Methodology

Background #

A mixed-methods methodological approach was chosen for this research (175-177). This was selected for its suitability to achieve the aims of 1) obtaining a snapshot on gender and leadership within RANZCOG, RANZCOG affiliated hospitals, and O&G departments within Australia and New Zealand, and 2) obtaining members experience and views on leadership, gender bias and quotas use at RANZCOG.

In order to obtain a snapshot of the current state of gender in leadership positions within RANZCOG and its affiliated institutions, three methods of analysis were chosen. The first method involved using content analysis to review and tabulate public document data. The second method involved the quantitative analysis of closed questions from a membership wide survey. To obtain more nuanced information (qualitative data) about RANZCOG members’ experiences and perspectives which might affect leadership in O&G, the membership wide survey included open-ended questions (Box 1). Here the third method of qualitative analysis occurred. This mixed-method approach would provide descriptive statistics, as well as more in-depth data focusing on factors relating to gender and leadership within O&G in Australia and New Zealand.

Defining gender and leadership #

For the purpose of this research ‘gender’ refers to the identity and state of being of a person, typically (though not exclusively) understood as ‘male’ or ‘female’ (178, 179). The gender of those in leadership positions was determined by name and confirmed by image and pronoun use.

‘Leadership’ was defined as holding a professional ‘position of leadership’ (12, 47-49). O&G leadership positions for this research included: the RANZCOG presidency, RANZCOG national board members, RANZCOG federal councilors, RANZCOG national chairs, RANZCOG Integrated Training Program (ITP) and Training and Assessment (T&A) state chairs, departmental or unit heads within O&G departments of RANZCOG accredited hospitals, as well as the departmental heads within university O&G departments in Australia and New Zealand.

Member inclusion criteria #

RANZCOG currently has 2,055 specialists, 475 trainees and 2,499 diplomates with its wider membership. For the purpose of this research only RANZCOG specialists and specialist trainees were included. ‘Diplomates’ are Australian General Practitioners who have completed the RANZCOG Diploma of Obstetrics and Gynaecology. They do not hold specialist O&G qualifications, and they were not included in the RANZCOG ‘membership’ for the purpose of this research as their primary qualification is with the Royal Australian College of General Practice (RACGP) (180) or the Australian College of Rural and Remote Medicine (ACRRM) (181) .

Data collection #

To obtain current data on the gender of those in RANZCOG leadership positions, a review of public documents from the RANZCOG website, RANZCOG activities reports, and RANZCOG media kit, was performed. This was achieved through the review of institutional websites, where documents and departmental staff listings were reviewed. When needed, phone directory listings were reviewed via institutional switchboards.

Data was obtained from RANZCOG, as well as all 98 RANZCOG accredited core training hospitals (182), and all 18 Australian and New Zealand universities with an O&G department (183, 184).

All current RANZCG trainees and specialists were invited to participate in an anonymous secure online survey (Appendix 1). The three authors of this research project designed this survey to gain quantitative and qualitative data from the RANZCOG membership (Box 1). Acknowledging the many ways to explore the concepts of leadership, this survey was designed to explore three areas. The first area was designed to obtain concrete information about currently held leadership positions, as well as aspirations for leadership among respondents. The second area aimed to explore views about remediating discrepancies in leadership related to gender. The third section explored perceptions on gender quotas (as one solution to improve gender leadership inequality). The survey was distributed through the RANZCOG Continuing Professional Development and Revalidation (CPRD) Committee. It was anticipated a minimum 23% response rate would be received, based upon minimum historical response rates from previously published membership- wide online surveys (185).

On the 15th of August 2017, 2530 RANZCOG members were emailed an invitation to complete the survey (via electronic link). On the 1st of September the CPRD committee emailed a survey reminder email and the link was subsequently closed 1 week later.

Data from the de-identified survey was uploaded to a secure computer for data analysis and long-term storage, as per the University of Melbourne Ethics guidelines.

Survey questions #

The full survey is located in appendix, with a summary of key questions is located below (Box 1). Each survey question was designed to address the secondary aims of this research, with an acknowledgement of the many leadership barriers within the medical literature (15, 29, 30, 34, 91, 97, 155-158). A recognition of these barriers including available time, family commitments, lack of mentors, gender bias, and perceived lower capability, provided the foundation to question 7 of the survey (Appendix q7). An acknowledging the substantial role gender bias plays in the medical literature with regards to leadership barriers for females, led to the gender bias section within the survey (Appendix q9-11). Gender quotas have played a key role in improving gender leadership equality within other disciplines (121, 123, 125), and this led to the inclusion of a separate section on gender quotas use (Appendix 1 – q12-14).

Data interpretation & presentation #

This study’s mixed-methods approach utilised descriptive statistical analysis of quantitative data (186), and thematic analysis of qualitative data (187). This approach provided simple summaries and observations about the data sample, as well as identified important themes that emerged from the free text comments. During the discussion of this research, the results of both qualitative and qualitative data will be compared to the international literature showing gender and leadership trends within other O&G communities (11-13).

Quantitative data analysis #

The data collected by reviewing and tabulating documents from RANZCOG, RANZCOG affiliated hospitals, and university O&G departments, was analysed using descriptive statistics, and used to identify gender leadership trends. Quantitative data from survey responses was analysed with descriptive statistics, facilitating the identification of trends among respondents addressing gender and leadership positions, desires and barriers to leadership, as well as views on gender quota use within the College. Data was again displayed in tabular form, with comparisons between males and females, as well as specialist and trainee responders. For all relevant quantitative data, chi-squared analyses were undertaken with statistical significance accepted at P < 0.05.

Qualitative data analysis #

Qualitative data from the survey free-text comments was analysed using thematic analysis (187, 188), with themed responses situated within feminist theories discussing gender schemas and biases in the leadership workplace space (46, 189-196).

Thematic analysis was chosen as the qualitative tool for this research as it provided a flexible and accessible, yet well outlined methodological approach, which was not tied to a particular theoretical or epistemological position. This approach supported the contextualisation of data in a specialty with limited published literature. A guideline to this approach was followed from Bruan and Clark’s paper (187). The inductive and semantic thematic analysis of the open text responses involved several steps and these are outlined below: