Background
Women graduate in equal numbers from medical school as men but comprise less than half of academic faculties.Reference Cydulka, D’Onofrio and Schneider 1 , Reference Reed, Ender and Lindor 2 Within academic settings, their rate of promotion and appointment to leadership roles lags significantly behind their male counterparts’, and their attrition rate exceeds that of men.Reference Cydulka, D’Onofrio and Schneider 1 - Reference Levine, Lin and Kern 3 Cited reasons include lack of perceived positive role models and insufficient support, mentorship and preparation.Reference Levine, Lin and Kern 3 , Reference Welch, Jimenez and Walthall 4 Women have more difficulty identifying potential mentors, despite seeking them more often than men do.Reference Welch, Jimenez and Walthall 4 Women also report satisfying mentoring relationships less frequently.Reference Welch, Jimenez and Walthall 4 , Reference Sambunjak, Straus and Marusic 5 The literature suggests that women may have specific mentoring needs and benefit from female mentors.Reference Welch, Jimenez and Walthall 4 Effective mentoring can enhance career satisfaction and professional development and has been linked to career choice, including the decision to pursue an academic career.Reference Sambunjak, Straus and Marusic 5 - Reference Cain, Schulkin and Parisi 7 Recent studies have demonstrated that women enter residency with comparable intention to pursue academic careers as men, but that their interest declines as training progresses.Reference Cain, Schulkin and Parisi 7 Residency is a critical time period to choose an academic career. However, studies show that residents perceive their acquisition of academic skills to be suboptimal.Reference Straus, Straus and Tzanetos 8
Numerous organizations with the mission of educating, supporting and mentoring women physicians to enhance recruitment and retention in academic medicine have been created. However, there are few reports describing local or departmental programs specifically for women in emergency medicine (EM), and there are no programs, to our knowledge, exclusively for women residents. An environmental scan of Canadian EM residencies conducted using a combination of direct inquiry of program directors via email and a review of program websites did not identify any such programs. As more women enter EM, such programs may have significant impact.
Rationale
Given the paucity of women’s programs exclusively for residents, we performed a needs-assessment in our residency program. We assembled a focus group of eight female residents and administered a questionnaire to all female residents, which had a 75% response rate. None of the respondents utilized national women’s resources due to time limitations, challenges navigating the organization or website, and lack of resource proximity. Emergency physicians face unique challenges given the nature of our work and schedules that general medical organizations may not address. We therefore designed and implemented a program for women residents to provide accessible role modeling and mentorship, as well as education in critical skills required to succeed in academic EM.Reference Cain, Schulkin and Parisi 7
Description of the Innovation
Our program was developed to provide an evidence-based framework of topics and informal mentorship opportunities. Topics were established after medical and business literature searches identified key components of leadership development and mentorship for women, reasons that women choose non-academic careers, and unique challenges in EM. Our program is multifaceted in order to maximize outreach.
We organized evening mentorship events hosted by faculty volunteers to establish contact and provide an ongoing support structure. A pre-selected theme and corresponding article were used to focus discussion with faculty, who offered experiential expertise. (Table 1) Discussions incorporated resident-specific needs, including strategies to secure academic jobs, interviewing tips, negotiation tactics for jobs and clinical practice, methods to navigate institutional systems as new faculty, ways to prevent burnout, and time management techniques for academic productivity in the context of shift work. Resident leaders encouraged attendance and participation and were instrumental in theme selection to ensure topical relevance to resident needs. Event evaluations (n=24) were uniformly positive. In all, 81.8% of senior residents said that the events provided them with mentorship and insight into life as an academician that they have not received elsewhere. For 76.4% of attendees, the events provided skills and insight to better inform their practice choice and prepare them for academics.
Suggested themes for women faculty-resident discussions.
We developed an online repository of resources accessible to all residents. Resources include information about useful institutional resources, information about challenges women in academics encounter, and educational articles about skills integral to academics, including public speaking, interviewing, and teaching techniques. In addition, a list of female faculty advisors includes residency graduates, physicians at local hospitals, and physicians from other departments willing to provide career and personal guidance.
Partnering with our institution’s Office for Women’s Careers, we co-sponsored a roundtable discussion for women trainees. Women faculty led discussions covering topics that included academic career advancement, finding mentorship, leadership development, and family-career balance. The format was interactive and provided cross-discipline, experiential mentorship and networking opportunities. Evaluations were uniformly positive, rated 4.89 out of 5 (n=15 respondents). Attendees commented most frequently that the session encouraged them to develop a broader network of mentors.
Discussion
Recruiting and retaining women in academic medicine can enhance the future of women in medicine by providing role models and relatable mentorship. Residency is a catalytic period in choosing an academic career, yet programs exclusively targeting female trainees and their specific needs are sparse. Statistics showing that women preferentially choose non-academic careers, or leave academics, underscore the need for programs tailored to women in residency training.Reference Straus, Straus and Tzanetos 8
Integrating such programs into a postgraduate curriculum requires an understanding of the competing demands of the intended audience and knowledge about existing educational gaps and learning needs, in order to create resilient mentoring themes. To maximize participation and learning, the program cannot create untenable demands on the resident and should be incorporated in a way that does not detract from clinical learning and does not alienate male residents.Reference Kern, Thomas and Hughes 11
Our program has been well-received, as shown by strong event attendance and participation. Over two-thirds of our women residents have attended each evening event. Clinical work has been the most commonly cited reason for not attending. Residents have commented about the supportive community that has been fostered.
Evidence suggests that assigned mentoring programs are not as productive as those derived from personal preferences and career objectives.Reference Yamada, Slanetz and Boiselle 12 Our program has fostered productive mentoring for many residents that has extended beyond the events themselves. Since the link between mentorship and career choice has been demonstrated, enhanced mentorship by academic women faculty may encourage more women trainees to pursue academic careers.Reference Sambunjak, Straus and Marusic 5 – Reference Cain, Schulkin and Parisi 7 The online resources are easily accessible and provide education in core academic and leadership skills. We plan to encourage their ongoing active use by providing asynchronous learning credits (credit for approved, alternate learning outside the traditional curriculum). Given EM residents’ highly variable schedules, this is an important element in increasing outreach.
Given the program’s initial success, we continue to expand and seek ways to improve. We are incorporating resident-only events to encourage peer-to-peer mentorship. This provides a unique perspective to junior residents and highlights the importance of mentorship. We are creating teaching case studies about women in academic medicine for residency didactics. The audience would include male residents who may be future EM leaders and thus will benefit from such education. Our program is a low-cost, low-resource and potentially highly significant intervention that other residency programs may easily adopt.
Summary
Given the disparate representation of male and female physicians on academic faculties and in leadership positions, providing access to relatable role models and mentorship is important. Residency training is a critical juncture at which to intervene. Our implementation of a multifaceted program to increase mentorship and education has been well-received. This program promotes the acknowledgement, exploration, discussion, and learning about issues that women encounter in the academic setting. Our model may be useful to other EM residency programs with this mission.
Acknowledgments
We would like to acknowledge the residents’ leaders, past and present, who made this educational program possible: Drs. Munirih Qualls, Radhika Sundararajan, Laura Janneck, Daphne Morrison Ponce, R. Eleanor Anderson, Emily Brumfield, Kathleen Davenport. We also thank Dr. Hanni Stoklosa for her leadership as a resident and her assistance now as a faculty member. All authors hold leadership positions in the Harvard Affiliated Emergency Medicine Residency.
Competing Interests: None to declare.
