Episode 4 - Women In Medicine

Theme:
Women In Medicine.

Participants:

Dr Danielle Unwin, Amanda De Silva (ED advanced trainee) Jessica Stabler (neurology advanced trainee), Istabraq Raashed (ED advanced trainee), Harry Hong (ED SRMO), Shreyas Iyer, Caroline Tyers and Samoda Wilegoda Mudalige.

Discussion 1:
Stehli, J., Martin, C., Brennan, A., Dinh, D., Lefkovits, J., & Zaman, S. (2019). Sex Differences Persist in Time to Presentation, Revascularization, and Mortality in Myocardial Infarction Treated With Percutaneous Coronary Intervention. Journal Of The American Heart Association, 8(10). https://doi.org/10.1161/jaha.119.012161.

Presenter - Amanda De Silva.
Starting - 02:30.

Take-Home Points:

• Women with STEMI had longer times to presentation and door to balloon times, compared with their male counterparts, with a higher rate of mortality.
• Such data has been produced before, however, the underlying reason for these discrepancies is unclear.
• Possible reasons behind delayed presentation to the emergency department include atypical symptoms, competing priorities (with homelife, children, or careers), and sick behaviours.
• This is a reminder to broaden our differentials for women with chest pain - could this be a STEMI?
• Remember time is myocardium: the outcomes are significantly different between men and women in the context of this delay to PCI.
• This is an issue that we need to make the public and our patients more aware of.

Discussion 2:
Hoffman, R., Mullan, J., Nguyen, M., & Bonney, A. (2020). Motherhood and medicine: a systematic review of the experiences of mothers who are doctors. Medical Journal Of Australia, 213(7), 329-334. https://doi.org/10.5694/mja2.50747.

Presenter -Jessica Stabler.
Starting - 24:55.

Three main themes raised in this review:

1. Motherhood: the impact of being a doctor on raising children.

• Women found decisions around balancing children and career progression difficult.
• Women defer having children for career reasons.
• Decisions about career progression are likely to influence family size (most women reported having smaller families as a consequence of prioritizing career advancement or starting families later in life).

2. Medicine: the impact of being a mother on a medical career.

• Motivation to return to work was not lessened by motherhood.
• There are significant systemic barriers that women face on returning to work.

3. Combining motherhood and medicine: strategies and policies to aid women in medicine.

• Maternity leave policies.
• Access to lactation rooms and childcare, as well as flexible working options.

Take-Home Points:

• It is important to acknowledge that medicine has a significant impact on the experience of motherhood (both in terms of the number and timing of children you have) and can contribute to the family strain.
• Equally, medical careers offer financial freedom and great job satisfaction for women.
• Mothers are not less motivated to make career advancements, but there are very real systemic factors and prejudice that can make this challenging.
• There is a mental load that is associated strongly with motherhood; women do bear the greater parenting and domestic load.

Discussion 3:
Ju, M., & van Schaik, S. (2019). Effect of Professional Background and Gender on Residents’ Perceptions of Leadership. Academic Medicine, 94, S42-S47. https://doi.org/10.1097/acm.0000000000002925.

Presenter - Istabraq Raashed.
Starting - 01:12:05.

Take-Home Points:

• This study asked residents (in the US) to rate male and female leaders in an identically scripted video of a resuscitation, on overall performance, leadership, communication, problem-solving, situational awareness, and resource utilization skills.
• Women were given statistically significant lower scores in both leadership skills and communication domains.
• This study raises the concept of a ‘backlash effect’: where women who do not display characteristics typical of a female stereotype are at increased risk of prejudice or discrimination.
• It is important for everyone to check their bias in the workplace.
• Reflect on your interactions (good and bad) and be careful with what you take personally.
• Empathise with your colleagues and consider what other things may be going on in their lives

Interlude Segment:
Presenter - Dr Danielle Unwin
Starting - 01:05:40.

Other References:
Mnatzaganian, G., Hiller, J., Braitberg, G., Kingsley, M., Putland, M., & Bish, M. et al. (2019). Sex disparities in the assessment and outcomes of chest pain presentations in emergency departments. Heart, 106(2), 111-118. https://doi.org/10.1136/heartjnl-2019-315667.

Credits:
The discussions were mediated by ED consultant Dr Danielle Unwin.

This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney, Deepa Dasgupta, Cynthia De Macedo Franco, and Paul Scott.

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