Glass slippers and glass cliffs: Fitting in and falling off

Nithya Krishnan, Deborah Biggerstaff , Ala Szczepura, Monica Dolton, Sondra Livingston, John Hattersley , Josette Eris , Nancy Ascher , Robert Higgins, Hillary Braun , Kathryn Wood , Neil Raymond

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)
131 Downloads (Pure)


BACKGROUND: A glass ceiling effect exists for women in male-dominated professions. Recent studies also show a glass-cliff effect where senior women can more easily fall from positions of leadership. Transplantation remains a male-dominated specialty. This study investigated gender and the perception of adverse clinical incidents in transplantation. METHODS: Prospective randomised web-based survey involving five clinical scenarios presenting two versions of episodes with errors or mistakes, with either a male or female as a randomly named protagonist (Set1 and Set2). To address unconscious bias, the study was described as examining actions following clinical adverse incidents in transplantation. Each scenario was followed by 2 closed questions: (1) clinical performance rating and (2) selection of action required. Reasoning was invited (open-text comments). Responses were analyzed using quantitative and qualitative methods. RESULTS: One hundred ninety-one invitees responded; 134 completed questionnaires. There were no statistically significant differences (P > 0.05) in responses between sets for performance ratings or recommended actions. However, for "first solo laparoscopic surgery" scenario, there was some indication that "No Action" was more likely if surgeon was male (P = 0.056). Male responses rated female performance as significantly worse (P = 0.035) for the laboratory-based scenario. One hundred two participants provided open-text comments. Thematic analysis identified 7 themes. Acceptable levels of risk theme demonstrated engendered leadership beliefs, that is, when clinical judgment proved incorrect, males described as forceful but females as needing support. In cases where things went wrong, respondents were more likely to comment females should not have decided to proceed. CONCLUSIONS: While gender may no longer be an overt issue in perceived performance of senior staff in transplantation, respondents' use of language and their choice of words display elements of unconscious (covert) engendered views.

Original languageEnglish
Pages (from-to)1486-1493
Number of pages8
Issue number7
Early online date18 Feb 2019
Publication statusPublished - 1 Jul 2019

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  • Leadership
  • gender identity
  • use of language
  • glass cliff
  • women physicians
  • stereotyping

ASJC Scopus subject areas

  • Health Professions(all)
  • Medicine(all)
  • Social Sciences(all)


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