Twelve Steps for Starting a Support Group for Women Resident Physicians

In 2017, for the first time, matriculating females accounted for more than half of all students entering medical school.(1) At SUNY Upstate Medical University, females make up about 41% of house staff across all resident specialties; the 2021 Internal Medicine roster is composed of 44% women residents.

Even with the increase in female medical students and residents, gender disparities within medicine remain. Women are under-represented in leadership positions, journal authorships, and speaker invitations, and are less likely than men to become full professors, despite taking into account age, experience, specialty, and independent measures of research and clinical productivity.(1)

Choo et al., describe best-practice recommendations and the core strategies of mentorship and networking to support the recruitment, retention, and promotion of women within academic emergency medicine.(2) Gender-specific groups can help women advance within academia by providing resources for mentorship and by creating opportunities for women in medicine to hold leadership positions early in their careers.

In 2019, Women in Residency Life (WiRL), a resident women’s support group (WSG), was established at SUNY Upstate Medical University in Syracuse, New York. Starting an empowering WSG takes commitment, effective communication, open discussion, and the ability to translate ideas into actions through a collaborative effort requiring considerable time and energy outside of clinical work hours. We hope to significantly minimize this work for others by offering these 12 steps and providing documents that will serve as a starting resource.

Figure 1. Twelve steps for starting a support group for women residents

Step 1: Recognize the Gender Disparity in Medicine.

While women have made great gains in medical education during the last decade, challenges remain. A 2020 report by the College and University Professional Association for Human Resources revealed that women hold the least number of senior executive positions and are among the lowest paid highly educated administrators.(3) Studies investigating past and ongoing pay and leadership disparities suggest lack of mentors/sponsors, increased rates of burnout, and concerns for adequate work-life balance as possible factors.(4)

The introduction of WSGs has been shown to increase productivity, collaboration, and camaraderie, and to expand one's professional network.(5) Creating a WSG in residency can foster mentor-mentee relationships, provide opportunities to discuss the unique challenges women face, and empower women who want to advance within their careers. WiRL proved that providing a judgment-free space to discuss gender issues allowed for diversified networking opportunities with senior faculty.

Step 2: Establish a Core Team of Leaders.

Spearheading a successful residency WSG requires dedicated time outside the allotted residency requirements. Success requires the collaboration of two or more motivated and passionate residents who have the readiness and drive to create a group aimed at positively impacting their female colleagues, the hospital community, and themselves.

The involvement of faculty members and chief residents can help the core team solidify the successful implementation of a WSG. Faculty support and chief residents who advocated for our cause were paramount to our success.

Step 3: Obtain Approval and Support from the Institution and Program.

Because residency training takes between three and seven years, resident turnover is high. To ensure the longevity of the group, it is essential that the residency program director (PD), associate program directors (APDs), and designated institutional officer (DIO) support the program.

The program proposal presented to the PD, APDs, and DIO should include the mission statement, personnel involved, group structure, and both short-term (three to six months) and long-term (two to three years) goals. The PD and/or APDs may direct the group to other administrators for further guidance if needed; additionally PDs and APDs can encourage their residents to join the group and can recruit faculty mentors. These relationships also help the group find solutions to unexpected problems and ensure measures are consistent with hospital policy.

Fortunately, we had no difficulty engaging our PD, but we acknowledge that this may not always be the case. It is important to express to administrators the positive impact and benefits this type of group can have on the program, particularly during recruitment season. With both program and hospital support, the residency WSG should last beyond the founding team members’ graduation.

Step 4: Adopt a Mission Statement.

The mission statement is a formal, succinct description of an organization’s purpose, practices, and core values. WSGs provide women residents with an outlet for mental, emotional, and professional support as they advance in their careers. A successful mission statement takes these attributes into consideration and adopts an inspirational tone that encourages members to work toward a common goal. The statement may be edited multiple times as the organization evolves.

WiRL’s mission statement is: “WiRL is an all-inclusive residency-run group designed to promote women’s success across all specialties, to learn from each other, network, and advance women in medicine. The purpose of WiRL is to support professional development and career advancement of women in residency through education, advocacy, community outreach, mentorship, and service.”

Step 5: Hold an Interest Meeting.

The next step is to create awareness about the group. Schedule an interest meeting, choosing a date and time that works with most residents’ schedules. Create a flyer to share with residents by email and on social media, and display hard copies in resident lounges and work areas.

The agenda for the first interest meeting should include information regarding the purpose of the group, its structure of board members and election process, and group goals for the upcoming year.

One of the challenges we faced was residents’ time constraints during training and during the pandemic. In response, we gave members an opportunity to join virtually and provided recorded sessions for those who were unable to attend.

Step 6: Encourage Diversity and Include Multiple Specialties.

A WSG that includes multiple specialties allows for interdisciplinary dialogue while fostering better working relationships and leads to increased employee satisfaction and better patient care.

WiRL uses social media platforms and recruits the help of the DIO and PDs to invite members across all 19 specialties at SUNY Upstate. Additionally, WiRL encourages and welcomes male support and membership. Out of the 120 residents involved, males constitute 18% of membership.

Step 7: Recruit Faculty Advisors and Mentors.

The mentor-mentee relationship is a catalyst for success in facilitating career selection, advancement, and productivity. Studies have shown that fewer than 50% of medical students and fewer than 20% of faculty members have a mentor.(6) Women have a more challenging time finding mentors as compared to their male counterparts.(7)

It is important to identify and actively recruit faculty advisors who are genuinely interested in mentoring. The qualities to look for in a faculty mentor include altruism, honesty, trustworthiness, patience, and active listening.

WSGs give residents an opportunity to speak directly to attendings on a personal level; this initial connection helps residents feel more comfortable approaching superiors regarding letters of recommendation and career advice/aspirations.

WiRL has recruited 40 faculty members, both male and female, including attending physicians from Internal Medicine, Emergency Medicine, Otolaryngology, Family Medicine, Anesthesia, and Pediatrics.

Step 8: Host Networking and Social Events.

Networking and collaboration positively impact working relationships, employee satisfaction, and patient outcomes.(8) Additionally, networking provides support for residents and opens the door for employment opportunities.

Williams, et al., describe a speed networking workshop between business students and alumni that helped students connect with their superiors and peers.(9) WiRL’s multiple fundraising events and workshops, geared toward professional and personal development, have made connecting with colleagues easy and fun. Social events can promote resident wellness and combat burnout. Social events also are an effective way to promote fundraising and community service. For example, WiRL combined a holiday sweater party with a warm clothing drive, where attendees were asked to donate at the door.

Step 9: Create Community Service Projects and Educational Workshops to Support the Mission.

Fundraisers and educational events are targeted toward a particular cause. WiRL hosted a virtual 5K, a feminine hygiene supply drive, a virtual coat drive, a warm clothing drive, and a toilet paper drive. Proceeds were distributed among community agencies that represent the underserved.

Educational workshops are an integral part of WSGs. WiRL has hosted workshops on understanding contracts, salary negotiation, navigating dual-physician families, family planning, women in fellowship, conflict resolution within the work setting, and fertility preservation. These types of workshops, typically not provided in medical school or residency, expand residents’ knowledge base. Members also participate in workshops to educate medical students, college students, and the youth within the community.

WiRL, in conjunction with the local Spanish Action League, pioneered the Women Inspiring Girls (WIG) program, a youth mentorship program that provided workshops on self-confidence, pursuing a career in medicine, body positivity, and career goals and aspirations. Additionally, we coordinated a pre-medical mentoring session with Syracuse University students.

Step 10: Elect an Executive Board.

An executive board provides female residents an opportunity to hold a leadership position early in their careers. Board members should support the mission statement and have effective communication and organizational skills.(7) Recruiting interns to the executive board contributes to the sustainability of the group.

The purpose of the board is to effectively collaborate and distribute responsibilities when organizing workshops, community service, and networking events. The roles and expectations of each board member should be clearly defined. WiRL achieved this by creating bylaws (see Figure 2).

Figure 2. WiRL Board Of Directors Bylaws

Step 11: Use a Common Workspace to Store and Edit Documents.

Determine how information will be stored and shared in a secure manner but easily accessed from separate locations at the same time. Shared documents include the bylaws, meeting minutes, fundraising details, donor lists, project proposals, power point presentations, and budget spreadsheet. WiRL utilizes Google Workspace with Gmail, Docs, Slides, and Sheets to facilitate these workflows.

Step 12: Establish a Fund To Manage Finances.

Marketing the purpose and the mission of the group is paramount to establishing funding sources, which include grants, organizations, and individual donations. WiRL has had remarkable success with targeted fundraising events such as a t-shirt sale.

WiRL established a centralized account for donations with the SUNY Upstate Foundation, a not-for-profit organization that manages multiple funds that support the institution and the local community. Alternate options to receive funds include PayPal, Venmo, Digit Savings, or Go-Fund-Me. These accounts are overseen by the WiRL president and chief financial officer (CFO) who create a quarterly budget and oversee operational costs.

Conclusion

While these 12 steps provide guidance for resident physicians wishing to implement a WSG at their institution, we acknowledge that the successful establishment of such a group can be challenging. It requires a coordinated and deliberate effort from board members, faculty mentors, sponsors, and program administration.

A WSG based on the 12 foundational steps described above can create a unique opportunity for women in residency to come together, mobilize and empower one another toward achieving greater job satisfaction, decreased rates of burnout, and mitigation of gender disparity.

References

1. Das D. The Importance of Women-Focused Groups in Academic Medicine. ACEP Now. www.acepnow.com/article/the-importance-of-women-focused-groups-in-academic-medicine . Accessed September 11, 2020.

2. Choo EK, Kass D, Westergaard M, et al. The Development of Best Practice Recommendations to Support the Hiring, Recruitment, and Advancement of Women Physicians in Emergency Medicine. Acad Emerg Med. 2016;23(11):1203–1209. doi:10.1111/acem.13028

3. Moghimi S, Khurshid K, Jalal S, et al. Gender Differences in Leadership Positions Among Academic Nuclear Medicine Specialists in Canada and the United States. AJR Am J Roentgenol. 2019;212(1):146–150. doi:10.2214/AJR.18.20062

4. Morello C, Keating D. More U.S. Women Pull Down Big Bucks. The Washington Post. October 7, 2010. www.washingtonpost.com/wp-dyn/content/article/2010/10/06/AR2010100607229.html . Accessed September 10, 2020.

5. Clerkin C. What Women Want—And Why You Want Women—In the Workplace. Research Report. Center for Creative Leadership; 2017. https://eric.ed.gov/?id=ED582896 . Accessed September 10, 2020.

6. Sambunjak D, Straus SE, Marusić A. Mentoring in Academic Medicine: A Systematic Review. JAMA. 2006;296(9):1103–1115. doi:10.1001/jama.296.9.1103

7. Altonji SJ, Baños JH, Harada CN. Perceived Benefits of a Peer Mentoring Program for First-Year Medical Students. Teach Learn Med. 2019;31(4):445–452. doi:10.1080/10401334.2019.1574579

8. Kubu CS. Who Does She Think She Is? Women, Leadership, and the ‘B’(ias) Word. Clin Neuropsychol. 2018;32(2):235–251. doi:10.1080/13854046.2017.1418022

9. Williams SG, Green RF, Diel K. A Speed Networking Event: Allowing Business Students to Apply Classroom-Taught Professional Networking Skills in a Fast-Paced Setting. Dev Bus Simul Exp Learn Proc Annu ABSEL Conf. 2017;44(1). https://absel-ojs-ttu.tdl.org/absel/index.php/absel/article/view/3068 . Accessed September 13, 2020.

10. Templeton K, Bernstein CA, Sukhera J, et al. Gender-Based Differences in Burnout: Issues Faced by Women Physicians. NAM Perspectives. Published online May 28, 2019. doi:10.31478/201905a