METHODS She Said, He Said - Resident Perceptions of Gender and Leadership in Acute Resuscitations: A Qualitative Analysis Jasmine S. Mathews 1, Alan H. Breaud 1, Patricia M. Mitchell 1,2, Michael Dempsey 1, Douglas Kauffman 2, Jeffrey I. Schneider 1,2, Kerry M. McCabe 1,2, Brian Clyne 3, Jessica L. Smith 3, Rebecca Barron 3, Tracey Dechert 1,2, Leslie E. Halpern 1, Judith A. Linden 1,2. 1 Boston Medical Center, Boston, MA; 2 Boston University School of Medicine, Boston, MA; 3 Alpert Medical School of Brown University, Providence, RI LEADERS- LEADership in Emergency ResuscitationS This IRB approved, exploratory qualitative study was conducted from April to June 2015 at 2 Level I trauma centers where EM residents lead medical/surgical resuscitations Inclusion Criteria: PGY 2-4 EM residents Interview guide pilot tested A trained qualitative interviewer conducted anonymous, in depth, semi-structured interviews with open ended questions until theme saturation reached Data Analysis: Interviews were audiotaped, transcribed, de-identified, coded, and analyzed using MAXQDA v12 software Resident physician, nurse, and non-clinical research assistant met as a group to code all segments and reached agreement in coding 16 EM residents participated: 6 female, 10 male, (6 PGY2, 6 PGY3, 4 PGY4) 100% of females reported gender impacted nursing relationships and team dynamics compared to 60% of males 83% of females reported the need to gain trust and respect of nurses to effectively lead resuscitations versus 10% of males Directive and commanding behavior in females was often perceived as overly assertive, which was more likely to be accepted as a leadership quality in males 83% of females and 80% of males felt that females faced an uphill battle being accepted as effective resuscitations leaders EM residents who lead resuscitations perceived gender as having a major effect on team dynamics Several themes regarding barriers to effective leadership were perceived as disproportionally affecting females Findings suggest gender related differences may impact team leadership dynamics Our results suggest the impact of gender on team leadership may need to be addressed in EM training and education Effective communication and team dynamics are critical to successfully led ED resuscitations Literature suggests that gender influences leadership style and how leaders are perceived To explore EM residents’ perceptions of gender and its impact on leadership and resuscitation team dynamics OBJECTIVE LIMITATIONS INTRODUCTION CONCLUSIONS RESULTS Inability to further validate residents’ perceptions on resuscitation experience Researcher presence may influence resident reporting Researcher biases may impact result gathering and interpretation Results may not be generalizable Figure 1. Frequency of Themes by Resident Gender

Table 1. EM RESIDENT PERCEPTIONS – IN THEIR OWN WORDS Key Themes Representative Quotes Team Dynamics "I do think people can perceive it as being mean. Or, in females, it's just bitchy. It's not directive. It's bitchy." [Interviewer] So if you're directive as a female, it's bitchy? "It's bitchy." [Interviewer] If you're directive as a male, it's...? "It's just aggressive or a leader leading, or whatever it is. Not bitchy." Trust/Respect of Team "Just, I think that they have to prove themselves a little more. Like I said, you know, a big, tall male walks in the room with a loud voice...I think...people would default to respecting and listening to what they have to say first and questioning them second. But, if a woman walks in, I think you have to prove yourself over time first before you get the same respect that maybe their peers would get." Gender Inequity/Uphill Battle "I think there's a natural, and unfortunate as it is built in our system, a natural preference for male leaders in medicine, and in general. They don't have to know peoples' names and they're accepted more. The nurses don't get offended if they don't know their names. But if I don't know their names there's much more....I've worked very hard to get on the good side of those people."