal Medicine physician and Professor of Medicine in the Mayo Clinic College of Medicine and Science [Exhibit 4]. Dr. Eve Bloomgarden, board-certified endocrinologist at NorthShore University Health System, Director of Thyroid Care and the Director of Endocrine Innovation and Education for the Division of Endocrinology at NorthShore led a session on advocacy.

Day 1: SEPTEMBER 16, 2022

Session 1:

Dr. Shikha Jain welcomed everyone to the fourth annual Women in Medicine Summit. Dr. Jain discussed women in medicine who are “getting things done” while acknowledging the continued systemic barriers and gender inequities these women encounter daily. She went on to discuss her “Top 10 Tips to Advance Yourself” and guiding advice for the WIM Summit, such as being introspective, networking, and balance [Exhibit 5].

Dr. Kimberly Manning, Associate Vice Chair of Diversity, Equity, and Inclusion for the Department of Medicine at Emory University School of Medicine gave the keynote address titled “Who do you think you are?” She outlined the importance of humanizing emotions, the power of gratitude, and the importance of introspection. She encouraged everyone to take an inventory of their strengths and to determine their own individual mission.

Dr. Arghavan Salles, national leader in diversity, equity, and inclusion, spoke on achieving your dream career on your own terms [Exhibit 6]. She discussed her background and the challenges she faced throughout her journey in medicine from marginalization and discrimination to her detour away from medicine. Dr. Salles then discussed what she wished she had done differently including placing more emphasis on knowing herself, living by her values, and being human first. She encouraged everyone to find a place within medicine that values each individual and avoid those spaces that do not.

Dr. Matifadza Hlatshwayo-Davis, Director of Health for the City of St. Louis, spoke about leading in an ongoing crisis presenting takeaways from the COVID-19 pandemic and the Monkeypox outbreak [Exhibit 7]. She opened by discussing health equity and the importance of funding public health efforts to implement change in policies and systems to combat inequity. Additionally, she explained how minoritized communities are disproportionately affected by health crises (as evidenced by the Monkeypox outbreak). She recommended five characteristics required to be an effective leader during and after a crisis: having a vision, transparency, relationship management, emotional intelligence, and taking care of yourself.

Session 2:

Dr. Tanya Menon, Professor at the Ohio State University's Fisher College of Business, led a talk titled “Negotiating for Yourself” [Exhibit 8]. Dr. Menon started her talk with a case study on influence in which she highlighted how former President Lyndon Johnson protected civil rights protestors by harnessing likeability, open ended questions, and relatability. She recommends physicians take into consideration shared interpersonal connections when negotiating, think about how they display power implicitly and explicitly, and understand what the counterparty wants when attempting to meet a mutual goal.

Dr. David Smith, Associate Professor at the Johns Hopkins Carey Business School, and Dr. Brad Johnson, Professor of Psychology in the Department of Leadership, Ethics, and Law at the United States Naval Academy, and a Clinical Faculty Associate in the Graduate School of Education at Johns Hopkins University, led a session on “Getting Men on Board” [Exhibit 9]. They began their talk discussing motivations for men to be involved with gender equity, an example being personal connections; men who learn about injustices to women around them are more motivated to advocate for them. Another being business, more diversity often means better performance for the team as a whole, and also morality, as it's the right thing to do. They discussed how women have been advocating for gender equity for a long time yet male engagement remains minimal. Drs. Smith and Johnson believe men stay on the sidelines due to anxiety, implicit bias, and perceived “riskiness” in the post-Me Too era. They presented tips for men for allyship including holding yourself accountable, sharpening gender intelligence, watching for assumptions, and developing situational awareness.

Breakout Session 1:

The first breakout session for the day included seven different sessions for attendees to select from. Communication Styles: Why they Matter and How to Improve Yours was led by Stacy Wood, founder of Through the Woods Consulting. She talked about how understanding your own communication style can allow you to communicate more effectively. She recommends attendees be mindful and flexible with their communication styles.

The second breakout session titled Entrepreneur and Medicine, was led by Dr. Nneka Chineme Unachukwu, pediatrician, and founder and CEO of Ivy League Pediatrics. Dr. Nneka Unachukwu opened her session by stating all physicians are entrepreneurs and no one is “just a doctor.” She told the story of her journey to starting Entre MD with the mission of “helping doctors learn how to build optimal businesses allowing them to live life and practice medicine on our terms.” Dr. Nneka Unachukwu encouraged attendees to know who they are, know their assets, know their opportunities, and create a statement of who they are professionally.

Dr. Diane Shannon, co-author of Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine and certified life coach led the third breakout session titled “Gaslighting vs. Imposter Syndrome: How to Know, What to Do”. Dr. Shannon opened by discussing how imposter syndrome is not a pathological syndrome and how to replace negative feelings with positive ones. She stated that self-doubt comes from r within you, imposter syndrome, or externally from being told one is inferior, i.e. gaslighting. She stated the importance of distinguishing the source of self-doubt by looking at your environment and influences. Dr. Shannon recommended empowerment strategies such as, aiming for mastery not perfection, keeping a journal, seeking support and validation, enlisting peers, allies, and mentors, being intentional with self-care, advocating for diversity, equity, and inclusion training, and holding leaders accountable. She emphasized the most important step being to overwrite negative thoughts by listing automatic negative thoughts and creating new thoughts based on strengths.

The fourth breakout session was a mentor-mentee session. The mentors were Dr. Laura Zimmerman, Dr. Andrea Pappalardo, Dr. Laura Desveaux, Dr. Jessi Gold, Dr. Joanna Bisgrove, Dr. Julie Oyler, Dr. Kelly Cawcutt, and Dr. Anita Raghavan. Mentees included medical students and early career physicians.

The fifth breakout session was led by Dr. Emily Silverman, creator and host and Dr. Alison Block, Executive Producer of The Nocturnists. They began their session with the question- “Why isn't medicine the way I expected it to be?” They then described how the podcast The Nocturnists was created to provide a forum for stories happening in medicine right now and revive passion in healthcare. Drs. Silverman and Block believe storytelling has the capacity to change the narrative for patients and for providers. They gave 10 tips for storytelling including putting yourself in the story, showing vulnerability, finding an arc of change, showing not telling, varying tone and pacing, adding humor, cutting content, finding strong opening and closing lines, knowing the central question, and knowing the audience.

The sixth breakout session was titled “Resiliency Workshop Using the Emory University CBCT Techniques”, given by Dr. Hansa Bhargava, Chief Medical Officer for Medscape Education. Dr. Bhargava opened by discussing physician burnout and the need for systematic solutions. She then introduced Cognitively Based Compassion Training (CBCT) which has the goal of increasing resilience and compassion toward others within 8 sessions. The three main strategies of CBCT include bringing ourselves from a hyperstimulated system to between the zone of resilience, prioritizing yourself, and prioritizing compassion for others.

The seventh and final breakout session was titled “Leveraging Media to Convey Reliable Medical Content” and was given by Dr. Lipi Roy, internal medicine physician and host of the YouTube series Health, Humor, and Harmony [Exhibit 10]. Dr. Roy opened by discussing the COVID-19 pandemic and the importance of public health messaging during this time. She discussed how science and storytelling can build trust while combating misinformation; emphasizing that trust and credibility are at the heart of doctor-patient relationships. Dr. Roy also discussed why women's voices in particular matter, and how the media can be used to promote public health. She used her own experiences with the media to discuss the positives (personal and professional exposure, brand development, opportunity to share knowledge and expertise) and the negatives (time consuming, online harassment, and health repercussions). She ended her talk by discussing the importance of self-care through mindfulness practices, doing what you enjoy, and asking for help.

Breakout Session 2:

Alice Chen, MD, Adjunct Assistant Clinical Professor at the David Geffen School of Medicine at University of California Los Angeles and Senior Advisor to Made to Save, a national grassroots public education and outreach campaign to get COVID-19 vaccines to vulnerable communities led a breakout session on Advocacy in Medicine, structured as a question and answer session. Questions came from the audience, such as how to approach vaccine hesitancy in marginalized communities, how to gauge risk in advocacy work, and how to balance advocacy, career, and life without guilt. Dr. Chen acknowledged the risk involved in advocacy. In answering a question about how to bridge the gap between being a part of an institution and being involved in community work, Dr. Chen emphasized the importance of serving as an ally and acting as a bridge between identifying community needs and advocating for those needs at faculty meetings. Lastly, Dr. Chen spotlighted the importance of avoiding burnout and setting boundaries. She encouraged the audience to remember that other people are doing the work alongside you, and that self care is necessary to keep the movement going.

Dr. Avital O'Glasser, a hospitalist specializing in perioperative medicine and Associate Professor of Medicine at Oregon Health & Science University led the breakout session, “Me, Myself, & I…Hate Updating My CV: Reclaiming the Professional Document.” Her talk emphasized reimagining the curriculum vitae (CV) and by including experiences traditionally seen as less relevant [Exhibit 11]. Dr. O'Glasser addressed the gender inequities associated with the number of citations and publications as primary or senior authors found traditionally on the CV, therefore Dr. O'Glasser advocated for including digital scholarship on one's CV, including: social media metrics, podcasts, blogs, OpEds, and media appearances. She also suggested advocacy efforts, retail or hospitality work, and other experiences that may seem irrelevant should be incorporated. She highlighted that these experiences held important qualities that are often overlooked in the traditional CV. She encouraged attendees to be allies by writing letters of recommendation for each other, normalizing gaps in the CV without explanation, expanding the definition of scholarship, and emphasizing quality over quantity.

Breakout Session 3:

Neelum Aggarwal, MD, cognitive neurologist, clinical trialist, and researcher in the field of population health and aging led the breakout session, “Caregiving Impact'' which discussed the reality of caregiving in light of a national worker shortage and quickly aging population. She defined caregiving as “the physical, emotional, and financial support of another person who is unable to care for themselves”. She outlined how caregivers suffer a 63% higher mortality rate from the strain with increased rates of depression. Specifically, caregivers for people with Alzheimer's Disease (AD) are estimated to on average spend 60 hours a week providing care. Dr. Aggarwal emphasized the importance as caregiver, to avoid neglecting one's needs and to provide for oneself physically, emotionally, socially, and spiritually.

Dr. Julie Oyler, Associate Professor and Associate Program Director at the University of Chicago Internal Medicine Residency Program, Dr. Vidhya Prakash, Associate Dean of Clinical Affairs and Population Health and Chief Medical Officer at Southern Illinois University of Medicine, and Dr. Rakhee Bhayani, associate professor of medicine at Washington University School of Medicine led a breakout session on “Creating Your Own Women in Medicine Group” structured as a group activity addressing the following questions: What are the needs for women at your organization? What are the barriers to these needs and to creating a Women in Medicine Group at your organization? Who will be allies in this discussion? What would be the proposed structure of your Women in Medicine Group? What are some strategies for creating a Women in Medicine Group? [Exhibit 12] Dr. Bhayani emphasized identifying the potential group's mission and goals, engaging speakers, creating infrastructure and a strategic plan within committees, promoting the group intentionally, and forging collaborations. Dr. Bhayani also encouraged engaging male allies and implementing longitudinal programming. Dr. Julie Oyler discussed her experience as Chair of the University of Chicago, Department of Medicine Women's Committee (DOMWC). The DOMWC was founded in 1999 and focused on fellows, residents, and faculty. Dr. Vidhya Prakash talked about starting and leading the Alliance for Women in Medicine and Science (AWIMS) at Southern Illinois University. The session concluded with the discussion of how women in medicine groups have power in numbers and the potential to successfully advocate for women and create change.

Dr. Kelly Cawcutt, Associate Professor of Medicine at University of Nebraska Medical Center in Omaha and critical care medicine and infectious disease physician, led a breakout session that discussed “Social Media and Healthcare.” She urged healthcare providers to become more present on social media to help battle misinformation and disinformation as well as amplify underrepresented voices. Dr. Cawcutt outlined advantages to utilizing social media including joining international groups, professional collaborations, and advocating for patients. Using professional social media is a valuable way to amplify and disseminate health information from trusted sources straight to patients.

Session 3:

Dr. Aletha Maybank, Chief Health Equity Officer and Senior Vice President, American Medical Association, led the Closing Keynote Session titled, “Building Power and Solidarity for Social Justice: Have Courage to be Yourself, Fully and Authentically” [Exhibit 13]. Dr. Maybank started her session by discussing how gender equity is ingrained within the fight for social and racial justice. In order to evolve as a society we must understand inequities of the past and develop strategies to rectify them. She then went on to describe how historically medicine itself has not been inclusive to all groups, but through valuing diversity, recognizing differences between people, acknowledging that these differences are assets, and striving for diverse representation a critical step towards equity can be taken.

Day 1 of programming concluded with a poster walk of accepted poster presentations, book signings with featured authors, and an evening event presented by the Nocturnists [Exhibit 14]. Medical storytellers from across the country gave powerful narratives of their experiences as women in medicine.

DAY 2: SEPTEMBER 17, 2022

Session 4

Dr. Shikha Jain welcomed everyone back to the WIM Summit. She described barriers faced by women in medicine, specifically, implicit bias, microaggressions, imposter syndrome, Twitter harrassment, and the “whisper network”. She then gave strategies on how to address microaggressions, such as, asking clarifying questions, sharing data, utilizing bystander intervention, and finding allies [Exhibit 15]. Dr. Jain also highlighted the amount of invisible work women in medicine undertake, and the need to re-structure models of compensation, and evaluation of work completed within the healthcare system.

Dr. Marina Del Rios, Associate Professor of Emergency Medicine at the Carver College of Medicine of the University of Iowa and Adjunct Professor of Emergency Medicine at the College of Medicine at the University of Illinois at Chicago, then led a session titled “Physicians as Community Organizers” [Exhibit 16]. Dr. Del Rios began her talk by outlining how physicians, by nature of their profession, are already community organizers. She used the COVID-19 pandemic as an example in which a health crisis exacerbated inequities and demonstrated the broken nature of health systems. Dr. Del Rios went on to explain that in order to create an impact in our community, we must be able to understand the struggles of that community, and how that environment affects overall health.

Session 5

Laurie Baedke, MHA, FACHE, FACMPE, Assistant Dean, Business & Leadership Education. Instructor at Creighton University gave a talk on mentorship, coaching, and leading [Exhibit 17]. She started by outlining the similarities and differences between a mentor, sponsor, and a coach. Dr. Baedke then explained how people require all three on the path to leadership and can lead to self-awareness, growth, performance, engagement, purpose, and well-being. The main barriers to mentorship and coaching are time, training, and resources. She also discussed mentorship etiquette and how to curate your circle to fulfill all of the different roles required for success.

Dr. Jessi Gold, Assistant Professor in the Department of Psychiatry at Washington University in St Louis' School of Medicine and Dr. Jamie Coleman, trauma and acute care surgeon at Denver Health and Associate Professor of Surgery at the University of Colorado School of Medicine in Denver, held a session titled “Spilling the Tea and All About Resiliency”, in which they discussed the realities of resiliency and the need for systemic change [Exhibit 18]. They described the frequent messaging that physicians are not resilient enough and gave strategies for overcoming this through power statements, setting boundaries, and learning to say no.

Breakout Session 4:

Mark Hertling, Lieutenant General, DBA led a breakout session titled “Adapting Leadership to Periods of Crisis.” He opened with a discussion on the characteristics of a successful leader. He explained how the military leadership manual goes by three words: Be, Know, Do. “Be” is what kind of person you are; “know” is your knowledge base; and “do” is how you go about getting things accomplished. Hertling went on to describe that the most important thing when in a leadership role during a crisis is to communicate– reinstate what you are trying to achieve and keep members updated. Assign people direct tasks and responsibilities and hold them accountable. He ended with, “Never let a good crisis go to waste,”– an encouragement to take action and try to make a change that benefits not only your team and yourself, but also your profession.

Dr. Jessi Gold, Assistant Professor in the Department of Psychiatry at Washington University in St Louis School of Medicine, led a session titled, “How are you, Really?: Debriefing the Past Few Years and Thriving in the Next Ones.” She opened by describing the impact of COVID-19 on mental health including the increased levels of acute stress, depressive symptoms, anxiety, moderate insomnia, and feelings of isolation and loneliness. She also touched on the gender disparities within those data. Specifically, women in medicine were found to have higher levels of depressive symptoms during the COVID-19 pandemic. Dr. Gold recommends utilizing self-check-ins to help individuals prioritize wellbeing. She encouraged the audience to share stories and narratives with others to help normalize mental health.

Laurie K. Baedke, MHA, FACHE, FACMPE, Director of Healthcare Leadership Programs, Program Director, Executive MBA in Healthcare Management, Assistant Dean, Physician Leadership Education, Creighton University, led a session titled, “Leveling Up in Leadership: Navigating Your Career Ascent.” She opened by discussing the transition from individual contributor to influential leader, stressing the importance of an emotionally intelligent leader. Baedka explained that women are often over mentored and under sponsored. She closed by giving seven tips for “leveling up” as a leader: clarify your brand, think outside of your own performance, ensure your leader is seeing you and acknowledging your accomplishments, telegraph your pass (tell people where you want to go and what you want to achieve), curate your circle of supporters, have a margin to restore yourself, and clarify your purpose.

Dr. Pamela Kunz, Associate Professor of Medicine in the Division of Oncology at Yale School of Medicine and Director of the Center for Gastrointestinal Cancers at Yale Cancer Center and Smilow Cancer Hospital led a breakout session titled, “Navigating the Whisper Network: Safeguarding Your Reputation, Overcoming Labels, and Controlling the Narrative” [Exhibit 19]. The “whisper network” is the informal communications network through which rumors and accusations are spread, and is often used as a form of gender harassment in the workplace. Breakout session attendees were asked to answer a live survey; with 50% of session attendees of those answering they had been a previous target of the whisper network. Dr. Kunz talked about her own experiences as a target of the whisper network and how she experienced microaggressions, misogynistic harassment, and retaliation from her colleagues. She then discussed how she was able to control the narrative surrounding her by being authentic to herself and her team's vision, overcoming labels, and defining a strong sense of self with the help of an executive coach.

Dr. Krishna Jain, Clinical Professor of Surgery at Western Michigan University Homer Stryker M.D. School of Medicine. Dr. Jain opened by explaining the two ways through which one can gain autonomy: clinical and financial. He then explained the various practice models available to physicians such as private practice (solo or group), hospital, academic institution employment, Veterans Affairs, and concierge based employment. He went on to describe the pros and cons associated with those practice models. Dr. Jain discussed barriers to autonomy which include insurance companies and chief financial officers and chief executive officers. His solutions for these barriers include starting your own practice, joining a private practice, starting a revenue generating ancillary service, understanding reimbursement, and building bridges with administrators.

Dr. Arianna Gianakos, Foot and Ankle Orthopedic Surgery Fellow at New York University in NYC, led a session on the organization, SpeakUpOrtho. She opened the session by introducing herself and her path through medicine. Dr. Gianakos was one of the founders of SpeakUpOrtho in 2021, an organization tasked with encouraging individuals “to speak up about harassment, bullying, abuse, marginalization, and underrepresentation in orthopaedic surgery.” Upon its creation, SpeakUpOrtho had >375 submitted stories within the first two months that described instances of bullying, harassment, sexual harassment, discrimination, and retaliation. Dr. Gianakos went on to define terms such as microaggression, bullying, discrimination, harassment, sexual harassment, and allyship. She also described the bystander effect and how it acts as a barrier to helping those experiencing abuse including, diffusion of responsibility, evaluation apprehension, pluralistic ignorance, normative influence, and cause of misfortune. She encouraged attendees to be an “upstander”, or someone who recognizes inequity or wrongdoing and speaks up to help and protect others.

Dr. Disha Spath, board certified Internal Medicine Physician for Dartmouth Hitchcock Putnam Physician, and founder and CEO of The Frugal Physician, led a session on the “Foundations of Investing.” Dr. Spath discussed how as of 2020, specialists make $346k on average and primary care providers, $243k. Many physicians make less than $1 million and may have accrued interest on their loans to equal that amount. Physicians are typically 10 years behind by the time they start investing because of the length of training. She then described the four key tenants to understanding how to become a frugal physician including, protection (via insurance, estate planning and emergency funds), investment opportunities, slashing debt, and growth. Dr. Spath then outlined how investing in stocks, colloquially, may seem to have its own risks, however, there are different types of stock opportunities including stocks, bonds, mutual funds, index funds, and exchange traded funds. She recommends setting up retirement accounts as a method for improving tax efficiency.

Breakout Session 5:

Jessica Himstedt, PhD, MS, MBA, Faculty Lead and Content Manager at Lake Forest Graduate School of Management led a breakout session titled, “Accelerating Your Path to Leadership.” Dr. Himstedt opened by discussing leadership, contrasting it to management, and the various behaviors associated with each. Dr. Himstedt built a foundation of understanding in which management creates routine and momentum, whereas leadership is supportive and guiding. She emphasized the importance of understanding that in fact both leadership and management must be implemented in order to be effective in a team and understanding this delicate balance can help us navigate our workplace environments and create opportunities of growth.

Laura Desveaux, PhD, PT, Scientific Lead at Trillium Health Partner's Institute for Better Health and Founder and Executive director of Women Who Lead, led a breakout session titled, “Building the Blueprint: Achieving Success through Non-Traditional Career Paths.” Her talk opened by defining objectives including reframing your mindset from following a blueprint for career success to creating the blueprint yourself, identifying elements of your career capsule, developing goals in line with specific career motivations. Her recommendations included identifying what drives you, taking a professional inventory regarding what you love to do, what you are good at, and what you want to stop, and prioritizing enjoyment over efficiency.

Amy Oxentenko, MD, FACP, FACG, AGAF, Professor of Medicine and Chair of Medicine for Mayo Clinic in Arizona and Vice Chair of Mayo Clinic's Clinical Practice Committee across the Mayo Clinic sites, led a breakout session titled, “Making Tough Choices in Career Advancement: Choosing the Path Less Traveled.” Dr. Oxentenko described her own career pivots and the lessons she learned from each. She has found that people tend to stay on a certain career path or leadership role because it feels “good” to be an expert in a certain area, but this path can actually be prohibitive to career advancement. Dr. Oxentenko recommends focusing on transferable skills, creating milestones as goals rather than titles, encouraging small experiments, pacing yourself within your career, and learning how to say “no.”

Dr. Julia A. Files, board certified in internal medicine and Professor of Medicine in the Mayo Clinic College of Medicine and Science led a breakout session titled, “Navigating a Path to Academic Promotion.” Dr. Files explained how academic rank is dependent upon the promotion process of each individual university or college and is not consistent across institutions. She believes the process of appointment and promotion should be criteria-based, transparent, consistent, and open to all. She described the general academic ranks including instructor, assistant professor, associate professor, and full professor. Dr. Files described the landmark study of Jena et al. in JAMA 2015, “Sex differences in Academic Rank in US Medical Schools in 2014” which showed that men were more likely than women to be full professors after adjusting for age, specialty, years since residency, and research productivity. She described how women in medicine can begin to pursue academic advancement through assessing their skills, clarifying their interest, and exploring mentorship.

Angela Cristine Weyand, MD, faculty at the University of Michigan, led a breakout session on Using Social Media for Good [Exhibit 20]. Dr. Weyand gave discrete examples of social media being used for advocacy work. Dr. Weyand then described her experiences on Twitter as “Shematologist, MD” emphasizing her work in education, advocacy, and fundraising. She outlined what as women in medicine we can do on social media and how to apply what you are passionate about to enact change.

Session 6:

Dr. Rebekah Gee and Dr. Kavita Patel gave the closing session titled “Majority Rules: A Real Conversation” [Exhibit 21]. Dr. Rebekah Gee is an Obstetrician and Gynecologist and President and Founder of Nest Health. Dr. Kavita Patel was previously a Director of Policy for The White House under President Obama and Deputy Staff Directory to the late Senator Edward Kennedy. She is currently a primary care physician in Washington DC. They opened their session by outlining data regarding gender inequities such as gaps in pay, tenure, and promotion. Dr. Gee and Dr. Patel then discussed solutions such as how friendships can help individuals develop both personally and professionally. They encouraged attendees to find a diverse group of women with whom to share goals and mutually promote, amplify, and lift each other.

Dr. Shikha Jain ended the fourth annual Women in Medicine Summit by thanking attendees and providing key take-aways from the summit including being introspective, finding balance, and networking. The fifth annual Women in Medicine Summit will be held September 22-23, 2023.

  Inspirational Perspective Number 6 Top

Deconstructing the “Angry Black Women” Trope: An Examination of How Racism Perpetuates Inequity in Medicine

Abiba Salahou

Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA

For Black women living in America, social disadvantage and racism are embedded within our medical care and silence has become our closest companion. If we dare to speak up against the injustices that are perpetrated against us, society is quick to dismiss our pain and label us as “angry.” The infamous “Angry Black Woman” trope has served as a way for America to mask the suffering experienced by Black women. When we cry out in distress after witnessing the murders of our sons, brothers, fathers, and husbands we are told that we are “too angry.” When we try to tell our doctors that something is not right with our bodies and beg them to take a deeper look, we are labeled as “difficult, non-compliant patients.” The type of patients who give some doctors a headache and make them want to rush out of the exam room as quickly as they arrived. In the face of adversity, Black women are expected to swallow their pain and remain submissive. If one were to peer into our stomachs, one would find the seeds of our swallowed traumas growing into magnificent gardens of shame; a visceral reminder of our mistreatment, permanently etched into our bodies. What started off as seeds slowly morphed into poor health outcomes, instability, depression, and healthcare inequality.

I was in the midst of studying for my course in Endocrinology when I learned about the tragic passing of Dr. Chaniece Wallace, a 4th year pediatric resident who died from postpartum complications on October 22, 2020. Dr. Wallace's death was another salient reminder of the detrimental effects of racial discrimination within our healthcare system. As I concluded my textbook passage on Addison's Disease, glancing once more over the homogenous images of Caucasian skin, I could not help but think that my medical education and ability to regurgitate these passages would not save me from experiencing the exact same fate as Dr. Wallace. Eradicating cultural bias in medical education, however, could save millions of Black women during the birthing process.

Society is often quick to mercilessly blame Black women for their poor health outcomes. Adverse events during childbirth and other routine procedures are, “issues of unpreventable outcomes due to comorbidities”, rather than an issue of preventable death due to long standing racism. As a Black female medical student, I often find myself trying to reconcile two juxtaposing identities. I am a third-year medical student who has been afforded the privilege to study medicine amongst a cohort of caring individuals. Despite this privilege, I am still the stereotypical Black woman anxiously sitting in the hospital waiting room with a list of concerns scribbled on the back of an old receipt. Similarly to many other Black women, I still dread the initial encounter that comes with meeting a new doctor for the first time. In preparation for the visit, I spend hours on google sifting through reviews to see if I will be going to a place where my blackness will be welcomed. Somewhere where my concerns will be validated and the physicians won't talk down on me, over me, or about me without ever making full eye contact. In the event that the visit is problematic, I leave feeling devalued and delay subsequent appointments until it is absolutely imperative that I go back. This toxic pattern is why people often joke that “Black people don't like going to the hospital”. It's not the medicine that we are avoiding, but rather, the racism.

While it is disheartening that two years after Dr. Wallace's tragic death, we are still witnessing the same disparity in healthcare for Black women, I believe there is potential for the medical community to engender positive change. In order to adequately address the public health crisis that is racism in America, medical providers must truly listen to the black voice in front of them on the exam table. We must consider the intentional role structural racism has served in ensuring that marginalized populations in America stay marginalized and unable to access their autonomy. Dr. Wallace's story must not be forgotten. Until we recognize systemic racism as a public health issue and consistently work on finding innovative ways to deconstruct the years of institutionalized medical racism, society will continue to be desensitized to the suffering experienced by Black women and in turn muffle their cries for help under the guise of the “Angry Black Women”.

  Inspirational Perspective Number 8 Top

Humanity - A Glimmer of Hope

Gaayathri Krishnan1,2

1PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India, 2Department of Internal Medicine, AdventHealth, Sebring Florida, USA

Humanity is defined as a state or quality of being human. But the most pressing question of them all is, 'what makes a human-being humane?'

How do we define that in a human being?

Early days of 2020, when the corona virus had just started making its rounds in India; when it was a mere ripple before the massive waves; When all of India was shrouded in fear and alarm, young doctors, who were to be relieved after one of the most intense and overwhelming years of their lives, were asked to stay back and help out in this dire situation.

It was a time when masks, gloves and hand sanitizers, an essential but scarce commodity, were being rationed among health care workers. They went into the battlefield armed with whatever little was known about the virus [a palpable fear of the unknown] but they soldiered on head first with hearts made of steel.

One night, in the ER, an elderly man, known asthmatic, was brought in with a fever that just wouldn't break and severe breathing difficulty. Anxious that he might be refused treatment and a consternation that he might be turned away, he failed to reveal his travel history to Spain, even after constant probing.

When someone is in distress, it is only human that they are looked after and looked after well. And that was what was done.

A day later he divulged information about his recent trip and panic bubbled through the walls of the hospital, all the health care workers within, all of its patients and the countless visitors. Hysteria spread like wildfire, a 'COVID suspect' was in the hospital and who knows where all he had been in the hospital.

The young doctor who attended to him in the ER, tested positive 5 days after exposure. This 23 year old's whole body racked with coughs, she drifted in and out of a dreamless sleep, waking up more tired than when she went to sleep. Delirious with pyrexia, unable to eat combined with the loneliness and absolute fear of the virus, sent her on a downward spiral. COVID can do that to you - push you to the brink, physically, mentally and emotionally.

Minutes seemed like years for the virus eats you up from the inside out. Days went by without physical and human contact.

When she felt she was sinking, a mellifluous sound to her troubled ears, 'It is me, thayamma*, darling. I just came to check in on you.' She yells from inside the closed door, 'It is not safe, amma [mother in native tongue]. Please leave'.

Thayamma, herself, aged and riddled with comorbidities, paid no caution to the girl's warnings. She came every single day, just to stand outside that door and ask how the young girl was doing.

Two long weeks passed, but she continued to visit. When that door finally opened, there she was on the other side with open arms and a crinkled smile, a tattered mask, her only armor. She engulfed the young doctor, embraced her with such love and affection, only a mother could do, comforting her. 'The worst is over, darling. You have made it. You will be fine, nothing will harm you from now on.' She continued to chide her, 'The only reason you contracted the virus is because you don't eat well.'

The young doctor's heart swole and her eyes welled with tears.

Thayamma, was neither her mother, sister, best friend nor a blood relative, but worked in the ladies hostel, scrubbing toilets and sweeping the floors for many many years. In many ways, thayamma was the reason this young girl pulled through. Her kindness shone through every facet, every wrinkle of her body, every curve of her spine and every bead of sweat she worked up. Warmth and love coursed through her veins and arteries admixed with blood and oxygen.

That, my dear reader, is humanity.

It exists everywhere, in each one of us, although in various degrees and forms.

Humanity is not serving one thousand people.

It is being there for someone when they need it.

It is making someone smile, when they cannot.

It is giving a hug to someone who needs it.

  Inspirational Perspective Number 9 Top

The Unequal World of Inequality

Gaayathri Krishnan1,2

1PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India, 2Department of Internal Medicine, AdventHealth, Sebring Florida, USA

I see whites, greens, blues and reds.

An assortment before my eyes

A sweet escape

My painful reality daunts

My fist full,

I roll the shapes in my palm,

Its my decision now

To spit or swallow.

”To what extent can you take this?”

I implore.

My mental health strays far away

No longer even that wisp of thread

But I have to,

I have to.

Wake up in the morning and repeat.

For it is my duty.

A lot is said about mental health. Yet what is its real significance? Mental illness affects us all, just in different ways, to different degrees.

Do you see it as a normal concept now? Has it now been overly normalized to the point we no longer visualize it? How do you distinguish a 'sad mood' from depression? In that, too, we differ. A fine line separates the two. A distinction we have to acknowledge.

A young doctor and a strong advocate for mental health, fell into destructive patterns. Hard work must come first, patients must come first, and nobody should say 'you are just a girl' to her. And so she hustled and hustled. Then one day, she couldn't anymore.

She was caught in a vicious cycle, pierced at every turn by its spokes.

There has been a steep in the curve of suicide among medical professionals especially this past year, with the pandemic looming over our heads. As a result, physician wellness has reached a tipping point due to heightened social isolation, a lack of community support, and fewer opportunities to seek counseling, among other issues.

However, why should someone so young and so deeply believes in the importance of mental health become a victim to this unseen, but strongly felt enemy? Our tendency is to overlook the fact that doctors are amazing at doctoring, but terrible at patient-ing. It is often associated with a feeling of privilege and power, and that is often what results in patterns of neglect. It is difficult to accept, although we know that, as with patients, physicians are susceptible to depression and suicide.

Here, we fall into a complex web of inequality. A bridge we are yet to cross completely.

At each stage of our careers, we are faced with complex scenarios but are forced and are guilty of normalizing them as they are part of the profession. A focus on physical stamina and mental toughness very early in medical school, or even earlier in our lives, in preparation for the future, leads to a tolerance for excessive amounts of stress, sleep deprived nights, extended working hours, and a lack of leisure time.

Those in the medical profession face a multitude of stressful factors, including heavy debt, administrative burdens, bureaucratic red tape, and more, as well as the added strain imposed by family obligations and raising children. It is no hidden fact that physicians are tough and tenacious, but when we depend on these characteristics above all others, we can endanger our own well-being and that of our patients and colleagues.

I conclude by requesting us all to check in. To check in on each other - it could be anyone. “The humanity we all share is more important than the mental illnesses we may not” ― Elyn R. Saks. One in four people suffer silently. It could be your boss, your best friend, your colleague or yourself. It is critical to recognize and heed to signs of burnout and despair, both within ourselves and among our coworkers, and to obtain help if we notice anything amiss. The act of seeking help shouldn't be stigmatized, especially in the medical fraternity.

  Inspirational Perspective Number 12 Top

Supervising Moms

Biana Kotlyar

Department of Psychiatry and Behavioral Sciences, Chicago Medical School, North Chicago, USA

As a physician, psychiatrist, and mom, I find myself very protective of my supervisee residents. Still, when those residents are also new moms, my supervision looks a little different. Whenever I supervise residents working with me for a more extended period, we do a wellness check from time to time. Usually, we talk about how they are experiencing their work environment, their interactions with others, and whether they feel supported. I have always struggled with balancing supervision. I want to make sure it doesn't feel like “helicopter supervision” and that the residents know I trust them to work independently. But when my residents are new moms, I have a completely different supervising dilemma. This month, I supervised two residents, a brand-new mom, and a young toddler, on the Consultation-Liaison Service in Psychiatry. This is a hectic service. There is a lot to learn and do. Despite having a full plate at home, they also have an enormous responsibility at work, not to mention the importance of their training. I was in awe of these residents since I had my kids after residency; I could only imagine the amount of stress and responsibility they had on their shoulders. They were juggling their families at home, their fellow residents, and all the group dynamics that come with that; they were studious, efficient, and hardworking.

These resident physicians were overachievers on steroids. Even when no other reasonable resident would do this, they felt compelled to see patients who had barely made it in the waiting room, let alone in the ED, so that fellow residents wouldn't be left with “additional work or things left pending.” One of the residents eventually told me she felt a lot of guilt over going on leave (she barely took 4 weeks) to not delay her graduation too much and having fellow residents take calls more often because she was out. It made me wonder, would being on leave for any other reason cause this much guilt and compensation when at work? What about other residents, many of whom had been only doing what was expected of them, never thinking about their colleague's workload being affected by their pace? I felt compelled to include balance and well-being in our supervision sessions.

The truth is, I should be having these discussions with all my residents. Still, it was of the utmost importance in my supervision with these newly minted moms. The psychiatry residency is four years long, and you become very close with your co-residents. Like any other group, there are unique dynamics that occur. Residents must be thoughtful of their co-residents whenever there is a family emergency, personal injury/illness, or pregnancy/parental leave. It is not precise if the pressure that new parents in residency feel is their own making or other factors. The fact is that when I supported these new parents, there was a loyal and hardworking team member, eager to learn and work hard. When new parents take time off, they often return with a rigor that makes them more productive and appreciative of their colleagues and work.

I see the need to support residents experiencing these major life-changing events and their return and make sure it is at a pace that they feel comfortable. I want to support residents' wellness and create an environment where they feel comfortable and capable of achieving both their personal and professional goals to make healthy physicians who are less prone to moral burnout and patient care errors. I saw the need to support and encourage women physicians who may have a limited window of time to start their families. I hope that I could teach and mentor these two superstar trainees successfully, but I think I got so much more in return from them and this experience. I am so grateful to have had to learn from so many great trainees. I hope they always know how impressed I am with everything they accomplish. One of my greatest privileges is to be a part of their training.

  Inspirational Perspective Number 13 Top

All the Things They Said

Madhumitha Mathivanan

Medisim Virtual Reality, Chennai, Tamil Nadu, India

My first encounter with queerness as a child came in the form of a song. It wasn't so much a sexual awakening as it was an aha! moment that opened my eyes to new possibilities. You would think that would have been the start of my path to self-discovery but it was not. Me, being the flighty child that I was, promptly proceeded to forget the fact and only remembered it again when I was in medical school, during a rambunctious night spent with my friends. Suffice it to say it came as a shock, and not a pleasant one.

But it wasn't because of some deep inner struggle that I had accepting myself, or even from my peers. It came in the form of bigotry from the faculty, the people entrusted to educate me. And my textbooks. Medical school in India is hardly a bastion of progress, it is notorious for being conservative and staunchly loyal to tradition. But even so the blatant display of homophobia and frank ignorance in its pages came as a shock to my system. And it was very evident that my professors, often the authors of these texts, staunchly believed in them. So, I, who has always been familiar with the comfort of progressive spaces online, was in for a rude awakening.

Despite everything, I did manage to find my fellow gays in my school. They were my seniors, my batchmates and my juniors. It is a well-known stereotype in the community that we tend to flock to each other unintentionally even when we're not out, and it turned out that this was based on fact! But fraternizing within our community was not without its perils. When one of my close friends was outed dating a girl who was our senior by a year. I too was unceremoniously dragged in through mere association. My private blog on Tumblr was broadcast to the whole world.

I survived with minimal repercussions, my friend and her girlfriend unfortunately weren't so lucky. To say it ended badly would be an understatement. That tragedy could have been wholly avoided with just a bit of kindness and understanding. What we got instead was hate and disgust. They were ripped apart from each other with the near gleeful blessing of our college administration. All through it all was the poisonous undercurrent of homophobia which was bolstered by its criminalization both in the law and in our literature.

It wouldn't be amiss to say that the experience had put me off dating for a long while. I had dated women casually in college but that all came to an end when I moved to Delhi. All the friendships I had cultivated drifted apart as they so often do after college. I didn't feel safe coming out to my close friends there and I longed for the connection I had gotten used to and taken for granted in Chennai. Now i am bisexual, so I did try my hand at dating men, but I always knew deep inside that I'd always envisioned myself with a wife.

Better days did come, however. I still remember the day when Section 377 was struck down and homosexuality was decriminalized. It was a pleasant evening in September, more than 3 years after I graduated. I was sitting on my bed in my hostel in Delhi at the time, vibrating slightly with excitement and almost beside myself with happiness when the news broke. I promptly came out to my roommate at the time and was met with wholehearted acceptance.

I have since then come out to my parents, several times in fact. Even though they are still somewhat in denial, I'm sure they will come around. I have also amassed a group of friends as gay as the day is long and am currently the happiest I've ever been with my girlfriend of 8 months. For all the other baby gays out there, I have one thing to say, as cliche as it is, it really does get better.

  Inspirational Perspective Number 17 Top

An Ode to Female International Medical Graduates and Their Journey to Becoming a Physician

Sushmita Prabhu

Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA

A letter to my younger self,

You will choose a path less taken,

And you will have doubts aplenty

But stay put and trust the journey,

Since it will reward you with more than you ever imagined diving into it.

As a young budding female doctor from a foreign country moving to the states for further studies, the decision will come with its own set of challenges. You will have to travel across seas, sometimes with new friends but mostly alone and start afresh on foreign soil. You may encounter many obstacles en route that will give birth to self doubt and question your decision to abandon the comfort of home ground, but there will also be experiences quite wholesome that will make the journey worthwhile. There will be chances galore to collaborate with not only the natives but also with your counterparts from across the globe. There will be lessons to grasp from varied cultures that will shape your decision making capabilities. It will guide you to be more sensitive and respectful towards people from all walks of life. On a professional note, the holistic training will reflect in your persona and your day to day interaction with patients. The sum total of all these experiences will mold you to be a better physician than you were ever before. The journey in itself will be the change maker at the personal level. This demanding journey will harness your potential to the maximum and you will emerge as an independent and empowered human being.

As a female physician who is an international medical graduate (IMG), we as a group are an integral part of the total IMG population which constitutes 23% of the total medical workforce in the United States. Our contribution is indeed instrumental, since we represent the voices of thousands of young female physicians out there. Studies have shown that there is an increase in first time licenses issued to IMG females from 25 to 45% between 1990 and 2014, reflecting the changing landscape of the medical world. Female physicians have been found to be more detailed in recognizing patient problems and especially IMGs are known to be more cognizant and respectful of all cultures. Our contribution to the table is unparalleled and unique since our skill set encompasses diversity and inclusion wielded in empathy.

One of my favorite teachers, a powerful female leader in the medical world, once said- “remember that you're all trailblazers, making way for the next generation of young doctors”. What we do today will make a difference for the world in the coming years. A step towards your dreams today, no matter how uncertain it seems now, will go on to fuel the flight for many female doctors across the globe.

Believe in yourself and take the plunge.

You are here to make a difference and the world is ready for you.

With lots of love and courage,


Prabhu MD

A female IMG who made it.

  Inspirational Perspective Number 20 Top

Go Ask Anna

Kristina Domanski

Department of Emergency Medicine, University of Nevada,

Las Vegas, Nevada, USA

”The ones that bruise blue make you crazy. And the red ones? They're poisonous, but they'll make you dream.”

I lecture on psychoactive and toxic fungi frequently. Each lecture includes an introduction to my grandmother Anna, who introduced me to mushrooms and who the above quote belongs to. In the current state of global uncertainty I find myself thinking more about how her experiences in the first half of the 20th century are relevant today. Hence why I'm writing an essay aimed at medical women about a girl who narrowly escaped a genocide.

I am Polish. I joke that we put mushrooms on everything. If there's a mushroom themed item on a restaurant menu, we order it. My childhood summers were spent in the northern part of England wandering near the canals and woodland looking for mushrooms. What we found ended up being dried in the kitchen and used for cooking. Anna always knew where to find them, which ones were edible and which ones to leave based on gills, veils and caps. Only later did I find where her knowledge came from.

The atrocities carried out by the Russians during WWII on the people of Eastern Poland are not common knowledge. After Russia invaded Poland in 1940, Stalin forcibly deported 1.7 million Poles to slave labor camps in Siberia. Only a third survived. The rest were killed by starvation, overwork, disease, extreme weather, torture and execution. Each family's story is unique. An 18 year old Anna was evicted from her home and escorted onto a cattle truck at bayonet point. From there, she ended up at a remote logging camp, surviving on whatever food she could find. In the forested region where she found herself, mushrooms were sometimes the only source of food and the inmates lived in a bizarre microcosm where the choice was often starvation versus eating something which could prove fatal. The learning curve was steep and pattern recognition was vital. Somehow she survived until 1941, when Nazi Germany attacked the Soviet Union. An amnesty was announced for all deported Poles and a Polish Army started to form in Russia. Anna and her brother made their way to a recruitment center where her brother lied about his age to enlist in the infantry. Anna was transported to a refugee camp in India and later resettled in England, where she was awarded a Gold Service Cross for her community work by the Polish Government in Exile. She died in 2010. To the end, she remained stubbornly Polish despite having British citizenship and spending more than three quarters of her life there.

I realized the significance of her quote as a Toxicology fellow. Anna spoke of the blue tinged oxidation products of psilocybin seen on Psilocybe species and the bright red caps of Amanita muscaria. Both mushrooms are psychoactive and grow all over Europe. Amanita muscaria use features heavily in Siberian shamanic practices and Psilocybe species are also found in India.1,2 To this day, I don't know whether her knowledge came from personal experience or observation, and where in her journey she learned it. Over time I have learned to be content with the fact that I'll never get a chance to ask.

The world wasn't ready for Anna's story. In the disorganized mess that was post WWII Europe, Soviet Russia was seen as an ally. Put simply, if you expressed anti-Russian sentiment, you were seen as pro-Nazi and immediately vilified. Research on the psychedelics stalled for decades due to public suspicion and increasing regulations, and has only recently started to gather momentum again.3 She would have followed the news coverage on the legalization of mushrooms in Oregon with interest. And as for the invasion of Ukraine? She would mutter something unrepeatable under her breath then start working out what she could do to help.

Looking at photographs of her is like looking in a mirror. We share the same stubborn jawline and ability to throw the kind of look that could wither a field of crops. At the same time there's a quiet serenity and an air of gratitude. I'm still learning that part. Anna taught me that we bloom where we are planted. We dream in psychedelic technicolor. We support the underdog. Sometimes the world isn't ready for us. And in those cases we mentor, we inspire and we survive.

  References Top

  1. Saar M. Ethnomyocological data from Siberia and North-East Asia on the effect of Amanita muscaria. J Ethnopharmacol 1991;31:157-73.
  2. Feeney K. The Significance of Pharmacological and biological indicators in identifying Historical uses of Amanita muscaria. In: Entheogens and the Development of Culture: The Anthropology and Neurobiology of Ecstatic Experience. Berkeley, CA: North Atlantic Books; 2013. p. 279-318.
  3. Hall W. Why was early therapeutic research on psychedelic drugs abandoned? Psychol Med 2022;52:26-31.

  Inspirational Perspective Number 27 Top

Women Trainees in Leadership: Lessons Learned in Founding a Non-Profit During the COVID19 Pandemic

Tricia Pendergrast, Tazim Merchant

Northwestern University Feinberg School of Medicine, Chicago, IL, USA

In early March 2020, medical students at Northwestern, Loyola, Rush, the University of Illinois at Chicago, and Rosalind Franklin/Chicago Medical School watched our friends, mentors, teachers, and colleagues work on the COVID19 frontlines without adequate personal protective equipment (PPE). Doing nothing was not an option.

Though we had never met in person, and attended different schools, we immediately recognized the importance of uniting our efforts. Together, we formed an organization (”GetMePPEChicago”), and devised a strategy to help our colleagues on the frontlines.

We are proud to say that this leadership team was made of 75% women.

We fundraised to purchase PPE, created our own makeshift PPE from appropriately sourced materials, and recruited more than 300 medical student/pre-med volunteers, who made thousands of calls to businesses who used or sold personal protective equipment. Overall, we succeeded in donating almost 1 million units of PPE to healthcare workers in the Chicagoland area.

While the COVID19 pandemic has not ended, PPE has become more plentiful in our communities and hospitals. Therefore, we now have the opportunity to reflect back on what this experience in leadership taught us as women trainees in medicine:

Lesson #1: Break out of our silos. We get farther together.

Our most valuable takeaway from this experience is that you always get farther together. We were supported by key faculty mentors who served as a sounding board for both small and large decisions throughout this process. We received grant funding because we put ourselves out there and asked for it, and became a sponsored non-profit because we advocated for ourselves and uplifted our work.

Lesson #2: Uplift and utilize the skills and knowledge of those around you.

Nobody on our team was an expert in the field of logistics, shipping, the science of personal protective equipment design, the ethical distribution of a scarce resource, or nonprofit management. That being said, as medical students, we did exactly what we have been trained to do: find a knowledgeable individual who is willing to help. Our team went out of our way to find experts to learn from. People were very willing to donate their time and expertise to a genuine cause.

Lesson #3: COVID did not create new social ills, it simply spotlighted and exacerbated existing inequity.

The pandemic is not the reason why our colleagues at community hospitals were wearing garbage bags in the ICU. The healthcare system was in danger long before this pandemic, putting profits over people and patients, and will continue to be without drastic change. Additionally, we observed in Chicago how the majority of deaths were in predominantly Black and Hispanic communities. The virus did not have a predilection for these individuals based on their race or ethnicity, the virus had a predilection for individuals who have been oppressed on the basis of their race or ethnicity.

Lesson #4: Trying to fix everything means you will achieve nothing.

When there are as many intersecting crises as we experienced in the early days of the pandemic, it's easy to feel paralyzed. We observed other groups attempt bigger challenges on a wider scale, and ended up making a smaller difference overall because the efforts were so scattered. Staying focused on a specific, attainable goal allowed us to make a real difference in our community.

To close, we encourage other women trainees in leadership to have no fear in asking for favors that benefit others. We encourage academic institutions to support and uplift those trainee leaders who put in work to care for their communities. Finally, as a society, we need to stop leaning on heroes and instead build reliable public health systems.

  Inspirational Perspective Number 32 Top

Women in Surgery Symposium

Isabela Amêndola

Marilia Medical School, Marilia, Brazil

Throughout history, the female presence in medicine has had a path riddled with struggles and challenges to overcome.[1] In Brazil, women were not allowed to attend medical school until 1879, albeit in separate places which were set aside for them.[2]

Currently, despite the majority of medical students being represented by women and also no longer being forced to sit in separate places, as in the time of the empire, discrimination remains based on gender.[3],[4]

The same studies which exhibit the rising feminization of medicine also disclose that women still experience significant negative impacts, resulting from sexist stereotypes and gender discrimination.[5],[6]

The fact remains that there is an over-representation of men in some medical specialties, such as general surgery, and that women still must deal with inequalities regarding wages and opportunities.[3],[7],[8]

Towards this regrettable reality, the Surgery Interest Group, of which I am part of, decided to promote a symposium named “Women in Surgery”. Our goal was to promote discussion about barriers which linger as obstacles to the achievement of equality between women and men. In addition, we aimed to address issues that hinder the female presence in the surgical field.

We invited two female surgeons and one female surgery resident to share their daily experiences regarding what they do to deal with different forms of discrimination in their professional practice. They emphasized the importance of raising awareness about gender inequality so that changes can be proposed to achieve gender equality in the medical field.

Furthermore, they supplied their contact information to all participants who were predominantly composed of female students from throughout the undergraduate medical program. The objective was to create a network of people who could mutually strengthen each other, continuing the pursuit to build an equitable society.

All of this experience related to organizing and participating in the symposium was greatly significant to me. I realized that unity between women is extremely essential for achieving gender equality, especially in the surgical field.

Among the speakers of the event and the first medical students in Brazil, a common feature that I have noticed within them was perseverance. These women, among so many other courageous female doctors who made history, serve as an inspiration and encouragement to me.

Yes! Surgery definitely is a place for women! I am certain of it.

Do I see myself giving up? Never.

Do I see myself standing firm with perseverance? Always. Striving for gender equality.

  References Top

  1. Troyo A, González-Sequeira MP, Aguirre-Salazar M, Cambronero-Ortíz I, Chaves-González LE, Mejías-Alpízar MJ, et al. Acknowledging extraordinary women in the history of medical entomology. Parasit Vectors 2022;15:114.
  2. Chamber of Deputies. Decree No. 7247, of April 19, 1879. Reforms Primary and Secondary Education in the Municipality of the Court and Higher Throughout the Empire. Brazil: Collection of Laws the Empire of Brazil Rio de Janeiro (RJ); 1879. p. 196. Available from: https://www2.camara.leg.br/legin/fed/decret/1824-1899/decreto-7247-19-abril-1879-547933-publicacaooriginal-62862-pe.html. [Last accessed on 2022 Jun 10].
  3. Scheffer MC, Cassenote AF. The feminization of medicine in Brazil. Rev Bioét 2013;21:268-77.
  4. Genç I, Arda K. What can we say about gender discrimination in medicine? A limited research from Turkey. Ankara University Faculty of Medicine Journal. 2010;63:1-8.
  5. Álvila RC. Women and medical schools. Rev Bras Educ Méd 2014;38:142-9.
  6. Mainardi GM, Cassenote AJ, Guilloux AG, Miotto BA, Scheffer MC. What explains wage differences between male and female Brazilian physicians? A cross-sectional nationwide study. BMJ Open 2019;9:e023811.
  7. Lo Sasso AT, Richards MR, Chou CF, Gerber SE. The $16,819 pay gap for newly trained physicians: The unexplained trend of men earning more than women. Health Aff (Millwood) 2011;30:193-201.
  8. Jagsi R, Griffith KA, Stewart A, Sambuco D, DeCastro R, Ubel PA. Gender differences in the salaries of physician researchers. JAMA 2012;307:2410-7.

  Inspirational Perspective Number 37 Top

Women in Ophthalmology

Joanne Thomas1, Yvonne Nguyen2, Divya Lagisetti1, Amy Estes3

1Departments of Medicine and 3Ophthalmology, Medical College of Georgia, Augusta, 2Department of Medicine, Mercer University School of Medicine, Macon, GA, USA

In 2019, the field of ophthalmology had only 26.7% female physicians, but the majority of medical students are now females per the Association of American Medical Colleges (AAMC) report in 2020.[1] In recent years, more women in ophthalmology have taken to the podium and served as leaders at national meetings. Many have publicly shared their experiences of having work life fit as surgeons and mothers - all while advocating for female trainees coming up in the ranks. However, despite advancements, there are still disparities in the profession that can be addressed to further increase equity.

Although women have gained more representation within ophthalmology over the past few decades, a gender gap in earnings persists even after controlling for part-time work, practice profile, and subspecialty. Data from 2016 found that in the United States, ophthalmology has one of the largest gender pay gaps of all specialties, with men reportedly earning 36% more than women.[2] Data from 2020 showed that women ophthalmologists earn 12.5% less than men in the first year of clinical practice, and this income gap is also observed within women working in academics and salaried positions. Furthermore, women have fewer opportunities to have the equal amount of training as their male counterparts. A retrospective study from July 2005 to June 2017 of United States ophthalmology residents showed that female residents performed 7.8 to 22.2 fewer cataracts and 36.0 to 80.2 fewer total procedures compared to male residents.[3] This study did factor in maternal leave, and similar numbers of operations were seen between women who took leave and those who did not. While this is a limited study with only 20% of programs included, further investigation of root causes is needed.

Additionally, a recent article analyzing gender-based differences in Medicare reimbursements in the field showed that women billed for a lower number of services and received less reimbursement with disparities persisting even when controlling for physician and practice characteristics.[4] While there are many factors contributing to this including women spending more time with patients and disparities in representation within higher-paying ophthalmology specialties, this is an important issue that needs to be addressed.

When we look at female representation within authorship in research articles and journals, the disparities have decreased over time especially for first authorship, but studies indicate that a sex-specific gap exists for senior authorship.[5] Additionally, a recent study in JAMA Ophthalmology showed that while the proportion of senior authors have increased, female authors are only 25.5% of all editorialists and more commonly first rather than senior author.[6] This is important to note as senior authorship is a factor that is often important for academic promotion. While some prominent ophthalmology departments are chaired by women, the numbers seen are not representative of the proportion of women in the field. Similarly, while there are more women speakers at conferences, there are fewer in non-paper roles (moderators and symposium presenters), which usually require an invitation.[7] Women are also underrepresented as award recipients in major ophthalmology societies despite an increase in females in the field.[8] While women are playing a bigger role in authorship and conferences than ever before, the disparities continue to exist, especially in areas that play a vital role in academic promotion.

This amalgamation of information further exhibits a need to improve equity in the field of ophthalmology, but how can we do that? One of the most impactful ways to lead to women's success in this field is through collective efforts. Mentorship allows us to learn and engage with the diverse and vibrant individuals in the field, broadening our horizons and network. Additionally, there is a need for sponsorship, which goes beyond providing guidance to amplifying and connecting others. As women gain access to the podium or leadership positions, they have pulled up other females in the field in acts of sponsorship. We know personally that we have been impacted by both female and male sponsors who have encouraged and named us for various opportunities in the field. Ophthalmology has seen the need to address the disparities. This has led to the development of targeted resources to increase both women entering the field and women accessing leadership opportunities. A few of the resources are listed below:


  References Top

  1. Association of American Medical Colleges. Active Physicians by Sex and Specialty. AAMC; 2019. Available from: https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-sex-and-specialty-2019. [Last accessed on 2022 Jun 14].
  2. Gill HK, Niederer RL, Shriver EM, Gordon LK, Coleman AL, Danesh-Meyer HV. An eye on gender equality: A review of the evolving role and representation of women in ophthalmology. Am J Ophthalmol 2022;236:232-40.
  3. Gong D, Winn BJ, Beal CJ, Blomquist PH, Chen RW, Culican SM, et al. Gender differences in case volume among ophthalmology residents. JAMA Ophthalmol 2019;137:1015-20.
  4. Halawa OA, Sekimitsu S, Boland MV, Zebardast N. Sex-based differences in Medicare reimbursements among ophthalmologists persist across time. Ophthalmology 2022;129:1056-63.
  5. Kramer PW, Kohnen T, Groneberg DA, Bendels MH. Sex disparities in ophthalmic research: A descriptive bibliometric study on scientific authorships. JAMA Ophthalmol 2019;137:1223-31.
  6. Fathy CA, Cherkas E, Shields CN, Syed ZA, Haller JA, Zhang QE, et al. Female editorial authorship trends in high-impact ophthalmology journals. JAMA Ophthalmol 2021;139:1071-8.
  7. Patel SH, Truong T, Tsui I, Moon JY, Rosenberg JB. Gender of presenters at ophthalmology conferences between 2015 and 2017. Am J Ophthalmol 2020;213:120-4.
  8. Nguyen AX, Ratan S, Biyani A, Trinh XV, Saleh S, Sun Y, et al. Gender of award recipients in major ophthalmology societies. Am J Ophthalmol 2021;231:120-33.

  Inspirational Perspective Number 38 Top

Beyond Mentorship As We Know It

Anjali Gupta

Department of Psychiatry, Georgetown University Medical School, Washington, DC, USA

Amazing mentors come to mind as I reflect on my journey. In medical school, whether I was rotating through Internal Medicine or Vascular Surgery, the residents and attendings taught me skills, knowledge, and the humanistic elements of being a physician. They modeled the importance of taking time to be empathic, explain thoroughly, and listen mindfully to patients amidst downward trending white blood cell counts and exploding differential diagnoses. As I progressed forward into residency, my attendings signaled a strong belief in me, fueling my curiosity and desire to keep learning and trying new things. As a new faculty member one year out of residency, my mentor asked me to be her Associate Residency Training Director. I was surrounded by opportunities to lead and potential opportunities to publish...incredible mentorship and sponsorship in the traditional sense.

Yet the mentorship and sponsorship that stands out in my journey is a more non-traditional type.

Value Your Personal Life

At the end of my PGY-2 year, my fiancē had the opportunity to start a consulting office abroad. Having already done long distance for two years, I was conflicted on how to blend my personal and professional journey on this path forward. He should take this opportunity yet I was a resident amidst a program I loved. How would I give up my spot? Would I be messaging that my career was not important to me? Dr. Y's mentorship was unpredictable and life-changing. As I sat in her office perplexed, she told me,”I think you know you need to go.” Then as if she had read my mind (How could I?) she followed up with, “I will save you your PGY-3 spot to return to next July.” Surpassing any traditional training director rules of mentorship, she modeled for me that it was alright to give importance to my personal life in the context of my professional one, a theme that can be a struggle at all ages.

Embrace Your Unique Path

As an early career physician in the 2000's, I decided to leave the academic world I loved to raise my children. Though it was something I chose, stepping out of the white coat identity I had worn since my teenage years in an accelerated medical program was much harder than I thought it would be. I had no mentors, no roadmap, no example of how to do this. Upon re-entry years later, I came back timidly, unsure of how I would tell my non-linear story. The first person I met with was Dr. K. She agreed to meet with me, having no idea who I was or what my story was. I explained my path and told her about the research I wanted to do. She moved forward with authentic excitement for my project, names of people I should connect with…completely unphased in her professorial cloak of mentorship by my non-linear route. My story was not a typical one in the halls of academia yet she treated me as if I had never left, as if my career break was inconsequential to the matters at hand.

Always Believe

Dr. E had been one of my formative mentors as a Chief Resident of Consultation-Liaison Psychiatry, but I had lost touch with him over the years. During the pandemic, I called him as I was contemplating where I wanted to spend my time and how I wanted to make an impact. His warmth and immediate comfort level despite all the years passed made me wish I had kept in touch. I felt a visceral sense of the responsibility a mentee has to the mentorship relationship. Dr. E looked into the Zoom screen and said to me with unwavering conviction, “This is not about what you can do. This is about what you want to do. Decide what that is and go for it. I know you, and you will get there.” Those sentences were exactly what I needed to take steps forward on my research. If Dr. E could believe in me years later, surely I could believe in myself and my path ahead.

Female physicians are less likely to be mentored than their male peers despite the benefits: enhanced support, productivity, growth, career advancement, career satisfaction, and networking for mentees. Beyond the explicit, mentors impart important implicit messages as well. At critical points in my life, the guidance I received was beyond publications and advancement yet crucial nonetheless in my journey: value your personal life, embrace your unique path, and always believe.

  Inspirational Perspective Number 40 Top

Breaking Barriers as a First Generation Latina Mother in Medicine

Kryztal Pena

Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA

My dream of becoming a physician, like many, started as a young child. I would play pretend doctor with my twin sister and cousin. In school I grew a passion for learning about science and health. Simultaneously, my family struggled to afford health care only seeking help during emergencies. As I made my way through college I learned that I could help bridge these gaps in our healthcare system, that I had experienced, by becoming a physician. However, I had to overcome many obstacles to even prepare myself to apply to medical school.

During college I struggled to keep my grades up while my mom was battling stage 2 breast cancer and my family was going through a divorce. I was scared of losing my mom but somehow had to put myself together to attend my classes, complete homework and study for tests. I continued to feel as if my life were falling apart as I lost childhood friends due to gang violence. I remember crying because I was so overwhelmed with all the personal issues I was facing and then having to wipe my tears, run to the bus so I could make it in time for my 9 am. After 4.5 long years I graduated with my bachelors making me the first in my family to have a Bachelor's degree.

Along with my dreams of one day becoming a doctor I had dreams of becoming a mother. However, I was told it was very difficult to be a mother in medicine. I would hear stories about how women were questioned in residency interviews on when they were planning on having children as if it were a limitation. I didn't want to ruin my chances of getting into medical school but I also knew I didn't want to surrender my dream of being a mother. I decided during my gap years I could start my family and then apply into medical school. I was ecstatic when I found out I was pregnant; unfortunately, a few weeks later I found myself bleeding in the bathroom. I was heartbroken that something so beautiful turned into such a nightmare. I pushed myself to get over it. I continued studying for the MCAT and working because life doesn't stop. A few months later I found out I was expecting again and again I was excited and nervous. This time around my pregnancy went much smoother and I continued to study and work as a medical assistant. I transitioned into a different role as a research coordinator and had the opportunity to work from home. I continued to work and study up until the day I delivered my baby. I gave myself a two week break from studying before I started up again.

My mornings consisted of pumping milk before leaving my 2 week old baby so I could go study and then coming back in the afternoon to try and rest before doing it all again. Sometimes my husband couldn't stay with the baby so I would pack up our things, put him in the carrier and walk over to our local coffee shop. It was frustrating to put all this effort and barely see improvements in my practice MCAT scores. I kept pushing through. I have my MCAT scheduled for the end of June and have been preparing my materials to apply this cycle for medical school. Studying for the MCAT while pregnant and after giving birth was a huge challenge but it goes to show how strong women can be. Although I don't know how everything will turn out I am hopeful because I have given it my all.

Being a first generation Latina pursuing a career in medicine has already had its challenges and becoming a mother has added more challenges but I wouldn't have it any other way. I created a perfect little human and I get the pleasure of pursuing my dream career. To all the women that would like to become mothers but are scared of the challenges it may bring, remember you are warriors capable of anything and everything. Becoming a mother is not a limitation and if anything it makes us stronger because we now have little bundles of joy that help motivate us through this long difficult career. Women in medicine are superheroes!

  Inspirational Perspective Number 46 Top

Unpaid Work is a “We” Problem

Zeest Khan1, Kristi Rible2

1The Remedy Executive Coaching Group, 2The Huuman Group, San Francisco, USA

As we look to solve gender inequity in medicine, a key factor has little connection to the actual practice of medicine. Instead, it lies in the highly valuable, but unpaid, work physicians do at home. And no, we don't mean charting. Among heterosexual couples in the US, the burden of domestic responsibilities in dual income households (namely household work and caregiving) continues to fall overwhelmingly on women.[1] Until this imbalance improves, we risk losing good doctors in droves. As two women from disparate backgrounds, a cardiothoracic anesthesiologist and global leadership consultant, we'll illustrate how unpaid domestic labor affects women physicians, how the field of medicine compares to global organizations facing the same gendered issues, and how the fair division of household labor could help save the field of medicine.

Exploring solutions for gender parity is integral to what we, the authors, do professionally. Zeest has practiced high-acuity medicine for ten years, has held positions as division chief and administrator and is also a physician coach; her clients include women clinicians, academic leaders, and healthcare executives. Kristi pivoted her international career to focus on workplace equity and women's advancement. Today, she is founder of The Huuman Group, a leadership consultancy focused on humanizing the workplace and also teaches a course at Stanford titled “Motherhood and Work”. While our clients come from diverse backgrounds, we see significant similarities in industry-wide obstacles. Plain and simple, gender-based imbalances at home impact career trajectories. So, in order to attract and retain more doctors, medicine must acknowledge that our lives outside of work are also complex and our systems and structures must adapt to better support medical professionals.

Many of our women clients, in medicine and out, have a shared narrative that goes something like this: “I worked so hard to build my career success and when we had children everything changed. I felt penalized for taking maternity leave and guilty for not being available to work. My husband got only a few days off so, by default, I was doing all the work at home. Over time this turned into managing childcare, meals, dentist appointments, birthdays and more. I became the de facto manager of all unpaid home and care work. I feel like I'm not succeeding at work nor at home. For a self-proclaimed egalitarian couple, how did we get here?”

Our clients often feel if only they can better organize their schedule, work a little harder or a little longer, they can achieve work-life balance. This idea reflects a philosophy of self-reliance that, while having served her well in medical training and early practice, is now harmful. The expectation that a woman be present and available to her family while showing up to work as if she didn't have one is the legacy of outdated gendered beliefs around what it means to be a good mother and a good worker. Consequently, women often feel in conflict between “family-devotion” and “work-devotion.”[2] This puts the bar impossibly high and leads to a silent suffering that is unsustainable, leading to extreme burnout or reduction in work hours.[3] Although women have been led to believe that this is a “me problem,” it is in fact a collective “we problem”.

If we are going to achieve gender equity in the field of medicine, we must explore solutions that value the complexity of our real lives and open up pathways to achieve it at home. We need to have hard conversations about re-shifting the balance of caregiving and unpaid work and normalize a construct in which men share in this work. Outside of medicine, we see momentum in this dialogue within organizations. The pandemic laid bare the inequities of unpaid work - a key contributor to “the great resignation”[4] - and suffering industries are restructuring work to attract and retain skilled women. We see momentum around paid family leave for both birthing and non-birthing parents and flexible work cultures that allow feasible childcare options to support dual working households; these households are the norm, not the exception. We are in the midst of a physician shortage that is likely to worsen[5] and the gendered imbalance of household responsibilities contributes to this shortage. Modifying workflow and culture in a field like medicine, which is steeped in tradition and comprises various business models and payor systems, is not easy. However, if we don't begin to address these issues loudly we will continue to suffer in silence and the gender inequity in medicine will continue to widen.

  References Top

  1. Charmes J. The Unpaid Care Work and the Labour Market. An Analysis of Time Use Data Based on the Latest World Compilation of Time-Use Surveys. The Unpaid Care Work and the Labour Market. An Analysis of Time Use Data Based on the Latest World Compilation of Time-use Surveys. International Labour Organization, Geneva, Swizerland; 2019. Available from: https://www.ilo.org/gender/Informationresources/Publications/WCMS_732791/lang--en/index.htm. [Last accessed on 2022 Nov 13].
  2. Collins C. Making Motherhood Work: How Women Manage Careers and Caregiving. Princeton, New Jersey: Princeton University Press; 2020.
  3. 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.
  4. Huang J, Krivkovich A, Rambachan I, Yee L. For Mothers in the Workplace, A Year (and counting) Like No Other. McKinsey & Company. McKinsey & Company; 2022. Available from: https://www.mckinsey.com/featured-insights/diversity-and-inclusion/for-mothers-in-the-workplace-a-year-and-counting-like-no-other. [Last accessed on 2022 Nov 13].
  5. The Complexities of Physician Supply and Demand: Projections from 2019 to 2034. AAMC. Available from: https://www.aamc.org/data-reports/workforce/data/complexities-physician-supply-and-demand-projections-2019-2034. [Last accessed on 2022 Nov 13].

  Inspirational Perspective Number 47 Top

Realigning With Purpose: How Being A #WomenInMedicine Can Help Combat Imposter Syndrome

Mysa Abdelrahman1

1Department of Medicine, St. George's University School of Medicine, True Blue, Grenada

”Each time I write a book, every time I face that yellow pad, the challenge is so great… I have written eleven books, but each time I think, 'Uh oh, they're going to find out now. I've run a game on everybody and they're going to find me out.”

-Maya Angelou

Imposter syndrome is defined as the persistent inability to believe that one's success is deserved. It is the doubting of one's own skillset and achievements because of a fear of being exposed as seemingly underqualified, despite earning your place through hard work and grit.

The idea that individuals who are accomplished, intelligent, and capable, still feel as though they are fooling people, begs the question, what can be done to combat this growing endemic within our academic and intellectual spaces?

The #WomenInMedicine community serves to empower, uplift, and support men and women alike, as they navigate the varying nuances that come with the field of medicine. Outlined below are some ways to mitigate the feelings of imposter syndrome I've learned through my time with #WomenInMedicine.

  1. Turn to your support networks for guidance:

  2. The most accomplished people in the world have at some point or another experienced a setback. The #WomenInMedicine community serves as an avenue to navigate the cognitive dissonance that arises when feelings of imposter syndrome set in. Varying doctors in their fields challenge the notion of perfection and share their vulnerabilities, paving the way for those behind them to do the same. Self-doubt can keep us from seeing ourselves clearly. It can prompt us to downplay our accomplishments and underestimate our skills; and can cost us in terms of our mental health and our willingness to take on new challenges. Having a network of physician's help challenge these systems, inspires growth to those who follow.

  3. Find growth in experiences you may dislike:

  4. Dr. Pamela Kunz, a fellow #WomenInMedicine, once described her mid-career awakening, dealing with a toxic work environment. She took pause in search of equanimity after “experiencing regular gender discrimination and harassment, mostly in the form of microaggressions.” Dr. Kunz, recalls being told by her male counterparts that her “physical appearance helped me to get speaking opportunities,” leaving her “alone, demoralized, and stripped of my self-confidence and, worse, was made to feel that I was at fault.” Though unfortunate, these experiences shed light on how Dr. Kunz strives to dismantle disparities within the medical community, her growth through an uncomfortable situation has since enabled her to advocate for women in the field, allowing her to flourish in the profession she loves.

  5. Know that what's meant for you won't pass you by

  6. Accept rejection as redirection and celebrate the moments that built you up to get you where you are. Having a bit of self-doubt catalyzes us to make necessary changes towards our goals, however, this same fear in excess may paralyze us, stunting any growth that may come. Understanding this delicate balancing act can help us reframe how we approach our understanding of imposter syndrome and look at any detour as an impetus toward unforeseen success.

  7. Show the same kindness to yourself as you do others

We must take a step back and extend the same grace we do to others, to ourselves. We would never imagine aiming the type of scrutiny and self-criticism we cast on ourselves onto others, therefore it is important to moderate the harshness of our inner critic. Find reasons to celebrate your wins and noteworthy achievements. In a world where the odds are seemingly stacked against our favor, the only logical move is to reverse the hand we were dealt, beginning with reclaiming our narrative.

The next time you notice imposter syndrome creeping in, understand that the microaggressions, the trauma, the stereotypes, and the bigotry that followed you to where you are, is not a reflection of yourself, but rather a merit of how far you've come and will continue to go. The #WomenInMedicine summit engenders doctors and healthcare professionals of all backgrounds to challenge their perceptions of “What If,” by consciously shifting the paradigm of imposter syndrome from something crippling into something empowering.

  Inspirational Perspective Number 50 Top

The Women Who Came Before Me

Aarti Kamat

Department of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, USA

My mother's face is a near-perfect replica of her mother's. Mine is a replica of both. I always thought that's where the similarities ended. Both them are strong, feisty, loud, and unafraid to speak their minds. Growing up, I was always the timid, introverted one. Somehow, their fiery personalities had skipped a generation. When I graduated from medical school and started pediatric residency, I decided it was time to come out of my shell and work on my self-confidence if I was expected to care for other people's children. Now, as a pediatric hematology/oncology fellow, I feel I have made major strides in that area but still do encounter moments of self-doubt. When this happens, I channel my mother and grandmother and reflect on their inspirational life journeys.

My mother moved to the United States from India by herself to complete her PhD when she was in her early twenties. At the time, in India, a single woman leaving her family and moving to a different country was unheard of, but my mom knew what she wanted and went after it, regardless of public opinion. Eventually, she worked her way up and became the PI of her own lab. Ultimately, in order to raise us, she sacrificed her promising career when my brother and I were born. While we were in middle school, she was diagnosed with breast cancer, enduring multiple surgeries, medications, and radiation therapy. She eventually won her battle with breast cancer, never allowing her spirit to be broken.

After 12 years of being out of academia, inspired by her bout with cancer and unsatisfied to remain sitting on the sidelines, she decided it was time to go back to work. At first it was difficult; no one wanted to hire someone who had been out of academics for so long. She was undeterred, however, and convinced the graduate school of the local university to hire her part-time. She worked her way through the ranks, and eventually, in a field where only a quarter of graduate school deans at research institutions are female, this immigrant, cancer survivor, and mother of twins came bursting back on to the workforce. She became dean of two large research institutions, in addition to establishing and heading an MD/ PhD combined program.

My mother clearly inherited her fighting spirit from my grandmother, my Nani. She was married by the age of 13 and a mother of 4 by 22. At that time in India, no one had heard of feminism or women's rights. A woman's job was to marry, have children, tend to the household, and keep her opinions to herself. This was not Nani; she never let societal standards get in the way of what she wanted and shattered gender norms to get there. When my grandfather started learning to fly planes, she demanded that he teach her too. Because, if he could do it, why couldn't she? She even piloted an airplane for the Prime Minister of India at the time, Jawaharlal Nehru, after he caught wind of this mythical female pilot. Despite only completing a middle school education, she never lost her zest for learning. She worked so hard to learn English in order to communicate with her grandchildren. She didn't let us speak to her in her native tongue so she could practice. While we lost Nani years ago, the story of how she chased a tiger out of her house with only a rolling pin lives on.

Whenever I feel self-doubt creeping in, I think back to all that these two amazing women endured and accomplished. I know I have two generations of fierce, trailblazing women supporting me. Neither woman let societal expectations or gender norms hold them back. I am lucky to be living in a time when gender equality, especially in medicine, is being increasingly discussed. With all the privileges and freedoms they never had, I hope to make my mom and Nani proud.

  Inspirational Perspective Number 58 Top

Reckoning with Recognition Inequity - Approaches for Incorporating Micro-Recognition

Kristina Krohn1, Beth Thielen2, Jessica Hane1, Caitlin Bakker3, Katelyn Tessier4, Sophia Gladding1, Elizabeth Rogers5, Michael Pitt6, Taj Mustapha7

1Division of Hospital Medicine, Department of Internal Medicine and Pediatric Hospital Medicine, Department of Pediatrics, 2Division of Pediatric Infectious Diseases, Department of Pediatrics, 3Discovery Technologies Librarian, University of Regina, 4Biostatistics Core, Masonic Cancer Center, University of Minnesota, 5Division of Geriatrics, Palliative and Primary Care, Department of Internal Medicine,6Pediatric Hospital Medicine, Department of Pediatrics, 7Division of Hospital Medicine, Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, USA

There are significant disparities in the promotion and retention of women in leadership roles in academic medicine. Improving the equity of recognition may help as recognition serves two fundamental roles: (1) demonstrating a national reputation is essential for promotion and (2) recognition may foster inclusion by affirming that an individual's work aligns with institutional values, which may improve retention. Improving “macro” level recognition requires structural changes in resource allocation and addressing bias in the promotion, hiring, and awards processes. However, there are smaller scale, often less regulated means of providing encouragement for good work, such as emails, newsletters or blogs, which we call micro-recognition. These micro-recognitions still contribute to reputation, opening doors to speaking invitations and collaborative research. When micro-recognitions are provided in an ad hoc manner, women receive fewer micro-recognitions than men for similar work. Many men reached out to leaders in manners consistent with traditional gender norms. Women, on the other hand, may suffer social consequences for similar self-promotion due to role incongruity. Creating systematic means for providing micro-recognition may be a worthy micro-intervention. The Pediatric Department of the University of Minnesota implemented two systems that provide micro-recognition in 2015, a newsletter and a web-based platform where faculty log their scholarship and can view others' accomplishments. These systems provided equitable micro-recognition. We hope to encourage others to identify areas where societal expectations prevent members of specific groups from fully participating and being fully recognized in academic medicine and intervene through both macro and micro interventions, including improving micro-recognition.

  Inspirational Perspective Number 60 Top

Time to Pump? Support for Lactating Providers

Kathleen Lane1, Adriana Dhawan2, Elizabeth Rogers3, Mary Logeais3, Carolyn Bramante4, Molly Wyman1, Taj Mustapha5, Brian Muythyala6, Michael Sundberg1, Briar Duffy1, Timothy Roach1, Kristina Krohn7

1Division of Hospital Medicine, 2Division of Hospital Medicine, Division of Pediatric Hospital Medicine, 3Division of Geriatrics, Palliative and Primary Care, Department of Internal Medicine, 4Division of Geriatrics, Palliative, and Primary Care, Program in Health Disparities Research, Department of Pediatrics, Center for Pediatric Obesity Medicine,5Division of Hospital Medicine, Department of Internal Medicine, 6Division of General Internal Medicine, 7Division of Hospital Medicine, Department of Internal Medicine and Pediatric Hospital Medicine, Department of Pediatrics

Lactation occurs during a critical period in one's life – after the birth or adoption of a child. This time is often stressful, highly emotional, and fraught with change. In an attempt to understand the experience of physicians who were breast/chest feeding and pumping at work, we reached out to providers to ask about their experiences and incorporated themes to create recommendations for our hospitalist group. These intimate accounts reflect the impact this period has on one's career trajectory and how the system's response affects the health and wellbeing of providers and their families. Inadequate support on an interpersonal and institutional level leads to exclusion, and inequitable circumstances whose impacts are felt long after lactation ends. Supporting lactating providers through this inherently stressful time at work has the potential to greatly improve how welcomed, included, and valued they feel at work. These stories and a brief review of relevant literature led to the implementation of new guidelines in our facility. Therefore, addressing the structural and belonging aspects during this transition time in a provider's life has the potential to have a greater impact on their career than interventions aimed at other times. In addition to sharing some of the provider's stories and the recommendations that stemmed from these experiences, we have shared our updated practices to other area hospitals.

Our recommendations fell into 3 categories: time, space, and equipment. Minnesota enacted a new law stating that all lactating employees need appropriate break times to pump and cannot have increased work at the end of the day or decreases in pay to ensure adequate pumping time. This resulted in multiple hospital groups in the area revisiting their practices. The new law primarily addresses the time and financial implications of pumping breaks, but logistical barriers remained. For clinicians we needed to specifically consider space in close proximity to patient care that allows provider privacy, a space to clean pump parts, a fridge for storing milk, and access to a computer and telephone in case providers want to/are able to continue to work while pumping. In addition, providers juggle erratic schedules and the need to be available to respond to pages in a timely fashion. Therefore, our guidelines for hospitalists accommodations included reprieve from night shifts for the first 6 months back at work with a new child and being scheduled on services where someone else could cover the pager during pump breaks. Importantly, we also schedule the provider on a service with a census cap of 2 fewer patients to ensure that they get adequate break time during the day without needing to stay later in the day to get work done which echoes another recent guideline in our department where outpatient providers receive an RVU generating block in their clinic for two appointments per full day of work to achieve adequate break time.

We now have stories from current providers who have experienced the new structure and would like to share our experience with others. Through this work we hope to better support lactating providers in hospital medicine and other disciplines to promote inclusion and tangible systemic structures that value individualized career and family balance.

  Inspirational Perspective Number 66 Top

Cervical Cancer: A Public Health Crisis With a Heightened Prevalence Correlated to Global Misogyny

Gina Noguera, Riddhimaa Sinha

Women's Health Institute, Rutgers University, New Brunswick, NJ, USA

Unprotected sexual activity can lead to sexually transmitted infections (STIs). Human papillomavirus (HPV) is classified as one of the most common STIs in the world. Incidentally, HPV vaccines can be successful in protecting vaccinated individuals against 90% of HPV-induced cancers. Despite this, there lies a gap in the administration of this vaccine in countries across the globe, and there is even a discrepancy between which sex is the vaccine is administered to. We conducted a literature based exploration of how the global standards of sexual education curriculum can often lack adequate information regarding feminine sexual health. This, as a result, can be correlated with low vaccination rates and high cases of sexually transmitted diseases, specifically HPV. Globally, there is a lack in prioritization of women's health and promotion of policies to vaccinate young children and lack of information about HPV-related ailments directly contributes to cervical cancer mortality rates, which is the fourth most common cancer in women globally. We also explore how the feminization of HPV has contributed to the poor regulation and administration of this vital vaccine. Since the main risk of HPV is cervical cancer development, there is a universal lack of urgency and pressure to eradicate HPV as it is a primarily woman-based consequence. Global sexism puts the health and safety of women on the back-burner and focuses mainly on other health conditions that affect men greater than or equal to women. The goal of this discussion is two fold: Firstly, we hope to shed light on the rise of this avoidable gynecological epidemic caused by an inherent lack of education and preventative measures that prevail due to gender inequality and lack of focus on female health disorders. Secondly, we wish to emphasize how organizations like the World Health Organization can both mandate comprehensive sexual education and implement a global policy that either necessitates comprehensive sexual education (CSE) or vaccine drives (like COVID-19 vaccines).

  References Top

  1. Daley EM, Vamos CA, Thompson EL, Zimet GD, Rosberger Z, Merrell L, et al. The feminization of HPV: How science, politics, economics and gender norms shaped U.S. HPV vaccine implementation. Papillomavirus Res 2017;3:142-8.
  2. Chawhanda C, Ojifinni O. Comprehensive sexuality education in six Southern African countries: Perspectives from learners and teachers. Afr J Reprod Health 2022;25:3. Available from: https://www.academia.edu/50942621/Comprehensive_sexuality_education_in_six_Southern_African_Countries_Perspectives_from_learners_and_teachers. [Last accessed on 2022 Nov 13].
  3. De Vuyst H, Alemany L, Lacey C, Chibwesha CJ, Sahasrabuddhe V, Banura C, et al. The burden of human papillomavirus infections and related diseases in Sub-Saharan Africa. Vaccine 2013;31 Suppl 5:F32-46.

  Inspirational Perspective Number 74 Top

Walking Away

Sital Bhargava1

1Direct Family Med, New Lenox, IL, USA

In May of 2002, I walked across a stage holding a diploma marking the conclusion of medical school and the beginning of my lifelong career. After four years of countless exams, short lab coats (with papers and books spilling out of the frayed pockets), and scut work, I was ready to enter residency and be a doctor. Twenty years have passed, and I now have three teenage children, two dogs and one supportive husband. I have completed a faculty development fellowship, a primary care research fellowship and a masters in epidemiology. I have taught residents and medical students, started my own practice, and navigated the healthcare system through a pandemic. I have been reprimanded for mistakes and in turn have berated others for their shortcomings (something I truly regret). I have cried with patients, fired a few patients, hugged many patients all the while striving for perfection.

Medicine is a tough profession. Doctors are not perfect and yet we are often penalized for our imperfections. Patients expect us to fix them and if we don't, a cloud of failure looms above us. Whether it is in Press Gainey scores, Yelp reviews, or more commonly in the conversations that take place in exam rooms we make every attempt to be faultless. In the House of God, Samuel Shem says: “The main source of illness in this world is the doctor's own illness: his compulsion to try to cure and his fraudulent belief that he can.”

Are we as doctors setting ourselves up for failure? Perfectionism is a personality trait that has been linked to depression. A recent study found a significant link between perfectionism and suicidal behavior through the fear of humiliation.[1] Studies have also showed perfectionism is more commonly found in females.[2] And when these females choose a profession that reveres flawlessness then we are bound to see higher rates of suicide. And in fact, a recent meta-analysis found that women physicians are 46% more likely than their female counterparts in the general population to die by their own hands. In contrast, male physicians are 33% less likely to die by suicide vs men in the general population.[3] It is due to these findings that I am considering laying down my stethoscope after all this time.

When did this happen? It's probably been in the works since I suffered from depression and anxiety as a resident working over 100 hours a week. Sleepless nights, the pressure of holding the fate of lives in my hands and the hazing that comes with residency took its toll. But I continued to walk through the tangled path alongside my colleagues because this is what I had signed up for. Then five years ago, a close friend, a fellow doctor and classmate died from suicide. I wonder how desperate she must have felt in those final moments; how unhappy she must have been and how she was unable to find any options besides the one she chose. I had known she was depressed, and she refused to seek help because she was worried about the repercussions for a female physician.

Studies have shown that women physicians tend to be more empathetic, spend longer with their patients and focus on psychosocial issues more often.[4] Yet over and over women make less money and are promoted less.[5] Is this equity gap responsible for the higher suicide rates; do women physician burn out walking, nay running on a treadmill of perfectionism that goes nowhere? Does the healthcare system fail women physicians by demanding the best while providing less rewards, few safety nets, and more expectations? It most certainly does.

Years of abuse and traumatic encounters have taken their toll on my nervous system, and I am spending more time listening to my body. While leaving medicine may be the right decision for me, I carry a sense of guilt that I am choosing to walk away from the cracked structure. I feel shame that I am leaving my fellow female physician soldiers to face an uphill battle, but I find some comfort in knowing that I can offer to be the wind behind their backs as I focus on the effects of trauma in medicine.

  References Top

  1. Pia T, Galynker I, Schuck A, Sinclair C, Ying G, Calati R. Perfectionism and prospective near-term suicidal thoughts and behaviors: The mediation of fear of humiliation and suicide crisis syndrome. Int J Environ Res Public Health 2020;17:1424. [Doi: 10.3390/ijerph17041424].
  2. Haase AM, Prapavessis H, Glynn Owens R. Domain-specificity in perfectionism: Variations across domains of life. Pers Individ Dif 2013;55:711-5.
  3. Duarte D, El-Hagrassy MM, Couto TC, Gurgel W, Fregni F, Correa H. Male and female physician suicidality: A systematic review and meta-analysis. JAMA Psychiatry 2020;77:587-97.
  4. Surchat C, Carrard V, Gaume J, Berney A, Clair C. Impact of physician empathy on patient outcomes: A gender analysis. Br J Gen Pract 2022;72:e99-107.
  5. Salles A, Awad M, Goldin L, Krus K, Lee JV, Schwabe MT, et al. Estimating implicit and explicit gender bias among health care professionals and surgeons. JAMA Netw Open 2019;2:e196545.

  Inspirational Perspective Number 76 Top

Impact of Coaching on Bringing Health to Medicine

Amelia Bueche

Coaching for Institutions, Traverse City, MI, USA

The ideal practice of medicine nurtures the health of patients. The sustainable ideal practice of medicine nurtures health of patients and physicians. It has been shown that physicians are significantly impacted by burnout, limiting their access to personal health and consequently affecting the care of patients and undermining the stability of the entire health care system. This is happening even at the earliest stages of medical education, continuing into post-graduate training and following physicians into their practice across specialties and sectors.

Coaching has been shown to be an antidote to burnout and can also serve as a potent preventative. Offering tangible tools for physicians at all stages of education, training and practice to take control of their experience, coaching encourages physicians to find their way back to, and can enrich their experience of, personal and professional health.

By creating meaningful resilience with skills developed through coaching, physicians are better able to care for themselves and for patients, to demonstrate health by example and are empowered to apply these principles to their practice.

Over the past two years, Coaching for Institutions and AMWA IGNITE have supported more than 700 participants through a variety of coaching programs with documented improvement in levels of distress, self-reporting on goals including an increased ability to identify and address burnout while finding satisfaction in any situation.

Testimonials following program completion illustrate increased enjoyment at work, sense of belonging with colleagues, efficiency and capacity to keep work at work. The ripple effect of shifting the experience of the practice of medicine from jaded to joyful, dread to delight, pessimistic to purposeful offers an opportunity to positively impact patients, colleagues, family, friends and the broader community.

Coaching is the practice of bringing health to medicine, infusing humanity into every encounter, building connections in the workplace, and reminding physicians of their amazing, unique, inherent capacity for success grounded in peace, ease and a greater capacity to handle a variety of experiences and feelings.

Coaching is the means by which the sustainable ideal practice of medicine that nurtures health of patients and physicians is cultivated.

  Inspirational Perspective Number 80 Top

The Hope That Shines Bright

Julia Morrill1

1Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA

On a sunny day in March 2022, my husband and I welcomed our baby boy into our arms. We named him Charlie.

Charlie was astonishingly perfect. Ten fingers, ten toes. He had my husband's nose, my full cheeks, and a strong frame.

Charlie was also born at 18-week gestational age. I was one week away from my anatomy scan to find out the biological sex of my unborn child, when I entered preterm labor, and delivered my first baby. We counted the special things we wish we could have done with Charlie. Meeting the grandparents, watching him suck on his thumb, celebrating his first birthday. His first bite of ice cream, his first day of school. Having him talk back at us when he's a teenager, watching him going on dates.

We only had hours to live a lifetime with Charlie, but we cherished every moment with him. We made sure he knew just how much we loved him, and how lucky we were to be his parents.

This happened in the midst of my pediatric core clerkship, while I helped my residents and attendings take care of sick children and families. After the loss, I took a week off to cope with a postpartum body without a baby in my arms. I managed to stay afloat in the ocean of grief, but every so often, the waves came crashing. Early mornings and evenings were especially difficult. Some mornings I woke up with tears streaming down my face. Some nights I had to remind myself to breathe and stay above water.

Returning to pediatric rotation almost felt therapeutic. I smiled as I took care of newborns and their mothers, pledging to myself that I would provide the best care possible. Several days later, a young resident took me out for lunch and shared her pregnancy story with me. She entered labor prematurely and safely delivered her twins. However, one of the twins struggled in the NICU. Four weeks later, she held her baby until the last breath became air. This happened in the middle of her residency interview season.

The resident gave me her phone number, asked me to call anytime, and made sure that I know it's OK to not be OK.

Her advocating for me opened my heart to connection, compassion, and the very essence of our shared humanity. Reflecting on her example, I feel that women in medicine often share our stories with others so that we can share in the hope.

The hope that from the shadow of our adversities, stronger and more courageous women are born.

The hope that in the face of stress, demands, and hardships in medical training, our resilience is refined.

The hope that we lead with examples of empathy, kindness, and empowerment.

The hope that we continue to show up for each other on this steep and rocky path, for we all have our share of stumbles and setbacks, and together is the only way to move forward.

We need women like this resident, especially in medicine.

  Inspirational Perspective Number 81 Top

Role of Feminism in Mental Healthcare: A Move Towards Gender Equity and Empowerment

Shweta Kapoor

Department of Psychiatry, Mayo Clinic, Phoenix, USA

Merriam-Webster Dictionary defines feminism as “belief in and advocacy of the political, economic, and social equality of the sexes expressed especially through organized activity on behalf of women's rights and interests”. Feminist theory brings attention to the inherent disparities in health care, particularly mental healthcare, based on gender, social structures, and patriarchy. Historically, the evolution of psychiatry and psychotherapy was almost exclusively based on males as the norm while ignoring the unique needs of women and the struggles they faced. During 1960s-1970s, feminist psychology started becoming more prominent and movements such as Consciousness-Raising provided a place for women to gather, speak, share, and be heard. This grassroots movement aimed to empower women and to challenge an overwhelmingly patriarchal psychotherapy stance. Feminist consciousness further challenged the prevailing patriarchal therapy views that the inequality and discrimination suffered by women was because of individual deficits and reframed this to emphasize that the unfair treatment suffered by women was due to them being members of a marginalized group. Phyllis Chesler in her seminal work, Women and Madness, described how psychotherapy oppressed women. Majority of the therapists during that time were males and the therapy sessions re-enacted the prevalent misogyny leading to more trauma while seeking mental healthcare. Since then, there have been significant progress made in the field of feminist psychology and mental health.

Feminist therapy, at its core, helps empower women to identify and challenge the oppressive systems they may be living in and bring about change. It is a psychotherapeutic approach that recognizes and addresses the unique stressors that impact women's mental health. The therapeutic relationship is postulated to be the primary source of change that helps women understand their psychological distress in context of the prevailing sociocultural environments. It empowers them to make positive changes leading to improved outcomes for women and society in general.

Feminist theory aims to understand gender inequality and focuses on gender politics, power relations, and sexuality. Focuses on the promotion of women's rights and interests. Feminist psychology directly addresses issues such as objectification, oppression, and patriarchy. Additionally, feminist therapy strove to understand the significant role of social structure and gender in mental health disparities. It is interesting to note that in the early to mid-1900s, the psychotherapeutic approaches and theories were largely patriarchal, most therapists were males who viewed mental health from a completely different perspective than their patients who were primarily women, adding to the shame and trauma.

Feminist psychotherapy encourages the patient to engage in their world in a more complete way. It helps bring awareness to not just the patient's individual circumstances but to the social and political world in which they exist. It theorizes that the majority of the psychological problems are due to or made worse by the disempowering sociopolitical climate and aims to recognize these forces and empower the client to make changes. The patient is gently supported and encouraged to become their own rescuer and places importance on strengths and empowerment. This form of psychotherapy aims to unentangle the role of gender bias, victim blaming, discrimination, and oppression in the psychological distress being experienced by women patients.

One of the most significant area that feminist psychotherapy has brought light to is how we treat traumatized women and shone a light on the disparities inherent in the more patriarchal psychotherapeutic approaches while working with this population. Feminist theory challenges the use of excessive pathologizing and diagnostic labeling of women who have suffered complex trauma in their lives. Feminist psychotherapy advocates against pathologizing traumatized women with stigmatizing diagnoses such as Borderline Personality Disorder and is making an effort in normalizing the primarily adaptive responses to trauma. Trauma-informed feminist therapy believes in an eclectic approach to trauma treatment and encourages the patients to share their lived experiences and provides a safe space to process their traumas.

Thus, feminist theory and psychotherapy has gradually advanced over the past several decades to dismantle the patriarchal stance in therapy, aims to empower women to understand the role of oppressive societal norms in the perpetuation of their psychological distress. By taking a uniquely women-centric approach towards treatment of mental illness, feminism continues to play a significant role in moving the society and medicine towards a more equal and just society and equitable mental health care.

  References Top

  1. Unger RK, Crawford ME. Women and Gender: A Feminist Psychology. Philadelphia, PA: Temple University Press; 1992.
  2. Grzanka PR. Intersectionality and feminist psychology: Power, knowledge, and process. In: APA Handbook of the Psychology of Women: History, Theory, and Battlegrounds (Vol 1). American Psychological Association: Washington, DC; 2018. p. 585-602.
  3. Clarke V, Braun V. Feminist qualitative methods and methodologies in psychology: A review. 2019:2;13-28. Available from: https://www.researchgate.net/publication/341025758_Feminist_qualitative_methods_and_methodologies_in_psychology_A_review_and_reflection. [Last accessed on 2022 Nov 13].
  4. Feminist Therapy. American Psychological Association. American Psychological Association. Available from: https://www.apa.org/pubs/books/4317192. [Last accessed on 2022 Nov 13].
  5. Chesler P. Women and Madness. Chicago: Lawrence Hill Books; 2018.
  6. Herman JL. Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror. New York: Basic Books; 2022.
  7. Theodora Blanchfield AMFT. What is feminist therapy? Verywell Mind. Verywell Mind; 2021. Available from: https://www.verywellmind.com/what-is-feminist-therapy-5204184. [Last accessed on 2022 Nov 13].
  8. History.com Editors. Feminism. History.com. A&E Television Networks; 2019. Available from: https://www.history.com/topics/womens-history/feminism-womens-history. [Last accessed on 2022 Nov 13].
  9. Repudiating feminism: Young Women in a Neoliberal World. Available from: https://www.routledge.com/Repudiating-Feminism-Young-Women-in-a-Neoliberal-World/Scharff/p/book/9781138274099. [Last accessed on 2022 Nov 13].
  10. Radke HR, Hornsey MJ, Barlow FK. Barriers to women engaging in collective action to overcome sexism. Am Psychol 2016;71:863-74.
  11. Feminism Definition & Meaning. Merriam-Webster. Merriam-Webster. Available from: https://www.merriam-webster.com/dictionary/feminism. [Last accessed on 2022 Nov 13].

  Inspirational Perspective Number 83 Top

The Case for Narrative Medicine: A Medical Student's Perspective

Adeline Fecker

Oregon Health and Science University, Portland, USA

This is a woman with two years of worsening back pain. She went to multiple urgent cares and every time she was sent home with the standard recommendation for back pain: rest and OTC pain medication. Her PCP gave her a physical therapy referral and she went to that even though it didn't help. No one would think she had a tumor growing in her spine until it had spread to her lungs. Until she finally had an MRI and you could clearly see a not-so tiny glowing sun in her lower spine. But there was nothing to be done now that it had spread. She passed peacefully with her family shortly after.

Truly her providers did not do anything out of protocol for back pain. They did not cause direct harm. There's no one to sue. Yet if they had heard her say (as was later put in her notes after diagnosis) that her back pain had been getting worse and waking her up in the night, would they have thought to do more? I have no place to judge. But she was a woman and a mother. That's not a coincidence.

In every one liner there was a reference to her having a tailbone injury when she gave birth a year prior to the start of her symptoms. I could hear my attendings' voices in my head telling me to guide the presentation to the answer. Frame the story. These providers did that every time; 'yes, that must be the reason for her back pain! Just your typical woman having back pain.' I don't wonder that if by the final urgent care visit, before she was admitted with shortness of breath from the mets in her lungs, the provider had to dig through her chart to find that 3-year-old tailbone injury to put into their one liner. They had found the detail in the note from the last visit. Like some bizzare game of telephone, her story changed along the way. Warped to fit a clinician's assumption about her pain.

I felt like an archeologist, piecing the story together. Though I am now part of the medical community, I strangely felt like an outsider. I was not seeing this patient through the same lens as her providers as they formed for a diagnosis. I was searching for her narrative.

This case confirms why narrative medicine is radical justice. When we document in the chart, we are story telling. Passing down information to people in our community. In a way, the same violence that is done in our history textbooks that whitewash and colonize and stigmatize, may also be perpetuated in a patient's records.

There is nowhere I can put this frustration except into this reflection where I may write a more complete narrative for this patient. A competing story to the chapters of 'back pain due to tailbone injury recommend PT and rest.' Yet I regret I will never speak to her. I will never hear her experience in her own words.

I have dinner with my parents the day after I read over this case. My mom just went to the doctor. She was told the same things for her worsening back pain. I try to reassure myself that the tumor type is rare. This is not history repeating itself. But in a way it is. We all know women whose problem was ignored for too long, who were misdiagnosed, who were dismissed. Whose histories, with every chart, are spinning further away from them. How can I break this cycle in the constraints of the medical system?

  Inspirational Perspective Number 85 Top

Lessons from My Brush with Female Infanticide

Dharshana Prem Anand

Department of Microbiology, S.R.M. Medical College, Hospital and Research Centre, Chennai, Tamil Nadu, India

It's early 2020, I'm finishing intern year with my Ob/Gyn rotation, witnessing the last of the pre-covid era.

A heavily pregnant, albeit malnourished girl is wheeled into the labor room. I start making conversation with the girl - she's 17, her husband is 34 - not too uncommon where I practiced in rural south India. “Is this going to hurt?”, she asked me, innocently in her tongue. I told her that it will be difficult, but we will be with her throughout the process. Breaking down, she squeezes my hand and says, “It has to be a boy”. This is why prenatal sex determination is banned in India - the rampant female foeticide. “We have no control over the sex of your child”, my colleague quips, visibly ticked off by the comment. Still sobbing, she says, “If I don't have a boy, I have to do this again. I can't do this again!”. We try to calm her down, but no book prepared us for this conversation. She goes on to tell us how she was engaged to her mother's younger brother a week after she was born. She told us how she was doomed from the very start - forced into a child marriage with a much older man, raped premaritally 'because she already belonged to him' and coerced into getting pregnant at 16. She was to have a male heir for the family and not put them through the shame of having a girl. She told us that she didn't want to have a girl because then her child would be put through the same thing. “I'd rather kill her than let her suffer the same way; this is no way to live”. We obviously didn't know how to respond to all this. Her labor progressed, every minute passing like an hour. The interns were tense with anticipation, but the older doctors and nurses who had seen this on a daily basis seemed unfazed. As they deliver the baby, the interns crowd around to watch this child's life be determined by their genitalia. A boy would be nourished with food, an inheritance and the choice of a bride, all while receiving a dowry from his wife's family. A girl would be shunned and made to do household chores while she waits for the birth of a brother. Thankfully for her, it was a boy. The once mean mother-in-law was now ecstatic. The new mother puts her head down. She doesn't seem happy, but she seems relieved.

As I carry the baby to the neonatal ward, my colleague joins me with a newborn girl from the other delivery room. The family outside looks at the baby in my arms and whispered that they wished he was theirs instead.

I felt angry and helpless about the societal construct we had to follow. Although we supported gender equality from a moral standpoint, morals meant nothing to this new mom. All she knew was that having a girl meant that both she and her daughter would suffer - logically, we silently rooted for a boy. I was enraged that I was rooting for one gender over the other. The stark dichotomy between the reactions in the delivery rooms was appalling.

In such times, it is important to remember why we joined the medical field in the first place. It's imperative to empathize with your patient, regardless of their views and background. When every other patient you get is a teen pregnancy from early wedlock, it's easy to become jaded. The injustice isn't as shocking as it used to be. Before you know it, you are doing your job as a doctor and moving on - to preserve your sanity, you lean into the same institutions that you detested. You are the unfazed doctor delivering the preterm teen and moving onto the next without batting an eye. But what is the alternative to this? Is it to become a social justice warrior? Maybe it's enough to acknowledge that these issues exist and that they are not okay. Maybe it's about educating the families that you come in contact with. Maybe it's sharing a story on the internet. Maybe it's any little thing that you can do to contribute to the cause you believe in.

  Inspirational Perspective Number 86 Top

Making the Most of the Fault in Her Stars

Japjee Parmar

Medial College, Government Medical College, Amritsar, Punjab, India

”She looks just like you!” my dad beamed with pride when he saw me for the first time. My mother's face erupted with a faint smile in acknowledgment. Faint like that of an exhausted soldier after having won a grueling war. Faint, for my birth, hadn't been an easy one.

You see, my mother had been dealing with pre-eclampsia which in spite of her being admitted to one of the most prestigious hospitals in our state went undiagnosed till the very end. The signs were all there; the headaches, the abdominal pain, the extreme weight gain on her delicate frame, the edema encircling her once petite legs, and yet in spite of the hospital boasting about its rigorous monitoring of vitals, one of the most common and straightforward diagnoses was missed. My mother had been a medical student back then, a year shy of graduating (which being in the same position as she was while writing this anecdote seems surreal) and she was quite upset at not only the missed diagnosis but as well as the unnecessarily extended episiotomy she would have to painstakingly endure now for the coming months whilst nursing a newborn me. A 23-year-old medical student in a world of adversity and all the excuses in the world to break down and give up she chose the road less taken.

And that has made all the difference.

In my limited life through largely unworldly eyes the one thing I know for certain is that there is a certain magic in being a woman. You see the thing about women is that they just perpetually go on to grow stronger and stronger with each role that they embody in this play called life. They cherish and excel at each role but none makes them stronger than that of being a mother. There is no human that can be as brave and as selfless as a mother, as capable and yet bridled by circumstances and yet not just accepting of this fate but rather being grateful for it.

So armed with the unshakable grit to provide me with the best education, she embarked on a journey; to further her own academic brilliance, in hopes that one day so could I.

And in case my foreshadowing missed the mark, she chose in an almost altruistic fashion to take up Obstetrics and Gynecology. Speaking of, I don't think they is a branch as underappreciated as hers, with the extremely unpredictable hours (the running joke in our family being how kids choose the most tragically comical times to be born), many a missed birthdays and special occasions because of work emergencies, antepartum and postpartum hemorrhages galore and having to have incredibly delicate conversations surrounding infertility and miscarriages almost on a daily basis, I can't help but wonder if the belittling of her branch is a product of our collective disregard for issues surrounding women or secondary to the archaic yet still rampant internalized patriarchy.

But I digress, in essence, I can't imagine the amount of stress she is perpetually under with all that going on in the background.

And yet her foreground has always been us, her family. She's raised me to always question the status quo, always fight for my rights, and to always be my biggest advocate. She has never shied from having tough conversations with me even if it resurfaces some hypocrisy on her own part or mine. I shall not comment on her professional prowess because of the obvious conflict of interest but I would like to stress the impact of her 'personal' maternal prowess in spite of the conflict of interest for it is unmatched and inspiring beyond words.

It is obvious that without her I wouldn't have been here but there is nuance to this statement for if it wasn't for her being who she is I wouldn't be who I am.

And who I am is the one traversing on that road not taken whilst she walks beside me holding my hand in the slightest, beaming as always.

It is not the road but her, SHE has made all the difference.

  Inspirational Perspective Number 90 Top


Ofure Akhiwu

Department of Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA

Residency was much harder than I thought it would be. Intern year was knocking me off my feet. Humbled on so many occasions, innumerous tears. It was the middle of the Coronavirus pandemic and the numbers continued to rise exponentially. There were murmurs of a vaccine that may be available by the end of the year but in the meantime, my routine was N-95, surgical mask, face shield, sanitize, glove, gown, glove, and repeat. So many layers between my patients and me. No one knew what anyone looked like. Lunches spent alone distanced in the cafeteria. Classmates I believed would be very good friends but with no opportunity to meet outside of work. It was in this new strange world that I found out about you.

I remember that day, clear as day. The days all seemed to merge into one, codes after codes, my mind resigned to the darkness with no hope in sight, but that night I saw light for the first time. The test was very surprisingly positive. I repeated it twice in disbelief. I laughed, I cried, I laughed again. That night I slept well for the first time in months. I felt light as air, like I could float to the sky.

I carried around my secret, a smile underneath my mask. If anyone looked closer than 6 feet, they could almost see the glitter in my eyes.

Nothing could surpass the joy I felt when I heard your heartbeat for the first time. In the dark ultrasound room alone due to visitor restrictions; but I never felt like it was just me. Because you were there. The hospital felt less lonely, because I had a piece of my family everywhere I went.

The first time I felt your kick, my excitement could not be explained, it was a particularly difficult day, another person prone in the ICU, the fear, the uncertainty, then there was your kick, like a nudge of encouragement. Like a reminder to say another prayer, to hope a little more, to just keep going.

As the days went on, you told of my secret. The bump was too big to miss, with every interaction, in every space, you made your presence known. “Is it a boy or is it a girl?” “I remember when I had my first…” Stories shared amongst mothers. Words of advice, ways to protect you from the pandemic. It was me, then it was you and finally, it was you, me and every parent we came across. The isolation was no more. We made new friends every day and with time, friends become family. In rooms full of bad news, there was always you- light. In months full of sorrow there was in you- life. Even with all the layers of PPEs there was a connection with my patients. They felt your kicks, we laughed, we cried, we talked, and we prayed.

My Ekan, my light, my gold, you taught me so much in nine months. Most of all resilience. You gave me the gift of peace through this stormy pandemic that may finally be dying down. I am thankful to have walked these halls with you in my first year in medicine. You have taught me more empathy and love.

Thank you.

Love, Mum

  Inspirational Perspective Number 99 Top

Surviving in Scrubs - Giving the victims of healthcare misogyny a voice

Chelcie Jewitt1, Becky Cox2

1Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, 2Centre for Academic Primary Care, University of Bristol Medical School, University of Bristol,

United Kingdom

Surviving in Scrubs is a campaign that was founded and launched in 2022, by two female doctors working within the UK's National Health Service (NHS) - Dr Chelcie Jewitt and Dr Becky Cox.

Dr Jewitt is an Emergency Medicine registrar working within the Liverpool city region. Her passion for promoting gender equality within the healthcare workforce came from her own experiences of sexism and gender inequality in the workplace. In 2021, she pioneered the British Medical Association's report entitled Sexism in Medicine and is now pushing this conversation beyond the confines of the medical profession.

Dr Cox is a GP specialist working in gynaecology and an academic GP with an interest in violence against women. As a survivor of domestic abuse as well as sexual harassment and assault at work, she advocates and campaigns to end the culture of misogyny in healthcare. From sharing her own experience of sexual violence and abuse, she recognises the power of survivor stories in bringing forth change.

These impassioned clinicians are collaborating with the aim of changing the culture of sexism and misogyny within healthcare. They are sharing their own knowledge and experiences of workplace sexism in order to inspire others to do so through the campaign website – www.survivinginscrubs.co.uk.

The website provides an anonymous platform where healthcare workers (of any professional or personal background) can submit their testimonies of workplace sexism, sexual harassment or sexual assault. The project is currently accumulating stories to provide a collective narrative of the contemporary issues facing healthcare workers today.

Through the 2021 BMA report, we know that 91% of female doctors have experience of workplace sexism, and that 47% felt they were less favorably treated due to their gender1. Over half of women (56%) said they had received unwanted verbal comments, and 31% had experienced unwanted physical conduct.[1]

These statistics are more than numbers, they are women who are having to cope with these horrendous incidences on a frequent, sometimes daily basis. Surviving In Scrubs is providing these victims with a voice. We are raising awareness of the prevalence of this issue which affects all healthcare workers, we are pushing for change through the power of these testimonies and voices.

The accounts of the victims of sexism, sexual harassment and assault bring a reality to this issue, they have more power than the numbers. They will be what enables this campaign to end the culture of misogyny in healthcare.

Twitter: @scrubsurvivors

Instagram: @scrubsurvivors

E-mail: [email protected]

  Reference Top

  1. Sexism in Medicine – British Medical Association. 2021. Available from: https://www.bma.org.uk/media/4492/sexism-in-medicine-bma-report-august-2021.pdf. [Last accessed on 2022 Nov 13].

  Inspirational Perspective Number 100 Top

Why Sex - and Gender-Based Women's Health Still Matters in Internal Medicine

Deborah Gomez Kwolek

Department of Internal Medicine, Harvard, Boston, USA

There is a national debate among the proponents of sex and gender medicine as to whether Women's Health should still exist as an academic and clinical focus. Some argue that Sex- and Gender-based Medicine (SGBM) is inclusive of all sex and gender differences, and thus the term Women's Health is outdated and should not be used. I would like to offer the perspective that, at least within internal medicine, Women's Health still matters to faculty and patients, and should not be cast aside at this time.

When we discuss SGBM among patients and faculty, there is often much confusion over what we mean. Most think that the term sex and gender refers primarily to LQBTQ and Trans- care and do not realize that SGBM applies to all persons. Further, within primary care, there is a documented deficiency in the preparedness of internal medicine residents to provide comprehensive care of women patients. If the emphasis in medical education is solely on sex and gender without Women's Health, it obscures the fact that specific training in reproductive care, contraception, menopause, and other sex- specific conditions are sorely needed by our future physicians. Women's Health has evolved over the years from a focus on reproductive organs to encompass the understanding that sex and gender differences exist throughout the body, and are relevant to every discipline in medicine. Sex- and Gender- Based Women's Health (SGBWH), as the integration of Women's Health and the newer field of Sex- and Gender- Based Medicine, is the solution that I believe we need.

What is Sex and Gender Based Women's Health (SGBWH), and what distinguishes a SGBWH provider or curriculum? SGBWH is a mindset, which grew out of the original Centers of Excellence in Women's Health Program. SGBWH is a paradigm shift, and includes a set of core competencies for comprehensive integrated clinical care. SGBWH research asks whether and why sex and gender differences exist, and most importantly, poses the question “are these differences clinically meaningful?” SGBWH is concerned with community outreach and addressing disparities through advocacy, so as to care for the underserved, members of minority populations, low income individuals, and immigrants. SGBWH values promoting women and minorities into leadership positions and accommodating providers in their roles as family caregivers while pursuing their professional career.

SGBWH affirms that sex is a biological variable (SABV) and that gender is a social construct; both factors influence the health of every person. In order to personalize healthcare, sex and gender must be factored into the care of every patient. The optimal care of women includes the integration of primary care medicine, primary care psychiatry, primary care gynecology, primary care breast health and sex and gender specific specialty care into the care of patients within the cultural and societal factors. As continued research into sex as a biological variable produces new information, those findings must be included into health education for all learners which will then translate into excellent comprehensive evidence-based primary and specialty care. Ultimately this process will help ensure excellent primary care for women and the delivery of more personalized healthcare for all patients.

To advance the field of SGBWH, researchers and educators in Women's Health must join forces with the proponents of SGBM, and use an interprofessional approach to promote sex based research, education, and clinical care. Persistent deficits, which include the lack of SGBWH knowledge and skills among health professionals, and the lack of research in which the studies which report findings according to sex and gender, must be addressed.

Lastly, in terms of promoting gender equity and the advancement of women in medicine, the Women's Health movement of the last 3 decades has been a tremendous vehicle for success. Women's Health Fellowships, clinical programs focused on women, research in sex and gender related to Women's Health and the establishment of endowed Chairs in Women's Health, have all helped lead to advancement, often with accommodations/understanding for the unique needs that women face as pregnant persons, birthing parents with breastfeeding parents. In all, the Women's Health movement (which has always been inherently concerned with sex and gender) has done much to enhance and promote better care for women and to address gender equity in the advancement of women. Perhaps in five or more years we will not need to distinguish a field of Sex- and Gender-based Women's Health, and will solely focus on SGBM: but that time is not now.

  Inspirational Perspective Number 101 Top

To be a Successful Surgeon, You Must Have The Heart of a Mother and The Hands of a Lady

Oviya Giri

P.S.G. Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India

I walked into her office as I rehearsed my introductive words within my anxious, knotted brain and tried to think over my loud thundering lungs after skipping up five flights of stairs. I hoped to gain a vanilla map to present and publish a research project. Little did I know, I would receive the mentorship that would point my eyes toward what I had been in search of, my whole life.

After graduating from medical school in 1982 at Stanley Medical College, Chennai, India, Dr. Pavai won two prestigious gold medals in the fields of General Surgery and Urology. Stanley medical college is informally known as the Temple of general surgery in India, being one of the oldest centers harboring the field, having history in its surgical annals dating back to the pre-independence era in India. In retrospect, it is no surprise that Dr. Pavai herself found her eyes looking in that one direction with fierce devotion from her very first clinical year of medical school. Forty years later, that devotion remains unrelenting.

One evening I sat before her husband, Dr. Ganesan, at dinner as she entered her sublime dining room; in one hand, a plate stacked of her crispy thin dosas, ready to serve us. Dr. Ganesan spoke of his first encounters with Dr. Pavai. His college friends would tease him, saying he was getting married to a highly dedicated gold medalist medical graduate, whereas he was the stark contrast, a movie enthusiast who would pursue his hobby at the expense of his medical school exams. He recalled a time when Dr. Pavai's father vehemently claimed that his daughter would only pursue a career in General Surgery with a sub-specialization in M.Ch. Pediatric Surgery. Dr. Ganesan, at the time, was immensely curious about the unwavering thunder that lay behind Dr. Pavai's dedication to surgery. He then decided to satisfy his curiosity by pursuing a career in neurosurgery himself.

After medical school, Dr. Pavai spent five years focused primarily on caring for her young son while studying for her post-graduate entrance exams and working in a clinic as a medical officer. As soon as she entered her post-graduate training, a few of her male colleagues felt strongly that surgery should not be pursued by women, especially a mother. This was strongly in resonance with a quote published in an 1870 issue of The Lancet journal.

”I believe most conscientiously and thoroughly that women as a body are sexually, constitutionally and mentally unfit for the hard-incessant toil, and for the heavy responsibilities of general surgical practice.”

- Dr. Bennett, the Lancet, 1870

More than a hundred years later, this mentality remains adulterating the minds of some members of the medical fraternity.

Dr. Pavai has a unique ability to heavily inspire others with her fervent engagement toward her work. I recall a time when I had to submit an abstract late towards the deadline, and Dr. Pavai had an emergency case the same evening. I told her I had queries, and she told me to accompany her to the OR. Moments later I found myself perched up on a two-foot height stool with my laptop laid out behind the anesthetist. She made the opening steps to her appendicectomy and coached a resident through his first taste of a laparoscopic case, all while throwing behind well-thought-out answers and wordings for the last draft of our abstract.

On multiple evenings before major exams, she would invite us, students, over for dinner to mentor us. I would notice the small details, the community she held within her home. Sometimes she would host patients' families from North India who could not afford accommodation during the perioperative period. We would never leave her home without a deeply satiating meal prepared by her. She would often advise me to always love everything I do, even if it is making breakfast at four am before morning rounds, it's the love we must harness in the small details of our day-to-day lives she would say. Through her, I found a homemaker and surgeon in such an effortless seamless blend.

It has been suggested by Lilly Trinh et al. that women medical students have a higher likelihood of pursuing specialty training in surgery if provided early access to mentorship. Ultimately it was through being blessed with an example of whom I wanted to become a few decades down the line, that I discovered more and more of my self-confidence and identity within medicine.

  References Top

  1. Hall L. Hilary Bourdillon, women as healers: A history of women and medicine, women in history, Cambridge University Press, 1988, 8vo, pp. 48. Med Hist 1989;33:395.
  2. Trinh LN, O'Rorke E, Mulcahey MK. Factors influencing female medical students' decision to pursue surgical specialties: A systematic review. J Surg Educ 2021;78:836-49.

  Inspirational Perspective Number 104 Top

One medical Student's Journey on Complications in Obtaining Pregnancy Related Health Care

Lilia Kazerooni1, Padmaja Sundaram2, Nicola Armour-Smith3, Rebecca Song4, Theresa Rohr-Kirchgraber5

1Department of Human Biology, University of Southern California, Los Angeles, CA, 2Obstetrics and Gynecology, Albany Medical College, Albany, NY, 3Department of Medicine, Kentucky College of Osteopathic Medicine, Pikeville, KY, 4Department of Biochemistry, Northeastern University, Boston, MA, 5Department of Medicine, Augusta University/University of Georgia Medical Partnership, Athens, GA, USA

All medical students are required to have health insurance upon matriculation, though how they obtain this insurance varies by state and institution as many are no longer eligible to be covered by their parent's health insurance. Obtaining health insurance can be complicated even for a well-educated, intelligent person. This case illustrates the difficulties one student encountered and highlights the inadequacies of our current health insurance system.

After graduating from college in Indiana, NF was excited to start her medical career in Kentucky in July 2020. Though she was aware of the requirement to have health insurance upon her matriculation, her medical school did not offer a policy. Though she had planned to marry after her graduation from college, the COVID pandemic caused a postponement of the wedding and delayed her ability to be added to her fiance's health insurance. After her college graduation in June 2020, she found out she was pregnant and was initially able to extend her health insurance plan from her college through October 2020. She moved to Kentucky, started medical school, and found an OBGYN.

In order to switch to affordable health insurance, she planned to join Kentucky Medicaid. Looking to maintain continuity, she was assured that the Medicaid plan she would change to in October 2020 would work fine with the OBGYN office and received verbal approval. She had a family history of preeclampsia and a large gestational age baby, so continuity was important to avoid complications. However, when the time came to switch health insurance plans, her OBGYN was not covered and, at 7 months pregnant, she was to change to the only physician covered by the Medicaid plan. An hour and a half away and not aware of her pregnancy concerns, the change to a new OBGYN was an additional stress added to being a first-year medical student, the ongoing pandemic, and being separated from her fiancé.

During a short period of time during her pregnancy, she was on three different state Medicaid plans trying to obtain better coverage, yet none of them would cover her preferred OBGYN. Three weeks before giving birth she decided to get legally married and get onto her husband's insurance plan which would cover her original OBGYN. Making this change meant that the cost of the health plan would be incredibly expensive, requiring a large portion of her monthly budget. When she reestablished care with her original OBGYN who was aware of the baby's large size, the decision was made to induce labor early to avoid an emergency C-section. A healthy child was born and further pregnancy complications were avoided, but the struggle to obtain health insurance, even when pregnant, was an unnecessary burden.

Women comprise ~50% of all medical school matriculants, thus having maternity coverage and consistent care throughout one's pregnancy is crucial. However, as a medical student who is neither married nor employed, obtaining affordable coverage is an impediment and can significantly increase the cost of a medical education.

  Inspirational Perspective Number 106 Top

The Open Secret of Female Genital Mutilation: Silencing the Hystera

Japjee Parmar

Medial College, Government Medical College, Amritsar, Punjab, India

Unfortunate as it is, our society has been built on the unfounded yet ubiquitous opinion of women being the weaker sex. Hence even as we continue to make strides and carve our own paths, we must be the voice of our less privileged counterparts who although capable of being equally as eloquent are incessantly muted by their circumstances.

Although criminalized and touted as a human rights violation, Female genital mutilation is far from obsolete. According to strenuous data collection by UNICEF it has been reported that as many as 200 million girls under the age of 15 especially those residing in the regions of Africa, Egypt, Ethiopia, and Asia amongst others live with the lifelong consequences of the procedure whilst another 4 million are at risk each year to being subjected to a similar fate.

Often regarded by those who defend it as an important cultural milestone, the procedure is done as an attempt to curb a girl's 'desires' and 'keep her pure and pristine for her husband'. The surgery has different variants with some involving the removal of much of the external genitalia followed by 'stitching up the female' leaving but a pea-sized hole to only allow for urination.

Other than the obvious psychological effects of mutilation which one has to live with, there are a plethora of other issues which are a consequence of the procedure including but not limited to pelvic pain, dysuria, high risk of urinary tract infections, and potentially fatal sepsis if performed in a dubious environment which it often is. Life-altering dysmenorrhea is often reported but rubbished by family members as the girl being “hysterical' ; an extremely harmful stereotype which although scholarly disproved continues to be a reason to disregard female pain and adversity. The biggest struggle, however, comes during childbirth which in the best case is excruciatingly painful and in the worst-case well virtually impossible. In some cases the women are 'opened up' or 'unstitched' post their wedding, something which seems like an utterly objectifying and dehumanizing action but alas is considered a required testament to purity ,echoing the same principle as it's equally archaic and outrageous counterparts 'the two-finger test' or 'the white bedsheet test' which are the source of immense distress and ruminations for women all over the world.

Some girls are also indoctrinated into believing that their sexuality is a sin and hence must be bridled and limited and sadly this is something that they pass on to their daughters sustaining this archaic perception and leading to its relentless propagation on a systematic level.

It must be acknowledged that although some do take pride in having had the procedure it is important to recognize that it might have been a consequence of blatant coercion, conscious and unconscious not to mention the misinformation in terms of the complications which are largely kept undisclosed. We must also stress the fact that the vast majority of the girls affected are under 15 and virtually incapable of comprehending what is happening to them.

But the stories which must be stressed the most are of those who tried to resist, tried to run away from the operating table, tried to scream and fight back only for a woman to cover their mouths to muffle their cries whilst another one pins down their legs. We must echo those muffled voices, we must hear these stories, uncomfortable as they are. It is our duty as women and as humans to do so. We must protect these women and for that, we have to acknowledge the reality staring us in the face. The reality 4 million girls are at risk annually, and the reality 200 million others live with already.

And for that, we must be compassionate towards the victims as well as the perpetrators for they are not much different. Regardless of our reservations, we must talk to women who believe in the perceived sanctity of his operation, we must be nuanced whilst talking about the mothers subjecting their daughters to this painful fate for it's their lived reality too, a reality which starts and ends and hence is limited to what they can provide, much less who they are or who they can be. We must talk to the men about their patriarchal misconceptions of purity. We must have all these conversations, none of which would be pleasant.

But in that, we must persevere and reiterate anyways, for making a difference seldom is.

  References Top

  1. Female Genital Mutilation. UNICEF. 2022. Available from: https://www.unicef.org/protection/female-genital-mutilation. [Last accessed on 2022 Nov 13].
  2. Kelly E, Hillard PJ. Female genital mutilation. Curr Opin Obstet Gynecol 2005;17:490-4.
  3. Khosla R, Banerjee J, Chou D, Say L, Fried ST. Gender equality and human rights approaches to female genital mutilation: A review of international human rights norms and standards. Reprod Health 2017;14:59.
  4. Epstein D, Graham P, Rimsza M. Medical complications of female genital mutilation. J Am Coll Health 2001;49:275-80.

  Inspirational Perspective Number 109 Top

Expanding the Scope of Sex- and Gender - Based Medicine

Sneha Chaturvedi1, Jan Werbinski2, Deborah Kwolek3

1Medical Scientist Training Program, Washington University School of Medicine, St. Louis, MO, 2Department of Obstetrics and Gynecology, Michigan State University College of Human Medicine, East Lansing, MI, 3Department of Internal Medicine, Massachusetts General Brigham Harvard Medical School, Boston, MA, USA

As a woman, I understood early on the disparities in how society regarded me versus my male counterparts. The evidence was conscious and unconscious: the common practice of taking a husband's last name, the running joke of women's clothes not having pockets, and the school dress codes that sparked protests. This bias is ingrained in all industries, including medicine and scientific research, fields that preach the importance of unbiased approaches. Bias is unavoidable as humans, yet when unchecked it can cause harm especially to groups historically marginalized. A striking example became public in 2013, when the US Food and Drug Administration recommended lowering the dose of Ambien by half in women. This change came 20 years after Ambien was approved, in response to research showing how women metabolized the drug at a slower rate and had an increased risk for motor vehicle accidents.

In the past decades, there has been a push to work on the sex and gender bias across fields. More recently, key groups like iGIANT, the Sex and Gender Health Collaborative of the American Medical Women's Association, the Society for Women's Health Research, the NIH Office of Research on Women's Health, Women's Health Offices at CDC and FDA, and the Laura W. Bush Institute for Women's Health have made further progress in bringing sex and gender health disparities to the forefront. In 2015, women comprised 57% of participants in NIH funded research, but just including women can keep them invisible unless the results are reported by sex.[1] Nature released an editorial in 2022 describing how papers will need to include “whether and how sex and gender were considered in their study design, or to indicate that no sex and gender analyses were carried out, and clarify why”.[2] And more journal editors are now adhering to the SAGER (Sex and Gender Equity in Research) Guidelines.[3] Stakeholders across the field are gaining a greater understanding of the importance of systemic change.

As we continue to advocate for inclusion of women subjects in studies, this is only the first step in overcoming decades of entrenched male bias. Studies must be properly designed to not just to increase participant numbers, but also create guidelines for data collection and analysis with the goal of evaluating sex and gender differences. Results must be analyzed by sex and gender, reported accordingly, and the research findings have to make their way into education and clinical care. This will be the cornerstone of personalized medicine.

It is imperative to be intersectional in our approach. As societal understanding of gender expression continues to evolve, our work must strive to keep up. Currently, we lack the necessary data to look at many gender differences. Sex and gender are frequently interchanged in educational, clinical, and scientific practice. Asking for a patient's sex and gender as two separate questions is a start towards unraveling the underlying aspects of sex and gender, instead of incorrectly categorizing them. By ignoring gender expression, we then exclude groups of people, including non-binary and gender fluid individuals. We need to continue researching how transgender individuals are uniquely impacted by disease and conditions. And sex cannot be seen as a binary, oversimplifying the complex nature of our gonadal and genetic interactions. Sex is a spectrum, including intersex individuals who are frequently unrepresented. Even in preclinical science, researchers should control for factors such as estrous state because hormonal fluctuations can mask or enhance sex differences in animal models. The story becomes even more complex when trying to address other identities such as race.

This complexity should not scare us from doing the work. Instead, it should motivate us to give these topics necessary attention. We need to keep intersectionality at the forefront and ensure our definitions are truly inclusive. Much work needs to be done to unpack how sex and gender impact medical conditions and treatments. And we have just started to scratch the surface of how multiple identities compound these effects. It is our responsibility to continue pushing the boundaries of our current system, developing new tools and policies to support us on the way.

  References Top

  1. Office USGA. National Institutes of Health: Better Oversight Needed to Help Ensure Continued Progress Including Women in Health Research. National Institutes of Health: Better Oversight Needed to Help Ensure Continued Progress Including Women in Health Research | U.S. GAO. Available from: https://www.gao.gov/products/gao-16-13. [Last accessed on 2022 Nov 13].
  2. Nature journals raise the bar on sex and gender reporting in research. Nature 2022;605:396.
  3. Heidari S, Babor TF, De Castro P, Tort S, Curno M. Sex and gender equity in research: Rationale for the SAGER guidelines and recommended use. Res Integr Peer Rev 2016;1:2.

  Inspirational Perspective Number 111 Top

The Dual Battle

Tanya Amal

Department of Pulmonary Medicine, All India Institute of Medical Sciences, Patna

As she put the stethoscope around the collar of her white coat, she took in a deep breath: trying to muster up all the energy she could for the events of the night. An hour ago, and an hour after she had fallen sleep, she received that call: A 15 year old girl with abdominal pain and swelling was on her way to the hospital. Her 20 years of experience as an obstetrician had well prepared her to predict what awaited her. What she could never be prepared for was the barrier waiting downstairs. “Do you really hey patients this late? It's not appropriate for the ladies of the house to be out at 1 am in the night” said the ever suspecting mother-in-law, her voice undeterred even though half asleep. “It's an Emergency”, muttered the doctor: loud enough so she could hear, but soft enough to qualify as being within the courtesy boundaries of the Indian Culture. She was well aware of the stream of expletives that followed her through the door.

At the hospital, she geared up for the next battle. The 15 year old on the stretcher stared at the Doctor with hopeful eyes. “ STAT pregnancy test and abdominal Ultrasound” shouted the doctor as the Nurse shifted the girl into the room. It wasn't the diagnosis of full term pregnancy and active labor that appalled the Doctor; it was the history given by the patient which painted the sad reality of gender discrimination. Orphaned at an early age, the 15 year old girl and her 8 year old brother were left to the mercy of their relatives. While the boy was admitted to the School, the girl was kept at home to manage the household chores. On one fateful day, about 8 months ago, she woke up in the basement with a pain between her legs and covered in sheets. With a mix of sadness and rage, the doctor told the diagnosis to the girl's grandmother waiting outside. The doctor was not surprised when the grandmother chided “She has brought disgrace to the family. She should be punished.” It was apparent to the doctor that leaving the girl to the mercy of the family might be fatal for the girl. Neither did she have the manpower to fight off a swarm of agitated relatives. So she went for the only route she could see. She locked the girl in the Operation theater of the small hospital with enough food and water for the night.

To the relatives she said, “You cannot see her till I am taking care of her”. With a racing heart, she further affirmed, “Any interference in my work would be reported to the authorities”. The 15 year old child delivered her own child : a baby boy. As soon as the doctor revealed the gender of the baby, the relatives who a day ago were planning to get rid of her, were now ecstatic. “ She has brought light to the family.” The doctor smiled at the irony. She was happy that girl would now be safe. She was sad that in the last 12 hours, she had witnessed gender discrimination at three different stages of life : at birth, at teenage, and at adulthood; the latter being the everyday struggle her 50 year old self had to go through with her in-laws. As she stepped into the house next morning to hear the second half of the expletives by her in-laws, she knew she was strong enough for the dual battle at home and at the hospital.

  Inspirational Perspective Number 112 Top

The “Perez” Sisters – Our Story

Brenda Perez, Jayline Perez, Susan Lopez

Rush University Medical Center, Chicago, IL, USA

Brenda: Growing up in the Belmont Cragin neighborhood meant seeing familiar faces daily at school, local grocery stores, and churches and hearing occasional gunfire in the middle of the night. My two younger sisters and I grew up in a humble home, where our grandparents raised us. Meanwhile, my parents worked multiple shifts to make ends meet. My father migrated from Mexico at fourteen, and my mother, born in Chicago, grew up on the city's westside. They met one another from mutual friends and started their marriage at sixteen and fourteen. The harsh reality that their young love wasn't primed for the outside world hit them when they worked overtime with little pay in manufacturing factories. My father tells us stories about his first arrival in the United States without his parents. His older brother enrolled him in high school without knowing any English. He recalls the long walks he took to get to school in the winter, often an hour earlier before classes started so he could make it in time for a free breakfast.

Jayline: Brenda moved to Mexico to follow her dream of becoming a physician. My dad began to consume more alcohol and fell into depression. My mom cried every night after she hung up on FaceTime with her. At that moment, I knew I had to be strong for them, even though I was about to begin one of my most feared years, my premed years.

I repeated my exam grade three times to a classmate who couldn't believe I scored the same score as her in a chemistry exam; she said, “Why did you score an A? Did you use your phone?” Initially, I did not consider my identity as a Latina, first-generation student of color premed. I felt a lot of frustration because she accused me of being a cheater when I was busting down every barrier that came my way to get to this point in my life. A conversation with my older sister, Brenda, made me wonder why my classmate doubted me to the extent of making me repeat my grade three times. It made me feel that my identity was the misconception in the bigger picture. I felt that she doubted me because I was a student of color and one out of the three Latinas in that chemistry class. Imposter syndrome showed me that I had to grow a thicker skin because the higher I climbed the latter, the less I would see of myself.

Brenda: I never had anyone in my corner to tell me that I was heading in the right direction; my parents were my cheerleaders, but they could only do so much. I needed that person to expel my feelings as I tried to fight the stigma of being an international medical student. The feeling of being an imposter comes with a lack of privilege. As a Latina in medicine, I was breaking barriers set up for us to fall in a poverty trap. When I left my family, I felt guilty. I felt selfish for following my dreams. I had an acceptance to a medical school, which meant so much to me; we sacrificed so much for me to be here, it was my only yes. Of course, I had nights that I could feel my beating heart from the anxiety of being alone in the middle of a drug war and a city thousands of miles away from my home. However, my purpose went back to knowing WHY I was putting myself through all this: I wanted to be the physician I needed growing up. I had to keep reminding myself that my story belonged in medicine.

Brenda and Jayline: We felt that we weren't alone, so we shared our story with program directors in education that could potentially help us fund a pre med program. We sent 23 emails, and only one responded and accepted our proposal. We established a program, MedSchool Bootcamp, to bring a sense of belonging to the premed years and medicine. We have interacted with 30 premed students through Zoom: non-traditional students, students of color, first-generation students, DACA students, and Non-DACA immigrant students. Twelve students received free MCAT prep: an MCAT course, UWorld MCAT, and AAMC MCAT Bundle. The establishment of the program allowed us to help create vehicles of change. They will be the physicians we all needed for our family when they felt invisible to the American world.

  Inspirational Perspective Number 113 Top

The Life Cycle of Female Physician Burnout

Gwendolyn Williams

Department of Internal Medicine, Sentara Careplex Hospital, Hampton, VA, USA

The field of medicine has perpetuated and enforced socially constructed gender biases since its inception. Women physicians battle every day for equality and opportunity, navigating the intersectionality of their identities in a historically patriarchal profession while outperforming in every phase of life. Society expects female physicians to prioritize family and fulfill the roles of mother, spouse, and doctor to the highest standards. This speaks volumes of the resilience of women in medicine, but it also uncovers the roots of a life cycle of female physician burnout.

Burnout is defined as emotional exhaustion, depersonalization, cynicism, and diminished personal accomplishment at work.[1] COVID-19 disrupted the facade of an already broken healthcare system, unveiling the crisis of physician burnout. In 2019, female physicians reported higher burnout rates than their male colleagues, fifty percent versus thirty-nine percent, respectively.[2] Women reported burnout as emotional exhaustion, while men described depersonalization. This important nuance suggests that gender-based differences in expression of burnout make it easier to identify among women.[3]

Women make up one-third of the professionally active physician workforce in the United States.[4] Despite this, and evidence that female physicians provide higher quality care with lower mortality rates than male physicians, their experiences as doctors are much different than men.[5] Gender inequalities and disparities women experience as medical students to attendings predispose them to burnout.

Medical students and residents are progressively indoctrinated to accept mistreatment, microaggressions, and blatant discrimination.[6] In the formidable years of training they accept medicine's hidden curriculum in which heterosexual masculinity and stereotyped sexism are prevalent as norms, while gendered stereotypes, biased treatment of women, and sexual harassment are implicitly taught by example.[7] For female students, the result is gaslighting, invalidation, harassment, exclusion, and dehumanization. These haphazard gender-specific atrocities have disproportionate long-term consequences that erode learning opportunities, restrict career choices, lead to imposter syndrome, and disengage the female identity.

The origins of burnout become more complicated as attendings. A survey of more than 80,000 physicians estimated women make 2 million dollars less than men over a 40-year career.[8] Additional factors which contribute to female physician burnout include slower promotions, fewer professional awards, less research funding, sexual harassment, double standards of respect and professionalism, reduced or non-existent maternal programs and paid leave, and a severe lack of female physician leaders.[9],[10] These factors, and their precursors, contribute to increased exhaustion, poor work-life integration, reduced career satisfaction, and a decline in female physician well-being. Furthermore, a lack of female representation in leadership contributes to uninformed and antiquated views of female doctors, and poor knowledge and insight into what women physicians require to lead balanced, integrated, and successful professional and personal lives.

Organizational policies to address inequalities and biases, inherent to the medical profession are needed to successfully mitigate female physician burnout. Organizational policies should address obstacles to career satisfaction, career advancement, and work-life integration. Interventions to improve burnout include increasing female physician leadership, creating formal mentorship programs, cultivating male allyship, reducing maternal bias, and supporting paid family leave and childcare. Research must also continue to inform best practices for measuring and addressing burnout among women physicians.[11]

Without an infrastructure of support in medicine, women are left in the quicksand of their professional and personal lives. Therefore, the culture of medicine must shift to reflect the climate of the era and dismantle system-wide policies that disadvantage women to achieve full equity for female physicians. Achieving this will translate into improved female physician wellness, decreased attrition of women physicians, and improved quality of healthcare delivered to all patients.

  References Top

  1. Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S, et al. Prevalence of burnout among physicians: A systematic review. JAMA 2018;320:1131-50.
  2. Medscape: Medscape Access. Medscape from WebMD. Available from: http://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056#4. [Last accessed on 2022 Nov 13].
  3. McMurray JE, Linzer M, Konrad TR, Douglas J, Shugerman R, Nelson K. The work lives of women Physicians results from the physician work life study. The SGIM career satisfaction study group. J Gen Intern Med 2000;15:372-80.
  4. Professionally Active Physicians by Gender. KFF. 2022. Available from: https://www.kff.org/other/state-indicator/physicians-by-gender/. [Last accessed 2022 Nov 13].
  5. Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of hospital mortality and readmission rates for Medicare patients treated by male versus female physicians. JAMA Intern Med 2017;177:206-13.
  6. Kulaylat AN, Qin D, Sun SX, Hollenbeak CS, Schubart JR, Aboud AJ, et al. Perceptions of mistreatment among trainees vary at different stages of clinical training. BMC Med Educ 2017;17:14.
  7. Hafferty FW. Beyond curriculum reform: Confronting medicine's hidden curriculum. Acad Med 1998;73:403-7.
  8. Whaley CM, Koo T, Arora VM, Ganguli I, Gross N, Jena AB. Female physicians earn an estimated $2 million less than male physicians over a simulated 40-year career. Health Aff (Millwood) 2021;40:1856-64.
  9. Rizvi R, Raymer L, Kunik M, Fisher J. Facets of career satisfaction for women physicians in the United States: A systematic review. Women Health 2012;52:403-21.
  10. Newman C, Templeton K, Chin EL. Inequity and women physicians: Time to change millennia of societal beliefs. Perm J 2020;24:1-6.
  11. Chesak SS, Cutshall S, Anderson A, Pulos B, Moeschler S, Bhagra A. Burnout among women physicians: A call to action. Curr Cardiol Rep 2020;22:45.

  Inspirational Perspective Number 117 Top

Vaginal Estrogen Therapy: Rejection of Postpartum “Norms”

Lauren Branon1, Angela Rutkowski2, Sandy Jun3, Theresa Bullen4

1Medical Student, University of Illinois College of Medicine at Rockford, 2Medical Student, Rush University Medical College at Rush University, Chicago, IL, 3Medical Student, University of North Texas Health Science Center Texas College of Osteopathic Medicine, Fort Worth, 4Medical Student, George Washington School of Medicine and Health Sciences, Washington, DC, USA

Childbirth and menopause are two common and unique experiences in womens lives in which they undergo drastic physiological changes. Despite these events often occurring at very different stages of life, women are known to experience similar, undesirable symptoms. These side effects that are common for women experience postpartum and during menopause include vaginal dryness, dyspareunia, urinary frequency and urgency, and vulvovaginal burning and itching. These symptoms result from a drastic decrease in a woman's estrogen levels. For women experiencing these vulvovaginal symptoms during menopause, physicians can offer vaginal estrogen therapy for symptomatic relief, which has become the gold standard for helping these patients. In fact, in recent years, the prescription of vaginal estrogen and knowledge of the symptom relief it can provide patients in hypoestrogenic states, has taken social media by storm. Physicians on every social media platform have rallied to raise awareness about vaginal estrogen therapy. One thing that is commonly agreed on is the significant improvement in quality of life.

Despite the success and growing advocacy of vaginal estrogen therapy for women in menopause, providers are not offering postpartum women being affected by these same symptoms this treatment. In the search to answer why this is, a few common concerns seem to come up. Firstly, providers feel as though there is not enough research that has been done specifically on vaginal estrogen therapy in postpartum women, so they do not know enough to be able to confidently tell their patient that they can recommend it. Knowing that women have been giving birth since the beginning of time and the amount of women who have suffered and continue to suffer from these same issues - why has there not been more research done so that we can adequately address this fundamental health concern?

While it is true that there is very little research that exists on the use of vaginal estrogen therapy in postpartum women, a recent study was published that supports the acceptability, safety, and satisfaction up to 12 weeks postpartum related to local estrogen regardless of lactation practices. Another common concern causing hesitation to provide postpartum women with vaginal estrogen is that upon googling “estrogen therapy,” one of the first headlines is that estrogen reduces lactation levels in breastfeeding mothers. This information is currently used to justify not offering postpartum women vaginal estrogen. However, this is unfortunate, as the studies that are reporting this concern reference the use of estrogen in the form of combined oral contraceptives. Furthermore, in one study, it was found that there was a decrease in milk volume in women who took the combined oral contraceptive which contained 30 mcg of estrogen. However, it is important to note that the standard dose of vaginal estrogen that is prescribed today is only 10 mcg and it is administered locally via the vaginal route. Knowing this, it stands to reason that we do not have evidence to be concerned that treating postpartum women with vaginal estrogen should have a definitive negative impact on breastfeeding.

Even more frustrating about the touted concern of effects of estrogen treatment on breastfeeding levels, is the implication of unfair reality. It implies that moms and providers should be concerned first and foremost that “breast is best” and they cannot consider doing anything that would ever potentially affect breastfeeding. With that said, what is known about the experience of breastfeeding mothers is that it does not come without major sacrifices to a woman's personal and professional life. The choice to breastfeed and for how long is deeply personal. Some women may choose not to breastfeed for a number of reasons and it is proven that having a baby fed by formula is still a safe and encouraged option. So why then, have we accepted that women should feel responsible for first being a breast feeder, before she is allowed to consider taking measures to experience a pain and symptom free, pleasurable life? The hesitations cited for not offering women this treatment ignores that postpartum moms are women first. Women, even after childbirth, deserve to continue having a healthy, pain and symptom-free sexual life; this cannot be clumped into being “part of postpartum norm.” As providers, we owe it to our patients to keep their quality of life – physical, mental, emotional – at the forefront of our care. We must act now.

  Oral Number 55 Top

Academic Frontline Clinicians Wellbeing and Resilience During the COVID-19 Pandemic: Were There Gender Differences?

Sima Patel1, Rahel Ghebre2, Kait Macheledt3, Roli Dwivedi3, Briar Duffy4, Snigdha Pusalavidyasagar4, Chen Guo5, Stephanie Misono6, Michael Evans7, Katie Lingras8, Alicia Kunin-Batson9, Catherine McCarty10, Carolina Sandoval-Garcia11, Nissrine Nakib12, Sam Barker5, Sarah Hutto13, An Church5, Elizabeth Rogers14, Vaiva Vezys15, Abby Girard3, Jerica M. Berge3

1University of Minnesota, Department of Neurology, 2University of Minnesota Medical School, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 3University of Minnesota Medical School, Department of Family Medicine and Community Health,4University of Minnesota Medical School, Department of Medicine, 5University of Minnesota Medical School, Department of Radiology, 6University of Minnesota Medical School, Department of Otolaryngology, 7Office of Academic Clinical Affairs, Clinical and Translational Science Institute, 8University of Minnesota Medical School, Department of Psychiatry and Behavioral Sciences, 9University of Minnesota Medical School, Department of Pediatrics,10University of Minnesota Medical School, Family Medicine & Behavioral Health - Duluth Campus, 11University of Minnesota Medical School, Neurosurgery, 12University of Minnesota Medical School, Department of Urology, 13University of Minnesota Medical School, Obstetrics, Gynecology & Women's Health, 14University of Minnesota Medical School, Department of Medicine and Department of Pediatrics,15University of Minnesota Medical School, Microbiology & Immunology

Objective: The COVID-19 pandemic has amplified stress on frontline workers (FLW). The aim of this paper is to understand the impact of COVID and gender on academic physician FLW regarding resiliency and emotional wellbeing compared to clinicians who were not FLW.

Methods: The cross-sectional survey was administered through email to University of Minnesota/M Health systems' faculty over the months of April-June 2021. The survey used validated measures including Work-Family/Family-Work Conflict Scale,[1] Work Autonomy Scale (WAS),[2],[3],[4] Brief Resilience Coping (BRC),[5] Brief Resilience Scale (BRS)[6] Patient Health Questionnaire-4 (PHQ-4).[7] Additional questions included personal demographics (gender, race, caregiver status etc.), academic demographics (school, rank, track, % effort allocations etc.), scholarly and clinical productivity, wellness, sleep, stress, and foreseeable benefits of change in working conditions. FLW status was self-reported by survey respondents.

Results: The survey overall included N358 academic faculty, with N150 included in this analysis of academic clinicians. Among the 150 clinicians, 88 (56.6 %) self-identified as FLWs. Among FLWs, 57 (64.8%) self-identified as women and 31 (35.2%) as men. Faculty at the rank of Assistant Professor were more represented in FLWs (61.4%) than non-FLWs (41.9%). There was no significant influence of FLW status on validated measures including the BRS, Family-Work/Work-Family Conflict Scale, WAS, PHQ-4, and BRC. Assistant professors were more likely to have FLW status (p = 0.56) and have more FWC (p <0.001). FLW tends to be highest for assistant professor rank and lowest for professor (unadjusted). After adjusting for rank and tenure status, women experienced higher family-work/work-family conflict compared to men colleagues. Men FLWs had higher BRS and scores compared to women FLWs despite consideration of sleep, PHQ-4, caregiver role, and rank. Further analysis identified that PHQ-4 is highest for associate professor FLWs.

Conclusion: COVID has exacerbated FLW stress and gender inequities. Women may experience higher FWC and WFC as compared to male colleagues due to structural/systemic/societal influences impacted by gender roles. One hypothesis as to why men FLW have better resiliency scores compared to women FLW may be that women experience structural/systemic/societal influences that may negatively impact resiliency, such as implicit gender bias and microaggression in the workplace. BRS and BRCS are self-evaluation questions, it is possible that women are more self-critical and this could impact the scores. Also, perhaps women are more burned out. Other factors that may contribute to this and are not captured include race/physical ability/etc. Lastly, PHQ-4 is highest for associate professor FLWs, suggesting increased demands and pressure on mid-career faculty. There are several considerations that were not explored in this survey such as FLW home support systems, responsibilities, and utilization of external resources that mitigate these conflicts. Future directions should focus on areas with increased demands on women faculty and potential solutions to retain and promote clinical women faculty. Findings from this study should inform planning for other potential public health crises to reduce negative outcomes for women in the future.

  References Top

  1. Cerrato J, Cifre E. Gender inequality in household chores and work-family conflict. Front Psychol 2018;9:1330.
  2. Gabster BP, van Daalen K, Dhatt R, Barry M. Challenges for the female academic during the COVID-19 pandemic. Lancet 2020;395:1968-70.
  3. Staniscuaski F, Kmetzsch L, Soletti RC, Reichert F, Zandonà E, Ludwig ZM, et al. Gender, race and parenthood impact academic productivity during the COVID-19 pandemic: From survey to action. Front Psychol 2021;12:663252.
  4. Woitowich NC, Jain S, Arora VM, Joffe H. COVID-19 threatens progress toward gender equity within academic medicine. Acad Med 2021;96:813-6.
  5. Mache S, Bernburg M, Vitzthum K, Groneberg DA, Klapp BF, Danzer G. Managing work-family conflict in the medical profession: Working conditions and individual resources as related factors. BMJ Open 2015;5:e006871.
  6. Mantri S, Song YK, Lawson JM, Berger EJ, Koenig HG. Moral injury and burnout in health care professionals during the COVID-19 pandemic. J Nerv Ment Dis 2021;209:720-6.
  7. Busch IM, Moretti F, Mazzi M, Wu AW, Rimondini M. What we have learned from two decades of epidemics and pandemics: A systematic review and meta-analysis of the psychological burden of frontline healthcare workers. Psychother Psychosom 2021;90:178-90.

  Oral Number 62 Top

Assessment of Perception and Knowledge of Medical Students Towards Telemedicine in Pakistan during COVID-19 Pandemic: Recommendations for Future Reforms

Nida Hashmi1, Irfan Ullah2,3, Muhammand Junaid Tahir4, Qudrat Ullah Quadrat2,3

1Department of Internal Medicine, Karachi Medical and Dental College, Karachi, 2Internal medicine, Kabir Medical College, Gandhara University, 3Undergraduate Research Organization, Dhaka, Bangladesh, Naseer Teaching Hospital, Peshawar, 4Department of Internal Medicine, Ameer-ud-Din Medical College, Lahore, Pakistan, Lahore General Hospital, Lahore, Pakistan

Objective: The field of telemedicine is continuously evolving and providing access to geographically disadvantaged people, especially during COVID-19 pandemic. The objective of our study is to appraise the knowledge, attitudes, and practices of medical students of Pakistan regarding telemedicine and to identify the perceived barriers affecting the practice of telemedicine.

Methods: This cross-sectional study was conducted among medical students of Karachi and Lahore, Pakistan. We received 450 responses from the participants. After removing incompletely filled responses, the total sample size (n) included was 426. Both male and female medical students aged 20 years and above were included. A self-designed online questionnaire and a non-probability convenient sampling technique are employed to record the responses. This questionnaire was distributed online using Google document form to avoid personal contact and violation of SOP during the pandemic. The data were collected during June and July 2020 through social media platforms i.e. Whatsapp and Facebook. Participation was voluntary and prior electronic consent was obtained from all the participants. The students studying in various fields other than medicine and doctors were excluded to avoid bias. The Chi-Square Test, Mann Whitney test and Kruskal–Wallis test were applied using SPSS v22 for analyzing the correlation between the variables, including advantages, disadvantages and barriers associated with Knowledge, Attitude and Perception. A p-value of less than 0.05 was considered statistically significant in all tests.

Results: About 66% of females and 35% of males participated in our study. 63.4% of females had heard about telemedicine before (p value = 0.042). The association of telemedicine knowledge with gender was assessed by applying the Chi-square Test (X2 = 4.122). The significant association was found and 63.4% females (and 36.6% males had heard about telemedicine before (p = 0.042). The source of telemedicine that showed significant association (X2 = 7.951 and p = 0.047) was social media, recorded in 69.3% females and 30.7%. [Table 1]. There were significant findings in response related to telemedicine to be practiced after COVID-19 (p =0.037). The majority accepted that it could prevent unnecessary hospital visits (Mean + 4.2) and is better for follow-up. The perception related to its barrier suggested that every disease cannot be managed easily (Mean = 4.045, SD ± 1.235). Due to the lack of technology in Pakistan telemedicine cannot be practiced efficiently. This mistrust in technology (Mean = 3.023, SD ± 1.194) may create insufficient medical evidence for diagnosis. Also, mistrust on healthcare providers (Mean = 2.746, SD ± 1.234) was considered as a barrier [Table 2].

Conclusion: Telemedicine knowledge among medical students was found to be good, and their perception correlates strongly with a positive outcome. Medical students found telemedicine to be time-saving and cost-effective, especially for follow-ups. This would provide students more resources and alternative job opportunities in future and reduce the burden of disease among patients. Most students agreed that telemedicine could not be practiced effectively due to a lack of technology in Pakistan. Therefore, acceptance of eHealth and telemedicine programs by patients is essential for the significant adoption of public policies. Also, the acceptance of medical students is necessary for development of digital health technologies in Pakistan.

  Oral Number 68 Top

Gender Differences in Parental Leave Usage at a Major United States Urban Institution

Maurgan Lee1, Mayra Shafique1, Lucki Word1, Julie Crego1, Leah Robinson2, Anil Aranha1, 2, 3, Beena G. Sood1,4

1Department of Medical Education, Wayne State University School of Medicine, 2Diversity and Inclusion, Wayne State University School of Medicine, 3Department of Internal Medicine/Geriatrics, Wayne State University School of Medicine, 4Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA

Background and Purpose: The United States lacks a nationally mandated parental leave policy. The months after birth are essential for overall health of both mother and offspring, family development, workplace productivity/satisfaction, as well as the promotion of career advancement for women. The purpose of this study is to describe the use of parental leave by all employees in a large urban public University, and further examine leave differences due to gender and profession.

Methods: Retrospective analysis was conducted on human resources data from a major urban university. Data included: socio-demographics, and length and number of parental leave. Data was analyzed using SPSS and statistical significance was established at p < 0.05.

Results: Data were available for a total of 5,484 employees over a 10-year period (January 2011 to December 2020); of these, 349 (6.4%) took parental leave. Of employees who took parental leave, 297 (85.1%) were female, majority Caucasian (57.9%), and married (79.7%). Study participants had mean incomes of $68,500. Although both men and women used parental leave; women were more likely to take parental leave, and take lengthier parental leaves compared to men (p < 0.05). Gender, professional, and citizenship status had major impacts on securing parental leave and parental leave duration. Women in medicine were less likely to take parental leave, and took shorter leaves, compared to counterparts in varying fields (<0.05).

Conclusion: Our study shows that multiple socioeconomic factors are related to obtaining parental leave, as well as its duration. Monetary and career repercussions may influence the decision to take parental leave, and overall preference to engage in parenthood. Such issues can be addressed by implementing institutional policies which inform employees about parental leave benefits and the existence of such policies. Parental leave policies can address the needs of parents in the workforce, and thus improve family bonding and dynamics, as well as workplace productivity and satisfaction.

  Oral Number 69 Top

Implicit Bias Assessment by Career Stage in Medical Training: A Scoping Review

Alisha Crump1, May Saad Ibrahim Al-Jorani2, Deborah D. Rupert3, Marah N. Kays4, Anna Sicilia5

1Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR, 3Stony Brook University, Stony Brook, NY, 4Kansas City University, Kansas City, MO, 5College of Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA,2College of Medicine, Mustansiriyah University, Baghdad, Iraq

Introduction: Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person based on individual characteristics. Of special concern to the healthcare field are those biases that result in the further marginalization of vulnerable populations (i.e., race, gender, age, and sexual orientation). Early evaluation of implicit bias in medical training can prevent long-term adverse health outcomes. However, to our knowledge, no present studies examine the sequential assessment of implicit bias through the different stages of medical training, namely pre-medical, graduate, and post-graduate (also referred to as medical graduate).

Objective: The objective of this systematic scoping review is to examine the breadth of existing publications that assess implicit bias at the current levels of medical training, pre-medical, graduate, and post-graduate.

Methodology: Protocol for this study was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols, Scoping Reviews extension (PRISMA-ScR). Keyword literature search on peer-reviewed databases Google Scholar, PubMed, Ebsco, Science Direct and MedEd Portal from January 1, 2017, to March 1, 2022, was used to identify applicable research articles. Articles were included in the study if they contained the following: 1) a title and abstract within the scope of implicit bias and medical training, 2) provided full text, 3) conducted in the United States, 4) in American English, 5) qualitative or quantitative research and 6) were within the scope of assessing implicit bias at one of the three identified levels of medical training. A standard reference management software was used to organize and collect all articles. Two reviewers assessed the eligibility of the identified papers based on precise content and quality criteria.

Results: The online database search identified 1,518 articles. Full screening resulted in 87 papers meeting the inclusion criteria. All papers included in the study assessed implicit bias at one of the various levels of medical training. Papers including mixed levels of medical training (medical student, resident, and practicing providers) were also collected. Seventeen (20%) of the extracted articles assessed gender-specific implicit bias, 15 (17%) assessed race-specific biases, and 31 (36%) examined implicit bias as a general definition. Four other biases were investigated, including weight, age, socioeconomic status, and sexual orientation. The majority of the extracted papers (74%) were published between 2019 and 2021 and investigated implicit bias at the post-graduate level (43%), followed by the graduate level (34%), and pre-medical level (10%). Thirteen percent were classified as mixed. At each level of medical training, results indicated that students demonstrated an implicit preference toward individuals identified as white, male, young, thin, and non-LGBTQIA+.

Conclusion: Our findings indicate the need for healthcare professionals to address implicit bias at all levels of medical training. Furthermore, this study highlights notable gaps within the sequential assessment of implicit bias, specifically at the pre-medical training level. Further research should be conducted on the impact of such biases and possible training programs aimed at addressing this healthcare disparity.

  Oral Number 71 Top

Gender Inequities in the Impact of COVID-19 Pandemic on US Researchers

Anna Volerman1, Monica Kowalczyk2, Sandra Hamt3, Rachel Wolfson4, Vineet Arora5, Valerie Press6

1Department of Medicine, University of Chicago, Chicago, IL, 2Department of Medicine, University of Chicago, Chicago, IL, 3Sandra Ham Consulting, Buffalo, NY, USA, 4Department of Pediatrics, University of Chicago, Chicago, IL, 5Department of Medicine, University of Chicago, Chicago, IL, 6Department of Medicine, University of Chicago, Chicago, IL,

Objective: To understand the impact of the COVID-19 pandemic on early career researchers and identify if gender inequities exist.

Study Design: This cross-sectional study surveyed early career researchers across the United States. An invitation was disseminated via email in fall 2021 to each person to complete an electronic survey in REDCap, with up to five follow-up emails to non-responders. The survey examined the pandemic's impact on professional advancement and career measures, personal / home life, and well-being / burnout; here we focus on the professional and career measures.

Population Studied: The study population was early career researchers, defined by all individuals having an active F32 or K-level award in 2020. Names and contact information were obtained from the National Institutes of Health. Of 4,440 researchers, 1, 587 (36%) completed survey questions with 61.2% identifying as female (n = 971), 32.96% male (n = 523), and 0.57% non-binary (n = 9). The majority of respondents were white (63.5%, n = 1008), with smaller percentages of Asian (15.6%, n = 248), Hispanic or Latino (7.2%, n = 114), multiracial (3.8%, n = 60), and Black or African-American (3.3%, n = 52). Most had a PhD (69.9%, n = 1,110) while just over one-third had an MD or equivalent (36.9%, n = 586). The majority (80.3%, n = 1274) were funded by a K-level award.

Principal Findings: Overall, most respondents reported negative impact of the COVID-19 pandemic on their career trajectory (61.5%, n = 976), research productivity (81.7%, n = 1,287), access to facilities (80.0%, n = 1,269), access to research staff (80.2%, n = 1,273), and access to colleagues (74.2%, n = 1,178). Nearly everyone reported their research project was slowed during the pandemic (96.0%, n = 1,523) and they were negatively affected by cancellation of in-person professional conferences (92.7%, n = 1,471). Fewer than half of respondents reported negative impact on grant submissions (43.0%, n = 683), funding awards (28.6%, n = 375), and access to mentors (48.6%, n = 722). Women were significantly more likely than men to report negative impact of the pandemic on overall productivity (83.4% vs 78.2%, p = 0.01), number of manuscripts submitted (62.4% vs 53.0%, p = 0.0004), and number of manuscripts published (59% vs 48.7%, p = 0.0002). Men were more likely than women to report a negative impact due to cancellation of conferences (94.8% vs 92.0%, p = 0.04). There were no reported differences between genders for grant submissions, awards, or access to labs, facilities, staff, and mentors.

Conclusions: The COVID-19 pandemic negatively affected early career researchers in the United States. Results show broad-based deleterious effects across areas that are foundational to advancing as independent investigators, including: access to facilities, staff, collaborators and mentors; submitting grant proposals; publishing research; and attending conferences. Notably, individuals were less impacted in terms of funding.

Implications for Policy or Practice: Support for early career researchers is needed for recovery of research productivity impacted by the COVID-19 pandemic. Programs and interventions that assist early career researchers in practical and tangible ways will be critical to mitigate the negative impacts of the pandemic and help them adapt career trajectories.

  Oral Number 103 Top

Mentorship Events at In-Person vs. Virtual Medical Conferences: Comparison of Platforms for Effective Networking

Nataly Montano Vargas1, Irene Kalbian2, Morgan Levy3, Alyssa Brown4, Selena Park5, Katherine Sharkey6

1Brown University, Providence, 2Department of Rehabilitation and Human Performance, Mount Sinai Hospital, New York, 3University of Miami Miller School of Medicine, Miami, 4Northwestern University, Chicago, 5Rutgers Robert Wood Johnson Medical School, New Brunswick, 6Warren Alpert Medical School of Brown University, Providence, USA

Introduction: At the beginning of the COVID-19 pandemic, professional medical organizations' meetings were forced to pivot rapidly to online platforms. Many organizations continue to host virtual or hybrid events due to continued concerns about the pandemic, lower costs, and increased convenience. Potential drawbacks of virtual events include fewer traditional networking and mentorship opportunities – a decline that may disproportionately affect women and other historically underrepresented groups. Our aim was to assess in-person and virtual mentorship events at annual national medical conferences to better understand these models.

Methods: We evaluated participant feedback forms from mentorship events at three conferences organized by the American Medical Women's Association: one pre-COVID (2019) and two during the global pandemic (2020 and 2021). In 2019 and 2020, interested physicians and students were paired and instructed to coordinate an in-person (2019) or virtual (2020) meeting. In 2021, students and physicians were invited to a scheduled “Power Hour” mentoring session consisting of small groups of students with 1-2 physicians. Participants completed an online feedback survey about their experiences. We used SPSS Version 25 (IBM Corp., Armonk, NY) to evaluate attendance, topics of discussion, and likelihood of future participation.

Results: We received feedback forms from 128 participants from the 2019 in-person event (student n = 50; physician n = 78); 57 from the 2020 virtual meeting (student n = 33, physician n = 24), and 44 from the 2021 virtual meeting (student n = 31, physician n = 13). The percentage of respondents who reported meeting with their assigned mentor/mentee differed significantly across years (Chi-square = 12.25, df = 2, p = 0.002). More than half of respondents reported having a meeting in 2019 (students = 54.0%, physicians = 55.1%), while 84.6% of physicians and 83.9% of students reported completing a meeting in 2021. In 2020, 55.1% of student respondents did not connect with a mentor, but 70.8% of faculty respondents reported meeting with a student. Failure to meet was attributed to different reasons each year (Chi-square = 80.949, df = 6, p < 0.001). The most commonly reported reasons for not meeting each year were as follows: 2019: failure to connect in person after being assigned to mentor-mentee pair (54.4%); 2020: no response from other party after pairing (77.8%); 2021: competing demands of work or school (100%). Participants reported a high likelihood of participating in a future mentoring event with no differences observed across years (overall mean (SD) = 4.2 (1.1) on a scale of 1-5; F (2) = 1.597, ns). The most frequently discussed topics were work/life balance (43.2%), specific fields of medicine (37.6%) and applying to residency (19.2%).

Discussion: The COVID-19 pandemic impacted all parts of medicine, including opportunities for mentoring and networking. Our data show that physicians and students were satisfied with career development opportunities in both in-person and virtual formats. Notably, respondents reported similar or increased participation in the virtual format meetings compared to in-person. This suggests that virtual mentoring scenarios have potential to increase mentoring opportunities to underrepresented groups by overcoming geographic limitations. Continued work is needed to further develop effective mentoring paradigms that foster professional advancement of women and other underrepresented groups in medicine.

  Oral Number 119 Top

Integrating (In) Fertility and Reproductive Health Curricula into Graduate Medical Education

Ritika Dhawan, Arushi Hukku, Megan Konopka, Mona Vashi, Mary Wood-Molo, Abhaya Trivedi

Rush University Medical Center, Chicago, IL, USA

Objective: We present our approach to integrating education about physician infertility and fertility into the Internal Medicine Residency Curriculum at Rush University Medical Center (RUMC). According to the AAMC,[1] in 2019 female enrollment in medical school exceeded that of men for the first time - a trend upheld annually since. Thus, in 2023 women will represent the majority of first year physicians entering the workforce from US MD granting medical schools. After 10 years of post-graduate training, these physicians, on average, will be 31 years when they become attendings. Most female physicians give birth for the first time at 32 years old, compared to 27 years of age for non physicians. Female physicians not only show higher rates of infertility compared to the general population, even among age-matched controls, but are at higher risk for severe maternal morbidity. Advanced maternal age, due to delayed age of childbearing common amongst female physicians, increased the risk of maternal morbidity.[4] Early intervention is critical to supporting and empowering the reproductive health of female physicians. As of 2017, the Accreditation Council for Graduate Medical Education (ACGME) revised the Common Program Requirements for all accredited residency and fellowship programs to address strategies to improve physician well-being, emphasizing “psychological, emotional, and physical well-being are critical in the development of the competent, caring, and resilient physician.”[6] To achieve this, programs accredited by the ACGME must identify and incorporate reproductive health into the curricula. This requires offering education akin to core medical training and resources geared towards financial literacy, physical wellbeing, mental health resources, and wellness.

Methods: In 2020, physicians from the Mayo Clinic, University of Chicago and Stanford University proposed three strategies to address physician infertility. First, increasing fertility education and awareness throughout medical education, training, and practice. Second, providing insurance coverage for and access to fertility assessment and management. Third, offering support for physicians undergoing fertility treatments. We incorporated these tenants to develop and execute a panel discussion during protected resident learning time addressing female physician (in)fertility.

Results: Faculty at RUMC developed a forum to address (in)fertility amongst female physicians with a reproductive endocrinology specialist, attending physicians in pulmonary critical care sharing their fertility journey, along with a fellow physician undergoing infertility treatment. Specifically, infertility and fertility treatments offered at RUMC along with parental leave were discussed. Additionally, time was designated at the end of the session to allow trainees to ask questions and generate further discussions about issues pertaining to reproductive health, fertility and infertility care, and pregnancy and postpartum resources.

Conclusion/Future Directions: Future directions of this project would include surveys to assess trainees' knowledge regarding these topics upon the start of their training program and at the end of their first year of training. This would determine their knowledge regarding specific policies and allow for feedback to extend discussions to relevant topics for trainees. This structure will allow for curation of benefits and resources available to physicians at all levels – student, house staff, and attending – and survey of resource utilization.

  Oral Number 120 Top

Sex Differences in Heart Failure Outcomes Are Not Accounted by Age, Co-Morbidities or Access to Care After Acute Myocardial Infarction

Perman Pandal1, Kwame Bodor-Tsia Atsina1, Eliseo Vasquez2, Elizabeth Cortez-Toledo1, Alejandra Galina Bernal Fausto1, Stephen Warren1, Shadi Nicole Nemanpour1, Daniel Hogan Slack1, Javier E. Lopez1

1Division of Cardiovascular Medicine, Department of Internal Medicine, UC Davis School of Medicine, University of California, Davis, 2Division of Infectious Diseases, Department of Internal Medicine, UC Davis School of Medicine, University of California, Davis, Davis, CA, USA

Background: Outcomes after an acute myocardial infarction (AMI) vary between women and men. While age, comorbidities and treatment access are proposed as explanations, the cause of this difference remains controversial. This study aimed at correlating all-cause mortality, recurrent AMI and/or heart failure (HF) hospitalizations after 1-year in men and women receiving percutaneous coronary interventions (PCI) for an AMI.

Methods: Data from the electronic medical record was collected on patients treated for AMI at our institution between 2003 and 2019. Univariate analysis identified demographics and comorbidities that varied between women and men. Multivariate logistic regression analysis assessed sex differences in clinical outcomes after AMI.

Results: Of the 882 AMI patients, 727 had clinical outcomes recorded 1-year post AMI. Compared with men, women were older and had a higher prevalence of co-morbidities except tobacco use [Table 1]. After adjusting for age and comorbidities, death and recurrent AMI were not significantly different between men and women. However, HF rehospitalizations were significantly higher in women [[Table 2], OR, 2.79; 95% CI, 1.48 – 5.26; p = 0.0014].

Conclusion: Despite receiving similar treatments for AMI and adjusting for age and comorbidities, women had 2.79 times higher odds than men for having HF rehospitalizations within 1 year. Further studies are needed to define the cause of this alarming rate of HF in women despite revascularization.

  Poster Number 4 Top

Skincare from the Inside Out: A Pilot Project Addressing Social Determinants of Health Through Dermatology

Kelly Kimball, Rachel Krevh, Adrianna Nicholson, Payas Shah, Shreya Gurumurthy, Jaqueline Graham

College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA

Many women's shelters across the nation have programs that emphasize and empower women through career workshops and skills training. However, what is not typically addressed is their dermatological and mental health needs, which are equally important. Through this dermatology pilot project, we aim to address the diverse interrelated issues concerning the whole woman and her body/mind systems including aging, skin cancer awareness, skincare, healthy sun habits, self-esteem, mental health, stress management, and body image. By addressing the woman holistically, we hope to positively impact the way she views and values herself. Our ultimate hope with this seminar is that when she leaves the shelter, she will be able to reenter society with the knowledge and confidence that she can be successful. We partnered with a local women's shelter to host a seminar focused on dermatological and mental health education. Pre- and post-seminar surveys were collected from participants. Surveys were anonymous and did not aim to generalize or draw conclusions about this population of women but to assess the success and efficiency of the workshop to guide and improve future seminars. The seminar had three workshops: skin cancer and sun protection, skincare, and mental health and wellness. At the end of the seminar, the attendees were provided with the opportunity to receive free skin examinations by two board-certified dermatologists, and referrals were made to Northeast Ohio Medical University's Student-Run Free Clinic. Upon completion of the seminar, attendees were provided with items such as sunscreen, skincare, and mental health resources.

  Poster Number 5 Top

Analysis of Gender-Differences in Perception of Sexual Dysfunction and Medical-Help Seeking Behavior among Medically-Educated Individuals at TTUHSC

Nicholas Householder, Akshay Raghuram, Skyler Thipaphay, Kofi Agyare, Cameron Tuazon, Wooyoung Jang

Texas Tech University Health Sciences Center, Lubbock, USA

Objective: The objective of this study is to analyze gender-differences in perception of sexual dysfunction and medical-help seeking behavior among medically-educated individuals (TTUHSC grad students and faculty).

Methods: Data was collected via an Omnibus survey that was administered online and sent to Texas Tech Health Sciences Center Staff, Faculty, and third and fourth year Medical Students in Lubbock, Permian Basin, Midland, and Odessa. Data from the survey was recorded and reorganized in excel for analysis.

Results: The results of our survey showed that far more women than man report experiencing sexual dysfunction in their own lives. It was also found that women surveyed were most likely to ignore/wait and see in the first 1-2 weeks of experiencing sexual dysfunction, and were found to be more likely than men to ignore/wait and see after 2 months of experiencing sexual dysfunction. Men were found to be more likely to make doctor's appointment after 2 months of sexual dysfunction, whereas women in this situation were found to be most likely to consult online resources at this mark. The results of this study also indicate that health-educated women are more likely to wait 2+ months from the onset of sexual dysfunction before making a doctor's appointment, compared to health-educated men. Among the sources of trusted information regarding sexual dysfunction, men and women were found to be equally most trusting of PCPs, Specialists, and Health Websites [Figure 1].

Significance: Although sexual dysfunction is usually thought to be associated with men, it is interesting to note that women surveyed in this cohort report experiencing much higher rates of sexual dysfunction. In addition, the majority of those women surveyed stated that they would not seek medical attention from a physician for sexual dysfunction within the first two months, whereas men were far more likely to seek medical aid in this time frame.

Conclusion: Despite sexual dysfunction being far more present amongst health-educated women at TTUHSC, the results of study found that they were less likely to seek medical aid from a professional at both the 2 week mark, 1 month mark, and 2 month mark. We hypothesize that this may be a result of underlying societal norms, taboos, and expectations for men to be more sexual beings than women, resulting in a perception that sexual dysfunction is more “normal” in women than in men. There could also be underlying hormonal mechanisms at play, potentially influenced by widespread use of hormone-modulating birth control medication amongst women.

  Poster Number 11 Top

Designing a Novel Cost-Effective Device to Prevent Perineal Tears During Labor

Yuvna Musuku

High Technology High School, Lincroft, USA

9 in 10 first-time births result in some form of perineal laceration. Such an injury can generate long-term challenges to a mother's mental and physical health. The goal of this project is to design a device that can decrease the risk of perineal tears during childbirth. Several designs and materials were tested on a CAD model of the female pelvic anatomy (the vaginal opening, perineum, and anal opening) until the optimal design was produced. First, the model was stress-tested without the device at forces of 22.3 N, 37.8 N, and 31.3 N. The model was then tested again with the device attached to determine the effectiveness of the design in reducing the stress at each level. Multiple stress tests were administered to ensure authentic results. Statistical analysis was then conducted between the mean stress values of each group. All three t-tests yielded a p-value less than the declared alpha value of 0.05, thereby indicating that the device significantly reduced the amount of strain placed on the perineum, and ultimately, minimized the risk of a perineal tear. Further testing and modifications will be continuously made to improve this device.

  Poster Number 14 Top

A Virtual Longitudinal Women in Medicine Leadership Series using Situational and Collaborative Learning models to help women gain confidence to achieve and succeed in leadership positions

Julie Schwartzman-Morris1, Karen Friedman2, Alice Fornai3, Nancy Lavine4, Johanna Martinez5, Shara Steiner6

1Division of Rheumatology, Department of Medicine, Zucker School of Medicine, 2Department of Medicine, Zucker School of Medicine, 3Department of Educational Skills Development, Zucker School of Medicine, 4Department of Medicine, Zucker School of Medicine, 5Department of Medicine, Zucker School of Medicine 6Department of Specialized Program in Education, Hofstra University, Hempstead, USA

Gender disparities for women in Academic Medicine exist at the individual, institutional and system-wide levels. Workplace discrimination against women, in particular women of color, have been noted. Women in academic medicine experience greater challenges finding mentors and sponsors than men which also contributes to career disparities. We developed a longitudinal Women in Medicine Leadership Series to offer strategies, skills development, and education to help women gain confidence to achieve and succeed in leadership positions. The program goals were improving career satisfaction for faculty members, to begin an institution-wide dialogue about gender equity, to create a community of practice amongst our School of Medicine Faculty from different departments, and to strengthen the resources for advancement of Women in Medicine. We provided learners with tools for career building, leadership, organizational and personal success. Learners attended monthly seminars that include both didactic and interactive portions. The program incorporates collaborative and social learning and situated learning model. The experience of attending the seminar and active participation during each unique session served to support the learners. Ultimately achieving measurable Gender Equity at the Academic rank and Institutional leadership levels in Northwell is critical and would signify long-term success of the program. Learners were taught initially via didactic format and with subsequent collaboration with peers in the group. The faculty guided and supervised discussions. The learning environment of the virtual platform was highly conducive to persons from multiple departments and with varying schedules of work and home life being able to participate. The faculty and moderators enhanced each learners' experience by encouraging participation and establishing a safe learning environment. Some learners may have already gained skills prior to the session if they happen to have attended similar sessions prior, while others may not have any experience at all. This curriculum is based on Kern's Six-Step Model and each step has been delineated above. Doing so allowed the activities to be fluid and adapt as learners adapt and develop. The desired results are readily identified, using this information to develop the course and methods of instruction supports this program and the need. One hundred fifty-two women Faculty Members from the Zucker School of Medicine registered for the course. Fifty percent of the learners had not previously attended any leadership course. At the end of the nine-session course, over 50% learners Strongly or Somewhat agreed participation would help achieve leadership roles and over 60% felt confident in achieving promotion in rank. Over 80% of learners believed participation would grant them both confidence and the ability to succeed in a leadership role. Learners stated: all the topics were relevant, current, and not only were the topics developed, but real-life insights and strategies were presented to apply these skills; the sense of comradery and developing a community with other women faculty were some of the greatest benefits. The course is currently in year two and we are collecting longitudinal data on leadership role and promotion in rank achievement for learners Full course details and data available.

  Poster Number 15 Top

A Pilot Study Assessing Resource Insecurity for Medical Students during the COVID-19 Pandemic

Dana Allison1, Vinh Le1, Richard Brach1,

Eileen Cichoski Kelly2

1University of Vermont College of Medicine, 2Department of Family Medicine, University of Vermont College of Medicine, The Robert Larner, M.D College of Medicine at The University of Vermont, Burlington, USA

Objectives: The LHOMe initiative was designed to assist medical students year-round in matters of emergency shelter and resources, as well as mental health. Following an internal assessment of the UVM Larner College of Medicine student body during the emerging COVID-19 pandemic, a resource hub was constructed for students to access avenues of support, enabling them to focus on academic and professional responsibilities, meet curricular expectations, and limit attrition in alignment with AAMC initiatives to address health equity efforts by the physician workforce.

Methods: A college-wide survey was delivered to examine (a) student living conditions and (b) knowledge of UVM LCOM emergency resources as it relates to: Disadvantaged status, Living arrangement (alone, roommate(s), etc.), Level of experience with resource insecurity (e.g. clothing, food, and shelter), Level of academic compromise relating to resource insecurity, and personal knowledge of UVM LCOM emergency resources.

Results: For 300 respondents out of 480 total students, ~73% of responses demonstrated unfamiliarity with local and institutional resources available to address resource insecurity, and ~84% of respondents indicated a lack of awareness about whom to contact for concerns on resource insecurity. Survey results helped propel the medical school to reinstate its CARES Act grant and develop new institutional services within the College of Medicine (free meetings with a CFP, increased financial wellness initiatives, and the establishment of a Student Advisory Council to Medical Student Financial Services). Additionally, the UVM Office of Student and Community Relations created additional venues to address student hardship using a food insecurity awareness campaign (social media and physical flyers) and community resource guides. Lastly, at a town hall sponsored by the College of Medicine, Hunger-Free Vermont led a discussion on Vermont's Supplemental Nutrition Assistance Program and newly revised policies that would accommodate medical students experiencing food insecurity.

Conclusions: Medical students, even while serving others, are a part of the community and therefore are subject to the same stressors that many individuals face regarding food and resource insecurity. The consequences of food insecurity, unstable housing, and financial instability – all social determinants of health – disproportionately impact non-traditional and underrepresented students. Students can struggle to maintain their grades and balance curricular commitments, suffer mental health crises, and, in some cases, put their medical education on pause or leave school entirely. As such, LHOMe was established with the intention of connecting students with resources that will meet their basic needs. On reflection, this project has provided a microscopic example of a lack of resource awareness that could be extrapolated to other medical schools nationwide. These results may propel similar assessments at other schools, and it is our hope that similar assessments are used to drive substantive action addressing resource insecurity and deficits in knowledge, just as in this project. As this work continues, we hope further exploration of resource insecurity within the medical student community will help students meet their basic needs, focus on academic and professional responsibilities, and limit attrition in alignment with AAMC initiatives to address health equity efforts by the physician workforce.

  Poster Number 16 Top

Gender Dysphoria and a Rare 46, XY Phenotype with 17-Beta Hydroxysteroid Dehydrogenase Type 3 Deficiency

Jason Kopp, Mahfujul Haque

Michigan State University College of Human Medicine, Grand Rapids, USA

Background: The 46 XY phenotype accompanied by a 17 beta-hydroxysteroid dehydrogenase type 3 deficiency (17BHSD) is an autosomal recessive disorder of sex development.[1] It is characterized by a deficit in testosterone production and can include male and female genitalia. The estimated incidence is 1 in 147,000 newborns.[2] Appropriately caring for these patients require a multidisciplinary approach which includes a geneticist, gynecologist, endocrinologist, psychiatrists, pediatric surgeon, and social workers.[3] Due to the rareness of this disorder, families are often confused by what this diagnosis means for their child. More importantly, a patient with 17BHSD faces unique challenges growing up. Here, we discuss the impact of the patient's clinical presentation, gender dysphoria, and uncertainty around her gender role.

Case Description: At 15 months during a hernia repair, the patient was discovered to have bilateral inguinal testes. A karyotype genetic test confirmed 46-XY. Additionally, at 11, she was diagnosed with 17BHSD after her testosterone levels were in male range (1.37 ng/mL), no uterus or ovaries were present, and a shallow vagina was noted. Her parents elected to delay a gonadectomy to allow the patient to decide gender closer to puberty. The risk of gonadal tumor development was deemed low (5-15%). The patient was diagnosed with a right multicystic kidney prior to birth and now has a solitary left kidney. As she got older, she began a testosterone blocker patch along with transdermal estrogen. She noted, however, signs of developing masculinity in her appearance, including voice cracking and substantial increases in height, weight, and pubic hair. At that time, the patient reported staying firm in her female gender identity. At 13 years of age, she was elected for a gonadectomy. She has recently been diagnosed with an adjustment disorder with an anxious mood. She reports this is related to her surgery and how she feels she may not have made the correct decision. Additionally, her mother reports concern for her feeling different and having many close friends who are male. The patient is unsure of what gender she prefers to identify as or if she prefers to identify as non-binary along with concerns about her gender role.

Discussion: With 17BHSD, there is a 25% chance a future child will also have 17BHSD. Careful newborn examination is important in the diagnosis of this condition. A study of 4 of 11 newborns with a 46-XY karyotype found that 8 remained undiagnosed after birth, of whom 7 had abnormal genitalia.[4] Once diagnosed, a patient and their family have treatment options including gonadectomy and initiation of estrogen or testosterone hormone replacement therapy. No gonadectomy is also an option provided there is a low-risk for tumor development.

For this patient, she has stated that she engages in repeated “what if” thinking related to her gonadectomy. It can be extremely debilitating for a patient to be unsure of their gender identity after a lifetime of procedures and medical therapy.[5] It is important that providers engage in a multidisciplinary approach to care for these conditions.

  References Top

  1. McEwan IJ, Brinkmann AO. Androgen physiology: Receptor and metabolic disorders. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, editors. Endotext. South Dartmouth (MA): MDText.com, Inc.; 2000.
  2. 17-Beta Hydroxysteroid Dehydrogenase 3 Deficiency: Medlineplus Genetics. MedlinePlus. U.S. National Library of Medicine. Available from: https://medlineplus.gov/genetics/condition/17-beta-hydroxysteroid-dehydrogenase-3-deficiency/. [Last accessed on 2022 Nov 13].
  3. Al-Jurayyan NA, Al Issa SD, Al Nemri AM, Al Otaibi HM, Babiker AM. The spectrum of 46XY disorders of sex development in a University Centre in Saudi Arabia. J Pediatr Endocrinol Metab 2015;28:1123-7.
  4. Sharp T, Fraser N, Shenoy MU, Randell T, Denvir L, Williams AR. 46XY girls: The importance of careful newborn examination. J Pediatr Adolesc Gynecol 2012;25:103-4.
  5. Köhler B, Kleinemeier E, Lux A, Hiort O, Grüters A, Thyen U, et al. Satisfaction with genital surgery and sexual life of adults with XY disorders of sex development: Results from the German clinical evaluation study. J Clin Endocrinol Metab 2012;97:577-88.

  Poster Number 18 Top

What To Expect When You're Not Expecting

Lena Carleton, Rebecca Kreston

Department of Internal Medicine/Emergency Medicine, University of Illinois Chicago, Chicago, IL, USA,

A 33 year old G0P0 woman with no significant past medical history presented to the emergency department with back pain. The pain started two days ago and was described as intermittent non-radiating crampy pain localized to the lumbar region. She was also on her menstrual period which similarly started two days prior and was “more watery” than usual. Her last menstrual period was two months ago and was normal. She had tried ibuprofen without any pain relief. The patient also endorsed two months of lower extremity edema and abdominal distention, for which she was prescribed furosemide by her primary care physician. On physical exam, she was hypertensive to 170/130 and tachycardic at 101. All other vital signs were normal. BMI was 33.9. She was uncomfortable appearing although not in acute distress. Her cardiovascular exam was notable only for 2+ bilateral lower extremity pitting edema. Lungs were clear bilaterally. Abdominal exam was notable for diffuse distention without ascitic fluid wave as well as a palpable firm mass in the RUQ with mild associated tenderness but no Murphy's sign. There was no CVA tenderness bilaterally, however she did have mild paraspinous lumbar tenderness bilaterally. CBC was remarkable for leukocytosis to 17.3 with leftward shift, with no anemia or thrombocytopenia. CMP showed an elevated alkaline phosphatase at 173 with no transaminitis. There was no evidence of renal dysfunction or electrolyte abnormalities. She was unable to urinate while in the emergency department so a serum b-HCG quantitative was ordered and elevated at 59,720 mUI/mL. The patient was immediately examined with bedside ultrasound and found to have an advanced intrauterine pregnancy, of which she was unaware. In the setting of severe range blood pressure consistent with preeclampsia with severe features, she was given IV labetalol and magnesium. On cervical examination, she was 8 cm dilated and a well-developed fetus was noted to be in the breech presentation. She was taken to the OR for an urgent Cesarean section and intraoperatively, was noted to be pregnant with twins. Two infants were delivered successfully, and gestational age was estimated to be 33 weeks and 4 days. The patient recovered well post-operatively and was discharged home on postoperative day 3. This case demonstrates the importance of including pregnancy in the differential diagnosis for women of child-bearing age presenting with abdominal pain or distention. In this population, a pregnancy test should be obtained before starting any medication or imaging that could potentially harm a fetus. This case also highlights the importance of diagnosis and appropriate management of hypertensive disorders of pregnancy, which can be associated with significant morbidity and mortality for both the mother and the fetus during the intrapartum and postpartum periods.

  Poster Number 21 Top

Use of Vaginal Iodine Preparation in High-Risk Pregnant Population to Reduce Risk of Post-Cesarean Endometritis

Madisyn Currie1, Joseph Henry1, Matthew Lenhard2, Bo Cai3

1School of Medicine, University of South Carolina, 2Department of Obstetrics and Gynecology, Prisma Health Midlands, Columbia, South Carolina 3Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, USA

Endometritis is an ascending pelvic infection that can complicate postpartum care for women, especially after delivering via cesarean section (c-section). Post-cesarean endometritis can increase morbidity and cost for women who give birth. The data on vaginal iodine cleansing before c-section is conflicting. Our goal is to determine the impact of a vaginal iodine preparation prior to c-section on incidence of endometritis with patients at Prisma Health Midlands. We hypothesize that women having an unplanned c-section who receive a vaginal iodine preparation prior to surgery will have a decreased incidence of endometritis. Data was collected using retrospective and prospective methods, and were evaluated on demographics of the population at Prisma Health Midlands. Retrospective data from previous years at Prisma Health Midlands were analyzed to find participants who fit the inclusion criteria. These participants were used as the control group, while prospective patients were consented at Prisma Health to receive a vaginal iodine preparation. Collection is still ongoing, but several preliminary data points have been obtained. Increased average time in labor correlated to greater incidence of endometritis with a P-value of 0.0196. A fever (> 38°C) was confirmed as a screening tool (p value <0.0001) for endometritis with a specificity of 99.2% and sensitivity of 69.2%. It was found that there was not a significant difference between white and black populations for the care and diagnosis of endometritis. Data collection is ongoing and will include 100 participants in order to increase the power of the study. Once these goals are met, more data analyses will be conducted. Future research on this topic includes expanding the generalizability of the study beyond large academic centers to include more rural areas.

  Poster Number 22 Top

Diversity Initiatives at Work: Recent Increases in Female Authorship among American Academy of Orthopaedic Surgeons Presentations

Hogan Brecount, Alyssa Goodwin, Steven Kurapaty, Rahim Laiwalla, Alexander Linton, Jacqueline Inglis, Nicholas Lanzetta, Wellington Hsu

Northwestern University, Chicago, IL, USA

Introduction: In 2018, the AAOS Board of Directors discussed diversity as a strategic goal. In the following years, AAOS increased social media outreach, panels, and encouraged further research. Limited literature within orthopedic surgery has examined rates of gender authorship over time. Trends at specialty-wide meetings like AAOS have not been described. The study aims to analyze poster authorship at AAOS Annual Meetings from 2021 to 2022 to track and assess trends regarding gender authorship.

Materials and Methods: Posters details from 2021 and 2022 published on the AAOS website were collected using a custom Python program. Poster ID, author name, author position (first, middle, or last), author country, were all collected. Gender identity for each author was predicted by using Genderize.io, a computer algorithm that has been validated in prior research. For the purpose of this study, gender was classified as male or female; however, we acknowledge that gender exists on a spectrum and is not binary. For authors with a low prediction probability (less than 0.5), manual validation via searching professional profiles or biographies was utilized. If unable to be found the author was excluded. Chi-squared tests were performed to compare gender authorship across the two years. Total authorship, authorship position (first, middle, last), and unique authors were compared from 2021 to 2022. Statistical analyses were performed using IBM SPSS for Windows Version 23.

Results: 12,662 authors were collected over the 2,014 posters in 2021 and 2022. Of these, 759 (6%) authors required manual validation of gender. Following manual validation, 12,564 total authors remained. There was a significant increase in the proportion of total female authors from 2021 to 2022 (16.5% to 17.9%, P = 0.034). There was also a significant increase in unique female authors, from 17.9% to 20.2% (P = 0.009). There were no significant differences in gender authorship by position (first, middle, last) [Table 1] and [Table 2].

Conclusion: Across the two most recent AAOS meetings, there was a significant increase in female authorship. There was also a significant increase in unique authors. This cross-sectional study suggests that recently, diversity initiatives both from AAOS and the field seem to be increasing female representation. Further work is needed to compare ongoing trends over the next several years to confirm these findings.

  Poster Number 24 Top

Presenting Options for Contralateral Prophylactic Mastectomy in Women Diagnosed with Breast Cancer: A Case Report

Riya Patel, Trisha Sindhu, Juana Hutchinson-Colas, Gloria Bachmann

Rutgers Robert Wood Johnson, Piscataway, NJ, USA

Objective: In 2020, female breast cancer was the most diagnosed cancer worldwide; there were 2,261,419 million new cases and 684,996 deaths. Breast cancer impacts many aspects of a woman's life, that can include her longevity and her emotional, social, and physical wellness. In terms of surgical treatment, women are usually offered different surgical interventions for treatment including simple mastectomy, contralateral prophylactic mastectomy, and breast-conserving surgery (with or without reconstruction). There have been studies that evaluated the link between different demographic factors and women's choice in surgery. These data relate the influences of age, socioeconomic factors, parenthood, family history of cancer, lactation status, body image, and/or marital status on the woman can influence her preference toward a particular breast cancer intervention. Moreover, the woman's perception and trust in the clinician also can play a role in her decision. Corresponding treatment selection that may affect the woman's appearance can have a significant impact on her long-term mental health. With these considerations, the objective of this case was to interview a Black woman, who is a breast cancer survivor to better understand the factors she considered in choosing contralateral prophylactic mastectomy.

Design: The woman is a 60-year-old breast cancer survivor who was interviewed by phone. She was enthusiastic to talk about her experience in order to potentially help other women diagnosed with breast cancer.

Results: As per her history, she first consulted a clinician after finding a lump in her breast ~10 years ago. After the diagnosis of breast cancer was confirmed, her surgeon recommended a unilateral mastectomy of the affected right breast followed by reconstruction. However, despite this recommendation, she opted for a contralateral prophylactic mastectomy without reconstruction. She chose to go against her doctor's recommendations and the desires of her family as they also wanted her to choose the unilateral mastectomy with reconstruction. She explained that her decision to have a bilateral mastectomy without reconstruction was made for these reasons: 1) she wanted to eliminate all breast tissue to reduce her worry of cancer relapse, 2) she did not want to have any potential surgeries in the future and 3) she has a strong sense of self-worth and although she considered the alterations this surgery would have on her body image, she believed that she would still be physically and sexually complete without having breasts. She continues to be extremely happy with her decision.

Conclusion: This case underscores the importance of clinicians also giving women the option of unilateral/bilateral mastectomy without reconstruction. This support and counseling are especially important if the woman is considering this surgery despite strong opinions by family/friends that she is making the wrong decision.

  Poster Number 25 Top

From Granulomatous Mastitis to Bilateral Primary B-Cell Non-Hodgkin Lymphoma of the Breast: A Journey

Maharshi Raval1, Suchi Shah2, Mrunal Patel3

1Department of Internal Medicine, Landmark Medical Center, Rhode Island, 3Department of Internal Medicine, Trumbull Regional Medical Center, Ohio, 2Department of Internal Medicine, AMC MET Medical College, Ahmedabad, India

Learning Objectives: (1) Recognize that even with mammography and MRI evidence, the diagnosis of PBNHL of the breast in relatively younger individuals might be challenging (2) Discuss why a biopsy is necessary to diagnose cases of PBNHL in the breast (3) Talk about the treatments that are available and underline the importance of established practices.

Case Presentation: A 47-year-old female patient from rural Western India came in with a right breast lump that has been bothering all quadrants for three months as her main complaint. Without any nipple secretion, the lump dramatically expanded in size the preceding month. A true cut biopsy was performed on the patient in a private hospital, and granulomatous mastitis was the subsequent diagnosis. She underwent a 2-month course of anti-tuberculosis medication therapy. A closer glance revealed redness, swelling, and a peau d'orange appearance in the right breast [Figure 1]. The nipple seemed to be in order. A diffuse mass that was present throughout the entire breast and was about 10x10 cm in size, firm to hard in texture, affixed to the skin but not to the chest wall, was discovered during palpation. The left breast looked to be normal, but with palpation, a well-defined, firm to hard-feeling lump of about 5 by 6 by 2 cm was felt in the upper outer quadrant; it was movable and not fixed to the skin and chest wall. On both sides, there were many, firm to hard, easily movable anterior axillary lymph nodes. Dilated ducts with hypoechoic regions were discovered during mammography. The signal intensity on the MRI was changed [Figure 2]. Because the results of imaging techniques are non-specific and very variable from case to case, a biopsy, the gold standard, was performed to confirm the diagnosis. After three cycles of R-CHOP and involved-field radiation therapy, the patient underwent a month of follow-up, and an examination revealed no palpable lumps [Figure 1].

Discussion: This case illustrates a very uncommon and early breast neoplasm presentation in the form of bilateral Primary B-cell Non-Hodgkin Lymphoma (PBNHL) of the Breast, which was initially misdiagnosed as granulomatous mastitis. The diagnosis was finally confirmed through surgical biopsy and immunohistochemical analysis. Thomas et al. In a study of 1034 patients with PBL found the median age of presentation was 66 years.[1] Because the prognosis and therapy depend on the diagnosis, it is important to distinguish it from secondary breast lymphoma. In the case of PBL, the common signs or symptoms of breast cancer such as skin retraction, erythema and peau d' orange are associated with high-grade lymphoma or diffuse parenchymal involvement.[2] Bilateral breast involvement is a poor prognostic sign with an increased risk of relapse and CNS involvement. In a patient with bilateral DLBCL, intrathecal CNS chemoprophylaxis is recommended, although its efficacy is debatable given the paucity of information on CNS relapse.[3],[4] It is necessary to have a standardized strategy for managing patients who have undergone bilateral PBL.

  References Top

  1. Thomas A, Link BK, Altekruse S, Romitti PA, Schroeder MC. Primary breast lymphoma in the United States: 1975-2013. J Natl Cancer Inst 2017;109: [Doi: 10.1093/jnci/djw294].
  2. Raj SD, Shurafa M, Shah Z, Raj KM, Fishman MD, Dialani VM. Primary and secondary breast lymphoma: Clinical, pathologic, and multimodality imaging review. Radiographics 2019;39:610-25.
  3. Ryan GF, Roos DR, Seymour JF. Primary Non-Hodgkin's lymphoma of the breast: Retrospective analysis of prognosis and patterns of failure in two Australian centers. Clin Lymphoma Myeloma 2006;6:337-41.
  4. Hall KH, Valla K, Flowers CR, Cohen JB. Intrathecal central nervous system prophylaxis in patients with diffuse large B-cell lymphoma at an academic healthcare system. Clin Lymphoma Myeloma Leuk 2019;19:89-94.

  Poster Number 29 Top

A Comparison of the Top 50 Most-Cite Article by Female First Authors and the Top 50 Most-Cited Articles by Male First Authors in the Orthopedic Literature: A Bibliometric Analysis

Yasmine Ghattas1, Cynthia Kyin1, Alison Grise1, Taylor Johnson2, Benjamin Service2

1University of Central Florida, 2Orlando Health, Orlando, USA

Background: The citation frequency for a journal article is a reflection of its academic impact.

Purpose: The aim of this study was to identify, characterize, and compare the top 50 cited journal articles in the orthopedic literature by both female and male first authors.

Study Design: Cross-sectional study.

Methods: The Web of Science and Scopus online databases were searched to identify the most cited articles for every Science Citation Index Expanded Orthopedic journal published between 2002 to present. The top 50 most cited articles by both male and female first authors were identified using a validated gender software, gender-api. The country of origin, publishing journal, publishing year, number of citations, citation density, number of authors, study type, level of evidence, and gender relationships between first and senior author were analyzed.

Results: The top 50 articles first-authored by both females and males respective total number of citations were 29,990 (~599.8 citations/paper) and 52,685 (~1,053.7 citations/paper) [Table 1] and [Table 2]. All studies were published in English. Female authors published in 17 journals and male authors published in 10. Female authors were primarily from American (n = 30, 60%) or Canadian institutions (n = 5, 10%), and male authors were primarily from America (n = 24, 50%) or the UK (n = 4, 8.0%). Overall, female authors represented 7 different countries of origin and male authors represented 13. When analyzing the association between first and last author gender, female first authors published at a significantly higher rate with female last authors than male first authors. 14 studies (28%) included both a female first and last author, but only 3 studies (6%) had a male first author and a female senior author (P = 0.0064).

Conclusion: This study provides an important look into the differences between the most cited and most influential papers published by both male and female authors in the orthopedic community. The top 50 female first-authored papers and top 50 male first-authored papers were cited a total of 29,990 and 52,865 times, respectively. Female first authors also published with female last authors at a significantly higher rate of 28% compared to 6% in male first authors.

  Poster Number 30 Top

Hardiness in Female Attending Orthopaedic Surgeons: A Pilot Study

Yasmine Ghattas1, Cynthia Kyin1, Vonda Wright2

1University of Central Florida College of Medicine, 2Hughston Clinic, Orlando, USA

Introduction: Resilience during trauma can be taught to gird surgeons against stress. Resilience is built via hardiness as measured by Stein & Bartone's Hardiness Resilience Gauge (HRG). This validated gauge measures common hardiness factors exhibited by highly resilient people. This pilot used the HRG to describe the landscape of current female orthopedic surgeons' hardiness and ability to cope with stressful situations to guide the design and execution of further research and training interventions in this area.

Methods: Hardiness data was anonymously gathered in a 3-step process. 1). The digital HRG was offered to members of the “Women in Orthopaedics'' Facebook page. 2). Volunteers were sent to the HRG (n = 68) 3). Surgeons who voluntarily completed the HRG were sent an anonymous follow-up survey (n = 48). Continuous and categorical variables were analyzed using a t-test and Fisher's exact test, respectively.

Results: 48 complete sets of HRG/survey results representing all subspecialties except tumor were analyzed. We analyzed several variables to determine the association with total HRG scores. Increased sleep, middle age, and self-reported well-being were all associated with higher HRG scores. Those who slept 7-8 hours (n = 28) significantly outperformed those who slept 5-6 (n = 20) hours on average on the HRG test (p = 0.016). Those scoring above 70% on the well-being scale outperformed those who scored less (p = 0.042). Years in practice and active child-rearing (p = 0.894) had no correlation to HRG total, while increased self-identified stress categories were associated with decreased total HRG scores.

Conclusion: Hardiness is a generalized mode of functioning influencing how people interpret the world and determines how they respond to stressful situations. In this study, age, sleep duration, and self-reported well-being positively impacted the total HRG scores significantly while self-identification of a high number of life stressors negatively correlated with total HRG. It was interesting to note that neither current child-rearing nor years in practice significantly affected total HRG in this group. Despite this study's limitations, it serves as an initial insight into the current mindset of female orthopedic surgeons and could be an integral part of the screening process in the Orthopedic residency match predicting successful applicants and as a tool for professional development to augment surgeon success throughout the career span.

  Poster Number 31 Top

Knowledge and Practices Concerning Prevention of Mother to Child Transmission of Hepatitis B infection: A Cross-Sectional Study in Rural Karnataka, India

Bhargavi R Budihal1, Tejasvi Kashyap2, Shankarsai Kashyap1, H. R. Rohith3

2General Practice, Jawarharlal Nehru Medical College, Belgaum, 3Department of Pediatrics, BGS Global Institute of Medical Sciences, 1BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India

Introduction: Sustainable Development Goal - 3 aims to reduce the disease burden of hepatitis by 2030. Worldwide over 300 million people are chronically infected with HBV and 75% of these are in Asia alone. In areas of intermediate prevalence like India (carrier rate 2%; prevailing infection in 20-50% population), if the mother is HBV positive, the risk of transmission of infection to a neonate can be as high as 85-90%. The present study was conducted to assess the knowledge of pregnant females concerning Hepatitis B infection, transmission, and prevention.

Materials and Methods: A cross-sectional study was conducted with 192 Pregnant females (in the third trimester), attending Ante-Natal Care (ANC) clinic using a structured questionnaire. The questionnaire had three sections namely the demographic details, the knowledge and practices regarding mother to child Hepatitis B transmission, and the Hepatitis B status of the mother. The data was collected and analyzed using Google Sheets.

Results: The mean age of the respondents was 23.2 +/- 1.9 years. Despite more than 90% (n = 176) of respondents being aware of Hepatitis B, only 2% (n = 4) knew that it was caused by a virus. The majority stated that infection was caused by the consumption of oily, spicy, unhygienic food, and pollution. Almost all pregnant females who gave blood samples were unable to name diseases for which screening was being done. Understanding of mother-to-child transmission of HBV infection was poor as 35.5% (n = 76) stated that any disease during pregnancy is transmitted to and affects the child. A very low percentage (10.4%, n = 20) of respondents were counseled during the antenatal period by health workers. Nearly 80% (n = 152) were aware of vertical transmission of Hepatitis B and only 35.4% (n = 68) were aware of vaccination as a prevention method. Our study suggested that pregnant women of lower socioeconomic status were more likely to be positive for Hepatitis B, yet didn't show any significant knowledge or proper practice towards prevention of transmission to the unborn child [Figure 1] and [Figure 2].

Conclusion: This study's findings highlight that pregnant women and mothers have insufficient knowledge and misconceptions concerning HBV infection especially those of lower socioeconomic status. Therefore, it is imperative to utilize the antenatal period as an opportunity to advocate for raising awareness about HBV infection.

  Poster Number 33 Top

Hybrid Closed-Loop Therapy as Management for Type 1 Diabetes Mellitus in Pregnant Patients

Edzel Lorraine Co1, Sneha Annie Sebastian2, Upasana Maskey3, Meghana Mehendale4, Selia Chowdhury5, Ivan Rodriguez6

1Division of Research and Academic Affairs, Larkin Community Hospital, South Miami, Florida, USA 2Division of Research and Academic Affairs, Larkin Community Hospital, South Miami, Florida, USA, 3Division of Research and Academic Affairs, Larkin Community Hospital, South Miami, Florida, USA 4Division of Research and Academic Affairs, Larkin Community Hospital, South Miami, Florida, USA 5Division of Research and Academic Affairs, Larkin Community Hospital, South Miami, Florida, USA 6Department of Family Medicine, Larkin Community Hospital, Hialeah, Florida, USA

Objectives: Type 1 diabetes mellitus (T1DM) is a hereditary, autoimmune disease that is very challenging to manage. Its management is geared towards utilizing hybrid-closed loop (HCL) therapy, an automated-insulin delivery consisting of an insulin pump, a control algorithm responsible for automatic adjustments in basal insulin delivery, and a continuous glucose monitor. In this study, the appropriate use of diabetes technology for pregnant patients with T1DM who are not amenable to the conventional insulin delivery method, its efficacy, and safety were discussed.

Methods: A systematic search of relevant articles from databases such as PubMed, Scopus, Google Scholar, EBSCOhost, ScienceDirect, and Clinicaltrias.gov was done independently by two authors. The risk of bias was assessed for all studies using the Joanna Briggs Institute critical appraisal tool.

Results: A total of 8 studies (3 randomized crossover trials, 3 case reports, 1 case series, and 1 retrospective study) with pregnant participants aged 19-29 years old were included in the study. The mean glucose concentration level ranged from 5.5 to 12.9 mmol/L, the mean HbA1c level during pregnancy was from 5.8 to 8.3%, and the median wear time based on the continuous glucose monitor (CGM) was reported from 61-93%. The average time spent when glucose was in the time in-target range, above the target range, and below the target range was 46.8 to 84.4%, 7.4 to 69%, and 0.3 to 10%, respectively. A short-term period was achieved to reach the optimal glucose control, which demonstrates a potential benefit of the use of HCL in challenging cases such as in conditions when there is a need for antenatal steroid administration and during labor and delivery. Different types of CGM were used [Abbott Diabetes Care, Freestyle Navigator 2, Dexcom G4, G5 or G6, Florence D2W, Florence D2A, Tandem T-slim insulin pump, RileyLink, Medtronic Minimed 670G, and Freestyle Libre) with only one study reporting 14 cases of skin reaction after the use of an unknown type of CGM. Out of 50 pregnant patients, better maternal outcomes were noted in the studies with a decrease in the episodes of hypoglycemia. Neonatal outcomes were significantly better in all the studies with no stillbirths or perinatal mortality thus reinforcing that CGM has better results.

Conclusion: HCL therapy is effective in managing pregnant patients with T1DM as it has better maternal and neonatal outcomes with a short-time period noted to reach the glucose target level.

  References Top

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  6. Murphy HR, Rayman G, Duffield K, Lewis KS, Kelly S, Johal B, et al. Changes in the glycemic profiles of women with type 1 and type 2 diabetes during pregnancy. Diabetes Care 2007;30:2785-91.
  7. Kerssen A, Evers IM, de Valk HW, Visser GH. Poor glucose control in women with type 1 diabetes mellitus and 'safe' hemoglobin A1c values in the first trimester of pregnancy. J Matern Fetal Neonatal Med 2003;13:309-13.
  8. Kallas-Koeman MM, Kong JM, Klinke JA, Butalia S, Lodha AK, Lim KI, et al. Insulin pump use in pregnancy is associated with lower HbA1c without increasing the rate of severe hypoglycaemia or diabetic ketoacidosis in women with type 1 diabetes. Diabetologia 2014;57:681-9.
  9. Murphy HR, Elleri D, Allen JM, Harris J, Simmons D, Rayman G, et al. Closed-loop insulin delivery during pregnancy complicated by type 1 diabetes. Diabetes Care 2011;34:406-11.
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  11. Murphy HR, Kumareswaran K, Elleri D, Allen JM, Caldwell K, Biagioni M, et al. Safety and efficacy of 24-h closed-loop insulin delivery in well-controlled pregnant women with type 1 diabetes: A randomized crossover case series. Diabetes Care 2011;34:2527-9.
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  Poster Number 39 Top

The Emergence of Positive Shift in Mindsets Regarding Diversity and Inclusion in Physician Mentors of Female and Minorities Under-Represented in Medicine Medical Students

Aviva Klein1, Aashna Sunderajan1, Vineet Arora1, Rachel Wolfson2

1Departments of Medicine and 2Pediatrics, The University of Chicago Prizker School of Medicine, Chicago, IL, USA

Objectives: The workforce of physician-scientists, particularly in senior leadership positions, persistently fails to reflect the diversity seen in both the general population and US medical schools, with women and minorities underrepresented in the physician-scientist pipeline. While mentor training does currently exist, many training programs are too cumbersome for clinical mentors to complete. Consequently, mentors of many medical students may not receive training, particularly on Diversity and Inclusion (D&I). As part of an ongoing NIH-funded randomized controlled trial, Boosting Mentor Effectiveness iN Training Of Research Scientists (Boosting MENTORS), we sought to articulate mentor reactions to a specific D&I training module.

Methods: A 10-minute D&I mentor training module (based on a previously peer-reviewed curriculum) was developed alongside higher education experts and included topics related to the importance of D&I conversations, various challenges marginalized students face, as well as their potential solutions. Mentors were asked two open-ended questions to gauge mentor baseline beliefs, including the positive and negative outcomes of having such conversations, and one question to determine the effects of the module. Responses to these open-ended questions were coded to highlight themes regarding D&I at baseline and at the conclusion of the module.

Results: In the summer of 2021, 28 mentors (5 men, 21 women, and 2 who preferred not to report) completed the module on D&I, 18 of whom worked with minorities underrepresented in medicine and 10 who worked with non-minorities represented in medicine females. Several themes from mentor responses emerged. At baseline, mentors could be classified as displaying passive (e.g., expecting mentees to initiate such conversations) or active (e.g., holding themselves accountable to initiate such conversations) approaches to D&I conversations. Mentors also identified differences in mentor/mentee demographics, questions of the usefulness of the conversation, and fear of accusations of prejudice (due to gender or otherwise) as reasons they hesitated to initiate conversations about D&I. After the module, mentors reported feeling empowered to stop avoiding D&I conversations and stop allowing biases to shape their actions by starting to get to know mentees personally. Mentors also expressed starting to be intentional about research group inclusivity by, for example, “.[making] a more concerted effort to intentionally include…individuals in discussions and activities of the group…Encourage their involvement in the project, and respect their point of view.”

Conclusion: It is imperative that mentors of female and underrepresented minority medical students are trained to address issues regarding D&I to provide better mentoring experiences. Completion of the D&I module appeared to decrease mentor hesitation while empowering them to confront D&I head-on and enact directed meaningful behavioral changes. Continued support of D&I mentor training initiatives will be critical in potentially helping to increase the numbers of female and underrepresented minority physician-scientists.

  Poster Number 42 Top

Delayed Diagnosis of Cervical Cancer in the Emergency Department - A Case Report

Kristina Domanski1, Roya Mahana2, Alexa Lewis3

1Department of Emergency Medicine, University of Nevada, Las Vegas, Las Vegas, 2Department of Emergency Medicine, Southern Colorado Emergency Medicine Associates, Pueblo, 3Department of Emergency Medicine, TeamHealth, Las Vegas, USA

Introduction: Cervical cancer is one of the most common causes of cancer-related deaths worldwide. Pelvic pain is one of the most common symptoms prompting women to present to the Emergency Department (ED). There is increasing literature suggesting that pelvic exams are invasive with limited utility and high inter-provider variability. The time and privacy required for these exams has also been suggested to impair ED workflow. We report a case of a patient who presented to the same ED on four occasions with pelvic symptoms before being diagnosed with advanced cervical cancer.

Case Details: Visit 1: A 36 year old female presented to the ED with pelvic cramping and vaginal discharge. Vital signs were within normal limits. The provider reported her history as significant for ovarian cysts and tubal ligation. Labs were remarkable for leukocytosis (WBC 20.1) and an elevated platelet count (533). Urinalysis showed small leukocytes. Pelvic ultrasound was read as showing a markedly thickened and hyperemic cervix with recommendation for pelvic exam. Pelvic exam was performed and the provider documented no cervical motion tenderness and “HPV warts on the cervix.” The patient was discharged with a diagnosis of cervicitis and urinary tract infection, given antibiotics, and advised to follow up with OBGYN. Visit 2: The patient presented to the ED three weeks later with lower abdominal pain, dysuria and vaginal bleeding. No pelvic exam was performed. A noncontrast CT scan of the abdomen and pelvis was performed and reported as showing no acute findings. Abdominal ultrasound showed no acute findings. Labs again showed leukocytosis and urinalysis showed small leukocytes. She was discharged with antibiotics and a diagnosis of cystitis. Visit 3: The patient presented to the ED again with pelvic and low back pain. Her previous records were reviewed and no new imaging was ordered. Labs showed persistent leukocytosis and urinalysis again showed leukocytes. No pelvic exam was performed. The provider documented concern for interstitial cystitis and discharged the patient with OBGYN follow up. Visit 4: The patient presented with abdominal pain. A detailed history was taken and the patient reported a remote history of cervical dysplasia treated with LEEP. Pelvic exam showed a fungating necrotic cervical mass measuring approximately 5 cm. OBGYN was consulted. Further diagnostic workup confirmed cervical carcinoma.

Discussion: This case is not novel, unique or rare and is important for this reason. The ED serves as a safety net for low-income or uninsured patients who are less likely to participate in cancer screening. Women presenting with gynecologic complaints are often dismissed. Despite increasing literature questioning the utility of the pelvic exam in the ED and the current trend of providers utilizing ultrasound and self-swabs as a substitute, in this case a repeat exam may have expedited this patient's diagnosis. Time pressures may also have affected history taking and decision making. This case serves as a reminder for providers to consider cancer diagnoses in women for whom the ED may be the only accessible source of care.

  Poster Number 43 Top

The Importance of the Therapeutic Alliance in Adolescents with Female Athlete Triad

Tonoya Sengupta1, Alexandra Pierce1, Tapash Kumar Sengupta2

1School of Medicine, St. George's University, True Blue, Grenada, 2Bloomsberg Pediatrics, Geisinger Health System, Danville, USA

Introduction: The female athlete triad (Triad) is the presence of low bone mineral density, menstrual disturbances, and low energy availability, especially in females participating in high-intensity activities. Though signs and symptoms are identified in all ages, Triad affects a significant portion of adolescent athletes. Identification of Triad is heavily reliant on the patient's narrative ability, the physician's thorough history taking and diagnostic discernment, as well as an open patient-physician relationship. The objective of this literature review is to examine the importance of the therapeutic alliance in the diagnosis, treatment, and health journey of adolescents diagnosed with Triad.

Methods: A literature review was constructed based on the PRISMA extension for scoping reviews. A computerized search was done within the following databases: EBSCO host, PubMed, and PCM via NCBI. Papers were limited to those published between January 2017 to June 2022 in English, with the search words of “female athlete triad” and “adolescent/adolescence.” Data regarding diagnostic criteria, history taking, management, treatment, health plan construction, and the patient-physician therapeutic alliance was noted.

Results: Prevention of Triad relies on ensuring adequate energy availability, via patient education and body appreciation of self. Promoting focus on function, and connecting proper nutrition with performance, may be beneficial as well. Screening with subjective questionnaires includes questions about diet, menstrual and fracture history, and perceptions about weight and self. Patient knowledge gaps and feelings of discomfort, as well as the physician's inability to interpret Triad from the patient narrative, may lead to a missed diagnosis. Screening with objective tools includes vitals, BMI, Tanner stage, thyroid function tests, vitamin D and calcium levels, CBC, CMP, and bone density testing. Treatment involves determining underlying causes of all aspects of Triad and addressing them, including referral to a nutritionist and/or psychiatrist.

Conclusions: Multidisciplinary avenues have been explored to help understand, and strengthen, the diagnostic certainty of Triad. This clinical diagnosis is reliant on the athlete's subjective patient narrative, in which comfort level, trust, and honesty play a significant role. Equally, it is the physician's responsibility to empower and encourage the patient to share and interpret the patient narrative with awareness of the Triad. Creating and maintaining the therapeutic alliance is not solely the responsibility of the patient, but rather a harmonization between the patient's experiences and their physician's art of medicine. A greater understanding of the bond of the therapeutic alliance between physicians and athletes with Triad needs to be explored.

  Poster Number 44 Top

Design, Implementation, Evaluation of an Education Program for Medical and Undergraduate Students to Advocate Diversity, Equity, and Inclusion for Women in Radiology

Divya Surabhi1, Daniel Heller2, Karen Xie3

1College of Medicine, University of Illinois, 2Department of Surgery, Loyola University Chicago, 3Department of Radiology, University of Illinois, Chicago, IL, USA

Objectives: Although diagnostic radiology is the 9th largest among the top 20 largest residency programs, it ranks 17th for female representation. Lack of preclinical exposure is a reason for misconceptions and less interest in radiology. Women lack mentorship and perceive radiology as competitive. Mentorship and education can increase diversity. The 5C's of Radiology framework (5C's) outlined factors (curriculum, coaching, collaborating, career, and commitment) to create an undergraduate medical radiology curriculum. The purpose of this study is to apply the 5C's to create a longitudinal educational program in radiology for students. The primary aim is to increase knowledge and interest in radiology. The secondary aim is to increase the diversity of students applying to radiology residency.

Methods: A series of virtual and in-person events were conducted at an urban, academic medical school and affiliated university. Events for medical students included one faculty-led career advising event, two M4-led post-MATCH panels, three radiology skills workshops, and one procedure workshop; one introduction to radiology event was for undergraduate students. Students were invited to participate in a survey, consisting of a demographics questionnaire and a knowledge questionnaire, at the end of each event. The demographics questionnaire gathered information regarding gender, race/ethnicity, training level, and radiology exposure; the knowledge questionnaire gathered thoughts on how effective the event was at addressing misconceptions and work-life balance along with event satisfaction and future interests in radiology. Responses were obtained using a Likert scale to gauge agreement with questions. Completed surveys were analyzed for trends based upon survey type, question type, race/ethnicity, and gender.

Results: Across all events, there were 97 attendees with a 52% survey completion rate (50 responses). 50 responses (23 female and 27 male) consisted of 39 individual students. One-tailed t-tests assessed statistical significance for gender trends. Although not statistically significant, the educational program demonstrated a positive impact in combating women's misconceptions of radiology [Figure 1] and further highlighted a positive impact on female's outlook with regards to flexible work-life balance [Figure 2]. Despite such trends, the educational program did not produce a statistically significant difference in the future interest in radiology between males and females.

Conclusions: Results indicate that educational programming in radiology for undergraduate and medical students can positively combat women's misconceptions of radiology and positively impact women's outlook regarding the work-life balance of radiology. Limitations of the study include limited emphasis on the coaching and collaborating factors of the 5C's. Future programming will identify resident mentors for medical students, host a women and minorities in radiology panel, and schedule more in-person procedure workshops. Events will be repeated in the upcoming academic year to increase participation. Future data analysis includes identifying if certain educational modalities are more effective at increasing women's interest in radiology.

  Poster Number 45 Top

The Effectiveness of a Memorandum of Understanding on Gender Equity Practices in Internal Medicine Residency Programs

Alexandra Lane1, Elizabeth Lee1, Tamara Goldberg1, Janani Rangaswami2

1Department of Internal Medicine, Cooper University Hospital, Camden, 2Department of Nephrology, Mount Sinai Hospital, New York, USA

Objectives: On January 8, 2020, we convened a regional conference on gender equity to develop consensus on best practices to reduce gender-based disparities in Internal Medicine (IM) training. Nine IM programs signed on to the developed Memorandum of Understanding (MOU), titled the Philadelphia Agreement for Gender Equity (PAGE), which focused on the subtopics of gender bias in recruitment, sexual harassment, family friendly policies, and career development. After one year of participation, we hypothesized that signing on to the memorandum led programs to better identify gender based gaps in their programs and to track metrics related to gender equity.

Methods: An anonymous survey was sent to all participants of the MOU one year after signing on to the consensus document. We performed a cross-sectional survey study consisting of a 30-item questionnaire regarding participants' knowledge of existing policies in their institutions applicable to gender equity issues and their experience with participating in the MOU. Each question gauged whether respondents changed their program practice in the year of participation, yes or no, or if the program had been doing the practice prior to participation. The responses were analyzed using descriptive statistics.

Results: 7 participating programs (78%) responded to the survey. Each subtopic was assessed separately. Across all subtopics, participants increased their attention to gender equity metrics. In the domain of recruitment, explicitly prioritizing DEI as part of the recruitment strategy increased from 29% to 100% after one year, training in implicit bias increased from 14% to 71%, and tracking of gender metrics increased from 43% to 57% as did the visibility of female residents and faculty during recruitment from 43% to 71%. In regard to sexual harassment, gains were made in the areas of ensuring an active policy exists and disseminating it (29% to 86%), face to face training on recognition and response to sexual harassment (0% to 57%), and educating trainees on reporting (43% to 86%). No movement was made in education of faculty with ongoing training. Family friendly policies also improved after one year. Prior to involvement, only 14% of programs reported that current trainees were aware of and had a copy of the parental leave policy. After, 86% were compliant. Similarly, 100% of programs reported providing safe, private, and clean lactation space after one year from 29% prior. Programs also proactively disseminated their family policies to applicants after involvement, from 43% to 86%. And tracking the effect of policy changes in this space also improved from 0% to 29%. Finally in the area of career development, programs reported improvements in evaluating resident scholarly output (0% to 14%); resident award (57% to 100%)s; and mentorship (14% to 29%) and developing strategies to mitigate bias in resident awards (14% to 86%) and mentorship (14% to 29%). No improvement was made in mitigating disparities in resident scholarly output.

Conclusion: Signing on to a consensus Memorandum of Understanding on best practices in gender equity to reduce gender-based disparities in Internal Medicine training led programs to better identify and address gaps in their programs.

  Poster Number 49 Top

The Gender Gap in Authorship of Medical Student Journals: A Cross-Sectional Analysis

Ibrahim Al-Busaidi1, Ahmad Hassan2, Kareem Sharif3, Wassim Hassan3

1University of Otago, Christchurch, New Zealand, 2Washington University School of Medicine, St. Louis, 3University of Illinois College of Medicine, Chicago, USA

Introduction: Recently, the field of medicine has witnessed an increased focus on promoting practices that seek to improve equity, diversity, and inclusion. This has occurred in countries across the world leading to a shift in the composition of medical students, trainees, and doctors known as the “feminization of medicine”. Despite this, women remain largely underrepresented in academic medicine, occupying a minority of editorial board positions and prominent authorship roles in mainstream medical journals. Medical student journals (MSJs) are student-friendly platforms that facilitate the dissemination of scholarly work performed by students. A previous study conducted by the authors showed that women are underrepresented in editorial board positions of MSJs.

Objective: This study aims to examine the presence and extent of gender disparities in the authorship of student-authored original research articles published in MSJs over the past decade (2010-2018).

Methods: Currently active English-language MSJs, with an uninterrupted operation period of ≥10 years, were identified using a predetermined search strategy conducted in December 2021. For each included journal, publication volume and authorship demographics of student-authored original research articles published in the first issue of the years 2010, 2012, 2014, and 2018 were determined.

Results: 7/23 MSJs were included in the analysis (median operation 18 years, range 12-99). Students were co-authors in around 79% (n = 57/72) of total original research (median 7, range 4-23; 50-100% of total articles per journal). Students were significantly more likely to be first authors (91.2%, p < 0.001). For all MSJs combined (n = 57 articles), women made up 50.5% of all authors, 56.1% of first authors, and 47.4% of senior authors.

Discussion: It is well-documented that significant gender disparities exist in academic medicine. Analyzing the gender composition of authors in MSJs is critical to identifying the point at which gender inequities emerge in scientific communication. Demographic analysis of the included 57 student-authored original MSJ articles found a female-to-male ratio of 1.02 for all (student and non-student) authors (50.5% female vs. 49.5% male). Furthermore, although women were over-represented as first authors, men made up most of senior authors. These results suggest that a gender gap in authorship exists, particularly among senior authors, although not as pronounced as that seen in mainstream medical journals. We conclude that gender disparities in academic medicine first manifest during the early phase of a physician's career and continue to widen following medical school graduation.

  Poster Number 51 Top

Fundamentals of Career Satisfaction and Burnout: Reflections from a Pan Asian Survey of Women Pediatric Surgeons

Oviya Giri, Pavai Arunachalam, Dhanashree Balaji

P.S.G. Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India

Introduction and Aims: Career satisfaction and burnout assessment is an important factor in choosing a career in any profession. About 50% of medical students are women but most of them choose a nonsurgical career due to the fear of early burn out and suboptimal career satisfaction. Liselotte N Dyrbye et al. concluded that women surgeons in comparison to their male counterparts were more likely to believe that child rearing had slowed career advancement and more likely to have undergone work-home conflict. The study quantified that women surgeons had a larger incidence of burnout and depressive symptoms. Donna A Caniano et al. in their study with the American women pediatric surgeons stated that the career satisfaction rate was 83%. Career satisfaction, gender discrimination and bias among women surgeons has been more extensively explored in the developed world, however, has been given less attention in developing countries such as Pakistan and India.[1] In the 1980s American women surgeons made up 2 % of all surgical residents, the number rose to 14% in 2001[2] and 18% specific to pediatric surgery in 2002-2003.[3] By the year of 2010, women accounted for 37% of surgical residents. However, such a sharp increase has not been seen in most Asian countries. Lily N. Trinh BS et al. concluded that increasing access to mentorship by matching female medical students to role models early in their education timeline, reducing pregnancy-related stigma, and implementing outreach programs for women may increase the appeal in pursuing a surgical career from the female medical student's perspective.[4] Our paper is to our knowledge the first in Asian literature to evaluate career satisfaction and burnout among women pediatric surgeons exclusively. We aim to assess the status of women pediatric surgeons across Asia with regards to career satisfaction and burnout. In addition to this, identify and quantify predictive variables of career satisfaction and burnout in this cohort.

Materials and Methods: Ethics approval has been obtained from our institution's ethics committee. Women pediatric surgeon members of various Asian pediatric surgery associations and societies will be invited to participate in a survey between the months of June to August 2022. Electronic mail contacts have been obtained using the membership lists of various organizations. Google forms will be used to conduct the career satisfaction survey – including the Maslach burnout inventory. Electronic mail will contain an informed consent form, cover letter elucidating the intended use of the survey, and a link to the survey + Maslach burnout inventory. With regards to statistical analysis survey responses will be evaluated using univariate analysis. Factors associated with burnout and career satisfaction will be determined using multivariable logistic regression. Survey responses will be combined into broader categories for statistical analysis based on previously published literature.

Results and Conclusion: Data collection is ongoing, therefore results and conclusions will be displayed at the time of the presentation.

  References Top

  1. Janjua MB, Inam H, Martins RS, Zahid N, Sattar AK, Khan SM, et al. Gender discrimination against female surgeons: A cross-sectional study in a lower-middle-income country. Ann Med Surg (Lond) 2020;57:157-62.
  2. Katz A, Mallory B, Gilbert JC, Bethel C, Hayes-Jordan AA, Saito JM, et al. State of the practice for pediatric surgery – Career satisfaction and concerns. A report from the American pediatric surgical association task force on family issues. J Pediatr Surg 2010;45:1975-82.
  3. 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.
  4. Caniano DA, Sonnino RE, Paolo AM. Keys to career satisfaction: Insights from a survey of women pediatric surgeons. J Pediatr Surg 2004;39:984-90.
  5. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. 3th ed. Palo Alto, CA: Consulting Psychologists Press; 1996.

  Poster Number 53 Top

Toolkit for Implementing Women in Medicine Interest Groups at the Pre-Medical, Undergraduate, and/or Graduate Medical Education Level

Sarah Bhagudas1, Alisha Crump2, Gabriela Sansoni3, Rakhee Bhayani4, Shikha Jain5

1St. George's University School of Medicine, St. George's, Grenada, 2Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, 4Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, 5Division of Hematology and Oncology, University of Illinois Chicago, Chicago, IL, USA, 3University of Milan, Milano, Italy

Objectives: Women in Medicine (WIM) interest groups can provide support for the professional development of women as they navigate the inequities that persist in the workplace. Mentorship, networking, and safe spaces are essential to female career growth. The present study assesses what has led to the success of such groups and uses those successes as guidance for our toolkit. The aim of this study is to provide a toolkit on developing and maintaining a WIM group in different career stages, namely pre-medical, graduate, and postgraduate educational levels.

Methods: Due to a paucity in the literature regarding WIM groups, a semi-systematic review was conducted. Keyword literature search on peer-reviewed platforms including Google Scholar, PubMed, OVID, Ebsco, and gray literature (i.e. medical societies toolkits) was used to identify applicable research articles.

Results: At the pre-medical level, interest in the medical field from exposure and positive experiences in early courses as well as with opportunities offered by funding of STEM (Science, Technology, Engineering, Medicine) programs show an increased interest amongst females, leading us to explore the advantages of faculty training in methods of networking for students as well as in providing mentorship. At the undergraduate level, well-developed WIM interest groups focused on exposure to healthcare environments (i.e volunteering opportunities in hospitals) and mentorship. For the postgraduate level, we've determined that the pillars of a sustainable WIM interest group rely on networking, allyship, and physician wellness, according to the Group on Women in Medicine and ScienceToolkit. Support and advocacy regarding family planning and motherhood are also key points for this career stage with an aim of preservation of familial balance with career prosperity. We propose a set of ten steps recommended for individuals and institutions to create their own WIM groups based on aspects of importance within each educational career level that would be pivotal to creating a sustainable WIM group.

Conclusions: Given the data gathered, it is conclusive that adequate resources, and monetary and administrative supportive efforts, provided to WIM groups play a pivotal role. A total of 10 steps were outlined as a result of the review [Table 1]. Further research should be conducted on the impact of such groups in developing a more equal work environment for physicians of all genders.

  Poster Number 54 Top

Impact of Gender on Pediatric Surgical Care in Africa: Methodological Considerations and Study Protocol

Sacha Williams1,2, Elena Guadagno2, Maeve Trudeau1,2, Dan Poenaru1,2

1Faculty of Medicine and Health Sciences, McGill University, 2Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital and McGill University Health Center, Montreal, Canada

Introduction: Globally 1.7 billion children lack access to safe and timely surgical care. Girls, whose care is more likely to be affected by barriers steeped in gender inequity, may be at higher risk of poor surgical outcomes. The study aims to identify methodologies able to reveal the impact of gender on pediatric surgical care in Africa.

Methods: As gender identity is seldom captured in global studies and registries, we will explore sex-based differences in access to care and clinical outcomes for multiple pediatric surgical conditions treated in Africa. We will thereby attribute any observed deviations from predicted sex ratios to systemic gender-based factors affecting this population. We have identified two distinct methods: (I) Interrogate the Institute for Health Metrics and Evaluation's Global Burden of Disease database between 1990-2019 for pre-selected congenital and acquired conditions with equal or known sex prevalence and severity. Case prevalence and disease burden (in disability-adjusted life years) by condition and sex will be analyzed using hypothesis-testing tests. (II) Conduct a systematic review and meta-analysis of sex-disaggregated pediatric surgical cohort studies, using multiple databases from inception through March 2022. Eligible studies will be screened using Rayyan and prevalence and outcome means by sex of individual studies will be analyzed in a random-effects meta-analysis [Figure 1].

Conclusion: Absent or inadequate care can have devastating repercussions on child health, and may be exacerbated by gender inequity. The proposed combined methodology is expected to generate first-time evidence for gender inequity in the care of a very vulnerable population.

  Poster Number 56 Top

COVID-19 and Intersectionality: Faculty Lived Experiences During COVID and Productivity and Well-being in Academic Medicine

Jerica M. Berge1, Rebecca Freese2, Kait Macheledt3, Sophie Watson4, Snigdha Pusalavidyasagar5, Alicia Kunin-Batson6, An Church7, Rahel Ghebre8, Nissrine Nakib9, Katie Lingras10, Sade Spencer11

1Department of Family Medicine and Community Health, University of Minnesota Medical School, 2Office of Academic Clinical Affairs, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA, 3Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA, 4Office of Diversity, Equity, and Inclusion, University of Minnesota Medical School, Minneapolis, MN, USA, 5Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota Medical School, Minneapolis, MN, USA, 6Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA, 7Department of Radiology, University of Minnesota Medical School, Minneapolis, MN, USA, 8Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Minnesota Medical School, Minneapolis, MN, USA, 9Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA, 10Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA, 11Department of Pharmacology, University of Minnesota Medical School, Minneapolis, MN, USA

Objectives: The aim of this study was to utilize an intersectional framework to guide the analysis of faculty lived experiences during COVID-19. We set out to (1) describe the multiple intersections represented by academic medicine faculty during COVID-19 at the UMN medical school and (2) examine potential disparities in productivity and well-being by intersectional factors such as Sex, Gender, Race/Ethnicity, Rank, Track, Disability status, Caregiver status.

Methods: This was a cross sectional survey research study. The Center for Women in Medicine and Science (CWIMS) at the University of Minnesota developed and implemented a survey in June 2021 in response to early evidence and numerous anecdotal reports of disparities in how COVID was impacting faculty who have lived experiences from multiple intersections (e.g., women, minority, assistant professors, caregivers, disability) compared to faculty with fewer lived experiences. Full-time faculty from the University of Minnesota Schools of Medicine (n = 3000 faculty), Public Health (n = 130 faculty) and Dentistry (n = 120 faculty) were eligible to participate in the study. There were 291 faculty who participated in the study, with some faculty (n = 12) holding dual-appointments in multiple schools (e.g. Medical School and the School of Public Health). We used methodological approaches which align with an intersectionality framework including intentional research questions, statistical methods, and data visualization (e.g. sunburst plots) which are mindful of social positions of power.

Results: Findings indicated that faculty with multiple lived experiences (e.g., women + assistant professor + caregiver + underrepresented in medicine) reported lower productivity with regard to research manuscript submission and publications and grant submissions, but higher clinical workload and service responsibilities compared to faculty with fewer lived experiences. In addition, faculty with multiple lived experiences reported higher levels of depression symptoms, work/family conflict, and stress compared to faculty with fewer lived experiences.

Conclusions: These findings confirm anecdotal evidence that faculty with lived experiences from multiple intersections (e.g., women, minority, assistant professors, caregivers, disability) may be disproportionately experiencing negative outcomes from the COVID-19 pandemic. These findings should inform decisions going forward about how to address these disparities moving into the next several years with regard to promotion and tenure, burnout and wellbeing, and faculty retention in academic medical settings. Given these disparities in findings, it is also important to use these results to intentionally plan responses for future public health crises in order to reduce the potential for negative outcomes for faculty with multiple lived experiences.

  Poster Number 57 Top

We Count! - Cross-Sectional Study among Polish Women in Surgical Specialties

Michalina Drejza1,2

1Foundation Polish Women in Surgery, Gdansk, Poland, 2Specialty Trainee in Obstetrics and Gynaecology, Cambridge University Hospitals, Cambridge, United Kingdom

Background: Worldwide women in surgery are experiencing discrimination based on sex and their technical skills are being disregarded due to harmful social stereotypes. Foundation “Polish Women in Surgery” (pl. Kobiety w Chirurgii) was established in 2021 and its goal is to support Polish women in surgical specialties. One of its first goals was to establish the evidence-base in order to identify most emerging issues and challenges for Polish Women in Surgery.

Methods: On-line cross-sectional survey distributed via social media channels targeting doctors, nurses and midwives who identify as female and work in surgical specialties. Survey had seven major components: (1) characteristics of the workplace; (2) work satisfaction and burnout; (3) discrimination based on sex in workplace; (4) influence of COVID-19 pandemics on work; (5) mentoring; (6) parenthood; (7) potential areas of support from Foundation.

Results (Selected): We surveyed 472 women working in surgery specialties: doctors (54%), nurses (39%) and midwives (7%). Nearly 80% are married (47%) or in partnership (30%). 49% have children. The respondents work on average in two workplaces.

44% of the respondents are satisfied with their current earnings (high professional diversification observed: 62% of female doctors are satisfied, 26% nurses and 10% midwives).

At least 39% of women have directly experienced gender-based discrimination. Only half of the doctors in training in the study believe that their specialty training is implemented in the same ways as among their male counterparts and report bigger bias from supervisors based on sex. Half of the respondents believe that women who are mothers are discouraged from choosing surgical specialties (doctors are more often affected - 70% of those who have children) and are perceived to be less engaged in work.

57% of the respondents report workplace mobbing (understood as employee intimidation, psychological and behavioral violence intentional humiliation, physical violence, threats, belittling competences, obstructing work performance). Many experience violations of employee's rights - including the right to rest (45%) and vacation (30%). These problems differ in the three types of the surveyed professions.

58% of respondents claimed that COVID-19 pandemic has negatively affected their working conditions. Most often this answer was indicated by midwives (65% vs. 58% doctors and 57% nurses).

57% of women report having a mentor in the workplace, and 88% find it useful on the day-to-day basis.

63% indicated that the need for childcare has negatively affected their professional career, 64% declared that the unsupportive environment and working conditions caused postponement of the decision about motherhood. 47% believe that employers discourage women from motherhood.

Almost half (48% of mothers) believe that they care for their children negatively affects the professional career (they think so more often doctors - 61%). 40% admitted that they postponed the decision about motherhood due to the environment and working conditions.

Conclusions: Polish women in surgical specialties are experiencing discrimination, sexism and mobbing in their workplaces. There is a huge need for more support in mentoring, growing soft skills and addressing discriminatory practices within clinical settings.

  Poster Number 59 Top

Exploring Sex Differences in Outcome of Malignant Brain Tumor Patients

Adeline Fecker, Joseph Nugent, Hao Tan, Kayla Maanum, Emma Richie, Caleb Nerison, Stephen Bowden, Ahmed Raslan

Department of Neurological Surgery, Oregon Health & Sciences University, Oregon Health and Science University, Portland, USA

Objectives: Incidence of malignant brain tumor is 30% lower in females than males leading some studies to suggest females may have a survival advantage.[1],[2],[3 Research assuming a sex difference requires continued study and humility. Neurosurgical management of brain tumors is not unaffected by systemic and implicit bias that harms female-identifying patients, in fact the risk may be greater. Patients seeking any surgery have frequent and consequential interactions with the medical system. To qualify for surgery patients must attend pre-operative visits and pass neuropsychological evaluation, requirements that may handle female and male patients differently. Our study evaluates whether there were sex differences in the outcome of brain tumor patients at our single institution and explores possible factors that could drive such differences.

Methods: We retrospectively reviewed patients who received elective awake craniotomy for primary tumor resection at Oregon Health and Science University from 2016 to 2020. We extracted pertinent patient demographic, clinical, and operative variables from the electronic health record. Progression-free survival (PFS) and overall survival were assessed via Kaplan Meier methodology. Fisher's exact test was used to compare frequencies of categorical variables. Marginal structural models were employed, which incorporated inverse probability weights generated using entropy balancing for each patient's sex based on mapping cohort, age, tumor pathology, molecular markers, and the number of times the procedure was aborted.

Results: There were 51 male-identifying patients and 24 female-identifying patients included in the study [Table 1]. Glioblastoma was the most common tumor type (n = 54, 72%). We found female patients had better overall survival [Figure 1] yet worse PFS [Figure 2] compared to male patients. There were no significant sex differences in EOR, post-surgical deficits, and follow up KPS; clinical measures associated with survival. There was significantly higher prevalence of MGMT methylation (p = 0.044) and IDH mutation (p = 0.030) among female patients compared to male patients. Lasso regression identified glioblastoma tumor type and mass location as important variables associated with outcome, yet the model remains unsatisfactory.

Conclusions: In our single institution study more male patients received awake tumor resection than female patients. Female patients after resection had greater overall survival and favorable MGMT methylation compared to male patients, which corroborates results from previous studies.[3],[4] However, female patients showed worse PFS compared to male patients, and as a result, may need second resections and continued treatment more often than their male counterparts. Our model does not adequately explain the sex difference in PFS, suggesting there may be a social disparity or systemic barrier we have not considered. Our unbalanced sample may not be simply attributed to low incidence and may indicate a selection bias, where fewer female patients than male patients are cleared for surgery. Further research should consider disparities and systemic inequalities manifesting prior to surgical intervention. We hope to raise awareness and continue the work of identifying the causes of these inequities so that we may one day dismantle them.

  References Top

  1. Ostrom QT, Rubin JB, Lathia JD, Berens ME, Barnholtz-Sloan JS. Females have the survival advantage in glioblastoma. Neuro Oncol 2018;20:576-7.
  2. Tavelin B, Malmström A. Sex differences in glioblastoma-findings from the Swedish national quality registry for primary brain tumors between 1999-2018. J Clin Med 2022;11:486. [doi: 10.3390/jcm11030486].
  3. Gittleman H, Ostrom QT, Stetson LC, Waite K, Hodges TR, Wright CH, et al. Sex is an important prognostic factor for glioblastoma but not for nonglioblastoma. Neurooncol Pract 2019;6:451-62.
  4. Patil N, Somasundaram E, Waite KA, Lathia JD, Machtay M, Gilbert MR, et al. Independently validated sex-specific nomograms for predicting survival in patients with newly diagnosed glioblastoma: NRG oncology RTOG 0525 and 0825. J Neurooncol 2021;155:363-72.

  Poster Number 63 Top

The Vulnerability of Brazilian Indigenous Women During the COVID-19 Pandemic

Beatriz Braz1, Andressa Feitosa2, Gdayllon Meneses1, Elizabeth Daher1

1Medical Sciences Post Graduate Program Federal University of Ceara, 2School of Medicine Federal University of Ceara, Fortaleza, Brazil

Objectives: To analyze the epidemiological and clinical profile of Brazilian indigenous women affected by the COVID-19 pandemic.

Methods: Anonymized data was obtained from the DATASUS system. Patients notified to the Influenza Epidemiological Surveillance Information System between January 1st and June 18th, 2021, with Severe Acute Respiratory Syndrome due to COVID-19 were included in this study. Variables regarding socio epidemiological data, signs, symptoms, comorbidities and clinical course including the need for admission to the intensive care unit (ICU), ventilatory support, and death were obtained. Missing data was excluded from the analysis.

Results: This cohort included 747,925 patients of which 449 were female indigenous patients. Regarding this vulnerable group, the mean age was 51.07 + 23.3, 41% did not have a basic education, 10.5% had completed high school and only 1.8% had completed higher education. 3.9% were pregnant. Furthermore, in this cohort, the most prevalent symptoms were cough (80.7%), dyspnea (77.2%) and peripheral O2 saturation < 95% (76.0%) followed by fever (72.9%), respiratory discomfort (69.2%), fatigue (44,1%), sore throat (36.8%) and diarrhea (20.6%). 49.2% (n = 221) of the indigenous women in our cohort had associated comorbidities, 57.8% of the patients had Cardiovascular disease, 57% had diabetes mellitus and 24.8% were obese. Regarding medical assistance, 2.5% were considered nosocomial infections, 28.1% needed ICU admission, and 22.1% required invasive ventilatory support. Lethality in this group was 38.1%. When comparing indigenous women to the remaining population, being an indigenous woman was a risk factor for the worst prognosis with a higher risk of ICU admission (RR = 1.303; CI95% 1,106-1,535) but no statistically significant difference was found regarding COVID-19-associated death (RR = 1.028; CI95% 0,907-1,167).

Conclusions: The Brazilian indigenous women are a vulnerable population group due to a lack of medical and social support. During the COVID-19 pandemic, this population has been profoundly affected. Our data revealed an association between this population and an increased need for intensive care. In addition, it also emphasizes the need for more care and efforts that improve the quality and availability of medical and social care for indigenous women.

  Poster Number 65 Top

The Perpetuation of the Infectious Cycle of Syphilis in Pregnant Women: A Risk to Brazilian Women;s Health

Rafaela Germano Toledo1, Rafael Riberioi Hernandez Martin1, Anne Salgado Castellano2,

Didier Silveira Castellano Filho3, Cristiane Marcos Soares Dias Ferreira4

1Urgency Care Department, Therezinha de Jesus Hospital and Maternity, 2Faculty of Medical and Health Sciences of Juiz de Fora - Suprema, 3Obstetrics and Gynecology Department, Therezinha de Jesus Hospital and Maternity, 4Infectious Disease Department, Therezinha de Jesus Hospital and Maternity, Juiz de Fora, Brazil

Objectives: In Brazil, patients are screened for syphilis during pregnancy and at the time of delivery. In recent years, the increase in prevalence and reinfection rates have drawn attention to the fact that the disease remains a public health problem even with a well-established diagnosis and treatment.[1],[2] The present study aims to evaluate the factors that influence its perpetuation, as well as its impact on women's health.

Methods: Cross-sectional, descriptive, retrospective study, carried out in a teaching Hospital and Maternity with care for users of the Unified Health System, in Brazil. There was analysis of Compulsory Notification Forms (CNF) in the Notifiable Diseases Information System of pregnant women admitted between January 2017 and December 2021. The data set shown underwent statistical analysis (chi-square and Fischer's exact).

Results: Of 8,543 patients, 2.4% (n = 207) had a confirmed diagnosis of syphilis, with a mean age of 23.9 years and 48.8% self-reported as black women. It was observed that 51.2% did not complete high school and 59.9% (n = 124) were housewives. The treatment had been performed in 57.4% of the women, but adequate in only 4.3% of the cases according to the Brazil's Health Ministry Guidelines. Furthermore, the ignored field accounted for 15.94% (n = 33) of the responses regarding the treatment or not of the partner and 21% of the answers about the regimen made in those treated. Asides from that, 30.4% of the partners were not treated. The motive for the non-treatment was ignored/other in 46.3%; absence of contact with the pregnant woman in 18.3%; and refusal of treatment/non-attendance to a health care unit in 2.89%. There were 4 cases of reinfection during pregnancy and 4 of fetal death.

Conclusions: Most pregnant women were black, young and housewives. Regarding the impact of the disease, there is a continuous exposure to syphilis, both due to a knowledge deficit to prescribe appropriate treatment, and by partners who increase the risk of reinfection when not treated. In addition, the poor completion of the CNF causes difficulties for the elaboration of public policies that can effectively contribute to changing the current scenario. Thus, these patients, who tend to occupy places of social vulnerability, find themselves trapped in a vicious cycle of misinformation, poor management of the disease and infection. This generates a negative impact on physical and psychosocial health, as in addition to being exposed to the prolonged effects of illness and repetitive painful treatment, they also carry the strains and taboos of the diagnosis during the pregnancy. It is necessary to improve health education about syphilis, including the approach of the patient and the partner with measures of promotion, protection, and control. Nevertheless, it is paramount to promote training and awareness of professionals about the correct management of the infection, considering its deleterious and avoidable consequences for the women.

  References Top

  1. Ministry of Health of Brazil. Health Surveillance Department. Epidemiological Situation of Syphilis in Brazil. Epidemiological Bulletin 2021. Special Number. 13 May, 2022.
  2. Domingues CS, Duarte G, Passos MR, Sztajnbok DC, Menezes M. Brazilian protocol for sexually transmitted infections, 2020: Congenital syphilis and child exposed to syphilis. Rev Soc Bras Med Trop 2021;54:e2020597.

  Poster Number 70 Top

The Mediation of Healthcare Barriers on Surgical Outcomes in Low-Middle Income Countries

Alisha Crump

Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, USA

Introduction: Approximately 11% of the global burden of disease is surgically treatable. However, the poorest third of the world's population receives only 3.5% of the estimated 234 million surgical operations conducted worldwide5 and significant data discrepancies exist for surgical care delivery. Despite global healthcare advancements, low middle-income countries (LMICs) continue to face great challenges regarding surgical treatment and outcomes.

Methods: Keyword literature search using PICO Evidence-Based Framework and peer-reviewed databases PubMed, Cochrane, and Web of Science was used to identify relevant research articles.

Results: Several organizational and personal barriers exist on the presentation of surgical outcomes in Low-Middle Income Countries [Table 1]. Use of guidelines, care protocols, medical checklists, and morbidity/ mortality meetings can also offer a means of appraisal of care delivered and can help improve surgical care across different settings. Personal barriers such as acceptability, accessibility, affordability, and health literacy have a significant impact on the care of surgical patients [Table 2]. However, limited literature was found in low-income countries. Thus, further literature is needed to establish the impact of personal barriers on preoperative/ postoperative outcomes. Conclusion: From the medical student to the medical institution level, strategies of the implementation of standardized evidence-based preoperative care guidelines and tools must be championed to improve health outcomes for patients around the world, with a highlight of low middle-income countries.

  Poster Number 72 Top

Medical Society Statements on Abortion and Ukraine: When Do Societies Take A Stand

Shira Fishbach1, Morgan Levy2, Arghavan Salles3, Vineet Arora4

1Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, 2Department of Medical Education, University of Miami Miller School of Medicine, Miami, 3Department of Medicine, Stanford University, Palo Alto, 4Department of Medicine, University of Chicago Prizker School of Medicine, Chicago, IL, USA

Introduction: On May 2nd, 2022, a leaked majority draft opinion by Justice Samuel Alito revealed the Supreme Court's intention to revoke the federal law granting the right to abortion.[1] Overturning Roe v Wade would severely limit access to abortion care in at least 26 states, leaving other states to meet the increased demand.[2] Limiting access to abortion care also affects physicians and trainees, as over 10% of physicians have had at least one abortion.[3] Medical societies often leverage their power to advocate for policies to improve the health and welfare of patients and healthcare workers alike. This study aims to describe which medical societies made a public statement on abortion access in the 2 weeks following the leaked Supreme Court opinion.

Methods: Study authors (ML, SF) reviewed websites and social media of medical societies to determine whether they made statements on abortion, the time in days from leak to statement, and whether statements contained the word “abortion.” The study included 130 U.S.-based medical societies from the AMA House of Delegates,[4] Council of Medical Specialty Societies,[5] CREOG, and other Ob/Gyn societies. Statements made in the 2 weeks post-leak (May 2-16) were included. We used a similar methodology to determine whether societies made statements after the Ukraine invasion, a recent humanitarian crisis with geopolitical implications.

Results: Only 13.1% (n = 17) of societies made a statement about abortion access in the 2 weeks following the leaked draft opinion [Figure 1]. The average time from leak to statement was 2.4 days. Most statements [82.4%, [n = 14]) used the word “abortion,” instead of terms like “reproductive healthcare.” Of Ob/Gyn societies, 60% (n = 6) made a statement on abortion. In the 2 weeks following the Ukraine invasion, significantly more (26.9% [n = 35]) societies made a statement (p = 0.005). The average time from the Ukraine invasion to a statement was 8 days.

Discussion: In the 2 weeks following the majority draft opinion threatening to strike down Roe v Wade, few medical societies published a statement affirming their commitment to abortion access. In contrast, societies were nearly three times more likely to publish statements condemning the invasion of Ukraine. Both the war in Ukraine and the overturning of Roe v Wade represent humanitarian crises with implications for the health and safety of vulnerable populations. Medical societies have a responsibility to advocate for essential healthcare, particularly when the health of our patients is threatened. These statements signify a powerful collective action to influence policymakers and to stand in solidarity with local and global stakeholders. Medical societies must act to advocate for abortion access for both our patients and our colleagues.

  References Top

  1. Exclusive: Supreme Court Has Voted to Overturn Abortion Rights, Draft Opinion Shows. POLITICO. Available from: https://www.politico.com/news/2022/05/02/supreme-court-abortion-draft-opinion-00029473. [Last accessed on 2022 Nov 13].
  2. Rubin R, Abbasi J, Suran M. How caring for patients could change in a post-roe v Wade US. JAMA 2022;327:2060-2.
  3. Levy MS, Arora VM, Talib H, Jeelani R, Duke CM, Salles A. Abortion among physicians. Obstet Gynecol 2022;139:910-2.
  4. Member Organizations of the AMA House of Delegates. American Medical Association. Available from: https://www.ama-assn.org/house-delegates/hod-organization/member-organizations-ama-house-delegates. [Last accessed on 2022 Nov 13].
  5. Societies. CMSS; 2022. Available from: https://cmss.org/membership/societies/. [Last accessed on 2022 Nov 13].

  Poster Number 73 Top

Survey Assessing the Attitudes and Knowledge of Programs on Characteristics That Promote Gender Equity

Miloni Shah1, Beena Sood1,2, Kate Sheppard3

1Wayne State University School of Medicine, 2Office of Faculty Affairs, Wayne State University School of Medicine, 3Hackensack Meridian School of Medicine, Nutley, USA

Background: As of 2019, the AAMC reported that women comprised over 50% of medical students. Women now make up 36.3% of the physician workforce, which is an eight percent increase since 2007. Although the number of women in medicine is growing, there are still barriers that limit women within their medical training. Overall, women occupy less leadership positions, lack mentorship opportunities in residency, and are compensated less than men in the same roles. Moreover, policies for parental/family leave disproportionately affect women, and negatively affect their residency experiences, placing them far behind their male counterparts. In 2018, the American College of Physicians created an eight part policy recommendation where they advised programs to make compensation more equitable between genders, standardize at least six weeks of paid family leave, increased mentorships opportunities for women in residency, create flexible opportunities for board certification in specific circumstances, involve more women in recruitment committees, and improve reporting policies for harassment and discrimination.

Objective: The purpose of this study is to survey individuals at all levels of medical education affiliated with major hospitals in Southeast Michigan in order to better understand (1) knowledge of program directors, faculty and staff of gender equity benefits in their own training programs, (2) what aspects of gender equity medical students, residents, and fellows value the most in residency and training programs, and (3) resident and fellow perspectives on what gender equity benefits are currently offered at their training programs. This study incorporates recommendations set forth by the ACP as a foundation of the current policies in place at hospital systems in Michigan.

Methods: Program directors, teaching faculty, staff, residents, fellows, and medical students from Southeast Michigan hospitals and WSUSOM completed an anonymous survey with questions adopted from ACP recommendations for gender equity. Program directors were asked about whether they offered certain benefits, while residents and fellows were asked how important these benefits were in choosing a residency program and whether they were offered in their home programs. Students were asked to rank how important certain factors/benefits were in selecting a future training program, as well as future recommendations to improve gender equity.

Results: A total of 508 participants completed the survey. Of these, 186 (36.6%) were program directors, faculty, and coordinators/administrators/managers, 99 (19.5%) were residents/fellows, and 209 (41.1%) were medical students. Statistically significant discrepancies were seen in how important residents and fellows ranked benefits such as paid medical/family leave, flexible considerations in board eligibility, implicit bias training, and harassment reporting procedures versus what was reported to be available to them. Moreover, many program directors were unsure about certain gender equity benefits their programs offered and whether the current policies in place were sufficient.

Conclusion: Residency and fellowship programs are a key part of medical training, where women must be given the agency and opportunity to grow in their field. It is important to understand what future physicians value as important benefits for their training so that programs can work to incorporate these policies.

  Poster Number 77 Top

Assessing How Diversity, Equity, and Inclusion is applied in the Residency Selection Process of Psychiatry Residency Programs

Kristina Cabañez1, Marah N. Kays2, Sergio Rafael Ortiz3, Sara Beltrán Ponce4, May Saad-Ibrahim Al-Jorani5, Ekas Abrol6, Sara Esteves7, Deborah D. Rupert8, Shikha Jain9

1University of Perpetual Help - Dr. Jose G. Tamayo Medical Universit, Biñan, Laguna, Philippines, 2Kansas City University, Kansas City, 4Radiation Oncology, Medical College of Wisconsin, Milwaukee, 6Department of Information and Decision Sciences, University of Illinois, Chicago, IL, 7Creighton University School of Medicine, Phoenix, 8Stony Brook University School of Medicine, Stony Brook, USA, 3Universidad Autónoma de Guadalajara, Guadalajara, Jalisco, Mexico, 5Mustansiriyah University College of Medicine, Baghdad, Iraq, 9Division of Hematology and Oncology, University of Illinois, Chicago, IL

Objectives: This study identifies US psychiatry residency programs that include a diversity statement or mention the importance of practicing Diversity, Equity and Inclusion (DEI) in reviewing residency applicants as specified on their respective websites and assesses the breakdown of international medical graduates (IMG), osteopathic medical students (DO), and allopathic medical students (US MD) in psychiatry residency programs. To our knowledge, no studies have compared the presence of a DEI statement with program-level resident diversity.

Methods: Psychiatry programs were determined utilizing the American Medical Association's Residency and Fellowship database (FREIDA). All listed programs were eligible for inclusion. Visa status was collected. Subsequently, program websites were utilized to determine 1) the presence of a diversity statement or noted importance of DEI and 2) the number of US MDs, DOs, and IMGs within each training class. This information was systematically recorded in a single database. If degree and/or medical school were not available for current residents, program coordinators were contacted utilizing e-mail addresses obtained from FRIEDA. They were given two weeks to respond to this inquiry. If there was no response at that time, the program was excluded from the analysis. A One-Way ANOVA was used to analyze psychiatry residents at different stages in training (PGY) by US MDs, DOs, and IMGs with results separated by PGY1, PGY2, PGY3, and PGY4.

Results: Among all PGY levels, psychiatry residents were 68% US MDs, 19% DOs, and 13% IMGs [Figure 1]. As shown in [Figure 2], only 125 programs (43%) of the Psychiatry programs in the US had a DEI statement or mentioned the importance of practicing DEI, while 57% did not have a DEI statement listed on their website. As seen in [Table 1], results showed that there were fewer IMGs at programs that had a DEI statement (9.51%) compared to programs that did not have a statement (17.7%). Similarly, there were fewer DOs at programs with a DEI statement (15.25%) compared to programs that did not have a statement (24.64%).

Conclusions: Despite recent emphasis on DEI in medical education, psychiatry residency programs in the US demonstrate a continued lack of support for IMGs and DOs. In fact, there are fewer IMGs and DOs in programs that had a DEI statement versus those that did not. Increasing diversity within the physician workforce can be accomplished by admitting traditionally underrepresented populations into medical school and recruiting these physicians into residency programs. With more visibility in psychiatry, patients of varying backgrounds with mental illnesses and substance use disorders gain a sense of belonging, grow comfortable opening up to their healthcare providers, and are encouraged to seek care more regularly.

  References Top

  • Ojo E, Hairston D. Recruiting underrepresented minority students into psychiatry residency: A virtual diversity initiative. Acad Psychiatry 2021;45:440-4.
  • Simonsen KA, Shim RS. Embracing diversity and inclusion in psychiatry leadership. Psychiatr Clin North Am 2019;42:463-71.

  •   Poster Number 84 Top

    Gender Differences in Median Nerve Cross-Sectional Area Measured Using Ultrasonography amongst Adult Filipinos

    Maria-Kassandra Coronel

    Department of Postgraduate Education, Harvard Medical School, Boston, USA

    Introduction: The neuropathy of the median nerve (MN) at the carpal tunnel is one of the most common entrapment neuropathies. Prior literature has reported a wide range of normal values for ultrasonographically measured MN sizes, with 0.09 mm2 being on the higher limit. However, there has been lack of consensus as to the true cutoff value for non-pathologic MN sizes due to historically nonhomogeneous study designs and non-geographically diverse or representative inclusion criteria.

    Objective: The aim of this study was to evaluate the sonographic measurements of the MN among Filipinos, and to investigate the effects of sex on nerve measurements.

    Methods: Forty healthy individuals (80 hands) from Manila, Philippines were included in this study (17 males, 23 females). Bilateral measurements of the cross-sectional area (CSA) of the MN were obtained at the carpal tunnel outlet (CTO), with the trapezium laterally and the hook of hamate medially, using a single portable diagnostic SonoSite Edge ultrasound machine with linear array transducer under the musculoskeletal setting.

    Results: Participants averaged at 38 +/- 11.06 years of age (p = 0.80) with an average BMI of 24.79 (p = 0.35). The average CSA of the male left MN was 0.062 cm2, while the male right MN was 0.065 cm2. In female participants, the average CSA of the left MN was 0.053 cm2, while the right MN was 0.058 cm2. The differences between both left and right hands for males and females were statistically significant (p < 0.05).

    Conclusion: This study augments the paucity of studies evaluating nerve size differences in gender and ethnic groups. Findings suggest that gender is associated with differences in MN sizes at the CTO. This may lead to an underdiagnosis of neuropathies such as Carpal Tunnel Syndrome among females. Further studies are recommended to compare Filipino ultrasonographic measurements to the international community, and to determine the appropriateness of utilizing non-Filipino or non-female specific measurements for diagnosis based on ultrasonographic measurements.

      Poster Number 87 Top

      Poster Number 88 Top

    Gender Bias Complicates the Diagnosis of Ehlers Danlos Syndrome (EDS): The Multiplicity of EDS and the Difficulty in Determining Etiology and Associated Features

    Yazmin Reategui-Almonacid1, Theresa Rohr-Kirchgraber1,2, Milene Argo3

    1Medical College of Georgia, Augusta, 2Department of Internal Medicine, University of Georgia, 3Department of Internal Medicine, St. Mary's Medical Group, Athens, USA

    A genetic mutation, autosomal dominant inheritance, EDS causes difficulty in the processing of collagen. This results in abnormalities in the structure and production of connective tissues, involving primarily skin, joints, and blood vessel walls. The abnormalities cause weakening of the joints, chronic pain, dislocations, joint hypermobility, and increased “stretchy” skin that bruises easily. The range of physical complaints, lack of diagnostic tests, and the rarity of EDS cause patients to see multiple physicians over many years before getting a diagnosis. While joint abnormalities are more frequently described, collagen abnormalities also create reproductive problems. A rare condition, affecting all sexes, racial and ethnic groups, it has been shown to be a particularly complicated diagnosis for women. Because women were generally not included in research studies until 1993 for all conditions, the resulting lack of knowledge about the pathophysiology of diseases in half of the population continues to persist. This is especially apparent when this deficiency of knowledge is complicated by the gender bias women experience in the healthcare system resulting in a delay in diagnosis further complicating management. A 28-year-old female had been having recurrent dislocations of her shoulders, thumbs, knees, and hips, had surgery on her knees twice, and was diagnosed with fibromyalgia as well as mast cell activation syndrome, anemia, preeclampsia, HTN, colonic dysmotility, intestinal malabsorption, osteoarthritis, IBS, and preeclampsia. Managed with a G-tube for intractable vomiting and electrolyte abnormalities and a J-tube used for feedings she also had difficulty with fertility and pregnancy and is G6P2 0040. Her two sons both have autism and special needs. Frustrated with her health and multiple diagnoses, she researched multiple conditions and sought care from a physician who specializes in EDS. At the age of 27, she was finally diagnosed with EDS. Women with EDS have a higher rate of reproductive problems than the general population, with increased rates of infertility (43.3%) spontaneous abortions, preterm labor, abnormal uterine bleeding, dysmenorrhea, and severe dyspareunia. For women with EDS counseling is vital to understand the possible implications of EDS on pregnancy. Pregnancy-associated complications are significant and include miscarriages, ectopic pregnancies, and premature delivery. Collagen provides structural support to the extracellular space within connective tissue and is found throughout the body. The variety of seemingly unconnected physical complaints from several organ systems makes EDS difficult to diagnose and may allow other comorbidities, such as gastrointestinal functional disorders, hernias, asthma, pneumonia, and osteoporosis to proliferate. The standard of care for EDS is to treat the symptoms and provide multidisciplinary care including pain medication, intensive physiotherapy, psychology, and occupational therapy. For this patient, the delay in diagnosis resulted in chronic comorbidities, reproductive complications, and additional medical and psychological problems. Because EDS is a complex syndrome, involving many organ systems, determining the best treatment for the patient can be difficult. Early diagnosis, supportive care, and a team-based approach can provide for a better outcome. Physicians and other health care providers should consider an EDS diagnosis in appropriate patients.

      Poster Number 89 Top

    The Impact of SARS-CoV-2 Pandemic on Violence against Women in Brazil

    Rafaela Germano Toledo, Rafael Ribeiro Hernandez Martin

    Faculty of Medical and Health Sciences of Juiz de For a – Suprema, Juiz de Fora, Brazil

    Objective: Violence is the third leading cause of mortality in Brazil, second only to cardiovascular diseases and neoplasms. According to some studies, there was a significant increase in cases of violence against women concomitant with the coronavirus pandemic in Brazil.[1],[2] This study aims to analyze and compare the impacts of violence against women after the beginning of the pandemic.

    Methods: A compilation of the data available in the Information System of Notifiable Diseases in the Brazilian Public Health System Database (DataSUS) was made on interpersonal violence from 2019 to 2021, associated with data on homicides committed in the same period. Then, the data were stratified by gender, race, age group and education.

    Results: In all years, women were more affected than men, representing an average of 71% of all cases of violence. In 2019, 289,742 cases of violence against women were reported. In 2020, 242,434 cases and 2021, 157,786, which represents a reduction of 16% and 46%, respectively, compared to the previous year. On the other hand, homicide cases behaved differently. In 2019, there were 3,739 cases, contrasting with 3,913 in 2020, representing an increase of 4%. In the years evaluated, 40% of notifications were women aged between 15 and 39 years old, 55% self-declared black or brown and 25% had not yet completed high school.

    Conclusions: It is noted that while the number of reports of violence against women has decreased, the cases of feminicide have increased [Figure 1]. What we hypothesized to demonstrate underreporting and underdetection due to changes imposed by the health crisis such as social isolation and the temporary interruption of some services. This can be explained by the woman's fear of reporting in the face of the aggressor's proximity, difficulty in asking for help, fleeing a dangerous scenario or fear of failing to comply with preventive measures against a previously unknown disease. The socioeconomic variables indicate a predilection for social vulnerability profiles: young, black/brown and with low education. To sum up, the pandemic has intensified a situation that was already severe, given not only physical and life risks, but also an intense psychological impact that triggers depression, eating/sleeping disorders and increased consumption of alcohol and illicit drugs.

      References Top

    1. Ministério da Saúde: Data SUS. Violência Interpessoal/Autoprovocada. Available from: <http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sinannet/cnv/violebr.def. [Last accessed on 2022 Jun 18].
    2. Instituto de Pesquisa Econômica Aplicada (Ipea).  Atlas More Details da Violência; 2021. Available from: https://www.ipea.gov.br/atlasviolencia/arquivos/artigos/1375-atlasdaviolencia2021completo.pdf. [Last accessed on 2022 Jun 18].

      Poster Number 95 Top

    Acute Hemorrhagic Encephalitis in a Post-Partum Female: A Rare and Devastating COVID-19 Complication

    Suchi Shah1, Meagan S. Reif2, Rushabh Somani1, Mrunal Patel3, Mhd Majd Mardini4, Sangita Rathod1

    1Department of Internal Medicine, AMC MET Medical College, Ahmedabad, Gujarat, India,2University of Alabama Birmingham, Birmingham, England, 3Department of Internal Medicine, Trumbull Regional Medical Center, Ohio, US, 4Department of Neurology, Damascus, Syrian Arab Republic

    Purpose: (1) In this report, we intend to familiarize healthcare providers with acute hemorrhagic encephalitis (AHE), a rare manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). (2) AHE must be recognized and reported to a regulating medical governing body in order to learn more about its prevalence, risk factors, and potential prevention via vaccination.

    Findings: A 38-year-old Asian female with no prior medical history aside from being 12-weeks postpartum presented to the emergency department with acute-onset severe headache associated with a week of fevers and myalgias. She denied vision changes, gait imbalance or recent falls and took no medications. Vitals were within normal limits aside from mild tachypnea, and the exam was negative for meningeal signs. Labs were significant for leukocytosis to 19 x 109 cells/L and a positive coronavirus disease-2019 (COVID-19) polymerase chain reaction test. Soon, the patient developed a generalized tonic-clonic seizure accompanied by vomiting and altered sensorium with a Glasgow Coma Scale of 8/15. A variety of differentials were considered including cerebral venous sinus thrombosis, meningitis, encephalitis, malignancy and cerebrovascular accident. Non-contrast computerized tomography was negative for acute abnormalities. However, magnetic resonance imaging of the brain revealed extensive edema throughout bilateral thalamic and periventricular regions, brainstem, and cerebellum, with significant hemorrhage of the brainstem and thalamus. Acute hemorrhagic encephalitis (AHE) was suspected based on clinical symptoms and radiologic findings. Patient's clinical status decompensated and she was mechanically ventilated for airway support. Despite high-dose steroids and aggressive hyperosmolar therapy, the patient, unfortunately, expired the day after admission.

    Discussion: For healthcare professionals, diagnosing and treating the wide range of COVID-19 manifestations presents a substantial challenge. AHE is thought to be a severe form of acute disseminated encephalomyelitis, a rare post-infectious event that has been reported in specific viral infections such as H1N1 influenza and herpes simplex virus.[1],[2] It is evident that AHE is not a widely described complication and is a diagnosis of exclusion. The pathophysiology of AHE is unknown although several mechanisms have been proposed, including hypercoagulability, cytokine-storm, hypoxic-injury, and direct virus-induced endothelial damage.[3],[4] We believe our patient was hypercoagulable due to being postpartum, but otherwise had no obvious risk factors for developing AHE.

    Our patient was unvaccinated against COVID-19 due to pregnancy-related vaccine apprehensions, although the association between AHE prevention and vaccines has yet to be investigated. Thus far in the literature, there is no report of AHE from COVID-19 in a postpartum female. Despite being symptomatic for a week, we learned that our patient did not seek medical attention due to the stigma surrounding COVID-19 and the fact that she was the primary provider for her family. Given that early detection and more robust social support might have significantly reduced the risk of disease progression and death in our patient, it is essential for ongoing efforts working to eliminate healthcare access hurdles and social stigma around COVID-19. Additionally, a macro-scale prospective cohort is required to assess the efficacy of high-dose steroids and other treatment modalities in patients with COVID-related AHE.

      References Top

    1. Jeganathan N, Fox M, Schneider J, Gurka D, Bleck T. Acute hemorrhagic leukoencephalopathy associated with influenza a (H1N1) virus. Neurocrit Care 2013;19:218-21.
    2. Kabakus N, Gurgoze MK, Yildirim H, Godekmerdan A, Aydin M. Acute hemorrhagic leukoencephalitis manifesting as intracerebral hemorrhage associated with herpes simplex virus type I. J Trop Pediatr 2005;51:245-9.
    3. Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, et al. Neurological associations of COVID-19. Lancet Neurol 2020;19:767-83.
    4. DosSantos MF, Devalle S, Aran V, Capra D, Roque NR, Coelho-Aguiar JM, et al. Neuromechanisms of SARS-CoV-2: A review. Front Neuroanat 2020;14:37.

      Poster Number 96 Top

    First Trimester Neutrophil to Lymphocyte Ratio (NLR) as a predictor of Preeclampsia in a Single Tertiary Care Hospital: A Prospective Cohort Study

    Alphecca C. Labitad

    Department of Obstetrics and Gynecology, Fatima University Medical Center, Valenzuela City, Metro Manila, Philippines

    Objectives: Preeclampsia is a progressive multisystemic syndrome which is known to complicate about two to eight per cent of all pregnancies according to American College of Obstetricians and Gynecologists, and is responsible for more than 70, 000 annual maternal deaths and 500, 000 annual fetal deaths worldwide according to World Health Organization. As per United Nations International Children's Emergency Fund and the Department of Health, in the Philippines, about eleven mothers die every single day from pregnancy related complications, in which the majority of cases are attributed to hypertension. Because of its multifaceted pathophysiological cascade, many biomarkers have attracted incomparable interest in the second decade of the twenty-first century for their conceivable usage in predicting a deadly disease of pregnancy such as preeclampsia. Therefore, this present research study aimed to determine the potential clinical use of a systemic inflammatory marker in the form of Neutrophil to Lymphocyte ratio (NLR) in the first trimester of pregnancy in the subsequent development of preeclampsia.

    Methods: This is a single-center institutional-based prospective cohort study. A total of 105 nulliparous women ages 15-35 years old at 11-14 weeks of gestation with singleton pregnancy were enrolled. The diagnosis of preeclampsia was based on the revised criteria of the American College of Obstetrics and Gynecology in 2013. Receiver operating characteristic (ROC) curve was also used to derive the optimal cut off value of NLR. The null hypothesis was rejected at 0.05 level of significance. All hypothesis testing were done via Epi Info 7 and validity of numerical results were crosschecked with the same analysis in R.

    Results: Of the 105 research participants, forty-nine (49) had a normal baseline NLR and fifty-six (56) had elevated baseline NLR. The first trimester Neutrophil to Lymphocyte Ratio (NLR) was significantly higher in preeclamptic group compared to that of the normotensive group. The difference was statistically significant (p < 0.001). The ROC analysis revealed a significant diagnostic accuracy of NLR to predict subsequent development of preeclampsia (Area under the curve: 0.8857, p < 0.001) at optimal cut off value of >4.19 with sensitivity of 90.7% and specificity of 86.3 %.

    Conclusion: Results of this research study revealed that first trimester Neutrophil to Lymphocyte ratio (NLR) has a potential significant clinical use as an inflammatory biomarker in predicting subsequent development of preeclampsia (Sn 90.7%; Sp 86.3%). Its cost-effectiveness, accessibility, affordability and simplicity make it a promising screening tool for clinical use especially in primary care and resource challenged community-based setting. Findings will also serve as a basis to strengthen the plan of action among health care providers in managing gravid population at risk of developing preeclampsia most especially those women who live in areas where resources are scarce in order to protect the lives of the every pregnant mothers and their forthcoming newborns.

      Poster Number 97 Top

    Words Matter: What is the Prevalence of Stigmatizing Language within the EHR?

    Courtney Lee1,2, Jackson Steinkamp1, Subha Airan-Javia1

    1Department of Medicine, Perelman School of Medicine at University of Pennsylvania, 2Department of Medicine, The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA

    Objectives: Unconscious bias within the U.S. healthcare system has been linked with disparities in the treatment of patients by age, gender, and race.[1] While many factors contribute to these disparities, implicit bias may play a significant role. Stigmatizing language often reflects the implicit bias that healthcare providers possess toward patients.[2] Recent research suggests that stigmatizing language is prevalent within medical records, more often used in reference to minority patients, and associated with perpetuating bias to other providers.[3],[4],[5] However, we have limited information on the patterns of stigmatizing language in medical records to aid in the development of future interventions. The objective of this study was to characterize variation in the usage of stigmatizing terms across age, gender, and race.

    Methods: We analyzed data from all clinical notes written at an academic medical center between January 1, 2015 and December 31, 2020. Our analysis included a variety of clinical notes such as history & physical examinations and discharge summaries. These notes were written by physicians, residents, advanced practice providers, registered nurses, and pharmacists in inpatient, outpatient, and emergency room settings. We used a simple regular expressions approach to identify twelve terms: compliance, poor historian, drug abuse, addict, lovely, cooperative, good historian, pleasant, defensive, manipulative, refused, and agitated [Table 1]. We selected these words from a list of stigmatizing words and phrases developed by the Center for Disease Control (CDC) and American Psychological Association (APA). We included simple present and past tense in our NLP search. We performed our analyses using the Python programming language and the Spark engine tool. We applied second-order rules to exclude unrelated terms (e.g., 'lung compliance').

    Results: The corpus included 104,456,653 notes from 1,960,689 unique patients and included 192,688,381,883 characters of text. Our analysis suggests that stigmatizing language varies across age and gender [Figure 1] with compliance and cooperation being found more often in comparison to other terms. However, use of these terms remained relatively consistent by race.

    Conclusions: Understanding variation in usage by age, gender identity, and racial identity has the potential to aid in future study of the role of these terms in perpetuating stigma and bias to patients. With the passage of the 21st Century Cures Act hospitals are required to offer patients access to their health records extending the impact of the clinicians' words to the patient-physician relationship.

      References Top

    1. Jiang HJ, Fingar KR, Liang L, Henke RM, Gibson TP. Quality of care before and after mergers and acquisitions of rural hospitals. JAMA Netw Open 2021;4:e2124662.
    2. Park J, Saha S, Chee B, Taylor J, Beach MC. Physician use of stigmatizing language in patient medical records. JAMA Netw Open 2021;4:e2117052.
    3. Bates MD, Griffin MT, Killion CM, Fitzpatrick JJ. African-American males' knowledge and attitudes toward genetic testing and willingness to participate in genetic testing: A pilot study. J Natl Black Nurses Assoc 2011;22:1-7.
    4. P Goddu A, O'Conor KJ, Lanzkron S, Saheed MO, Saha S, Peek ME, et al. Do words matter? Stigmatizing language and the transmission of bias in the medical record. J Gen Intern Med 2018;33:685-91.
    5. Sun M, Oliwa T, Peek ME, Tung EL. Negative patient descriptors: Documenting racial bias in the electronic health record. Health Aff (Millwood) 2022;41:203-11.

      Poster Number 102 Top

    In-Hospital Mortality Risk Factor Analysis in Multivessel Percutaneous Coronary Intervention Inpatient Recipients in the United States: Addressing Gender Disparity

    Gagan Kaur1, Suchi Shah2, Ravi Tummala3

    1Sri Guru Das Institute of Medical Sciences and Research, Amritsar, 2AMC MET Medical College, Ahmedabad, 3Nellore Medical College and Hospital, Nellore, India

    Background: Multivessel percutaneous coronary intervention (MVPCI) like any medical intervention pose certain risks of morbidity and mortality. MVPCI has arguably changed in terms of procedural techniques and superior stent design features making it important to study its outcomes. The primary goal of our study is to evaluate the mortality rate in in-patients recipients of MVPCI, and to evaluate the demographic risk factors and medical conditions that increase the risk of in-hospital mortality.

    Methods: We conducted a cross-sectional study using the nationwide inpatient sample (NIS, 2016) and included 127,145 inpatients who received MVPCI as a primary procedure in US hospitals. We used a multivariable logistic regression model adjusted for demographic confounders to measure the odds ratio (OR) of association between medical conditions and in-hospital mortality risk in MVPCI recipients.

    Results: The in-hospital mortality rate was two per cent and was seen majorly in older-age adults (>64 years, 74%) and males (61%). Even though the prevalence of mortality among females was comparatively low, in the regression model, they were at a higher risk for in-hospital mortality than males (OR 1.2; 95% CI 1.13-1.37). While comparing ethnicities, in-hospital mortality was prevalent in Caucasians (79%) followed by African Americans (9%), and Hispanics. Patients who developed cardiogenic shock were at higher odds of in-hospital (OR 9.2; 95% CI 8.27-10.24) followed by respiratory failure (OR 5.9; 95% CI 5.39-6.64) and ventricular fibrillation (OR 3.5; 95% CI 3.18-3.92).

    Discussion: In-hospital mortality was significantly higher in females by 24% compared to males. Females tend to have a higher mean low-density lipoprotein (LDL) than men because of physiologically higher estrogen levels, wider use of hormonal contraceptives, and hormone replacement therapy contributing to a higher comorbid profile.[1] Other factors like smaller body size, limited access to the quality of care, and inadequate usage of cardioprotective medicines could also contribute to the discrepancy.[2] Gender disparities in terms of preference for cardiovascular testing have also led to seeking healthcare at an advanced stage of the disease, which can directly alter the mortality with reperfusion.[3]

    Conclusion: The accelerated use of MVPCI made it important to study in-hospital mortality risk factors allowing us to devise strategies to improve the utilization and improve the quality of life of these at-risk patients. The highest in-hospital mortality following MVPCI was among females and whites. Cardiogenic shock presented the largest risk (raised by nine times), followed by respiratory failure (increased by six times), and VFib (increased by three times), in MVPCI in patients with medical comorbidities (increased by 3.5 times). The periprocedural risks and patient morbidity profile of MVPCI prevent aggressive use despite its effectiveness and comparably lower mortality profile.

      References Top

    1. Boardman HM, Hartley L, Eisinga A, Main C, Roqué i Figuls M, Bonfill Cosp X, et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev 2015;3:CD002229.
    2. Butalia S, Lewin AM, Simpson SH, Dasgupta K, Khan N, Pilote L, et al. Sex-based disparities in cardioprotective medication use in adults with diabetes. Diabetol Metab Syndr 2014;6:117.
    3. Golden KE, Chang AM, Hollander JE. Sex preferences in cardiovascular testing: The contribution of the patient-physician discussion. Acad Emerg Med 2013;20:680-8.

      Poster Number 105 Top

    Developing an Academic Based Podcast Exploring the Highlights and Challenges of Being a Woman in Medicine with the Long Term Goal of Gender Parity and Empowerment of Women Leadership in Academic Medicine

    Mary Rensel1, Cara King1, Sylvia Perez Perotto1, Boyle Cathy2, Rita Pappas1

    1Cleveland Clinic, Cleveland, USA, 2Cleveland Clinic, Cleveland, United States Minor Outlying Islands

    Objective: Create a podcast highlighting women leaders in academic medicine to encourage recruitment, retention, and promotion of women leaders.

    Background: Underrepresentation of women in leadership of academic medicine needs to be addressed and corrected. Barriers to gender equity in academic medicine are far reaching and require a culture shift and evaluation of local, regional, and institutional norms. We sought to encourage and support the development of women considering a career in medicine through the power of stories. Women's experience in leadership has complex layers with highly gendered assumptions about expertise and knowledge, with every journey being unique. Podcasts can be used to share information and over the past 2 decades has become an easy inexpensive way to disseminate information. The distribution of female guests on medical podcasts are low and when present, often invite other female guests. There was a paucity of academic based podcasts modeling and thereby normalizing women leaders in academic medicine. We sought to start a podcast to enhance the accessibility and dispersion of personalized leadership stories and address the unique highlights and challenges of women leaders in academic medicine to encourage and empower students, trainees and women in medicine and increase the representation of women leaders in academic medicine.

    Methods: We built a podcast team to brainstorm and solidify a podcast concept, delineated goals and optimized format including desired audience and cadence of episode release. We chose an engaging podcast name as this became a core component of our brand. Our model included 1-2 hosts to allow flexibility in interview scheduling and recording. We curated a diverse list of potential interviewees from our academic leadership pool at Cleveland Clinic. We created our podcast artwork and chose engaging music that aligned with our envisioned podcast theme. We recorded the intro/outro to allow an overview of the mission of our show. We enhanced our podcast equipment expertise through collaboration with other experts. We recruited medical students to attain the background information of our guests to optimize inclusion and engagement. We have interviewed academic leaders from Cleveland Clinic (CC) and released them on multiple platforms and the CC podcast website. We have shared the podcast on social media to enhance distribution and dissemination.

    Results: To date we have distributed 17 podcasts with a total page view of 6389 from multiple countries. Each episode has multiple views ranging from 92-357. Our guests' locations have varied as our enterprise has multiple national and international locations including Florida and Ohio.

    Conclusions: Disseminating the stories, highlights and challenges of women leaders in academic medicine through a podcast is an accessible, inexpensive way to encourage and engage others to consider a career as a leader in academic medicine. Next steps are to share the start up plan with other academic centers to continue to disseminate women academic leadership stories and we will also enhance our marketing plan and include international guests to reach further students, trainees and staff.

      References Top

    1. Ludmerer KM. Seeking parity for women in academic medicine: A historical perspective. Acad Med 2020;95:1485-7.
    2. Mannix A, Gore K, Parsons M, Rehman M, Monteiro S, Gottlieb M. Gender distribution of emergency medicine podcast speakers. Ann Emerg Med 2022;80:60-4.

      Poster Number 107 Top

    Students Advancing Sex- and Gender-Based Medicine: A National Medical Education Initiative

    Sneha Chturvedi1, Jeanna Qiu2, Shayna Levine2, Nora Galoustian3, Brooke Hartenstein4, Jan Werbinski5, Deborah Kwolek6

    1Washington University School of Medicine, St. Louis, 2Mass General Brigham Harvard Medical School, Boston, 3UCLA David Geffen School of Medicine, Los Angeles, 4Florida State University College of Medicine, Tallahassee, 5Department of Obstetrics and Gynecology, Western Michigan University Homer Stryker School of Medicine, Michigan State University College of Human Medicine, East Lansing, 6Department of Internal Medicine, Medical Student, Mass General Brigham Harvard Medical School, Boston, USA

    Sex- and gender- based medicine (SGBM) aims to understand how biological sex and gender affect the pathophysiology and expression of human disease. It is now recognized that many factors including hormones, anatomy, gender expression, and environmental exposures affect the differential presentation and course of common diseases, as well as the efficacy and adverse effects of therapeutics between men and women. However, decades of research lacking female animal models and diversity in clinical trial participants continues to limit our understanding of sex and gender-specific differences in health. Education about these differences is still lacking in medical education, with less than 20% of medical schools having an integrated SGBM curriculum outside of traditional obstetrics and gynecology (Jenkins et al., 2016). Despite efforts since the 1990s to include women in medical research and report data by sex, there has been little translation of known sex and gender differences into medical education.

    The Sex and Gender Health Collaborative (SGHC) is a national group associated with the American Medical Women's Association (AMWA), with the goal of advancing SGBM education. We aim to create a publicly available resource of factsheets and videos for students and healthcare providers that will help to expand awareness of SGBM. Students will have the opportunity to conduct in-depth research on sex and gender differences in specific medical conditions and form a nationwide network of physicians-in-training and physicians with similar interests.

    The first phase involved nine students who designed innovative educational materials, including factsheets and toolkits, to highlight sex and gender differences in diseases that are not traditionally emphasized in medical education. This phase of the project is complete and available on the SGHC/AMWA website. Survey data show that all students strongly agreed participating increased their knowledge of sex and gender differences in medicine and allowed students to feel more connected to others interested in these topics. Qualitative data suggests the process encouraged students to develop skills in literature review. Medical students benefited from mentorship with physicians and gained experience mentoring undergraduate students.

    For the second phase, we used the AMWA network to recruit over 300 premedical and medical students from throughout the United States to continue this project. Students will be paired with physician experts to produce factsheets, slide sets, and videos. We will survey the students to evaluate if participating in the project has increased their exposure to sex and gender specific medicine, increased their knowledge of sex and gender differences in common diseases, and enabled them to form connections with others interested in similar topics. Students will present their findings locally to student groups and through social media. We will track student presentations, social media engagement, views of educational videos, and the number of clicks and downloads of content from the SGHC website, to estimate the breadth of impact of this national project. Finally, readers and viewers will be asked to evaluate the utility of these factsheets and videos, with the goal of encouraging medical institutions to incorporate SGBM curricula nationwide.

      Reference Top

    1. SGHC Crunch Sheets & Toolkits. American Medical Women's Association; 2021. Available from: https://www.amwa-doc.org/sghc/sghc-crunch-sheets-toolkits/. [Last accessed on 2022 Nov 13].

      Poster Number 108 Top

    Supporting Our Physician Parents (SOPPort): A Pilot Program for Parental Wellness at the Massachusetts General Hospital

    Josephine Li1, Lauren Hanley2, Camille Powe1, Jacqueline Seiglie1, Jacqueline Seiglie1, Melanie Haines1, Marc Wein1, Amy Bregar2, Karen Miller1, Laura Dichtel1

    1Departments of Medicine and2Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, USA

    Introduction: New parents and parents of young children are particularly vulnerable to burnout and reduced productivity due to child rearing activities. Because women generally carry more of the childbearing and all lactation responsibilities, they are disproportionately affected, which can have negative consequences on their careers. A recent nationwide survey study of physician mothers identified lack of/inconvenience of lactation facilities, lack of time available for breast pumping, discrimination because of breastfeeding, and difficulty finding childcare as prevalent negative experiences when returning from parental leave.[1] The COVID-19 pandemic has exacerbated these issues, particularly for women. The goal of this pilot program, Supporting Our Physician Parents (SOPPort), was threefold: (1) Improve wellness and productivity and reduce burnout of expectant and new parents of all genders, (2) provide lactation and feeding support and (3) design a structured program that could be widely implemented.

    Program Description: Funding was obtained through an internal Massachusetts General Hospital (MGH) wellness pilot grant to the Endocrine Division and OBGYN Department. The core program included a formalized coaching program that provided practical advice over four 1-hour sessions during the expectant phase through 1 year of life. Stipends for lactation support were provided ($500 intended to defray the cost of a wearable pump; could also be applied to formula or feeding supplies) and access to lactation resources was streamlined. A backup pump part supply program was designed, funded and initiated. A virtual new parent's group was created.

    Results: Twelve women received lactation stipends from the program. Eleven physicians were coached (8 women and 3 men). Anonymous feedback from participants (n = 6 at the time of survey) suggested that all participants (6/6, 100%) felt that the program improved their productivity upon returning to work. Parental coaching (6/6, 100%) and lactation support grants (5/6, 83%) were particularly helpful. One female participant stated: “I strongly believe that the program made me feel productive on my return to work during a really difficult time, made even more difficult by the uncertainties of childcare during this pandemic. I didn't have to choose between productivity and breastfeeding/pumping, and I didn't have to reinvent the wheel on return to work.” In a survey of Department of Medicine (DOM) physician parents who were not eligible for this pilot program, 78% rated their return to work after becoming a new parent as “difficult” or “very difficult,” 82% reported that they had no one at work advising them on this transition, and 96% stated that our program would have been helpful to them.

    Discussion: There was positive feedback for this formalized parental wellness program, which was used to secure expanded funding in the MGH DOM. The expanded program now has 62 participants. The authors hope to continue this important parental wellness work with an emphasis on supporting junior faculty women in medicine and promoting a wider change in culture. Through these efforts, we hope to improve parental wellness, morale and satisfaction, reduce burnout at a particularly vulnerable time and lead to community building among parents of young children.

      Reference Top

    1. Juengst SB, Royston A, Huang I, Wright B. Family leave and return-to-work experiences of physician mothers. JAMA Netw Open 2019;2:e1913054.

      Poster Number 110 Top

    Sociodemographic and Clinical Characteristics of Newly Diagnosed Women with HIV at the Dr. Mario Catarino Rivas Hospital in San Pedro Sula, Honduras

    Krisia Banegas-Carballo, Obed Quiroz-Murillo, Andrea Quiroz-Rivera, Karen Erazo

    HIV Clinic/SAI – Hospital Dr. Mario Catarino Rivas, Dr. Mario Catarino Rivas Hospital, San Pedro Sula, Honduras

    Objectives: To characterize in a sociodemographic and clinical manner women with a new diagnosis of HIV for two years (2020-2021) in order to obtain information on the vulnerability that makes women in Honduras more susceptible to HIV infection and its complications.

    Methods: Observational, descriptive research: retrospective cross-sectional cohort. Population of 72 women between 17-68 years of age who were diagnosed with HIV at the Dr. Mario Catarino Rivas Hospital in San Pedro Sula, Honduras between January 2020 and December 2021. A total of 13 patients with incomplete medical records were excluded from the study, resulting in a sample of 59 women. Data was obtained by reviewing the medical records of patients who met the inclusion criteria.

    Results: The mean age at diagnosis was 35 years old. 12% (7) were illiterate and only 18% (11) completed high school or higher education. Regarding the reason for HIV testing, 40% (24) were screened during pregnancy or childbirth, 25% (15) due to contact with a positive case, 22% (13) due to clinical manifestations associated with HIV and only 7% (4) due to routine screening. Regarding the HIV status of their partners, 27% (16) were HIV positive, 10% (6) were negative and 63% (37) did not know or wanted to know their HIV status. 8% (5) of partner deaths were associated with HIV-related complications. 8% (5) of patients had at least one child with HIV-positive serology. 59 % (35) initiated sexual activity at ≤16 years of age. 17% (10) of the patients had a history of sexual abuse and 3% (2) were sex workers. 76% (45) denied using condoms while 24% (14) used them only occasionally. 53% (31) started treatment with a regimen including Dolutegravir. In terms of clinical characteristics, 32% (19) were in immunological failure. Only 14% (8) were screened for cervical cancer. Of the patients who were screened for cervical cancer, one had CIN I, two had CIN II and five had negative results. 8% (5) were diagnosed with at least one STI. 59 % (35) did not receive psychological care at the time of diagnosis.

    Conclusions: Given that the HIV clinic of the Dr. Mario Catarino Rivas Hospital has the largest cohort of patients with HIV at the national level, the small number of women with newly diagnosed HIV obtained for two years is striking. It is of great relevance that most of the diagnoses were obtained through mandatory screening of pregnant women instead of routine check-ups motivated by the self-perceived risk of acquiring the virus. In Honduras, women may be more prone to HIV-related complications due to late diagnosis. It is established through this study the need to implement an educational program aimed at women to increase knowledge and thus the self-perception of the risk of contracting HIV to increase early diagnosis to improve the prognosis of our patients.

      Poster Number 115 Top

    Gender-Differentiated Analysis of Implantable Cardioverter Defibrillator Indications in American Heart Failure Guidelines

    Prima Wulandari

    Harvard Medical School, Massachusetts General Hospital, Boston, USA

    Introduction: Despite emerging evidence which demonstrate that women obtained a more significant amount of inappropriate discharges and do not benefit as much as men from implantable cardioverter-defibrillator (ICD) implantation, the guidelines for heart failure clinical practice do not consider a distinct attitude when it comes to taking gender differences into consideration.

    Objective: This study aims to investigate registries and clinical trials on which the proposals and recommendations for heart failure clinical practice guidelines are based.

    Methods: A selection in the references of the 2021 American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Failure Society of America (HFSA) guidelines for the management of heart failure was examined. We explored and included clinical trials, clinical essays, and the registries within the guidelines. We investigated the references focusing on gender outlooks corresponding to the subsequent inquiries: (1) What is the proportion of women in the study? (2) Are gender differences being considered as a primary variable or as a secondary variable? (3) Are analyses differentiated by sex and/or gender performed? (4) Are side effects designated in a distinct separation by sex and/or gender?

    Results: We investigated 24 studies. The proportion of women is between 10% to 35%. Only 9 in 24 studies elaborated an analysis differentiated by sex and/or gender. There were four studies that performed distinct separation of side effects according to sex and/or gender. Between studies that reported differentiated analyses by sex and/or gender, three of these studies demonstrates that women did not significantly reap the benefit of ICD implantation.

    Conclusions: Gender-differentiated analyses should be compulsory in all the clinical studies being conducted in the future. Upcoming guidelines on heart failure clinical practice should contemplate on different recommendations according to gender. Being excluded or underrepresented in studies has the potential to acclimatize a discriminative treatment to women, not only in the current but also in the future practices in the management of heart failure.

      Poster Number 121 Top

    Genome-Wide Transcriptomics Reveals New Sex-Specific Gene Expression and Pathways in Patients with an Acute Myocardial Infarction.

    Aaron Shulkin1, Perman Pandal2, Eliseo Vazquez2, Elizabeth Cortez-Toledo2, Alejandra Galina Bernal Fausto2, Tesfaye B. Mersha3, Javier E. Lopez2

    1Department of Molecular, Cell, and Developmental Biology, University of California Santa Cruz, Santa Cruz,2Cardiovascular Division, Department of Internal Medicine, UC Davis School of Medicine, University of California, Davis, Davis, CA, 3Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA

    Background: Clinical evidence suggests that outcomes of acute myocardial infarction (AMI) vary between females and males; however, the nature of this sex dimorphism remains controversial. Most AMI transcriptomic studies have not considered differences between females and males, and combined sexes in their analysis to increase sample size and gain power (canonical approach). Our objective was to (1) use a sex-specific differentially expressed gene meta-analysis (ss-DEGma) in blood and (2) identify sex-specific pathways related to the early phase of AMI.

    Methods: Gene expression data (7 sets) for sex-combined (canonical) and sex-specific analysis (ss-DEGma) were obtained from the publicly-available GEO database. Datasets from whole blood and peripheral blood cells sampled within 3 days post-AMI were analyzed using GEO2R. The massiR tool identified sex in 72% of samples. The top-ranking DEGs were used to identify significant sex-specific biological pathways in the KEGG database (FDR <0.05).

    Results: We performed this meta-analysis in 291 women and 452 men and > 20,000 genes [see Table 1 for identified DEGs]. Sex-combined DEGs yielded 100 significant KEGG pathways. Sex-specific DEGs yielded 8/61 (13%) additional new pathways not identified by the sex-combined analysis. Sex-combined pathways were predominantly immunological (35%), while male- and female-specific pathways were 43% and 18% immunological, respectively. Proliferative and metabolic pathways were the next most represented pathways in females, which were not present in males at all.

    Conclusion: We present 8 new sex-specific AMI-related transcriptional pathways not identified in the canonical sex-combined analysis. Furthermore, we find that 53% of pathways identified in the canonical sex-combined analysis are not shared between sexes. This data underscores an urgent need for prospective sex-specific transcriptomic analysis to define the sex-specific biological difference post-AMI.

      Poster Number 123 Top

    An Op-ed Writing Opportunity and Workshop Integrated in a Medical School Health Policy Course Resulted in Op-ed Publications by Medical Students at an Equal Rate among Women and Men

    Venkatesan Krishnamoorthi1, Shikha Jain2

    1Department of Medicine, University of Chicago Pritzker School of Medicine, 2Division Hematology and Oncology, School of Medicine, University of Illinois, Chicago, IL, USA

    Introduction: Studies have shown that opinion pieces written by women, such as Op-eds and letters-to-the-editor, have historically been underrepresented in newspapers and magazines. However, training provided by programs such as The OpEd Project may have contributed to an increased number of women with published Op-eds. Op-ed writing can be a powerful and accessible advocacy tool for women in medicine, but few opportunities or curricula exist in medical education for this type of writing. We integrated an Op-ed writing opportunity in a required health policy course for medical students and implemented and evaluated an Op-ed writing workshop. Here we report the rate of engagement among women in this writing opportunity and the number of published Op-eds by women.

    Setting and Methods: All 90 first-year medical students at the University of Chicago Pritzker School of Medicine are required to take the course “The American Healthcare System.” During the autumn 2021 course, for their final required writing assignment, students were given the option to 1) write an essay on one of the prompts provided by the course directors or 2) write an Op-ed advocating for change in a health-related issue of their own choice. An optional Op-ed writing workshop was offered, teaching format and style and also encouraging students to recognize the power of their voice as members of the medical community. Students were encouraged to submit their pieces for publication and were provided additional editing to improve chances for publication. Students were surveyed for their prior advocacy experience, prior publication experience, whether they attended the workshop, and whether they found it helpful for their confidence in Op-ed writing. Gender identity was reported on a separate student roster and matched to the authors of writing submissions.

    Results: Women comprised 54 percent (N = 49) of the class. Of all 90 students, 48 (53%) chose the Op-ed writing option, and 24 (50%) of these authors were women. Forty-nine percent of women took the Op-ed writing opportunity, compared to 59% of men. Women wrote to advocate on various topics, such as improving racial disparities in breast cancer survival and increasing funding for healthcare for the homeless. Out of all submissions for publication, seven Op-eds were published in major news outlets or physician blogs (three in The Chicago Tribune, three on KevinMed, one in Newsweek) and one was published as a letter-to-the-editor in The Chicago Sun-Times. Of these eight authors, four (50%) were women. Pre-workshop survey (N = 68 respondents) revealed that 93 percent of all students had never published an opinion piece before. Thirty-three percent of post-course survey respondents (N = 73) reported attending the Op-ed writing workshop, and 88% of attendees found it helpful.

    Discussion: An opportunity and a workshop for Op-ed writing for medical students resulted in lower uptake of the Op-ed opportunity by women compared to men but in an equal number of published pieces. Integrating the opportunity and training in a medical school curriculum may encourage women learners to submit opinion pieces on health issues at higher rates and improve representation in the opinion pages.

    Disclosures: Dr. Parul N Barry Disclosures, Elsevier Pathways Consultant, Speaker, Varian with paid honoraria, ACRO New Practitioner Grant, Member, ACRO Board of Chancellors, UPMC Hillman Cancer Center DSMB. Dr. Shikha Jain Disclosures, Founder and Chair, Women in Medicine.

    Financial support and sponsorship

    The 2022 Women in Medicine Summit was supported by the following benefactors: Healio, Horizon, Natera, Novartis Pharmaceuticals, Explore the Space, Illinois State Medical Society, Oak Street Health, University of Chicago Medicine, and other benefactors. Readers can access the full list at https://www.womeninmedicinesummit.org/sponsors.

    Ethical conduct of research

    All of the abstracts and case reports included herein were required to follow applicable EQUATOR Network (http://www.equator-network.org/) guidelines prior to acceptance for presentation at the Women in Medicine (WIM) Summit. This includes approval by Institutional Review Board / Ethics Committee and patient consent declaration for case reports or series. Verification of the above pre-requisites was performed by the WIM Abstracts and Research Committee.


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