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.

Emotionally intelligent themes in medical leaders' decision-making during COVID-19.

BACKGROUND: The COVID-19 pandemic presented unprecedented challenges for leaders in healthcare requiring decision-making and crisis response that can often be tricky without the right level of trust. Trust is fostered and facilitated with emotional intelligence (EI); thus, a critical examination of medical leaders' reflections was essential to understand how leaders perceived their leadership responses during the initial response to COVID-19. This exploratory study used an EI lens to investigate leaders' perceptions of their decision-making during COVID-19. METHODS: A purposeful sample of seven leaders in medicine who experienced leading during COVID were invited to participate in semi-structured interviews. RESULTS: Four themes around leadership response during the uncertain times of the COVID-19 were identified. The themes included communication, interprofessional collaboration including decision-making and strategic planning, internal and external awareness, and finally, trust and psychological safety. CONCLUSIONS: Incorporating EI competencies into crisis leadership education for healthcare professionals could enhance medical leaders' preparedness to adapt, collaborate and communicate effectively in a crisis.

The impact of accreditation on continuous quality improvement process in undergraduate medical education programs: A scoping review.

Background: Accreditation in medical education has existed for more than 100 years, yet the impact of accreditation remains inconclusive. Some studies have shown the effects of accreditation on student outcomes and educational processes at medical schools. However, evidence showing the impact of accreditation on continuous quality improvement of undergraduate medical education programs is still in its infancy. This scoping review explores the impact of accreditation on continuous quality improvement (CQI). Methods: This scoping review followed the methodology of the Preferred Reporting Items of Systematic Reviews and the Meta-Analysis extension for scoping reviews (PRISMA-ScR) checklist outlined by Arksey and O'Malley (2005). Databases, including PubMed, Medline, ERIC, CINHAL, and Google Scholar, were searched to find articles from 2000 to 2022 related to the accreditation of undergraduate medical education programs and continuous quality improvement. Results: A total of 35 full-text articles were reviewed, and ten articles met our inclusion criteria. The review of the full-text articles yielded four themes: Accreditation and its standards in general, Accreditation and its impact on student outcomes, Accreditation and its impact on medical school's educational processes, Accreditation and CQI. However, the literature evidence suggesting the impact of accreditation on CQI is minimal. The quality assurance approach is based on meeting the standards of accreditation. The quality improvement approach is based on striving for excellence. Literature suggests a requirement to move from student outcomes to CQI measures. CQI requires everyone in the organization to take responsibility and accountability, considering quality as the result of every single step or process and leaders supporting improvements in data collection and data analysis for quality improvement. Conclusions: The literature on accreditation and CQI are limited in number. More research studies are required to enhance undergraduate medical education accreditation practices' value to medical students, educators, academic leaders, programs, and the public. It was recommended that medical schools embrace the culture and vision perpetuated by the CQI process.

The one cloud on a sunny day: Using emotional intelligence to manage emotions from negative written feedback.

Physician trainees receive anonymous written feedback about their clinical performance, which can be challenging to interpret. Negative written feedback can evoke a strong emotional response. An educational gap exists on how to handle receiving negative written feedback and the accompanying emotions. Teaching trainees the tenets of emotional intelligence, including emotional self-awareness and self-management, could be an avenue to improve the experience of receiving feedback. Face-to-face coaching may also help improve the emotional experience of receiving written feedback.

Women's professional development programs for emergency physicians: A scoping review.

Background: Gender disparities in emergency medicine (EM) persist, with women underrepresented in leadership positions and faced with unique challenges, such as gender discrimination and harassment. To address these issues, professional development programs for women have been recommended. Objectives: The purpose of this scoping review was to examine current women's professional development programs for EM and develop a collection of program characteristics, meeting topics, and tips for success that can be useful to new or existing women's professional development programs. Methods: The authors systematically searched research databases for literature detailing current women's professional development programs for EM physicians. Studies detailing professional development programs for female physicians in EM were included. Results: After 149 unique articles were screened, 11 studies met inclusion criteria, describing 10 professional development programs for women in EM. The most commonly cited program objectives included providing mentors and role models (n = 9, 90%), offering career advice and promoting professional advancement and leadership skills (n = 5, 50%), increasing academic recognition for women (n = 4, 40%), and promoting work-life balance and integration (n = 2, 20%). The most common topics covered in program sessions included mentorship and coaching, compensation and/or negotiation, leadership skills, and career advancement and promotion. Challenges and barriers to the success of these programs included a lack of funding and support, difficulty in recruiting participants, lack of institutional recognition and support, lack of time, and difficulty in sustaining the program over time. Conclusions: The study's findings can inform the development of programs that promote gender equity and support the advancement of women in EM.

Analysis of narrative assessments of internal medicine resident performance: are there differences associated with gender or race and ethnicity?

BACKGROUND: Equitable assessment is critical in competency-based medical education. This study explores differences in key characteristics of qualitative assessments (i.e., narrative comments or assessment feedback) of internal medicine postgraduate resident performance associated with gender and race and ethnicity. METHODS: Analysis of narrative comments included in faculty assessments of resident performance from six internal medicine residency programs was conducted. Content analysis was used to assess two key characteristics of comments- valence (overall positive or negative orientation) and specificity (detailed nature and actionability of comment) - via a blinded, multi-analyst approach. Differences in comment valence and specificity with gender and race and ethnicity were assessed using multilevel regression, controlling for multiple covariates including quantitative competency ratings. RESULTS: Data included 3,383 evaluations with narrative comments by 597 faculty of 698 residents, including 45% of comments about women residents and 13.2% about residents who identified with race and ethnicities underrepresented in medicine. Most comments were moderately specific and positive. Comments about women residents were more positive (estimate 0.06, p 0.045) but less specific (estimate - 0.07, p 0.002) compared to men. Women residents were more likely to receive non-specific, weakly specific or no comments (adjusted OR 1.29, p 0.012) and less likely to receive highly specific comments (adjusted OR 0.71, p 0.003) or comments with specific examples of things done well or areas for growth (adjusted OR 0.74, p 0.003) than men. Gendered differences in comment specificity and valence were most notable early in training. Comment specificity and valence did not differ with resident race and ethnicity (specificity: estimate 0.03, p 0.32; valence: estimate - 0.05, p 0.26) or faculty gender (specificity: estimate 0.06, p 0.15; valence: estimate 0.02 p 0.54). CONCLUSION: There were significant differences in the specificity and valence of qualitative assessments associated with resident gender with women receiving more praising but less specific and actionable comments. This suggests a lost opportunity for well-rounded assessment feedback to the disadvantage of women.

Complex decision making in an intensive care environment: Perceived practice versus observed reality.

RATIONALE: Advancing our understanding of how decisions are made in cognitively, socially and technologically complex hospital environments may reveal opportunities to improve healthcare delivery, medical education and the experience of patients, families and clinicians. AIMS AND OBJECTIVES: Explore factors impacting clinician decision making in the Boston Children's Hospital Cardiac Intensive Care Unit. METHODS: A convergent mixed methods design was used. Quantitative and qualitative data sources consisted of a faculty survey, direct observations of clinical rounds in a specific patient population identified by a clinical decision support system (CDSS) and semistructured interviews (SSIs). Deductive and inductive coding was used for qualitative data. Qualitative data were translated into images using social network analysis which illustrate the frequency and connectivity of the codes in each data set. RESULTS: A total of 25 observations of eight faculty-led interprofessional teams were performed between 12 February and 31 March 2021. Individual patient characteristics were noted by faculty in SSIs to be the most important factor in their decision making, yet ethnographic observations suggested faculty cognitive traits, team expertise and value-based decisions were more heavily weighted. The development of expertise was impacted by role modeling. Decisions were perceived to be influenced by the system and environment. CONCLUSIONS: Clinician perception of decision making was not congruent with the observed behaviours in a complicated and dynamic system. This study identifies important considerations in clinical curricula as well as the design and implementation of CDSS. Our method of using social network analysis to visualize components of decision making could be adopted to explore other complex environments.

Exploring gender and thematic differences in qualitative assessments of internal medicine resident performance.

INTRODUCTION: Evidence suggests gender disparities in medical education assessment, including differences in ratings of competency and narrative comments provided in resident performance assessments. This study explores how gender manifests within the content of qualitative assessments (i.e., narrative comments or performance feedback) of resident performance. METHODS: Qualitative content analysis was used to explore gender-based differences in narrative comments included in faculty assessments of resident performance during inpatient medicine rotations at six Internal Medicine residency programs, 2016-2017. A blinded, multi-analyst approach was employed to identify themes across comments. Patterns in themes with resident gender and post-graduate year (PGY) were explored, focusing on PGY2 and PGY3 when residents are serving in the team leader role. RESULTS: Data included 3,383 evaluations with narrative comments of 385 men (55.2%) and 313 women residents (44.8%). There were thematic differences in narrative comments received by men and women residents and how these themes manifested within comments changed with training time. Compared to men, comments about women had a persistent relationship-orientation and emphasized confidence over training including as interns and in PGY2 and PGY3, when serving as team leader. The relationship-orientation was characterized not only by the residents' communal attributes but also their interpersonal and communication skills, including efforts supporting others and establishing the tone for the team. Comments about women residents often highlighted confidence, including recommendations around behaviors that convey confidence in decision-making and team leadership. DISCUSSION: There were gender-based thematic differences in qualitative assessments. Comments about women resident team leaders highlight relationship building skills and urge confidence and actions that convey confidence as team leader. Persistent attention to communal skills suggests gendered expectations for women resident team leaders and a lost opportunity for well-rounded feedback to the disadvantage of women residents. These findings may inform interventions to promote equitable assessment, such as providing feedback across the competencies.

Formalizing the curbside: digitally enhancing access to specialty care.

Asynchronous medical care has increased in utilization, patient interest, and industry demand. While E-consults have been discussed extensively in the literature, there are rare examples of a multispecialty implementation within a large health system. Here, we describe our experience in implementing an internal E-consult program for asynchronous, nonurgent communication between ambulatory specialists and primary care providers in our large multispecialty regional health system. To ensure adoption of the program, patient, specialist, and primary care physician concerns were systematically addressed. The program commenced in February 2022 with three high referral rate specialties: cardiology, orthopedics, and dermatology. In the 12 months after implementation, 2243 total E-consults were ordered among 505 ordering providers. Dermatology received the most consultations, and we have expanded to 19 specialties and subspecialties available in the program in the first year. Our E-consult implementation experienced substantial growth in a short time period, demonstrating the viability of E-consult utilization for increasing asynchronous access to ambulatory specialists' expertise in a large healthcare system.

Using an Educational Intervention to Map our Surgical Teams' Function, Emotional Intelligence, Communication and Conflict Styles.

OBJECTIVE: The leadership team invited surgical team members to participate in educational sessions that created self and other awareness as well as gathered baseline information about these topics: communication, conflict management, emotional intelligence, and teamwork. DESIGN: Each educational session included an inventory that was completed to help participants understand their own characteristics and the characteristics of their team members. The results from these inventories were aggregated, relationships were identified, and the intervention was evaluated. SETTING: A level 1 trauma center, Baylor Scott and White Health, in central Texas; a 636-bed tertiary care main hospital and an affiliated children's hospital. PARTICIPANTS: An open invitation for all surgical team members yielded 551 interprofessional OR team members including anesthesia, attending physicians, nursing, physician assistants, residents, and administration. RESULTS: Surgeons' communication styles were individual focused, while other team members were group focused. The most common conflict management mode for surgical team members on average was avoiding, and the least common was collaborating. Surgeons primarily used competing mode for conflict management, with avoiding coming in a close second. Finally, the 5 dysfunctions of a team inventory revealed low accountability scores, meaning the participants struggled with holding team members accountable. CONCLUSIONS: Helping team members understand their own and others' strengths and blind spots will help create opportunity for more purposeful and clear communication. Additionally, this knowledge should improve efficiency and safety in the high-stakes environment of the operating room.

Personal Growth and Emotional Intelligence: Foundational Skills for the Leader.

Emotional intelligence (EI) has gained popularity and is being seen as a necessity, spreading beyond the business world, and becoming universal. In that shift, medicine and medical education have started to see the importance. This is evident in mandatory curriculum and accreditation requirements. EI includes 4 primary domains with several subcompetencies under each domain. This article outlines several of the subcompetencies necessary for success as a physician, competencies that can be honed with targeted professional growth. Empathy, communication, conflict management, burnout, and leadership are discussed in an application way to help identify importance of and how to improve each.

Moving beyond teamwork in the operating room to facilitating mutual professional respect.

Psychological safety enables the interpersonal risk-taking necessary for providing safer patient care in the operating room (OR). Limited studies look at psychological safety in the OR from the perspectives of each highly specialized team member. Therefore, we investigated each member's perspective on the factors that influence psychological safety in the OR. Interviews were conducted with operative team members of a level 1 trauma center in central Texas. The interviews were transcribed, de-identified, and coded by two investigators independently, and thematic analysis was performed. Responses were collected from 21 participants representing all surgical team roles (attending surgeons, attending anesthesiologists, circulating nurses, nurse anesthetists, scrub techs, and residents). Circulating nurse responses were redacted for confidentiality (n = 1). Six major themes influencing psychological safety in the OR were identified. Psychological safety is essential to better, safer patient care. Establishing a climate of mutual respect and suspended judgment in an OR safe for learning will lay the foundation for achieving psychological safety in the OR. Team exercises in building rapport and mutual understanding are important starting points.

Building Communication and Conflict Management Awareness in Surgical Education.

OBJECTIVE: A group of surgeons and a medical educator constructed a curriculum to strengthen communication and emotional intelligence skills in the surgical setting. DESIGN: The curriculum consisted of a small group discussion series occurring during medical students' eight-week surgery clerkship. The curriculum targeted the following objectives: building team rapport, exploring self-management strategies in team communication, recognizing communication styles, diagnosing conflict, identifying opportunities in professional and personal development, and discussing professionalism in medicine. Students completed pre-post Likert style tests about their knowledge and understanding of the above-mentioned topics. SETTING: Texas A&M University College of Medicine, Surgical Clerkship at Baylor Scott and White Medical Center, a level 1 trauma center, in Temple, TX. PARTICIPANTS: Twenty-four students in their third year of medical school completed the communication curriculum. RESULTS: Wilcoxon sign test was used to analyze the non-parametric data and multiple repeat tests required the significance level (p-Value) be adjusted to 0.003. Students showed significant increase in understanding of conflict management, their ability to communicate effectively, and their awareness of communication preferences (p < 0.001). In addition, they recognized better ways to engage with other students, residents, and staff on their rotation (p = 0.002) and felt more confident in their ability to handle feedback (p = 0.001). Open-ended responses on the post-test had overwhelmingly positive feedback with themes of awareness, psychological safety, and team rapport. Finally, students requested that the curriculum be taught longitudinally throughout their third-year clerkships. CONCLUSIONS: Our curriculum enabled students to improve their awareness of communication, conflict management, team dynamics, and professionalism. These important competencies will support students throughout their training and in their practice as future surgeons.

The lived experience of medical training and emotional intelligence.

The shifting health care landscape in the United States has surfaced challenges related to increased accountability, interprofessional health care teams, and changes in federal policy-all of which compel physicians to adopt roles beyond clinician such as clinical investigator, team leader, and manager. To address these challenges, leadership development programs across the continuum of medical education aim to develop critical leadership skills and competencies, such as emotional intelligence. Such skills and competencies are largely taught through didactic approaches (e.g., classroom). These approaches often neglect the context of learning. From medical residency to a hospital or clinic, the contextual lived experience is habitually overlooked as a vehicle for developing emotional intelligence. This article highlights lived experience, such as medical residency, as an approach to develop emotional intelligence. First, we address the need for developing emotional intelligence as a leadership skill as well as the suitability of medical residency for such development. Next, we discuss the background of lived experience and emotional intelligence. Lastly, we identify future directions for leveraging lived experiences of medical residency to develop emotional intelligence.

Conflict Management Education in the Intensive Care Unit.

BACKGROUND: Conflicts in medical settings affect both team function and patient care, yet a standardized curriculum for conflict management in clinical teams does not exist. OBJECTIVES: To evaluate the effects of an educational intervention for conflict management on knowledge and perceptions and to identify trends in preferred conflict management style among intensive care unit workers. METHODS: A conflict management education intervention was created for an intensive care team. The intervention was 1 hour long and incorporated the Thomas-Kilmann Conflict Mode Instrument as well as conflict management concepts, self-reflection, and active learning through discussion and reviewing clinical cases. Descriptive statistics were prepared on the participants' preferred conflict management modes. A pretest/posttest was analyzed to evaluate knowledge and perceptions of conflict before and after the intervention, and 3 open-ended questions on the posttest were reviewed for categories. RESULTS: Forty-nine intensive care providers participated in the intervention. The largest portion of participants had an avoiding conflict management mode (32%), followed by compromising (30%), accommodating (25%), collaborating (9%), and competing (5%). Pretest/posttest data were collected for 31 participants and showed that knowledge (P < .001) and perception (P = .004) scores increased significantly after the conflict management intervention. CONCLUSIONS: The conflict management educational intervention improved the participants' knowledge and affected perceptions. Categorization of open-ended questions suggested that intensive care providers are interested in concrete information that will help with conflict resolution, and some participants understood that mindfulness and awareness would improve professional interactions or reduce conflict.

Ad hoc teams and telemedicine during COVID-19.

The pandemic has required creative and agile teamwork and leadership. Creativity was especially necessary when employing the social distancing requirements for this disease. To ensure compliance while also meeting the needs of our system and community, a huge telemedicine initiative was deployed. Administrative leadership utilized ad hoc teams to overcome challenges and ensured success with a shared vision, clarity, communication, and a positive culture. This article outlines how the team was developed, what challenges the team faced, and how they were successful in the unchartered waters of a COVID-19 response. Finally, best practices are shared for inconsistent teams in an inconsistent setting, ensuring success within an ad hoc team residing in a fluid environment.