PRESIDENT’S LETTER
Defining the Gender Gap in Medicine: From EBM to FBM and Beyond By Mildred J. Willy, MD Guest Writer: Ken Milne, MD, MSc, CCFP-EM, FCFP, FRRMS - Emergency Medicine Physician
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he term evidence-based medicine (EBM) was originally defined by Dr. David L. Sackett 24 years ago. He defined EBM as: “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett et al BMJ 1996). This definition can be represented in a Venn diagram. Many people think that EBM is just about the scientific literature. This is not correct, and EBM is more than just the published literature. The evidence is only one of three pillars of EBM. The published literature informs and should guide our care, but it should not dictate our care. EBM also needs physicians to use their good clinical judgment based on their experience. We also need to engage with patients and ask them about their preferences and values.
It is these three components that make up EBM: The literature, our clinical judgment and the patient’s values/preferences. However, there are limitations to EBM. One is the gender inequity that can be found in each of these three pillars of EBM. The Medical Literature There are many examples of gender inequity in medical literature. • Females are less likely to get their research funded than men. • Women are less likely to rise to the top academic positions at universities compared to men. • Men are more likely to rise to the top academic positions in medicine. • Men are more likely to rise to the top academic positions in emergency medicine. • Men are more likely to be the first author on a medical publication. • Men are more likely to be the first author on an emergency medicine publication. • Pediatric emergency medicine (PEM) is 62 percent female, but women are the lead author of only 42 percent of PEM papers. Women are also often
excluded from being participants in medical research. We need to ensure that women are getting equal access to grant money, so they can ask the questions important to women and create the medical literature that informs our care of women. This will also lead to more women being first author on a medical publication. We need to include rather than exclude women as participants in medical research and not just extrapolate from male subjects. The Clinicians There are many examples of gender inequity in the second pillar of EBM, the clinician. Men have historically been the physician in the room. Men are more likely to rise to the top leadership positions within the hospital. Only three percent of healthcare CEOs are women, six percent are Department Chairs, nine percent are Division Chiefs, and three percent are serving as Chief Medical Officers. This is despite women comprising 80 percent of the healthcare workforce. continued on page 5
Many people think that EBM is just about the scientific literature. This is not correct, and EBM is more than just the published literature. 4
The Bulletin | Fall 2020
