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Leung TI, Sagar A, Shroff S, Henry TL. Can AI Mitigate Bias in Writing Letters of Recommendation? JMIR MEDICAL EDUCATION 2023; 9:e51494. [PMID: 37610808 PMCID: PMC10483302 DOI: 10.2196/51494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
Letters of recommendation play a significant role in higher education and career progression, particularly for women and underrepresented groups in medicine and science. Already, there is evidence to suggest that written letters of recommendation contain language that expresses implicit biases, or unconscious biases, and that these biases occur for all recommenders regardless of the recommender's sex. Given that all individuals have implicit biases that may influence language use, there may be opportunities to apply contemporary technologies, such as large language models or other forms of generative artificial intelligence (AI), to augment and potentially reduce implicit biases in the written language of letters of recommendation. In this editorial, we provide a brief overview of existing literature on the manifestations of implicit bias in letters of recommendation, with a focus on academia and medical education. We then highlight potential opportunities and drawbacks of applying this emerging technology in augmenting the focused, professional task of writing letters of recommendation. We also offer best practices for integrating their use into the routine writing of letters of recommendation and conclude with our outlook for the future of generative AI applications in supporting this task.
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Affiliation(s)
- Tiffany I Leung
- Department of Internal Medicine (adjunct), Southern Illinois University School of Medicine, Toronto, ON, Canada
- JMIR Publications, Toronto, ON, Canada
| | - Ankita Sagar
- CommonSpirit Health, Chicago, IL, United States
- Creighton University School of Medicine, Omaha, NE, United States
| | - Swati Shroff
- Division of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, United States
| | - Tracey L Henry
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
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Leung TI, Wang KH, Lin TL, Gin GT, Pendharkar SS, Chen CYA. Women Physicians in Transition Learning to Navigate the Pipeline from Early to Mid-Career: Protocol for a Qualitative Study. JMIR Res Protoc 2022; 11:e38126. [PMID: 35653172 PMCID: PMC9204597 DOI: 10.2196/38126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Women physicians face unique obstacles while progressing through their careers, navigating career advancement and seeking balance between professional and personal responsibilities. Systemic changes, along with individual and institutional changes, are needed to overcome obstacles perpetuating physician gender inequities. Developing a deeper understanding of women physicians' experiences during important transition points could reveal both barriers and opportunities for recruitment, retention, and promotion, and inform best practices developed based on these experiences. OBJECTIVE The aim is to learn from the experiences and perspectives of women physicians as they transition from early to mid-career, then develop best practices that can serve to support women physicians as they advance through their careers. METHODS Semistructured interviews were conducted with women physicians in the United States in 2020 and 2021. Eligibility criteria included self-identification as a woman who is in the process of transitioning or who recently transitioned from early to mid-career stage. Purposeful sampling facilitated identification of participants who represented diversity in career pathway, practice setting, specialty, and race/ethnicity. Each participant was offered compensation for their participation. Interviews were audio-recorded and professionally transcribed. Interview questions were open-ended, exploring participants' perceptions of this transition. Qualitative thematic analysis will be performed. We will use an open coding and grounded theory approach on interview transcripts. RESULTS The Ethics Review Committee of the Faculty of Health, Medicine, and Life Sciences at Maastricht University approved the study; Stanford University expedited review approved the study; and the University of California, San Diego certified the study as exempt from review. Twelve in-depth interviews of 50-100 minutes in duration were completed. Preliminary analyses indicate one key theme is a tension resulting from finite time divided between demands from a physician career and demands from family needs. In turn, this results in constant boundary control between these life domains that are inextricable and seemingly competing against each other within a finite space; family needs impinge on planned career goals, if the boundary between them is not carefully managed. To remedy this, women sought resources to help them redistribute home responsibilities, freeing themselves to have more time, especially for children. Women similarly sought resources to help with career advancement, although not with regard to time directly, but to first address foundational knowledge gaps about career milestones and how to achieve them. CONCLUSIONS Preliminary results provide initial insights about how women identify or activate a career shift and how they marshaled resources and support to navigate barriers they faced. Further analyses are continuing as of March 2022 and are expected to be completed by June 2022. The dissemination plan includes peer-reviewed open-access journal publication of the results and presentation at the annual meeting of the American Medical Association's Women Physicians Section.
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Affiliation(s)
- Tiffany I Leung
- Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Internal Medicine (adjunct), Southern Illinois University School of Medicine, Springfield, IL, United States
| | - Karen H Wang
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
- Center for Medical Informatics, Yale School of Medicine, New Haven, CT, United States
| | - Tammy L Lin
- Department of Medicine (voluntary), University of California San Diego Health Sciences, San Diego, CA, United States
| | - Geneen T Gin
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Sima S Pendharkar
- Division of Hospital Medicine, Jersey City Medical Center, Jersey City, NJ, United States
| | - Chwen-Yuen Angie Chen
- Department of Primary Care and Population Health, Stanford University, Palo Alto, CA, United States
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Stephenson AL, Diehl AB, Dzubinski LM, McErlean M, Huppertz J, Sidhu M. An Exploration of Gender Bias Affecting Women in Medicine. Adv Health Care Manag 2021; 20:77-95. [PMID: 34779186 DOI: 10.1108/s1474-823120210000020004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Women in medicine face barriers that hinder progress toward top leadership roles, and the industry remains plagued by the grand challenge of gender inequality. The purpose of this study was to explore how subtle and overt gender biases affect women physicians, physician leaders, researchers, and faculty working in academic health sciences environments and to further examine the association of these biases with workplace satisfaction. The study used a convergent mixed methods approach. Sampling from a list of medical schools in the United States, in conjunction with a list of each state's medical society, the authors analyzed the quantitative survey responses of 293 women in medicine. The authors conducted ordinary least squares multiple regression to assess the relationship of gender barriers on workplace satisfaction. Additionally, 132 of the 293 participants provided written open-ended responses that were explored using a qualitative content analysis methodology. The survey results showed that male culture, lack of sponsorship, lack of mentoring, and queen bee syndrome were associated with lower workplace satisfaction. The qualitative results provided illustrations of how participants experienced these biases. These results emphasize the obstacles that women face and highlight the detrimental nature of gender bias in medicine. The authors conclude by presenting concrete recommendations for managers endeavoring to improve the culture of gender equity and inclusivity.
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Griffin AC, Leung TI, Tenenbaum JD, Chung AE. Gender representation in U.S. biomedical informatics leadership and recognition. J Am Med Inform Assoc 2021; 28:1270-1274. [PMID: 33555005 DOI: 10.1093/jamia/ocaa344] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/25/2020] [Accepted: 01/25/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study sought to describe gender representation in leadership and recognition within the U.S. biomedical informatics community. MATERIALS AND METHODS Data were collected from public websites or provided by American Medical Informatics Association (AMIA) personnel from 2017 to 2019, including gender of membership, directors of academic informatics programs, clinical informatics subspecialty fellowships, AMIA leadership (2014-2019), and AMIA awardees (1993-2019). Differences in gender proportions were calculated using chi-square tests. RESULTS Men were more often in leadership positions and award recipients (P < .01). Men led 74.7% (n = 71 of 95) of academic informatics programs and 83.3% (n = 35 of 42) of clinical informatics fellowships. Within AMIA, men held 56.8% (n = 1086 of 1913) of leadership roles and received 64.1% (n = 59 of 92) of awards. DISCUSSION As in other STEM fields, leadership and recognition in biomedical informatics is lower for women. CONCLUSIONS Quantifying gender inequity should inform data-driven strategies to foster diversity and inclusion. Standardized collection and surveillance of demographic data within biomedical informatics is necessary.
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Affiliation(s)
- Ashley C Griffin
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tiffany I Leung
- Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Jessica D Tenenbaum
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Arlene E Chung
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of General Medicine and Clinical Epidemiology, Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA.,Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA.,Program on Health and Clinical Informatics, UNC School of Medicine, Chapel Hill, North Carolina, USA
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Bunting ST, Oldaker T, Qualtieri J, O'Donahue M, Maremont S, Harricharran H, Kelliher A, Kdouh L, Devitt K, Cherian S, Stetler-Stevenson M, Moore J. ICCS Women in Cytometry-Impact 10 years later: A call to promote gender equity. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 100:282-284. [PMID: 32830879 DOI: 10.1002/cyto.b.21942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/02/2020] [Accepted: 07/20/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Silvia T Bunting
- Department of Pathology, Cleveland Clinic Florida, Weston, Florida, USA
| | - Teri Oldaker
- Oldaker Consulting, San Clemente, United States, USA
| | - Julianne Qualtieri
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sara Maremont
- Sonora Quest Laboratories/Laboratory Sciences of Arizona, Phoenix, AZ, USA
| | | | | | | | - Katherine Devitt
- University of Vermont Medical Center/Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Sindhu Cherian
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | | | - Jonni Moore
- Pathology and Laboratory Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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Banks L, Randhawa VK, Caterini J, Colella TJF, Dhanvantari S, McMurtry S, Connelly KA, Robinson L, Anand SS, Ouzounian M, Zieroth S, Mak S, Straus S, Graham MM. Sex, Gender, and Equity in Cardiovascular Medicine, Surgery, and Science in Canada : Challenges, Successes, and Opportunities for Change. CJC Open 2020; 2:522-529. [PMID: 33305212 PMCID: PMC7711008 DOI: 10.1016/j.cjco.2020.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/29/2020] [Indexed: 01/01/2023] Open
Abstract
Background A previous review of sex, gender, and equity within cardiovascular (CV) medicine, surgery, and science in Canada has revealed parity during medical and graduate school training. The purpose of this study was to explore sex and gendered experiences within the Canadian CV landscape, and their impact on career training and progression. Methods An environmental scan was conducted of the Canadian CV landscape, which included an equity survey using Qualtrics software. Results The environmental scan revealed that women remain underrepresented within CV training programs as trainees (12%–30%), program directors (33%), in leadership roles at the divisional level (21%), and in other professional or career-related activities (< 30%). Our analysis also showed improvements of career engagement at these levels of women at over time. The thematic analysis of the equity survey responses (n = 71 respondents; 83% female; 9.7% response rate among female Canadian Cardiovascular Society members) identified the following themes reported within the socio-ecological framework: desire to report inequities vs staying the course (individual level); desire for social support and mentorship and challenges of dual responsibilities (interpersonal level); concerns over exclusionary cliques and desire for respect and opportunity (organizational level); and increasing awareness and actions to overcome institutional barriers and accountability (societal level). Conclusions Although women face challenges and remain underrepresented in CV medicine, surgery, and science, this study highlights potential opportunities for improving access of female medical, surgical, and research trainees and professionals to specialized cardiovascular training, career advancement, leadership, and research.
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Affiliation(s)
- Laura Banks
- Cardiovascular Prevention and Rehabilitation Program, University Health Network, Toronto, Ontario, Canada.,Faculty of Health Sciences, Ontario Tech University, Ontario, Canada
| | - Varinder K Randhawa
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Tracey J F Colella
- Cardiovascular Prevention and Rehabilitation Program, University Health Network, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Savita Dhanvantari
- Imaging Program, Lawson Health Research Institute, London, Ontario, Canada
| | - Sean McMurtry
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Kim A Connelly
- Department of Cardiology, St Michaels Hospital, Toronto, Ontario, Canada
| | - Lisa Robinson
- University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sonia S Anand
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Maral Ouzounian
- University of Toronto, Toronto, Ontario, Canada.,Department of Cardiothoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Shelley Zieroth
- Section of Cardiology, St Boniface Hospital, and University of Manitoba, Winnipeg, Canada
| | - Susanna Mak
- University of Toronto, Toronto, Ontario, Canada.,Department of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - Sharon Straus
- Department of Medicine, St Michaels Hospital, Toronto, Ontario, Canada
| | - Michelle M Graham
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
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