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      Challenges faced by women in radiology during the pandemic - A summary of the 2020 ACR Women's Caucus

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          Abstract

          The COVID-19 pandemic has dramatically altered the professional and personal lives of radiologists and radiation oncologists. This article summarizes the 2020 American College of Radiology (ACR) Women's Caucus, an annual caucus led by the American Association for Women in Radiology (AAWR). The caucus focused on the major challenges that women in radiology have faced during the pandemic.

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          Most cited references 21

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          COVID-19 medical papers have fewer women first authors than expected

          The COVID-19 pandemic has resulted in school closures and distancing requirements that have disrupted both work and family life for many. Concerns exist that these disruptions caused by the pandemic may not have influenced men and women researchers equally. Many medical journals have published papers on the pandemic, which were generated by researchers facing the challenges of these disruptions. Here we report the results of an analysis that compared the gender distribution of authors on 1893 medical papers related to the pandemic with that on papers published in the same journals in 2019, for papers with first authors and last authors from the United States. Using mixed-effects regression models, we estimated that the proportion of COVID-19 papers with a woman first author was 19% lower than that for papers published in the same journals in 2019, while our comparisons for last authors and overall proportion of women authors per paper were inconclusive. A closer examination suggested that women’s representation as first authors of COVID-19 research was particularly low for papers published in March and April 2020. Our findings are consistent with the idea that the research productivity of women, especially early-career women, has been affected more than the research productivity of men.
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            Coronavirus Disease 2019 (COVID-19) and Beyond: Micropractices for Burnout Prevention and Emotional Wellness

            With coronavirus disease 2019 (COVID-19), the demands and stresses on radiologists and physicians have increased dramatically. Even before this pandemic, the high prevalence of burnout, complex causes, and critical consequences had been widely reported [1,2]. Many institutional and individual interventions have been advocated to address burnout and promote wellness, including decreased workload, improved work schedules and electronic health record, mindfulness (including mindfulness based stress reduction [MBSR]), and personal coaching [1, 2, 3]. The need for effective strategies and tools is only increasing as both individuals and institutions navigate the current anxiety and uncertainty. We have conducted workshops on emotional intelligence exclusively for physicians, including radiologists (D.F.) and separately for managers and business leaders (C.C.). In our experience, both physicians and managers hunger for skills and strategies to help successfully navigate their increasingly complex worlds. In particular, physicians long to serve their patients and practices with energy and inspiration and have some semblance of balance in their lives. In our experience, physicians especially enjoy highly actionable tools that require minimal time to learn and implement, aka “micropractices.” Micropractices only require a few seconds to a few minutes to implement. Those that connect with an already existing activity offer a special appeal and ease, such as a moment for mindfulness when using hand sanitizer [4]. Hand hygiene—now a constant routine in and out of the hospital—is a continual opportunity for self-awareness and self-management. It can be an opportunity and invitation to focus on one’s breath, center one’s mind and body, and visualize the kind of presence, empathy, and calmness one would like to bring to the next patient and the next moment. It is also an opportunity to self-connect—Am I well hydrated? Hungry? Carrying an unreasonable emotional or mental vestige from the last patient or the last news update? Quick micropractices like these are potentially possible even for the busiest radiologist or other health care provider. Opportunities to engage in this type of mindfulness micropractice are available on a daily basis. Examples include the wait time when logging into the PACS or electronic health records. Such opportunities present themselves continually outside our work lives as well—when hearing the concerns of family or friends, when waiting at a red light, before answering e-mails or texts, or when brushing one’s teeth. Any recurring event can serve as a cue for a wellness self-check. Over time, such built-in wellness moments have the potential to shift one’s energy level and the tone of one’s day. Another favorite micropractice from our physician workshops is taking a moment to name one’s emotions, especially challenging emotions. For example, when I notice that I am feeling upset, is it anger? Concern? Exhaustion? Such naming aids self-awareness and self-management. This “name it to tame it” practice, to paraphrase Dr Dan Siegel, MD, has supportive functional MRI research; it has been show to shift brain activity from the amygdala, the emotional center of the brain, to the higher-order thinking area of the brain, specifically the right ventrolateral prefrontal cortex. In so doing, it can help bring calm and ease [5]. Helpful lists of the range of human feelings are readily available and can help facilitate this process [6]. An additional evidence-based practice that can appeal to frazzled radiologists and other physicians is the simple act of writing down three things one is grateful for several times a week. This quick practice can aid well-being [7]. Sexton and Adair studied a similar practiced called “Three Good Things” in health care workers including physicians, physician assistants, nurses, and administrative staff. They found that a 15-day practice of recording three good things had significant positive benefits on self-reported happiness, burnout, work-life balance, and depression [8]. Extending gratitude practices into groups, such as starting meetings by giving kudos for recent efforts, can also help stimulate positive emotions and positive relationships among team members. Clearly many good things are happening in the midst of all the stress and swirl—the dedication of so many, kindness and consideration for those most at risk, and emotional support. To help us survive, our minds are biased to notice risks and danger; consciously noticing the good can help bring balance and calm. In our experience, radiologists and physicians find it empowering to share their personal practices around burnout prevention and wellness in a workshop setting, and they enjoy learning from their peers. An important element of “Oh, I am not alone with these challenges” seems to spontaneously arise. They see, and hear, that others they know and respect face similar circumstances and stresses. While learning about these micropractices, they also gain practical tips from their colleagues’ hard-earned wisdom and experience. One radiologist reported tracking her tension level during a busy workday. If the level is high and she gets a flurry of questions from technologists, she has learned to pause and consciously respond with the statement, “I just need a minute.” This simple phrase gives her time to settle and then offer a more connecting response, rather than a reflexive reaction. The technologists have come to know the short wait is well worth the few extra seconds of time. Lastly, a simple technique known as diaphragmatic breathing has also shown promise for reducing stress and self-perceived anxiety and can be an additional micropractice. This involves inhaling deeply by expanding the lungs downward rather than inhaling using the abdomen or rib cage alone [9]. Inhaling is done through the nose, with a pause before exhaling slowly and completely through the mouth. Some find silent counting during inhalation and exhalation helpful to establish a respiratory rate of six to eight breaths per minute (eg, inhale for a count of 5 seconds, pause, and exhale for a count of 5 seconds for a respiratory rate of approximately six breaths per minute). In preliminary experimental studies, diaphragmatic breathing has demonstrated a statistically significant improvement in stress reduction as measured by both physiologic biomarkers (blood pressure and salivary cortisol) and self-reported stress levels via the widely used Depression Anxiety Stress Scales-21 [9]. The mechanism is thought to act by increasing parasympathetic activation. Given that diaphragmatic breathing is low cost, self-administered, nonpharmacological, and highly portable, it is easy to try (provided no prohibiting health conditions exist). Further study is needed to better define its mechanism and efficacy and the minimal time needed for positive benefits. One study has noted statistically significant benefits on blood pressure with one 10-min session of diaphragmatic breathing [9]. One could take a deep breath or three before the start of a readout session or between each case or spend 30 to 60 seconds in deep breathing on bathroom breaks, after reading e-mail updates or news, or before starting a meeting. Such small changes may seem inconsequential and futile in the face of immense pressures. Small changes, however, have the advantage of being doable and sustainable. Over time, anchoring deep breathing and other micropractices into our existing habits can help build more wellness into our lives. These micropractices are not advocated as prescriptions for treating burnout, and they will not extinguish the stress and anxiety of COVID-19. Individuals experiencing burnout should seek professional help. These practices are intended for strengthening burnout prevention and for adding a bit more wellness. Such micropractices do not replace but rather complement previously described individual efforts such as MBSR and personal coaching. Studies have indicated mindfulness practices and coaching can be beneficial provided one can devote the time and energy they require [2,3]. The micropractices we describe are quick and easy and can be done solo or with others, at the PACS workstation, in one’s office, at home, while commuting, or almost anywhere. Such practices are intended to build personal resources; they are potential tools in an individual’s “wellness toolbox.” Given personal differences and preferences, it is expected that some practices will have more appeal and benefits than others for a specific individual. Having a robust toolbox of practices that resonates with you can be a helpful resource in navigating expected, and unexpected, challenges. Clearly larger and randomized studies of these micropractices, with active controls and a longitudinal time course, are needed. As with the many structural and cultural changes that are needed to help prevent burnout and promote wellness, such studies will require considerable time, energy, and resources. Meanwhile, these micropractices may be of help. As the demands and stresses of COVID-19 evolve, we can use and build our resources—both internal and external. Micropractice by micropractice, breath by breath, we can move toward increased calm and elevated emotional wellness.
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              Why don't female medical students choose diagnostic radiology? A review of the current literature.

              While the number of women entering medical schools is approaching 50% nationally, women continue to be underrepresented in a number of specialties including diagnostic radiology. While diagnostic radiology has many characteristics that might be desirable to women, such as reasonable call hours, flexible scheduling, and high salaries, women still do not choose diagnostic radiology as a career. This article examines the literature to discern possible reasons for why women are entering diagnostic radiology at a lower rate. We address trends among women in academic medicine, which resemble trends among women in diagnostic radiology, and examine the effects of gender and socialization in medical school on specialty choices among women. The current literature suggests a constellation of factors may be responsible for the gender differences in diagnostic radiology. We suggest that further research is needed to elucidate why women do not seem to be choosing diagnostic radiology as frequently as one might predict based on the lifestyle of diagnostic radiologists and the numbers of women currently entering medical school. Once these reasons are made clear, it will be possible for residency program directors and medical schools to ensure that women are making informed specialty choices, whatever those choices may be.
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                Author and article information

                Contributors
                Journal
                Clin Imaging
                Clin Imaging
                Clinical Imaging
                Published by Elsevier Inc.
                0899-7071
                1873-4499
                28 August 2020
                28 August 2020
                Affiliations
                [a ]Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
                [b ]Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
                [c ]Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, United States
                [d ]Department of Radiation Oncology, VA New Jersey Health Care System, East Orange, NJ, United States
                [e ]Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
                [f ]Coastal Radiology Associates, New Bern, NC, United States
                [g ]Department of Radiology, University of Kentucky, Lexington, KY, United States
                [h ]Department of Radiology, Medical University of South Carolina, Charleston, SC, United States
                [i ]Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
                [j ]Vanderbilt Ingram Cancer Center, Nashville, TN, United States
                [k ]Veterans' Health Administration - Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center, Nashville, TN, United States
                Author notes
                [* ]Corresponding author at: Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Ave South, Nashville, TN 37232, United States. lucy.b.spalluto@ 123456vumc.org
                Article
                S0899-7071(20)30317-X
                10.1016/j.clinimag.2020.08.016
                7453221
                © 2020 Published by Elsevier Inc.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                Categories
                Article

                women in radiology, pandemic, covid-19, gender equity

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