A Qualitative Exploration of the Career-Choice Journey of Women in Anesthesiology.

Background: Women are underrepresented in the anesthesiology physician workforce. Additionally, recruitment of women into the specialty has been stagnant over the past 2 decades. Current evidence is lacking regarding how and why women navigate the career-exploration journey to find anesthesiology. The purpose of this study was to investigate the phenomenon of women choosing a career in anesthesiology, specifically identifying facilitators and barriers to career choice and professional identity formation. Methods: Using constructivist grounded theory, we explored the self-reported experiences of women anesthesiology trainees, including resident physicians and senior medical students. Seven resident physicians and 4 medical students participated in the study. Through semistructured interviews, data collection, and iterative analysis, the authors identified codes and emerging themes, thereby advancing the understanding of the career-choice journeys of women anesthesiologists. Results: Iterative analysis revealed 6 themes related to career-choice journeys for women in anesthesiology. Three emerging themes have been previously described in career-choice reviews (specialty characteristics, gender awareness, and pathway support). Additionally, 3 novel themes emerged from our study population (hidden curriculum, learning environment, and mystery behind the drape). Conclusions: The findings of this study highlight factors and experiences that impact career-choice decisions for women who choose anesthesiology. Only in understanding the how and why of women physicians' journeys can we hope to build on this knowledge, thereby striving to develop educational, clinical, professional, and personal experiences that support women along their professional journeys to ultimately find anesthesiology.

Wake up to the gender gap in academic anesthesiology and address the pipeline.

Diversity, equity, and inclusion are important values in health care and academic medicine. Although women have comprised nearly 50% of all US medical school graduates since the early 2000s, gender disparities continue in many specialties and persist in medical education leadership. For women in anesthesiology, gender inequities exist along the academic pipeline, with greater disparity in the higher ranks of academia and leadership. Successful endeavors to improve gender equity in the specialty include increasing awareness, engaging in faculty development, and encouraging transparent promotions processes. The strides will be short and change will be slow unless we shift focus to when the gender imbalance begins-at the transition from undergraduate medical education to graduate medical education. Currently women comprise 37% of academic anesthesiology faculty; however, the current resident pool is only 33% women. If recruitment of a gender-equitable workforce at the undergraduate-to-graduate medical education transition is not a priority, the downstream measures will have minimal impact toward gender equity in academic anesthesiology.

Rates of major obstetrical complications vary almost fivefold among US hospitals.

Of the approximately four million women who give birth each year in the United States, nearly 13 percent experience one or more major complications. But the extent to which the rates of major obstetrical complications vary across hospitals in the United States is unknown. We used multivariable logistic regression models to examine the variation in obstetrical complication outcomes across US hospitals among a large, nationally representative sample of more than 750,000 obstetrical deliveries in 2010. We found that 22.55 percent of patients delivering vaginally at low-performing hospitals experienced major complications, compared to 10.42 percent of similar patients delivering vaginally at high-performing hospitals. Hospitals were classified as having low, average, or high performance based on a calculation of the relative risk that a patient would experience a major complication. Patients undergoing a cesarean delivery at low-performing hospitals had nearly five times the rate of major complications that patients undergoing a cesarean delivery at high-performing hospitals had (20.93 percent compared to 4.37 percent). Our finding that the rate of major obstetrical complications varies markedly across US hospitals should prompt clinicians and policy makers to develop comprehensive quality metrics for obstetrical care and focus on improving obstetrical outcomes.

Can parturients identify the midline during neuraxial block placement?

STUDY OBJECTIVE: To determine whether parturients can reliably identify their midline during epidural or spinal needle insertion, and to determine whether parturient feedback helps the anesthesiologist successfully identify the midline. DESIGN: Survey instrument completed by anesthesiologists. SETTING: Labor and delivery unit of a university-based, tertiary-care hospital. MEASUREMENTS: Completed questionnaires were obtained for 554 of 904 (61.3%) neuraxial blocks. Data were collected on the type of neuraxial block, number of needle redirections required to identify the midline, the patient's height and weight, the patient's position during block placement, whether the patient was questioned for assistance identifying the midline, and if so, how helpful the patient was in redirecting the needle to locate the epidural or subarachnoid space. MAIN RESULTS: The anesthesiologist requested the assistance of 194 patients (35.0%) for needle location. Of those questioned, the anesthesiologist reported 128 instances (66.0%) when the patient's response was helpful in identification of the midline. Morbidly obese parturients (BMI > 35 kg/m²) were questioned more often than their non-morbidly obese counterparts (48.9% vs. 30.5%; P < 0.0005). Of those morbidly obese parturients who were questioned (n = 64), 76.6% were reported by the anesthesiologist to be helpful. CONCLUSIONS: Most patients, including morbidly obese patients, are helpful in identifying the midline during neuraxial anesthesia.