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Table 2 Clustered themes and illustrative quotations from interviews with senior female leaders in EM

From: Deciding to lead: a qualitative study of women leaders in emergency medicine

Themes Illustrative quotations
Women leaders made an intentional decision to pursue opportunities to influence emergency medicine.
 Made strategic decisions and took risks I think people in emergency medicine, we are not very good at saying, “You need me to do that?” I mean, we are really bad at walking past a crisis and not responding to it.
So, I guess I learned first of all, transparency—being fair and being transparent are about the most important things about a leader.
I think that the first couple of years you have to develop your confidence in your clinical area and get your boards through. I think the skill set that helped me the most was being open to possibility. I did not say no to things. I think you miss out on opportunities. I think being open to possibility is an important skill set.
 Are women leaders necessary? I think one of the most important things is the critical mass. We need more women in leadership roles because that will make this a continued process without it being a battle to keep us there.
Gender balance in leadership brings a more diverse and innovative range of ideas.
 Do women leaders need to be like men? The women who are coming up I think are still having the same baggage that we did years ago: I am not good enough. This is the imposter thing that people talk about. I mean, we have that, we all have that big-time but women have it bigger than men.
Most women are less competitive, because I think women are socialized more to work in groups, which is why they are better collaborators.
I do not think male mentors would talk to anyone about their dress, even though I have seen women hurt themselves in a professional environment by the way they presented themselves.
When a woman is offered a good position, she might say ‘Oh, I am not ready yet, I have to study, I have to do a number of things first to do an excellent job from day one and I do not yet know how to do it.’ A lot of men would say, ‘That sounds like a cool challenge and I’ll try it’.
 Gender bias I think that women need to be aware that there is still gender bias. It may not be overt, it may not be as wide spread as it was but there is still gender bias. And when we as women assume that there is none we are doing a disservice to other women. I think women need to be aware that there is still a bias out there and take that into account when they make decisions.
Women sought out natural mentors and sponsors to facilitate career development.
 Are mentors necessary? Mentors provide clear visioning about what people want for themselves. And it has to be real. Not what they should do, but what they really want to do.
 Find mentors for content development and career advancement Someone pointed out to me that one person cannot be your be all to end all whether it’s in marriage or your children or in choosing mentors. And that what you should do if you are smart is find someone to help you, who can help you with something specific that you need. I did broaden out who I asked for advice about certain things. One mentor may not be broad enough to cover all of your interests.
Any doctor, leader, or teacher can act as informal mentors if we only observe and learn from what they are doing.
 Sponsorship Part of it is that we are not encouraged, we as women are not encouraging other women to get involved. You know there were people that had to sort of hit me over the side of the head to say you are ready. Move, go for it.
The problem is we have a human affinity to sponsor people who are like us.
I really was not looking for a leadership role, and yet I was requested by my program director and peers in my class… he very much encouraged me and offered his ongoing services to talk me through if I came to some bumps in the road that were challenging.
Women cannot sit back and wait to be recognized. Women need to share their drives and goals with the right people who can help them succeed. It is not enough to work really hard and wonder why you are not recognized for it.
 Establish supportive connections I do think the networking is important, because men do networking much better.
Women interested in leadership, a chair or a Dean, need a network.
We need to get together; we need to spread the word that there is support out there.
Women leaders intentionally planned their out of work life to support their leadership role.
 Work/Life issues Adaptations and accommodations we make around childbearing and family are very important, but the best thing you can do for a woman in that process is to tell her that you really believe in her ambition. We need to keep supporting them in feeling good about being super capable.
An important work focus was to help others achieve excellence.
 Identify and reinforce leadership potential Do not be afraid to surround yourself with people who are better than you are. Because if you provide the right environment for them, they will grow, and you will grow with them. They will bring you their best, and you will be learning from them.
Consciously look for leadership talent that you see. And start it early. I think that means starting with medical students. I think that means residency. You look for that early on. Who has that kind of leadership potential and start actually putting the idea in their heads? So, I might meet with one of my senior residents and just say you know I have noticed that you really have a skill set for leading people through. Have you ever thought about becoming a chair some day? Nobody’s talked to them about it, they have never thought about it. Put that little bit of seed of interest in their head and see what happens.
I think we also must allow people to find their own way, and how to do it. I have always been very supportive and taken advantage of programs like that but I did not define myself by those programs. The idea is to be a human being and citizen and not use gender as your defining feature.