May 20, 2017
Show Notes for Podcast Two of seX & whY
Code Leadership and Gender “Behavior” Pod Hosts: Jeannette Wolfe
and Simon Carley Major Question: Are there potential unique
gender challenges associated with stepping into traditional code
leadership roles? What we know- importantly there is no
evidence that men and women differ in competence of running actual
resuscitations (Wayne 2012). This discussion is based on whether
unique gender associated variables should be considered when
learning and then running resuscitations. Streiff
Study This study looked at a code simulation run by
randomized groups of three Swiss fourth year medical students.
Before participating in the simulation, students filled out basic
demographic information and then took tests that evaluated for
certain personality traits and for basic resuscitation knowledge
and experience. The authors main objective was to see which
variables were associated with code leadership by using “leadership
statements” as a surrogate marker. Leadership statements were
statements made by participants that could be categorized into one
of four areas: what should be done; how it should be done; who
should do it; direction/command to another person that prompted
action or change of action. Results: 237 students Variables that
were associated with leadership statements were: Male sex,
extraversion and low scores on agreeableness personality trait.
Factors not associated with leadership statements were: height,
experience or(most concerningly) fund of knowledge. Study
implications:
- Individuals with the most knowledge might not actually be the
ones taking charge/ speaking up in critical situations
- Individuals who are less concerned with typical social
conformity (tact, modesty) may be more comfortable stepping up to
lead in short term emergencies
- There are likely gender specific factors that need to be
considered when teaching providers to become effective code
leaders. (d = 0.38)
Kolehmainen’s study
- Qualitative study on resuscitation perspectives
- 25 residents from 9 internal medicine programs
- Semi-structured telephone or in-person interviews
Men and women both shared that effective code leadership was
extremely important for patient care and team cohesion and that the
most effective code leaders ran codes in a classic “agentic” style
(i.e. loud, direct and authoritarian). Women found it much more
stressful to step into this style of leadership and were concerned
about potential backlash from team members who assumed they were
acting “witchy with a b”. The authors contend this is a legitimate
concern because when women step into code leadership they are
bucking implicit bias around cultural stereotypes that expect men
to be more aligned with agentic roles and women to be more aligned
with communal ones (i.e. cooperative and soft spoken)
“Leadership and gender:
All participants thought that men and women were equally
effective leaders, and both described the same ideal leadership
behaviors and their struggles to achieve them. However, the larger
majority of female participants expressed their discomfort and
stress in acting more assertively during codes. One female
participant observed that “tall men with a deep voice may naturally
appear more authoritative.” A male participant confirmed this
advantage, saying “Anyone who tells you that being a white male
with a deep voice who’s a little bit taller is not an advantage …
would be lying.” Another female participant said, “I act
differently during a code … you’re trying to assume this persona of
being in charge and I think that’s probably a little more stressful
(for women).” Almost half of the female participants described
their apprehension in appearing “bossy” when leading codes, whereas
no male participants expressed this concern.”
Kolehmainen’s tips to help women cognitively prepare for running a
resuscitation.
- Establish “Identity safety”
- Remind them there are no gender differences in code
competencies
Validate potential awkwardness
- Acknowledge that transitioning from one’s typical communication
style can be difficult but it is also necessary for running
effective resuscitations
- Practice “Enclothed cognition”
- Use pager and white coat as external symbols that validate
leadership role
- Consciously transition by tying hair back
- Adopt “Embodied Cognition”
- Take advantage of body positioning
- Stand elevated at head of bed
- Use power stance
- Deepen voice
- Debrief (and possibly acknowledge awkwardness of leadership
role) afterwards
Other tips from podcasters: Reframe resuscitation scenario-
advocate for patient, optimize their outcome Liberal use of time
outs- this allows summary, direction and formally solicits input
- Consciously creating a space that empowers others in the room
to have the opportunity to speak up is paramount to patient
safety
Bottom line of these two studies: it is important to consider
the potential of gender specific issues and possibly gender
specific consequences associated with traditional code leadership.
Kolehmainen c, Brennan M, Filut A, Issac C, Carnes M” Afrain of
being “witchy” with a “b”: a qualitative study of how gender
influences residents’ experiences leading cardiopulmonary
resuscitations. Academic Medicine: 2014 89 (9) 1276-81. Wayne DB,
Cohen ER, McGaghie WC. Leadership in medical emergencies is not
gender-specific. Simul Healthc 2012;7:134. Streiff S, Tschan F,
Hunziker S, et al. Leadership in medical emergencies depends on
gender and personality. Simul Healthc 2011;6:78Y83. Tool to
understand Cohen’s d effect graph: Magnussen, K:
http://rpsychologist.com/d3/cohend/
In gender associated research the following d effect size is
commonly used (d 0.10) or small (0.11 d 0.35) range, a few are in
the moderate range (0.36 d 0.65), and very few are large (d
0.66–1.00) or very large (d 1.00).