SCCM Resource Library-Targeting 50:50 for SCCM's 50th Anniversary: Bringing Gender Equity to Center Stage in Pediatric Critical Care

Targeting 50:50 for SCCM's 50th Anniversary: Bringing Gender Equity to Center Stage in Pediatric Critical Care

Video Transcription

today. So after a year like no other where the importance of fairness or the lack of it become front and center, and as the SCCN turns 50, this felt like it is a unique opportunity  to bring the theme of gender equity in pediatric critical care to center stage. So where did all this start for me? Well, I've seen a real shift during my career from  a field that was heavily male dominated when I started out towards there being more women than men entering pediatric critical care. But obviously it's not just about numbers  at the entry point. I'm always being asked by females who are much younger and smarter than me as to how I got here. And the reality is that I've been very lucky all along the  way to have progressed in our field. And I think it's through appreciating this and seeing what is happening around me, I started to realize a few years ago that I couldn't and  I shouldn't be as comfortable with the status quo when it comes to equity. And then my real wake-up call came when I was looking through a program for an annual  meeting that's related to our field, and I noticed that only 10 percent of the physician speakers were female. As you can see on this photo of the mantle that accompanied some  of the online highlights, this was obviously felt to be fine by organizers. But it wasn't fine with me. And then I started to look at data from different  cardiac intensive care meetings from a few years back now. And please understand that when I show these slides, I don't mean to discredit non-physicians, but speaker numbers  by gender can be made to look very different when we include advanced practitioners and nurses in the data. So this data about physicians only and our  own intensive care faculty for cardiac intensive care is exactly 50-50 males and females. But this chart here from the national meeting shows a very, very different picture. This  data got me really fired up. A pie chart, I think, tells a thousand words. And I felt surely these should actually match each other. So this data, and as I got older I think harder  and I get more introspective. And I felt uneasy. I felt sad and kind of angered by this. And I started to peel back some more layers of what obviously was a fairly precarious onion.  And actually locally in our own hospital and Department of Pediatrics, I developed and I set up our own equity committee in the department. I figured that people in my position  are perfectly placed, we're perfectly poised to help make a difference to the next generation.  And the first thing to do for me was to really identify some low-hanging fruits and targets that we could really tackle and hopefully start to make a difference and to share some  of these thoughts with many of you. So I'm going to give a few examples of what I've looked at in my own world. And I know that my friends who are going to be talking  after me in this session will go into some of these things in a lot more and more elegant and more expert detail. So there are a few things we can influence as leaders. And this  paper here, albeit from nearly a decade ago now, shows quite nicely it doesn't cost money to look at promotion and it doesn't cost money to create equity in our departments. This  is something that we should be able to tackle ourselves. This data comes from the University  of Colorado, and it shows a stark gender gap as we go up the academic ranks in the Department of Pediatrics and look at the difference when you look at tenured versus non-tenured in  women and in men. Now, this is from about nine, ten years ago, this data. And of course, we know that more women have entered the field of pediatrics over that decade. But I think  it would be very bold to suggest that that gap has narrowed significantly over that decade. Similarly, in leadership positions in the department, while medical directors are often  women at the high level, at vice chair level, at section chief, section head level, again, there's a big gap that we need to have a look at. And there's a suggestion here, a hint  at the bottom when we look at salaries. Again, there's a subtle, but I think an important gap between women and men. And this isn't okay.  Let me look at the departments and the leadership positions. I'd love to show you an org chart  from our own Department of Pediatrics, obviously, where I work. And this is Baylor College of  Medicine. And I think this is a picture that we should all really strive for. In our department, more than half of the women and more than half of the leaders, whether it's at vice  chair, executive vice chair, or section chief level, more than half are female. I think this makes me feel very lucky, very privileged, and very proud to be part of a department  like this. So here's some data then from the American Academy of Pediatrics that actually looks at the salary gap. And they actually call  it the gender wage gap in pediatrics. And it shows data that they have started off as unadjusted and then across the graphs to the right moves to adjusted data. And unadjusted  salary differences are over 50,000 between women and men in pediatrics.  Now, as we start adjusting for all sorts of things, such as labor force characteristics, job-specific characteristics, and then work family characteristics, I think this is a  dangerous adjustment, that gap obviously narrows to a much smaller level. But we could argue that the real gap without insurmountable adjustments that relate to potentially things  that women may not have a control over would probably meet somewhere in the middle of those dollar numbers. Now, let's have a look at grand rounds. We  probably all work in institutions or have worked in institutions where grand rounds are an important part of the academic environment. And again, these provide an opportunity for  juniors, for all of us, to shine, to be seen, to showcase, and to demonstrate the talents  and the productivity that particularly young faculty have. This paper here from five Canadian  sites, they're all academic institutes, showed data that we really shouldn't consider, okay.  And again, I think this is low-hanging fruit for many of us to attack. Again, these things don't cost money. They just take time and consideration and just a little bit of stepping  outside of what has become a norm for many. So I mentioned what I felt is an unacceptable gap at meetings earlier in the talk. And I'll reiterate, for me, this inequity is probably  the thing that has bothered me most over the past several years. This paper here shows data,  again, from five key critical care meetings. These were international meetings and obviously predominantly adults and include the SCCM. And this data here shows the proportion of  speakers that were female over seven consecutive years of meetings. And it's kind of depressing,  the two meetings that did make some headway, some progress over that period of time with the UK  Intensive Care Society and the Society of Critical Care Medicine. The other three, the European  meeting, the Canadian critical care meeting, really very static, no progress, no improvement  in female representation. So what can we do about this? I think it's up to us to lobby program  committees, give others an opportunity to speak rather than ourselves, and potentially mandate  equity or use equity as a condition to participate in the organization or the delivery of the meeting.  So let's ask the question now, who's actually going into the field of critical care? Well, when we look at the adult data, you can see here, I've shown you three graphs of the three  typical subspecialties or the, if you like, the backgrounds that feed adult critical care,  anesthesia, internal medicine, and surgery. And over the past decade, shown here from 2004 to 2014,  very little change over time, and around about a third at most of intensivists from these backgrounds  were female. But if we look at pediatrics, it's a very difficult, pediatric critical care, it's a very different story, a different picture. We all know the vast majority of  people entering pediatric training are female, over 70% typically in all large academic institutions.  And look at pediatric critical care, and I do apologize that the colors here are flipped. So pediatric critical care should be in blue and residency should be in red. But pediatric  critical care is now 64% females entering the fellowship program. So two-thirds of all pediatric  critical care fellows entering nowadays are female, very different to the adult world. So it looks like  we are getting something right, and we are making some progress there, at least making this an  attractive field for females coming into. So when it comes to the faculty themselves, here's some  data from our own section. I joined our team in 2010. I was the sixth female out of 20 faculty.  Fast forward one decade, another hundred or so beds, et cetera, and we've closed that gap. We're  almost at 50-50. We have more than 80 attendings now, and we're getting there. And it's not  deliberate, and it certainly shouldn't be mandated that your next 10 hires should be female. But I do believe that departments, divisions, and sections, they own reputations  around factors such as equity, and I think this evolution doesn't necessarily happen by accident.  We have an amazing team. We have fantastic male, fantastic female intensivists, and I'm very, very proud that we've closed that gap over time, as indeed we should,  particularly when we consider the balance shifting towards females in the workforce.  So with balance emerging in our intensivist workforce, we'd hope that external opportunities  would mirror this, but it's not always the case. I'm sure everyone in this room will have read  this amazing landmark publication, of course, for the Surviving Sepsis Campaign, and this is a masterpiece. But to me, it also represents a really great opportunity to have  embraced gender equity, and less than one-fifth of the authors of this seminal paper are female.  And the same applies, then, to the COVID update that was published just a couple of months ago.  Now, only 15% of those authors were female. Now, this is not…it's not a…I could be tough and say  it's a failing. Perhaps it's just a knee-jerk. A lot of these statements are further developments  or further iterations of prior statements, but I really ask people in influential positions to  consider how we approach these and potentially reboot in the future. A little bit of a call to  action, if you like. So, what can we do as leaders, as mentors, and potentially as influencers?  I think the answer is a whole lot. I mean, this is small font here, and I could have added another  10 or 15 lines, but it can be fun. And I would ask you all to work together and strive to a new  norm. Be a role model. Think about work-life balance. The guys like it just as much as the  women, believe me. Things won't change overnight, nor should they. Everyone has to equally earn  rewards. You cannot purely advance or get an opportunity by virtue of being female. One should  not. And, of course, the workforce is…the female workforce is disproportionately junior, but we will  nurture, develop, and grow these talented young women into talented senior interns to this too.  And then the other things that we can do as leaders, we focus on equity when we hire.  Salaries and compensation, leadership committees, mentorship, etc., etc. All these ideas are there, and I'm sure many of you have many more ideas that you could add to our list.  I'm going to give one slide. This…equity does not end with gender. Clearly, there are many other  facets to equity that you'll all be thinking, why aren't we talking about this today? And that should  be another thing we tackle in the future. There's race, ethnicity, sexual orientation, ability, disability, etc., etc. This is just the tip of the iceberg we're talking about today.  So, I'm going to end with where you might have thought I should start today, and this is an  introduction to our speakers. You've seen my credentials. I've been in the game a long time  since the late 1990s, and thankfully, I think I'm probably one of the last of a generation that has seen the real old school, and we're seeing the dawn of a new day as it relates to  equity in medicine, which I find so exciting. I did carry a briefcase for my boss as a surgical intern, and I used to make coffee for everybody after rounds. That was my job.  And I'm a single parent through choices. My son, Max, saying goodbye to 2020. What a great night  that was. I think I got to where I am now through being in the right place at the right time,  opportunities that came up, and I am very thankful to many, many of my mentors, male mentors along  the way who helped guide me in my career. I try to guide others. I hope I do, too, so that they don't  I try to guide others. I hope I do, too, so that they don't get there by chance.  And I chair an equity committee for our Department of Pediatrics, which is a role I absolutely  cherish. Our next speaker is going to be Nikki Kolivos, who's in St. Louis. She's a medical  director. She's an editorial board member for Pediatric Critical Care Medicine. She's a passionate  mentor. She's a passionate, active fundraiser who supports cancer research, and the thing I am  doing is a six-time marathon finisher, which is just super cool. After Nikki, Paul Keckier, who's  a former colleague of hers, is going to speak. Paul is in the next door office to me at Texas  Children's. He is one of our associate chiefs, former medical director of the cardiac ICU.  Paul used to be president of PCICS. He's a senior associate editor of the Pediatric Critical Care Medicine Journal. He's famous on social media. I don't know how he does it,  but he really does, and as I said, he's my next-door neighbor, so we talk through the  walls and in each other's doorway with masks on, of course. After Paul, we'll hear from Bob Berg,  who's at CHOP. Bob, many of you, I'm sure most of you will know, and all of you will have read, he's a really highly acclaimed resuscitation scientist, has decades of experience in  clinical translational research, and particularly known for chairing and having been on many AHA  and ill court committees. He's a division chief at CHOP, and he has mentored numerous trainees and researchers. I'm sure there's many of you listening to this talk today.  Our last speaker is Adrienne Randolph from Boston Children's. Adrienne is a Harvard professor.  She is a phenomenal international research leader. I have no idea how she does it because I do  believe she has a life outside of work. She's the founder and chair of the Polisi Network. She's the  PI for the Pig Flu Study, and recently obtained huge CDC funding for the Overcoming COVID study.  With that, I'm going to leave you with one last slide. Today's session is the beginning for all  of us. We hope that this is a diverse audience. We hope you enjoy the session. We hope it makes  you feel mildly uncomfortable. If it doesn't, then we haven't quite done our job. We do hope  you go away with some new ideas, and we very much hope you will act on these. Thank you very much,  and we look forward to the discussion at the end of the speaker's talks. Thank you.  Hello. This is Paul Kekia from Texas Children's Hospital. Today I'm going to talk about societies,  journals, and editorial boards, and hopefully give a little bit of insight from the inside, as it were. I have no disclosures, except this is my mother, Irene Kuras Kekia. She  was an immigrant and a physician, came from Lithuania during World War II to flee the Soviets. She was the first female physician at the Southside Hospital that she came to apply  for residency at. She had finished her medical training in Lithuania and Germany, and she wanted  to be an OB-GYN, but the chief of staff at the hospital said, no, that's actually a male subspecialty, but we have this pediatric spot for you. Well, she then went on to practice 60  years as a solo pediatric practitioner on the Southside of Chicago, eventually retiring and  unfortunately passing away a few years ago, but she was a female role model to me, to say the  least. With that as the background, I also want to just talk about the two women who have organized  this and I'm fortunate enough to share what should be the podium, but in this situation the screen with my two friends and colleagues who developed this session. So jumping in, the  societies and journals. So societies really are the old boys club and hopefully the last vestiges  of it. Those are actual pictures of medical society meetings. They are dying, but are they  dead yet? This review of a 10-year period ending in 2017, published in 2019, really goes through  to look at the makeup of the physicians in practice, their gender, the physicians who are in  the society, and then the leadership of those societies, and I want to call to mind these  far columns on the right. The years that there's a woman who's been president, the percentage, and then that difference number is how it equates to the number of female physicians  within that subspecialty. So the more negative the worst, the more positive, the more equitable  or more gender equitable as it were compared to the rest of the practicing physicians.  There's a whole lot of negative there. The ones that we are part of, pediatrics, still a problem.  Here for Society of Critical Care Medicine, however, we're on the positive side. So there is more representation at leadership level of females as compared to the rest of society  membership and practicing physicians. This not only is in leadership roles, but also these percentages  here of all these societies, not looking at each one, but just looking at this column which are  the percentage of female trainees over a 10-year period and comparing them to the percentage of  female members within the society. I will just summarize by saying the numbers of females within  the societies are far, far lower than those practicing. So for societies this question is a matter of survival. The question that we all face is why do we even belong to medical  societies? That's your own question to answer, but I will contend that if the society doesn't actually look like, doesn't represent its members, it will fail. If the leadership of  that society doesn't look like its members or its future members, it will fail because they will not attract new members. So this is an issue for all societies. These really  are the last bastions of the old boys network, but there are some glimmers of hope, but there remain significant issues. This is an area though I think that initiatives can make the  most impact and the reason being, again, it's about membership and money. And also there is a potential within society for a nimbler response. You can move this ship a  little faster from the inside. And to that my own individual experience with the Pediatric Cardiac Intensive Care Society. It's definitely a smaller society than SCCM. There's only  a 20-year track record of its existence and when I started being associated with it in 1999, it was also viewed as an old boys network. But interestingly, an old boys network only  from Boston and Philadelphia. So it became even more insular. In fact, here are the opening  leadership within the society back in 1999. And if you can see, as I highlighted, very male.  Well, it's nice to see that now in 2020, I'll highlight all the female members of the board  of directors, leadership, president, ex-presidents. So we've made some progress. And while leadership  is important, it's really about the talks and the podium spots at national meetings that help to  move careers forward. Well, there is a trend to improvement of female speakers at medical conferences. In the 10 years from 2007 to 17, there was an increase from 24.6% to 34%.  So definitely an improvement. And this can be seen across the spectrum of subspecialties and how that gap is slightly improving. So there is, again, room for some applause.  In terms of my experience with PCICS, it really does start with the program committee. And so  we moved first over the years to populate the program committee with equal gender representation.  This then led to new speakers being uncovered in their own institutions. And this last meeting  in 2020, it's nice to see that the committee was predominantly female and the speakers were  predominantly female. So we can make progress. Now, in terms of the meeting speakers, again,  I'll highlight to represent gender on the organizing committees. This leads to the podiums.  And this should not be a 50-50 requirement, but a meaningful effort to highlight great  individuals doing great work. This is not a gimme to just say we have to have equal representation.  This involves conversations, real conversations within your own professional friends and colleagues to find, quote, new and incredible names. There is an ease to finding names that  we all fall into. And it's up to us to break through and look for female and gender equity when it comes to the speaking spots. Now, when it comes to journals and editorial boards,  it is a harder issue to tackle. There's more room for implicit bias. There's far less transparency,  especially when it comes to reviews and reviewers. And just historically, remember that the removal  of bias regarding subjects of research didn't happen that long ago. In the 70s and 80s is when  journals started to actually require that there be female representation within research of the  things they're publishing. And while these issues start with the science, it doesn't end there.  While it starts with the careers, it doesn't end there either. It really goes to understanding that  there's gender bias and room for improvement within everything of the design of studies, the interpretation of the results, and the conclusions.  This study just came out last month in PCCM and it looked at gender authorship in pediatric  randomized control trials and while it did increase from 28% to 39% in the period studied, this table really demonstrates how far we still have to go.  Among physician last authorship, senior authorship is only 20% still of female physicians. I think there's a huge room for improvement there.  And here's another gender issue for journals and of course, once again, it's about COVID. But this is a real-time issue.  COVID is widening the gender gap among the world's top scientists. Here is just a representation from Nature of the number, the explosion of COVID studies  over the past year, but if you look deeper, whether you be PhD, physician, or professor, the gender gap is huge now in the new studies coming out in COVID.  And this study in JAMA really did show that this is in preprint, in the preprint servers, but you can see that the gender gap has widened in the past year and is continuing as such  because of a variety of issues where women can't get back into their labs or they have other responsibilities in the home and that's a problem.  So it does come down to personal accountability. Can each one of us honestly say that we never look at the gender of authors? Well maybe we should and let me highlight this.  So for example, this open access journal looked at how reviewers were assigned and what they did and there is substantial same gender preference. This goes both ways.  Editors assigned, female editors assigned female reviewers, male editors assigned male reviewers, and reviewers of female authors and reviewers of male authors stayed within  their same gender in terms of preference. So to be gender blind is an interesting concept, but there are some interesting ways to look at this. Is it actually an obstacle?  The myth of racial or gender blindness is one that's useful only to those in the dominant group.  People who are marginalized or in lower status groups don't have the luxury of being blind to the identities of others.  There is a difference between equity and equality and why this matters as such. Gender equality means equal outcomes for men, women, and gender diverse people.  Gender equity is the process of achieving that. It recognizes that women are not in the same starting position.  They have historical and social disadvantages and to be equal may not actually be fair. There need to be measures that level the playing field and make up for that disadvantage.  So what about some solutions and proposals? Well how about blinding authors? Well we do get into the question then of equity versus equality, but we should have real open  data on reviewers' genders and how that gender deals with their reviews and looking at that data. Bob Tasker and I have had already some email conversations.  This is an initiative that I want to push as an editorial board member over the next year. This concept of the Reviewer Academy for Pete CCM.  Originally it was thought to teach people how to do an excellent scientific review and that will be part of it, that's for sure, but it's also a way can we have modules and  educational requirements before you can be a reviewer that will teach you things like how to review, but also to recognize bias within the authors and within the subject  and also other things like conflict of interest and things like that. This will level the playing field and teach us about gender bias.  And then what about a feature or a highlight each issue to applaud when there's substantial gender, race, or geographic success to again help even the playing field.  Editorial boards, this is also where impact can be made. We need to declare that we're jumping over a step to populate the board with gender diversity  and then we must listen to that board and their suggestions. Now I'm going to close in the last couple slides about the concept of this Finkenbeiner test.  This is something I noticed when I was doing some of the research.  Now again this talks about profiles of female scientists. What it is is Anne Finkenbeiner is an author for science and she was told to do a profile on a female astronomer.  And then her friend Christy Ashwanden interviewed her about this and she said there are certain rules that must not be broken when it comes to profiles of female scientists and here  they are. If you're going to tell a story about a female scientist or physician, you cannot mention the fact she's a woman. You can't mention her husband's job.  You can't mention her childcare arrangements. You can't mention how she nurtures her underlings. You shouldn't mention how she was taken aback by the competitiveness of the field.  You can't talk about how she's such a role model for other women or how she's the first woman to. So this is the way to approach removing that type of bias.  Now if you notice something, I've failed in every one of these, or not every one, but most of these earlier in my talk when I was even talking about my own mother.  I mentioned the fact she's a woman, how she was not allowed to have an OB spot, how she's a role model and how she was the first woman at the hospital.  So it's hard not to fall into this trap, but as Anne Finkenbeiner said, a lot of comments have said, but isn't it sometimes okay to mention things about a woman?  And my answer is yes. In some circumstances, it's perfectly fine. For instance, if you're writing a story about sexism in science or about the gender gap  in leadership role in science, or you're writing about sex-related issues specifically, what's  not okay is to turn a story about a scientist's professional life into one about her personal life or her gender roles.  What's especially problematic is to frame the story, and the most remarkable thing is that she accomplished all of this while being a woman.  Now, this is just scratching the surface of this issue. This is a long journey. This is a journey that we're still on, and we have a lot of work to do.  But if we don't begin that journey now together, looking at these pockets of gender bias, we're never going to get to where we need to go.  So thank you for letting me be part of this session, and I look forward to the end for some more of the discussion. Thank you.  Good afternoon, and thank you so much for attending this virtual presentation. It is an honor to be invited, and thank you to Dr. Lara Shaker-Damian for bringing your  vision to life. My name is Nicoletta Kolobos, and I am an Associate Professor of Pediatrics at Washington  University School of Medicine and an attending physician in the Pediatric Intensive Care Unit at St. Louis Children's Hospital.  I am here today to discuss, does prioritizing work-life balance have to present a disadvantage?  My goals today are to discuss the traditional attitudes and current state in both medicine and particular pediatric critical care medicine.  I will discuss the need for future approaches that naturally consider the need to integrate the balance between academic achievement and career progression with outside life.  I have no actual potential conflict of interest in relation to this presentation. When I was your age, I walked to school in the snow, both ways, uphill.  This quote is frequently attributed to grumpy grandfathers, but as a bit of history, was actually printed in a Tallahassee newspaper in 1956.  We've all heard this in some way, shape, or form, and now, on occasion, the senior intensivist  can be heard saying, back before the 80-hour work week, but the truth is, things have changed. Trainee time constraints are now shouldered by faculty.  The electronic medical record has its own challenges, and our electronic devices keep  us tethered to work and are increasingly difficult to turn off, which has introduced the concept of work-life balance, or lack thereof.  I start with a 2019 New York Times article about how medicine became the stealth family-friendly profession.  The article begins with Dr. Brittany Hebert, who was a chief resident in internal medicine married to another physician.  She planned a fellowship in medical oncology, and her husband was planning a radiology fellowship.  When she learned she was pregnant with twins, she chose to change her career track to geriatrics.  The article goes on to say how medicine is incredibly flexible in a time where employers are expecting an increased amount of time.  Sounds great, but Dr. Hebert estimates she halved her lifetime earnings, and that she made sacrifices, likely not only monetary, but academic as well.  There were over 750 comments on the article, the overwhelming majority of which were not in agreement with the sentiment.  But that said, how do you make the field of pediatric critical care medicine one in which people seek, not just for women, but for all trainees making career decisions?  It is well known in our profession that women choose specialties with fewer hours in the pursuit of work-life balance.  As you can see in this New York Times infographic, 70% of women are pediatricians, and only obstetrics and gynecology have a higher percentage of women in their ranks.  Very few women become orthopedic or cardiovascular surgeons, which are certainly higher-paying specialties than pediatrics.  The number of hours works seems to be a driving force, but at what cost? And does it have to be that way?  We discuss work-life balance a great deal in the context of preventing burnout. But what does work-life balance mean in academics and career progression?  I'm here today to convince you that optimizing work-life balance should not only be a hindrance  to academic success, but also imperative to ensure the future of critical care medicine. The MacMillan Dictionary has a definition of work-life balance, which is the amount  of time you spend doing your job compared with the amount of time you spend with your family doing things you enjoy. Seems intuitive.  A Google search of work-life balance resulted in over 1.7 billion hits in 0.63 seconds. A PubMed search generated 3,385 results, with an exponential rise in publications over the  last 15 years. Do other professions have work-life balance figured out? I look at four different professions here.  Attorneys all focus on the billable hour, and those hours can happen at all times of day or night.  Billing is seen as value to firms, and there is an undertone of the more you bill, the more valuable you are to the firm.  More than 10% of female attorneys work part-time, and most attorneys do not take all their vacation days. What about hospital CEOs? Most of them work more than 60 hours a week.  The turnover rate amongst healthcare CEOs is about 20%, and one only has to glance at Becker's Hospital Review to see how frequently jobs change. And what about women?  Fewer than 25% of healthcare CEOs are women. Let's move on to NFL head coaches. A few years ago, ESPN published the typical week of an NFL coach.  Their day usually starts at 6 a.m. and ends at least at 10 p.m., sometimes later. That coach sleeps in his office two to three days per week, which rivals in-house call.  Now maybe sleeping in one's office doesn't equate life-and-death situations, but the average tenure with an organization for an NFL coach is less than four years.  Finally, what about Google? The company seems to be the panacea for work-life balance, with free food and nap pods and ping-pong tables.  But interestingly, 70% of Google employees say work-life separation is challenging. Google has responded by creating a Framingham-like study in which questionnaires are distributed  to Google employees twice a year. Thus far, they've found that there are segmenters, about 30% of their ranks, who are more effective  at separating work and life, while work looms large for the integrators. I suspect we will learn more from Google and their gDNA studies in years to come.  What are your colleagues and future colleagues saying? In 2017, Frontiers in Pediatrics published a collection of work from 22 authors devoted  specifically to the topic of work-life balance. The 26 articles were divided by phase of career, trainees, junior and senior faculty.  The overarching theme amongst trainees was one of recognition. They recognized the needs for debriefs, assigning priorities, and acknowledgment that change was ahead.  Junior faculty discussed ways in which to promote well-being, the concept of moral distress, and in particular, my former fellow, Dr. Arun Saini, discussed the importance of setting  and reassessing priorities. The senior faculty focused on acceptance, that balance is not equal, sometimes an illusion, and that finding resiliency is important.  So what to make of all this? Work-life balance is discussed, important, and may not look the same for everyone, which  is why you need to think about this as leaders and to continue to attract the best and brightest to the field. And this is why.  This slide illustrates the number of first-year pediatric subspecialty fellows from 2003 on. You can see that the specialties with the greatest growth are pediatric critical care  medicine, pediatric emergency medicine, neonatology, pediatric hematology-oncology, and pediatric gastroenterology.  These specialties, along with pediatric cardiologies, comprise what are considered the procedural-based specialties.  In critical care medicine, 2010 marked a sustained increase in the number of the women who matched in the discipline. But this growth is not sustained.  Women are leaving the ranks at every academic level. This slide shows the number of women certified in pediatric critical care medicine by age.  In the 30s, 62% of women comprise the workforce in pediatric critical care medicine, which decreases to 47% in their 40s, 38% in their 50s, and 26% when they are over 60.  This represents a 58% reduction in women comprising the pediatric critical care medicine workforce.  Men also have attrition, but their departures are relatively stable by comparison. This is also seen in pediatric cardiology with a reduction of 43%, neonatology 34%,  emergency medicine 33%, gastroenterology 59%, and hematology-oncology 38%. This is a significant reduction in the workforce, and the biggest departure seems to be between  the 30s and 40s. This is when people have young families, and when they realize the specialty they chose for work-life balance, like Dr. Hebert did, is not sustainable.  It is imperative that you find ways to prevent this attrition from happening. It goes beyond sustaining the workforce.  People who leave pediatric critical care medicine cannot become leaders in their chosen field of interest.  People who leave critical care medicine are not present as role models for trainees to show them the challenges and rewards of what we do every day.  I challenge you to create the standard in harmonizing academic success with personal pursuits. Attracting the best starts with you. Find ways to support their areas of interest.  Invest in your faculty. It doesn't have to be expensive. Teach people time management. Share your epic templates and ways you've learned efficiency over the years.  Lobby to put your faculty in positions of leadership. Learn about your faculty, what their interests are, and support them. In terms of life, model the behavior.  Support programs at the institutional level that support better child care. Get or renew a hobby. Get some sleep. Exercise more.  This doesn't just apply to women or men or people with children or people with dogs. Not every woman wants to do school pickup every day, and not every junior faculty member  wants to spend their weekends in the lab. If people aren't happy with life, they won't be productive at work. Then no one wins.  As Steve Jobs said, innovation distinguishes between a leader and a follower. Create the standard for the future.  In closing, I would like to thank all my co-contributors to this session, Lara, Paul, Adrian, and Bob.  Special thanks to Lara for designing and seeing this project to fruition, and to Paul, thank you for the many discussions from both near and far that have kept me going on some of  the toughest days. I'd also like to thank my colleagues at WashU, including Julie Bubeck-Wordenberg, my division chief.  She is the first person to climb up a hill when she asks us to go. She's also introduced me to orchids while I encourage her running.  I'd also like to thank my fellows and partners, both past and present. I've had the good fortune to work with such outstanding people, and for that I am incredibly grateful.  Finally, a big thank you to my family. My husband is a trauma surgeon. I have a teenage daughter and a pandemic puppy.  Most days we epitomize the complete lack of work-life balance, but we're working on it, and that's all you can do.  Thank you, Lara and Nicoletta, for inviting me to join this impressive panel to discuss this important issue. It's a great pleasure and an honor.  I'm not sure that it's quite as exciting to have the title that Lara gave me, which is May the Best Person Win.  It's a little bit intimidating, but I want to try and address this issue for you, the next generation of pediatric critical care medicine leaders.  The goals over the next few minutes is to discuss a little bit about leadership in academic medicine, how leaders are chosen, approaches to increase gender diversity, and how you  can prepare to be a leader. The basis for my perspectives are my experiences. I spent decades on the faculty at a mid-sized school of medicine, the University of Arizona,  and the last decade plus at the University of Pennsylvania in the Children's Hospital of Philadelphia.  I've had these various roles as listed here, but I think most importantly, I've been the  chair of many American Heart Association and ill core committees and a critical care medicine sub-board member of the American Board of Pediatrics, in which we've had a great deal  to do with inviting the new members and the new chairs of those committees. I've also been a chair or a member of numerous division chief, department head, and dean  search committees at both this mid-level and large institution. First of all, I want to mention something from Simone's Maxim.  Simone has some famous maxims on understanding academic medical centers, and one of them was that leadership does matter.  Clear vision, being fair, being transparent, providing clear expectations do in fact matter. Further on, he mentions that attitude and team compatibility are grossly underestimated.  In this discussion on leadership, Dr. Simone mentions that leaders are often chosen primarily for characteristics of little or no correlation with a successful tenure as a leader.  Long bibliography, scientific eminence, institutional longevity, ready availability, willingness to not rock the boat, and willingness to accept inadequate resources.  When I came into medicine, the traditional expectations of leaders were to be number one leader and number two manager.  Under that rubric of leader, frequently they were looking for a symbol. The department, the division, or the school of medicine wanted a symbol for them as excellence,  and so therefore star power was preferred, and scholarly excellence was at the top. They wanted somebody who was going to be a strategic planner for that group.  But most importantly, the person that chose them wanted that person to be a trusted member of their leadership team.  But they also needed managers, and that leader serves a management role as well, in terms  of managing resources, people, money, space, in critical care in particular, managing clinical operations and patient care, recruiting, and dealing with the inevitable HR issues  that happen whenever you have more than a handful of people together you're managing.  Over the last 10 to 20 years, there have been a real increase in what the leadership expectations have been.  Now the expectations is that the leader was going to provide inspiration, be a mentor,  a sponsor, and a coach for that group, establish and nurture team culture, be a master collaborator,  delegate responsibilities in order to nurture growth of others, advocate for team and individuals,  and be what I will call a caring cheerleader, thereby recognize the achievements of the many people you're leading.  These and a whole other set of things are included under the rubric of the now critically important issue of emotional intelligence is recognized as being a necessary element  for excellent leaders. And I must say that all of these changes have been driven by political and social cultural  demands of both the groups that are being led and the choosers that want to bring new leaders and their leadership team and have the team be most effective.  While we've learned a lot of things during the COVID pandemic, among them is what leadership characteristics are particularly highlighted as important during a pandemic, the ability  to pivot, communication skills in a timely and effective manner, ability to provide calm in the storm, humility, and perhaps above all, resilience.  I'm going to switch gears a little bit and talk a little bit about leadership choices. Everybody on this panel believes that they were chosen in an objective and fair manner,  and we believe that we choose everybody else in an objective and fair manner.  But I want to say that although it's intended to be objective and fair, all leadership choices  are inherently subjective, political, social, cultural, and personal choices with inherent conscious and unconscious biases.  My experience is there are two very different forms of leadership searches. The informal sort, for example, if you're a chair of a national committee, frequently  the chair chooses the next member and often chooses the chair-elect. Usually it's done with committee input, sometimes with a vote, sometimes it's  done with just a council of a couple of members of the committee. At a smaller university, like the University of Arizona where I was, the department chair  chooses the next division chief, oftentimes with input from other department leaders, but sometimes not. They often choose the next in line. Personal and political implications  are at the forefront. In contrast, a bigger place, like the University of Pennsylvania or the Children's Hospital of Philadelphia, have very formal leadership searches.  Frequently, the search committee chair is the lead of it all, plus minus a headhunter firm. And they initiate the effort based on criteria  from the chooser, the chair, the dean, or the board that is going to ultimately choose this new leader. And their first pass on who to include for the selection  or the final interviews is based on metrics, reputation, and the story that the individual puts forth for themselves. Not surprisingly, publications, grants, and successful mentees  are the easiest to measure, but also highly considered are leadership and management successes and training. Diversity is always mentioned, but typically  considered among, quote unquote, comparable candidates. Most committees favor candidates who will make the team better rather than candidates  who will have star power only, but not all of them. I think a little surprising to some people is that the search committee does not include faculty from the division or department  that they are going to lead in most circumstances because of potential conflicts of interest.  I want to emphasize that the final choices by the choosers, the chair, the dean, or the board, are inherently personal, and they depend greatly on how much they trust that person.  I'm going to switch gears a little bit and talk about women in medicine because that's what this panel is about. In 2017, the national statistics show  that 51% of first-year students were women and still are. 72% of pediatric residents were women and still approximately that amount are. 41% of medical school faculty are women,  yet only 18% of department chairs and 17% of deans are women. I think it's notable that greater than 40% of medical students for the last 20 years  have been women, suggesting that the lack of department chairs and deans is not just simply a pipeline issue, as mentioned by Dr. Nancy Spector  in this terrific article on pediatrics and by the data from the AAMC.  Well, why are we focusing on this panel on diversity, equity, and inclusion, particularly with women? I think everybody's heard the quote that every system is perfect for women.  Everybody's heard the quote that every system is perfectly designed to get the results it gets. And it's true. Thus, changes are required. Intentional, personal, political,  and social-cultural interventions of those changes don't occur. But we must be humble enough to acknowledge that fair is in the eye of the beholder  and absolute fairness is not attainable.  Dr. Nancy Spector is the Director of the Executive Leadership in Academic Medicine Program for Women, the famous e-lab program at Drexel University that is used  as a national leadership opportunity for women across America in academics. Dr. Spector wrote this terrific article on pediatrics. I recommend everybody in this panel  that's interested read on women in pediatrics progress barriers and opportunities for equity, diversity, and inclusion. And she and other women leaders in academic medicine  have come up with this equity, diversity, and inclusion cycle, a strategic approach that they have used very effectively. Number one, examine equity, diversity, and inclusion data.  Number two, transparently report results to stakeholders. Investigate the causality. Implement strategic interventions. Implement strategic interventions.  Track outcomes and adjust strategies. Publish and disseminate results. And then go through the virtuous cycle again and again. And these have resulted in effective changes  in academic medicine. When I started out in medicine, we all learned about a career ladder, going from assistant to associate to full to division chief to chair  to dean with fewer people at each level in the cycle. But I want to say to you that you should consider the pros and cons for yourself. What is your why?  Do you want to be a clinical leader, a medical director, a CMO, a quality improvement leader? Do you want to be an academic leader, lead a research  program, a center director, division chief, fellowship director, DIO, dean? These are very different tracks, CSO, department chair, that should differ amongst you.  And some of you may not want to be leaders. I want to tell you that your why today is not your why tomorrow. That will develop over time.  Well, who are the people in this audience right here? Many of you are young academic faculty, 30-somethings. And you have a lot of typical stressors, like plus-one relationships.  Do you have one? Why in? Stress either way. Marriage issues. Yes, no? Doesn't make a difference. It's stress either way. Do you have children? Yes, no? Either way, very stressful.  Career development issues, the omnipresent imposter syndrome. Trying to become an outstanding clinician like your mentors, stressful. Trying to become an exemplary researcher,  an exemplary teacher, a clinical operations leader as a young faculty member, all of them very stressful. Remember to walk before you run. Focus on these issues first.  Well, with that in the background as you start, you can start thinking about leadership preparation in your next phase.  Seek leadership opportunities in your focused area of interest. Seek opportunities to be on local and national committees or programs.  And when you get an opportunity, do a great job. Get informal training. As Yogi Berra said, you can see a lot just by watching. See the positive controls and negative controls  and what you can incorporate in your armamentarium. Seek mentors to help with career counseling. Cultivate relationships with leaders and mentors. They are your future sponsors.  Get formal training. Local and national leadership training programs abound. For all of you that know me, I always like to finish with some positive comments.  These are data from Michael Agus, the Pediatric Critical Care Chiefs Network, the PC3N that he developed, include division chiefs and or their designated medical directors.  Of those 184 leaders, 40% are women. I'm also proud to say that women leaders in the Federation of Pediatric Organizations, these major organizations  that you see on the slide, over half of the members are now women. And three of the eight presidents or president equivalents are women.  And I'm very proud to say at the University of Pennsylvania at our Children's Hospital of Philadelphia, four of the six critical care medicine full professors are women.  And I want to congratulate Daniela Davis, Margaret Priestley, Athena Zuppa, and Wynne Morrison on their achievements. Finally, leadership is important.  Our future depends on great leadership. The choice of leaders is political, social, cultural, and personal. You have agency in this process.  Be your best self as clinicians, teachers, and academics. Seek leadership opportunities. Cultivate mentor-mentee relationships. Get formal training.  And your leadership goals should focus on your why and change over time. And most importantly, don't lose sight of balance. Thank you very much for including me in this panel.  Thank you for giving me this opportunity to talk about gender equity in pediatric critical care medicine research. I'm Adrienne Randolph, a senior associate  in critical care at Boston Children's and a professor of anesthesia and pediatrics at Harvard Medical School. I would like to first share a bit of my own journey  in what I felt were keys to my success in pediatric critical care research, the importance of mentors, sponsors, the important role of research  networks in supporting women, and then also talk a bit of talk about gender disparities and representations on guidelines and panels  and how, going forward, we can advance gender equity in pediatric critical care medicine. So my first mentor who started mentoring me in medical school  was Gene Washington, who I was doing research with as a medical student, a resident, and a pediatric critical care fellow.  He later became dean at UCLA and at Duke University Medical System. And we published quite a few papers together. And I really attribute a lot of my success  to his major mentorship at the time. And what he did also later on in life was become a sponsor, giving me opportunities for things that I otherwise would not have.  So there's a real difference between mentors and sponsors. And going throughout my whole journey of pediatric critical care, I really was very dependent on constantly  connecting with different mentors. I also, early on, learned the value of networking. There was a pick-you-list server that I was one of the very first people on.  And through that, I did this survey of pediatric critical care beds and characteristics at the time in the United States. And I got connected to every pediatric intensivist  pretty much in the United States that way. And I also did some research through this network on the pick-you-list serve, as well as published this paper  that was about what was the status of piece critical care. The next thing I did is connect with the evidence-based medicine working group.  And those individuals was another key network of all of these different people who were working on the user's guides to medical literature,  evidence-based medicine critical appraisal. And I even was given the opportunity to write one of the different beyond the different guidelines  for critical care and network with a lot of different individuals. Most of these mentors were all men, and except for Deborah Cook, who was at the time  head of Canadian Critical Care Trials Group and was hugely influential to me in my journey going forward in pediatric critical care and networking.  And we published a lot of different meta-analyses and articles together. And she was a very key individual in helping me with my research career.  I also got a medical informatics degree and had mentorship from individuals at University of Utah. And then I had quite a bit of trouble,  actually, after all of this training and mentoring and networking, when I first started out, getting my initial funding from NIH for being able to put all this training together  and do randomized trials. Luckily, I was able to get some funding from, of all places, Ronald McDonald House Charities to do my first randomized trial.  So after networking with all these different people, bringing it all together, I was able to do a randomized trial of the effective mechanical ventilator weaning protocols  that was published in JAMA. Surprising, most of all of the different site principal investigators and people that I networked with were actually, again, men who were at the time  that I was working with. I was relatively young, a very junior faculty member. And at the same time, I was also having my first child. And my personal life was also very busy.  But actually, this group of these 10 centers was key in building a network, a research network that called the Pediatric Acute Lung Injury and Septic Investigators Network,  where these two individuals joined with my people from my trial on weaning and extubation, and we had the first PoliciNetwork meeting. It was in Stowe, Vermont, in 2002.  And at that time, we had 40 people come from 25 hospitals. This was really important, and this is the first time a lot of young women came to this meeting,  a lot of young female attendings. And at the time, my network of young female attendings and people with families was growing, and that became very, very important to the future  of both the network and my career because as the PoliciNetwork grew bigger and bigger and bigger, it turns out that most of these site PIs  were women at most of these different sites who were helping to run the trials. And the PoliciNetwork now has over 80 different sites and hundreds of investigators.  But when it started, I remember bringing my daughter to the meeting, and at the time, not very many women brought their children to the meetings, but I was a single parent,  and I'd been away from her all day running this meeting. And I remember bringing her to the reception, and I remember somebody making a comment to me,  why would you bring a baby to a reception? But it turns out that this was really, really important because over time, both young women and men  brought their kids to the policy meetings. We had them at ski lodges and other fun places, and the children would make friendships. And so this was a really great way  to combine both research and family, which if there is a potential to do that, that's really, really important to take that opportunity.  I also collaborated with other networks like the ARDSNet, who all of these mentors were very key in helping us design robust research. Again, they were all these mentors.  A lot of them were men, but they were very, very supportive to my career. We did publish these Pediatric Sepsis Consensus Conference Guidelines as well, the definition of sepsis,  and started collaborating more on the sepsis area. And at the time, as I moved into this other area of research, my family was growing bigger, and things were getting very busy.  But it was really still hard to get NIH funding, so eventually I did get a K23 grant going on more traditional track of funding, and my mentor, Scott Weiss,  was very, very helpful and supportive, and I focused the rest of my research on genetic susceptibility to severe infections. And my family kept growing,  and it was the subnetworks that we grew off the Polisi network, which I have to say is most of these people that I was working with, a lot, lot of them are women and men,  probably about half and half of site leaders, but research coordinators, everyone. There's a very, very large group, and we've been doing very successful research studies  with now COVID after first focusing on flu, and we have a lot of different sites in this network. And it's been really, really a great opportunity for people to collaborate,  do things somewhat on their own time, and I think this type of research networking is very, very supportive of women with young families and men as well,  but it can really help overcome some of the gender disparities that had existed as far as opportunities by creating more and more opportunities for people to succeed  and be flexible as they raise their families. So I just want to say that a lot of the networking and the people that I had collaborations with in the evidence-based medicine area,  sepsis area, ARDS area, everything wasn't going completely smoothly when, you know, in 2016, you know, these guidelines came out, and it was very much noted  that there was no women on the guideline. This was the new definition of sepsis, and there was not one woman represented here, despite the fact on the JAMA website  they're claiming that there's an interdisciplinary representative. There was not. At the time, a lot was coming out about mannels.  This panel here, as you see, says the Summit on Women. All of them in there, all the people on the panel are men, and then there started to be websites,  all-male panels, and they put... This was the signal of the all-male panel that they put on different things, and they would now tweet them, and it became very much a no-no  to have these all-male panels, and multiple websites came up. This one on Tumblr has 200 all-male panels where clearly there's women who could be experts in the area.  There was another one on fertility where there's no women representation, and so one thing that's coming up now on these mannels is that people need to say no,  including people who are invited to these all-male panels, to try to stop some of this and improve the diversity in medicine. It's also very much important to,  you know, in the area of sepsis, to speak out, so this group spoke out of all mostly women, some men as well, that it wasn't okay, these surviving sepsis guidelines.  They actually looked at multiple guidelines. They looked at 413 guidelines from 2012 to 16, and only 13% of the guideline authors were female physicians  where 50% of the critical care workforce was females, so one thing that has changed in critical care is now, you know, people are,  women are speaking out when some of these things happen, that they're cut out of leadership positions, presenting on these very important panels  that frame the research agenda going forward, that frame how different syndromes are defined. They pointed out that even the Berlin definition didn't have any female physicians  on the Berlin definition of ARDS either, so both ARDS and sepsis in our field, it's very important to have representativeness of women on these different panels,  and luckily the, you know, Society of Critical Care Medicine, well, you know, clearly this is very unlikely to be a random effect, and is it possible, you know,  in this paper that was written, they brought up, is it possible that assertive or opinionated women were intentionally left out of these panels,  and is there, are there gender expectations that women have to meet to, in order to be invited? Is that part of the problem? So, you know, SCCM has taken, addressed some of this.  In this gender parity in critical care medicine article, they talked about the importance of societies establishing and enforcing diversity policies,  that the authors document in journals report principles and methods of panel composition, that the publicly available metrics of women's representation on panels be put in,  that it be addressed in bylaws of all critical care organizations, and that there be training on unconscious bias and diversity. That's really important. SCCM has addressed this.  It is in the bylaws. They took it on in 2017, created a diversity committee, and a diversity statement was published, and the Pediatric Critical Care Medicine  Surviving Sepsis Guidelines did have a very diverse task force, not only women and men, but also middle-income countries represented and underrepresented in medicine, individuals.  So, you know, this is very, their progress has been made. Now that my children are much older, you know, I'm in a different phase of my life,  and I spend a lot of my time mentoring younger individuals in their research careers a lot, and it's very important to give back  for those people who are in that stage of their career to mentor and sponsor in order to overcome the disparities in gender representation.  So thank you very much for letting me share a bit of my personal journey, and now I will take any questions.  Thanks everybody and welcome to the live chat. Just before we start talking I'd like to just thank José Díaz-Gómez who's on the program committee at ACCM for believing in us when  we proposed this session to him. So thanks José, hopefully this lived up to your expectations.  Really enjoyed listening to the talks and looking forward to a discussion. I'm just going to give a  couple of facts that have come out of the chat that I was wondering about myself and  one relates to there was a question asked about the proportion of women and men attending this  specific session. I think that data will come out after the conference as a whole but probably not drilled down to individual sessions. There was also one comment from Laurence  which is important. In my talk I mentioned the kind of evolution of or lack of it for some  meetings I guess of male-female proportions at international conferences and Laurence pointed  out that the data which is fantastic this year, the 50th year of ACCM, we are at 60% female speakers for this congress which is amazing. If you'll remember it was kind of in the 30s  back in 2016 so that's really wonderful and hopefully I'll use that as a new benchmark.  So I am going to look at the chat here. There are kind of a couple of questions that really  speak to the work-life balance theme. I'm going to ask Nikki to talk about it first off. How do  we get our employers and I guess that means our chiefs, our bosses, our chairs to kind of  talk, walk the walk not just talk to the talk. Nikki maybe you can kick off and of course  everybody, we all know each other so this should be relatively informal. I mean I think you know  much like I said in the presentation people have to be willing to you know model the behavior. I mean if you're not getting sleep, if you're not doing things that you enjoy,  why would your faculty believe that? You know much like the attorneys,  you know they perceive you know many attorneys perceive their value to be how much they bill  right like if it's if the message is your value is showing up to work and I'm going to do the same  that's how people are going to feel but you know if as leaders you know you have hobbies, you do things, you try to say this is my family, these are the fun things that I do,  then that makes it okay for those to follow and so that's what I think.  Absolutely so kind of leading by example is really important and the only reason I'm in my office today is that because I don't trust my home network for something so important.  My dog is too loud so that's why I'm here. And the dog and the Amazon man, yes our delivery man. Adrienne what about you and then we'll kind of open it up to everybody.  I think that it's so important that you know division chiefs and leaders really are flexible  in designing you know their career paths for people because at different stages people need  different things and I remember when I you know when my children were young and all of a sudden  we implemented a sick call system where being a single parent it's not easy to find a babysitter  emergently if somebody calls in sick and I'm supposed to cover you know so I offered well  I'll do a lot of extra nights of call but it needs to be scheduled so I can get a babysitter you know but it was very problematic and that everybody had to be treated equally  and have the same thing but that's really not realistic and I think as  people have different stages of their life they need different things. My kids are older I need  different things now I don't have the same issues when people have very young children they  they have completely different issues it's very hard to juggle things their children get ill they  need flexibility and they may need to work part-time and then come back in later one of my  most the one of the women I respect a lot named Jane Neuberger some people may know her a  cardiologist she's a Kawasaki disease expert who you know she told me years ago that you know  she worked did her research and worked part-time on her clinical and you know then later you can  always work more full-time on your on clinical which she does she works harder than anybody I  know but she but you have to be flexible and give people when their children are young I think  different options. Thank you. Yeah I wonder if what we're going to see now is the pendulum swings after everybody's been remote for most of this year and how I'm sure we've all had  the experience where it was sort of frowned upon if you left the the office when you're not on  clinical service you know a few minutes before 5 p.m. everybody sort of noticed back in the day  and now we'll see how that plays out where people realize wait a minute I can actually be productive  at home and get things done and what that's really going to look like of course I personally and  everybody on this this panel knows I personally would much rather be around people than stuck  at home and so I gained that strength of being in the office but I think we're entering a new  dynamic of what it means to be balanced in in the emerging as we emerge from the pandemic.  Absolutely Bob did you have anything to add? So I'm confused about this whole discussion so first  of all I have no idea what balance is like nobody that knows me thinks I have any balance whatsoever  but I am a happy person it's I'm even answering my daughter's home calls right now but I'm a happy  person and I don't think I think that the flexibility that Adrian talked about is more  important than what the modeling of I should be I am not a model for a 30 year old and I shouldn't  be and I don't have young kids right now I was different at that time but I should be flexible  and I think there's lots of opportunities I don't think that leaving the office early means you're  doing less work at least not among the faculty I'm around they're all gunners they want to get  a lot of stuff done and they find out how to do it most effectively in an integrated fashion with  their lives with their choices and I think that openness about different possibilities has to be left with people some people would not feel good working less and getting less done  other people will and I think they're that you have to look at what it what is where the goals and what kinds of people you want in your program what do they want when they're done  and help support them in many different ways and I gotta tell you it's all very confusing to me  I love that I mean it is confusing and I think probably we are all at a certain stage where I  think you're absolutely right Bob I would hate anyone to go through what I went to when I was  doing research in the early 90s at you know in the middle of the night small hours of the morning  like Adrian described a little later and it's but I think it's important for people to realize it's  okay to have to do that or not to be expected to do that I think when I came into this job here 10 years ago I used to kind of see there might be some of my colleagues on me in the  audience walking around like zombies at four o'clock in the afternoon after they'd done a night of call having been in the hospital all day the previous day you know the 30 hours  exactly and I'd come from you know Australia where we transitioned to a real shift system  and I had to spell out that it was okay to go home in the morning and that the world wouldn't  stop without you and that we have administrative assistants who can actually organize a diary and  it was kind of revolutionary of course you have to do it yourself so are the scene but it it slowly  slowly made made a difference but it takes time and you have to develop the trust obviously as a  leader but I would just throw in thank god we have changed in that manner over the lot but but a lot  of it changed because there were two and three people covering units and five and six and if you  left the place fell apart that was then this is now it's a different world that's right  I'm just scrolling through the um there was a specific question to me but I would open it out  to others because I did show that slide that you know we're almost 50 50 and actually in the  cardiac ICU we have more than half of our attendings are female um how did we get there I  it wasn't conscious um we do have a reputation certainly when we interview people at fellowship  certainly when we interview people at fellowship and attending level that um you know we're very  very very diverse section in every shape or form everything goes in our section but I am sure we  are not unique and it's truly not a conscious thing we have done but I think that is how we've  evolved and Paul's probably kind of seen it happen he's been here nearly as long as me but I'd be  curious as to the rest of you because I know that you know we're not the only team where we're kind  of pretty close to half females half women and half men um what about the others and it's probably  the nature of the fact that 70 percent of our trade 60 something percent of our trainees in  our female we've had nearly fully female fellowship years in the last couple of years what about others  I think um we have uh you know I think uh the ratios um in our institution and and a lot of  the institutions that I know are also half and half but one thing I still see is in a gap is  what you mentioned that the clinical directors and sort of the managerial roles um tend to be  led by women and the the I think it's um less common to see uh division chiefs who are women  or having key leadership roles on the departmental level or in hospital leadership um roles so that  is still I think even though the numbers are even the roles are not necessarily even  yeah I agree and um I think one of the things that I think we've probably all struggle with a  little in our own teams is is getting up that kind of um academic ladder because you know you will not  get beyond uh in our institution a medical director level if you're not at least an associate  professor for example I'd be curious maybe Bob um you can speak to how you've been able to Bob um you can speak to how you encourage promotion in your own place I mean I think  having a four out of six of your four professors being females fantastic I think many of us would  try this but would love to aspire to that well I would start by saying that that we 100 of our  division chiefs are males I'm just teasing it's a bad sense of humor but we have a group when I came  there were a great group of women leaders in fact when I came um there was uh being on myself  and about four women that were leaders in the place or so um that were senior and and they've  all done very well they've done great so I'm not sure that I want to say that there was um thoughtful  about who was going to be the leaders it was it was perforce the people they were just amazing people that was uh so that's partly how it happened in our place the same thing in the  residence in our place when you have 60 or 70 percent of your residents of Children's Hospital  Philadelphia and at Boston Children's Hospital and Texas Children's Hospital that are coming by  you can't help but have a whole lot of very competent women applying for fellowship programs  um so and I it's funny when you ask what the percentage I actually don't have a clue what the percentage of women on our faculty are um it's more than it's it's more than a third it  might be more than half I don't actually know um and I um but I do know that in terms of leadership  the force of the people is what drives them in leadership and most of our faculty have found in  one way or another to be leaders in something some of them are national organizations and are  not leaders in local things some of them are leaders in the local things um some people have  chosen um management and uh and um when I would say that is in the operations quality improvement  uh um hospital management kind of areas that may well end up being CMO COOs and CEOs over time  but I'm not sure that I would say that that that I would um uh include that as lower or higher it's  just different I I find that there's an awful lot of people who want to be leaders in our group once  they get past their first if they survive their 30s uh with all the other struggles uh I think  that most people choose to be leaders of various sorts and they find ways to do it in a multitude  of ways. Thanks Bob there's a reference here from one of our chat members probably not a question  but it's a really important thing I think to throw out there and I'm it was I think it was  Adrienne who who made the um note in her talk about the imposter syndrome and um a comment about  the alliance for women in medicine and science helped this individual um get promoted to full professor despite uh less not not a great enthusiasm from her own institutional chair  so that might be just something to take away but I think the imposter syndrome or phenomenon is  is an incredibly important thing for everybody to know about not not just about gender but about all  sorts of kind of aspects of um of how we perceive ourselves I guess in our own environment. I'm  going to throw a question to Adrienne specifically that just occurred to me when when you were  talking how do you pitch assuming that the approach is different the new generation are  not going to want to kind of do what we did 20 years ago how do you pitch a research career to  a budding young individual whether they're male or female? I think that uh you know that's a really  good question because um I think one thing that that uh I think honestly is doing a disservice  to um young individuals is is the hours limits for clinical time um sometimes people try to  extrapolate that which is very important for being tired for doing the right thing etc is very as I'm  not saying that we shouldn't have hours limits for clinical time but trying to put those hours limits  and having certain hours of the day that you're going to do your research and say that I'm going  to do it you know eight to four and I'm going to my evenings are my own and I'm going to be off  every weekend. I mean I don't know one researcher that I've ever met who's successful who doesn't  have the flexibility to integrate it like Bob had a lot of good advice there about integrating it  with your life constantly into you know answering your phone talking while you're making dinner  um on you know um email is a great uh connector and way to follow up on things and and most people  I know work you know weekends etc and and being flexible so I do think that that the mindset has  to be that that um you know you do whatever it takes to get it done but it also takes sort of  a burning desire that you love research and I think it's our job to turn these people on to  these opportunities and give them opportunities and with once they get their first success in  their first publication um and they learn the ropes I think that's the way to um to get them  connected. Laura I'm very impressed that there's some people that do research at our place that  that separate completely their work and their personal lives and they protect themselves  incredibly well uh and and they feel comfortable there and there's other people that say that  doesn't protect me that doesn't make sense I think there's wide variability about how people  what they can integrate and what they have to keep separate some people that have an obsessive  compulsive ability to to stay in boxes that are phenomenal and they protect themselves that way  and other people that feel very um off balance with trying to do that and uh I just think there's  a lot of ways of doing things but in terms of exciting people about doing research oh man that's  the easiest thing in the world to do there it's just there's so much good that can come out of it  but uh that's another time um what about there's a question here it's very specific do you think  we should change our practice to make it more attractive to female intensivists if so which  changes um I mean I I think our in the clinical realm our our specialty is pretty attractive  because I mean it naturally builds in the ability to have a life outside to have family time you  work incredibly hard when you're in service we don't most of us don't do clinics um and we have  a we have a good deal of non-clinical time certainly in academic institutions um what do other people think I mean I I think we are probably ahead we're well ahead probably of  adult intensive care in that in that um in that way and when you look at the number of people  entering pediatric critical care training versus adult it's kind of pretty static on the adult  front whereas ours is is at least uh double the proportion um any comments from the group  maybe nick you start I mean I think a big part of it is that if we want to eventually retire  we have to find people that are interested and I think the only way you can do that is to show  you love what you do and if you don't love what you do you're going to be miserable and your people  will see that and the only way we again eventually I want to retire um but if they see us productive  happy in positions of leadership not even just women men too to it to have people be interested  in our field be it clinical be it research-based we have to show them that we're happy and you know  bob you said you're happy you say you have no work but as long as you're happy that's okay right  I hope so you know as that's the thing is happy people are productive so I think we have to show  that even though we work really hard on service we are able to do other things and this is why  it works for us and I would say that that what maybe what you just said is exactly it because  this then really strips away the gender issue and it's more about um humane right I think that  people will be attracted into critical care medicine and pediatrics because of a humane way  of approaching what we do and I think we've all lived through times when uh that just wasn't the  case um and so if we do it then we get to actually as as leaders regardless of our gender we get to  be a little selfish and say no this is not the way we're going to set up the the schedule because  that's I don't like it either thank you, Paul. I'm going to change, it's impossible to do, to spend more than two hours  doing anything these days without talking about COVID unless we're asleep. So I'm going  to ask the group how, I think probably personally, how we have been impacted by COVID. Hopefully  we all got through it healthily ourselves, but in terms of, you know, did it impact our non-clinical productivity in a positive way, a negative way? And what about the kind of  personal aspect? I mean, I think for me as a leader, it's been like the most extraordinary kind of rollercoaster I've ever been through. And I, I've learned an awful lot. I think  there have been some good things and I would, but I would want never to go through something  like this again. I don't know that my productivity has changed, but for sure the hours I've worked  in the last year have gone up kind of extraordinarily. And again, I wouldn't wish that on most people,  but what about, what about others in the group, whether it's, you know, teaching, academic,  because our approach to everything has changed. I do believe that we have much better, this  is anecdotal, I guess, but certainly in our group, we have way better attendance at section meetings, educational research forums, et cetera, than we did pre-COVID. And I hope  some of the new practice and flexibility in where you join a meeting from changes even after it's behind us. So I'm going to throw it out. First come, first served.  I guess I'll say that it's, it's been an evolution almost like week to week. Right. And so whatever,  you know, I, I just remember being very much sort of thrown back on my heels early on and then gaining a sense of, okay, so now this is the way I'm going to become productive.  This is the way I'm going to engage. This is the way I'm going to go about academic life. So I think if you asked me this in June, it would be a different answer than in September.  And it's a different answer than it is today. And maybe that's the lesson to take out of all of it is that we have to be more facile and flexible.  Absolutely. Who else has comments? I think for me, one of the bigger struggles is we are a two physician household and trying, you know, with the inevitable increase in  both of our clinical schedules, I'm trying to manage virtual school. It's some of it unfortunately has fallen back to, you know, I will manage some of the stuff at home because  I can work from home, you know, I can attend conference from home. You know, so that, you know, while my spouse is, you know, doing more meetings at work and I, I think in the  short term, it's probably fine. But I, you know, as Paul alluded to, it's going to, it's going to change. I think trying to stay out of those, you know, certainly gender-based  roles, you know, saying, I don't want to be the one at home. You stay home this week and  I'm going to go into the office. But I think that's, that's sort of been, I think the biggest  struggle for me is, you know, how do you manage all the other things when you, you know, it  seems like when you're in survival mode, you go back to what has worked in the past and it may not necessarily be the right thing for everybody.  Thanks, Nikki. How about you, Adrienne, if we talk research? Yeah, I think that it has been a really exhausting experience for me just the not, I  mean, I have this, this study called overcoming COVID-19 and we had everything had to happen very fast. And, and it's just, you know, it's not winding down, if anything, it's  another grant and then another contract and then more things to do. And I think that all this opportunity is fantastic. But I worry that my people as well are getting burned out on.  You can't keep up that intensity forever. And people have very good will to jump in. We're  going to solve this, we're going to, but you know, week after week is very challenging. And  you have to be very selective about how you spend the time and what you're doing, what you agree to do, I think. And then it is what Nikki said as well about the, you know, family,  trying to deal with three teenagers at home, trying to do remote school. And, you know, my  mom got COVID on top of trying to run this study on my little laptop from my home desk. I feel  sometimes like I'm just the Wizard of Oz with this study of people really knew that I'm just  here with my laptop, you know, right, that they would, but it does show the power of Zoom and  the power of these prior relationships, how everybody banded together, which is, to me, very  inspirational, that all these people in our community are so willing to jump in and give up  their time and do this, to me, is so amazing, our community, so that sort of overcome some of the exhaustion.  I think it's been a crazy year in every way, shape and form. As leaders, we probably never  worked harder in our leadership roles, because people needed us more than ever before. That's, I  guess it's, it makes us feel good, because we wanted to do this, otherwise, we wouldn't be doing  it. But it's exhausting. Many, when we talk about work-life balance, most of us were on  conferences, conferences about what's going on clinically, and how to reestablish our clinical  programs daily for months, daily for months. So the idea of getting separate was crazy. At the  same time, there's been a, everybody says our productivity went way down. But actually, many of  you are on the on this call or on the Pediatric Critical Care Medicine Editorial Board, just 17%  increase in the number of manuscripts by the people in this audience sent in. People are working  hard. They're not just sitting at home. Grants have gone up substantially. And at the same time,  the what probably bothers me the most is the culture of our place is being undermined by the fact  that we're not around each other. We're, we're next to each other a lot on on our iPhones. And on  these zooms, we have what some people refer to as status zoomicus, but we don't have real life  connections with people in the same manner. And it's, I think some of the small talk, you know, what  they used to talk about in industry is talking by the cooler, we don't have any coolers around where  we are. But we certainly, we certainly would sit around and talk about things that were very  important in terms of our culture and who we are. And, and I see that being undermined. And I just  hope to God that it's not for too much longer that we have to hang on by our fingernails.  Um, Paul just texted me a provocative question, quote, unquote.  So just to you know, because I think we also there's only so much COVID we can we're gonna we  can talk about. Here's a provocative question for this panel. You're all department chairs. You're  all the sole decider of a job. Bob, you and I are about as privileged as they get on this panel in  terms of white men. What do people think about the statement that there should be an exclusion of  white men in the job process, prospects of a division chief, and you're the chair and you get to  say yes or no to that, that you would only take a female applicant for the job. Again, I purely provocative. Let's just hear what people say.  I'm not in favor of swinging in the opposite direction. I think, you know, as Bob's talk was  based on the right people, the best people have to get have the right opportunities. I think it's  encouraging the right women to take opportunities that they might not otherwise consider. And then if  you're in an everything else is equal scenario, then that may be the time to go for it if your  department needs a change or if a section would benefit from something different. I think it's not  fair to exclude from anything, because that's, that's exactly what what we've such a long way in, in  our field, at least in the last 10 to 20 years. But I know it was a provocative question. I know that's not what you believe, but it is a fair one. Absolutely.  But you know, I think the part that it skips is how important leadership is to the group and what kind of  people are applying for the position that would make sense for both the group that they're going to  lead. And then the part that I was sort of subtle about, but not so subtle as it's a personal choice by the  chooser, it actually doesn't make any difference what I think, it's going to be the person that's, you know,  the dean or the department head or whomever that's going to make the choice has to find somebody that  they feel comfortable with. And that's why I want the, the intent of that wasn't to scare people or to say  that we're unfair. But for, for the women in this audience, to think about how do I engender that trust  by, by my, by my CV rather than let's exclude a group. I do believe that there's that there has to be some  great attention to making up for issues in the past. But I, it's exclusionary, you got to think about the  end user, that that faculty needs to have a leader that's, that they can trust. And it's hard to come by good leaders. It just really is.  I think something to think about is making sure that there's equal representation on search committees. You  know, it's hard to bring anyone to the table. If your search committee looks like one thing. So I think that's  where you could definitely make a start is making sure that the people whose names get put up there include men, women, you know, every sort of balance.  That's a really important point. I'm on a committee locally, I would say whether it's Hospital College or Houston. And it's  very, there's a disproportionate number of men versus women. And I brought it to the committee's leader to say, hey, you  know, could we target and of course, you can't throw people off a committee, but the natural history or terms of office or  whatever. And I said, well, can we, can we, you know, aim for 50-50 over the next five years. And the response from the  person I took this to as well, let's, let's, we wouldn't do that because the current status of the pool that we're assessing  for A, B, or C is two thirds male, one third female. And I was kind of, I was a bit stumped because I, I still wasn't expecting that  response that I actually could, I said, well, why not aim for something? And, you know, what's the word? Just have a goal that we  can aspire to, let's aspire to it. And it was kind of met with a little bit of silence. But it's like, well, this is the way it is. So  we'll just continue with the way it is. It's kind of self-fulfilling.  Laura, every system is made perfectly to, to, to be exactly what it is. Its results are predictable. I'm so sorry.  Yeah, no, I think you put that better than I did. But that's so true. And I'm going to ask one quick one about journals and  authorship. Paul, you kind of did allude to it in your, as a, as a review, as I'm sorry, as an editor. Do you think there is scope for  editors to actually review and dissect out authors, contributors, and ever take that to, back to either the senior author or first author? Or is that just too intrusive?  Yeah, you know, and it actually sort of is exactly the same kind of commentary, just even about the job position. I really went down a  rabbit hole in preparing for this talk about the whole equity equality issue. And, you know, I don't know that I have an answer for  that. I don't know whether it's the right thing to say, let's just blind the gender of all the authors to the gender of all the  authors. There are some journals, I know, we've all been part of them that you don't even know who the authors are at all, right? I have  yet to dive into that data to say whether that's better, worse or indifferent, just from a scientific perspective. It is something I think  we're going to have to struggle with. And I think that there are lots of ways to approach the answer to it. I think from a  grassroots level, it does, if there's a little bit of pressure put on across the entire system, in other words, then the most senior author and  the funded investigator, if they look at that, their contributors, and they know that somebody's going to ask that question at some point, it  starts to move the bar just a little bit every single day with every interaction. But I don't know whether the journal reviewer  process should be the final wall that has to be broken. I'd rather just sort of get more grassroots to change it. So I'm going to not  answer it, I guess. But it's not easy. It's not easy.  I wonder about consensus statements, because it's not a clinical trial, or, you know, it's, you know, a local review. I mean, that could be a  way to go. Bob, Adrienne, what do you guys think?  I think that, you know, the, you know, things that I showed a bit about, you know, people saying, when you confront some of these  guidelines, or new consensus name of a, you know, new syndrome, or how to define it, and say, why weren't there any women on the panel? I  mean, someone said to my face, you know, oh, well, we couldn't, we looked and looked, we couldn't find any qualified women. And I think that,  and it's completely serious. And this is somebody who likes me a lot. And, and I, it could have pulled out five women that I could have given to  those panels easily. And so I think that somebody told me this, and I wish I knew who it was. But they made, you know, a list of  positions, but they made, and it could have been something for government, but they made books of qualified women in different things, when they were  looking for different leadership positions. And I think that it's really important that, instead of making these assumptions that there's no  qualified women, and often women are the ones who do know other women who are qualified, and we'll pull out, but men as well. But I think that  that, that it's important to have women connecting as well. But to be able to have books in these societies of different experts, and what is their  expertise, so people really can't say that, oh, I really couldn't find someone. Because once you start putting people on these panels, the  guidelines, they become prominent, they now become the person, the go to person, when you exclude them, you give the message that their, their work is  not important. And so I think it's really important for SCCM, as a society to really have lists of experts that people can go to for these. And, and  also, one thing about SCCM, I saw that there's a lot of female, it's not just about being female. Because SCCM, there's a lot of nurses, nursing is  also very prominent in leadership and talks, and there's a, and a lot of nursing is predominantly female. And so, but then I think it's, it's, the  balance is if there's all these male physicians, mostly female nurses, that's an issue too, in a society like SCCM. And, and so, you know, I think it's  not just female, or male, it's also, and, you know, underrepresented in medicine, as well, is very, we are not doing very well in leadership there, it needs to be  attended to. So it, these things are really challenging, but at least making it apparent as what people's expertise is in pushing them forward, I think is really important.  I completely agree. And we have a couple more minutes, questions I can see from the, from the audience, more specifics. Has anyone got a final question or comment from within?  It entered my head as I was listening to Adrienne, and I was talking about leadership. And she mentioned that women frequently know other women leaders. One thing you can do, you're excluded, you typically, from the group that's going to have the new  leader is typically excluded from being on the group, but they're not excluded from getting people to, from talking to people they know around the country to, to invite them to put up their CV, and take the chance to look for the  position. That's the kind of advocacy that's needed. Similarly, I, and it's different advocacy in different kinds of places. For a place like the Society of Critical Care Medicine, there's so many women leaders that are in the  organization. When we have policy statements, having women that are part of the group that's going to have, that's going to put out the bid for having a white paper on sepsis, or a white paper on guidelines. If you're in broad organizations, having men and women involved, and then looking at how well you're doing with that, because those, the idea that there weren't any women available, I can't believe that was said, but it is really 2020.  I'm a little stunned, but I probably shouldn't be. But there are different answers in each one of the organizational structures about how advocacy can be provided to increase the, the numbers. And I have to tell you, this is, this is a women, and you're talking about nurses and doctors and various interprofessional things.  It seems to me a little uncomfortable that we're not talking at all about underrepresented minorities, which are another group that, that certainly deserves some advocacy, but we're down to the last minute, so I'll keep my mouth shut for a little bit.  Maybe that's for 2021 if they invite us back.  I think it's been a fantastic discussion. I thank everybody for participating, and I think the questions, if they keep coming in, we will, I will be able to access them and hopefully respond or collate them and distribute them to my colleagues on the, on the panel.  So thanks so much, everybody, and enjoy.  Absolutely. This is Laura's brainchild. I just want to thank Laura for organizing this, for bringing us together for making this happen. This wasn't the Society of Critical Care Medicines, it wasn't the, the program committee.  Laura saw a problem, saw some issues that needed to be dealt with, and she advocated in. Thanks for letting me be a very small part of what you're doing, Laura.  Thank you, Bob. Thank everybody and to the organizers too. Have a great evening. Bye bye. Thank you.

Video Summary

The video discusses the need for gender equity in pediatric critical care and highlights challenges and opportunities for achieving this goal. Dr. Lara Daimon shares her observations on the increasing number of women entering the field but also highlights the lack of gender equity in leadership positions and representation at conferences. She emphasizes the importance of addressing these inequities and encourages leaders to promote gender equity in hiring, salaries, committees, and mentorship programs. Dr. Daimon also discusses the impact of work-life balance on career progression and calls for support and retention of talented individuals. The panel discussion further delves into the experiences of women in pediatric critical care medicine and highlights the importance of mentors, sponsors, and research networks in supporting career development. COVID-19's impact on work-life balance is also addressed, as well as the need for gender representation on guidelines and panels. The panelists acknowledge progress made in gender representation but stress the need for equal representation on search committees and support for women in leadership positions. The issue of authorship and academic publishing equality is also touched upon. Overall, the video provides valuable insights into the challenges and solutions for achieving gender equity in pediatric critical care medicine.

Asset Subtitle

Administration, Behavioral Health and Well Being, 2021

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Learning Objectives

Describe traditional attitudes and current and future approaches that naturally consider the balance between academic advancement and/or career progression and outside life
Recognize disruptive mechanisms to challenge the status quo of current leadership positions within societies, journals, and editorial boards
Address the potentially contentious and sensitive theme of equity in the workplace and opportunities to address it and provide academic fulfillment, particularly to junior faculty
Discuss how to influence those who are comfortable with the status quo and how to make a positive impact while identifying and developing future leaders in our profession independent of gender and other factors
Define new ideas as to how we approach such bodies and work from the grassroots level to incorporate equity and inclusivity in the research environment

Being Introspective: How Do We Provide the Right Environment and Opportunities in Our Own Workplace? Lara S. Shekerdemian

Societies, Journals, and Editorial Boards: Notes From the Inside Paul A. Checchia

Does Prioritizing Work-Life Balance Have to Present a Disadvantage? Nikoleta Kolovos

May the Best Person Win: Defining the Next Generation of Leaders Robert A. Berg Research Matters and Celebrating the End of "Manels" Adrienne G. Randolph

Meta Tag

Content Type Presentation

Knowledge Area Administration

Knowledge Area Behavioral Health and Well Being

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Medical Legal Issues

Tag Pediatric Intensive Care Unit PICU

Tag Well Being

Year 2021

Keywords

gender equity

pediatric critical care

challenges

opportunities

women in leadership

representation

conferences

inequities

hiring

salaries

committees

mentorship programs

work-life balance

career progression

support and retention

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