Neha Joshi Purkey

All Publications

• Advancing Women Physicians in Academic Medicine: A Scoping Review ACADEMIC MEDICINE Purkey, N. J., Han, P., Woodward, A., Davis, A. S., Johnston, L., Klein, R., Krawczeski, C. D., Leeman, K. T., Machut, K. Z., Patel, M. D., Scala, M., McBride, M. E. 2025; 100 (7): 860-870

  Abstract

  Multiple studies have described higher rates of attrition for women in academic medicine, but actionable strategies to retain women in the field have not been well studied in the current era. This study reviewed the existing literature for studied interventions to support the advancement of women physicians in academic medicine.A scoping review was conducted by searching the PubMed, Embase, and Scopus databases for articles describing interventions intended to support women physicians on September 12, 2022, and updated on August 23, 2024. All articles from inception of the databases through the search dates were included. Search terms included female physician , mentoring , leadership , career development , job satisfaction , advancement , and synonyms. Articles related to inequities in patient care, interventions related to nonphysician health care workers, and studies describing sexism without measured solutions were excluded from the analysis. Kirkpatrick's framework for the evaluation of educational programs was used to further classify results by 4 levels of evaluation for an educational or training program: reaction, learning, behavior, and results.A total of 2,813 articles underwent abstract screening and full-text review, with 64 articles included in the final analysis. Seven studies (10.9%) were randomized controlled trials. Only 2 studies (3.1%) specifically examined mid- or late-career women. Career development programs (15 [23.4%]), mentorship programs (10 [15.6%]), and women's interest groups (7 [10.9%]) were the most described interventions. Outcome measures were most commonly satisfaction with the intervention (22 [34.4%]), self-perceived improvement in skills (17 [26.6%]), and representation or recruitment of women into a field (12 [18.8%]).This study describes 64 articles of studied interventions to support the advancement of women in medicine. Additional studies are needed and should emphasize rigorous study methods, a focus on institutional solutions, and identifying and targeting the needs of women physicians beyond their early career.

  View details for DOI 10.1097/ACM.0000000000006052

  View details for Web of Science ID 001517194000013

  View details for PubMedID 40137941

• Actionable Areas of Distress among Pediatric Cardiology Fellows. The Journal of pediatrics Rajapuram, N., Tandel, M. D., Tawfik, D., Weng, Y., Rassbach, C. E., Purkey, N. J. 2025: 114572

  Abstract

  To quantify burnout and identify specific stressors among a national sample of pediatric cardiology fellows.We invited program directors at all 61 ACGME-accredited pediatric cardiology training programs to distribute a 40-item survey to their categorical (year 1-3) fellows from February-April 2023. The survey included the Stanford Professional Fulfillment Index and ratings of key stressors to understand levels of burnout and associated stressors.In total, 67% (261/391) of contacted pediatric cardiology fellows completed the survey, representing 50% of all categorical fellows in the US. Of these, 42% reported symptoms of burnout. Fellows without children were found to have increased odds of experiencing burnout symptoms compared with those with children (OR 2.03). 13 of 15 stressors were associated with increased burnout scores, of which "excessive number of work hours," "challenges to prioritizing self-care," and "mistreatment from supervisors" were the top three.This national study of pediatric cardiology fellows shows a high prevalence of burnout. The modifiable stressors identified in this study offer opportunities to improve the well-being of this group of trainees.

  View details for DOI 10.1016/j.jpeds.2025.114572

  View details for PubMedID 40185308

• The four Cs of physician leadership: A key to academic physician success. Qualitative research in medicine & healthcare Collins Ii, R. T., Purkey, N. J., Singh, M., DeSantis, A. D., Sanford, R. A. 2024; 8 (2): 11519

  Abstract

  Leadership is increasingly recognized as important in medicine. Physician leadership impacts healthcare delivery and quality. Little work has been done to determine how physician leadership in practice aligns with established models in leadership theory. We conducted 40 semi-structured, 50-minute interviews of physicians who had achieved the rank of professor in our school of medicine and were serving, or had served, in leadership positions. We used an inductive content analysis approach to identify content categories, with leadership emerging as one such category. Subsequently, for the present study, we performed a secondary analysis of the data. To do this, we reviewed all transcripts, seeking to identify if and how participants discussed leadership in relation to success in academic medicine. Following identification of sub-categories related to leadership, we performed qualitative content analysis. We then used a deductive content analysis approach to determine how participants' discussions of leadership aligned with major leadership theories. Then, the principal investigator conducted a secondary inductive content analysis revealing leadership themes that were synthesized into a new model of physician leadership. Twenty-nine participants spontaneously discussed leadership and leadership-related topics as important to their own academic success and comprised the present study cohort. Participants identified contributors to leadership success that aligned with multiple major leadership theories, including leadership traits, skills, behaviors styles, and situational leadership. None of the leadership theories aligned completely with our physician leaders' discussions, suggesting an alternate leadership framework was operating. Further analysis revealed a new model of leadership comprised of the "Four Cs of Physician Leadership": character, competence, caring, and communication. Our participant group of academic physicians identified leadership capabilities as being important in their academic success. While they discussed leadership in ways that fit to varying degrees with the major leadership theories, their discussions revealed a novel, more holistic leadership framework. Further work will be beneficial to determine if this model of leadership is specific to physicians or is more generalizable.

  View details for DOI 10.4081/qrmh.2024.11519

  View details for PubMedID 39381128

  View details for PubMedCentralID PMC11460181

• Factors Associated with Transfer Distance from Birth Hospital to Repair Hospital for First Surgical Repair among Infants with Myelomeningocele in California. American journal of perinatology Kancherla, V., Ma, C., Purkey, N. J., Hintz, S. R., Lee, H. C., Grant, G., Carmichael, S. L. 2023

  Abstract

   The objective of our study was to examine factors associated with distance to care for first surgical repair among infants with myelomeningocele in California. A total of 677 eligible cases with complete geocoded data were identified for birth years 2006 to 2012 using data from the California Perinatal Quality Care Collaborative linked to hospital and vital records. The median distance from home to birth hospital among eligible infants was 9 miles, and from birth hospital to repair hospital was 15 miles. We limited our analysis to infants who lived close to the birth hospital, creating two study groups to examine transfer distance patterns: "lived close and had a short transfer" (i.e., lived <9 miles from birth hospital and traveled <15 miles from birth hospital to repair hospital; n = 92), and "lived close and had a long transfer" (i.e., lived <9 miles from birth hospital and traveled ≥15 miles from birth hospital to repair hospital; n = 96). Log-binomial regression was used to estimate crude and adjusted risk ratios (aRRs and 95% confidence intervals (CIs). Selected maternal, infant, and birth hospital characteristics were compared between the two groups. We found that low birth weight (aRR = 1.44; 95% CI = 1.04, 1.99) and preterm birth (aRR = 1.41; 95% CI = 1.01, 1.97) were positively associated, whereas initiating prenatal care early in the first trimester was inversely associated (aRR = 0.64; 95% CI = 0.46, 0.89) with transferring a longer distance (≥15 miles) from birth hospital to repair hospital. No significant associations were noted by maternal race-ethnicity, socioeconomic indicators, or the level of hospital care at the birth hospital. Our study identified selected infant factors associated with the distance to access surgical care for infants with myelomeningocele who had to transfer from birth hospital to repair hospital. Distance-based barriers to care should be identified and optimized when planning deliveries of at-risk infants in other populations.· Low birth weight predicted long hospital transfer distance.. · Preterm birth was associated with transfer distance.. · Prenatal care was associated with transfer distance..

  View details for DOI 10.1055/s-0042-1760431

  View details for PubMedID 36646096

• A Scoping Review and Appraisal of Extracorporeal Membrane Oxygenation Education Literature. ATS scholar Han, P. K., Purkey, N. J., Kuo, K. W., Ryan, K. R., Woodward, A. L., Jahadi, O., Prom, N. L., Halamek, L. P., Johnston, L. C. 2022; 3 (3): 468-484

  Abstract

  Background: Despite a recent rise in publications describing extracorporeal membrane oxygenation (ECMO) education, the scope and quality of ECMO educational research and curricular assessments have not previously been evaluated.Objective: The purposes of this study are 1) to categorize published ECMO educational scholarship according to Bloom's educational domains, learner groups, and content delivery methods; 2) to assess ECMO educational scholarship quality; and 3) to identify areas of focus for future curricular development and educational research.Methods: A multidisciplinary research team conducted a scoping review of ECMO literature published between January 2009 and October 2021 using established frameworks. The Medical Education Research Study Quality Instrument (MERSQI) was applied to assess quality.Results: A total of 1,028 references were retrieved; 36 were selected for review. ECMO education studies frequently targeted the cognitive domain (78%), with 17% of studies targeting the psychomotor domain alone and 33% of studies targeting combinations of the cognitive, psychomotor, and affective domains. Thirty-three studies qualified for MERSQI scoring, with a median score of 11 (interquartile range, 4; possible range, 5-18). Simulation-based training was used in 97%, with 50% of studies targeting physicians and one other discipline.Conclusion: ECMO education frequently incorporates simulation and spans all domains of Bloom's taxonomy. Overall, MERSQI scores for ECMO education studies are similar to those for other simulation-based medical education studies. However, developing assessment tools with multisource validity evidence and conducting multienvironment studies would strengthen future work. The creation of a collaborative ECMO educational network would increase standardization and reproducibility in ECMO training, ultimately improving patient outcomes.

  View details for DOI 10.34197/ats-scholar.2022-0058RE

  View details for PubMedID 36312813

• Distance from home to birth hospital, transfer, and mortality in neonates with hypoplastic left heart syndrome in California. Birth defects research Purkey, N. J., Ma, C., Lee, H. C., Hintz, S. R., Shaw, G. M., McElhinney, D. B., Carmichael, S. L. 2022

  Abstract

  BACKGROUND: Prior studies report a lower risk of mortality among neonates with hypoplastic left heart syndrome (HLHS) who are born at a cardiac surgical center, but many neonates with HLHS are born elsewhere and transferred for repair. We investigated the associations between the distance from maternal home to birth hospital, the need for transfer after birth, sociodemographic factors, and mortality in infants with HLHS in California from 2006 to 2011.METHODS: We used linked data from two statewide databases to identify neonates for this study. Three groups were included in the analysis: "lived close/not transferred," "lived close/transferred," and "lived far/not transferred." We defined "lived close" versus "lived far" as 11miles, the median distance from maternal residence to birth hospital. Log-binomial regression models were used to identify the association between sociodemographic variables, distance to birth hospital and transfer. Cox proportional hazards models were used to identify the association between mortality and distance to birth hospital and transfer. Models were adjusted for sociodemographic variables.RESULTS: Infants in the lived close/not transferred and the lived close/transferred groups (vs. the lived far/not transferred group) were more likely to live in census tracts above the 75th percentile for poverty with relative risks 1.94 (95% confidence interval [CI] 1.41-2.68) and 1.21 (95% CI 1.05-1.40), respectively. Neonatal mortality was higher among the lived close/not transferred group compared with the lived far/not transferred group (hazard ratio 1.77, 95% CI 1.17-2.67).CONCLUSIONS: Infants born to mothers experiencing poverty were more likely to be born close to home. Infants with HLHS who were born close to home and not transferred to a cardiac center had a higher risk of neonatal mortality than infants who were delivered far from home and not transferred. Future studies should identify the barriers to delivery at a cardiac center for mothers experiencing poverty.

  View details for DOI 10.1002/bdr2.2020

  View details for PubMedID 35488460

• Timing of Transfer and Mortality in Neonates with Hypoplastic Left Heart Syndrome in California. Pediatric cardiology Purkey, N. J., Ma, C., Lee, H. C., Hintz, S. R., Shaw, G. M., McElhinney, D. B., Carmichael, S. L. 2021

  Abstract

  Maternal race/ethnicity is associated with mortality in neonates with hypoplastic left heart syndrome (HLHS). We investigated whether maternal race/ethnicity and other sociodemographic factors affect timing of transfer after birth and whether timing of transfer impacts mortality in infants with HLHS. We linked two statewide databases, the California Perinatal Quality Care Collaborative and records from the Office of Statewide Health Planning and Development, to identify cases of HLHS born between 1/1/06 and 12/31/11. Cases were divided into three groups: birth at destination hospital, transfer on day of life 0-1 ("early transfer"), or transfer on day of life≥2 ("late transfer"). We used log-binomial regression models to estimate relative risks (RR) for timing of transfer and Cox proportional hazard models to estimate hazard ratios (HR) for mortality. We excluded infants who died within 60days of life without intervention from the main analyses of timing of transfer, since intervention may not have been planned in these infants. Of 556 cases, 107 died without intervention (19%) and another 52 (9%) died within 28days. Of the 449 included in analyses of timing of transfer, 28% were born at the destination hospital, 49% were transferred early, and 23% were transferred late. Late transfer was more likely for infants of low birthweight (RR 1.74) and infants born to US-born Hispanic (RR 1.69) and black (RR 2.45) mothers. Low birthweight (HR 1.50), low 5-min Apgar score (HR 4.69), and the presence of other major congenital anomalies (HR 3.41), but not timing of transfer, predicted neonatal mortality. Late transfer was more likely in neonates born to US-born Hispanic and black mothers but was not associated with higher mortality.

  View details for DOI 10.1007/s00246-021-02561-w

  View details for PubMedID 33533967

• Toward Opioid-Free Fast Track for Pediatric Congenital Cardiac Surgery. Journal of cardiothoracic and vascular anesthesia Esfahanian, M., Caruso, T. J., Lin, C., Kuan, C., Purkey, N. J., Maeda, K., Tsui, B. C. 2019

  View details for DOI 10.1053/j.jvca.2019.02.003

  View details for PubMedID 30852093

• Birth Location of Infants with Critical Congenital Heart Disease in California PEDIATRIC CARDIOLOGY Purkey, N. J., Axelrod, D. M., McElhinney, D. B., Rigdon, J., Qin, F., Desai, M., Shin, A. Y., Chock, V. Y., Lee, H. C. 2019; 40 (2): 310–18

  View details for DOI 10.1007/s00246-018-2019-0

  View details for Web of Science ID 000460553100007

• Birth Location of Infants with Critical Congenital Heart Disease in California. Pediatric cardiology Purkey, N. J., Axelrod, D. M., McElhinney, D. B., Rigdon, J., Qin, F., Desai, M., Shin, A. Y., Chock, V. Y., Lee, H. C. 2018

  Abstract

  The American Academy of Pediatrics classifies neonatal intensive care units (NICUs) from level I to IV based on the acuity of care each unit can provide. Birth in a higher level center is associated with lower morbidity and mortality in high-risk populations. Congenital heart disease accounts for 25-50% of infant mortality related to birth defects in the U.S., but recent data are lacking on where infants with critical congenital heart disease (CCHD) are born. We used a linked dataset from the Office of Statewide Health Planning and Development to access ICD-9 diagnosis codes for all infants born in California from 2008 to 2012. We compared infants with CCHD to the general population, identified where infants with CCHD were born based on NICU level of care, and predicted level IV birth among infants with CCHD using logistic regression techniques. From 2008 to 2012, 6325 infants with CCHD were born in California, with 23.7% of infants with CCHD born at a level IV NICU compared to 8.4% of the general population. Level IV birth for infants with CCHD was associated with lower gestational age, higher maternal age and education, the presence of other congenital anomalies, and the diagnosis of a single ventricle lesion. More infants with CCHD are born in a level IV NICU compared to the general population. Future studies are needed to determine if birth in a lower level of care center impacts outcomes for infants with CCHD.

  View details for PubMedID 30415381

• Long-term pediatric ventricular assist device therapy: a case report of 2100+ days of support. ASAIO journal Purkey, N. J., Lin, A., Murray, J. M., Gowen, M., Shuttleworth, P., Maeda, K., Almond, C. S., Rosenthal, D. N., Chen, S. 2017

  Abstract

  Ventricular assist devices (VADs) have been placed as destination therapy in adults for over twenty years but have only recently been considered an option in a subset of pediatric patients. A 2016 report from the Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS) revealed only eight pediatric patients implanted as destination therapy. We report the case of an adolescent male with Becker Muscular Dystrophy (BMD) who underwent VAD placement in 2011 as bridge to candidacy. He subsequently decided to remain as destination therapy and so far has accrued over 2100 days on VAD support, the longest duration of pediatric VAD support reported in the literature to date.

  View details for DOI 10.1097/MAT.0000000000000546

  View details for PubMedID 28195883