The reasons for the persistent lag of women as leaders are complex. Attrition is an issue for women for many reasons, including traditional gender roles that may affect how women are perceived and the choices they have available (or they make), a lack of role models, the undervaluing of women's traditional communication and leadership styles, and organizational culture. Within medicine (clinical environments) and academic medicine (medical school and clinical environments), it is clear that the lack of women in leadership positions is more than a pipeline or a labyrinth problem. We undertook this case study to better understand the current challenges experienced by women aspiring to leadership positions in medicine and academic medicine. What types of challenges do women face as they move up in an academic or medical environment? And which challenges impact more than others in attaining leadership roles in these organizations: race and ethnicity, differences in leadership style and skills, mentorship and network, life experiences and family responsibilities, organizational culture, or gender? Our study addresses a gap in the literature by examining the leadership experiences of eight successful women in the fields of medicine and academic medicine. The emerging insights from these leaders may be useful for women from diverse backgrounds aspiring to be senior leaders in the future.

Expressed barriers to writing for publication include lack of time, competing demands, anxiety about writing and a lack of knowledge about the submission process. These limitations can be magnified for practitioners in non-university environments in which there are fewer incentives or expectations regarding academic publication productivity. However, as members of professional disciplines, practitioners have both the responsibility and, oftentimes, the insights to make valuable contributions to the professional literature. Collaborative writing groups can be a useful intervention to overcome barriers, provide the necessary skills and encouragement as well as produce publications and conference presentations that make worthy additions to the professional body of knowledge. This article discusses the evolution and outcomes of writing groups at Lehigh Valley Health Network and describes how this strategy can be adopted by other academic community hospitals to promote professional development and publication. WHY DID WE START?The impetus to create writing groups came from two healthcare professionals (the chair of medicine and a medical anthropologist/research scientist) who shared a desire to bring innovations (and failures) of hospital projects to the professional literature. While interested in the personal satisfaction that comes from authorship, these colleagues also strongly believed that professionals in all disciplines had the responsibility to share "what works" with fellow practitioners and make meaningful contributions to the literature. Both of these individuals had a publication track record, and enjoyed writing and working in groups.A "writing group" offered a structure that would be familiar to hospital colleagues who were accustomed to team-based work to accomplish specific goals. While the first group included colleagues with a shared interest (and passion) in a single topic (cross-cultural health care), subsequent "writing groups" have formed within the context of existing project teams (such as quality improvement, hospital efficiency, cultural awareness and palliative care).

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Introduction The Toxicology Investigators Consortium (ToxIC) database, created in 2010 by the American College of Medical Toxicology (ACMT), compiles data recorded by medical toxicologists. In January 2017, the data field for transgender (and if transgender, male-to-female or female-to-male) was added to the ToxIC form. Little is known regarding trends in poisonings among transgender patients. We sought to review consultations managed by a bedside toxicologist and provide descriptive data in trends among types of exposures within the transgender demographic. Methods A retrospective ToxIC database evaluation of cases in which the patient identified as transgender were reviewed from January 2017-June 2019 and descriptive demographics reported. ResultsThe registry contained 113 cases that involved transgender patients. Of those with complete data, 41 (36.6%) were maleto-female, 68 (60.7%) were female-to-male, and 3 (2.7%) identified as gender non-conforming. Of those with complete data, the most common reason for encounter was intentional use of a pharmaceutical drug (N = 97, 85.8%), of which 85 (87.6%) were classified as intentional pharmaceutical use intended for self-harm. Analgesics were the most common class of drugs used out of those reported (N = 24, 22%). Forty-six (90.2%) patients aged 13-18 with complete data were identified as encounters due to selfharm. Attempt at self-harm was the most common reason for intentional pharmaceutical encounter among the sample of transgender patients with complete data (N = 85, 87.6%); with female-to-male patients having an N = 53 (77.9%). Conclusion Among transgender patients in the ToxIC registry,themost commonprimaryreasonfortheencounter was intentionaluse of a pharmaceutical drug intended for self-harm. In this small cohort, there were some age and transition differences in prevalence. These findingsmayinformpoisoningpreventionpracticesaswellassex-andgender-basedmanagementofpatientsinthisvulnerablepopulation.