Women at the top: a qualitative study of women in leadership positions in emergency medicine in Canada.

OBJECTIVES: For the last two decades, more than half of Canadian medical students have been women, with an increasing number of medical trainees choosing emergency medicine as their careers. Despite a proportional increase of women in full-time faculty positions in emergency medicine, women are still underrepresented in leadership. The purpose of this study is to explore the experiences of women leaders in emergency medicine to identify common themes that may have contributed to their acquisition of leadership roles. METHODS: Participants included women emergency medicine physicians in Canada who currently or previously held a leadership position. Data were collected through semi-structured interviews. Inductive thematic analysis was performed on the interview transcripts. Transcribed data were coded and categorized into recurrent themes. A narrative summary of the most impactful themes was presented. RESULTS: Twenty participants were interviewed. Most participants perceived career opportunities were due to chance, related to personal skill set, or required additional training. Participants highlighted the importance of mentorship and sponsorship. Gender expectations and traditional gender roles were perceived as having a negative impact on career leadership success. Participants acknowledged the need for women in leadership to empower younger generations of women to become leaders. For future emergency medicine leaders, participants suggested applying for leadership positions early, networking, and seeking mentorship. Potential supportive changes to leadership structures included explicit parental leave policies, flexible scheduling, and job sharing to encourage women leaders. CONCLUSION: To date, there has been no Canadian specific study exploring the factors contributing to the success of women leaders in emergency medicine. This study examines career advancement of women leaders in emergency medicine and provides useful insight to those aspiring to grow their careers, as well as to mentors and sponsors of women in emergency medicine.

RéSUMé: OBJECTIFS: Au cours des deux dernières décennies, plus de la moitié des étudiants en médecine canadiens étaient des femmes, et un nombre croissant de stagiaires en médecine ont choisi la médecine d'urgence comme carrière. Malgré une augmentation proportionnelle du nombre de femmes occupant des postes de professeurs à temps plein en médecine d'urgence, les femmes sont encore sous-représentées dans les postes de direction. Le but de cette étude est d'explorer les expériences des femmes leaders en médecine d'urgence pour identifier les thèmes communs qui peuvent avoir contribué à leur acquisition de rôles de leadership. MéTHODES: Parmi les participantes figuraient des femmes médecins d'urgence au Canada qui occupaient actuellement ou auparavant un poste de direction. Les données ont été recueillies au moyen d'entrevues semi-structurées. Une analyse thématique inductive a été effectuée sur les transcriptions des entrevues. Les données transcrites ont été codées et classées en thèmes récurrents. Un résumé narratif des thèmes les plus percutants a été présenté. RéSULTATS: Vingt participants ont été interrogés. La plupart des participants estimaient que les possibilités de carrière étaient attribuables au hasard, à des compétences personnelles ou à une formation supplémentaire. Les participants ont souligné l'importance du mentorat et du parrainage. Les attentes en matière de genre et les rôles traditionnels de genre ont été perçus comme ayant un impact négatif sur le succès de leadership de carrière. Les participants ont reconnu la nécessité pour les femmes dirigeantes de permettre aux jeunes générations de femmes de devenir des leaders. Pour les futurs dirigeants en médecine d'urgence, les participants ont suggéré de postuler tôt pour des postes de leadership, de réseauter et de chercher du mentorat. Parmi les changements favorables possibles aux structures de direction, mentionnons des politiques de congé parental explicites, des horaires souples et le partage d'emploi pour encourager les dirigeantes. CONCLUSION: À ce jour, aucune étude canadienne n'a exploré les facteurs qui contribuent au succès des femmes chefs de file en médecine d'urgence. Cette étude examine l'avancement professionnel des femmes chefs de file en médecine d'urgence et fournit des renseignements utiles aux personnes qui aspirent à faire progresser leur carrière, ainsi qu'aux mentors et aux parrains des femmes en médecine d'urgence.

The Addis Ababa toxicology curriculum project: educational needs assessment for the toxicology modules of an emergency medicine training program.

BACKGROUND: The Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) is a bi-institutional partnership between the University of Toronto (UofT) and Addis Ababa University (AAU) focused on addressing the need for emergency medicine (EM) postgraduate training and care in Ethiopia. Toxicology is a key competency in EM. EM physicians are often the first and sole clinicians to identify and treat patients presenting with a wide range of intoxications. The goal of this project was to conduct an educational needs assessment to inform the development of a context-specific toxicology curriculum for the AAU EM training program. METHODS: Our needs assessment employed a survey (available electronically and in paper format) and face-to-face interviews conducted with Ethiopian EM faculty (all graduates of the AAU EM residency training program) and current AAU EM residents. The survey was distributed in October 2018 and the interviews were conducted in November 2018. RESULTS: Of the 63 surveys distributed, we received 17 complete responses and completed 11 interviews with AAU EM faculty and residents. The survey conducted on toxicology training highlighted overall satisfaction with current training, with thematic analysis revealing key areas for growth. System-related themes focused on resource availability, healthcare access, and public health education. Provider-related themes emphasized the need for context-specific training, including common local toxins, and for advanced toxicology training such as poison center rotations. Patient-related themes centered on specific toxicological presentations in Ethiopia, highlighting the importance of public health advocacy, education on safe handling, and governmental regulation of toxic substances. Both survey and interview data highlighted challenges stemming from inconsistent availability of resources and underscored the need for tailored education to manage poisoned patients with locally available resources. CONCLUSIONS: Our findings indicate the need to focus on the most prevalent local toxicological presentations and practical management challenges in local contexts, including resource limitations and delayed presentations. Moreover, it emphasizes the importance of public health initiatives such as regulation of the sale and promotion of safe handling of toxic substances to mitigate toxicological risks. These findings are likely relevant to other resource-constrained settings outside of Ethiopia.

Towards gender equity in emergency medicine: a position statement from the CAEP Women in Emergency Medicine committee.

As of January 2019, over half of all doctors working in Canada under the age of 40 were women. Despite equal representation in the profession of medicine, women still experience harassment, discrimination, and pay inequity when compared to their male colleagues. Gender discrimination is present at all levels of medical training and negatively impacts women who want to become emergency physicians. The right to gender equity is part of the Canadian Charter of Rights and Freedoms. The World Health Organization states that "gender inequities are socially generated and, therefore, can be changed." CAEP recognizes that gender equity is important to its members and that it intersects with inequities experienced by other minority groups. This position statement from the committee for Women in Emergency Medicine (EM) is intended to support women and those who identify as women who have chosen EM as their career. Furthermore, it is meant to inform and support policy makers as they consider the unique challenges that women face in their pursuit of excellence in EM.

A review of published literature on emergency medicine training programs in low- and middle-income countries.

BACKGROUND: The objective of this review is to identify and critically evaluate the published literature on emergency medicine (EM) training programs in resource-limited health-care settings in order to provide insight for developing EM training programs in such health systems. METHODS: A literature search was conducted up to the end of April 2011 using MEDLINE, EMBASE, The Cochrane Library, EBM Reviews, Healthstar and Web of Science databases, using the following search terms: Emergency Medicine, Emergency Medicine Services, Education Training Residency Programs, Emergency Medical Systems and Medical Education, without limitation to income countries as outlined in the World Bank World Trade Indicators classification 2009-2010 (World Trade Indicators Country Classification by Region and Income, July 2009-July 2010). As the intent of the review was to identify and critically evaluate the literature readily available (published) to LMICs developing EM programs, the gray literature was not searched. RESULTS: The search yielded 16 articles that met the final inclusion criteria. As the majority of articles provide a narrative description of the processes and building blocks used in developing the residency programs reported, we present our results in narrative format. By providing a summary of the lessons learned to date, we hope to provide a useful starting point for other resource-limited settings interested in establishing emergency medicine specialty training programs and hope to encourage further information exchange on this matter. CONCLUSIONS: The results of the review indicate that EM training is in its infancy in resource-constrained health-care systems. There are few detailed reports of these programs successes and limitations, including efforts to optimize graduate retention. Despite the paucity of currently published data on the development of EM residency training programs in these settings, this review demonstrates the need for encouraging further information exchange to aid in such efforts, and the authors make specific recommendations to help guide future authors on reporting on such efforts.