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Afraid of Being “Witchy With a ‘B’”: A Qualitative Study of How Gender Influences Residents’ Experiences Leading Cardiopulmonary Resuscitation

Kolehmainen, Christine MD, MS; Brennan, Meghan MD, MS; Filut, Amarette; Isaac, Carol PhD; Carnes, Molly MD, MS

doi: 10.1097/ACM.0000000000000372
Research Reports

Purpose: Ineffective leadership during cardiopulmonary resuscitation (“code”) can negatively affect a patient’s likelihood of survival. In most teaching hospitals, internal medicine residents lead codes. In this study, the authors explored internal medicine residents’ experiences leading codes, with a particular focus on how gender influences the code leadership experience.

Method: The authors conducted individual, semistructured telephone or in-person interviews with 25 residents (May 2012 to February 2013) from 9 U.S. internal medicine residency programs. They audio recorded and transcribed the interviews and then thematically analyzed the transcribed text.

Results: Participants viewed a successful code as one with effective leadership. They agreed that the ideal code leader was an authoritative presence; spoke with a deep, loud voice; used clear, direct communication; and appeared calm. Although equally able to lead codes as their male colleagues, female participants described feeling stress from having to violate gender behavioral norms in the role of code leader. In response, some female participants adopted rituals to signal the suspension of gender norms while leading a code. Others apologized afterwards for their counternormative behavior.

Conclusions: Ideal code leadership embodies highly agentic, stereotypical male behaviors. Female residents employed strategies to better integrate the competing identities of code leader and female gender. In the future, residency training should acknowledge how female gender stereotypes may conflict with the behaviors required to enact code leadership and offer some strategies, such as those used by the female residents in this study, to help women integrate these dual identities.

Dr. Kolehmainen is a physician, William S. Middleton Memorial Veteran’s Hospital, and clinical adjunct assistant professor, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

Dr. Brennan is a women’s health fellow, William S. Middleton Memorial Veteran’s Hospital, and clinical instructor, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

Ms. Filut is research assistant, Center for Women’s Health Research, University of Wisconsin, Madison, Wisconsin.

Dr. Isaac is assistant professor in research, Mercer University, Atlanta, Georgia.

Dr. Carnes is professor of medicine, psychiatry, and industrial and systems engineering and director, Center for Women’s Health Research, University of Wisconsin, and director of women veterans health, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.

Funding/Support: This study was supported by funding from the Advanced Fellowship in Women’s Health, William S. Middleton Memorial Veteran’s Hospital, and University of Wisconsin–Madison Center for Women’s Health Research. The funding body played no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. The contents do not represent the views of the Department of Veterans Affairs or the U.S. Government. Dr. Carnes’s work on increasing scientific workforce diversity is funded by the National Institutes of Health (R01 GM88477 and DP4 GM96822). GRECC manuscript #2014-03.

Other disclosures: None reported.

Ethical approval: The University of Wisconsin–Madison institutional review board approved this study.

Previous presentations: This study was presented in oral abstract form at the Society of General Internal Medicine Annual Meeting in Denver, Colorado (April 2013).

Correspondence should be addressed to Dr. Kolehmainen, Geriatric Research Education and Clinical Center (GRECC)–11G, 2500 Overlook Terrace, Madison, WI 53705-9895; telephone: (608) 280-7000; e-mail:

© 2014 by the Association of American Medical Colleges