Nithya Krishnan1, Deborah Biggerstaff2, Neil Raymond1, Monica Dolton3, Hillary Braun4, Sondra Livingston5, John Hattersley1, Josette Eris6, Nancy Ascher4, Robert Higgins1, Kathryn Wood3, Ala Szczepura7  

1Renal Unit, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom; 2Mental Health and Wellbeing, University of Warwick, Coventry, United Kingdom; 3Transplantation Research Immunology Group, University of Oxford, Oxford, United Kingdom; 4Transplantation, University College San Francisco, San Francisco, CA, United States; 5The Transplantation Society, Montreal, QC, Canada; 6Transplantation, University of Sydney, Sydney, Australia; 7Health & Life Sciences Faculty, University of Coventry, Coventry, United Kingdom

It is well known that representation of women in many fields of medicine is much lower than men1 and historically, gender has precluded females from becoming leaders in some fields. This ‘glass-ceiling’ effect is recognised to be more prevalent in male-dominated specialities with fewer women in senior positions. Despite the introduction of many positive changes aimed at helping women who work in medicine to flourish, the number of women holding senior leadership roles is a minority across many specialties. Transplantation is one such area. Research from other professions has found that when women do reach senior positions they appear to be judged more harshly and are more likely to fall from their position of seniority, even because of a single mistake, the ‘glass cliff effect’2. To date, there have been no studies in transplantation looking at this ‘glass cliff’ effect.

Aim

We wanted to explore if there were any engendered differences in participants’ perceptions and study their views on potential wrong decisions by senior medical transplant staff, using hypothetical clinical scenarios in an online survey.

Methodology

Ethical approval was obtained from West Midlands Research Ethics Committee, U.K and Biomedical and Scientific Research Ethics Committee, University of Warwick, U.K.

The study was a prospective web-based survey involving five clinical scenarios, with either a male or female protagonist (Set 1 and Set 2). Each scenario was followed by two questions (i) rating of clinical performance (score from 1 to 10, where 1 = unacceptable and 10 = exemplary) and (ii) action to be taken based on clinical performance (no action; informal action; written report to department; written report to national regulatory body). Respondents were invited to comment on their reasoning.

To ensure elimination of any inherent biases in responses the survey was advertised as a study exploring whether adequate actions are taken following adverse clinical incidents in transplantation. Participants were recruited by advertising through the websites of various professional bodies. Individuals were randomly assigned to either Set 1 or Set 2 questionnaires, with each Set receiving the same scenarios in the same order, differing only in whether a male or female protagonist was mentioned.

Results

189 invitees responded; 55 did not complete any questions and were excluded from the main analysis, leaving 134 (64 Set 1 and 70 Set 2) completed questionnaires. Comparison of respondent characteristics showed no significant differences between the two randomly allocated Sets with respect to age group, gender, ethnicity, country and respondent status. Mean clinical performance scores in each of the Scenarios 1 to 5 between Set 1 versus Set 2 were not statistically significant. Analysing grouped scores using chi squared tests similarly found no significant differences between Sets. There were no significant differences between Sets with regards to actions or grouped actions.

Analysis of the Sets versus clinical performance groups and action within gender defined groups also showed no significant difference between the Sets.

102 participants provided further explanation and comments on the clinical performance. Data were analyzed using thematic analysis. Themes identified included: issues of informed consent and acceptable risk; clinical judgment; systems errors; consensus among clinical teams; training issues; mentoring; and judgments as to whether appropriate actions had been taken at the time. Participants’ described male protagonists as “forceful individual”; “maverick who ignores his colleagues” or, “one who has “cautious colleagues”. Meanwhile, female protagonists were described using slightly different, more nuanced characteristics like competency; mentoring; training needs; need for supportive senior colleagues; or as having ‘saved the day’. However, when things went wrong, participants were more likely to opine that female protagonists should not have gone ahead. Risk was perceived by respondents to be a more male leadership trait.

Conclusions

The quantitative survey showed no significant differences between the sets but the thematic analysis of participants’ comments provided evidence of a subtle and nuanced use of language; where those traits identified in male leadership being viewed and described differently to those applied to women leaders. While gender may no longer be such an issue as in the past, respondents’ use of language and their choice of words display elements of an engendered description. These findings suggest that the ‘glass cliff’ effect may still be a problem in transplantation but has become subtle and therefore, may not be so easily identified in the workplace.

References

1. AAMC. Distribution of residents by specialty, 1996 to 2006. http://www.aamc.org/ members/wim/statistics/stats07/table02. pdf.

2. Victoria L. Brescoll, Erica Dawson and Eric Luis Uhlmann. Hard Won and Easily Lost: The Fragile Status of Leaders in Gender- Stereotype-Incongruent Occupation. Psychological Science. 21(11) 1640–1642, 2010.