Meeting expectations: An exploration of academic emergency medicine faculty experiences and preferences in the virtual meeting environment by age, gender and parental status

Abstract

Background

During the COVID‐19 pandemic, virtual meetings became the norm in academic emergency medicine (EM) departments. This study explores the experiences of academic EM faculty within this environment.

Methods

In 2021, authors surveyed a cross‐sectional convenience sample of EM faculty using a mixed‐methods approach to explore perceptions of the virtual meeting environment. Authors reported data on a five‐point Likert scale, summarized as percentages, and calculated differences using Pearson’s chi‐squared test, where p < 0.05 was significant. Free text responses were analyzed qualitatively.

Results

Two‐hundred‐fifty‐nine responses were collected, (female [55.6%], ≤40 years old, [39.8%]) of which 33.2% had children ≤7 years old. Most respondents felt the total number of virtual meetings had increased and were more likely to happen outside of regular business hours compared to in‐person meetings. Most faculty preferred meetings during regular hours and liked the virtual format overall. Younger faculty respondents were more polarized in their preferences of timing of meetings and reported more pressure to accept meetings outside of regular hours. Female respondents with young children were more likely to dislike meetings outside regular hours and to have declined them. Women faculty, younger faculty, and women faculty with young children were significantly more likely to agree that women had been “more impacted by the new virtual work environment.” Qualitative themes highlighting the flexibility provided by the virtual work environment and decreased commuting time, though many felt communication was limited in virtual meetings.

Conclusions

Academic EM faculty mostly preferred keeping meetings during regular business hours and in a virtual format. Experiences varied by age but not by gender overall. Women with young children reported greater challenges than women without. Men did not differ by parental status. The virtual format provided increased flexibility but limited communication and engagement. Academic EM departments may use this data to inform future meeting practices.

INTRODUCTION

During the COVID‐19 pandemic, social distancing recommendations ¹ abruptly and significantly changed workplace dynamics in all types of work environments, including academic emergency medicine (EM) departments. In order to maintain communication and productivity while adhering to infectious control safety guidelines, in‐person meetings for both faculty and residents were converted to virtual platforms. In an environment already known for its challenges to work–life balance, ² , ³ , ⁴ , ⁵ this has added a layer of complexity.

Remote work, including resident conference time, has allowed administrative, academic, and educational work to continue and may present new opportunities as well as some perceived benefits on flexibility and quality of life. ⁶ , ⁷ , ⁸ In parallel, there is an increasing movement towards considering the “right to disconnect” (e.g., not participate in after‐hours virtual meetings) ⁹ , ¹⁰ and acknowledgement of the negative effect that around‐the‐clock availability may have on employees and their families in terms of wellness and “work–home interference.” ¹¹ , ¹² , ¹³ , ¹⁴

In addition to these personal implications, academic implications of working from home, especially for women, have been recognized, with childcare factoring heavily into the disproportionate effect on women. ¹⁵ , ¹⁶ , ¹⁷ The United States healthcare workforce has significant personal dependent care needs, with 29.9% of physicians and surgeons having children 3–12 years of age under their care. ¹⁸ Women spend 8.5 hours more per week on domestic activities than men and are more likely to take time off when regular childcare arrangements are disrupted. ¹⁹ During the COVID‐19 pandemic, physician mothers of elementary school–aged children were more concerned about parenting and homeschooling issues, as well as work–life balance, while mothers of preschool‐aged children were more concerned about access to childcare and partner relationships than those without similarly aged children. ²⁰ This all highlights the need to give particular consideration to the effects the virtual meeting environment may have on women physicians, especially those with children.

The purpose of this study was to describe academic EM faculty perceptions of meeting scheduling trends, experiences in navigating the virtual environment, and the effect of virtual meetings on boundaries between work and personal life. Further, we explore the influence of gender, age, and parental status on these experiences.

METHODS

We undertook a cross‐sectional survey‐based study employing a mixed‐methods Embedded Design ²¹ approach to explore EM faculty perceptions and opinions with regard to work‐related virtual meetings. It was reviewed by the Yale School of Medicine institutional review board and deemed exempt.

Survey design

As no previously validated surveys on this topic were available in the literature, the study survey instrument was investigator developed using best practice recommendations for survey design. ²² We began with an iterative design process until the investigators reached consensus on the final instrument. The questions were then reviewed and refined after consultation with a survey development expert and psychometrician. To establish response process validity, the survey was piloted with EM faculty members who completed the survey and provided feedback that was incorporated as edits into the questions. These faculty were then excluded from study participation. The final survey consisted of 17 questions on a five‐point Likert scale, 5 demographic questions, and 1 free text question. Regular business hours were defined as 8 a.m. to 5 p.m., based on the assumption that family members and other personal activities would be scheduled around such times, even if EM shift schedules are usually not, and because women with children have been shown to find meetings outside this time frame as problematic to career advancement. ²³ Surveys were distributed electronically using Qualtrics (Qualtrics, Provo, UT) and data were collected in March and April 2021 (Supplement 1).

Study setting and population

Study participants included members of the Academy for Women in Academic Emergency Medicine (AWAEM, 656 recipients) and Council of Residency Directors in Emergency Medicine (CORD, 1477 recipients) listservs, as these were freely accessible to the study investigators. Recruitment emails were sent to each listserv twice, 2 weeks apart, inviting members to participate by accessing a link provided. Surveys were anonymous and no identifying data were collected. The first page of the survey included information on informed consent, which was implied by completion of the survey. Participants received no incentive for participation. Study investigators and survey pilot participants were excluded from participation in the study.

Data analysis

Data were exported from Qualtrics to R (R Studio, Version 1.0.136, 2016) for quantitative analysis. Descriptive statistics were reported as percentages and differences were evaluated using Pearson’s chi‐squared test, with p < 0.05 indicating statistical significance.

Participant responses were analyzed for differences based on gender, age, and parental status. Age cutoffs for analysis were agreed upon by investigator consensus. Age >40 years was selected as reflecting a time when most respondents were likely to feel a sense of having an established career and level of comfort within their department. Age 8 years or older was chosen as an age where the level of self‐sufficiency of the children likely allowed for some increasing flexibility for parents to conduct work at home without significant uninterrupted supervision being required.

The Framework Method was used for qualitative analysis. ²⁴ Three authors collaboratively undertook inductive coding of participant responses (KG, JB, RC). After reviewing and coding responses individually, coders jointly discussed preliminary categories to create an initial conceptual framework. This was iteratively refined until a final framework with thematic saturation was achieved. One coder then sorted responses into themes and subthemes of the framework. All three coders reviewed the resulting grid in its entirety for consistency, discussing and reconciling any disagreements until full consensus was reached. Coders deliberately considered their own perceptions and personal contexts in an exercise of reflexivity to optimize objectivity throughout the iterative coding process.

RESULTS

There were 259 participants, of which 220 completed the entire survey. The minimum response rate calculated based on listserv participants was 12.1%, though this does not account for any overlap of members of both listservs, which could not be estimated but would decrease the denominator. Partially completed surveys were included in the Likert scale analysis but excluded for comparisons based on demographic traits for which respondents gave no information. Demographics of respondents are presented in Table 1.

TABLE 1.

Demographics and participant characteristics

	n	%
Gender
Female	144	55.6
Male	72	27.8
Nonbinary/third gender	1	0.4
Prefer not to say	3	1.2
No answer	39	15.1
Age
<30	3	1.2
31–40	100	38.6
41–50	73	28.2
>51	45	17.4
No answer	38	14.7
Academic rank
Clinical instructor	21	8.1
Assistant professor	107	41.3
Associate professor	58	22.4
Professor	33	12.7
No answer	40	15.4
Years as attending
0–5	57	22.0
6–10	58	22.4
>10	103	39.8
No answer	41	15.8
Any children
Yes	146	56.4
No	76	29.3
No answer	37	14.3
Young children (age 0–7 years)
Yes	86	33.2
No	136	52.5
No answer	37	14.3

Quantitative data

General data

Responses to questions in percentages are shown in Figure 1. There were no significant differences in distribution based on age, women as parents of young children, or gender for any questions except as detailed below.

FIGURE 1.

Participant Responses to survey: Meeting scheduling, social pressures, experiences, and preferences (%)

Age

While the majority of respondents overall agreed that they “dislike meetings outside of regular business hours,” those ≤40 years old were significantly more polarized in their opinions than those >40 years old, with a larger proportion liking after hours meetings, (“somewhat disagree” 14.6% for ≤40 years old vs 5.1% for >40 years old and “strongly disagree” 6.8% vs 0.8%, p < 0.05). Respondents ≤40 also reported feeling more “pressure to accept virtual meetings outside business hours” than older respondents (“strongly agree” 29.4% vs 16.9% and “somewhat agree” 36.3% vs 33.1%, p < 0.05).

Women with young children

Though all women overall agreed, women with young children under the age ≤7 years old (n = 91, 63.2%) were significantly more likely than women without young children (n = 53, 36.8%) to agree with the following: dislike virtual meetings scheduled outside regular business hours (“strongly agree” 60.4% for women with young children vs 37.4% and “somewhat agree” 18.9 vs 28.6%, p < 0.05); feel that there was generally a higher expectation for them to be available for virtual meetings than for in‐person meetings (“strongly agree” 22.6% vs 37.4% and “somewhat agree” 56.6% vs 30.8%, p < 0.05); feel that it was harder to decline meetings during regular business hours as they were assumed to be available (“strongly agree” 32.1% vs 34.1% and “somewhat agree” 43.4% vs 23.1%, p < 0.05); and were more likely to have declined virtual meetings outside business hours that interfered with personal or family time (“strongly agree” 39.6% vs 20.9%, “somewhat agree” 41.5% vs 38.5% and “strongly disagree” 0% vs 4.4%, p < 0.05). None of these showed a significant difference when comparing men with and without young children.

Reported experiences of women participants

Overall, more than half of respondents in all subgroups, except for men, strongly or somewhat agreed that “women have been more impacted by the new virtual work environment than men” (Figure 2). There was a significant difference in distribution of answers when stratified by gender, age, and women with young children. Women (p < 0.001), women with young children (p < 0.05), and respondents aged ≤40 years old (p < 0.05) were all more likely to “strongly agree” or “somewhat agree” with the statement.

FIGURE 2.

Participant responses to survey question: Women have been more impacted by the new virtual work environment than men; by gender, parental status, and age (%)

Qualitative data

Three core themes emanated from the coded qualitative interview data and 13 additional subthemes were identified from the free text final question of the survey (Table 2).

TABLE 2.

Inductive core themes, subthemes, and participant qualitative excerpts

Themes	Subthemes	Quotes
Convenience & scheduling	Multitasking, flexibility to attend	“Easy to keep. Easy to dress for.” “I have a 45 min drive to work [...] traditionally I wouldn’t drive down [for a single meeting], but now I will take that call” “I have been better able to participate [on non‐clinical days, so I am] more engaged within my department…” “Can multitask home chores like dishes/laundry”
	Frequency and timing of meetings	“...last minute meetings [in a virtual format are] SO much less disruptive…” “...the fact that they are easier to schedule has gotten to a level of craziness. The amount of Zoom calls scheduled outside of regular work is insane and really hard to manage.” “...times are often picked arbitrarily [and] it seems to be the default that if you can’t find a mutually agreeable time you just have a meeting at 8 or 9pm...” “...in general people seem to be respectful and only schedule meetings during business hours for most purposes…”
	Meeting characteristics	“Meetings tend to run overtime or have no defined end time” “Each meeting goes up to the end of the hour, so no time to even stand between them. In the past, at least you walked from one place to another.”
	Commute, travel time, accessibility	“The amount of time saved by not commuting [...] has changed my life for the better” “What a waste of gas/time to go driving somewhere for a 1‐hr meeting”
Communication	Camaraderie	“More flexibility but less camaraderie…” “I miss the informal ‘meetings’ that go on before and after scheduled meetings.” “The sense of community lost is real.”
	Networking, collaboration	“There is a clear need for networking [as occurs] at in‐person meetings.” “Love [virtual meetings] ‐ they are more efficient and equitable as people are not lingering making ‘side deals’” “[Conversations around in‐person meetings] help us catch up [and] make progress either in specific meeting agenda items or things outside of the meeting topic.” “Some meetings do well [virtually], some are better for in‐person (when we need to collaborate and better read body language, etc.)”
	Efficacy	“Large meetings that require discussion are basically useless over Zoom” “Things that naturally were resolved in person turn into email storms [...] or a series of informal meetings” “Many quick things that could be handled by poking your head in a colleagues’ office […] are now scheduled meetings.”
	Engagement	“The interactivity and energy of virtual meetings does not match those of in‐person meetings” “I was more productive at in‐person meetings”
Personal boundaries	Separation of work and home life	“I like being able to call in from bed [and] immediately switch to family time or another activity at the end of a meeting.” “It is hard to separate home vs. work time [...] and hard for my family to know when I am working and not working” “My chair has gotten used to children during meetings”
	Distractions	“There is much greater distraction...” “Often harder because they can be interrupted by other things going on at home…” “...many interruptions [...] make me feel less professional.”
	Time for personal and family activities	“A big improvement to faculty wellness to work from home” “It’s nice to [...] be able to meet after kids are in bed” “Not having to commute [...] has opened up personal time for exercise and family meals” “[Virtual meetings allow] me to be present for my kids and [...] to work out regularly for the first time in years.” “Perceived flexibility does not outweigh benefits of in‐person” “Definitely virtual does not free up more time for [me, but] the idea of being at home makes me think I have flexibility.”
	Protection of personal time	“[Virtual meetings] allow for shorter commitment [...] but do not protect time off at home.” “I make my own boundaries ‐ available 9‐5 M‐F for meetings. No meetings during day or night shift days. Only 3h for meetings after 11a when I have an evening shift.” “I now try to have a no meet day each week”
	Pressure to be available	“I like the flexibility. I hate that it makes me feel like meetings can happen anytime and I’m expected to be there.” “...there are more [virtual meetings] scheduled outside of regular business hours with greater expectation that I am available” “Ideally, the group should support their team and respect boundaries/obligations regardless of meeting type.”

Theme 1: Time factors—convenience, multitasking, and scheduling

Respondents felt strongly that virtual meetings provided flexibility, including increased ease of attendance and ability to multitask while listening to a meeting. Frequency of meetings was felt to have increased and timing has become more varied, which some viewed as a positive, but most as a negative. Meetings were often held back to back, without breaks, which respondents did not enjoy. Many respondents were very happy with the diminished need to commute to attend in‐person meetings.

Theme 2: Communication

Many faculty members felt the loss of camaraderie and missed the social aspect of in‐person meetings. Similarly, many noted an effect, both positive and negative, on networking opportunities and loss of a collaborative space. Respondents described the effect virtual work has had on communication dynamics. Many felt their engagement was diminished compared to in‐person meetings.

Theme 3: Personal boundaries

Respondents noted the interface of work and home life in the context of virtual meetings. Distractions and interruptions were more likely to occur at home than during in‐person meetings. While a number of respondents described the effect of extra time for personal and family activities, some questioned this benefit. Virtual meetings made it more challenging to protect personal time and faculty did feel an increased pressure to be available for virtual meetings. Several respondents took the initiative to create boundaries.

DISCUSSION

To the best of our knowledge, this study is the first to evaluate academic EM faculty experiences with meetings in the virtual work environment during the COVID‐19 pandemic. The participant survey was conducted 11 months into the COVID‐19 pandemic and thus is reflective of faculty perceptions and opinions during a time when social distancing guidelines were still in place and most of the general population was not vaccinated. Qualitative data provided support for quantitative findings and were able to give color to the preferences expressed, including, for example, why over half of all respondents prefer virtual meetings overall: “I have been better able to participate,” “last minute meetings [are] SO much less disruptive,” and “the amount of time saved by not commuting […] has changed my life for the better.”

Study participants, particularly those ≤40, reported feeling pressured to accept meetings outside regular business hours, (“I hate that it makes me feel like meetings can happen at any time and I’m expected to be there”). Though some actually did not dislike meeting at those times, (“it’s nice to […] be able to meet after kids are in bed”), the feeling of pressure may have come about by more senior colleagues setting meeting schedules and the respondents’ desire to demonstrate motivation. While younger faculty might have been expected to dislike the lack of in‐person meetings due to lost networking opportunities, ²⁵ , ²⁶ , ²⁷ , ²⁸ their responses showed that they were slightly more likely to prefer virtual meetings than older faculty, though the differences in distribution of responses were not significant. Younger faculty being more likely to have younger children at home may be contributing to this sentiment.

Recently, much has been written about the effect of the pandemic and virtual work environment on women in academia. ¹⁵ , ¹⁶ , ²⁹ , ³⁰ Interestingly, while our study sample demographics show a greater representation of female respondents, likely due to being sent to the AWAEM listserv, responses from male and female physicians did not differ significantly except in the perception of whether women were more impacted by the virtual work environment. Instead, parental status was a bigger driver of experiences and preferences when women with and without young children were compared, in a way that was not true for men. While we did not specifically elicit their role as primary caregiver, this is consistent with the broader literature suggesting women physicians are more affected by domestic expectations than men ¹⁹ and that their parental status correlates with experienced career obstacles and disparities, both before and during the pandemic. ¹⁶ , ²³ , ³¹

Compared to responding women without young children, those with young children reported feeling greater pressure to be available virtually than in‐person and felt it was harder to decline virtual meetings even during regular business hours, as they were presumed to be available when not working clinically (“[virtual meetings] do not protect time off at home,” “it’s hard to separate home vs work time”). They were also more likely to have declined meetings outside of regular business hours. These experiences, though similar to difficulties identified by female academic faculty even before the pandemic, ²³ , ³² may have provided an additional challenge in a year with often limited childcare options ¹⁵ , ¹⁷ , ¹⁸ , ²⁰ for a group that, as presumably more junior faculty, may frequently have less control over meeting schedules.

Younger respondents and women with young children were more likely to agree that the impact of the new virtual work environment was greater on women than on men. It is possible that younger respondents may be more primed to consider gender differences in the workplace due to recent shifts in societal focus, such as recognition of inequities according to race, ethnicity, sex, and gender. Women with young children agreed more strongly with the statement than women without young children, suggesting that this subgroup of women may have felt the effect of the change in both the work and home environment more strongly during the initial year of the COVID‐19 pandemic.

Interestingly, while female respondents were significantly more likely than males to agree that women have been more impacted by the new virtual work environment, significant gender differences did not appear in any of the questions regarding respondents’ personal experiences. For example, when asking specifics on how personal time was affected, responses by gender were similar. Female respondents may be answering the question globally, rather than in reference to their own specific personal experiences, with more senior women and mothers of older children recognizing and reflecting the effect on their junior colleagues. Further study to identify specific reasons as to why female subjects felt more affected by changes in the meeting environment could have important implications for equity and inclusion in the workplace. Our results also indicate that further exploration of parental status, alone and in the context of gender, as a factor impacting virtual workplace preferences may be warranted.

Qualitative themes and subthemes explored the various positive and negative facets of virtual meetings. While most faculty enjoyed the flexibility allowed by the virtual format, many missed the ability to socialize and network. Similar data have been reported for resident perceptions of virtual didactics. ⁷ Many appreciated the ability to quickly pivot to other activities, while some felt challenged to maintain a sense of boundaries between work and personal life. Respondents did perceive the virtual format to be less effective for certain types of meetings. While some meetings will clearly benefit from direct face‐to‐face interactions, such as those intended to promote networking, collaboration, and open discussion, many others, including those intended to unilaterally disseminate information, may be more efficiently held on a virtual platform.

This study provides data that may help inform academic EM departments in planning and organizing work‐related meetings once in‐person congregation is again routinely an option. Careful selection of meeting format can help balance the social and networking benefits of in‐person meetings with the flexibility and decreased time consumption of virtual meetings. Considering the experiences of members of diverse age groups, parental status, and gender may help optimize the satisfaction, efficiency, and engagement of those involved. The familiarity and acceptance of virtual platforms gained over the past year provides an opportunity to improve the experiences of academic EM faculty in their nonclinical work responsibilities, which, when contributing to balancing personal and family time, may also benefit their overall wellness and reduce burnout. ³³ , ³⁴ , ³⁵

LIMITATIONS

The perceptions of faculty reported during the study phase may shift with changing community rates of COVID‐19 infection and vaccination status and may be affected by personal concerns, such as safety of self and family members and monetary and job security concerns. It would be worthwhile to reassess perceptions at a future date to capture changes in faculty opinions and preferences as social distancing recommendations, infection and vaccination rates, and school reopening guidelines change.

We did not identify any differences in responses between genders to clarify why women felt they were affected more strongly by the virtual work environment. Phrasing of questions may have limited the information collected; in particular we did not specify whether the “impact” was positive or negative and this was left open to the interpretation of the respondent. Additionally, though efforts were made to optimize the survey, several questions were potentially primed either positively or negatively. The question of whether “women have been more impacted” might have been less subject to acquiescence bias and yielded different responses if it had been phrased with equipoise, (e.g., “which gender has been more impacted?”). A further question clarifying the role of the respondent as the primary caretaker of the household could have provided additional context.

While the age cutoff of under 8 years of age was selected as one where children may have gained some level of independence, mitigating the need for uninterrupted supervision, this may not be true for all children. Similarly, at age >40 years old, not all respondents will have a similar level of comfort in their departments, given some may have started second careers and obvious individual variations in personality. While we do feel these chosen cutoffs are useful in displaying and reflecting some general variations in departmental demographics, these were based on investigator consensus and not on prior literature. Likewise, the definition of “regular business hours” as 8 a.m. to 5 p.m. may not be meaningful to some emergency physicians, given their clinical scheduling, but is likely the framework within which family members and other personal activities function. Additionally, it has been shown that women with children find meetings scheduled outside this time frame to be a barrier to career development. ²³

The response rate for our study population could not be definitively calculated as the survey was sent to two listservs without a clear response denominator. It is unknown how many survey recipients were active consumers of the listserv communications and how many were members of both listservs. Certainly, the choice of listservs, one geared predominantly towards women in academic EM and one towards educators, may also have resulted in some voluntary response bias in the data collection. This may limit the generalizability of the study, as we do not know which subset of faculty members may have been more likely to respond. Additionally, the AWAEM listserv likely consisted of women with a specific interest in the implications of gender difference and inequities in academia. We attempted to explore the influence of this by analyzing responses by gender.

Although there were some statistically significant differences in the distribution of answers between genders, age groups, and women with and without young children, it is important to note that due to the small sample size, further and more detailed analysis to compare other subgroups could not be accomplished.

CONCLUSIONS

In our study sample of academic EM faculty, we found that most agree that they would prefer to keep meetings during regular business hours and the majority prefer a virtual format. Experiences and preferences varied by age. While gender did not affect responses in the full sample, women with young children were more likely than those without to report challenges in the virtual meeting environment. No such differences appeared for men with young children. Flexibility provided by the virtual format may need to be balanced with its reported limitations in communication and engagement. These results may help inform decisions in academic EM departments on meeting timing and format, while considering target faculty demographics.

CONFLICT OF INTEREST

KG, IC, JB, RC, CB, PA, AT report no conflict of interest.

AUTHOR CONTRIBUTIONS

Study concept and design: KG, IC, CB, PA. Acquisition of data: KG. Analysis and interpretation: KG, IC, JB, RC. Drafting of manuscript: KG, IC, AT. Critical revisions: KG, IC, JB, RC, CB, PA, AT. Statistical expertise: IC, Acquisition of funding: none.

PRESENTATIONS

Parts of this data were informally presented as part of a didactic during SAEM 2021.

Supporting information

Supplementary Material

Goldflam K, Crichton IC, Coughlin RF, et al. Meeting expectations: An exploration of academic emergency medicine faculty experiences and preferences in the virtual meeting environment by age, gender and parental status. AEM Educ Train. 2022;6:e10724. doi: 10.1002/aet2.10724