Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
J Hosp Med. 2020 Aug;15(8):454-460. doi: 10.12788/jhm.3471.
Women in medicine experience discrimination, hostility, and unconscious bias frequently and with deleterious effects. While these gender-based challenges are well described, strategies to navigate and respond to them are less understood.
To explore the lived experiences of female teaching attending physicians emphasizing strategies they use to mitigate gender-based challenges in clinical environments.
Multisite exploratory, qualitative study.
Inpatient general medicine teaching rounds in six geographically diverse US academic hospitals between April and August 2018.
With use of a modified snowball sampling approach, female attendings and their learners were identified; six female attendings and their current (n = 24) and former (n = 17) learners agreed to participate.
Perceptions of gender-based challenges in clinical teaching environments and strategies with which to respond to these challenges were evaluated through semistructured in-depth interviews, focus group discussions, and direct observations of rounds. Observations were documented using handwritten field notes. Interviews and focus groups were audio recorded and transcribed. All transcripts and field note data were analyzed using a content analysis approach.
Attending experience levels ranged from 8 to 20 years (mean, 15.3 years). Attendings were diverse in terms of race/ethnicity. Strategic approaches to gender-based challenges clustered around three themes: female attendings (1) actively position themselves as physician team leaders, (2) consciously work to manage gender-based stereotypes and perceptions, and (3) intentionally identify and embrace their unique qualities.
Female attendings manage their roles as women in medicine through specific strategies to both navigate complex gender dynamics and role model approaches for learners.
女性在医学领域经常经历歧视、敌意和无意识偏见，这对她们造成了有害影响。尽管这些基于性别的挑战已得到充分描述，但应对这些挑战的策略却知之甚少。
探索女性教学主治医生的亲身经历，强调她们在临床环境中使用的应对基于性别的挑战的策略。
多地点探索性定性研究。
2018 年 4 月至 8 月期间，在美国六家地理位置不同的学术医院进行的住院内科教学查房。
使用改良的雪球抽样方法确定了主治医生和她们的学员；六位女性主治医生及其当前（n=24）和前（n=17）学员同意参与。
通过半结构化深入访谈、焦点小组讨论和对查房的直接观察，评估临床教学环境中基于性别的挑战的感知以及应对这些挑战的策略。观察结果使用手写现场笔记记录。访谈和焦点小组的录音并转录。所有转录本和现场笔记数据均采用内容分析方法进行分析。
主治医生的经验水平从 8 年到 20 年不等（平均 15.3 年）。主治医生在种族/族裔方面存在多样性。基于性别的挑战的策略性方法围绕三个主题聚类：女性主治医生（1）积极将自己定位为医师团队领导者，（2）有意识地努力管理基于性别的刻板印象和观念，以及（3）有意地识别和接受自己独特的品质。
女性主治医生通过特定的策略来管理她们作为女性医生的角色，这些策略既可以应对复杂的性别动态，也可以为学员树立榜样。
