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Open Access Publications from the University of California

The Leaky Pipeline in Emergency Medicine: Understanding Factors Pushing Women Away and Informing Interventions

Creative Commons 'BY' version 4.0 license

Learning Objectives: Understand the environmental factors which influence selection of Emergency Medicine as a specialty by women medical students.

Background: Women represent 28.3% of EM physicians. There is now gender parity in US medical schools, but women applicants to EM ranges 33-37%. Prior research does not explain these gender differences. There are known differences in resident experiences and assessments based on gender.

Objectives: We sought to explore how clinical experiences and perceptions of the specialty influence selection of EM by women.

Methods: Using purposive and convenience sampling to represent diverse learning environments, we conducted semi-structured interviews of men and women US senior medical students who considered EM as a specialty. Interviews were transcribed, de-identified, and coded using constant comparative analysis until saturation. We conducted thematic analysis using a constructivist approach and grounded theory. Reflexivity and credibility activities were performed.

Results: 25 students from 11 geographically diverse schools completed interviews. 68% (17/25) were women. The majority (21/25) expressed commitment to EM. Four main themes were identified: 1. EM culture was perceived as exclusionary; 2. Beliefs about attributes of EM physicians and the specialty were influenced by gender; 3. Distressing patient encounters and physician/staff behaviors negatively affected students; and 4. Access to mentors, representation and exposure to EM affected interest. Table 1.

Conclusions: The EM gender differential is affected by societal gender roles and an environment that rewards traditional masculine traits. Conflict with behavioral norms may hinder women forming their professional identity as an emergency physician. Potential interventions include recognizing the gendered perception of the field; establishing early, longitudinal mentoring and engagement with the specialty; and building a supportive culture to overcome mistreatment concerns. As for limitations, students hold multiple intersecting identities, and this study primarily focused on gender.

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