Dr Justin Rheese is an Intensivist at a tertiary hospital in Melbourne. Justin has a unique ability to bring people together and to celebrate diversity. Justin’s open and non-judgemental approach to practicing Intensive Care encourages collaboration from every single team member, resulting in outstanding patient care, a positive workplace culture and continuous learning.
My name is Justin, my pronouns are he/him and I’m an Intensivist working in Naarm/Melbourne, on the lands of the Bunurong and Wurundjeri Woi-Wurrung peoples.
Recently I had the opportunity to complete a Graduate Diploma in Clinical Education, including a module titled “Teaching in the era of #MeToo”. This module aimed to increase awareness of factors influencing the relationship between health practitioners, students and patients; and how to create a safe and inclusive teaching environment. This post is based on an essay for the Graduate Diploma, some of the reading for that module and reflections on the Intensive Care training pathway and the role that educators, supervisors and teachers have. In that essay I described the role that ICU educators have in creating a safe and inclusive teaching environment and some minimum steps towards achieving this.
Much of the literature discussing gender in medical education references the “changing demography” (1) of medical education – noting the increasing proportion of women entering medical schools. In traditionally “Western” medical systems such as Australia, Europe and North America, the majority of medical students are women (1). Despite this widely documented change from the status quo, women remain under-represented in leadership and education positions. In particular, data collected in 2021 by the College of Intensive Care (CICM) showed that 16% of ICU directors in Victoria, 27% of Supervisors of Training (SOTs) and 16-38% of examiners identify as female (2). Understanding this demography is important in understanding that Intensive Care Medicine training can still be considered a “traditionally male institution” (3) with a training program and assessments that were developed with a biased male gaze. Although there are strategies in place to increase female representation at more senior levels within the CICM (4), the current training program and assessments have been developed in a time when the numbers of trainees and examiners have been dominated by men.ales.
Traditional assessment approaches, such as a focus on high-stakes assessment (for example, an expensive, twice-yearly pass/fail written or clinical exam that determines career progression) perpetuate patriarchal approaches to teaching and learning. These approaches may prioritise autonomy and self-directed learning rather than collaboration (1) – unlike the real-world environment that ICU trainees work in – and create a number of inherent barriers for trainees who may also have traditionally gendered roles.
A crucial step in improving the understanding of the impact of gender on ICU training is to increase the number of women in the role of SOT and examiner. This is essential for the role-modelling and visibility presented to ICU trainees (1,5), but also because women faculty may make more effective facilitators (1) and are more likely to introduce gender issues into the curriculum (1). This will require systemic support at the levels of the College, individual departments and hospitals to institute targets (5) for representation and ensure women Intensivists are supported to take on these roles.
Educators in ICU have an important role to play in addressing gender inequity. An important resource for me was an article by Professor Kathleen Elliott discussing challenging toxic masculinity in schools (6) that is quite transferable to the ICU training environment. In this article Prof Elliott discusses the requirement for men to commit as allies; and similar to addressing toxic masculinity in schools, gender inequity in ICU training cannot be considered a “women’s problem, something that does not involve men and that can be addressed by focusing on women alone.” (6) It should be expected of all educators to role model inclusive, respectful behaviour and communication, demonstrate sensitivity and empathy and encourage the same of trainees (6). The burden of addressing inequity should not belong to the under-represented group (5). The current (male-majority) educators need to be aware of the low-intensity, harmful workplace behaviours (such as eye-rolling, talking-over and exclusion) (7) that may be experienced by female trainees and call out and address this behaviour to begin to develop a safe, inclusive teaching environment. Resources are available from VicHealth (8) and Women’s Health Victoria (9) to aid individuals in calling out harmful behaviour in the workplace safely as this may not come naturally. Concepts of gender and gender equality may be difficult for educators to embrace (10) and there is a role for gender awareness or unconscious bias training although this alone cannot be relied upon to create a safe and inclusive space.
I was grateful for the opportunity to undertake this course and access some of the resources referenced below. It’s not uncommon during the ICU training pathway to take on an education role without much training in “how to teach” and this course has provided me the opportunity to reflect on my role as an educator, and the role that all educators can play in addressing gender inequity in ICU training. I’m also very privileged to have been able to work with some incredible educators and role models of the kind of culture, and safe and inclusive teaching space I’d like to see continue to develop and to improve the experience of learning ICU for all trainees.
REFERENCES:
Bleakley A. Gender matters in medical education. Medical education. 2013 Jan 1;47(1):59–70.
Lussier S. CICM - Gender Equity – International Women’s Day report 2023 from WIN [Internet]. 2023 [cited 2023 Oct 7]. Available from: https://www.cicm.org.au/News-Summary/Gender-Equity-%E2%80%93-International-Women%E2%80%99s-Day-report-2
Vojdik VK. Gender Outlaws: Challenging Masculinity in Traditionally Male Institutions. Berkeley Women’s Law Journal. 2002 May 1;17:68.
Lussier S. women-intensive-care. 2019 [cited 2024 May 5]. CICM publishes WIN authored statement on gender balance in intensive care. Available from: https://www.womenintensive.org/post/cicm-publishes-win-authored-statement-on-gender-balance-in-intensive-care
Yong SA, Moore CL, Lussier SM. Towards gender equity in intensive care medicine: Ten practical strategies for improving diversity. Critical Care and Resuscitation. 2021 Jun 1;23(2):132–6.
Elliott K. Challenging toxic masculinity in schools and society. On the Horizon. 2018 Mar 12;26(1):17–22.
Bennet L, Sojo Monzon V. Workplace Bullying in the #MeToo Era [Internet]. [cited 2023 Oct 7]. (Eavesdrop on Experts). Available from: https://pursuit.unimelb.edu.au/podcasts/workplace-bullying-in-the-metoo-era
How to be an active bystander [Internet]. 2019 [cited 2023 Oct 8]. Available from: https://www.vichealth.vic.gov.au/news-publications/research-publications/how-be-active-bystander
Women’s Health Victoria [Internet]. 2018 [cited 2023 Oct 8]. Active Bystander Training. Available from: https://www.whv.org.au/training/active-bystander-training
Lahelma E. Troubling Discourses on Gender and Education. Educational Research. 2014 Jun 1;56(2):171–83.