Gender and Code Leadership: Continued!

Authors: Josie Acuna, Kelly Tighe, Devjani Das

Not long ago we raised the question of whether a difference exists between male and female physicians as leaders; specifically when it comes to running a code. While there remains a lack of robust research pertaining to the effectiveness of men and women as leaders in the medical field, there are a number of smaller studies available which explore the role that gender may play in leadership during cardiopulmonary resuscitation. The majority of research has found no difference in outcomes when it comes to males versus females as leaders.

We asked for your opinion on several topics in regards to gender and code leadership and invited you to participate in a brief survey. We received 18 responses in total: 9 women and 9 men. All participants are emergency medicine physicians at Staten Island University Hospital.

  • “I feel women have to be louder, more aggressive to get their voices heard and to get people to do what they say” (female respondent)

  • “Yes, I think that women, whether consciously or unconsciously, are aware of the different way they are perceived when running a code as compared to men” (female respondent)

  • “Male physicians tend to appear more comfortable with delegating tasks. Female physicians are more likely to embrace team members input” (male respondent)

  • “My code persona is a lot tougher and more definitive when I call out commands than I am on a day to day basis. I am, unfortunately, very short so I often stand at the foot of the bed with my arms folded and call out orders so that others are aware that I am the leader of the code.” (female respondent)

  • “I'm definitely louder and sound more aggressive. I've been told I have an attitude when I'm doing a code.” (female respondent)

  • “The tone of my voice changes during a code and I assume tougher attitude” (female respondent)


Participants were asked to comment on their own specific struggles they have faced when running a code. It was noted that a number of responses followed a similar theme. Most physicians, regardless of their gender, have struggled with not feeling heard and maintaining control of a busy room.

  • “Sometimes I'll notice that I have to repeat myself several times before I'm heard. I'm trying to sound loud and confident and many times I'm perceived as being rude” (female respondent)

  • “If control is lost, resorting to yelling louder has been my go to. Probably not the best strategy” (male respondent)

  • “Being interrupted” (female respondent)

  • “Just trying to figure out what is going on and fighting the urge to get involved physically when I am running the code.” (male respondent)

  • “(Maintaining) emotional neutrality at the time of informing the family of poor result” (male respondent)

Participants were also asked to discuss different strategies they have employed to demonstrate leadership when trying to command a room:

  • ”If you are confident in your abilities, gender does not play a role when demonstrating leadership” (female respondent)

  • ”I try to be more confident when I call out things and try to use names more often to make sure I'm heard.” (female respondent)

  • “I focus on my role and constantly reevaluate what my task is. I employ direct communication participants and request read back of the direction. I utilize feedback and after-action huddles to evaluate the success of the event. A code leader must believe they can fix any problem they encounter; whether it be personnel, resources, medical difficulties. I modify my plan as needed, restate the goals, and augment with resources to accomplish the task.” (male respondent)

  • “Speaking louder, clearer. Don’t doubt myself.” (female respondent)

Thank you to everyone who participated in the survey! As always, we invite all comments and suggestions.