Glass Slippers and Glass Cliffs: Fitting in and Falling Off

Background: A 'glass-ceiling' effect exists for women in male-dominated professions. Recent studies also show a 'glass-cliff' effect where senior women can more easily fall from positions of leadership. Transplantation remains a male-dominated specialty. This study investigated gender and the perception of adverse clinical incidents in transplantation. Methods: Web-based survey involving five clinical scenarios which described errors or mistakes with male or female named protagonists. Questionnaires allocated at random. To address unconscious bias, the study was described as examining 'actions following clinical adverse incidents in transplantation'. Each scenario was followed by two closed questions (i) clinical performance rating (ii) selection of action required. Reasoning was invited (open text comments). Responses were analysed using quantitative and qualitative methods. Results: 191 invitees responded; 134 completed questionnaires. Total responses showed no differences (P>0.05) in performance ratings, although for 'first solo laparoscopic surgery' scenario some indication 'No Action' more likely if surgeon male (P=0.056). Male responses rated female performance as significantly worse (P=0.035) for the laboratory-based scenario. 102 participants provided open text comments. Thematic analysis identified seven themes. 'Acceptable levels of risk' theme demonstrated engendered leadership beliefs i.e. when 'clinical judgement' proved incorrect, males described as 'forceful' but females as 'needing support'. In cases where things went wrong, respondents were more likely to comment females should not have decided to proceed. Conclusion: While gender may no longer be an overt issue in perceived performance of senior staff in transplantation, respondents' use of language and their choice of words display elements of unconscious (covert) engendered views. Financial disclosure: Coventry Kidney Research Fund – Support towards funding statistical work. LINC Medical Systems Ltd, U.K- Support towards funding statistical work. Conflicts of interest: None. Corresponding Author: Nithya Krishnan, FRCP, MD, Renal Unit, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK. Email: nithya.krishnan@uhcw.nhs.uk Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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