March 9, 2017

What's it like to be a woman in medicine? Two new studies shed light

Daily Briefing

    When compared to their male peers, women in medicine are underrepresented in grand rounds and tend to be perceived as less experienced after completing an ED residency, according to a pair of new studies published Monday in JAMA Internal Medicine.

    Female physicians don't present grand rounds as often as men

    In one study, researchers found that women are underrepresented as grand rounds speakers across clinical specialties. Grand rounds, the researchers explained, are "a time-honored method of disseminating clinical and research knowledge to medical audiences" and "showcase[e] speakers as successful academic role models."

    For the study, researchers looked at whether the percentage of female grand rounds speakers reflected their representation in academic medical workforces. The researchers looked at 2014 data on speakers from nine specialties from a nationally representative sample of hospitals and medical schools. According to STAT News, the dataset included more than 200 grand rounds websites and calendar listings for speaker series as well as more than 7,000 individual sessions.

    Researchers classified speakers based on gender as well as trainee status and institutional status. The researchers compared the percentages of female speakers with workforce demographics.

    The researchers found that women presented a median of 28.3 percent of grand rounds sessions. In comparison:

    • 46.7 percent of medical students are women;
    • 46 percent of residents are women; and
    • 36 percent of faculty overall are women.

    When looking just at grand rounds sessions presented by faculty or other non-trainees, the researchers found that women presented a median of 26.2 percent of sessions. The researchers wrote, "Compared with national academic medical workforces, the percentages of non-trainee female speakers were uniformly significantly lower than the female composition of the resident workforces."

    When broken down by specialty, the percentage of non-trainee female speakers was below the female composition of the faculty workforce in every specialty except obstetrics/gynecology and surgery.

    Lead study author Julie Boiko, a pediatrics resident at the University of California, San Francisco, said the gender imbalance reduces the visibility of female leaders and could discourage women in academic medicine. "When you don't see people who look like you, it can cause you to say, 'This doesn't look like a field I can thrive in," Boiko said.

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    Separately, Harvard University's Ashish Jha, who was not involved in the latest paper, said, "It's problematic for the people in the audience because you're getting a far less diverse set of views. If you have a system that doesn't encourage new voices, it makes the quality of the grand rounds meaningfully lower." He added, "Organizations need to make a commitment to bringing in more diverse voices."

    Further, the study authors added that "because women will not constitute half of the senior faculty at existing rates, it is unlikely that waiting for current trainees to ascend academic ladders will equalize gender representation at grand rounds podiums."

    Study finds gender disparity in ED milestone attainment

    A separate study published Monday in JAMA Internal Medicine found that female doctors were judged to have less experience than their male counterparts when they finished an ED residency.

    For the study, researchers assessed 33,456 evaluations submitted by 285 supervising physicians between 2013 and 2015, grading the performance of 359 residents at eight ED programs in the United States.

    The researchers found that while male and female residents scored similarly during their first years of residency, but at the end of residency the rate of milestone attainment was 13 percent higher for men than women. According to the researchers, female physicians at the end of their residencies received poorer evaluations across tasks, whether they were diagnosing a patient or completing a physically demanding task.

    The researchers did not assess why women received lower evaluations than men, but the study's lead author, Vineet Arora of the University of Chicago Pritzker School of Medicine said it could suggest that women are judged more harshly when they adopt leadership traits that are more stereotypically male.  

    Arora said the ED milestone study "adds to a variety of other studies published recently suggesting that female physicians face a negative consequence in their work—for a lack of a better explanation—because they're female" (Ross, STAT News, 3/6; Boiko et. al, JAMA Internal Medicine, 3/6; Seaman, Reuters, 3/6; Dayal, JAMA Internal Medicine, 3/6).

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