CC BY
19
Section 1. Clinical medicine
Arai Yoichi,
National Medical University of Kyiv E-mail: yoichiarai@yahoo.de
Comparison of women in department leadership in obstetrics and gynecology with those in other specialties
Abstract: in our article we focalize on the presence and the representation of women in academic department-based leadership and besides to compare their roles in nine clinical specialties while accounting for gender differences in historical residency cohorts, with considerable attention to department of Obstetrics and Gynecology.
Keywords: gynecology, department, women, academic, gender differences, leadership.
Across specialties, the representation of women in cialties while accounting for gender differences in his-
academic department leadership roles is lower than the representation of men. There are nearly equal numbers of women and men among medical school students and residents, and although women comprise 38 % of faculty, only 15 % ofdepartment chairs and 24 % of division directors are women. Faculty representation of women ranges from 22 % in general surgery to 57 % in obstetrics and gynecology, whereas the proportion of women who were department chairs in 2013 ranged from 1.4 % for general surgery to 22 % for obstetrics and gynecology. However, since 1993, more women than men have entered obstetrics and gynecology, whereas the proportion of women entering general surgery remains under 38 % [2, 801].
Accounting for representation of women in historical residency cohorts allows a meaningful comparison of each specialty's advancement ofwomen. Studies comparing historical cohorts of obstetrics and gynecology residents with subsequent cohorts of leaders have noted gender disparities. We hypothesized that these gender disparities persist across medical specialties.
To adequately evaluate women's representation in leadership positions, the cohort of physicians who have been in practice long enough to advance to leadership roles must be examined. If women and men attained leadership positions at similar rates, the gender distribution of current leaders should match that of the historical residency cohort. The objective of this study was to compare the representation of women in academic department-based leadership roles in nine clinical spe-
torical residency cohorts [1, 122].
Materials and methods
This was a cross-sectional observational study of U. S. academic departments of anesthesiology, diagnostic radiology, general surgery, internal medicine, neurology, obstetrics and gynecology, pathology, pediatrics, and psychiatry. We defined academic departments as those whose residency programs were accredited in the 2012-2013 academic year and were categorized as university hospital-based by the American Medical Association's FREIDA online database. The institutional review board at Beth Israel Deaconess Medical Center approved this project [4, 133].
The methods of this study are described in detail elsewhere. Briefly, we searched each department's website from November 2012 through October 2013 to determine the gender of the individuals in each of three major leadership roles (department chair, vice chair, division director) and one educational leadership role (residency program director). We also searched faculty biographies and conducted web searches when needed. We determined the gender of each leader using names, and when available, we confirmed the gender with pronoun use and images from the department websites.
The number and percentage of women in the 1990 residency cohorts for each specialty were determined using data provided by the Association ofAmeri-can Medical Colleges. The year 1990 was chosen for the historical residency cohort because it was the most dis-
Comparison of women in department leadership in obstetrics and gynecology with those in other specialties
tant year that had data available for both the number and percent of women who were residents in each specialty. We assumed that 23 years is sufficient time for faculty members to advance to career positions from which promotion to leadership positions is common [1, 125].
We calculated the representation ration, which was defined as the proportion of department-based leaders in each role (chair, vice chair, division director, residency program director) in 2013 who were women divided by the proportion of residents in 1990 who were women. In addition to calculating the representation ratio for each role individually, we calculated the representation ratio for all major department leadership roles combined (chair, vice chair, division director) to provide a meaningful summary measure of the representation of women in major department leadership roles.
We used the representation ratio to directly compare specialties because this ratio accounts for the gender distribution differences in historical residency cohorts. A representation ratio of 1 indicates proportionate representation ofwomen in leadership in 2013 relative to their representation in the 1990 residency cohort; a representation ratio less than one indicates underrepresentation of women. For example, a specialty with 25 % women chairs and 25 % women residents in the historical residency cohort would have a representation ratio of 1.0, indicating proportional representation ofwomen. In contrast, a specialty with 30 % women in chair roles and 40 % women residents in the 1990 residency cohort would have a representation ratio of 0.75, indicating that women are underrepresented in leadership roles [5, 13].
Study data were collected and managed using Research Electronic Data Capture, a secure, web-based electronic data capture tool. All statistical analyses were performed using Stata 12 and GraphPad Prism 6.00 for Windows. All tests were two-sided, and P values < 0.05 were considered statistically significant. Categorical variables are presented as the frequency and proportion and were compared using the x2 or Fisher exact test. The representation ratio of the proportion of women leaders relative to the proportion of women residents in the historical cohort is presented with 95 % confidence intervals (CIs), which were calculated by treating the representation ratio as a risk ratio [5, 13-14].
Results
Of the 950 U. S. academic clinical departments listed by the Accreditation Council for Graduate Medical Education in 2012-2013 for these nine specialties, 948 (99.8 %) had websites with information about at least one of the leadership roles. The number of de-
partments with leadership information available for at least three roles was 84 in anesthesiology (85.7 %), 94 in diagnostic radiology (91.3 %), 101 in general surgery (94.4 %), 121 in internal medicine (93.8 %), 91 in neurology (91.9 %), 105 in obstetrics and gynecology (94.6 %), 81 in pathology (82.7 %), 93 in pediatrics (93.0 %), and 81 in psychiatry (78.6 %). A total of 7,250 faculty leaders were identified [3, 472].
In all nine specialties, there were more men than women in the major department-based leadership roles of chair, vice chair, and division director. Overall, women comprised 13.9 % of department chairs, 22.6 % of vice chairs, 21.6 % of division directors, and 39.0 % of residency program directors. Obstetrics and gynecology had the highest proportion of department chairs (24.1 %) and vice chairs (38.8 %) that were women. Pediatrics had the highest proportion of division directors (31.5 %) and residency program directors (64.6 %) that were women [2, 803].
The representation ratios, which account for the proportion ofwomen entering each field, demonstrated that women were significantly underrepresented among department chairs for all specialties (all ratios 0.60 or less; all P < 0.02). The highest representation ratio of women in the department chair role was in diagnostic radiology (0.60, 95 % CI 0.38-0.95). Although the vice chair representation ratios were below 1.0 for all specialties except anesthesiology, many of the CIs were rather wide, and this finding did not reach statistical significance for several specialties. In the division director role, women were significantly underrepresented in all specialties except anesthesiology (ratio 1.13, 95 % CI 0.87-1.46) and diagnostic radiology (ratio 0.97, 95 % CI 0.81-1.16; all other representation ratios 0.63 or less; all P < 0.001) [8, 82].
This study used an innovative representation ratio to meaningfully compare proportions of women leaders and demonstrated that across nine major clinical specialties, women were not represented in the proportions in which they entered their fields. It is notable that both obstetrics and gynecology and pediatrics, specialties with the highest proportions of department-based leaders who were women, did not fare better when comparing representation ratios. Both specialties also had the highest proportions of residents in 1990 that were women, and representation ratios were calculated to account for historical residency cohorts. The fact that obstetrics and gynecology is similar to general surgery and internal medicine in promoting women to department-based leadership may be contrary to common perceptions of advancement of women as leaders in obstetrics and gy-necology.
Although women were overrepresented in the residency program director role in four specialties, with the highest representation ratio in general surgery, this finding may not be cause for celebration. Many medical schools now have clinician-educator faculty tracks, which may not lead to major department-based leadership roles at the same rates as research-based tracks. Occupational interest in roles that are traditionally associated with certain genders, as teaching is for women, may lead to more women than men choosing educational tracks in academic medicine [7, 15].
The finding of greater gender parity in leadership in anesthesiology and diagnostic radiology was unexpected. Anesthesiology and diagnostic radiology have been described as "controllable lifestyle" specialties because work hours may be more predictable and may impinge less on personal time; they also have higher-than-average incomes. Although controllable lifestyles should benefit both men and women, it is possible that advantages disproportionately benefit women's advancement because women typically assume greater responsibilities at home. The dual advantage of controllable lifestyle and higher income, allowing more flexibility to pay for support for home responsibilities, may give women in anesthesiology and diagnostic radiology greater ability to devote time and mental energy to career advancement [7, 17-18].
Many theories address why women continue to be underrepresented in leadership in academic medicine. Women are more likely to assume "institutional housekeeping" tasks — roles that, although critical to sustaining the organization, may not help them advance as leaders. Women in research-based tracks start with less funding than men. Male faculty at medical schools are more highly compensated than their female colleagues, and when this difference increases with seniority, women may choose to leave academic medicine. There may be unconscious gender bias that results in a lack of mentoring and networking for women, organizational cultures or institutional supports that differentially affect
women and men, and a slower initial rate of publication among women. However, one would expect these issues to impede women's advancement equally across specialties; thus, there may be lessons to learn from the successes in anesthesiology and diagnostic radiology [1, 128].
Limitations of this study are that we relied exclusively on information that could be obtained online, which may not be accurate or current. However, our results were nearly identical to overall proportions published by the Association of American Medical Colleges, suggesting the methodology was sound. In our analysis, we assumed women and men were equally likely to choose academic paths after residency in 1990 and therefore should be equally likely to advance to departmental leadership positions, but gender bias contributing to those early career decisions could affect our results. We also could not account for choice of academic track such as clinician-educator or investigator; clinical expertise; research productivity; experience; or personal strengths — all of which may influence attainment ofleadership roles. Our choice of resident cohort was another potential limitation. However, even if it does not take 23 years to attain all leadership roles, our choice was conservative. Given the proportion of women residents has increased for all specialties, a more recent cohort would yield even lower representation ratios.
The culture of academic medicine is quite different today than in 1990, when there was far less emphasis on support for women and families. Maternity leaves during residency training increased after 2011 duty-hour reforms. A renewed emphasis on enhancing the culture of academic medicine benefits all faculty and trainees, although women and underrepresented minorities appear to benefit the most. Analyzing representation ratio trends over time may elucidate trends and better determine which changes are supportive. Future improvement efforts also should include overt recognition that striving for diversity in leadership in medicine is good for all.
References:
1. Baecher-Lind L. Women in leadership positions within obstetrics and gynecology: does the past explain the present?//Obstet Gynecol. - 2012. - P. 120-141.
2. Conrad P., Carr P., Knight S., Renfrew M. R., Dunn M. B, Pololi L. Hierarchy as a barrier to advancement for women in academic medicine//J Women's Health. - 2010. - P. 799-805.
3. Hofler L., Hacker M. R., Dodge L. E., Ricciotti H. A. Subspecialty and gender of obstetrics and gynecology faculty in department-based leadership roles//Obstet Gynecol. - 2015.- P. 471-476.
4. Lautenberger D. M., Dandar V. M., Raezer C. L., Sloane R. A. The state of women in academic medicine: the pipeline and pathways to leadership 2013-2014. - Washington, DC: Assoc. of Am. Med. Colleges, 2014. - P. 131-138.
The experience of the work of mobile dental clinic city municipal institution «City Pediatric Dental Policlinic» Chernivtsi, Ukraine
5. Rayburn W. F. The obstetrician-gynecologist workforce in the United States: facts, figures, and implications 2011. - Washington, DC: American Congress of Obstetricians and Gynecologists, 2011. - P. 11-38.
6. Tesch B. J., Wood H. M., Helwig A. L., Nattinger A. B. Promotion of women physicians in academic medicine. Glass ceiling or sticky floor? - Jama, 1995. - P. 273-275.
7. White F. S., McDade S., Yamagata H., Morahan P. S. Gender-related differences in the pathway to and characteristics of U. S. medical school deanships//Acad Med. - 2012. - P. 87-10.
8. Wright A. L., Schwindt L. A., Bassford T. L., Reyna V. F., Shisslak C. M., et al. Gender differences in academic advancement: patterns, causes, and potential solutions in one U. S. College of Medicine//Acad Med. - 2003. - P. 78-88.
Budayev Iuij Victorovych, Bukovynian State Medical University, Assistant professor of the Department of Surgical and Pediatric Dentistry E-mail: dronykivan@ukr.net
The experience of the work of mobile dental clinic city municipal institution «City Pediatric Dental Policlinic» Chernivtsi, Ukraine
Abstract: The article describes advantages and disadvantages of the mobile dental clinic for children in urban conditions.
Keywords: mobile dental clinic, regular sanation, organized groups of children.
A problem of caries preventive measures still remains topical despite numerous researches on the topic. Investigations of the Ukrainian children's dental diseases show a rapid increase of such diseases like caries, gingivitis, parodontitis, etc. In 12-year-old children in western regions of Ukraine caries prevalence is up to 93-100 %, intensity — 3.4-6.5 [1]. During dentistry development the basis of the stomatological preventive measures appeared; they present a complex ofhealthy measures aiming at prevention and elimination of pathological changes in the mouth cavity and bordering tissues. Teeth caries preventive measures are the leading trends in the world dentistry as it presents low economic expanses comparing to the disease or its complications treatment.
"City Children's Dentistry" have two departments: outpatient clinic, clinic for preventive medicine. The outpatient clinic is providing a centralized planned sanitation of the oral cavity. Also it includes 4 dental clinics in the city schools which provide planned sanitation; and the mobile dental clinic (MDC). In Chernivtsi there are 42 secondary schools, 4 lyceums, 53 preschools (kindergartens).
Children's Dentistry and the outpatient clinic are comfortably placed according to the city center, though there are some schools and kindergartens in the remote territories. That is why sometimes difficulties may occur while transporting the patients especially children.
Though, we can omit those difficulties when using mobile dental clinics.
Preventive measures cannot be fulfilled without the schools' authorities. Before the work there is an agreement signed by the City Children's Dentistry which obliges to hold the whole treatment course of the school children (preschoolers), maintaining all the sanitary standards; and the school director on the other side who is responsible for the mobile dental clinic and allows connecting up the power and water supply.
The equipment of the MDC are:
- ergonomic and comfortable dental device with a compressor;
- doctor's chair with a height control;
- dental X-ray unit;
- dry sterilizer;
- Ultrasonic cleaner;
- Electric waterheater;
- Container for instruments cleaning;
- Ultra-violet bactericidal chamber;
- Air conditioner;
- Irradiation machine;
- Two wash sinks;
- Fan heater;
- Dry closet.
The equipment supplies independent water supply with the bactericidal system, instruments and materials'
