Publications by authors named "Julie K Silver"

136 Publications

The Impact of a Culinary Coaching Telemedicine Program on Home Cooking and Emotional Well-Being during the COVID-19 Pandemic.

Nutrients 2021 Jul 5;13(7). Epub 2021 Jul 5.

Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02129, USA.

The coronavirus pandemic enforced social restrictions with abrupt impacts on mental health and changes to health behaviors. From a randomized clinical trial, we assessed the impact of culinary education on home cooking practices, coping strategies and resiliency during the first wave of the COVID-19 pandemic (March/April 2020). Participants ( = 28) were aged 25-70 years with a BMI of 27.5-35 kg/m. The intervention consisted of 12 weekly 30-min one-on-one telemedicine culinary coaching sessions. Coping strategies were assessed through the Brief Coping with Problems Experienced Inventory, and resiliency using the Brief Resilient Coping Scale. Home cooking practices were assessed through qualitative analysis. The average use of self-care as a coping strategy by the intervention group was 6.14 (1.66), compared to the control with 4.64 (1.69); = 0.03. While more intervention participants had high ( = 5) and medium ( = 8) resiliency compared to controls ( = 4, = 6, respectively), this difference was not significant ( = 0.33). Intervention participants reported using home cooking skills such as meal planning and time saving techniques during the pandemic. The key findings were that culinary coaching via telemedicine may be an effective intervention for teaching home cooking skills and promoting the use of self-care as a coping strategy during times of stress, including the COVID-19 pandemic.
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http://dx.doi.org/10.3390/nu13072311DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8308430PMC
July 2021

Diversity of residency applicants to anaesthesiology and other specialties in the USA from 2014 to 2019.

Br J Anaesth 2021 07 25;127(1):e27-e30. Epub 2021 May 25.

Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada; Department of Anesthesiology, St Paul's Hospital/Providence Health Care, Vancouver, BC, Canada.

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http://dx.doi.org/10.1016/j.bja.2021.04.013DOI Listing
July 2021

Burn model system national longitudinal database representativeness by race, ethnicity, gender, and age.

PM R 2021 Apr 22. Epub 2021 Apr 22.

Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.

Introduction: Representativeness of research populations impacts the ability to extrapolate findings. The Burn Model System (BMS) National Database is one of the largest prospective, longitudinal, multi-center research repositories collecting patient-reported outcomes after burn injury.

Objective: To assess if the BMS Database is representative of the population that is eligible to participate.

Design: Data on adult burn survivors who were eligible for the BMS Database from 2015 to 2019 were analyzed.

Setting: Not applicable.

Participants: Burn survivors treated at BMS centers meeting eligibility criteria for the BMS Database. Eligibility for the database is based on burn size and receipt of autografting surgery.

Interventions: Not applicable.

Main Outcome Measure(s): Race, ethnicity, gender, and age were compared between individuals who did and did not enroll. Regression analysis examined the correlation between demographic characteristics and study enrollment. Additional regression analysis examined the association between enrollment and the intersection of race, ethnicity, and gender.

Results: A total of 982 adult burn survivors were eligible for the BMS database during the study period. Of those who were eligible, 72.1% Enrolled and 27.9% were Not Enrolled. The Enrolled group included more female and more younger survivors compared to the Not Enrolled group. In regression analyses, Black/African American burn survivors were less likely and individuals identifying as female were more likely to enroll in the BMS Database. Furthermore, White men and women were more likely to enroll compared to Black/African American men and women, and non-Hispanic/Latino men were more likely to enroll compared to Hispanic/Latino men.

Conclusions: This study found differences in BMS Database enrollment by race, ethnicity, and gender. Further research is warranted to investigate causes for the disparities found in this study. In addition, strategies are needed to improve enrollment to ensure future representativeness.
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http://dx.doi.org/10.1002/pmrj.12618DOI Listing
April 2021

Letter to the Editor: How Do Medical Students Perceive Diversity in Orthopaedic Surgery, and How Do Their Perceptions Change After an Orthopaedic Clinical Rotation?

Clin Orthop Relat Res 2021 07;479(7):1626-1627

Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts General Hospital, Brigham and Women's Hospital, and Spaulding Rehabilitation Hospital, Boston, MA, USA.

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http://dx.doi.org/10.1097/CORR.0000000000001762DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8208404PMC
July 2021

An Analysis of the Inclusion of Women, Older Individuals, and Racial/Ethnic Minorities in Rehabilitation Clinical Trials.

Am J Phys Med Rehabil 2021 06;100(6):546-554

From the Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (JKS); Spaulding Rehabilitation Hospital, Charlestown, Massachusetts (JKS); Massachusetts General Hospital, Boston, Massachusetts (JKS); Brigham and Women's Hospital, Boston, Massachusetts (JKS); College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska (LEF); Universidad Central del Caribe, Bayamón, Puerto Rico (AMG); Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF); and Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF).

Objective: Our objective was to investigate whether women, people 65 yrs and older, or individuals who identify with racial and/or ethnic minority groups, were underrepresented among participants in rehabilitation clinical trials.

Design: This is a cross-sectional study of completed rehabilitation clinical trials investigating the number and percentage of women, older adults, and racial and/or ethnic minorities enrolled in rehabilitation clinical trials between January 1, 2011, and January 1, 2020. Secondary outcome measures were inclusion by diagnostic group, as well as International Classification of Functioning, Disability and Health category, and intervention by diagnostic group.

Results: Of the 108 studies meeting inclusion criteria, a majority (69%) were based in the United States. Stroke was the most frequent diagnostic group, followed by musculoskeletal conditions. Ninety-six percent of the United States-based trials included at least one female participant in their study, but among specific diagnostic groups, this ranged from 5% to 73%. Age information was reported inconsistently; however, of the trials reporting age, 100% of cardiac trials included older adults, whereas no spinal cord injury (SCI) trials included them. Among trials based in the United States reporting race, 70% of participants were White, followed by 20% Black or African American and 1% Asian. Among trials based in the United States reporting ethnicity, Hispanic or Latino participants were underrepresented overall and among each diagnostic group.

Conclusions: In this study, we found that among participants of rehabilitation clinical trials women, older individuals, and racial/ethnic minorities were generally underrepresented. In contrast, Black or African American participants were overrepresented with the exception of cardiac trials. An important finding was that many trials did not report age and/or race/ethnicity. Investigators should aim to include underrepresented populations and improve reporting.
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http://dx.doi.org/10.1097/PHM.0000000000001750DOI Listing
June 2021

How Can More Women be Elected to Leadership Positions in Medical Specialty Societies?

Acad Med 2021 04;96(4):479

Associate professor and associate chair, Department of Physical Medicine and Rehabilitation, Harvard Medical School, clinical associate, Massachusetts General Hospital, associate in physiatry, Brigham and Women's Hospital, and attending physician, Spaulding Rehabilitation Hospital, Boston, Massachusetts.

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http://dx.doi.org/10.1097/ACM.0000000000003930DOI Listing
April 2021

Investigation of work-life integration on burnout symptoms in women physician runners: a cross-sectional survey study.

BMJ Open Sport Exerc Med 2021 19;7(1):e001028. Epub 2021 Feb 19.

Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.

Objective: To investigate which factors, from demographics to work-life integration, are associated with burnout symptoms among self-declared active women physicians practising in the USA.

Methods: Cross-sectional study of those actively engaged in a social media group for women physician runners. Electronically surveyed using 60 questions covering demographics, compensation, debt and domestic responsibilities with burnout assessed by the Mini-Z Burnout Survey.

Results: Of the 369 women meeting inclusion criteria as attending physicians practising in the USA, the majority reported being White (74.5%) and at least 6 years out from training (85.9%). There was a significant association of increased burnout level with working more hours per week and being responsible for a greater percentage of domestic duties (p<0.0001 and p=0.003, respectively). Both factors remained significant in a multivariable model (p<0.0001).

Conclusion: By exploring burnout in the physically active, we are better able to investigate contributors to burnout despite healthy exercise habits. Increased burnout was significantly associated with greater domestic responsibility and hours working. These findings in women physician runners suggest that exercise alone may not control burnout. Poor work-life integration deserves attention as a burnout contributor in women physicians, potentially serving as a target for burnout prevention strategies.
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http://dx.doi.org/10.1136/bmjsem-2020-001028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898857PMC
February 2021

h-Index and Academic Rank by Gender Among Breast Surgery Fellowship Faculty.

J Womens Health (Larchmt) 2021 Feb 24. Epub 2021 Feb 24.

Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.

Gender disparities in academic promotion and leadership are well documented. Scholarly impact is essential for promotion. The Hirsch-index (h-index) is a measure of impact using number of publications and citations. We sought to (i) evaluate breast surgery fellowship faculty in North America by academic rank and research impact using the h-index, (ii) determine whether there is a gender difference in scholarly productivity, and (iii) determine the relationship between academic rank, h-index, and gender. A retrospective cross-sectional study of h-index and academic rank disparity in breast surgery faculty by gender was performed. We reviewed the faculty of Society of Surgical Oncology-accredited breast surgery fellowships in February 2019. Rank, gender, academic appointment, years in practice, program directorship, National Cancer Institute-designated cancer center association, size of the program, and h-index (via Scopus) were recorded. Univariate and multiple linear regression analyses were performed. Fifty-two programs were identified, and 209 faculty had an h-index. Of them, 69.9% were women and 30.1% were men. h-index increased with academic rank although there was considerable overlap between ranks. Women were underrepresented at the professor level (46.4%), but accounted for the majority of assistant professors (91.5%,  < 0.001), and program directors (70.7%). Men professors had a significantly higher mean h-index than women professors,  < 0.001. However, women associate professors had a higher mean h-index than men, but this did not reach significance. Mean h-index increased with increasing rank among breast surgery faculty for both genders. Average h-index was significantly higher for men professors compared to women professors. No significant gender difference in h-index was found for assistant professors. For associate professors, h-index for women was higher than for men. Women are underrepresented at higher academic ranks despite forming the majority of breast surgical teaching faculty.
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http://dx.doi.org/10.1089/jwh.2020.8579DOI Listing
February 2021

Assessment of the Inclusion of Racial/Ethnic Minority, Female, and Older Individuals in Vaccine Clinical Trials.

JAMA Netw Open 2021 02 1;4(2):e2037640. Epub 2021 Feb 1.

Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts.

Importance: Medical research has not equitably included members of racial/ethnic minority groups or female and older individuals. There are limited data on participant demographic characteristics in vaccine trials despite the importance of these data to current trials aimed at preventing coronavirus disease 2019.

Objective: To investigate whether racial/ethnic minority groups and female and older adults are underrepresented among participants in vaccine clinical trials.

Design, Setting, And Participants: This cross-sectional study examined data from completed US-based vaccine trials registered on ClinicalTrials.gov from July 1, 2011, through June 30, 2020. The terms vaccine, vaccination, immunization, and inoculation were used to identify trials. Only those addressing vaccine immunogenicity or efficacy of preventative vaccines were included.

Main Outcomes And Measures: The numbers and percentages of racial/ethnic minority, female, and older individuals compared with US census data from 2011 and 2018. Secondary outcome measures were inclusion by trial phase and year of completion.

Results: A total of 230 US-based trials with 219 555 participants were included in the study. Most trials were randomized (180 [78.3%]), included viral vaccinations (159 [69.1%]), and represented all trial phases. Every trial reported age and sex; 134 (58.3%) reported race and 79 (34.3%) reported ethnicity. Overall, among adult study participants, White individuals were overrepresented (77.9%; 95% CI, 77.4%-78.4%), and Black or African American individuals (10.6%; 95% CI, 10.2%-11.0%) and American Indian or Alaska Native individuals (0.4%; 95% CI, 0.3%-0.5%) were underrepresented compared with US census data; enrollment of Asian individuals was similar (5.7%; 95% CI, 5.5%-6.0%). Enrollment of Hispanic or Latino individuals (11.6%; 95% CI, 11.1%-12.0%) was also low even among the limited number of adult trials reporting ethnicity. Adult trials were composed of more female participants (75 325 [56.0%]), but among those reporting age as a percentage, enrollment of participants who were aged 65 years or older was low (12.1%; 95% CI, 12.0%-12.3%). Black or African American participants (10.1%; 95% CI, 9.7%-10.6%) and Hispanic or Latino participants (22.5%; 95% CI, 21.6%-23.4%) were also underrepresented in pediatric trials. Among trials reporting race/ethnicity, 65 (48.5%) did not include American Indian or Alaska Native participants and 81 (60.4%) did not include Hawaiian or Pacific Islander participants.

Conclusions And Relevance: This cross-sectional study found that among US-based vaccine clinical trials, members of racial/ethnic minority groups and older adults were underrepresented, whereas female adults were overrepresented. These findings suggest that diversity enrollment targets should be included for all vaccine trials targeting epidemiologically important infections.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.37640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7896193PMC
February 2021

Rehabilitation Utilization by Cancer Patients with Pathology-Confirmed Leptomeningeal Disease Receiving Intrathecal Chemotherapy.

Am J Phys Med Rehabil 2021 01;100(1):100-104

From the Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas (JBF, AHN, EB); Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, Florida (DMM); College of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, Joplin, Missouri (EAP); Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan (SM); and Department of Physical Medicine & Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Boston, Massachusetts (JKS).

Abstract: The incidence of leptomeningeal disease (LMD) is believed to be increasing in part because of more effective chemotherapy treatments allowing cancer progression behind the blood-brain barrier. However, little has been published about the rehabilitation of this growing patient population. In this study, impairments and rehabilitation utilization by cytology-proven LMD patients receiving intrathecal chemotherapy at a cancer center are described. A total of 109 consecutive patients with pathology-confirmed LMD who received an intrathecal chemotherapy infusion from January 1, 2017, through October 31, 2017, were retrospectively reviewed. Of the 109 patients, 103 (95%) had impairments described in their medical record that could impact physical function, including 74 of 109 (68%) who had deconditioning or fatigue. Kaplan-Meier median survival from initial LMD diagnosis was 13.1 mos. The median number of hospital admissions and intrathecal chemotherapy administrations was both 8. Of the 109 patients, 43 (39%) had magnetic resonance imaging radiology interpreted LMD. Most LMD patients used rehabilitation services (95/109, 87%) and most were able to forego post-acute inpatient rehabilitation facilities (96/109, 88%). Additional research and education for rehabilitation professionals about this increasingly common syndrome are needed.
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http://dx.doi.org/10.1097/PHM.0000000000001565DOI Listing
January 2021

Multiphasic Prehabilitation Across the Cancer Continuum: A Narrative Review and Conceptual Framework.

Front Oncol 2020 11;10:598425. Epub 2021 Jan 11.

Department of Anesthesia, McGill University Health Center, Montreal, QC, Canada.

The field of cancer survivorship has significantly advanced person-centered care throughout the cancer continuum. Within cancer survivorship, the last decade has seen remarkable growth in the investigation of prehabilitation comprising pre-treatment interventions to prevent or attenuate the burden of oncologic therapies. While the majority of evidence remains in the surgical setting, prehabilitation is being adapted to target modifiable risk factors that predict poor treatment outcomes in patients receiving other systemic and localized anti-tumor treatments. Here, we propose a multiphasic approach for prehabilitation across the cancer continuum, as a conceptual framework, to encompass the variability in cancer treatment experiences while adopting the most inclusive definition of the cancer survivor.
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http://dx.doi.org/10.3389/fonc.2020.598425DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831271PMC
January 2021

Representation of Women on Journal Editorial Boards Affiliated with the Association of American Medical College's Council of Faculty and Academic Societies.

J Womens Health (Larchmt) 2021 Aug 26;30(8):1095-1106. Epub 2021 Jan 26.

Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts General Hospital, Brigham and Women's Hospital and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA.

The Council of Faculty and Academic Societies (CFAS) comprises representatives from medical schools and professional societies who guide the Association of American Medical Colleges (AAMC). Given the AAMC's stated mission to improve diversity and inclusion, we used gender-related representation on journal editorial boards as a proxy for evaluating CFAS member societies' commitments to equity. From screenshots of journal mastheads ( = 44) collected June 3-6, 2019, individuals were categorized by editorial position. Outcome measures included numbers of men and women among faculty, deans, department chairs, physicians, and nonphysicians on editorial boards. Outcomes were compared with 2018 AAMC and US Bureau of Labor Statistics workforce data. Overall, the proportion of women among journal editors was 29.0% (364 of 1,255), range 0%-53.3%. This proportion was significantly less than the proportion of women among US medical school faculty and medical scientists. The lowest percentages of women were found among journals' section or topic editors (19.2%) and editors-in-chief (20.4%). Men were significantly more likely to be a professor or department chair and women were significantly more likely to be an associate professor or assistant professor, suggesting a bidirectional process between rank and editorial position that may inhibit the advancement of academic women, particularly women physicians. This study revealed disparities in the equitable representation of women among CFAS member-affiliated journal editors. Because CFAS member societies participate in a mutually beneficial relationship with the AAMC, they should strive to attain the equity goals set forth by the AAMC.
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http://dx.doi.org/10.1089/jwh.2020.8676DOI Listing
August 2021

Representation by Gender of Recognition Award Recipients from Gastroenterology and Hepatology Professional Societies.

J Womens Health (Larchmt) 2021 Jan 12. Epub 2021 Jan 12.

Division of Gastroenterology and Hepatology, Oregon Health and Sciences University, Portland, Oregon, USA.

Recognition awards from professional medical societies play an important role in physicians' career advancement. Our aim was to evaluate the gender representation of award recipients from gastroenterology and hepatology societies. We analyzed the lists of award recipients from the American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy and determined the gender of these award recipients. The primary outcome was the overall representation of women physician award recipients as compared with the representation of women in the specialty. Between 1941 and 2019, there were 921 awards, of which 77 (8.4%) were given to women and 844 (91.6%) to men. There was a significant increase in the proportion of women recipients over time, from 0% in 1970-1984 to 22.0% in 2015-2019 ( for trend <0.0001). Compared with the concurrent representation of women in the specialty, women physician recipients were underrepresented from 1970 to 1981 and 1984 to 2015, equitably represented from 1981 to 1984, and overrepresented from 2015 to 2019. Of the total number of awards in each category, women received 13.8% of teaching/mentorship awards and 3.8% of the highest achievement awards ( = 0.002). The proportion of women recipients varied among the societies, from 6.8% to 14.5%. The representation of women physician recipients of gastroenterology and hepatology society recognition awards has generally been low until most recently, when it has surpassed the proportion of women in the specialty. Because award recognition is important to career development, professional societies should have transparent processes that aim to identify and reduce various forms of bias, including gender-related bias, in all phases of award recognition.
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http://dx.doi.org/10.1089/jwh.2020.8627DOI Listing
January 2021

The Women Physiatrists Facebook Group: Evaluating the Value of a Private Online Community.

Am J Phys Med Rehabil 2021 10;100(10):996-1002

From the Department of Physical Medicine and Rehabilitation, University of California, Davis, Sacramento, California (ANC); BU Department of Dermatology, BU Dermatology Residency Program, Boston, Massachusetts (ARL); Cancer Rehabilitation, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (JKS); and Department of Rehabilitation Medicine, Long School of Medicine at UT Health San Antonio, San Antonio, Texas (MV-G).

Abstract: This study evaluated Women Physiatry Facebook group members' perceptions of the value of an online community. The authors hypothesized that members would find the group protective against burnout, and early career participants would be more likely to use the group for education and networking. This was a cross-sectional survey study of women physicians in the field of physical medicine and rehabilitation primarily in the United States. The survey consisted of 51 questions covering demographic information, work/life satisfaction, and physician burnout.There were 310 respondents. Those at an earlier career stage accessed the Women Physiatrists Facebook page significantly more often (P = 0.038). Most respondents were neutral regarding the group reducing burnout. Across all career stages, the group was most often used as an educational tool to review patient cases (82.2%). Mid- to late-career members were more likely to use the group to learn about maintenance of certification or continuing medical education requirements (P = 0.019) and searching for a physiatrist in another part of the county (P = 0.016). This study suggests that closed Facebook groups can be useful educational tools across career stages.
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http://dx.doi.org/10.1097/PHM.0000000000001680DOI Listing
October 2021

Association of Academic Physiatrists Women's Task Force Follow-up Report.

Am J Phys Med Rehabil 2021 06;100(6):610-619

From the Harvard Medical School and Spaulding Rehabilitation Network, Boston, Massachusetts (JKS); Association of Academic Physiatrists Women's Task Force, Owing Mills, Maryland (JKS, SC); JFK Johnson Rehabilitation Institute and Rutgers Robert Wood Johnson Medical School/Hackensack Meridian School of Medicine, Edison, New Jersey (SC, TKF); New York University, Long Island School of Medicine, Mineola, New York (LW); Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York City, New York (CV); NewYork-Presbyterian Hospital-Columbia and Cornell, New York, New York (CV); University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (GS); Burke Rehabilitation Hospital, Albert Einstein College of Medicine, Montefiore Health System, New York City, New York (MO-P); University of California Irvine School of Medicine, Irvine, California (DPK); University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF); McGovern Medical School at University of Texas Health Science Center, Shriners Hospital for Children in Houston, TIRR Memorial Hermann Hospital, Houston, Texas (GB); Montefiore Medical Center, Albert Einstein College of Medicine, New York City, New York (AFA); and Association of Academic Physiatrists, Owing Mills, Maryland (TK).

Abstract: The Association of Academic Physiatrists convened a Women's Task Force in 2016, under the leadership of then Association of Academic Physiatrists President Gerard Francisco, MD, to evaluate data and metrics pertaining to the representation and inclusion of female physiatrists in the society. An initial published report focused on a retrospective analysis of data in categories such as leadership, conference presentations, and recognition awards. The findings, which highlighted areas in which the Association of Academic Physiatrists had been successful in supporting gender equity as well as areas in which female physiatrists were underrepresented, provided a base from which to strategically focus on closing gaps in representation. The task force developed an action plan that was approved by the Board of Trustees and included strategies aimed at closing gaps and collecting data to determine corresponding effectiveness. Because most of the categories fell under the supervision of various Association of Academic Physiatrists committees, an appointee from each committee ("diversity steward") liaised with the Women's Task Force. The diversity stewards reviewed the plan with their respective committees and collected data within their committee's purview. This task force follow-up report documents recent progress, consistent with the Association of Academic Physiatrists Board of Trustees commitment to transparency and gender equity.
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http://dx.doi.org/10.1097/PHM.0000000000001670DOI Listing
June 2021

Physical Medicine and Rehabilitation Faculty Diversity Trends by Sex, Race, and Ethnicity, 2007 to 2018 in the United States.

PM R 2021 Sep 1;13(9):994-1004. Epub 2021 Mar 1.

Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.

Introduction: Sex and race/ethnicity disparities persist in academic Physical Medicine and Rehabilitation (PM&R). This study contributes to the current body of knowledge by demonstrating changes in academic PM&R by sex and race/ethnicity in multiple categories over a 12-year period.

Objective: To evaluate workforce disparities in academic PM&R by measuring sex and race/ethnicity diversity in academic degree, rank, and tenure status.

Design: Surveillance study.

Setting And Methods: Self-reported data for PM&R from the Association of American Medical Colleges (AAMC) annual Faculty Roster report from 2007 to 2018.

Main Outcome Measures: The 12-year average percentage composition in academic degree, rank, and tenure status was calculated to compare the overall distribution. Counts and proportion changes were plotted to depict the temporal trends. Absolute changes in racial percentage composition were graphed to highlight the progress.

Results: From 2007 to 2018, the increase by sex was roughly equal (male = 216; female = 236), whereas most of the increase was in White faculty (207). The representation of female and Underrepresented in Medicine (URiM) faculty decreased as academic level advanced. Instructors is the only category with a higher proportion of female faculty, from 2007 (53%) to 2018 (59.3%), whereas male faculty occupied over 75% of the full professor positions at any time. Among the non-White faculty, Asian faculty had the greatest increase in proportion of full professors (3.7% to 10%) and Hispanic/Latino faculty in associate professors (2% to 7.1%), whereas full professors who were Black/African American decreased from 4 persons (2.5%) to 2 persons (0.8%).

Conclusion: An increase in total number of female and URiM faculty was observed in academic PM&R over 2007 to 2018, but sex and ethnicity/race disparities persisted, especially in higher ranks and leadership positions. For non-White faculty, greater disparities existed, pointing toward the need to target challenges faced by URiM race/ethnicity status.
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http://dx.doi.org/10.1002/pmrj.12537DOI Listing
September 2021

Should her name begin with "Doctor"?

Authors:
Julie K Silver

BMJ 2020 12 16;371:m4754. Epub 2020 Dec 16.

Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.

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http://dx.doi.org/10.1136/bmj.m4754DOI Listing
December 2020

How Physician Compensation and Education Debt Affects Financial Stress and Burnout: A Survey Study of Women in Physical Medicine and Rehabilitation.

PM R 2021 Aug 1;13(8):836-844. Epub 2021 Feb 1.

Department of Physical Medicine and Rehabilitation, Harvard Medical School, Massachusetts General Hospital, Brigham and Women's Hospital, Spaulding Rehabilitation Hospital, Boston, MA.

Objective: To investigate the contribution of financial stress to physician burnout and satisfaction among women physiatrists. Relationships among education debt and compensation with demographic, sociologic, and workplace factors were also assessed.

Design: This was a cross-sectional survey study of women physicians in the field of physical medicine and rehabilitation (PM&R) in the United States. The survey consisted of 51 questions covering demographic information (current and maximum education debt, race/ethnicity, years out of training, practice type and setting, hours worked, family structure, and domestic duties), work/life satisfaction, and burnout. The association between current/maximum debt and demographic characteristics, work/life satisfaction, and physician burnout were examined.

Results: Of the 245 U.S. women attending physiatrists who met inclusion criteria, 222 (90.6%) reported ever having education debt (median category $101 000-150 000) and 162 (66.1%) reported current debt (median category ≤ $50 000). Of these participants, 218 (90.5%) agreed that they would have fewer burnout symptoms if they were able to do more work that is core to their professional mission and 226 (92.2%) agreed that feeling undervalued at work is linked to physiatrists' burnout symptoms. Greater debt was seen in those who identified as Black/African American, were fewer years out of training, practiced general physiatry, and had both inpatient and outpatient responsibilities. Greater current debt had a significant relationship with measurements of work/life dissatisfaction. Burnout was associated with higher debt, lower compensation, more hours worked per week, and fewer hours of exercise performed per week.

Conclusions: This study examined women physiatrists' perceptions of financial stress and found that greater education debt was associated with personal life dissatisfaction, career regret, and burnout. Further research is needed to address related causes and solutions.
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http://dx.doi.org/10.1002/pmrj.12534DOI Listing
August 2021

Trends in Representation of Female Applicants and Matriculants in Canadian Residency Programs Across Specialties, 1995 to 2019.

JAMA Netw Open 2020 11 2;3(11):e2027938. Epub 2020 Nov 2.

Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.

Importance: Disparities in representation between sexes have been shown at multiple career stages in medicine despite increasing representation in the overall physician workforce.

Objective: To assess sex representation of applicants to the Canadian R-1 entry match for postgraduate training programs from 1995 to 2019, comparing distribution between different specialties as well as applied vs matched applicants.

Design, Setting, And Participants: This cross-sectional analysis of aggregate data provided by the Canadian Resident Matching Service between 1995 and 2019 analyzed aggregate data for the Canadian R-1 residency match from 1995 through 2019.

Exposures: Applicant sex as reported in the Canadian Resident Matching Service database.

Main Outcomes And Measures: The sex representation of applicants was compared and the longitudinal trends in sex representation were analyzed by specialty between 1995 and 2019. The sex representation of overall applicants to the Canadian R-1 entry match were compared with matched applicants, and both were stratified by specialty.

Results: A total of 48 424 applicants were identified (26 407 [54.5%] female applicants), of which 41 037 were matched applicants. Using specialty groupings, female applicants were most highly represented in obstetrics and gynecology (1776 of 2090 [85.0%]) and least represented in radiology (658 of 2055 [32.0%]). Within individual subspecialties, female applicants had the lowest representation in neurosurgery (90 of 394 [22.8%]). While female applicants represented an increasing proportion of the overall applicant population between 1995 and 2019 (z = 2.71; P = .007), significant increases were seen in some, but not all, individual specialties. Differences by sex were found among Canadian medical graduate match rates to their top-ranked specialty: female applicants had a lower likelihood of being rejected for family medicine (rejection of male applicants: OR, 0.46; 95% CI, 0.39-0.54; P < .001) and psychiatry (OR, 0.59; 95% CI, 0.46-0.76; P < .001) and were more likely to be rejected for all-encompassing surgery (acceptance of male applicants: OR, 1.19; 95% CI, 1.10-1.28; P < .001).

Conclusions And Relevance: Increasing representation of female residency applicants over time was seen in some, but not all, medical specialties in Canada, and sex-based differences in successful match rates were observed in some specialties. The reasons for these disparities require further investigation for corrective strategies to be identified.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.27938DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686870PMC
November 2020

How is gender bias from the trainees' ground addressed?

Am J Obstet Gynecol 2021 03 16;224(3):333-334. Epub 2020 Nov 16.

Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Massachusetts General Hospital, Boston, MA; Brigham and Women's Hospital, Boston, MA; Spaulding Rehabilitation Hospital, Boston, MA.

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http://dx.doi.org/10.1016/j.ajog.2020.11.016DOI Listing
March 2021

Citizenship Tasks and Women Physicians: Additional Woman Tax in Academic Medicine?

J Womens Health (Larchmt) 2021 07 17;30(7):935-943. Epub 2020 Nov 17.

Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska, USA.

Our aim was to evaluate differences in reported citizenship tasks among women physicians due to personal or demographic factors and time spent performing those tasks for work. Attendees of a national women physician's leadership conference (Brave Enough Women Physicians Continuing Medical Education Conference) replied to a survey using Qualtrics (2019 Qualtrics, Provo, UT), in September 2019. Data collected included age, race, ethnicity, training level, medical practice, specialty, current annual total compensation, educational debt, and number of children. We asked about employment-related citizenship tasks, including time spent on those activities, and perceived obligation to volunteer for citizenship tasks. Descriptive and impact of demographic factors on those opinions were evaluated using IBM SPSS v26.0. Three hundred eighty-nine women physicians replied. When compared with their younger counterparts, women physicians older than 49 years stated they feel obligated to volunteer for these tasks because of their gender ( = 0.049), and were less likely able to decide which citizenship tasks they were assigned to ( = 0.021). Furthermore, a higher proportion of women of color physicians perceived race as a factor in feeling obligated to volunteer for work-related citizenship tasks, when compared with White women physicians ( < 0.001). Additionally, nearly 50% of women physicians reported spending more time on citizenship tasks than their male counterparts. Our findings suggest that gender, race, and age may play a role in the decision of women physicians to participate in work-related citizenship tasks. To our knowledge, this is the first study to report on work-related citizenship tasks as described by women physicians. Still, an in-depth assessment on the role citizenship tasks play in the culture of healthcare is warranted.
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http://dx.doi.org/10.1089/jwh.2020.8482DOI Listing
July 2021

Representation of women as editors in major pain journals.

Reg Anesth Pain Med 2021 04 16;46(4):356-357. Epub 2020 Nov 16.

Department of Anesthesia University of Iowa, Iowa City, Iowa, USA

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http://dx.doi.org/10.1136/rapm-2020-101675DOI Listing
April 2021

Representation of women plenary speakers at the American Academy of Neurology Annual Meeting.

Neurology 2020 12 27;95(22):e3045-e3059. Epub 2020 Oct 27.

From the Department of Neurology (D.S.), University of Oklahoma, Oklahoma City; Department of Neurology (A.M.B.), Columbia University Medical Center, New York, NY; Department of Physical Medicine and Rehabilitation (J.A.P., J.K.S.), Harvard Medical School; Spaulding Rehabilitation Hospital (J.A.P., J.K.S.), Boston, MA; Department of Anesthesiology and Critical Care Medicine (T.L.D.), Johns Hopkins University, Baltimore, MD; American College of Cardiology (R.P.), Washington, DC; Massachusetts General Hospital (R.P.), Boston; Department of Surgery (S.P.), Harvard Medical School, Massachusetts General Hospital, Boston; Department of Anesthesiology (H.W.H.), University of Utah, Salt Lake City; Department of Anesthesiology (R.C.), University of California San Diego; Department of Dermatology (A.R.L.), Boston University School of Medicine, MA; and Brigham and Women's Hospital (J.K.S.), Boston, MA. Dr. Bank is now at the Department of Neurology, Lenox Hill Hospital/Northwell Health, Hofstra Zucker School of Medicine, New York.

Objective: To determine whether women have been equitably represented among plenary speakers at the American Academy of Neurology (AAN) Annual Meeting by counting and categorizing speakers and comparing outcomes to AAN membership and US neurology workforce data.

Methods: Lists of plenary speakers between 1958 and 2019 (62 years) were obtained from the AAN. The primary outcome measures were numbers and proportions of men and women in aggregate and among physicians.

Results: We identified 635 plenary speakers, including 148 (23.3%) women. Specifically, women made up 14.6% (19 of 130) of presidential and 25.5% (129 of 505) of nonpresidential plenary session speakers. The inclusion of women plenary speakers was meaningfully higher ( = 0.33; difference 14.9%; 95% confidence interval 4.2%-26.7%) for nonphysicians (27 of 74 [36.5%]) than physicians (121 of 561 [21.6%]). Although at zero levels for Annual Meetings held between 1958 and 1990 and at mostly low but varying levels thereafter, the representation of women and women physicians has been at or above their proportions in the AAN membership and US neurology workforce since 2017. Comparison of representation by plenary session name revealed an unequal distribution of women, with women physicians concentrated in the Sidney Carter Award in Child Neurology presidential session.

Conclusion: Historically and recently, women and women physicians were underrepresented among AAN plenary speakers. As the AAN has taken active steps to address equity, women have been included in more representative proportions overall. However, notable gaps remain, especially in specific prestigious plenary sessions, and further research is needed to determine causality.
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http://dx.doi.org/10.1212/WNL.0000000000011058DOI Listing
December 2020

A systematic review of rehabilitation and exercise recommendations in oncology guidelines.

CA Cancer J Clin 2021 03 27;71(2):149-175. Epub 2020 Oct 27.

Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, Massachusetts.

Guidelines promote high quality cancer care. Rehabilitation recommendations in oncology guidelines have not been characterized and may provide insight to improve integration of rehabilitation into oncology care. This report was developed as a part of the World Health Organization (WHO) Rehabilitation 2030 initiative to identify rehabilitation-specific recommendations in guidelines for oncology care. A systematic review of guidelines was conducted. Only guidelines published in English, for adults with cancer, providing recommendations for rehabilitation referral and assessment or interventions between 2009 and 2019 were included. 13840 articles were identified. After duplicates and applied filters, 4897 articles were screened. 69 guidelines were identified with rehabilitation-specific recommendations. Thirty-seven of the 69 guidelines endorsed referral to rehabilitation services but provided no specific recommendations regarding assessment or interventions. Thirty-two of the 69 guidelines met the full inclusion criteria and were assessed using the AGREE II tool. Twenty-one of these guidelines achieved an AGREE II quality score of ≥ 45 and were fully extracted. Guidelines exclusive to pharmacologic interventions and complementary and alternative interventions were excluded. Findings identify guidelines that recommend rehabilitation services across many cancer types and for various consequences of cancer treatment signifying that rehabilitation is a recognized component of oncology care. However, these findings are at odds with clinical reports of low rehabilitation utilization rates suggesting that guideline recommendations may be overlooked. Considering that functional morbidity negatively affects a majority of cancer survivors, improving guideline concordant rehabilitative care could have substantial impact on function and quality of life among cancer survivors.
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http://dx.doi.org/10.3322/caac.21639DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7988887PMC
March 2021

Disparities in Health Care for Black Patients in Physical Medicine and Rehabilitation in the United States: A Narrative Review.

PM R 2021 02 5;13(2):180-203. Epub 2020 Dec 5.

Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.

Racial health disparities continue to disproportionately affect Black persons in the United States. Black individuals also have increased risk of worse outcomes associated with social determinants of health including socioeconomic factors such as income, education, and employment. This narrative review included studies originally spanning a period of approximately one decade (December 2009-December 2019) from online databases and with subsequent updates though June 2020. The findings to date suggest pervasive inequities across common conditions and injuries in physical medicine and rehabilitation for this group compared to other racial/ethnic groups. We found health disparities across several domains for Black persons with stroke, traumatic brain injury, spinal cord injury, hip/knee osteoarthritis, and fractures, as well as cardiovascular and pulmonary disease. Although more research is needed, some contributing factors include low access to rehabilitation care, fewer referrals, lower utilization rates, perceived bias, and more self-reliance, even after adjusting for hospital characteristics, age, disease severity, and relevant socioeconomic variables. Some studies found that Black individuals were less likely to receive care that was concordant with clinical guidelines per the reported literature. Our review highlights many gaps in the literature on racial disparities that are particularly notable in cardiac, pulmonary, and critical care rehabilitation. Clinicians, researchers, and policy makers should therefore consider race and ethnicity as important factors as we strive to optimize rehabilitation care for an increasingly diverse U.S. population.
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http://dx.doi.org/10.1002/pmrj.12509DOI Listing
February 2021

Beyond a Hashtag: Strategies to Move Toward a More Inclusive Physiatry Workforce.

Am J Phys Med Rehabil 2021 07;100(7):712-717

From the Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York (MXE, GV); Division of Pain Medicine, Department of Anesthesiology and Pain Medicine, University of California, Davis, Sacramento, California (CDM); Department of Physical Medicine and Rehabilitation, Harvard Medical School; Massachusetts General Hospital, Brigham and Women's Hospital, and Spaulding Rehabilitation Hospital, Boston, Massachusetts (JKS); Department of Physical Medicine and Rehabilitation, University of Alabama School of Medicine, Birmingham, Alabama (KMK); and Department of Rehabilitation Medicine, Long School of Medicine at the University of Texas Health Science Center at San Antonio, San Antonio, Texas (MV-G).

Abstract: The field of physical medicine and rehabilitation should strive for a physician workforce that is ethnically/racially, sex, and ability diverse. Considering the recent realities of disparities in health outcomes related to COVID-19 and in racial injustice in the United States, we are called to be champions for antiracism and equity. The specialty of physical medicine and rehabilitation should be the leaders in fostering a culture of inclusion and pay special attention to the population of applicants who are underrepresented in medicine. The specialty needs tools to start addressing these disparities. This article aims to provide strategic and intentional evidence-based recommendations for programs to follow. Holistic review, implicit bias training, structured interviews, and targeted outreach for those underrepresented in medicine are some of the tools that will help students enter and become successful in our specialty. Furthermore, this article provides novel guidance and considerations for virtual interviews during the COVID-19 pandemic.
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http://dx.doi.org/10.1097/PHM.0000000000001623DOI Listing
July 2021
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