Review

A review of a journal article created by a Journal Watch contributor

Gender Gap

A Qualitative Study of Women and Leadership Acquisition in Anesthesiology

Anesthesia Analgesia

Submitted January 2023 by Dr Susan Hale

Read by 152 Journal Watch subscribers

Introduction
This study investigated the role of internal and external factors influencing the career pathways of 26 women identified as being in leadership positions in academic anesthesiology in North America. The topic was identified as an important area of research due to ongoing large gaps in the representation of women in leadership in academic medicine and in particular the specialty of anesthesia. In addition, there are few studies investigating the process of leadership emergence and there is a need to focus on women’s experiences in order to provide practical knowledge about gaining leadership positions.

Methods
This is a qualitative study of 26 women in leadership positions in anesthesiology in North America. The participants were identified using a purposive sampling strategy. Eligible participants were considered from the following groups – current and former presidents of national societies, chairs of academic anesthesiology departments and influential contributors to anesthesiology (published authors, American Board of Anesthesia Examiners and hospital executives) and identified using the ASA website, the Association of Academic Anesthesiology Chairs and the ASA Committee of Women in Anesthesiology. 4 participants were known to 1 or more of the authors. Of the participants, 92% identified as White and 8% as Black, 81% were married, 71% had spouses who were working physicians and 81% had children. The method used was constructivist grounded theory (CGT), a process which aims to construct an explanatory theory from systematically obtained data which is then analysed using comparative analysis. The primary source of data was semi-structured interviews with secondary data obtained from curriculum vitae.

Interview transcripts were analysed using CGT methodology with initial coding to identify and label patterns then subsequent focused coding on the following factors: early influences, mentorship, leadership attainment, self-perception, how to succeed and gender bias. A qualitative analysis software program was then used for further analysis which identified central themes. Theoretical coding was then used to develop a cohesive theoretical framework.
Results
The 4 central themes identified were personality traits, leadership preparation, gender-related considerations and leadership. Self-reported personality traits seen as helping to achieve career success included adaptability, hard work, perseverance and ability to overcome failures. Failure and obstacles were commonly reframed as opportunities for growth. Formal leadership courses and professional coaching were seen as vital for the
development of leadership skills as was networking at departmental, hospital and national level. In addition, 77% of participants identified an early career mentor with 65% of those individuals being categorised as high value mentors defined as someone with power or authority.

Regarding gender-related considerations, the majority of participants were of the opinion that there was gender bias in their workplace, an example being gender-related reasons for delayed promotion. Family obligations discussed included maternity leave, role conflict, maintaining work-life balance and maintaining work commitments. Contributions to leadership acquisition included self-promotion or putting oneself forward for consideration of leadership roles, however, sponsorship by a powerful sponsor was seen as the most important pathway to gain a leadership role.

Commentary
Limitations include small numbers (however this is reflective of the issue being investigated), cultural specificity to North America and furthermore to the dominant demographic characteristics of being white, married, married to a physician or having children. The issue of some of the participants being known to the authors was not specifically addressed although researcher bias is mentioned as a limitation in the discussion. Some of the results pertaining to personality traits and gender related considerations are only presented as narratives with examples given of answers to questions and experiences but no data as to the proportion of participants who expressed these views.

However, this is an interesting study in that it uses qualitative methodology to answer questions about perception of intrinsic qualities, personal experiences and external resources that are important for career progression to leadership positions. It provides a useful perspective which adds to the narrative around gender gap inequality in academic anesthesiology leadership and may be helpful for those aspiring to leadership positions.

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