Network Five: Women in medicine

Network Five: Episode 4 – 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.

Part 1

In this episode, we first explore gender-based differences with respect to morbidity and mortality among patients with myocardial infarction. Presenter – Amanda De Silva

• Stehli J, Martin C, Brennan A, Dinh DT, Lefkovits J, Zaman S. Sex Differences Persist in Time to Presentation, Revascularization, and Mortality in Myocardial Infarction Treated With Percutaneous Coronary Intervention. J Am Heart Assoc. 2019 May 21;8(10):e012161

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.

Part 2

In this second part of the series, we discuss the impact of a medical career on the experience of motherhood. Presenter -Jessica Stabler.

• Hoffman R, Mullan J, Bonney AD. Motherhood and medicine: systematic review of the experiences of mothers who are doctors. Med J Aust. 2021 Jun;214(11):533-533.e1.

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. 

Part 3

In this final part of the series, we talk about the potential challenges that females face in the workplace especially in areas such as leadership.

• Ju M, van Schaik SM. Effect of Professional Background and Gender on Residents’ Perceptions of Leadership. Acad Med. 2019 Nov;94(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 58th Annual Research in Medical Education Sessions):S42-S47.

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  

Other references

Other

• Mnatzaganian G, Hiller JE, Braitberg G, Kingsley M, Putland M, Bish M, Tori K, Huxley R. Sex disparities in the assessment and outcomes of chest pain presentations in emergency departments. Heart. 2020 Jan;106(2):111-118
• van Oosterhout REM, de Boer AR, Maas AHEM, Rutten FH, Bots ML, Peters SAE. Sex Differences in Symptom Presentation in Acute Coronary Syndromes: A Systematic Review and Meta-analysis. J Am Heart Assoc. 2020 May 5;9(9):e014733
• Sederholm Lawesson S, Isaksson RM, Thylén I, Ericsson M, Ängerud K, Swahn E; SymTime Study Group. Gender differences in symptom presentation of ST-elevation myocardial infarction – An observational multicenter survey study. Int J Cardiol. 2018 Aug 1;264:7-11

These episodes were produced with help of HETI’s Emergency Medicine Training Network 5. Please send us an email to let us know what you thought. You can contact us at [email protected]