Overcoming the gender gap: increasing gender diversity, scientific scholarship and social legitimacy of our profession

OBJECTIVES

This article examines a recent college review of the gender distribution on Royal Australian and New Zealand College of Psychiatry (RANZCP) committees. It includes an analysis of the key reasons we should seek to address the gender disparity in our committees and conference speakers and strategies by which to achieve this.

CONCLUSIONS

The gender gap in Royal Australian and New Zealand College of Psychiatry leadership influences the perception, social legitimacy, problem-solving capacity and scientific direction of our field. We could improve equality in our college committees and conference speakers by adopting strategies used by governments and other professional associations.

Distributional Cost-Effectiveness Analysis: A Tutorial

Distributional cost-effectiveness analysis (DCEA) is a framework for incorporating health inequality concerns into the economic evaluation of health sector interventions. In this tutorial, we describe the technical details of how to conduct DCEA, using an illustrative example comparing alternative ways of implementing the National Health Service (NHS) Bowel Cancer Screening Programme (BCSP). The 2 key stages in DCEA are 1) modeling social distributions of health associated with different interventions, and 2) evaluating social distributions of health with respect to the dual objectives of improving total population health and reducing unfair health inequality. As well as describing the technical methods used, we also identify the data requirements and the social value judgments that have to be made. Finally, we demonstrate the use of sensitivity analyses to explore the impacts of alternative modeling assumptions and social value judgments.

Reaching across group boundaries: Respect from outgroup members facilitates recategorization as a common group

Two laboratory experiments tested the hypothesis that (equality-based) respect from outgroup members facilitates recategorization of the original ingroup and outgroup as a common group. In Experiment 1, we varied respect from outgroup members (low vs. medium vs. high) and measured recipients' willingness to recategorize. As predicted, high respect from an outgroup source increased willingness to recategorize as a common group relative to low respect. In Experiment 2, we orthogonally varied respect (low vs. medium vs. high) and its source (ingroup members vs. outgroup members) and employed a more differentiated recategorization measure including an intermediate or nested-group option (i.e., two subgroups of a common group). While the recategorization effect of high versus low respect from outgroup members was replicated, no such effect was observed for respect from ingroup members. Instead, there was some indication that, when it comes from ingroup members, a medium level of respect may be optimal for inducing a shift towards recategorization as a common group. Implications of the present research for the conceptualization of respect are discussed.

Equality bias impairs collective decision-making across cultures

We tend to think that everyone deserves an equal say in a debate. This seemingly innocuous assumption can be damaging when we make decisions together as part of a group. To make optimal decisions, group members should weight their differing opinions according to how competent they are relative to one another; whenever they differ in competence, an equal weighting is suboptimal. Here, we asked how people deal with individual differences in competence in the context of a collective perceptual decision-making task. We developed a metric for estimating how participants weight their partner's opinion relative to their own and compared this weighting to an optimal benchmark. Replicated across three countries (Denmark, Iran, and China), we show that participants assigned nearly equal weights to each other's opinions regardless of true differences in their competence-even when informed by explicit feedback about their competence gap or under monetary incentives to maximize collective accuracy. This equality bias, whereby people behave as if they are as good or as bad as their partner, is particularly costly for a group when a competence gap separates its members.

Equality Hypocrisy, Inconsistency, and Prejudice: The Unequal Application of the Universal Human Right to Equality

In Western culture, there appears to be widespread endorsement of Article 1 of the Universal Declaration of Human Rights (which stresses equality and freedom). But do people really apply their equality values equally, or are their principles and application systematically discrepant, resulting in equality hypocrisy? The present study, conducted with a representative national sample of adults in the United Kingdom (N = 2,895), provides the first societal test of whether people apply their value of "equality for all" similarly across multiple types of status minority (women, disabled people, people aged over 70, Blacks, Muslims, and gay people). Drawing on theories of intergroup relations and stereotyping we examined, relation to each of these groups, respondents' judgments of how important it is to satisfy their particular wishes, whether there should be greater or reduced equality of employment opportunities, and feelings of social distance. The data revealed a clear gap between general equality values and responses to these specific measures. Respondents prioritized equality more for "paternalized" groups (targets of benevolent prejudice: women, disabled, over 70) than others (Black people, Muslims, and homosexual people), demonstrating significant inconsistency. Respondents who valued equality more, or who expressed higher internal or external motivation to control prejudice, showed greater consistency in applying equality. However, even respondents who valued equality highly showed significant divergence in their responses to paternalized versus nonpaternalized groups, revealing a degree of hypocrisy. Implications for strategies to promote equality and challenge prejudice are discussed.

Development of in-group favoritism in children's third-party punishment of selfishness

When enforcing norms for cooperative behavior, human adults sometimes exhibit in-group bias. For example, third-party observers punish selfish behaviors committed by out-group members more harshly than similar behaviors committed by in-group members. Although evidence suggests that children begin to systematically punish selfish behavior around the age of 6 y, the development of in-group bias in their punishment remains unknown. Do children start off enforcing fairness norms impartially, or is norm enforcement biased from its emergence? How does bias change over development? Here, we created novel social groups in the laboratory and gave 6- and 8-year-olds the opportunity to engage in costly third-party punishment of selfish sharing behavior. We found that by age 6, punishment was already biased: Selfish resource allocations received more punishment when they were proposed by out-group members and when they disadvantaged in-group members. We also found that although costly punishment increased between ages 6 and 8, bias in punishment partially decreased. Although 8-y-olds also punished selfish out-group members more harshly, they were equally likely to punish on behalf of disadvantaged in-group and out-group members, perhaps reflecting efforts to enforce norms impartially. Taken together, our results suggest that norm enforcement is biased from its emergence, but that this bias can be partially overcome through developmental change.

A 12-year comparison of students' perspectives on diversity at a Jesuit Medical School

BACKGROUND

Many studies have assessed perspectives of medical students toward institutional diversity, but few of them have attempted to map changes in diversity climate over time.

OBJECTIVE

This study aims to investigate changes in diversity climate at a Jesuit medical institution over a 12-year period.

METHODS

In 1999, 334 medical students completed an anonymous self-administered online survey, and 12 years later, 406 students completed a comparable survey in 2011. Chi-square tests assessed the differences in percent responses to questions of the two surveys, related to three identities: gender, race, and sexual orientation.

RESULTS

The 1999 versus 2011 samples were 46% versus 49% female, 61% versus 61% Caucasian, and 41% vs. 39% aged 25 years or older. Findings suggested improvements in medical students' perceptions surrounding equality 'in general' across the three identities (p<0.001); 'in the practice of medicine' based on gender (p<0.001), race/ethnicity (p=0.60), and sexual orientation (p=0.43); as well as in the medical school curriculum, including course text content, professor's delivery and student-faculty interaction (p<0.001) across the three identities. There was a statistically significant decrease in experienced or witnessed events related to gender bias (p<0.001) from 1999 to 2011; however, reported events of bias based on race/ethnicity (p=0.69) and sexual orientation (p=0.58) only showed small decreases.

CONCLUSIONS

It may be postulated that the improvement in students' self-perceptions of equality and diversity over the past 12 years may have been influenced by a generational acceptance of cultural diversity and, the inclusion of diversity training courses within the medical curriculum. Diversity training related to race and sexual orientation should be expanded, including a follow-up survey to assess the effectiveness of any intervention.

Notes on testing equality and interval estimation in Poisson frequency data under a three-treatment three-period crossover trial

When the frequency of event occurrences follows a Poisson distribution, we develop procedures for testing equality of treatments and interval estimators for the ratio of mean frequencies between treatments under a three-treatment three-period crossover design. Using Monte Carlo simulations, we evaluate the performance of these test procedures and interval estimators in various situations. We note that all test procedures developed here can perform well with respect to Type I error even when the number of patients per group is moderate. We further note that the two weighted-least-squares (WLS) test procedures derived here are generally preferable to the other two commonly used test procedures in the contingency table analysis. We also demonstrate that both interval estimators based on the WLS method and interval estimators based on Mantel-Haenszel (MH) approach can perform well, and are essentially of equal precision with respect to the average length. We use a double-blind randomized three-treatment three-period crossover trial comparing salbutamol and salmeterol with a placebo with respect to the number of exacerbations of asthma to illustrate the use of these test procedures and estimators.

Implementation of a standardised health education in a local context. A case study

Educational interventions are generally poorly described and the active elements underlying several successful interventions have insufficient descriptions. The aim of the present study was to analyse and discuss the theoretical principles according to which a standardised health education programme originating from a Norwegian Learning and Mastery Centre was performed, and how these principles influence practice at a local Learning and Mastery Centre. A descriptive embedded multiple-case study, with two cases and three defined units, was chosen for the analysis. Data consisted of observations, documents and relevant theoretical literature. The findings indicate that both cases were organised and practised in a scholastic way. The professionals paid little attention to the participants' beliefs and ideas as part of the learning process. Professional knowledge and user knowledge did not appear to be considered to be of equal value. The professionals did not stress reflection as a main prerequisite for learning, therefore participants' learning potential was not utilised. Attention must be paid to improving the professional's educational competence. The educational competence of the professionals should not only include educational techniques but also knowledge about how to facilitate learning processes and an understanding of the concept of health literacy. The theoretical foundations of the Learning and Mastery Centre, as well as its learning philosophy and approach must be stated more explicitly. To benefit from a Learning and Mastery course, the participants should have a minimum understanding about their medical conditions before attending the course, and the professionals should have knowledge about the participants' pre-knowledge.

Analysis of Poisson frequency data under a simple crossover trial

When the frequency of occurrence for an event of interest follows a Poisson distribution, we develop asymptotic and exact procedures for testing non-equality, non-inferiority and equivalence, as well as asymptotic and exact interval estimators for the ratio of mean frequencies between two treatments under a simple crossover design. Using Monte Carlo simulations, we evaluate the performance of these test procedures and interval estimators in a variety of situations. We note that all asymptotic test procedures developed here can generally perform well with respect to Type I error and can be preferable to the exact test procedure with respect to power if the number of patients per group is moderate or large. We further find that in these cases the asymptotic interval estimator with the logarithmic transformation can be more precise than the exact interval estimator without sacrificing the accuracy with respect to the coverage probability. However, the exact test procedure and exact interval estimator can be of use when the number of patients per group is small. We use a double-blind randomized crossover trial comparing salmeterol with a placebo in exacerbations of asthma to illustrate the practical use of these estimators.

How to add more "family" to the work-life-balance? - family friendliness in medical under- and postgraduate studies and the workplace

Today universities have to compete for the best brains more than ever before. The issues of reconciliation of work/study and family and the work-life balance have become increasingly important recently in higher education policy development as higher education institutions in the competition for the best minds are already forced to tackle these issues, some of which are still novel to them, as they are faced with demographic change. High dropout rates among students with children, increasing shortages of physicians and high sector emigration and high levels of childlessness among graduates serve as indicators for urgent action towards more family-oriented university and faculty strategies. But how can medical schools, hospitals and (teaching) hospitals achieve a family-oriented profile? Which key players, which areas of higher education management are relevant to management and decision-making structures? What exemplary measures for designing family-friendly medical studies and work places offer success? The underrepresentation of women in the next generation of scientists also poses an additional challenge to the development of an innovative higher education policy if it is to be sustainable. Thus strategies promoting the next generation and family orientation are key factors for a future-oriented higher education policy. These factors should therefore be seen as leadership strategies which will introduce measures that will make (re)design the university's profile. To this end, a holistic approach which will lead to fundamental reforms of higher education structures which are outlined below and illustrated with examples are a prerequisite for successful implementation.

I love you with all my brain: laying aside the intellectually dull sword of biological determinism

Background

By organizing and activating our passions with both hormones and experiences, the heart and mind of sexual behavior, sexual motivation, and sexual preference is the brain, the organ of learning. Despite decades of progress, this incontrovertible truth is somehow lost in the far-too-often biologically deterministic interpretation of genetic, hormonal, and anatomical scientific research into the biological origins of sexual motivation. Simplistic and polarized arguments are used in the media by both sides of the seemingly endless debate over sexual orientation, equality, and human rights with such catch phrases as ‘born gay’ contrasted against attempts of “reparative therapy” or “pray the gay away”. Though long abandoned in practically every other area of psychology, this remnant of the nature-nurture controversy remains despite its generally acknowledged insufficiency in explaining any adult aspect of the human condition within the scientific community.

Methods

This theoretical review article identifies three factors: 1) good intentions with regard to the argument from immutability; 2) false dichotomies limiting intellectual progress by oversimplification of theory and thus hypothesis, and most dangerously, interpretation and; 3) Tradition: a historical separation of the disciplines of biology and psychology, which, to this day, interferes with the effective translation of well-conducted science into good public understanding and policy.

Results

Studies clearly demonstrate that progress toward sexual-orientation equality is being made, if slowly, despite the apparent irrelevance of the “born gay” argument from immutability. Evidence is further provided supporting the inadequacy of polarized, dichotic theories of sexual development, particularly those pitting “blank slate learning” against a fated, deterministic biological perspective. Results of this review suggest that an emerging interactionist perspective will promote both better scientific progress and better public understanding, hopefully contributing to progress toward nondiscriminatory public policy.

Conclusion

Accepting that the brain is a highly plastic, modularly dimorphic, developmentally biased organ of learning, one which is organized and activated by both hormones and experiences across the lifespan, is essential for doing “good science” well. Interactionist theories of psychosexual development provide an empirically sound, strong, yet modifiable foundation for testable hypotheses exploring biologically biased sexual learning.

Evolution, appearance, and occupational success

Visual characteristics, including facial appearance, are thought to play an important role in a variety of judgments and decisions that have real occupational outcomes in many settings. Indeed, there is growing evidence suggesting that appearance influences hiring decisions and even election results. For example, attractive individuals are more likely to be hired, taller men earn more, and the facial appearance of candidates has been linked to real election outcomes. In this article, we review evidence linking physical appearance to occupational success and evaluate the hypothesis that appearance based biases are consistent with predictions based on evolutionary theories of coalition formation and leadership choice. We discuss why appearance based effects are so pervasive, addressing ideas about a "kernel of truth" in attributions and about coalitional psychology. We additionally highlight that appearance may be differently related to success at work according to the types of job or task involved. For example, leaders may be chosen because the characteristics they possess are seen as best suited to lead in particular situations. During a time of war, a dominant-appearing leader may inspire confidence and intimidate enemies while during peace-time, when negotiation and diplomacy are needed, interpersonal skills may outweigh the value of a dominant leader. In line with these ideas, masculine-faced leaders are favored in war-time scenarios while feminine-faced leaders are favored in peace-time scenarios. We suggest that such environment or task specific competencies may be prevalent during selection processes, whereby individuals whose appearance best matches perceived task competences are most likely selected, and propose the general term "task-congruent selection" to describe these effects. Overall, our review highlights how potentially adaptive biases could influence choices in the work place. With respect to certain biases, understanding their origin and current prevalence is important in order to potentially reduce discrimination in the work place.

Geographic distribution of need and access to health care in rural population: an ecological study in Iran

INTRODUCTION

Equity in access to and utilization of health services is a common goal of policy-makers in most countries. The current study aimed to evaluate the distribution of need and access to health care services among Iran's rural population between 2006 and 2009.

METHODS

Census data on population's characteristics in each province were obtained from the Statistical Centre of Iran and National Organization for civil registration. Data about the Rural Health Houses (RHHs) were obtained from the Ministry of Health. The Health Houses-to-rural population ratio (RHP), crude birth rate (CBR) and crude mortality rate (CMR) in rural population were calculated in order to compare their distribution among the provinces. Lorenz curves of RHHs, CMR and CBR were plotted and their decile ratio, Gini Index and Index of Dissimilarity were calculated. Moreover, Spearman rank-order correlation was used to examine the relation between RHHs and CMR and CBR.

RESULTS

There were substantial differences in RHHs, CMR and CBR across the provinces. CMR and CBR experienced changes toward more equal distributions between 2006 and 2009, while inverse trend was seen for RHHs. Excluding three provinces with markedly changes in data between 2006 and 2009 as outliers, did not change observed trends. Moreover; there was a significant positive relationship between CMR and RHP in 2009 and a significant negative association between CBR and RHP in 2006 and 2009. When three provinces with outliers were excluded, these significant associations were disappeared.

CONCLUSION

Results showed that there were significant variations in the distribution of RHHs, CMR and CBR across the country. Moreover, the distribution of RHHs did not reflect the needs for health care in terms of CMR and CBR in the study period.

Will biomedical enhancements undermine solidarity, responsibility, equality and autonomy?

Prominent thinkers such as Jurgen Habermas and Michael Sandel are warning that biomedical enhancements will undermine fundamental political values. Yet whether biomedical enhancements will undermine such values depends on how biomedical enhancements will function, how they will be administered and to whom. Since only few enhancements are obtainable, it is difficult to tell whether these predictions are sound. Nevertheless, such warnings are extremely valuable. As a society we must, at the very least, be aware of developments that could have harmful consequences. Indeed, if important values were to be jeopardized, we should take appropriate measures to protect them. This paper focuses on four central values: solidarity, personal responsibility, equality and autonomy. It delineates the conditions under which biomedical enhancements would undermine these values. It also details the circumstances under which these values would be unaffected by enhancements as well as those under which they would be promoted. Specifying these conditions is valuable; it would enable society to prepare appropriate ethical guidelines and policy responses in advance.

Allocation of renal grafts to older recipients does not result in loss of functioning graft-years

BACKGROUND

Most deceased donor kidney allocation protocols are based on waiting time and do not take into account either recipient's life expectancy. This study investigates whether graft survival is affected by patient life expectancy.

METHODS

A total of 640 adult kidney transplants were performed. Recipients were divided in group A (patients ≤ 50 years) and group B (patients > 50 years). The status of graft+recipient combination was characterized as: a) deceased recipient with functional graft, b) alive recipient with functional graft and c) deceased or alive recipient with nonfunctional graft.

RESULTS

Mean kidney recipient survival was 15.15 (95% CI: 14.54, 15.77) and 12.40 (95% CI: 11.47, 13.33) years for groups A and B respectively (p < 0.0001). Mean graft survival was 13.62 (95% CI: 12.81, 14.43) and 12.42 (95% CI: 11.59, 13.25) years for groups A and B respectively (p=0.6516). Non-functional grafts were identified in 18.4% (n=57) and 16.4% (n=54) of group A and B respectively.

CONCLUSIONS

Allocation of renal grafts to older patients does not result in significant loss of graft-years. Recipients' life expectancy has a small impact on graft survival. We should not deviate from the basic principles of equality, when kidney allocation systems are designed.

Lesbian access to justice

SUMMARY Although some aspects of New Zealand family law have been criticised as discriminatory, the New Zealand legal system has yet to be critically examined from a lesbian perspective. This article begins a development of lesbian legal theory for Aotearoa/New Zealand by analysing the contribution that the 1999 Law Commission study, Women's Access to Legal Services,has made to our knowledge about the impact of the law on lesbian relationships and communities.