Diversity and Inclusion

FEM@BCM: A Response to The Call for Equality, Mentorship, & Leadership

Underrepresentation of women in academic medicine persists. Women comprise 47% of medical school entrants and only 21% of full professors in academic medicine in the United States.1

The gap between men and women in academic medicine is evident, and multiple groups in emergency medicine, including ACEP, EMRA, SAEM, AAEM, and CORD, advocate for diversity and inclusion.2 The solution begins long before residency, but our access to trainees and ability to diversify our workforce and promote embracement begins here, in residency.

As EM physicians, we strive for excellence in all aspects of EM training and practice, providing care for all comers at all times, regardless of race, gender, socioeconomic status, disability, or access to care. Achieving this goal demands formal education and training in diversity, inclusion, and health care equity. At the Baylor College of Medicine (BCM) EM residency program, we incorporate this into our curriculum and promote this outside of formal didactics.

Creating a cultivating and supportive environment for women in EM has been an ongoing effort in our community, yet we continue to have difficulty closing the gender gap. Various hypotheses regarding the etiology of this gap exist, from contrast in clinical performance to varying numbers of academic publications; however, most of these theories have been debunked by recent literature. There is no difference in clinical practice between male and female EM physicians in regards to patient evaluation, diagnostic tool use, patient dispositions and 72-hr ED revisit rates, according to a study across four emergency departments in Taiwan.3 Another study states that female faculty lag in academic productivity, publishing significantly less articles in peer-reviewed journals than their male counterparts;4 however, that same year a study found there is no discrepancy between the proportion of female academic EM faculty and female academic EM authorship.5  Female residents are not immune either, with a study finding that although male and female EM residents received similar evaluations at the beginning of residency, the rate of milestone attainment was higher for male than female residents.6

This is not prevalent only in EM. Studying 1.5 million Medicare patients found that those who were treated by a female physician were less likely to die or be readmitted to the hospital within 30 days than those patients treated by a male physician.7 100,000 surgical patients found the same effect: patients who were operated on by a female surgeon were significantly less likely to die within the next 30 days.8 For over 500,000 patients who experienced a sudden heart attack, any patient treated by a female physician was more likely to survive, compared with those treated by a male physician.9 Despite all of this data demonstrating either equivalent or superior performance, a study looking at 91,073 physicians with medical school faculty appointments found that even after accounting for age, years post-residency, specialty, and research productivity, male faculty are much more likely to obtain full professorship than female faculty.10

Given that women physicians provide the same quality of care3 and publish proportionately to their male counterparts,5 it is unclear the reason women physicians are underrepresented in leadership positions and in EM as a whole. So, what can we DO about this?

Different models were assessed at 23 institutions and found that many medical schools lack a program supporting gender equality.11 Of those institutions who do have programming, they largely target the individual through mentoring, networking, child care and spousal hiring programs. However, Carr et al. found that programs are lacking efforts at the academic community and policy levels.11 Few institutions have faculty development programs or diversity and inclusion policies in place to support recruitment, retention and promotion of female faculty despite evidence that national professional programs such as the Hedwig van Ameringen Executive Leadership in Academic Medicine for Women (ELAM) are beneficial in regards to career advancement.12

At BCM, our EM Department conducted a needs assessment as our first step in identifying the gravity and breadth of the problem.  We found the following key points:

  1. There are currently not enough women leaders in EM
  2. No women in our department were above the Assistant Professor level
  3. There is no policy to protect breastfeeding women in the BCM EM Department when they need to go pump while on shift
  4. There is no formal education on gender equality within EM

We took our findings and established FEM@BCM: Females in Emergency Medicine at Baylor College of Medicine. Our mission is to promote the advancement and equality of women in EM by mentoring and inspiring leadership. Service is a key component to our goals because we want to be supportive of our community and better understand the scope of issues facing local women.  Our inaugural event included a clothing and suit drive called Dress for Success with the goal to empower women to achieve economic independence by donating professional attire needed for professional opportunities. We created a mentor network for our residents that included current faculty and past graduates of our program - a great opportunity to get local alumni involved. 

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Recognizing individuals who support diversity and inclusion is paramount to our future success. We annually award faculty, APPs, residents and nursing staff who support women in academic EM individually and through organizational initiatives addressing the gap in recruitment, promotion, development and advancement of women physicians. At the institutional level, our college awarded eight women in our department as Women of Excellence; the awardees included faculty, APPs, residents and administrative staff.

We organized social and networking events for our residents, created and distributedawards to our residents and faculty who demonstrated commitment to advancing and promoting diversity, inclusion and women in EM, and successfully applied for multiple FIX18 and AWAEM resident scholarship awardees.

At the policy level, FEM@BCM established a Lactation policy and secured our department's first hospital-grade breast pump. We are currently working on plugging in our faculty to our institution faculty development programming and seeking out women at higher levels to come and speak to provide remote mentorship. Being part of a program that is actively looking for ways to not only support and advance women in EM but also supporting diversity on other fronts is key.13, 14 FEM@BCM is the tip of the iceberg and the first group in our department’s Diversity and Inclusion in EM initiative. We support women in EM by fostering gender equity both inside and outside of the workplace. We seek positive social change and advancement of women in EM through education, empowerment, and advocacy. We will inspire our community through mentorship and leadership.


References
1. Lautenberger DM, Dandar VM, Raezer CL, Sloane RA. The State of Women in Academic Medicine The Pipeline and Pathways to Leadership. 2014.
2. Parker RB, Stack SJ, Schneider SM, et al. Why Diversity and Inclusion Are Critical to the American College of Emergency Physicians Future Success. Ann Emerg Med. 2017;69(6):714-717.
3. Huang KC, Lin YR, Syue YJ, Kung CT, Chiu IM, Li CJ. Comparison of Clinical Practice in the Emergency Department: Female Versus Male Emergency Physicians. Am J Med Sci. 2018;355(3):215-219.
4. Cydulka RK, Donofrio G, Schneider S, Emerman CL, Sullivan LM. Women in Academic Emergency Medicine. Acad Emerg Med. 2000;7(9):999-1007.
5. Tinjum BE, Getto L, Tiedemann J, et al. Female Authorship in Emergency Medicine Parallels Women Practicing Academic Emergency Medicine. J Emerg Med. 2011;41(6):723-727.
6. 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.
7. Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians. JAMA Intern Med. 2017;177(2):206-213.
8. Wallis CJ, Ravi B, Coburn N, Nam RK, Detsky AS, Satkunasivam R. Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. BMJ. 2017;359:j4366.
9. Greenwood BN, Carnahan S, Huang L. Patient–physician gender concordance and increased mortality among female heart attack patients. PNAS. 2018;115(34):8569-8574.
10. Jena AB, Khullar D, Ho O, Olenski AR, Blumenthal DM. Sex Differences in Academic Rank in US Medical Schools in 2014. JAMA. 2015;314(11):1149.
11. Carr PL, Gunn C, Raj A, Kaplan S, Freund KM. Recruitment, Promotion, and Retention of Women in Academic Medicine: How Institutions Are Addressing Gender Disparities. Womens Health Issues. 2016;27(3):374-381.
12. Dannels SA, Yamagata H, Mcdade SA, et al. Evaluating a Leadership Program: A Comparative, Longitudinal Study to Assess the Impact of the Executive Leadership in Academic Medicine (ELAM) Program for Women. Acad Med. 2008;83(5):488-495.
13. Heron S, Haley LL. Diversity in Emergency Medicine—A Model Program. Acad Emerg Med. 2001;8(2):192-195.
14. Heron SL, Lovell EO, Wang E, Bowman SH. Promoting Diversity in Emergency Medicine: Summary Recommendations from the 2008 Council of Emergency Medicine Residency Directors (CORD) Academic Assembly Diversity Workgroup. Acad Emerg Med. 2009;16(5):450-453.

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