Harden, Jeni

Lone, Nazir

Baruah, Rosaleen

2026-05-26T12:52:13Z

2026-05-26

Research into workforce planning undertaken by the Faculty of Intensive Care Medicine (FICM) has acknowledged that the United Kingdom (UK) Intensive Care Medicine (ICM) workforce gender balance is misaligned with the gender balance of UK medical graduates. Evidence from the United States of America, Canada and Australia and New Zealand suggest the gender imbalance in ICM may be driven by factors such as lack of work life balance, sexism, limited access to career development opportunities, lack of role models and valorising of stereotypically masculine traits. To date there is no qualitative research from within the UK examining gender and how it may shape the experiences of those working within the specialty. My thesis explores gender and how it shapes the experience of training and working within intensive care medicine in Scotland. For this study, I recruited thirty participants using a purposive recruitment strategy, informed by information power to determine the final number of participants. Eligible participants included specialty trainees in ICM, consultants and non-consultant career grade doctors from the 16 general ICUs in Scotland registered with FICM for training. I recruited a total of 15 consultants (six female) and 15 trainees (ten female). I conducted online one-to-one semi-structured interviews. Using reflexive thematic analysis, I iteratively analysed data from interview transcripts using an inductive approach guided by a subtle realist epistemology and ontology, informed by feminist research methods. I generated five themes and one subtheme from my data: Intensivists are super-heroic high achievers (but at a cost); The culture of ICM equates struggle with strength (with its subtheme A ‘New School’ culture could humanise ICM); Invisible barriers make the playing field look level; Women in ICM face a confidence and credibility deficit and Female intensivists have a hidden care burden. The overarching linking concept between all themes involves the archetype of the Old School intensivist, a personification of the masculine culture within ICM. Veneration of this archetype leads to the persistence of masculine medical hegemonic practices within ICM, including status homophily and banter culture favouring male career progression; testimonial injustice; gendered microaggressions in the form of microinvalidations and microinsults; benevolent sexism; and the need to engage in unseen emotional and cognitive labour, being experienced by women. Participant accounts described ways in which masculine medical hegemonic practices within ICM led to formation of a male ingroup and female outgroup. Female participants were subjected to frequent covert workplace discrimination but appeared unaware of the presence or nature of this discrimination, frequently attributing negative workplace experiences to personal or professional inadequacy. Male participants described being subject to rigorous policing of their emotional state, and felt unable to express personal or professional vulnerability by asking for help or admitting gaps in knowledge. The persistence of these hegemonic practices perpetuated the masculine culture of ICM, which in turn promoted the persistence of the hegemonic practices. An alternative New School archetype described by participants personified a culture less masculine than Old School culture. This archetype and the culture associated with it appeared close to participants own personal values, but was perceived to involve loss of status for the specialty and therefore likely to be resisted. I discuss the concepts of hermeneutical injustice and stigma as potential contributors to this resistance to cultural change. Initiatives at national and international level promoting recruitment and retention of female intensivists already exist. My findings suggest that an increase in the number of women entering ICM may not result in culture change. In order to promote positive culture change within ICM, a deeper understanding of the gendered culture of the specialty, the practices perpetuating this culture and the ways this impacts the experience of intensivists is needed. I propose formation of ‘Men in ICM’ initiatives alongside Women in ICM initiatives to give male intensivists knowledge and space to reflect on gender and how it shapes their experience of training and working in ICM. Setting up of such groups will require further exploratory work to assess the most effective ways of delivering such interventions.

https://era.ed.ac.uk/handle/1842/44745

https://doi.org/10.7488/era/7260

en

Chadwick, A.J. and Baruah, R. (2020) ‘Gender disparity and implicit gender bias amongst doctors in intensive care medicine: A “disease” we need to recognise and treat’, Journal of the Intensive Care Society, 21(1), pp. 12–17. Available at: https://doi.org/10.1177/1751143719870469

Critchley, J., Schwarz, M. and Baruah, R. (2021) ‘The female medical workforce’, Anaesthesia, 76(S4), pp. 14–23. Available at: https://doi.org/10.1111/anae.15359

Gender

Culture

Intensive Care Medicine (ICM)

ICM

Hegemonic practices

Masculine

How gender shapes the experience of training and working in Intensive Care Medicine in Scotland

Thesis

Doctoral

PhD Doctor of Philosophy