Strategies of Female Teaching Attending Physicians to Navigate Gender-Based Challenges: An Exploratory Qualitative Study.

BACKGROUND: Women in medicine experience discrimination, hostility, and unconscious bias frequently and with deleterious effects. While these gender-based challenges are well described, strategies to navigate and respond to them are less understood. OBJECTIVE: To explore the lived experiences of female teaching attending physicians emphasizing strategies they use to mitigate gender-based challenges in clinical environments. DESIGN: Multisite exploratory, qualitative study. SETTING: Inpatient general medicine teaching rounds in six geographically diverse US academic hospitals between April and August 2018. PARTICIPANTS: With use of a modified snowball sampling approach, female attendings and their learners were identified; six female attendings and their current (n = 24) and former (n = 17) learners agreed to participate. MEASUREMENTS: Perceptions of gender-based challenges in clinical teaching environments and strategies with which to respond to these challenges were evaluated through semistructured in-depth interviews, focus group discussions, and direct observations of rounds. Observations were documented using handwritten field notes. Interviews and focus groups were audio recorded and transcribed. All transcripts and field note data were analyzed using a content analysis approach. MAIN OUTCOMES: Attending experience levels ranged from 8 to 20 years (mean, 15.3 years). Attendings were diverse in terms of race/ethnicity. Strategic approaches to gender-based challenges clustered around three themes: female attendings (1) actively position themselves as physician team leaders, (2) consciously work to manage gender-based stereotypes and perceptions, and (3) intentionally identify and embrace their unique qualities. CONCLUSION: Female attendings manage their roles as women in medicine through specific strategies to both navigate complex gender dynamics and role model approaches for learners.

The 'July Effect' in supervisory residents: assessing the emotions of rising internal medicine PGY2 residents and the impact of an orientation retreat.

Background: The arrival of new residents brings challenges for residency programs and residents. Many residency programs conduct orientation sessions to help transition rising supervisory residents into their new roles, but no evaluation of their impact on residents' emotional well-being has been performed.Objective: This study assesses the impact of a half-day orientation retreat on rising internal medicine post-graduate year (PGY) 2 residents' emotions toward PGY2 year and their self-confidence in fulfilling the supervisory resident role.Design: A survey was administered to a class of rising supervisory residents immediately before and after an orientation retreat in May 2017. The survey provided participants an open-ended prompt to describe their emotions toward PGY2 year and a 5-point Likert scale to rate their confidence in fulfilling supervisory resident roles. Differences were assessed using McNemar's exact and Wilcoxon signed-rank tests, respectively.Results: Forty-four of 50 (88%) eligible participants completed pre- and post-intervention Likert scales and 40 of 50 (80%) eligible participants completed corresponding emotion sections. Pre-intervention the most common emotions were anxiety (n = 33, 82.5%) and excitement (n = 32, 80.0%). Post-intervention, participants' fear was reduced (45.0% vs 12.0%; p < 0.001). Participants reported greater confidence that internship prepared them for PGY2 year and understanding of triaging and admitting principles (agree or strongly agree from 65.9% to 84.0% and from 25.0% to 68.2%, respectively; p < 0.005 for improvement by Wilcoxon signed-rank for both).Conclusions: Orientation retreats may be an effective way to reduce fear and demystify the supervisory resident role.