Gender-based Barriers in the Advancement of Women Leaders in Emergency Medicine: A Multi-institutional Qualitative Study

Abstract

Introduction: Leadership positions occupied by women within academic emergency medicine have remained stagnant despite increasing numbers of women with faculty appointments. We distributed a multi-institutional survey to women faculty and residents to evaluate categorical characteristics contributing to success and differences between the two groups. Methods: An institutional review board-approved electronic survey was distributed to women faculty and residents at eight institutions and were completed anonymously. We created survey questions to assess multiple categories: determination; resiliency; career support and obstacles; career aspiration; and gender discrimination. Most questions used a Likert five-point scale. Responses for each question and category were averaged and deemed significant if the average was greater than or equal to 4 in the affirmative, or less than or equal to 2 in the negative. We calculated proportions for binary questions. Results: The overall response rate was 55.23% (95/172). The faculty response rate was 54.1% (59/109) and residents’ response rate was 57.1% (36/63). Significant levels of resiliency were reported, with a mean score of 4.02. Childbearing and rearing were not significant barriers overall but were more commonly reported as barriers for faculty over residents (P <0.001). Obstacles reported included a lack of confidence during work-related negotiations and insufficient research experience. Notably, 68.4% (65/95) of respondents experienced gender discrimination and 9.5% (9/95) reported at least one encounter of sexual assault by a colleague or supervisor during their career. Conclusion: Targeted interventions to promote female leadership in academic emergency medicine include coaching on negotiation skills, improved resources and mentorship to support research, and enforcement of safe work environments. Female emergency physician resiliency is high and not a barrier to career advancement.

Gender differences in emergency medicine resident assessment: A scoping review

“…These findings are in keeping with previous studies that have shown that the greatest levels of attrition in commitment to academia for females occurs during residency 48 with increasing levels of attrition continuing up each faculty rank position to the title of full professor 49 . A recent multi‐institutional survey sent to female EM faculty and residents found that 68.4% of respondents experienced gender discrimination as they progressed throughout their academic careers and that this continues to be a significant barrier to female advancement within academia in EM 50 . While these differences are striking, future research investigating the direct impacts of discordant and critical feedback on female resident professional development and methods to address these gender differences within assessment feedback is needed.…”

“…49 A recent multi-institutional survey sent to female EM faculty and residents found that 68.4% of respondents experienced gender discrimination as they progressed throughout their academic careers and that this continues to be a significant barrier to female advancement within academia in EM. 50 While these differences are striking, future research investigating the direct impacts of discordant and critical feedback on female resident professional development and methods to address these gender differences within assessment feedback is needed.…”

Physician Men Leaders in Emergency Medicine Bearing Witness to Gender-Based Discrimination

“…This even occurs for men leaders, who, like our high-ranking participants, may find that "silence is pervasive in organizations due to the widely shared belief that speaking up about sensitive issues is futile or even dangerous." 22,23 While the perceptions of GBD among women who are targeted are well-documented, 1,3,7 our findings add to the literature by addressing the perceptions of GBD among an advantaged group, men leaders, who bear witness to it. Witnessing GBD produced negative emotional responses, including feelings of shame, guilt, disbelief, and anger, in these men participants.…”

“…4 In EM, women report high rates of GBD: 52.6% of women in EM report being sexually harassed, 25% report genderbased disrespect, and 9.5% report at least 1 encounter of sexual assault by a colleague or supervisor during their career. 1,[5][6][7] Women physicians are more likely to experience GBD than men, particularly from patients, other physicians, or nursing staff. 1,8 Despite GBD's prevalence, women physicians report only approximately 5% of incidents, often due to the belief that nothing will be done or changed or the fear of retaliation.…”

“…Women report experiencing GBD, such as sexual harassment, patronizing actions, comments on appearance, sexual advances, and innuendos . In EM, women report high rates of GBD: 52.6% of women in EM report being sexually harassed, 25% report gender-based disrespect, and 9.5% report at least 1 encounter of sexual assault by a colleague or supervisor during their career . Women physicians are more likely to experience GBD than men, particularly from patients, other physicians, or nursing staff …”