The Trump administration is leaving a trail of destruction through American science with its war on ‘woke’. The consequences are also being felt in the Netherlands. In a letter to the editor published today in the Volkskrant, signed by 300 scientists, healthcare professionals, and other experts, universities, policymakers, and the government are urged to continue supporting researchers and to safeguard high-quality and inclusive healthcare for everyone. I wholeheartedly added my signature to this letter. You can still show your support by signing the petition.
Today’s Netherlands Medical Journal reports that the path to professorship is still more often successful for male doctors than for their female colleagues. Colleagues from ErasmusMC published this well-underpinned supported research finding regarding gender differences in medical science. The largest explanatory factor (55%) they found was the number of publications. There was no difference between men and women in terms of the number of successful grant applications.
As board member of the Dutch Women Professors, I was asked to reflect on these findings for the Dutch national newspaper Volkskrant in an interview with journalist Erna van Dalen. Lidwien Poorthuis, director of the Dutch Women Professor, was interviewed about the same study for Radio 1, News Weekend. The findings are not new for the Network; in the annual Monitor Female Professors – the report on the representation and progression of female scientists – we have been reading for years about persistent inequality between male and female scientists. Medical faculties currently have just over 30% female professors. This percentage is increasing, but too slowly. While lecture halls and the scientific pipeline are more than filled with women, it is still the men who more frequently move on to higher leadership, decision-making, and culture-defining positions. To achieve the desired equality between men and women more quickly, it is essential to change the appointment system and the dominant masculine culture within the university medical centers (UMCs). The fact is that female department heads are underrepresented in all UMCs (ranging from 14.7% to 42%); the current culture bearers at the department level are mostly men. Professors are typically nominated by the department leadership. Programs such as ‘Acknowledgment & Recognition’ aim to make this culture – and thus the system – more diverse by, for example, broadening appointment criteria. Not only the grant application success rates and the H-index (publication numbers) of scientists should weigh in the decision, but also other important aspects for the academy, such as teaching efforts, academic duties, societal impact, and good leadership of research teams.
We wondered if, when, and how residents feel valued in the workplace. In other words, how do residents appreciate appreciation? This interview study by Rosa Bogerd et al. provided some important answers, valuable insights, and a nuanced view of appreciation. Peers, patients, and supervisors can make residents feel valued. This can be through a word, a question, a positive outcome, a thank you, a compliment, or even by giving them additional responsibilities. Whether, and to what extent, something is experienced as feeling valued depends on the timing of the expressed appreciation and the values that are important to the resident.
For colleagues, supervisors, and trainers who want to express more appreciation, and bring positivity to the workplace, the reported experiences of residents may be useful. See this Academic Medicine publication Appreciating Appreciation: Residents Experience Feeling Valued Differently as Learners, Physicians and Employees.
I wish you happy holidays and a new year filled with POSITIVITY. Reading the news, it’s clear we could all use a little more of it. And in my personal life too, I often hear too much negativity. A positive life isn’t just more fun and enjoyable—it’s also, as scientists show, better for our relationships, well-being, and happiness.
I delve into this in my periodic contribution to the Leading Doctors newsletter. In “The 3 from Kiki,” where I highlight three articles I find noteworthy, this edition focuses on positive emotions. Let’s appreciate them for the treasures they are, and perhaps even inspire ourselves to cultivate them more consciously.
One particularly powerful positive emotion is the “Awe” emotion—that feeling you get when watching a sunset, listening to music, or witnessing genuine kindness. It’s a sensation bigger than yourself, one that lifts you beyond your own boundaries. When do you experience this? Do you allow yourself to feel it more often? Could you build more “awe” moments into your life? Perhaps by taking a daily “awe walk”, spending 15 minutes undisturbed with your favorite music, or performing a small act of kindness? Science tells us that doing so will make us feel better, and our surroundings will benefit as well. Learn more in this edition of The 3 from Kiki.
In delivering the Anatomical Lecture, British professor Sadaf Farooqi, Professor of Metabolism and Medicine at the University of Cambridge, educated around 2,000 people on the genetic causes of obesity. The pre-program was designed as both “learning and amusement.” It’s no longer news that the industry entices us to consume unhealthy, (literally) disease-causing products, but it is still surprising that stronger actions are not being taken. Fortunately, Trijntje Oosterhuis serenaded us with her rendition of What the world needs now…. in the always impressive Royal Concertbuilding.
What is WellMed? A conference about the well-being of healthcare professionals that also energizes you. Through the passionate and knowledgeable colleagues, the hospitality of the Greeks, and the beautiful surroundings (see photo: the Velos area, located between Athens and Thessaloniki). “Conference” might not be the right word; it was more of a meeting with about 50 participants who spent three days discussing the causes of reduced well-being among healthcare professionals and effective solutions. After 10 years of WellMed, much has been achieved and much is worth sharing. It is clear that well-being as a theme for research and policy no longer needs to be advocated for—it is receiving the recognition and attention it deserves. However, the decline in well-being (psychological ill health) among doctors and other healthcare professionals is not solved yet. New evidence on “what approach works in which context” (a strong argument for realistic approaches from our English colleagues) is hopefully bringing us closer to solutions. I’m happy to contribute with research and collaboration.
A wonderful end to the summer holidays and a great start to the new (academic) year: the Rogano meeting. Our annual scientific conference on research in medical education. A summery snapshot with colleagues Ellen Ricke, Anne van Graafeiland, and Sofiya Abedali. The scientific results will follow later.
Some studies reach the heart just a bit more deeply than others. This study is one of those, and it just so happens to be about the heart. The warm heart, the compassionate heart, the heart of healthcare professionals that beats for their patients.
Previous research has already shown how important compassion is for patients and healthcare professionals (and really, for everyone). Compassionate doctors observe that their patients feel less stressed and anxious, are more likely to follow advice, take better care of themselves, and even report better clinical outcomes. Moreover, doctors themselves also benefit from “more compassion”; in short, it makes them healthier and happier.
So, the combination of “compassion” and “patient care” is a no-brainer? Unfortunately, no.
Patients still report too often that they did not receive compassionate treatment. Doctors acknowledge that compassion in care is important. In this study, we wanted to explore where things go wrong. We therefore interviewed both patients and medical residents about compassionate care. The study reveals how implicit assumptions, expectations, lack of connection and communication, and practical barriers in clinical practice help explain the compassion mismatch between doctor and patient. The article makes three suggestions for incorporating compassionate actions into training. Read this study on Compassion through different lenses here.
This paper is the result of a team project on compassionate care, initiated by Dr. Maarten Debets and financially supported by a contribution from the Amsterdam Public Health research institute.
When I began developing the SETQ system over 15 years ago (The system that evaluates the teaching qualities of supervisors in residency training programs, and provides them with feedback), I could not have anticipated that one day there would be a Brazilian version. The fact that SETQ Smart is now being used in Brazilian residency programs is thanks to the vision, determination, enthusiasm, and dedication of Brazilian family physician and researcher Dr. Naarai Comboin Bezerra. Since our first email contact in 2019, the connection between Amsterdam and Florianopolis has only grown stronger. This publication in Brazil’s leading medical education journal is one of the outcomes of our collaboration. The publication (SETQ Brazil 2024) demonstrates the importance of ongoing validation of (social science) tools in the context in which they are used. Naarai is now temporarily with us in Amsterdam as a visiting scholar. She has become a valuable member of the team, and I enjoy all the cross-cultural lessons she teaches us daily. Read the article SETQ Brazil 2024 here.
Once again, a study reports a quality difference in patient outcomes between female and male specialists. This study was published today in Annals of Internal Medicine. The evidence of the impact of a treating physician’s gender on patient clinical outcomes is growing stronger. This study also shows that female patients, in particular, benefit from being treated by a female specialist. The question of why these consistently reported differences exist is becoming increasingly pressing. The popular science magazine Quest.nl covered this publication, and I was asked to comment on the study (in Dutch).
Great, finally a male perspective on the discussion about the performance of male and female doctors. None other than dr Bert Keizer, physician and philosopher, opens his column in the Dutch newspaper Trouw with an intriguing scenario, presented in the title: The nightmare of a man with prostate problems is a female doctor. With his sharp and humorous voice, he discusses the interview with me published earlier (see December 18th) in the NTvG. I am happy with his support and critical reflections.
As with many, my new year started with a phone full of messages. On January 1st, I received many good wishes for 2024 from family and friends. But today, January 2nd, it was mainly reactions to a big interview in the AD about women and female qualities in healthcare.
Large clinical studies show that female patients are ‘better off’ if they are helped by a female medical specialist; this has been demonstrated for surgeons (based on research into 25 different surgical procedures), cardiologists (study of patients who present with a heart attack at the emergency department) and internists (research into 8 most common internal diagnoses). ‘Better off’ means hard patient outcomes such as fewer complications, fewer readmissions and lower mortality rates. The studies I refer to are done with American, Canadian and Swedish data. Sometimes the differences between male and female doctors are large and (also clinically) relevant, other times small, but always significant and consistent in favor of women.
Yet the question is not a men-versus-women issue. We do need to (want to) investigate what can be learned from the observed differences. For men and women. And also the unequal appreciation of male versus female qualities is more than worth discussing. Why? Because all human qualities are important for being able to provide good patient care. I spoke about these topics with AD journalist Ellen van Gaalen. It became a page-wide story (in Dutch). On January 3rd, the interview appeared in Het Parool.
NPO1 radio picked up the article and talked about it further in the Fact & Fiction section (EenVandaag). Listen here.
At the end of the year, the Dutch Medical Journal – NTvG – discusses ‘tipping points’ in care and society. In an interview (in Dutch) with Rosie Sikkel, I spoke about the shift to more women and ‘female qualities’ in medicine. The latter is especially necessary. ‘Female qualities’ – such as listening, empathizing, compassion and intuition – were long attributed to women, but men and women can of course be compassionate, comforting and really empathize with the patient in front of them. It is important that we also appreciate these human qualities as indispensable for good and effective care, and (therefore) pay more attention to them in the training. Not as an ‘extra’ or ‘nice to have’ or ‘optional’, but simply because there is scientific evidence that these qualities are good for patient outcomes and good for the care professionals.
As expected, Maarten Debets defended his impressive and relevant book, Physicians Enhancing Their Professional Performance, with great skill. Here is the radiant new young doctor, along with his equally radiant PhD thesis committee: Dr. Milou Silkens, Dr. Karen Kruijthof, and myself. Many thanks to all the opponents: Prof. Eva Knies (UU), Prof. Bart van Berden (UvT, not pictured), Prof. Hans Goudoever (UvA), Prof. Christiaan Vinkers (VU), Prof. Joris van der Post (UvA), and Prof. Suzanne Geerlings (UvA).
This is what team work looks like. What a continuous challenge to align patient care and educational goals. In a previous publicatie in Academic Medicine we addressed the efficient use of clinical performance data, by using known data from the EHR for residents’ assessment and feedback. In this new publication, under the leadership of dr Alina Smirnova, PhD, we test cased our own ideas for two clinical paediatric illnesses. Spoiler alert: this study contains new perspectives to positively impact patient care and residency training.
Today Iris Jansen convincingly defended her PhD thesis, titled: Interactions that Matter: Understanding Residents’ Professional Growth Through Workplace Relationships. Please go read this impressive work here. This picture shows the all female research team: dr Milou Silkens, PhD en dr Renee Stalmeijer, PhD as Iris co-supervisors, and myself as Iris proud supervisor.
What a great start of the week! I feel honoured to be presented as the newest board member of the Dutch Network of Women Professors (LNVH). Thank you LNVH for this important position. Please be assured of my enthousiasm for and commitment to further strengthening the position and professional fulfilment of women (of all backgrounds) in academia!
Gender equality is not ‘just’ about equal representation of women in all positions, and in particular in positions of power. Ultimately it is about justice. Women are still experiencing a gender gap to the invisible but undoubtedly masculine norm in academia: in the way we treat female academics, organise our institutions and value our researchers. Let’s get to work!
The feminist novelist Virginia Woolf once observed, “Science, it would seem, is not sexless; she is a man.” In the same spirit, one could argue that medicine is not gender-neutral — she is male. This is what we come to conclude in our paper published today in the New England Journal of Medicine. ‘We’ here is my co-author, Stanford physician and novellist Abraham Verghese, and myself. We hope our work will be supportive of the much-needed dialogue about today’s gendered medicine.
The world around us is constantly changing. Digitization, individualization, acceleration, feminization, robotization, and other societal developments have a significant impact on healthcare and the training of doctors and other healthcare professionals. The (In)Sanity in Healthcare Symposium – June 16th 2022 – revolves around the question which developments to embrace and which to be more critical of and/or cautiously monitor. Against this backdrop we focus on the topics of professionalism, vitality, and compassion. The Symposium is Dutch spoken, with the exception of the keynote lecture given by Canadian McGill University and dear personal friend Professor Yvonne Steinert, a world renowned expert in the field of medical education and training.
All good things must come to an end. I am deeply grateful for the CASBS experience. What a absolutely transformative year it has been. Thank you my dear fellow class mates and thank you wonderful staff of Stanford University’s Centre for Advanced Study in the Behavioural Sciences. Thank you Margaret Levi for your leadership in this very challenging year, and allways. A big thanks also to Stanford Medicine’s Presence Program and in particular my host and dear friend Abraham Verghese.
I will continue my studies and hope to see you all again soon. Miss you already!