Distinguished Service Awards in Anesthesiology Specialty Societies: Analysis of Gender Differences.

The authors queried 9 anesthesiology societies to examine Distinguished Service Award recipients over time by gender. Of the 211 total Distinguished Service Awards given by all 9 societies, women received 25 (11.8%). Comparing pre-2008 data to the most recent decade, there was no statistical difference in the number of women Distinguished Service Award recipients with 8.9% and 17.1% women Distinguished Service Award recipients, respectively (P = .076). Societies varied greatly in their women awardees, from 40% to 0% in the last decade. Low levels of awardees stand in contrast to the increasing number of women in the academic pipeline. The authors recommend that societies collect gender membership data and study their award processes from nomination to selection.

Satisfaction of Women Faculty in Academic Medicine.

Purpose: Research about academic medicine women faculty has focused on comparisons of men and women or specific groups who achieved leadership. To better understand the low percentages of women in academic medicine leadership, attention should be paid to the career continuum within genders. Study findings will inform policies and programs to support women in building careers and acquiring leadership positions. Materials and Methods: Association of American Medical Colleges (AAMC) StandPoint Faculty Engagement Survey data are used to describe and compare women assistant, associate and full professors' perceptions of (1) career development and advancement opportunities, and (2) a culture and climate that fosters diversity, equity, and inclusion. Specific similarities and differences with men are highlighted. Results: Fifty-nine percent of women respondents were assistant, 25% associate, and 16% full professors. Associate professors of both genders were the least satisfied on the main measures. Women were less satisfied than men at each career stage across the majority of variables. Among women, fewer than half of full and associate professors, and 52% of assistant professors believe they can express their opinions without fear of retribution. While the majority at all ranks (69%-75%) report feeling respected in the workplace, among those who did not, the highest percentage of disrespect based on gender was among associate professors. Conclusions: The perceptions of >7,500 academic medicine women faculty, representing different generations and ranks, underscore the need to broadly address gender inequity and sexism throughout the career continuum. It identifies the mid-career stage as a challenging experience for both men and women. Women, especially at the associate professor rank, remain a critically dissatisfied and underresourced group that is at risk for underutilization and potentially exit from academic medicine. All ranks of women need career development and equitable policies to support their sense of belonging and career advancement.

Individual, organizational, and policy strategies to enhance the retention and a sense of belonging for health care professionals in rehabilitation medicine.

The retention of physicians and other health care professionals in rehabilitation medicine is a critical issue that affects patients' access to care and the quality of the care they receive. In the United States and globally, there are known shortages of clinicians including, but not limited to, physicians, nurses, physical therapists, occupational therapists, and speech-language pathologists. These shortages are predicted to worsen in the future. It is known that attrition occurs in a variety of ways such as a clinician reducing work hours or effort, taking a position at another organization, leaving the field of medicine altogether, stress-related illness, and suicide. Retention efforts should focus on stay factors by creating a positive culture that supports a sense of belonging as well as addressing a myriad of push and pull factors that lead to attrition. In this commentary, we provide a roadmap that includes examples of stay strategies for individuals and organizations to adopt that are aimed at enhancing the retention of rehabilitation medicine professionals.

Lessons and Future Directions for a Gender Equity Pledge Campaign.

Background: In November 2019, the IWill gender equity pledge campaign called individuals in a health sciences university to make public pledges for gender equity and fostered meaningful dialog to alter mental models and power dynamics. Over 1400 staff, faculty, and students chose 1 of 18 pledges or created their own. Methods: A follow-up, mixed-methods survey was sent to 1405 participants in July 2020. Results: Fifty-six percent (n = 769) responded. Over 70% endorsed fulfilling their pledge and believed they had the power to promote equity. Men were significantly more likely to endorse fulfilling their pledge, and men and learners endorsed having the power to create change at significantly higher rates than women. Key barriers included time, support for completion, and nonconducive culture or hierarchy. Key supports included personal reminders, self-reflection, and support from a partner, community, or leader. Top reasons for participation in the campaign included fairness or justice, being part of a community, team diversity as an inherent good, and the sense that the Medical College of Wisconsin's (MCW) should be a leader in gender equity. Conclusion: The IWill campaign successfully encouraged faculty, staff, and learners to reflect upon and engage in equity work. Key learnings included the need to streamline administrative support while building a sense of community around equity, and the further work needed to engage leaders and directly support not just individual but also departmental and institutional efforts in gender equity.

Advancing Salary Equity in Schools of Medicine in the United States.

Equity, in broad terms, is a critical issue and has been identified as an area that needs particular attention in academic medicine. Gender equity, as a subset of overall equity, has equally been shown to be lacking in academic medicine, and most medical schools and academic health systems are involved in substantive journeys to improve all dimensions of equity, diversity, and inclusion. This Invited Commentary calls for including gender-based salary equity as a foundational accomplishment for institutions seeking to achieve overall equity. In addition, the authors provide evidence and recommendations to guide institutions toward best practices in achieving salary equity. They propose 4 areas of consideration: (1) prioritization by leadership; (2) prioritization of resources to ensure success; (3) development of corrective action plans which are "automatic" and based on clear guidelines; and (4) transparency of methodology, data, and results.

The Almost Perfect Scale in medical students: factor analysis, measurement invariance, and profile analysis.

Incoming medical students at a private midwestern medical school are routinely surveyed at the time of matriculation on wellness measures, one of which is the Almost Perfect Scale - Revised (APS-R). An 8-item subset of this 23-item scale has been suggested as an alternative perfectionism measure, called the Short Almost Perfect Scale (SAPS). To confirm the within-network and between-network construct validity of both scales in our population, responses in 592 matriculating medical students from the years 2020-2022 were analyzed using both versions of this scale. Confirmatory factor analysis found the items significantly measured the construct of perfectionism in the SAPS scale, but not the APS-R. The APS-R was not analyzed further. SAPS was analyzed for measurement invariance (MI) and was equivocal for gender at the scalar level; differential item functioning indicated that any MI effect was small. Latent profile analysis was inconclusive in our sample, possibly because our students' scores on the latent variable "standards" were consistently higher than previously reported. We recommend that the SAPS be used rather than the APS in medical students, that gender differences be analyzed with caution, and that profiles of types of perfectionists not be utilized in this population without further investigation. Finally, we suggest that the discrepancy scale alone may be a better indicator of perfectionism in this population of high achievers.

Labor analgesia for the obese parturient.

Obese parturients present obstetric anesthesia providers with multiple challenges, including increased incidence of maternal coexisting disease, labor complications, and potential for difficult initiation and failure of neuraxial labor analgesia. This focused review discusses these challenges, and suggests potential methods to increase labor analgesia success in this population.

The Effect of COVID-19 on the Medical School Experience, Specialty Selection, and Career Choice: A Qualitative Study.

OBJECTIVE: While COVID-19 had a profound impact on healthcare, its effects on medical students are less clear. This study explored the effects of COVID-19 safety measures on medical students' specialty selection and career choices. It further considers the potential differential effects of COVID by gender. DESIGN: Between June and November 2020 at a Midwestern medical university, medical students with an anticipated graduation in 2021 through 2023 participated in virtual focus group sessions, which explored students' transition to remote learning during COVID-19, perception of gender bias within medical education, and personal and professional goals. Nine focus groups were held, with two to six students per session (n = 22). Focus groups were video recorded, transcribed verbatim, and data were deidentified. Transcripts were coded and analyzed using consensual qualitative analysis to identify themes. RESULTS: Our analysis captured 3 themes: (1) Impact of Institutional Decision-Making due to COVID-19, (2) Impact of Unstructured Time on Professional and Personal Decision Making, and (3) Impact of Societal Pressures, Gender Bias, and Mentorship on Career Planning. CONCLUSIONS: COVID-19 disrupted important learning opportunities for medical students. Mentorship and shadowing are critical in helping students make career and specialty decisions, particularly for women. The loss of these opportunities may have lasting career impacts for all students.

Winners and Losers in Academic Productivity During the COVID-19 Pandemic: Is the Gender Gap Widening for Faculty?

Background: The coronavirus pandemic accelerated academic medicine into the frontline of research and clinical work, leaving some faculty exhausted, and others with unanticipated time off. Women were particularly vulnerable, having increased responsibilities in both academic work and caregiving. Methods: The authors sought to determine faculty's responses to the pandemic, seeking predictors of accelerated versus decelerated academic productivity and work-life balance. In this survey of 424 faculty from a private Midwest academic medical center completed in August-September 2020, faculty rated multiple factors both "pre-COVID" and "during the COVID-19 lockdown," and a change score was calculated. Results: In a binary logistic regression model comparing faculty whose self-rated academic productivity increased with those whose productivity decreased, the authors found that controlling for multiple factors, men were more than twice as likely to be in the accelerated productivity group as women. In a similar model comparing partnered faculty whose self-rated work-life balance increased with partnered faculty whose work-life balance decreased, being in the positive work-life balance group was predicted by increased academic productivity, increased job stress, and having higher job priority than your partner. Conclusions: While the COVID-19 pandemic placed huge stressors on academic medical faculty, pandemic placed huge stressors on academic medical faculty, some experienced gains in productivity and work-life balance, with potential to widen the gender gap. As academic medicine evolves post-COVID, leaders should be aware that productivity and work-life balance predict each other, and that these factors have connections to work location, stress, and relationship dynamics, emphasizing the inseparable connections between work and life success.

The IWill MCW Campaign: Individual Actions to Advance Gender Equity.

Advancing equity for women remains an urgent and complex problem at academic health centers. Attempts to mitigate gender gaps have ranged widely and have been both slow to occur and limited in effect. Recognizing the limitations of previously attempted solutions and fueled by the #MeToo and #TimesUp movements, the Medical College of Wisconsin (MCW) stepped outside known approaches (e.g., women's leadership plans and programming) to design and implement a strategic campaign that promotes gender equity through fostering change in systems and social norms. This campaign, IWill MCW (launched in 2019), emphasizes the power of individual responsibility for positive change. The IWill MCW campaign employs a 2-pronged approach. The first is the creation of personal call-to-action public pledges focused on 5 aspects of gender equity, along with the provision of supportive resources to reinforce positive change. The second is the use of those pledges to raise awareness of gender inequity in academic medicine by fostering meaningful dialogue meant to alter mental models of equity, relationships, and power dynamics. In the initial 6-week phase of the IWill MCW campaign, leaders reached out to all MCW faculty (2,002), staff (4,522), and learners (1,483) at multiple campuses. This outreach resulted in nearly 1,400 pledges, including 30% (n = 420) from men. The effort also engaged over 90% (n = 101) of members of MCW senior leadership teams. The feedback from the initial campaign has been positive. Lessons learned include realizing the importance of public pledges, engaging male allies, and following up. The authors suggest that the IWill MCW campaign provides a model for academic health centers to advance gender equity and shape an environment in which people of all genders can thrive.

Representation of Women on Journal Editorial Boards Affiliated with the Association of American Medical College's Council of Faculty and Academic Societies.

Background: The Council of Faculty and Academic Societies (CFAS) comprises representatives from medical schools and professional societies who guide the Association of American Medical Colleges (AAMC). Given the AAMC's stated mission to improve diversity and inclusion, we used gender-related representation on journal editorial boards as a proxy for evaluating CFAS member societies' commitments to equity. Methods: From screenshots of journal mastheads (n = 44) collected June 3-6, 2019, individuals were categorized by editorial position. Outcome measures included numbers of men and women among faculty, deans, department chairs, physicians, and nonphysicians on editorial boards. Outcomes were compared with 2018 AAMC and US Bureau of Labor Statistics workforce data. Results: Overall, the proportion of women among journal editors was 29.0% (364 of 1,255), range 0%-53.3%. This proportion was significantly less than the proportion of women among US medical school faculty and medical scientists. The lowest percentages of women were found among journals' section or topic editors (19.2%) and editors-in-chief (20.4%). Men were significantly more likely to be a professor or department chair and women were significantly more likely to be an associate professor or assistant professor, suggesting a bidirectional process between rank and editorial position that may inhibit the advancement of academic women, particularly women physicians. Conclusions: This study revealed disparities in the equitable representation of women among CFAS member-affiliated journal editors. Because CFAS member societies participate in a mutually beneficial relationship with the AAMC, they should strive to attain the equity goals set forth by the AAMC.

The effect of obesity on neuraxial technique difficulty in pregnant patients: a prospective, observational study.

BACKGROUND: Practitioners often presuppose that obesity will increase neuraxial technique difficulty in pregnant patients, but few investigators have systematically examined this population for risk factors associated with difficult epidural or spinal needle placement. We designed this study to prospectively identify factors that predict neuraxial technique difficulty in pregnant patients. METHODS: Using a prospective, observational format, pregnant patients were examined for multiple potential risk factors for neuraxial technique difficulty, including current body mass index, ability to palpate spinous processes, maximum back flexion, scoliosis, and experience of the practitioner. Neuraxial technique difficulty was then assessed using two measures: 1) the number of needle passes needed to reach the desired space, and 2) the placement time from skin infiltration to either spinal injection or epidural catheter threading. Predictors of total needle passes were determined by fitting the data to a generalized linear model with negative binomial error. Predictors of neuraxial anesthetic time were determined by fitting a linear model to the log of neuraxial anesthetic placement time. A survival model was used to account for bias introduced when attending physicians intervened in resident physician procedures. RESULTS: Neuraxial procedures in 427 pregnant patients were studied. For both the number of needle passes and the neuraxial anesthetic placement time, the significant predictors of difficulty were the practitioner's ability to palpate the patient's bony landmarks and the patient's ability to flex her back. Obesity, as measured by body mass index, was not an independent predictor of either end point. Obesity did, however, strongly predict both the ability to palpate landmarks and flex the back. CONCLUSIONS: Despite concerns that obesity may cause difficulty with neuraxial technique, some obese patients have surprisingly easy neuraxial block placements. When approaching any neuraxial anesthetic in a pregnant patient, and especially in the obese parturient, back flexion and landmark palpation predict neuraxial technique difficulty.

No Room to "Lean In": A Qualitative Study on Gendered Barriers to Promotion and Leadership.

INTRODUCTION: The gender gap in professorship and leadership roles persists in academic medicine, whereas reasons for these disparities remain unclear. MATERIALS AND METHODS: Open-ended text responses to a 2013 faculty engagement survey were analyzed by using the grounded theory and consensual qualitative analysis techniques. The authors grouped 491 faculty's text responses into descriptive codes and three themes: (1) No Obstacles, (2) Barriers to Success, and (3) Concerns Regarding Processes. Demographics of codes were compared by using chi-square analysis. RESULTS: Male faculty identified barriers that included negative views of leadership or leaders. Female faculty, especially those in clinical roles, expressed barriers related to role overload, including that the demands of their current positions prevented advancement or addition of further roles, no matter how desirable further roles may be. Women also shared that considerable self-promotion was required to receive acknowledgement of their work and support by leadership. CONCLUSION: A proposed framework depicts male and female faculty's concerns on a continuum. No Obstacle and Process Concerns were relatively gender neutral, whereas large gender disparities occurred within the Barriers to Success theme. Women's barriers largely revolved around internal obstacles (I can't do any more), and men's barriers largely revolved around external factors (leaders are impeding my progress). Resources are needed to mitigate work overload specifically for female faculty, and to ensure that all faculty are both engaged in advanced career opportunities and encouraged to pursue leadership positions.

Women and the Decision to Leave, Linger, or Lean In: Predictors of Intent to Leave and Aspirations to Leadership and Advancement in Academic Medicine.

BACKGROUND: The Association of American Medical Colleges reports continued low rates of female faculty as professors and in leadership positions. While attrition and discrimination have both been proposed as explanations, recent literature has suggested that women's professional motivations, ingrained behavior, and perceptions of organizational support may also play a role. METHODS: The authors employed a series of scales informed by the turnover theory (which predicts intent to leave an organization), previously validated and used in business and engineering studies, but rarely used in academic medicine. The authors proposed and tested a multiple regression model to assess predictors (role strain, work-life balance, and organizational climate) for three outcome variables: seeking promotion, seeking leadership, and intent to leave. RESULTS: Survey results from 614 faculty members indicated that gender significantly influenced both promotion and leadership seeking, but not intent to leave. Perceived work-family conflict was negatively correlated with leadership seeking for women, but not for men. Positive views of organizational support and commitment were associated with promotion seeking and persistence for all participants. Role strain was positively correlated with desire for promotion and leadership, as well as with intent to leave. CONCLUSIONS: Female faculty may not be leaning in to promotion and leadership roles because of increased role conflict, work-life concerns, and organizational factors; this seems to be more of a factor for female clinical rather than research faculty. Work-family conflict affects male and female faculty differently and should be addressed in efforts to retain faculty and to remove barriers for female faculty seeking leadership opportunities.

Increasing body mass index predicts increasing difficulty, failure rate, and time to discovery of failure of epidural anesthesia in laboring patients.

STUDY OBJECTIVE: Obese parturients both greatly benefit from neuraxial techniques, and may represent a technical challenge to obstetric anesthesiologists. Several studies address the topic of obesity and neuraxial analgesia in general, but few offer well described definitions or rates of "difficulty" and "failure" of labor epidural analgesia. Providing those definitions, we hypothesized that increasing body mass index (BMI) is associated with negative outcomes in both categories and increased time needed for epidural placement. DESIGN: Single center retrospective chart review. SETTING: Labor and Delivery Unit of an inner city academic teaching hospital. PATIENTS: 2485 parturients, ASA status 2 to 4, receiving labor epidural analgesia for anticipated vaginal delivery. INTERVENTIONS: None. MEASUREMENTS: We reviewed quality assurance and anesthesia records over a 12-month period. "Failure" was defined as either inadequate analgesia or a positive test dose, requiring replacement, and/or when the anesthesia record stated they failed. "Difficulty" was defined as six or more needle redirections or a note indicating difficulty in the anesthesia record. MAIN RESULTS: Overall epidural failure and difficulty rates were 4.3% and 3.0%, respectively. Patients with a BMI of 30kg/m2 or higher had a higher chance of both failure and difficulty with two and almost three fold increases, respectively. Regression analysis indicated that failure was best predicted by BMI and less provider training while difficulty was best predicted by BMI. Additionally, increased BMI was associated with increased time of discovery of epidural catheter failure. CONCLUSIONS: Obesity is associated with increasing technical difficulty and failure of neuraxial analgesia for labor. Practitioners should consider allotting extra time for obese parturients in order to manage potential problems.