11 minute read
Increased Mental Workload for Academic Women Physicians Since the Pandemic Era
By Erin L. Simon, DO; Ashley I. Heaney, MD; Rebecca A. Merrill, MD; and Sarah Greenberger, MD, on behalf of the SAEM Education Committee
We are all anxiously awaiting the day when the COVID-19 pandemic is a distant memory and life seems more “normal.” There have been many changes that have occurred during the past two years because of COVID-19. Some changes have simplified our lives, and some have complicated them. Many of us have noticed an increased mental workload despite the many virtual options we have been given for activities, tasks, and meetings that were previously conducted in person.
As we evolve to our new “normal,” we are evaluating the efficiency of how things were done pre-pandemic versus how they are done now. Academic women physician activities may include working clinical shifts, administrative emails and paperwork, faculty and department meetings, preparation for clinical teaching and resident didactics, hospital committees, office hours, national committee responsibilities, and scholarly activity, to name a few. Personal activities may include parenting, time with family, spiritual wellness, and personal wellness such as exercise and hobbies. As we transition back and forth between virtual and in person duties, are the changes we have seen over the past two years lightening our load or increasing it? Virtual events eliminate travel expenses and commute times and allow for breaks to do other tasks at home such as laundry, cooking, and childcare. Some of the lines between work-life balance blurred, with no clear “time off.” When our boundaries become blurred between work life and home life, we may not be devoting our full attention to either task. Many women find it challenging to take on administrative duties while at home, especially when young children are in the picture. The COVID-19 pandemic exacerbated this by disrupting normal school routines and childcare support. There is an innate desire for children to want to be near their parents when
they are in the home, and parents may feel the pull to meet those needs while simultaneously juggling work duties previously accomplished outside of the home.
As women academic emergency medicine physicians, the changes from the COVID-19 pandemic aren’t limited to our personal lives. Professionally, we have found recruiting and interviewing for our residency programs to be challenging in the virtual era. Hosting virtual events, interviews and reading thousands of applications all without having face to face time with most candidates creates gaps in this experience. Developing COVID friendly events, such as resident conferences, graduations, intern welcome events and team building, has been difficult and time intensive. Budgets for live events have been cut or removed at many institutions, leaving few options for social wellness within residency programs. Faculty become fatigued on virtual meetings, courses, retreats, and networking and find themselves working in isolation instead of as a cohesive team. This makes it difficult to build and maintain meaningful connections with coworkers.
As we pivot between virtual and inperson worlds, how do we maintain our physical and mental wellness? Wellness is something that must be actively pursued and with COVID-19, our ability to actively pursue wellness was challenged. Gyms and restaurants were closed, time with friends and family was limited, and travel was restricted. Without a clear delineation between work life and personal time, defining intentional time for wellness became imperative.
Multitasking is a strength of women academic emergency medicine physicians, but for many, this became a detriment when boundaries blurred. Multitasking led to feelings of inadequacy. We found ourselves making dinner and homeschooling children all while attending meetings, responding to emails, completing charts, and developing innovative virtual residency education. Initially, there was a sense of being able to maintain previous productivity; however, we learned many things were being done mediocrely and nothing greatly. To optimize performance we needed to learn how to incorporate selective multitasking and define time separately for work and personal lives.
We found a threefold approach to delineate our work and personal time. First, we became more selective in the tasks we said “yes” to. For every opportunity given, you must consider the time you must sacrifice to meet that goal. It is also important to examine if that opportunity aligns with your professional ambitions. Acknowledging the opportunity and determining if it is best suited for you or someone else is an important aspect of work-life balance. Instead of simply saying “no,” you can assist colleagues interested in building their leadership skills by offering them the role. If you are interested in the opportunity and it conflicts with your personal life schedule, it is reasonable to state your interest and to suggest a time that enables your attendance. Secondly, we found outsourcing tasks that took time away from our professional and personal lives helped us to maintain productivity. Tasks such as grocery shopping could be expedited with grocery pick up or delivery. Hiring someone to help with maintaining the home was also helpful. As women we often feel the pressure to do it all, but outsourcing a few simple tasks can lighten your load. Thirdly, schedule time for yourself. Put it on the calendar and give yourself uninterrupted time for an activity that allows you to have a mental break. Read a book, exercise, or choose your preferred wellness activity. Protecting time for yourself and making it uninterrupted from screen time and personal duties will prepare you to tackle other responsibilities.
We look forward to brighter days ahead as COVID cases decline, vaccination rates climb, and life slowly edges back towards normal. However, we expect virtual meetings and events aren’t going away entirely and some postpandemic changes are likely here to stay. The next step is to figure out which elements of our new normal should be preserved. These elements should provide equity for women physicians while promoting productivity and wellness.
ABOUT THE AUTHORS
Dr. Merrill is an assistant professor of emergency medicine and the M3 clinical experiential director in emergency medicine for Northeast Ohio Medical University. She is the program director for the emergency medicine residency at Cleveland Clinic Akron General. Dr. Heaney is an attending physician in the Department of Emergency Medicine at Cleveland Clinic Akron General. She currently serves as assistant clerkship director for the emergency medicine clerkship and associate program director for Cleveland Clinic Akron General’s Emergency Medicine Residency. Dr. Simon is an associate professor at the Northeast Ohio Medical University and the Emergency Medicine research director for Cleveland Clinic Akron General.
Dr. Greenberger is an associate professor and associate residency program director in the Department of Emergency Medicine at the University of Arkansas for Medical Sciences.
Congratulations on Your R01! A Q&A With First-Time Recipient Dr. Bory Kea
By Joshua Lupton, MD, on behalf of the SAEM Research Committee
Bory Kea, MD, MR, is an associate professor in the Department of Emergency Medicine at Oregon Health & Science University. Here first RO1 is for her project, “Optimizing Stroke Prophylaxis of Acute Atrial Fibrillation with an Electronic Clinical Decision Support Tool: A SteppedWedge Cluster Randomized Trial Design.”
Congratulations on your first R01, “Optimizing Stroke Prophylaxis of Acute Atrial Fibrillation with an Electronic Clinical Decision Support Tool: A Stepped-Wedge Cluster Randomized Trial Design.” Can you give a summary of your project?
Thank you! Although atrial fibrillation (AF) Bory Kea is commonly diagnosed and treated in the emergency department (ED), oral anticoagulation is significantly underprescribed even though it can reduce stroke risk. Under prescribing has been attributed to a lack of empowerment and deferral of prescribing to longitudinal care clinicians; however, patients often do not follow up, resulting in missed opportunities to provide guideline-recommended care. My R01 focuses on this missed opportunity to change the trajectory of care in the ED for patients with atrial fibrillation with appropriate early prescribing of oral anticoagulants and thereby improve clinical outcomes. The study is a convergent parallel quantitativequalitative study consisting of three components: 1.) Implement a clinical decision support tool in a multi-centered stepped-wedge cluster randomized trial; 2.) Identify clinician facilitators and barriers to excellent AF care and refine clinical decision support tool for different
settings using qualitative approaches; and 3.) Explore patient satisfaction with the tool for future scalability and generalizability.
What findings are you hoping for from your R01?
I hope this research will allow me to learn how the unique environments of each hospital setting interact with the clinical decision support tool and evaluate the level of engagement needed to change clinical behavior. The quantitative information will provide information on the impact of the clinical decision support tool. The qualitative aspect will provide us with information on how to refine and implement the tool to change clinical behavior.
What prior grants did you receive before your R01 award? How did these impact your success in obtaining an R01?
Before my R01, I received an NHLBI K08 Mentored Career Development Award, NHLBI K12 Institutional Mentored Career Development Award, OHSU Tartar Trust, OHSU Jerris Hedges Research Award, UCSF CTSI Resident Research Grant, and Stanford Medical Scholars Grant, which was my first grant. Although I have not pursued bench research since then, that first grant allowed the exploration of an intensive research experience and led to a desire for a career as a physician-scientist. I have received other smaller grants along the way, which were steppingstones to the larger ones, providing support for projects or developing a grant proposal. These included the OHSU BioInnovation Program grant and OHSU Faculty Development Grant.
How did you develop an interest in research?
While I was an undergraduate student, I had the opportunity to visit NIH for a weeklong exposure to NIH research, which turned into a summer research experience at NHGRI. These initial experiences where physicians researched the clinical needs of their patients were highly inspiring and motivating to follow a similar physician-scientist career path.
What piece of advice would you give a medical student or resident interested in pursuing a career as a physician-scientist?
Find a topic that you are passionate about or one that causes confusion or triggers questions, as those questions can lead to research ideas and proposals. It is okay to change topics. I started with fish scales that detected toxins in a lab as an undergrad, worked on mice with pulmonary atresia, in vitro fertilization research on embryos, using microarrays for dermatomyositis, to guidelines for chest x-rays in trauma, opioid prescribing in emergency medicine, and now to atrial fibrillation (and other stuff in between)! As you have yet to be exposed to the multitude of topics out there, it may take time to determine what may interest you or the ideal environment to launch your research idea (topic, mentors, data, lab, etc…)! Find mentors of different types that can help you achieve your goals, as well as sponsors that can help move you into places that you wouldn’t normally be
Know Someone We Should Highlight?
This article is the first in a new SAEM Research Committee Q & A series that highlights and celebrates SAEM members who have received their first R01 or equivalent funding. If you or a colleague you know, are someone who should be highlighted, please let us know by sending us an email at grants@saem.org
at. Also stay in contact with friends from medical school or other walks of life — a wide network can come in handy! Peer mentors are also extremely important.
Who are some of the mentors you look to who have made a positive impact on your career?
Rob Rodriguez (UCSF-ZGH), Ben Sun (formerly OHSU, now UPenn), Leslie Biesecker (NGHRI), Mohamud Daya (OHSU). Peer mentors: Anna Marie Chang (Jefferson), Hemal Kanzaria (UCSF)
What has been the most challenging aspect of your work as a physician-scientist?
Trying to do it all, including being a parent, spouse, teacher, physician, researcher. One of my mentors told me that for every three things you try to do, you can only do two of them well. It’s not necessarily about work-life balance, it’s about compromise. At some point, you won’t be great at all things, but there are times when it’s more important to be great at one or two of those things and let someone else pick up the slack.
How has SAEM impacted your path to an R01?
I have networked tremendously through SAEM and have served on the research committee and grants committee. By evaluating other projects and grants, I glean on how I can improve my own studies and grants. Learn more about the NIH Research Project Grant (R01) program: https:// grants.nih.gov/grants/funding/r01.htm
ABOUT THE AUTHOR
Dr. Lupton is a Research Fellow in the Department of Emergency Medicine at Oregon Health & Science University and a member of the SAEM Research Committee. Dr. Lupton is the recipient of the 2022 SAEMF Research Training Grant.
