From the Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Department of Anesthesiology, Mount Sinai Health System, New York, New York.
Anesth Analg. 2024 Jan 1;138(1):187-197. doi: 10.1213/ANE.0000000000006538. Epub 2023 May 24.
Women's underrepresentation in positions of leadership in medicine has been attributed to environmental, structural, motivational, and situational factors. The purpose of this study was to design and validate a survey instrument based on these constructs, using a sample of men and women anesthesiologists from 3 urban academic medical centers.
Following institutional review board review, survey domains were defined based on a literature review. Items were developed, and content validation was performed by external experts. Anesthesiologists at 3 academic institutions were invited to complete the anonymous survey. Validation measures were performed on the collected responses, including reliability, convergent, and discriminant validity. In addition, differences between men and women respondents were evaluated.
Content validation by external experts yielded 38 items with 5-point Likert scales, defining 3 constructs: environmental (14 items), structural (13 items), and motivational (11 items) factors, with single-item measures on situational factors. Content validity indices used Cohen's Kappa coefficients, with 0.85 as the acceptance cutoff. Two hundred seventy-four anesthesiologists in 3 academic institutions received the online survey. One hundred fifteen responses were received (42% response rate), yielding 103 complete survey responses, of which 86 cases included gender. Cronbach's α reliability estimates for the environmental, structural, and motivational scale scores were .88, .84, and .64, respectively, after scale revision. Evidence of convergent (Pearson's r = 0.68; P < .001) and discriminant validity (Pearson's r = 0.017; P = .84) confirmed theoretical expectations. Gender group differences showed statistically significant differences in perceptions toward environmental but not toward structural and motivational factors.
The iterative design and validation processes yielded a 3-scale survey instrument with parsimonious item sets. The preliminary evidence of construct validity and reliability fills a gap in the instrumentation literature for assessing gender issues in medicine. Findings were consistent with theoretical expectations. Women are more likely than men to experience challenges in the work environment for career advancement. No differences were found between men and women on perceived resources and overall motivation factors. Investigations should continue with larger and more diverse samples and medical specialties.
女性在医学领域的领导职位中代表性不足，这归因于环境、结构、动机和情境因素。本研究的目的是基于这些结构设计和验证一个调查工具，使用来自 3 个城市学术医疗中心的男性和女性麻醉师样本。
在机构审查委员会审查后，根据文献回顾确定了调查领域。制定了项目，并由外部专家进行内容验证。邀请 3 个学术机构的麻醉师完成匿名调查。对收集到的回复进行了验证措施，包括可靠性、收敛性和判别有效性。此外，还评估了男性和女性受访者之间的差异。
外部专家的内容验证产生了 38 个项目，采用 5 点李克特量表，定义了 3 个结构：环境（14 个项目）、结构（13 个项目）和动机（11 个项目）因素，情境因素采用单项测量。内容有效性指数使用 Cohen 的 Kappa 系数，接受截距为 0.85。3 个学术机构的 274 名麻醉师收到了在线调查。收到 115 份回复（42%的回复率），产生了 103 份完整的调查回复，其中 86 份包含性别。环境、结构和动机量表分数的 Cronbach's α 可靠性估计值分别为.88、.84 和.64，经过量表修订后。收敛性（Pearson's r = 0.68；P <.001）和判别有效性（Pearson's r = 0.017；P =.84）的证据证实了理论预期。性别群体差异显示，在环境感知方面存在统计学显著差异，但在结构和动机因素方面没有差异。
迭代设计和验证过程产生了一个具有简约项目集的 3 量表调查工具。构建有效性和可靠性的初步证据填补了评估医学中性别问题的仪器文献中的空白。研究结果与理论预期一致。与男性相比，女性在职业发展的工作环境中更有可能面临挑战。在感知资源和整体动机因素方面，男性和女性之间没有差异。应继续使用更大和更多样化的样本和医学专业进行调查。
