The culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized groups) and compromises workforce ...vitality. Existing research has been limited by a lack of comprehensive, validated measures, low response rates, and narrow samples as well as comparisons limited to the binary gender categories of male or female assigned at birth (cisgender).
To evaluate academic medical culture, faculty mental health, and their relationship.
A total of 830 faculty members in the US received National Institutes of Health career development awards from 2006-2009, remained in academia, and responded to a 2021 survey that had a response rate of 64%. Experiences were compared by gender, race and ethnicity (using the categories of Asian, underrepresented in medicine defined as race and ethnicity other than Asian or non-Hispanic White, and White), and lesbian, gay, bisexual, transgender, queer (LGBTQ+) status. Multivariable models were used to explore associations between experiences of culture (climate, sexual harassment, and cyber incivility) with mental health.
Minoritized identity based on gender, race and ethnicity, and LGBTQ+ status.
Three aspects of culture were measured as the primary outcomes: organizational climate, sexual harassment, and cyber incivility using previously developed instruments. The 5-item Mental Health Inventory (scored from 0 to 100 points with higher values indicating better mental health) was used to evaluate the secondary outcome of mental health.
Of the 830 faculty members, there were 422 men, 385 women, 2 in nonbinary gender category, and 21 who did not identify gender; there were 169 Asian respondents, 66 respondents underrepresented in medicine, 572 White respondents, and 23 respondents who did not report their race and ethnicity; and there were 774 respondents who identified as cisgender and heterosexual, 31 as having LGBTQ+ status, and 25 who did not identify status. Women rated general climate (5-point scale) more negatively than men (mean, 3.68 95% CI, 3.59-3.77 vs 3.96 95% CI, 3.88-4.04, respectively, P < .001). Diversity climate ratings differed significantly by gender (mean, 3.72 95% CI, 3.64-3.80 for women vs 4.16 95% CI, 4.09-4.23 for men, P < .001) and by race and ethnicity (mean, 4.0 95% CI, 3.88-4.12 for Asian respondents, 3.71 95% CI, 3.50-3.92 for respondents underrepresented in medicine, and 3.96 95% CI, 3.90-4.02 for White respondents, P = .04). Women were more likely than men to report experiencing gender harassment (sexist remarks and crude behaviors) (71.9% 95% CI, 67.1%-76.4% vs 44.9% 95% CI, 40.1%-49.8%, respectively, P < .001). Respondents with LGBTQ+ status were more likely to report experiencing sexual harassment than cisgender and heterosexual respondents when using social media professionally (13.3% 95% CI, 1.7%-40.5% vs 2.5% 95% CI, 1.2%-4.6%, respectively, P = .01). Each of the 3 aspects of culture and gender were significantly associated with the secondary outcome of mental health in the multivariable analysis.
High rates of sexual harassment, cyber incivility, and negative organizational climate exist in academic medicine, disproportionately affecting minoritized groups and affecting mental health. Ongoing efforts to transform culture are necessary.
Women in Medical Physics Paradis, Kelly C.; Moran, Jean M.; Hendrickson, Kristi R. G.
Medical physics (Lancaster),
June 2023, 2023-06-00, 20230601, Letnik:
50, Številka:
S1
Journal Article
The purpose of this study was to quantify gender diversity in leadership positions within the field of medical physics, as well as within award categories and other recognitions by the American ...Association of Physicists in Medicine. The April 2019 PDF version of the AAPM membership directory was searched for all users self‐reporting as holding a leadership position at their place of employment, those elected to leadership positions within the AAPM, those serving as chair of an AAPM council, and those listed as having received an award or other such recognition from AAPM (beginning in 1972 with the William D. Coolidge Award). Historical data for these categories were obtained from archived membership directories on the AAPM website. The AAPM website was also used to identify members who have served on the Medical Physics Editorial Board. The Commission on Accreditation of Medical Physics Education Programs (CAMPEP) website was used to identify the current directors of graduate and residency programs (as of July 2019). Because gender was not a reported field in any of these categories, gender was assigned by reviewing names and photographs. Percentage representation in these respects was compared to the overall percentage of women in the AAPM in 2019 (23.3%) and reported the number of women working as medical physicists globally (29.8%). Within the AAPM, the percentage of women reporting clinical leadership roles is 12.0% within the US, 13.6% in Canada, and 18.0% in all other countries combined. Women comprise only 7.5% of CAMPEP graduate program directors and 21.5% of residency program directors. The percentage of female presidents in AAPM is 8.1%. A woman has never served as Editor‐in‐Chief of Medical Physics, and the average for the past 10 yr for female board membership is 13.6%. With the exception of the John R. Cameron Young Investigators Symposium Award, the percentage of all female AAPM awardees is less than the percentage of women AAPM members. The lowest percentage of female representation within AAPM is among council chairs with only one woman having held a chair position out of 42 positions (2.4%) from 1970 to July 2019. Similar to the traditional discipline of physics, medical physics displays a clear gender disparity with regard to leadership positions, both within educational training programs and the AAPM. Further investigation into the demographics of the field and psychosocial factors affecting medical physicists may help to elucidate the origin of these disparities and inform strategies to address them.
Promoting a diverse workforce of health care professionals that delivers equitable patient care is an important goal in oncology, as in all of medicine. Although most medical schools have a diversity ...office and associated initiatives, little is known about radiation oncology (RO) department-level efforts to promote diversity, equity, and inclusion (DEI). We describe the current state of DEI leadership and initiatives in RO departments in the US to guide future policies and programs.
A total of 124 US RO departments affiliated with a medical school were contacted to identify departmental DEI leadership. Identified DEI leaders were asked to complete an anonymous survey assessing characteristics of their departmental DEI leadership, committee/organizational structure, activities, and perceived barriers to, and effect of, their work. Descriptive statistics are reported.
Among 85 RO departments that responded (68.5% response rate), 48 (56.5%) reported having a departmental DEI leader. Thirty-four DEI leaders completed the survey (70.8%). Of those who answered each survey question, most DEI leaders were assistant or associate professors (n = 24, 82.8%), women (n = 19, 73.1%), and identified with at least one non-White race or Hispanic ethnicity (n = 15, 53.6%). Nineteen (57.6%) had an associated departmental DEI committee; with 10 of these starting in 2020 or later. Few DEI leaders had administrative support (38.2%), funding (29.4%), protected time (23.5%), or increased compensation for added duties Fifteen (50.0%) believed their DEI-focused efforts were considered for promotion. The most reported initiatives included offering programming/education, supporting students from backgrounds underrepresented in medicine, improving recruitment practices/hiring, and implementing pipeline/pathway projects. The perceived impact of DEI initiatives included an increased culture of respect (89.7%), improved health care disparity awareness (75.9%), and improved systemic/structural racism awareness (79.3%).
Departmental DEI efforts are increasingly common within RO, however, the structure, resources, and recognition associated with DEI work are variable. Additional dedicated resources and recognition for these efforts will help ensure a culture of inclusive excellence for the RO workforce and patients.
Medical physics consultation is critical to the safe and appropriate management of patients undergoing reirradiation. A rigorous and efficient workflow in radiation oncology departments is crucial to ...ensure the safety and quality of treatment. The need for this service is steadily increasing year after year with the increasing complexity of treatment. This article provides an overview of how the Retreatment Special Medical Physics Consult is performed at the University of Michigan, along with a detailed patient-specific example, the results of a survey of how other institutions approach this workflow, and recommendations for future work to improve this process.
The American Association of Physicists in Medicine (AAPM) shares the results, conclusions, and recommendations from the initial Equity, Diversity, and Inclusion Climate Survey conducted in 2021.
The ...climate survey targeted medical physicists who are full members of the AAPM and included demographic inquiries and questions intended to assess the working environmental climate in terms of a sense of belonging and inclusion, experiences of discrimination and harassment, and obstacles to participation within the AAPM. The survey invitation was sent to 5,500 members. Responses were collected from 1385 members (response rate of 25%) between January and February 2021.
Overall, the medical physics workplace climate was positive. However, some demographic and professional subgroups reported lower levels of agreement with positive characteristics of their workplace climates. Compared with men, women ranked lower 7 of 8 categories that characterized the workplace climate. Other subgroups that also ranked the workplace climate descriptors lower included individuals not originally from the United States and Canada (3/8). Most respondents strongly agreed/agreed that the climate within the AAPM was welcoming. However, 17% of respondents reported personally experiencing or witnessing microaggressions within the AAPM. Overall, medical physicists reported low levels of agreement that opportunities within the AAPM were available to them, from 34% to 60% among 8 categories, including opportunities to volunteer, join committees, and compete for leadership positions within the AAPM. Several subgroups reported even lower levels of agreement that these opportunities are available. Asian and Asian American respondents (3/8) and physicists with origins in countries outside the United States and Canada (7/8) reported fewer opportunities to participate in the AAPM. Medical physicists reported their experiences of discrimination and sexual harassment in their workplaces and within the AAPM. For those who reported personal experiences of sexual harassment, only 24% (15/63) felt comfortable reporting when it occurred within their workplaces, and 35% (9/26) felt comfortable reporting when it occurred within the AAPM.
The report concludes with several recommendations for action.
Gender-based discrimination and sexual harassment have been well-studied in the fields of science, technology, engineering, math, and medicine. However, less is known about these topics and their ...effect within the profession of medical physics. We aimed to better understand and clarify the views and experiences of practicing medical physicists and medical physics residents regarding gender-based discrimination and sexual harassment.
We conducted in-depth, semistructured, and confidential interviews with 32 practicing medical physicists and medical physics residents across the United States. The interviews were broad and covered the topics of discrimination, mentorship, and work/life integration. All participants were associated with a department with a residency program accredited by the Commission on Accreditation of Medical Physics Education Programs and had appointments with a clinical component.
Participants shared views about gender-based discrimination and sexual harassment that were polarized. Some perceived that discrimination and harassment were a current concern within medical physics, while some either perceived that they were not a concern or that discrimination positively affected women and minoritized populations. Many participants shared personal experiences of discrimination and harassment, including those related to unequal compensation, discrimination against mothers, discrimination during the hiring process, gender-biased assumptions about behaviors or goals, communication biases, and overt and persistent sexual harassment.
There is an urgent need to acknowledge, better understand, and address gender-based discrimination and sexual harassment in the field of medical physics.
AbstractPurposeTo present a systematic approach to the reirradiation special medical physics consult (ReRT-SMPC) process.Materials and MethodsAn in-house reirradiation committee of physicians and ...physicists was formed to develop a streamlined and well-documented approach to ReRT-SMPCs. Dosimetric goals and considerations for tissue repair were generated by the committee with input from the literature, clinical trial guidelines, and physician experience. Procedural workflow was also defined.ResultsThe total number of ReRT-SMPCs performed in our department in 2018 was 401, corresponding to 369 unique patients and 16% of the total number of patients receiving external beam radiation in our department that year. This constituted a large increase over the 183 ReRT-SMPCs performed in 2017. We have found that a standardized ReRT-SMPC workflow helps to safeguard patients, documents the clinical decision-making process for medical and legal purposes, and facilitates the peer-review process. The data being collected from each consult along with toxicity and outcomes data can be used to help inform future re-treatment guidelines.ConclusionsAs the number of patients returning for additional courses of radiation continues to increase, a uniform method for the ReRT-SMPC workflow and analysis is a powerful tool for ensuring patient safety, understanding and predicting treatment toxicity, and refining reirradiation dosimetric limits.
Underestimation of the spinal cord's volume or position during spine stereotactic radiosurgery can lead to severe myelopathy, whereas overestimation can lead to tumor underdosage. Spinal cord ...delineation is commonly achieved by registering a magnetic resonance imaging (MRI) study with a computed tomography (CT) simulation scan or by performing myelography during CT simulation (myelosim). We compared treatment planning outcomes for these 2 techniques.
Twenty-three cases of spine stereotactic radiosurgery were analyzed that had both a myelosim and corresponding MRI study for registration. The spinal cord was contoured on both imaging data sets by 2 independent blinded physicians, and Dice similarity coefficients were calculated to compare their spatial overlap. Two treatment plans (16 Gy and 18 Gy) were created using the MRI and CT contours (92 plans total). Dosimetric parameters were extracted and compared by modality to assess tumor coverage and spinal cord dose.
No differences were found in the partial spinal cord volumes contoured on MRI versus myelosim (4.71 ± 1.09 vs. 4.55 ± 1.03 cm3; P = 0.34) despite imperfect spatial agreement (mean Dice similarity coefficient, 0.68 ± 0.05). When the registered MRI contours were used for treatment planning, significantly worse tumor coverage and greater spinal cord doses were found compared with myelosim planning. For the 18-Gy plans, 10 of 23 MRI cases (43%) exceeded the spinal cord or cauda dose constraints when using myelosim as the reference standard.
Significant spatial, rather than volumetric, differences were found between the MRI- and myelosim-defined spinal cord structures. Tumor coverage was compromised with MRI-based planning, and the high spinal cord doses were a concern. Future work is necessary to compare thin-cut, volumetric MRI registration or MRI simulation with myelosim.
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