"The straw that broke the camel's back": An analysis of racialized women clinicians' experiences providing diabetes care.

INTRODUCTION: Racialized women clinicians (RWCs) experience the brunt of unfair racial and gendered expectations, which is a direct result of their visible identity. Our study sought to understand how these experiences intersect to impact the personal and professional well-being of RWCs, and their approach to diabetes care. METHODS: Data were collected from 24 RWCs working within Canadian diabetes care settings, who participated in semi-structured, one-on-one interviews conducted from April 2021 to September 2021. The data were qualitatively analyzed using thematic analysis to develop emergent themes, and interactions were explored using the socioecological model (SEM), adapted to our study context. RESULTS: We identified three themes: (1) Discordance between self-identity and relational identity impacted how RWCs interacted with others, and how others interacted with them; (2) Tokenistic, "inclusive" organizational policies/practices and inherently racist and sexist social norms permitted acts of discrimination and led to the systematic othering and exclusion of RWCs within the workplace; and (3) Differential treatment of RWCs had both positive and negative impacts on participants' relational, workplace and self-identity. Using the SEM, we also found that differential treatment of RWCs stems from upstream policies, structures, and social norms, percolating through different levels of the SEM, including work environments and communities, which eventually impacts one's relational identity, as well as one's perception of oneself. CONCLUSION: The differential treatment of RWCs arises predominantly from macro systems of the work environment. The burden to address these disparities must be shifted to the source (i.e., namely systems) by implementing interventions that equitably value diversity efforts, institute policies of accountability and correction of implicit biases, and prioritize an inclusive culture broadly across faculty and leadership.

Impact of a virtual coaching program for women physicians on burnout, fulfillment, and self-valuation.

BACKGROUND: Coaching has been demonstrated to be an effective physician wellness intervention. However, this evidence-based intervention has not yet been widely adopted in the physician community. Documentation and implementation research of interventions to address physician burnout in real world settings is much needed. OBJECTIVE: Assess the impact of a virtual physician coaching program in women physicians. DESIGN: Pre- and post-intervention surveys administered to participants enrolled in the program (N = 329). Effect size was calculated comparing pre- and post-intervention paired data (N = 201). PARTICIPANTS: 201 women physicians from 40 states in the United States of America and 3 international participants. INTERVENTIONS: Participants were given access to an 8 week virtual coaching program including eight individual, six small group, and 24 large group sessions. MAIN MEASURES: Stanford Professional Fulfillment Inventory (PFI) containing categories for assessing professional fulfillment, burnout, and the Clinician Self-Valuation (SV) Scale (a measure of self-compassion). KEY RESULTS: Burnout was found in 77.1% (N = 155) of participants at baseline, which reduced to 33.3% (N = 67) at completion with large effect size (Cohen's d 1.11). The percentage of participants who endorsed significant professional fulfillment started at 27.4% (N = 55) and improved to 68.2% (N = 137) with a large effect size (Cohen's d 0.95). Self-valuation improved from 17.9% (N = 36) of the participants endorsing a compassionate self-improvement perspective to 64% of the same participants eight weeks later. The self-valuation metric showed a very large effect size (Cohen's d 1.28). CONCLUSIONS: Virtual physician coaching programs led by physician coaches can decrease burnout, improve professional fulfillment, and increase self-compassion. Non-institution-based opportunities for coaching available to any physician across the United States and internationally can facilitate access to effective physician well-being interventions.

A Cross-Sectional Study of Gender-Specific Influences of Orthopedic Subspecialty Selection.

Background: Per the American Academy of Orthopaedic Surgeons, 6.5% of practicing orthopedic surgeons are female and a majority subspecialize in pediatrics, hand, and foot and ankle surgery. The study purpose is to evaluate influences of orthopedic subspecialty selection, specifically factors such as perceived strength, lifestyle, and mentorship influence on subspecialty decisions and to identify if gender plays a role in these perceptions. Methods: An IRB approved cross-sectional study was conducted via email distribution of a REDCapTM survey to U.S. licensed orthopedic surgeons. Data regarding demographics, professional degree, training and current practice location, and perceptions regarding orthopedic surgery was obtained using Likert rating scales. Data was analyzed using descriptive statistics with two-tailed student's t-tests (α=0.05). Results: The survey yielded 282 responses (182 females and 100 males). Overall, the distribution of residents (28%), fellows (6%), and attendings (66%) correlates well with the prevalence of each respective physician category in the field of orthopedic surgery. The study demonstrated no difference in subspecialty choice based on mentorship, work-life-balance, career advancement, subspecialty culture, salary potential, family planning, or schedule. However, a statistically significant difference exists regarding stereotypes, perceived strength required, and perception of discrimination from pursuing a specific orthopedic subspecialty. 27% of females and 10% of males reported discouragement from any subspecialty (p<0.05). Adult reconstructive and oncology were most frequently discouraged. Women reported not choosing a subspecialty because of perceived physical demands more often than men (p<0.001). Women reported an increased use of adaptive strategies in the operating room (p<0.001). Women were also more likely to report feeling discouraged from pursuing a subspecialty due to their gender (p<0.001). Both men and women reported mentorship as the most influential factor in subspecialty selection. Conclusion: Women and men reported different factors were important in their decision of subspecialty. Women were more likely to be discouraged from a subspecialty and experience discrimination based on their perceived strength compared to male peers. Residents, fellows, and attending surgeons valued mentorship as the most influential in their subspeciality choice. This study suggests intrinsic and extrinsic influences that may differentially affect male and female orthopedic surgeons when they choose a subspecialty. Level of Evidence: III.

Gender-based support systems influencing female students to pursue a bachelor of medicine, bachelor of surgery (MBBS) in Rwanda.

BACKGROUND: While Sub-Saharan Africa contains nearly one third of the global burden of disease, it only contains 3.5% of the healthcare workforce. Furthermore, female medical doctors are underrepresented across the continent. Studies show that increasing gender representation in medicine not only bridges this gap but may have a positive impact on patient care. This study explores the support systems influencing female students to pursue medical school in Rwanda, aiming to recommend ways to increase female participation through support systems. METHODS: This is an exploratory, interpretive study employing qualitative methods. The study was conducted at thirteen secondary schools within two provinces and three universities in Rwanda that offer a medical degree program. Participants were divided into focus groups, including female and male secondary students in science and non-science combinations; teachers of secondary students; female and male students enrolled in medical school; and parents of secondary students in science and non-science combinations. Private and public, mixed and girls-only secondary schools that met the criteria were selected in each province, and all universities offering a medical degree. Participants were selected via random stratified sampling. Thirty-four semi-structured focus group discussions were conducted (28 secondary-level and 6 university-level) and 16 interviews. Data was coded inductively, with common themes identified. RESULTS: Four main themes were identified as support systems that can either serve as facilitators or barriers to pursuing an MBBS, including teacher support, parental or familial support, financial or institutional policy support, and having access to female mentors or role models. CONCLUSION: Social support systems are enablers encouraging female students to join medical school. Integrating social support systems in schools and the community has the potential to increase female applicants to medical school in Rwanda.

Gender Difference of Burnout in Physicians Working in Tertiary Care Hospital: A Cross-Sectional Study.

Burnout and emotional exhaustion are becoming common among health workers in the busy teaching hospitals due to increased workload and the dearth of human resource. This study aimed to determine the causes of burnout among doctors and across gender differences. This was a descriptive cross-sectional study conducted in the Fauji Foundation Hospital, Rawalpindi, Pakistan, from 1st July to 30th September 2022. Two hundred and forty-five randomly recruited doctors who filled out self-administered questionnaires were included in the study. Independent samples t-test was used for comparison of the mean emotional burnout score. Female doctors felt more emotionally drained, more fatigued, and more worn out from work than male doctors (p < 0.05). Overall emotional exhaustion was also higher in female doctors (p < 0.05). This situation was more serious during the COVID-19 pandemic. Gender-sensitive environments, workplace policies, and necessary interventions will save physicians' burnout and brain drain. Emotional burnout is greater in female doctors as compared to their male counterparts. This evidence not only calls for prevention and treatment but also certain service-related reforms to facilitate female physicians to balance out their work and family lives more effectively. Key Words: Physicians, Emotional exhaustion, Burnout, Gender difference, Pakistan.

Supporting Our Women Colleagues.

Burnout is a challenge for all of us. Many of us experience burnout and know the toll it can take on our health and well-being. This editorial focuses on the experiences of women physicians and learners by highlighting the lived experience of one woman physician, briefly examining the extensive research into women physicians' practice, and identifying solutions that all genders can leverage to support women physicians and learners.

More Than a Joke: The Intersection of Gender-Based Humor and Gender Inequities Experienced by Women Department Chairs in Academic Medicine.

Purpose: The purpose of this qualitative descriptive study is to describe how women academic department chairs in emergency medicine, surgery, and anesthesiology experience humor in the workplace. Method: Interviews were conducted with 35 women department chairs in academic medicine from 27 institutions that aimed to describe women's leadership emergence. The data from the primary study yielded rich and revealing themes involving participants' experiences with humor in the context of their leadership roles, justifying a secondary analysis focusing specifically on these experiences. Relevant remarks were extracted, coded, and summarized. Results: Participants discussed two broad types of humor-related experiences. First, they described how they responded to aggressive gender-based humor directed at themselves or their colleagues by tolerating it or expressing disapproval. This humor includes demeaning quips, insulting monikers, sexist jokes, and derogatory stories. Participants often did not confront this humor directly as they feared being rejected or ostracized by colleagues. Second, they described how they initiated humor to address gender-related workplace issues by highlighting gender inequalities, coping with sexual harassment and assault, and managing gender-based leadership challenges. Participants felt constrained in their own use of humor because of the need to be taken seriously as women leaders. Conclusion: Women leaders in academic medicine use humor to confront gender-related issues and experience aggressive gender-based humor in the workplace. The constraints placed on women leaders discourage them from effectively confronting this aggressive gender-based humor and perpetuating gender inequities. Eliminating aggressive gender-based humor is needed to create safe and equitable work environments in academic medicine.

Short-time mentoring - enhancing female medical students' intentions toward surgical careers.

BACKGROUND: Women pursuing a career in surgery or related disciplines are still in the minority, despite the fact that women compose at least half of the medical student population in most Western countries. Thus, recruiting and retaining female surgeons remains an important challenge to meet the need for surgeons and increase the quality of care. The participations were female medical students between their third and fifth academic year. In this study, we applied the well-established psychological theory of planned behavior (TPB) which suggests that the intention to perform a behavior (e.g. pursuing a career in surgery) is the most critical and immediate predictor of performing the behavior. We investigated whether a two-part short-mentoring seminar significantly increases students' intention to pursue a career in a surgical or related specialty after graduation. METHOD: The mentoring and role-model seminar was conducted at 2 days for 90 minutes by six inspiring female role models with a remarkable career in surgical or related disciplines. Participants (N = 57) filled in an online survey before (T0) and after the seminar (T1). A pre-post comparison of central TPB concept attitude towards the behavior, 2) occupational self-efficacy and 3) social norm) was conducted using a paired sampled t-test. A follow-up survey was administered 12 months later (T2). RESULTS: The mentoring seminar positively impacted female students' attitude towards a career in a surgical specialty. Female students reported a significantly increased positive attitude (p < .001) and significantly higher self-efficacy expectations (p < .001) towards a surgical career after participating in the mentoring seminar. Regarding their career intention after the seminar, female students declared a significantly higher intention to pursue a career in a surgical specialty after graduating (p < .001) and this effect seems to be sustainable after 1 year. CONCLUSION: For the first time we could show that short-mentoring and demonstrating role models in a seminar surrounding has a significant impact on female medical student decision´s to pursue a career in a surgery speciality. This concept may be a practical and efficient concept to refine the gender disparity in surgery and related disciplines.

Still a 'boys' club': a qualitative analysis of how gender affects a career in anaesthesia in Australia and Aotearoa New Zealand.

Gender inequity remains an issue in anaesthesia despite increasing numbers of women training and achieving fellowship in the speciality. Women are under-represented in all areas of anaesthetic research, academia and leadership. The Gender Equity Subcommittee of the Australian and New Zealand College of Anaesthetists recently conducted a survey asking "Does gender still matter in the pursuit of a career in anaesthesia in 2022?". The survey was distributed to a randomly selected sample of 1225 anaesthetic consultants and completed by 470 respondents (38% response rate) with 793 free-text comments provided. Three overarching themes were identified: gender effects on the career and family interface; women do not fit the mould; and gender equity changes the status quo. Women respondents described a need to make a choice between career and family, which was not described by men, as well as stigmatisation of part-time work, a lack of access to challenging work and negative impacts of parental leave. Women respondents also described a sense of marginalisation within anaesthesia due to a 'boys' club' mentality, a lack of professional respect and insufficient structural supports for women in leadership. This was compounded for women from ethnically and culturally diverse backgrounds. A need for specific strategies to support anaesthetic careers for women was described as well as normalisation of flexibility in workplaces, combined with a broadening of our definition of success to allow people of all genders to experience fulfilment both at home and at work. This study is the first published qualitative data on factors affecting gender equity for anaesthetists in Australia and Aotearoa New Zealand. It highlights the need for further exploration, as well providing a foundation for changes in attitude and structural changes towards advancing gender equity.

A Gravid Situation: General Surgery Faculty Support for Pregnant Surgical Residents.

INTRODUCTION: The perceptions of teaching faculty toward pregnant general surgery residents have been overlooked despite the daily interactions amongst these groups. METHODS: A 32-question survey designed to measure general surgery teaching faculty perceptions toward pregnant residents was distributed electronically from March 2022 to April 2022 to general surgery teaching faculty in the United States. Descriptive statistics were used to characterize responses and differences in perceptions, and qualitative analysis identified recurring themes from free-text responses. RESULTS: Among 163 respondents included in the final analysis, 58.5% were male and 41.5% were female. Despite 99.4% of surgeons feeling comfortable if a resident told them they were pregnant, 22.4% of surgeons disagreed that their institutions have supportive cultures toward pregnancy. Almost half (45.4%) have witnessed negative comments about pregnant residents and half (50.3%) believe that pregnant surgical residents are discriminated against by their coresidents. Nearly two-thirds of surgeons (64.8%) believe that someone should have a child whenever they wish during training. Given recent reports, 80.2% of surgeons recognized that female surgeons have increased risks of infertility and pregnancy complications. Recurring themes of normalizing pregnancy, improving policies, and creating a culture change were expressed. CONCLUSIONS: In this national survey, although there appears to be positive perceptions of pregnancy in surgical training amongst those surveyed, there is acknowledged necessity of further normalizing pregnancy and improving policies to better support pregnant residents. These data provide further evidence that though perceptions may be improving, changes are still needed to better support pregnancy during training.

"That is when I understood everything": Ideological trajectories of pro-choice female doctors in Mexico.

OBJECTIVES: There is little evidence about how physicians become abortion clinicians or advocates. We describe the ideological trajectories of pro-choice female Mexican doctors and the factors that made them pro-choice. STUDY DESIGN: In this qualitative study, we conducted semistructured interviews with members of the Mexican Network of Female Pro-choice Physicians. Participants came from eight diverse states. We used a feminist epistemology approach and analyzed data using inductive coding as well as a priori categories (becoming pro-choice, trajectories, and training). RESULTS: We included 24 female pro-choice physicians. We identified five intersecting factors that influenced becoming pro-choice: feminism, personal experiences, confrontation with the inequalities and violence that women experience, role models, and routine exposure to abortion care. Participants described three ideological trajectories: being pro-choice before studying medicine, not having a specific opinion, and changing from "pro-life" to "pro-choice." Participants described the absence of abortion training in medical schools, stigmatizing training, and the use of alternative training sources. CONCLUSIONS: In the absence of training on abortion during medical education, a combination of intersecting personal as well as work-related experience may turn doctors into pro-choice abortion clinicians and/or advocates. The findings of this study may be used to develop comprehensive medical curricula as well as strategies directed at doctors who have never received training on abortion care, such as promoting interactions with nonmedical abortion providers, education on inequalities and violence against women, moving beyond public health to a human rights and gender perspective, and exposure to routine safe abortion care. IMPLICATIONS: Mexican female doctors become pro-choice clinicians who provide abortion care and/or advocates in spite of their medical education.

Pediatric Emergency Medicine and Mentoring: What Women Want.

BACKGROUND: Women in medicine have reported gender-specific obstacles to career success, such as a dearth of mentors and role models. Pediatric emergency medicine (PEM) is a female-dominated subspecialty of pediatrics yet is still impacted by gender inequality in many areas. No previous study has explored mentoring experiences of women PEM physicians and the impact on their career trajectory. We sought to explore the experiences of female PEM physicians with mentorship to determine aspects of mentoring that were successful or unsuccessful. METHODS: This was a qualitative study with criterion sampling of female PEM physicians. Members of the American Academy of Pediatrics Section of Emergency Medicine completed semistructured interviews in 2022, recorded and transcribed verbatim. Our research team consisted of 3 PEM physicians. Using the constant comparative method, we analyzed transcripts by inductively developing codes, grouping codes into categories, and refining codes, descriptions, and group assignments to identify themes. Interpretations of and relationships among themes were iteratively discussed and revised by the team. RESULTS: Twenty-two participants were interviewed via telephone. The mean age of participants was 44 years old, and the majority (73%) identified as White, non-Hispanic, and at the rank of assistant professor (45%). Four themes were identified: (1) benefits of mentorship (recognition of need for mentorship and finding professional success), (2) finding mentors (processes to find mentors and mentor roles), (3) characteristics of successful mentors (personal and professional), and (4) impact of mentorship (career advancement or career sabotage). CONCLUSIONS: We identified 4 themes that could be incorporated into mentoring programs and are associated with successful experiences for women PEM physicians. The detail and descriptions in our data provide guidance for mentoring programs that specifically address the needs of women in PEM.

Gender Differences in the Pediatric Neurosurgical Workforce: Professional Practice, Work-Life Balance, and Beyond.

BACKGROUND AND OBJECTIVES: Evidence suggests that female neurosurgeons experience unique challenges in the workplace including lack of academic advancement, challenges with work-life balance, harassment, and discrimination. How these factors influence the gender gap in neurosurgery remains unclear. This analysis investigated gender differences in pediatric neurosurgeons in professional and nonprofessional activities and responsibilities. METHODS: A survey examining professional activities, work-life balance, family dynamics, career satisfaction, and workplace discrimination and harassment was administered to 495 pediatric neurosurgeons. Response rate was 49% (n = 241). RESULTS: One-third of the pediatric neurosurgical workforce is female. There were no gender differences in race/ethnicity, American Board of Neurological Surgery/American Board of Pediatric Neurological Surgery certification rates, or pediatric neurosurgery fellowship completion. No gender differences were found in operative caseload, weekly hours worked, or working after 8 pm or weekends. Women took call more frequently than men ( P = .044). Men were more likely to work in academia ( P = .004) and have salary subsidization from external sources ( P = .026). Women were more likely to anticipate retirement by age 65 years ( P = .044), were less happy with call commitments ( P = .012), and worked more hours at home while off ( P = .050). Women more frequently reported witnessing and experiencing racial discrimination ( P = .008; P < .001), sexual harassment ( P = .002, P < .001), and feeling less safe at work ( P < .001). Men were more likely married ( P = .042) with 1 ( P = .004) or more children ( P = .034). Women reported significantly greater responsibility for child and domestic care ( P < .001). There were no gender differences in work-life balance, feeling supported at work, or having enough time to do things outside of work. CONCLUSION: Despite little difference in workload and professional responsibilities, women held more domestic responsibilities and experienced and witnessed more racial and sexual discrimination in the workplace. Surprisingly, there were no reported differences in work-life balance or feeling supported at work between genders. These findings suggest that factors unique to female neurosurgeons may contribute to continued gender disparity in the field.

A Shadow of Doubt: Is There Implicit Bias Among Orthopaedic Surgery Faculty and Residents Regarding Race and Gender?

BACKGROUND: Orthopaedic surgery continues to be one of the least diverse medical specialties. Recently, increasing emphasis has been placed on improving diversity in the medical field, which includes the need to better understand existing biases. Despite this, only about 6% of orthopaedic surgeons are women and 0.3% are Black. Addressing diversity, in part, requires a better understanding of existing biases. Most universities and residency programs have statements and policies against discrimination that seek to eliminate explicit biases. However, unconscious biases might negatively impact the selection, training, and career advancement of women and minorities who are underrepresented in orthopaedic surgery. Although this is difficult to measure, the Implicit Association Test (IAT) by Project Implicit might be useful to identify and measure levels of unconscious bias among orthopaedic surgeons, providing opportunities for additional interventions to improve diversity in this field. QUESTIONS/PURPOSES: (1) Do orthopaedic surgeons demonstrate implicit biases related to race and gender roles? (2) Are certain demographic characteristics (age, gender, race or ethnicity, or geographic location) or program characteristics (geographic location or size of program) associated with the presence of implicit biases? (3) Do the implicit biases of orthopaedic surgeons differ from those of other healthcare providers or the general population? METHODS: A cross-sectional study of implicit bias among orthopaedic surgeons was performed using the IAT from Project Implicit. The IAT is a computerized test that measures the time required to associate words or pictures with attributes, with faster or slower response times suggesting the ease or difficulty of associating the items. Although concerns have been raised recently about the validity and utility of the IAT, we believed it was the right study instrument to help identify the slight hesitation that can imply differences between inclusion and exclusion of a person. We used two IATs, one for Black and White race and one for gender, career, and family roles. We invited a consortium of researchers from United States and Canadian orthopaedic residency programs. Researchers at 34 programs agreed to distribute the invitation via email to their faculty, residents, and fellows for a total of 1484 invitees. Twenty-eight percent (419) of orthopaedic surgeons and trainees completed the survey. The respondents were 45% (186) residents, 55% (228) faculty, and one fellow. To evaluate response biases, the respondent population was compared with that of the American Academy of Orthopaedic Surgeons census. Responses were reported as D-scores based on response times for associations. D-scores were categorized as showing strong (≥ 0.65), moderate (≥ 0.35 to < 0.65), or slight (≥ 0.15 to < 0.35) associations. For a frame of reference, orthopaedic surgeons' mean IAT scores were compared with historical scores of other self-identified healthcare providers and that of the general population. Mean D-scores were analyzed with the Kruskal-Wallis test to determine whether demographic characteristics were associated with differences in D-scores. Bonferroni correction was applied, and p values less than 0.0056 were considered statistically significant. RESULTS: Overall, the mean IAT D-scores of orthopaedic surgeons indicated a slight preference for White people (0.29 ± 0.4) and a slight association of men with career (0.24 ± 0.3), with a normal distribution. Hence, most respondents' scores indicated slight preferences, but strong preferences for White race were noted in 27% (112 of 419) of respondents. There was a strong association of women with family and home and an association of men with work or career in 14% (60 of 419). These preferences generally did not correlate with the demographic, geographic, and program variables that were analyzed, except for a stronger association of women with family and home among women respondents. There were no differences in race IAT D-scores between orthopaedic surgeons and other healthcare providers and the general population. Gender-career IAT D-scores associating women with family and home were slightly lower among orthopaedic surgeons (0.24 ± 0.3) than among the general population (0.32 ± 0.4; p < 0.001) and other healthcare professionals (0.34 ± 0.4; p < 0.001). All of these values are in the slight preference range. CONCLUSION: Orthopaedic surgeons demonstrated slight preferences for White people, and there was a tendency to associate women with career and family on IATs, regardless of demographic and program characteristics, similar to others in healthcare and the general population. Given the similarity of scores with those in other, more diverse areas of medicine, unconscious biases alone do not explain the relative lack of diversity in orthopaedic surgery. CLINICAL RELEVANCE: Implicit biases only explain a small portion of the lack of progress in improving diversity, equity, inclusion, and belonging in our workforce and resolving healthcare disparities. Other causes including explicit biases, an unwelcoming culture, and perceptions of our specialty should be examined. Remedies including engagement of students and mentorship throughout training and early career should be sought.

The Careers and Professional Well-Being of Women Oncologists During the COVID-19 Pandemic: Responding for Tomorrow.

The COVID-19 pandemic exacerbated gender inequity in medicine, with women physicians reporting greater household responsibilities than their men counterparts and steeper barriers to career advancement. The pandemic highlighted the systemic assumptions and challenges faced by women physicians, which we anticipate is also true in our field of oncology. Prior literature suggests that women physicians were tasked with increased personal and professional responsibilities without compensation for their additional work, as well as derailments in career progression and significant burnout. Our aims are to highlight areas of opportunity to optimize the workplace experience of the oncology workforce and to invest in the professional well-being and sustainability of women oncologists as a step toward global workplace equity and future pandemic preparedness.

Physician Men Leaders in Emergency Medicine Bearing Witness to Gender-Based Discrimination.

Importance: Approximately 60% of women physicians in emergency medicine (EM) experience gender-based discrimination (GBD). Women physicians are also more likely to experience GBD than men physicians, particularly from patients, other physicians, or nursing staff. Objective: To describe the responses of men who are academic department chairs in EM to GBD directed toward a woman colleague. Design, Setting, and Participants: This qualitative study was a secondary data analysis drawn from interviews of men EM academic department chairs at 18 sites who participated in a qualitative descriptive study between April 2020 and February 2021 on their perceptions of the influence of gender and leadership in academic medicine. Narrative data related to GBD were extracted and coded using conventional content analysis. Codes were clustered into themes and subthemes and summarized. Data were analyzed from November to December 2021. Exposure: Semistructured interviews conducted via teleconferencing. Main Outcomes and Measures: Qualitative findings identifying experiences witnessing or learning about incidents of GBD against women colleagues, the impact of these observations, and personal or leadership actions taken in response to their observations. Results: All 18 men participants (mean [SD] age, 52.2 [7.5] years; mean [SD] time as a department chair, 7.2 [5.1] years) discussed witnessing or learning about incidents of GBD against women colleagues. The participant narratives revealed 3 themes: emotional responses to GBD, actions they took to address GBD, and reasons for not taking action to address GBD. When witnessing GBD, participants felt anger, disbelief, guilt, and shame. To take action, they served as upstanders, confronted and reported discrimination, provided faculty development on GBD, or enforced "zero-tolerance" policies. At times they did not take action because they did not believe the GBD warranted a response, perceived a power differential or an unsupportive institutional culture, or sought self-preservation. Conclusions and Relevance: In this qualitative study of men physician leaders, we found all participants reported feeling troubled by GBD against women colleagues and, if possible, took action to address the discrimination. At times they did not take action because of unsupportive workplace cultures. These findings suggest that institutional culture change that supports the interventions of upstanders and does not tolerate GBD is needed.