“Hi, I’m Dr. [Lastname]. I’ll be the doctor taking care of you today,” a female resident introduces herself to her patient. He responds: “Oh, hi, nurse, nice to meet you. Yeah, I just met Joe, the doctor,” referring to the attending physician, who introduced himself by his first name.
“We’re going to need to do a transvenous pacer for the patient in room 15,” the attending announces. A female senior resident, is eager to perform the procedure, but before she can express interest, a junior male resident has jumped up from his workstation and said, “I’d love to do it. I’ll grab the supplies now.” The attending responds: “Great!”
The above incidents are common types of gendered interpersonal interactions that affect female physicians’ confidence and educational opportunities in residency. They reflect broader problems of gender discrimination that female residents face in emergency medicine training.
Within our residency, we identified professional introductions and access to procedural opportunities as two areas of concern for female residents. A small working group above led residency-wide discussions to develop consensus strategies to respond to these issues, with the goal of promoting a more equitable training environment.
We took a multi-modal approach to initiate conversations and distribute actionable interventions to residents and faculty. First, the residency hosted a journal club addressing gender disparities in EM residency evaluations. (1,2) Subsequently, at our annual residency retreat, we led small groups focusing on residents’ experiences with collaborative care team introductions and improving access to procedural opportunities.
Discussions included framing the problems, sharing personal anecdotes, and identifying solutions. Through these events, our residency developed the following practices:
We modeled consistent use of “Dr. Last Name.” We have promoted this practice among those who feel comfortable sharing their last name with patients. Importantly, some residents voiced a desire to go by a first name or a nickname due to ethnic/racial discrimination from patients when sharing their last name.
We encouraged residents to develop the practice of a personal “mini-timeout” before volunteering to do a procedure. This involves taking stock of one’s own experience with a procedure, other residents in the department and assessing their interests, offering to walk another resident through a procedure with which one is already familiar, prioritizing senior residents in performing rare procedures.
Written summaries were shared with residents and faculty, and reviewed at faculty meetings for both of our affiliated teaching institutions. Residents were then surveyed regarding the impact of these interventions (results in Tables 1 & 2).
Impact
The journal club had the highest-ever attendance, and the actionable practices for improved gender equity have been well-received. Sixty percent of surveyed residents reported introducing themselves as “First Name” prior to these conversations. On a follow-up survey six weeks after the discussions, over 80% reported introducing themselves as “Dr. Last Name.” The journal club and retreat working group were cited as key motivating factors for this change. Perceived differences in procedural opportunities have led us to study procedural distribution and access to procedural training by gender. Strong leadership support and protected time for small group conversation outside of the clinical environment added to this initiative’s value.
Next Steps
Culture and practice change will depend on longitudinal engagement regarding these issues and regular reminders of consensus best practices. We hope to continue to emphasize gender equity in our didactic curriculum going forward. We have also received feedback from residents that they hope for increased faculty participation in sessions addressing gender equity.
Anita Chary MD PhD, (1) Laura Dean MD, (1) Chris Nash, MD, (1) Adaira Landry MD MEd, (1,2) Eric Shappell MD MHPE, (1,3)
1 Harvard Affiliated Emergency Medicine Residency
2 Department of Emergency Medicine, Brigham and Women’s Hospital / Harvard Medical School
3 Department of Emergency Medicine, Massachusetts General Hospital / Harvard Medical School
References
1. Dayal A, O’Connor DM, Qadri U, Arora VM. Comparison of Male vs Female Resident Milestone Evaluations by Faculty During Emergency Medicine Residency Training. JAMA Intern Med. 2017;177(5):651-657. doi:10.1001/jamainternmed.2016.9616
2. Mueller AS, Jenkins TM, Osborne M, Dayal A, O’Connor DM, Arora VM. Gender Differences in Attending Physicians’ Feedback to Residents: A Qualitative Analysis. J Grad Med Educ. 2017;9(5):577-585. doi:10.4300/JGME-D-17-00126.1