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“I am the doctor”: gender-based bias within the clinical practice of emergency medicine in Canada—a thematic analysis of physician and trainee interview data

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Abstract

Objectives

While women comprise about half of current Canadian medical students and physicians, only 31% of emergency medicine physicians identify as women and women trainees are less likely to express interest in emergency medicine compared to men. Gender-based bias continues to negatively impact the career choice, progress, and well-being of women physicians/trainees. Although instances of gender-based bias are well documented within other medical specialties, there remains a gap in the literature addressing the role of gender specific to the Canadian emergency medicine clinical environment.

Methods

Using a qualitative study with a thematic analytical approach, participants were purposively and snowball sampled from a cross-section of centers across Canada and included emergency medicine attending physicians and trainees. A thematic analysis using an inductive and deductive approach was undertaken. All data were double coded to improve study trustworthiness. Descriptive statistics were used to characterize the study population.

Results

Thirty-four individuals (17 woman-identifying and 17 man-identifying) from 10 different institutions across 4 provinces in Canada participated in the study. Six themes were identified: (1) women experience gender bias in the form of microaggressions; (2) women experience imposter syndrome and question their role in the clinical setting; (3) more women provide patient care to women patients and vulnerable populations; (4) gender-related challenges with family planning and home responsibilities affect work-life balance; (5) allyship and sponsorship are important for the support and development of women physicians and trainees; and (6) women value discussing shared experiences with other women to debrief situations, find mentorship, and share advice.

Conclusions

Gender inequity in emergency medicine affects women-identifying providers at all levels of training across Canada. Described experiences support several avenues to implement change against perceived gender bias that is focused on education, policy, and supportive spaces. We encourage institutions to consider these recommendations to achieve gender-equitable conditions in emergency medicine across Canada.

Abstrait

Objectifs

Bien que les femmes représentent environ la moitié des étudiants et des médecins en médecine au Canada, seulement 31 % des médecins d’urgence qui s’identifient comme des femmes et des femmes stagiaires sont moins susceptibles d’exprimer leur intérêt pour la médecine d’urgence que les hommes. Les préjugés fondés sur le sexe continuent d’avoir une incidence négative sur le choix de carrière, les progrès et le bien-être des femmes médecins/stagiaires. Bien que les cas de biais fondés sur le sexe soient bien documentés dans d’autres spécialités médicales, il reste une lacune dans la documentation traitant du rôle du sexe propre au milieu clinique de la médecine d’urgence au Canada.

Méthodes

À l’aide d’une étude qualitative avec une approche analytique thématique, les participants ont été échantillonnés à dessein et en boule de neige dans un échantillon représentatif de centres à travers le Canada et comprenaient des médecins urgentistes et des stagiaires. Une analyse thématique utilisant une approche inductive et déductive a été entreprise. Toutes les données ont été codées en double pour améliorer la fiabilité de l’étude. Des statistiques descriptives ont été utilisées pour caractériser la population étudiée.

Résultats

Trente-quatre personnes (17 femmes et 17 hommes) de 10 établissements différents de quatre provinces canadiennes ont participé à l’étude. Six thèmes ont été cernés : (1) les femmes sont victimes de préjugés sexistes sous la forme de microagressions; (2) les femmes sont victimes du syndrome d’imposteur et remettent en question leur rôle dans le milieu clinique; (3) plus de femmes prodiguent des soins aux patientes et aux populations vulnérables; (4) les défis liés au genre que posent la planification familiale et les responsabilités familiales ont une incidence sur l’équilibre entre le travail et la vie personnelle; (5) l’alliance et le parrainage sont importants pour le soutien et le perfectionnement des femmes médecins et stagiaires; (6) les femmes apprécient de discuter des expériences partagées avec d’autres femmes pour faire le point sur des situations, trouver du mentorat et partager des conseils.

Conclusions

L’inégalité entre les sexes en médecine d’urgence touche les fournisseurs de soins qui identifient les femmes à tous les niveaux de formation au Canada. Les expériences décrites appuient plusieurs avenues pour mettre en œuvre des changements contre les préjugés sexistes perçus qui sont axés sur l’éducation, les politiques et les espaces de soutien. Nous encourageons les établissements à tenir compte de ces recommandations afin de parvenir à des conditions équitables entre les sexes en médecine d’urgence partout au Canada.

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Data availability

The data that support the findings of this study are not publicly available to protect the privacy of participants. Consent was not provided to share the raw data outside of the study team.

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Acknowledgements

Thank-you to the CAEP Gender Equity Working Group for sharing their secondary survey responses with us, which helped guide our interview question development. Thank-you to the Queen’s University School of Medicine for the Equity, Diversity, and Inclusion and the McLaughlin Research Summer Studentships that allowed GJ to undertake this work.

Funding

The authors declare that they have no relevant financial disclosures.

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Authors and Affiliations

  1. Undergraduate Medical Education, Faculty of Health Sciences, School of Medicine, Queen’s University, Kingston, ON, Canada

    Gabriele Jagelaviciute, Melanie Walker & Molly Steer

  2. Department of Emergency Medicine, Faculty of Health Sciences, School of Medicine, Queen’s University, Kingston, ON, Canada

    Melissa Bouwsema, Melanie Walker, Damon Dagnone & Erin Brennan

  3. Department of Public Health Sciences, Faculty of Health Sciences, School of Medicine, Queen’s University, Kingston, ON, Canada

    Melanie Walker

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  1. Gabriele Jagelaviciute
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Contributions

GJ, MB, MW, DD, and EB contributed to research design, GJ collected the data, and GJ and MS performed the analysis. All authors contributed to final manuscript preparation.

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Correspondence to Gabriele Jagelaviciute.

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Jagelaviciute, G., Bouwsema, M., Walker, M. et al. “I am the doctor”: gender-based bias within the clinical practice of emergency medicine in Canada—a thematic analysis of physician and trainee interview data. Can J Emerg Med 26, 249–258 (2024). https://doi.org/10.1007/s43678-024-00672-w

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