Organizations in science and medicine must hold each other accountable for discriminatory practices.

Many organizations persist in working with others that engage in known, remediable structural discrimination. We name this practice interorganizational structural discrimination (ISD) and argue it is a pivotal contributor to inequities in science and medicine. We urge organizations to leverage their relationships and demand progress from collaborators.

Association Between Anesthesiologist Sex and Patients' Postoperative Outcomes: A Population-based Cohort Study.

OBJECTIVE: To examine the association of anesthesiologist sex on postoperative outcomes. BACKGROUND: Differences in patient postoperative outcomes exist, depending on whether the primary surgeon is male or female, with better outcomes seen among patients treated by female surgeons. Whether the intraoperative anesthesiologist's sex is associated with differential postoperative patient outcomes is unknown. METHODS: We performed a population-based, retrospective cohort study among adult patients undergoing one of 25 common elective or emergent surgical procedures from 2007 to 2019 in Ontario, Canada. We assessed the association between the sex of the intraoperative anesthesiologist and the primary end point of the adverse postoperative outcome, defined as death, readmission, or complication within 30 days after surgery, using generalized estimating equations. RESULTS: Among 1,165,711 patients treated by 3006 surgeons and 1477 anesthesiologists, 311,822 (26.7%) received care from a female anesthesiologist and 853,889 (73.3%) from a male anesthesiologist. Overall, 10.8% of patients experienced one or more adverse postoperative outcomes, of whom 1.1% died. Multivariable adjusted rates of the composite primary end point were higher among patients treated by male anesthesiologists (10.6%) compared with female anesthesiologists (10.4%; adjusted odds ratio 1.02, 95% CI: 1.00-1.05, P =0.048). CONCLUSIONS: We demonstrated a significant association between sex of the intraoperative anesthesiologist and patient short-term outcomes after surgery in a large cohort study. This study supports the growing literature of improved patient outcomes among female practitioners. The underlying mechanisms of why outcomes differ between male and female physicians remain elusive and require further in-depth study.

Association between anaesthesia-surgery team sex diversity and major morbidity.

BACKGROUND: Team diversity is recognized not only as an equity issue but also a catalyst for improved performance through diversity in knowledge and practices. However, team diversity data in healthcare are limited and it is not known whether it may affect outcomes in surgery. This study examined the association between anaesthesia-surgery team sex diversity and postoperative outcomes. METHODS: This was a population-based retrospective cohort study of adults undergoing major inpatient procedures between 2009 and 2019. The exposure was the hospital percentage of female anaesthetists and surgeons in the year of surgery. The outcome was 90-day major morbidity. Restricted cubic splines were used to identify a clinically meaningful dichotomization of team sex diversity, with over 35% female anaesthetists and surgeons representing higher diversity. The association with outcomes was examined using multivariable logistic regression. RESULTS: Of 709 899 index operations performed at 88 hospitals, 90-day major morbidity occurred in 14.4%. The median proportion of female anaesthetists and surgeons was 28 (interquartile range 25-31)% per hospital per year. Care in hospitals with higher sex diversity (over 35% female) was associated with reduced odds of 90-day major morbidity (OR 0.97, 95% c.i. 0.95 to 0.99; P = 0.02) after adjustment. The magnitude of this association was greater for patients treated by female anaesthetists (OR 0.92, 0.88 to 0.97; P = 0.002) and female surgeons (OR 0.83, 0.76 to 0.90; P < 0.001). CONCLUSION: Care in hospitals with greater anaesthesia-surgery team sex diversity was associated with better postoperative outcomes. Care in a hospital reaching a critical mass with over 35% female anaesthetists and surgeons, representing higher team sex-diversity, was associated with a 3% lower odds of 90-day major morbidity.

The lived experiences of transgender and gender-diverse people in accessing publicly funded penile-inversion vaginoplasty in Canada.

BACKGROUND: Canada's health care systems underserve people who are transgender and gender diverse (TGD), leading to unique disparities not experienced by other patient groups, such as in accessing gender-affirmation surgery. We sought to explore the experiences of TGD people seeking and accessing gender-affirmation surgery at a publicly funded hospital in Canada to identify opportunities to improve the current system. METHODS: We used hermeneutic phenomenology according to Max van Manen to conduct this qualitative study. Between January and August 2022, we conducted interviews with TGD people who had undergone penile-inversion vaginoplasty at Women's College Hospital, Toronto, Ontario, since June 2019. We conducted interviews via Microsoft Teams and transcribed them verbatim. We coded the transcripts using NVivo version 12. Using inductive analysis, we constructed themes, which we mapped onto van Manen's framework of lived body, lived time, lived space, and lived human relations. RESULTS: We interviewed 15 participants who had undergone penile-inversion vaginoplasty; they predominantly self-identified as transgender women (n = 13) and White (n = 14). Participants lived in rural (n = 4), suburban (n = 5), or urban (n = 6) locations. Their median age was 32 (range 27-67) years. We identified 11 themes that demonstrated the interconnected nature of TGD peoples' lived experiences over many years leading up to accessing gender-affirmation surgery. These themes emphasized the role of the body in experiencing the world and shaping identity, the lived experience of the body in shaping human connectedness, and participants' intersecting identities and emotional pain (lived body); participants' experiences of the passage of time and progression of events (lived time); environments inducing existential anxiety or fostering affirmation, the role of technology in shaping participants' understanding of the body, and the effect of liminal spaces (lived space); and finally, the role of communication and language, empathy and compassion, and participants' experiences of loss of trust and connection (lived human relations). INTERPRETATION: Our findings reveal TGD patients' lived experiences as they navigated a lengthy and often difficult journey to penile-inversion vaginoplasty. They suggest a need for improved access to gender-affirmation surgery by reducing wait times, increasing capacity, and improving care experiences.

Lived experiences of transgender and nonbinary people in the perioperative context: a qualitative study.

BACKGROUND: Transgender and nonbinary (TNB) people experience obstacles that create barriers to accessing health care, including stigmatization and health inequities. Our intention was to describe the lived experiences of TNB patients and identify potential gaps in the education of health care professionals. METHODS: We conducted a qualitative descriptive study influenced by phenomenology by interviewing with TNB adults who underwent surgery in Canada within the previous 5 years. We recruited participants using purposeful and snowball sampling via online social networking sites. Audio recordings were transcribed. Two authors coded the transcripts and derived the themes. RESULTS: We interviewed 21 participants, with a median interview duration of 49 minutes. Participants described positive and negative health care encounters that led to stress, confusion, and feelings of vulnerability. Major themes included having to justify their need for health care in the face of structural discrimination; fear and previous traumatic experiences; community as a source of support and information; and the impact of interactions with health care professionals. INTERPRETATION: Participants detailed barriers to accessing care, struggled to participate in shared decision-making, and desired trauma-informed care principles; they described strength in community and positive interactions with health care professionals, although barriers to accessing gender-affirming care often overshadowed other aspects of the perioperative experience. Additional research, increased education for health care professionals, and policy changes are necessary to improve access to competent care for TNB people.

A matter of life and death: physician gender and patient outcomes after surgery.

Accumulating evidence supports an effect of physician gender (or sex, a surrogate used in many studies) on important patient outcomes such as death, complications, and hospital length of stay. Recent studies suggest that these effects result from the gender diversity of the team rather than individual physician gender. Here, we reflect on the potential mechanisms of an effect of physician gender on patient outcomes.

Unmasking imposter syndrome: individual responsibility or repercussions of systemic oppression?

In contemporary and popular discourse, imposter syndrome is frequently outlined as an individual problem that can be overcome. Rather than the locus of responsibility being placed on the individual, we posit that neoliberal academic institutions contribute to imposter syndrome by (de)legitimising certain forms of knowledge.

Relinquishing control? Supervisor co-regulation may disrupt students' self-regulated learning during simulation-based training.

When uncertain, medical trainees often seek to co-regulate their learning with supervisors and peers. Evidence suggests they may enact self-regulated learning (SRL) strategies differently when engaged in self- versus co-regulated learning (Co-RL). We compared the impacts of SRL and Co-RL on trainees' acquisition, retention, and preparation for future learning (PFL) of cardiac auscultation skills during simulation-based training. In our two-arm, prospective, non-inferiority trial, we randomly assigned first- and second-year medical students to the SRL (N = 16) or Co-RL conditions (N = 16). Across two learning sessions separated by two-weeks, participants practiced and were assessed in diagnosing simulated cardiac murmurs. We examined diagnostic accuracy and learning trace data across sessions, and conducted semi-structured interviews to explore participants' understandings of their underlying choices and learning strategies. SRL participants' outcomes were non-inferior to Co-RL participants on the immediate post-test and retention test, but not on the PFL assessment (i.e., inconclusive). Analyzing interview transcripts (N = 31) generated three themes: perceived utility of initial learning supports for future learning; SRL strategies and sequencing of murmurs; and perceived control over learning across sessions. Co-RL participants regularly described relinquishing control of learning to supervisors and regaining it when on their own. For some trainees, Co-RL seemed to interfere with their situated and future SRL. We posit that transient clinical training sessions, typical in simulation-based and workplace-based settings, may not allow the ideal processes of Co-RL to unfold between supervisor and trainee. Future research must examine how supervisors and trainees can share accountability to develop the shared mental models that underlie effective Co-RL.

Variation in Anesthesiology Provider-Volume for Complex Gastrointestinal Cancer Surgery: A Population-Based Study.

OBJECTIVE: Examine between-hospital and between-anesthesiologist variation in anesthesiology provider-volume (PV) and delivery of high-volume anesthesiology care. BACKGROUND: Better outcomes for anesthesiologists with higher PV of complex gastrointestinal cancer surgery have been reported. The factors linking anesthesiology practice and organization to volume are unknown. METHODS: We identified patients undergoing elective esophagectomy, hepatectomy, and pancreatectomy using linked administrative health data sets (2007-2018). Anesthesiology PV was the annual number of procedures done by the primary anesthesiologist in the 2 years before the index surgery. High-volume anesthesiology was PV>6 procedures/year. Funnel plots to described variation in anesthesiology PV and delivery of high-volume care. Hierarchical regression models examined between-anesthesiologist and between-hospital variation in delivery of high-volume care use with variance partition coefficients (VPCs) and median odds ratios (MORs). RESULTS: Among 7893 patients cared for at 17 hospitals, funnel plots showed variation in anesthesiology PV (median ranging from 1.5, interquartile range: 1-2 to 11.5, interquartile range: 8-16) and delivery of HV care (ranging from 0% to 87%) across hospitals. After adjustment, 32% (VPC 0.32) and 16% (VPC: 0.16) of the variation were attributable to between-anesthesiologist and between-hospital differences, respectively. This translated to an anesthesiologist MOR of 4.81 (95% CI, 3.27-10.3) and hospital MOR of 3.04 (95% CI, 2.14-7.77). CONCLUSIONS: Substantial variation in anesthesiology PV and delivery of high-volume anesthesiology care existed across hospitals. The anesthesiologist and the hospital were key determinants of the variation in high-volume anesthesiology care delivery. This suggests that targeting anesthesiology structures of care could reduce variation and improve delivery of high-volume anesthesiology care.

The Association Between Hospital High-volume Anesthesiology Care and Patient Outcomes for Complex Gastrointestinal Cancer Surgery: A Population-based Study.

OBJECTIVE: To examine the association of between hospital rates of high-volume anesthesiology care and of postoperative major morbidity. BACKGROUND: Individual anesthesiology volume has been associated with individual patient outcomes for complex gastrointestinal cancer surgery. However, whether hospital-level anesthesiology care, where changes can be made, influences the outcomes of patients cared at this hospital is unknown. METHODS: We conducted a population-based retrospective cohort study of adults undergoing esophagectomy, pancreatectomy, or hepatectomy for cancer from 2007 to 2018. The exposure was hospital-level adjusted rate of high-volume anesthesiology care. The outcome was hospital-level adjusted rate of 90-day major morbidity (Clavien-Dindo grade 3-5). Scatterplots visualized the relationship between each hospital's adjusted rates of high-volume anesthesiology and major morbidity. Analyses at the hospital-year level examined the association with multivariable Poisson regression. RESULTS: For 7893 patients at 17 hospitals, the rates of high-volume anesthesiology varied from 0% to 87.6%, and of major morbidity from 38.2% to 45.4%. The scatter plot revealed a weak inverse relationship between hospital rates of high-volume anesthesiology and of major morbidity (Pearson: -0.23). The adjusted hospital rate of high-volume anesthesiology was independently associated with the adjusted hospital rate of major morbidity (rate ratio: 0.96; 95% CI, 0.95-0.98; P <0.001 for each 10% increase in the high-volume rate). CONCLUSIONS: Hospitals that provided high-volume anesthesiology care to a higher proportion of patients were associated with lower rates of 90-day major morbidity. For each additional 10% patients receiving care by a high-volume anesthesiologist at a given hospital, there was an associated reduction of 4% in that hospital's rate of major morbidity.

Patient reported symptoms and adverse outcomes seen in Canada's first vaginoplasty postoperative care clinic.

IMPORTANCE: Vaginoplasty is a relatively common gender-affirming surgery with approximately 200 Ontarians seeking this surgery annually. Although Ontario now offers vaginoplasty in province, the capacity is not meeting demand; the majority of trans and gender-diverse patients continue to seek vaginoplasty out of province. Out-of-province surgery presents a barrier to accessing postsurgical follow-up care leaving most patients to seek support from their primary care providers or providers with little experience in gender-affirming surgery. OBJECTIVE: To provide an account of the common postoperative care needs and neovaginal concerns of Ontarians who underwent penile inversion vaginoplasty out of province and presented for care at a gender-affirming surgery postoperative care clinic. DESIGN, SETTINGS, AND PARTICIPANTS: A retrospective chart review of the first 80 patients presenting to a gender-affirming surgery postoperative care clinic who had undergone vaginoplasty at an outside surgical center was performed. Descriptive analyses were performed for all variables. RESULTS: The sample consisted of 80 individuals with the mean age of 39 years (19-73). Most patients had surgery at another surgical center in Canada (76.3%). Many patients (22.5%) accessed care in the first 3 months after surgery, with the majority (55%) seeking care within the first perioperative year. Most patients (61.3%) were seen for more than one visit and presented with more than two symptoms or concerns. Common patient-reported symptoms during clinical visit included pain (53.8%), dilation concerns (46.3%), and surgical site/vaginal bleeding (42.5%). Sexual function concerns were also common (33.8%) with anorgasmia (11.3%) and dyspareunia (11.3%) being the most frequent complications. The most common adverse outcomes identified by health care providers included hypergranulation (38.8%), urinary dysfunction (18.8%), and wound healing issues (12.5%). CONCLUSIONS AND RELEVANCE: Findings from chart review offer valuable insights into the postoperative needs and neovaginal concerns of Ontarians who have had vaginoplasty out of province. This study demonstrates the need for routine postoperative care in patients undergoing vaginoplasty. Patients experience numerous symptoms and concerns that often correlate with clinical findings and require multiple follow-up appointments. Health care providers may benefit from further education on the more common nonsurgical issues identified in this study.

Outcomes of COVID-19 manuscripts submitted to the Canadian Journal of Anesthesia: a retrospective audit of author gender and person of colour status.

PURPOSE: We aimed to evaluate the representation of women and persons of colour (POC) authors of COVID-19 manuscripts submitted to, accepted in, and rejected from the Journal and to evaluate trends in their representation during the pandemic. METHODS: All COVID-19 manuscripts submitted to the Journal between 1 February 2020 and 30 April 2021 were included. Manuscript data were retrieved from Editorial Manager, and gender and POC status were obtained through: 1) e-mail communication with corresponding authors; 2) e-mail queries to other coauthors; 3) NamSor software, and 4) Internet searches. The data were described using percentages and summary statistics. A two-sample test of proportions was used for comparisons and trends were analyzed with linear regression. RESULTS: We identified 314 manuscripts (1,555 authors), 95 (461 authors) of which were accepted for publication. Of all authors, 515 (33%) were women, and women were the lead and senior authors of 101 (32%) and 69 (23%) manuscripts, respectively. There were no differences in women's representation as authors between accepted and rejected manuscripts. Overall, 923/1,555 (59%) authors were identified as POC, with a significantly lower proportion of POC authors among accepted vs rejected manuscripts (41%, 188/461 vs 67%, 735/1,094; difference, -26%; 95% CI, -32 to -21; P < 0.001). We did not observe significant trends in the proportion of women and POC authors over the study period. CONCLUSION: The proportion of women authors of COVID-19 manuscripts was lower than men's representation. Further research is required to determine the factors that account for the higher proportion of POC authors across rejected manuscripts.

RéSUMé: OBJECTIF: Nous avions pour objectif d'évaluer la représentation des femmes et des personnes de couleur ayant rédigé des manuscrits portant sur la COVID-19 soumis, acceptés et rejetés au Journal et d'évaluer les tendances concernant leur représentation pendant la pandémie. MéTHODE: Tous les manuscrits portant sur la COVID-19 soumis au Journal entre le 1er février 2020 et le 30 avril 2021 ont été inclus. Les données des manuscrits ont été extraites de la plateforme de gestion des manuscrits Editorial Manager, et le sexe et le statut de personne de couleur ont été obtenus par : 1) la communication par courrier électronique avec les auteurs et autrices correspondant·es; 2) des requêtes par courrier électronique envoyées à d'autres coautrices et coauteurs; 3) le logiciel NamSor, et 4) des recherches sur Internet. Les données ont été décrites à l'aide de pourcentages et de statistiques sommaires. Un test de proportions à deux échantillons a été utilisé pour les comparaisons et les tendances ont été analysées par régression linéaire. RéSULTATS: Nous avons identifié 314 manuscrits (1555 auteurs et autrices), dont 95 (461 autrices et auteurs) ont été acceptés pour publication. Parmi tou·tes les auteurs/autrices, 515 (33 %) étaient des femmes, et les femmes étaient les autrices principales et senior de 101 (32 %) et 69 (23 %) manuscrits, respectivement. Il n'y avait aucune différence dans la représentation des femmes en tant qu'autrices entre les manuscrits acceptés et rejetés. Dans l'ensemble, 923/1555 (59 %) auteurs et autrices ont été identifié·es comme étant des personnes de couleur, avec une proportion significativement plus faible d'autrices et d'auteurs de couleur parmi les manuscrits acceptés vs rejetés (41 %, 188/461 vs 67 %, 735/1094; différence, -26 %; IC 95 %, -32 à -21; P < 0,001). Nous n'avons pas observé de tendances significatives dans la proportion d'auteurs et d'autrices femmes et de couleur au cours de la période à l'étude. CONCLUSION: La proportion de femmes autrices de manuscrits sur la COVID-19 était inférieure à celle des hommes. D'autres recherches sont nécessaires pour déterminer les facteurs qui expliquent la plus grande proportion d'autrices et d'auteurs de couleur parmi les manuscrits rejetés.

Queer(ing) medical spaces: queer theory as a framework for transformative social change in anesthesiology and critical care medicine.

Queer theory is a disruptive lens that can be adopted by researchers, educators, clinicians, and administrators to effect transformative social change. It offers opportunities for anesthesiologists, critical care physicians, and medical practitioners to more broadly understand what it means to think queerly and how queering anesthesiology and critical care medicine spaces improves workplace culture and patient outcomes. This article grapples with the cis-heteronormative medical gaze and queer people's apprehensions of violence in medical settings to offer new ways of thinking about structural changes needed in medicine, medical language, and the dehumanizing application of medical modes of care. Using a series of clinical vignettes, this article outlines the historical context underlying queer peoples' distrust of medicine, a primer in queer theory, and an understanding of how to begin to "queer" medical spaces using this critical framework.

RéSUMé: La théorie queer est une lentille perturbatrice qui peut être adoptée par la communauté de la recherche et de l'éducation, les personnes en clinique et les directions d'établissement pour apporter des changements sociaux transformateurs. Elle offre aux anesthésiologistes, aux intensivistes et aux médecins l'occasion de comprendre plus globalement ce que signifie le fait de penser de manière queer et comment la 'queer-icisation' des espaces d'anesthésiologie et de médecine de soins intensifs améliore la culture du milieu de travail et les devenirs des patient·es. Cet article s'attaque au regard médical cis- et hétéronormatif et aux appréhensions des personnes queer face à la violence dans les milieux médicaux afin de proposer de nouvelles façons de penser les changements structurels nécessaires en médecine, le langage médical et l'application déshumanisante des modes de soins médicaux. À l'aide d'une série de vignettes cliniques, cet article décrit le contexte historique sous-jacent à la méfiance des personnes queer à l'égard du monde médical. Il propose également une introduction à la théorie queer et une interprétation de la façon de commencer à rendre plus queer les espaces médicaux en utilisant ce cadre critique.

Gender-based differences in physician payments within the fee-for-service system in Ontario: a retrospective, cross-sectional study.

BACKGROUND: Differences in physician income by gender have been described in numerous jurisdictions, but few studies have looked at a Canadian cohort with adjustment for confounders. In this study, we aimed to understand differences in fee-for-service payments to men and women physicians in Ontario. METHODS: We conducted a cross-sectional analysis of all Ontario physicians who submitted claims to the Ontario Health Insurance Plan (OHIP) in 2017. For each physician, we gathered demographic information from the College of Physicians and Surgeons of Ontario registry. We compared differences in physician claims between men and women in the entire cohort and within each specialty using multivariable linear regressions, controlling for length of practice, specialty and practice location. RESULTS: We identified a cohort of 30 167 physicians who submitted claims to OHIP in 2017, including 17 992 men and 12 175 women. When controlling for confounding variables in a linear mixed-effects regression model, annual physician claims were $93 930 (95% confidence interval $88 434 to $99 431) higher for men than for women. Women claimed 74% as much as men when adjusting for covariates. This discrepancy was present in nearly all specialty categories. Men claimed more than women throughout their careers, with the greatest gap 10-15 years into practice. INTERPRETATION: We found a gender gap in fee-for-service claims in Ontario, with women claiming less than men overall and in nearly every specialty. Further work is required to understand the root causes of the gender pay gap.

Women in anaesthesia: a scoping review.

Despite an increase in the proportion of women anaesthesiologists over time, women remain under-represented in academic and leadership positions, honour awards, and academic promotion. Current literature has identified several reasons for the observed gender disparity in anaesthesiology leadership and faculty positions, including unsupportive work environments, lack of mentorship, personal choices, childcare responsibilities, and active discrimination against women. A scoping review design was selected to examine the nature and extent of available research. Our review provides an overview of the literature that explores gender issues in anaesthesiology, identifies gaps in the literature, and appraises effective strategies to improve gender equity in anaesthesiology. We searched PubMed, MEDLINE, and EMBASE up to July 2019, and included 30 studies for analysis. Most reports used retrospective or survey methodologies. The review shows that women anaesthesiologists face gender biases in the work environment, are under-represented in various positions of leadership or influence, and as authors. Work-life demands may impose a challenge. Motivation and interest in career advancement of women anaesthesiologists have not been well studied. Several strategies have been proposed, ranging from an individual to administrative level, which may help anaesthesiologists achieve equal representation of women in the field.

Dismantling the master's house: new ways of knowing for equity and social justice in health professions education.

Health professions education (HPE) is built on a structural foundation of modernity based on Eurocentric epistemologies. This foundation privileges certain forms of evidence and ways of knowing and is implicated in how dominant models of HPE curricula and healthcare practice position concepts of knowledge, equity, and social justice. This invited perspectives paper frames this contemporary HPE as the "Master's House", utilizing a term referenced from the writings of Audre Lorde. It examines the theoretical underpinnings of the "Master's House" through the frame of Quijano's concept of the Colonial Matrix of Power (employing examples of coloniality, race, and sex/gender). It concludes by exploring possibilities for how these Eurocentric structures may be dismantled, with reflection and discussion on the implications and opportunities of this work in praxis.

Women anesthesiologists' journeys to academic leadership: a constructivist grounded theory-inspired study.

BACKGROUND: Women continue to be underrepresented in academic anesthesiology, especially in leadership positions. Possible reasons for this gender disparity include family responsibilities, inadequate mentorship, lack of desire for leadership, the leaky pipeline effect (i.e., attrition of women physicians over the course of their career trajectories), and discrimination. Our objective was to understand the lived experiences of Canadian anesthesiologists in leadership positions. METHODS: In this constructivist grounded theory-inspired study, we used purposeful sampling to identify women anesthesiologists in leadership positions at one Canadian institution. Each participant underwent a one-on-one semi-structured interview of 40-60 min in length, sampling until theoretical saturation was reached. We included questions about the participant's practice setting, influences on their career, and advice the participant would provide to other women in leadership. We used an iterative approach to theoretical sampling and data analysis. The audio-recorded semi-structured interviews were transcribed and coded. NVivo12 was used for open and axial coding, and cross-referencing. RESULTS: Eight women anesthesiologists were recruited and interviewed. Our iterative process identified four interconnected themes: difficulty internalizing a leadership identity, identifying systemic barriers and biases, dissonance between agentic traits and communal social gender roles, and mentorship as shaping lived experiences. Participants consistently expressed experiencing discrimination, articulated barriers related to family responsibilities and ingrained societal expectations, and discussed how typical leadership traits are applied differently to women and men. Women perceived themselves as more compassionate and communicative than men. Despite these traits, these women have expressed barriers to obtaining mentorship. CONCLUSION: We identified consistent interconnected themes among the experiences of our sample of women anesthesiologists in academic leadership and found that academic anesthesiology is a gendered profession as experienced by these women leaders. Further research should focus on strategies to remove barriers to participation in academic anesthesiology for women.

RéSUMé: CONTEXTE: Les femmes continuent d'être sous-représentées en anesthésiologie académique, et tout particulièrement dans les positions de leadership. Parmi les raisons expliquant cette disparité entre les sexes, citons les responsabilités familiales, un mentorat inadapté, le manque de désir de leadership, l'effet de tuyau percé (soit l'attrition des femmes médecins au cours de leur parcours professionnel) et la discrimination. Notre objectif était de comprendre les expériences vécues par les anesthésiologistes canadiennes en position de leadership. MéTHODE: Dans cette étude inspirée de la théorie ancrée constructiviste ('constructivist grounded theory'), nous avons utilisé un échantillonnage ciblé afin d'identifier les femmes anesthésiologistes en position de leadership dans un établissement canadien. Chaque participante a pris part à un entretien semi-structuré privé de 40-60 minutes, soit jusqu'à atteindre une saturation théorique. Nous avons inclus des questions concernant le cadre de pratique des participantes, les influences sur leur carrière, et les conseils qu'elles donneraient à d'autres femmes en position de leadership. Nous avons utilisé une approche itérative pour l'échantillonnage théorique et l'analyse de données. Un enregistrement sonore des entretiens semi-structurés a été réalisé pour être ensuite retranscrit et codé. Le progiciel NVivo12 a été utilisé pour le codage ouvert et axial ainsi que pour le référencement croisé. RéSULTATS: Huit femmes anesthésiologistes ont été recrutées et interviewées. Notre processus itératif nous a permis d'identifier quatre thèmes interconnectés : la difficulté d'internaliser une identité de leader, l'identification d'obstacles et de biais systémiques, la dissonance entre l'agentivité individuelle et les rôles de genre socialement construits, et le mentorat en tant que formatif des expériences vécues. Les participantes ont toutes exprimé ressentir de la discrimination, elles ont articulé des obstacles liés aux responsabilités familiales et aux attentes sociétales enracinées, et ont expliqué comment les caractéristiques typiques de leadership étaient appliquées différemment selon le sexe. Les femmes se percevaient comme étant plus empathiques et communicatives que les hommes. Malgré ces traits de caractère, ces femmes ont exprimé qu'il existait des obstacles à l'obtention de mentorat. CONCLUSION: Nous avons identifié plusieurs thèmes interconnectés récurrents parmi les expériences de notre échantillonnage de femmes anesthésiologistes dans des positions de leadership académique et observé que l'anesthésiologie en milieu académique est une profession genrée, comme l'ont ressenti ces femmes leaders. Les recherches futures devraient mettre l'accent sur des stratégies visant à déjouer les obstacles à la participation des femmes en anesthésiologie académique.

Representation of women amongst speakers at the Canadian Anesthesiologists' Society annual meeting: a retrospective analysis from 2007 to 2019.

PURPOSE: Despite an increase in the proportion of women entering the field of anesthesiology, women remain underrepresented in academic and leadership positions. Speaking at national and international conferences is an important component of academic visibility and promotion. To date, the gender representation of speakers at the Canadian Anesthesiologists' Society (CAS) annual meeting has not been examined. METHODS: We conducted a retrospective analysis of the representation of women amongst speakers at the CAS annual meeting between 2007 and 2019, inclusively. We also examined the representation of women in different subspecialty subject area symposia at each CAS annual meeting, and the gender composition of meeting symposia panels (i.e., groups of two or more speakers in a session) at the meeting. RESULTS: Overall, 28.5% (358/1,256) of speaker slots included women, similar to their representation in Canadian clinical anesthesiology over the study period (26.7%), and increasing significantly over the study period. Women were more highly represented as obstetric anesthesia speakers at the CAS annual meetings, with lower representation in cardiothoracic anesthesia, transplant anesthesia, and critical care symposia. Of the 311 meeting symposia, 146 (46%) were composed of all men speakers. CONCLUSION: The representation of women speakers at the CAS annual meeting was similar to the representation of women in the anesthesiology workforce in Canada over the study period. Gender representation varied widely by subspecialty symposia, subject area, and women were absent from nearly half of all symposia at the CAS annual meetings, which are potential areas of future investigation and intervention.

'There shouldn't be anything wrong with not knowing': epistemologies in simulation.

CONTEXT: Medical education embraces simulation-based education (SBE). However, key SBE features purported to support learning, such as learner safety and learning through experience and error, may not align with the dominant culture of medicine, in which portraying confidence and certainty about one's knowledge prevails. Misaligned conceptions about knowledge and learning may produce unintended negative effects, including the suboptimal implementation of SBE, which could consequently compromise SBE and its outcomes. METHODS: To uncover the epistemological beliefs of students experiencing SBE, we conducted a theory-informed analysis of interviews with 24 pre-clerkship medical students following their participation in an SBE training study. Our analysis borrowed from coding methods common in constructivist grounded theory and used Hofer and Pintrich's four dimensions of epistemology as sensitising concepts. RESULTS: Participants subscribed to a dominant view of knowledge as consisting of concrete facts, derived from external sources. By contrast, they described but did not prioritise a conception of building their own knowledge through different learning experiences. Participants positioned experts (i.e. teaching faculty members) as the ultimate knowledge validators through their presence and feedback. Participants also noted that faculty staff could counter medicine's pressures to perform with certainty and confidence at all times by instead embodying and modelling an authentic appreciation of learning through experiences, errors and discovery. CONCLUSIONS: Medicine's tendency to idealise the objective pursuit of singular truths may compromise the purported culture of SBE as a space for learning many wide-ranging aspects of medicine, including how and when to innovate and deviate from norms. Explicit attempts to bridge the epistemological beliefs of medicine and SBE may better enable the realisation of safe experiential learning. Faculty members are positioned to play key roles in enabling this bridging.

Representation of female authors in the Canadian Journal of Anesthesia: a retrospective analysis of articles between 1954 and 2017.

PURPOSE: Females remain under-represented in academic anesthesiology. Our objectives were to investigate gender differences over time in the first and last authors of published articles as well as corresponding citation rates in the Canadian Journal of Anesthesia (CJA). METHODS: We conducted a cross-sectional, retrospective analysis of first and last authors' gender from editorials and original articles published in the CJA in a sample of one calendar year of each decade between 1954 to 2017. We analyzed the relationships between author gender, year of publication, article type, and number of citations. RESULTS: Out of 639 articles identified, 542 (85%) were original investigations and 97 (15%) were editorials. Where gender could be confidently identified, the majority (461/571, 81%) of first authors were male. Although there was an increase in the proportion of female first authors over time, this increase was outpaced by the overall increase in female anesthesiologists in Canada. Original articles received more citations and were more likely to have a female first author than editorial articles were. An original article with a female first author resulted in 0.34 (95% confidence interval, 0.28 to 0.39; P < 0.001) more citations per article than a male first author when adjusting for year of publication. CONCLUSIONS: Our study shows that, despite a slow increase over time, female authors are under-represented relative to male authors in the CJA and relative to the changing demographics of anesthesiologists in Canada. The reasons for this disparity are multifactorial and further research is needed to identify effective solutions.

RéSUMé: OBJECTIF: Les femmes restent sous-représentées dans le monde de l'anesthésiologie universitaire. Nos objectifs étaient d'étudier l'évolution des premiers et derniers auteurs en fonction du sexe au fil des années dans les articles publiés ainsi que les taux correspondants de citation dans le Journal canadien d'anesthésie (CJA). MéTHODES: Nous avons mené une analyse transversale rétrospective du sexe des premiers et derniers auteurs des éditoriaux et des articles originaux publiés dans le CJA dans un échantillon d'une année civile pour chaque décennie entre 1954 et 2017. Nous avons analysé les rapports entre le sexe des auteurs, l'année de publication, le type d'articles et le nombre de citations. RéSULTATS: Sur 639 articles identifiés, 542 (85 %) étaient des recherches originales et 97 (15 %) étaient des éditoriaux. Lorsque le sexe a pu être identifié avec certitude, la majorité des premiers auteurs (461/571, 81 %) étaient des hommes. Bien qu'il y ait eu une augmentation du pourcentage de femmes premières auteures au fil du temps, cette augmentation n'a pas suivi la progression du nombre global des femmes anesthésiologistes au Canada. Les articles originaux ont été cités plus souvent et ont été plus susceptibles d'avoir un premier auteur féminin que les éditoriaux. Après ajustement pour l'année de publication, un article original dont le premier auteur était une femme comptait 0,34 (intervalle de confiance à 95 %, 0,28 à 0,39; P < 0,001) fois plus de citations que lorsque le premier auteur était un homme. CONCLUSIONS: Notre étude montre que, malgré une lente augmentation avec les années, les femmes auteures sont sous-représentées par rapport à leurs collègues masculins dans le CJA et par rapport aux changements démographiques de l'anesthésiologie au Canada. Les raisons de cette disparité sont multifactorielles et d'autres recherches sont nécessaires pour trouver des solutions efficaces.