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May - 2019

   

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Toward Gender Equity in Critical Care Medicine: A Qualitative Study of Perceived Drivers, Implications, and Strategies

J Parsons Leigh, C vegrood, SB Ahmed, et al Crit Care Med, 2019, 47(4) 286-291

Comment

Gender equity remains an important and unresolved issue in the specialty of critical care medicine. In 2017 we saw a perspective published in AJRCCM https://www.crit-iq.com/index.php/Library/Review/1332/gender-parity-intensive-care-critical-care-diversity , suggesting;

1. Critical Care Societies establish diversity policies for populating the panels they commission, sharing this responsibility with panel chairs and members. Merit-based representation should reflect sex, gender, geography, ethnicity, economy, and discipline.

2. Authors document, and journals report, the principles and methods of panel composition for professional document development.

3. Publically available metrics of women’s representation on panels for definition documents, consensus statements, and practice guidelines.

4. Gender parity policies be incorporated into relevant bylaws within all areas of academic critical care, containing explicit targets which reflect, at a minimum, the proportion of women in the specialty.

5. Training on diversity and unconscious bias for all critical care academics, particularly for those in leadership positions.

Is there progress? Perhaps not.

This qualitative interview based study conducted in 13 Canadian Universities with adult critical care medicine training programs, invited 371 faculty (20% women, 80% men) and 105 trainees (28% women, 72% men) to participate. 48 interviews were conducted to achieve theme saturation. 

The goals was to better understand gender inequity, through perspectives and experience. 

They report;

  1. 25 women, 23 men interviewed
  2. Participants unanimously described critical care medicine as a specialty practiced predominantly by men
  3. 22 of 25 (90%) women described experiences of being personally (belittled or underestimated) or professionally (eg no path to leadership) impacted by gender inequity in their group. 1/3 of men report indirect impact (eg loss of colleague to together specialty). 
  4. Postulated drivers of the gender gap included;
    1. Organisation of ICU work
    2. Predominantly male leadership and paucity of women I leadership
    3. Women identified open value paced on male dominant traits 
    4. Quarter of men perceived women to be inherently unattracted to high-pressure medical specialties - not identified by women!
  5. Implications 
    1. Women don not feel respected
    2. Limited specialty development due to lack of diversity
    3. Women experience subtle discrimination 
  6. Mentorship programs that span institutions, targeted policies to support family planning, and opportunities for modified role descriptions were common strategies suggested to attract and retain women. 

 

Abstract

Objectives: Critical care medicine is a medical specialty where women remain underrepresented relative to men. The purpose of this study was to explore perceived drivers (i.e., influencing factors) and implications (i.e., associated consequences) of gender inequity in critical care medicine and determine strategies to attract and retain women.

Design: Qualitative interview-based study.

Setting: We recruited participants from the 13 Canadian Universities with adult critical care medicine training programs.

Participants: We invited all faculty members (clinical and academic) and trainees to participate in a semistructured telephone interview and purposely aimed to recruit two faculty members (one woman and one man) and one trainee from each site. Interviews were transcribed verbatim, and two investigators conducted thematic analysis.

Interventions: Not applicable.

Measurements and Main Results: Three-hundred seventy-one faculty members (20% women, 80% men) and 105 trainees (28% women, 72% men) were invited to participate, 48 participants were required to achieve saturation. Participants unanimously described critical care medicine as a specialty practiced predominantly by men. Most women described experiences of being personally or professionally impacted by gender inequity in their group. Postulated drivers of the gender gap included institutional and interpersonal factors. Mentorship programs that span institutions, targeted policies to support family planning, and opportunities for modified role descriptions were common strategies suggested to attract and retain women.

Conclusions: Participants identified a gender gap in critical care medicine and provided important insight into the impact for personal, professional, and group dynamics. Recommended improvement strategies are feasible, map broadly onto reported drivers and implications, and are applicable to critical care medicine and more broadly throughout medical specialties.

May


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