Reducing Implicit Gender Leadership Bias in Academic Medicine With an Educational Intervention

Short-time mentoring - enhancing female medical students' intentions toward surgical careers

BACKGROUND

Women pursuing a career in surgery or related disciplines are still in the minority, despite the fact that women compose at least half of the medical student population in most Western countries. Thus, recruiting and retaining female surgeons remains an important challenge to meet the need for surgeons and increase the quality of care. The participations were female medical students between their third and fifth academic year. In this study, we applied the well-established psychological theory of planned behavior (TPB) which suggests that the intention to perform a behavior (e.g. pursuing a career in surgery) is the most critical and immediate predictor of performing the behavior. We investigated whether a two-part short-mentoring seminar significantly increases students' intention to pursue a career in a surgical or related specialty after graduation.

METHOD

The mentoring and role-model seminar was conducted at 2 days for 90 minutes by six inspiring female role models with a remarkable career in surgical or related disciplines. Participants (N = 57) filled in an online survey before (T0) and after the seminar (T1). A pre-post comparison of central TPB concept attitude towards the behavior, 2) occupational self-efficacy and 3) social norm) was conducted using a paired sampled t-test. A follow-up survey was administered 12 months later (T2).

RESULTS

The mentoring seminar positively impacted female students' attitude towards a career in a surgical specialty. Female students reported a significantly increased positive attitude (p < .001) and significantly higher self-efficacy expectations (p < .001) towards a surgical career after participating in the mentoring seminar. Regarding their career intention after the seminar, female students declared a significantly higher intention to pursue a career in a surgical specialty after graduating (p < .001) and this effect seems to be sustainable after 1 year.

CONCLUSION

For the first time we could show that short-mentoring and demonstrating role models in a seminar surrounding has a significant impact on female medical student decision´s to pursue a career in a surgery speciality. This concept may be a practical and efficient concept to refine the gender disparity in surgery and related disciplines.

Women speaker representation at SAGES annual meetings: a cross-sectional analysis

BACKGROUND

Gender representation trends at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Annual Meetings and the effect of the 2018 'We R SAGES' initiatives are unknown. We assessed gender trends in oral presentations at the SAGES Annual Meeting between 2012 and 2022 with a focus on assessing the impact of the 2018 initiatives.

METHODS

Abstracts selected for oral presentations from 2012 to 2022 were reviewed for presenter and first, second, and senior author gender. Gender was categorized as woman, man, or unknown using public professional profiles. Subsequent publications were identified using search engines. The primary outcome was the temporal trend of proportion of women in each role using interrupted time series analysis. Secondary outcomes included publication rates based on first and senior author genders in 2012-2018 versus 2019-2022.

RESULTS

1605 abstracts were reviewed. The proportion of women increased linearly in all categories: presenter (2.4%/year, R2 = 0.91), first author (2.4%/year, R2 = 0.90), senior author (2%/year, R2 = 0.65), and overall (2.2%, R2 = 0.91), (p < 0.01 for all). Prior to 2018, the proportion of women increased annually for presenters (coefficient: 0.026, 95% CI [0.016, 0.037], p = 0.002) and first authors (coefficient: 0.026, 95% CI [0.016, 0.037], p = 0.002), but there was no significant increase after 2018 (p > 0.05). Female second author proportion increased annually prior to 2018 (coefficient: 0.012, 95% CI [0.003, 0.021], p = 0.042) and increased by 0.139 (95% CI [0.070, 0.208], p = 0.006) in 2018. Annual female senior author proportion did not significantly change after 2018 (p > 0.05). 1198 (75.2%) abstracts led to publications. Women were as likely as men to be first (79% vs 77%, p = 0.284) or senior author (79% vs 77%, p = 0.702) in abstracts culminating in publications. There was no difference in woman first author publication rate before and after 2018 (80% vs 79%, p = 1.000), but woman senior author publication rate increased after 2018 (71% vs 83%, p = 0.032).

CONCLUSION

There was an upward trend in women surgeons' presentations and associated publications in the SAGES Annual Meetings over the last decade.

Estimating implicit and explicit racial and ethnic bias among community pharmacists in Canada

Background

Bias, whether implicit (unconscious) or explicit (conscious), can lead to preferential treatment of specific social groups and antipathy towards others. When healthcare professionals (HCPs), including pharmacists, act on these biases, patient care and health outcomes can be adversely affected. This study aims to estimate implicit and explicit racial/ethnic bias towards Black and Arab people among community pharmacists in Ontario, Canada.

Methods

Community pharmacists participated in a secure, web-based survey using a cross-sectional design that included Harvard's Race and Arab Implicit Association Tests (IATs) to examine bias towards Black and Arab people. Explicit (stated) preferences were measured by self-report. Data were analyzed using descriptive and inferential statistics.

Results

The study surveyed 407 community pharmacists, 56.1 % of whom were women with an average age of 46.9. Implicit Association Test (IAT) results showed a statistically significant moderate preference for white people over both Black (mean IAT = 0.41) and Arab people (mean IAT = 0.35). However, most pharmacists explicitly stated that they had no racial/ethnic preference, with 75.7 % expressing a neutral preference between Black and white and 66.6 % neutral between Arab and white. However, a slight preference for white individuals was observed. Demographic factors such as age, place of birth, race/ethnicity, and experience significantly impacted IAT scores. For example, older, Canadian-born, white pharmacists with more experience displayed higher implicit bias scores. A mild correlation was found between implicit and explicit bias, indicating as implicit bias increases, explicit bias tends to become more negative.

Conclusions

This study is the first to explore the issue of pharmacist bias in Canada and concentrate on anti-Arab bias. Our findings reveal that Ontario community pharmacists tend to have an unconscious inclination towards white people, which calls for further understanding of this matter. Additionally, we discovered a moderate degree of anti-Arab bias, indicating that studies on other HCPs should consider bias against this social group. Educational interventions are needed to address the implicit biases among community pharmacists in Ontario, Canada. These findings should aim to raise self-awareness of biases, educate about the potential implications of these biases on patient care, and provide strategies to reduce bias.

Designing Communication Feedback Systems To Reduce Healthcare Providers' Implicit Biases In Patient Encounters

Healthcare providers' implicit bias, based on patients' physical characteristics and perceived identities, negatively impacts healthcare access, care quality, and outcomes. Feedback tools are needed to help providers identify and learn from their biases. To incorporate providers' perspectives on the most effective ways to present such feedback, we conducted semi-structured design critique sessions with 24 primary care providers. We found that providers seek feedback designed with transparent metrics indicating the quality of their communication with a patient and trends in communication patterns across visits. Based on these metrics and trends, providers want this feedback presented in a dashboard paired with actionable, personalized tips about how to improve their communication behaviors. Our study provides new insights for interactive systems to help mitigate the impact of implicit biases in patient-provider communication. New systems that build upon these insights could support providers in making healthcare more equitable, particularly for patients from marginalized communities.

Organizational Leadership Gender Differences in Medical Schools and Affiliated Universities

Objective: To compare gender compositions in the leadership of the top 25 medical schools in North America with the leadership of their affiliated university senior leadership and other faculties. Materials and Methods: This retrospective cross-sectional observational study used publicly available gender data from 2018 to 2019 of universities drawn from the U.S. News Best Global Universities for Clinical Medicine Ranking report. Gender compositions in eight leadership tiers from senior leadership to medical school department directors were analyzed. Data analysis included gender compositions by leadership tier and faculty. Results: Male representation is greater at higher leadership tiers, with the largest imbalance being at the level of medical school department heads. The faculty of medicine has more men in leadership positions than the average of the other faculties (p = 0.02), though similar to schools of engineering, business, dentistry, and pharmacy. Across the eight leadership tiers, a significant trend exists between tier and proportions, indicating that male representation was greater at higher tiers (p < 0.001). No correlation was found between a university's leadership gender composition and its ranking. Conclusion: The under-representation of women is greater in medical school leadership than the leadership of their affiliated universities. The faculty of medicine has greater male over-representation than the average of the other faculties.

A logic framework for addressing medical racism in academic medicine: an analysis of qualitative data

BACKGROUND

Despite decades of anti-racism and equity, diversity, and inclusion (EDI) interventions in academic medicine, medical racism continues to harm patients and healthcare providers. We sought to deeply explore experiences and beliefs about medical racism among academic clinicians to understand the drivers of persistent medical racism and to inform intervention design.

METHODS

We interviewed academically-affiliated clinicians with any racial identity from the Departments of Family Medicine, Cardiac Sciences, Emergency Medicine, and Medicine to understand their experiences and perceptions of medical racism. We performed thematic content analysis of semi-structured interview data to understand the barriers and facilitators of ongoing medical racism. Based on participant narratives, we developed a logic framework that demonstrates the necessary steps in the process of addressing racism using if/then logic. This framework was then applied to all narratives and the barriers to addressing medical racism were aligned with each step in the logic framework. Proposed interventions, as suggested by participants or study team members and/or identified in the literature, were matched to these identified barriers to addressing racism.

RESULTS

Participant narratives of their experiences of medical racism demonstrated multiple barriers to addressing racism, such as a perceived lack of empathy from white colleagues. Few potential facilitators to addressing racism were also identified, including shared language to understand racism. The logic framework suggested that addressing racism requires individuals to understand, recognize, name, and confront medical racism.

CONCLUSIONS

Organizations can use this logic framework to understand their local context and select targeted anti-racism or EDI interventions. Theory-informed approaches to medical racism may be more effective than interventions that do not address local barriers or facilitators for persistent medical racism.

Sports Medicine Patient Experience: Implicit Bias Mitigation and Communication Strategies

Unconscious bias, also known as implicit bias, is the principal contributor to the perpetuation of discrimination and is a robust determinant of people's decision-making. Unconscious bias occurs despite conscious nonprejudiced intentions and interferes with the actions of the reflective and conscious side. Education and self-awareness about implicit bias and its potentially harmful effects on judgment and behavior may lead individuals to pursue corrective action and follow implicit bias mitigation communication strategies. Team physicians must follow existing communication strategies and guidelines to mitigate unconscious bias and begin an evolution toward nonbiased judgment and decision-making to improve athlete care.

Evaluation of Culture Conducive to Academic Success by Gender at a Comprehensive Cancer Center

INTRODUCTION

The primary objective of this study was to determine whether workplace culture in academic oncology differed by gender, during the COVID-19 pandemic.

MATERIALS AND METHODS

We used the Culture Conducive to Women's Academic Success (CCWAS), a validated survey tool, to investigate the academic climate at an NCI-designated Cancer Center. We adapted the CCWAS to be applicable to people of all genders. The full membership of the Cancer Center was surveyed (total faculty = 429). The questions in each of 4 CCWAS domains (equal access to opportunities, work-life balance, freedom from gender bias, and leadership support) were scored using a 5-point Likert scale. Median score and interquartile ranges for each domain were calculated.

RESULTS

A total of 168 respondents (men = 58, women = 106, n = 4 not disclosed) submitted survey responses. The response rate was 39% overall and 70% among women faculty. We found significant differences in perceptions of workplace culture by gender, both in responses to individual questions and in the overall score in the following domains: equal access to opportunities, work-life balance, and leader support, and in the total score for the CCWAS.

CONCLUSIONS

Our survey is the first of its kind completed during the COVID-19 pandemic at an NCI-designated Cancer Center, in which myriad factors contributed to burnout and workplace challenges. These results point to specific issues that detract from the success of women pursuing careers in academic oncology. Identifying these issues can be used to design and implement solutions to improve workforce culture, mitigate gender bias, and retain faculty.

Stereotype Threat and Gender Bias in Internal Medicine Residency: It is Still Hard to be in Charge

BACKGROUND

Despite similar numbers of women and men in internal medicine (IM) residency, women face unique challenges. Stereotype threat is hypothesized to contribute to underrepresentation of women in academic leadership, and exploring how it manifests in residency may provide insight into forces that perpetuate gender disparities.

OBJECTIVE

To quantify the prevalence of stereotype threat in IM residency and explore experiences contributing to that stereotype threat.

DESIGN

We used a mixed methods study design. First, we surveyed IM residents using the Stereotype Vulnerability Scale (SVS) to screen for stereotype threat. Second, we conducted focus groups with women who scored high on the SVS to understand experiences that led to stereotype threat.

PARTICIPANTS

The survey was sent to all IM residents at University of California, San Francisco (UCSF), in September-November 2019. Focus groups were conducted at UCSF in Spring 2020.

APPROACH

The survey included an adapted version of the SVS. For focus groups, we developed a focus group guide informed by literature on stereotype threat. We used a thematic approach to data analysis. The mixed methods design enabled us to draw metainferences by integrating the two data sources.

KEY RESULTS

Survey response rate was 61% (110/181). Women were significantly more likely than men to have a score indicating stereotype threat vulnerability (77% vs 0%, p < 0.001). Four themes from focus groups characterized women's experiences of gender bias and stereotype threat: gender norm tension, microaggressions and sexual harassment, authority questioned, and support and allyship.

CONCLUSIONS

Gender-based stereotype threat is highly prevalent among women IM residents. This phenomenon poses a threat to confidence and ability to execute patient care responsibilities, detracting from well-being and professional development. These findings indicate that, despite robust representation of women in IM training, further attention is needed to address gendered experiences and contributors to women's vulnerability to stereotype threat.

Identifying Gender and Racial Bias in Pediatric Fellowship Letters of Recommendation: Do Word Choices Influence Interview Decisions?

OBJECTIVES

To describe linguistic differences in letters of recommendation (LORs) for pediatric fellowship candidates based on applicant and letter writer demographics and to examine if these differences influenced the decision to interview a candidate for a fellowship position.

STUDY DESIGN

LORs for applicants to 8 pediatric subspecialty fellowships at a single academic center from the 2020 Match were analyzed in this cross-sectional study. Frequency of validated agentic and communal terms in each letter were determined by a language processing web application. Bias was determined as having a >5% surplus of agentic or communal terms.

RESULTS

We analyzed 1521 LORs from 409 applicants: 69% were women, 28% were under-represented minorities in medicine (URM), and 50% were invited to interview. Overall, 66% of LORs were agentic biased, 16% communal biased, and 19% neutral. There was no difference in bias in LORs by an applicant's gender (woman 67% agentic vs man 62% agentic; P = .058), race, or ethnicity (non-URM 65% agentic vs URM 67% agentic; P = .660). Despite a lower frequency of agentic terms in LORs for applicants invited for interviews, when accounting for other components of an application and applicant demographics, no significant association was made between language bias in LORs and fellowship interview status.

CONCLUSIONS

The frequency of agentic and communal terms in LORs for pediatric subspecialty fellowship candidates were not found to influence the decision to invite a candidate to interview. However, raising awareness of potential areas of bias within the pediatric fellowship selection process might lead to a more equitable and holistic approach to application review.

Gender trends in dentistry: Dental faculty and academic leadership

OBJECTIVES

Gender equality in the healthcare workforce has been a topic of discourse for many decades. In dental academia, women's representation of enrolled students and faculty has risen consistently since the 1980s. However, women in faculty leadership positions may still be lagging when compared to men. The purpose of this study was to evaluate the number of women who occupy the upper echelons of academic rank and title by analyzing cross-referenced data from the American Dental Association and the American Dental Education Association on women dental school graduates in relation to academic appointments.

METHODS

Gender distribution in rank, title, and appointments in the decade from 2011 to 2019, as well as percentage of women graduates over the same period, were collected for descriptive statistics. Multiple linear regression analysis, Cochran Armitage, and chi-square tests were conducted to examine trends over the years and to determine significant differences in overall percentages (p < 0.05).

RESULTS

The total women faculty percentages ranged from 36% to 40%. While the lower-level rank of instructor retained a higher representation of women (56%-65%), the higher rank of professor had disproportionately lower women percentages (18%-26%). Graduates, full-time faculty, lower-level academic ranks, and higher-level academic ranks for women followed similar upward trends that were statistically significant (p < 0.05). When comparing the different groups against each other, the annual increase in women DMD/DDS graduate percentage was higher than women full-time faculty (0.28%), instructor rank (0.92%), professor rank (0.50%), and department chair appointments (0.49%).

CONCLUSIONS

Our data show that women are still underrepresented at higher academic ranks. However, the upward trends for professors, assistant deans, and program chairs suggest that in recent years, more women faculty may have been encouraged, mentored, or offered higher administrative positions in academic institutions.

Surgeon Implicit Association of Women With Supportive Roles in Medicine

BACKGROUND

In a previous study, we documented patient implicit bias that surgeons are men. As a next step, we tested the implicit bias of surgeons that women in medicine have leading (chair, surgeon) or supporting roles (medical assistant, physician assistant).

QUESTIONS/PURPOSE

(1) What is the relationship between the implicit associations and expressed beliefs of surgeons regarding women as leaders in medicine? (2) Are there factors associated with surgeon implicit association and explicit preference regarding the roles of women in medicine?

METHODS

A total of 102 musculoskeletal surgeon members of the Science of Variation Group (88 men and 12 women) completed an implicit association test (IAT) of implicit bias regarding sex and lead/support roles in medicine and a questionnaire that addressed respondent demographics and explicit preference regarding women's roles. The IAT consisted of seven rounds with five rounds used for teaching and two rounds for evaluation.

RESULTS

On average, there was an implicit association of women with supportive roles (D-score: -48; SD 4.7; P < 0.001). The mean explicit preference was for women in leadership roles (median: 73; interquartile ranges: 23 to 128; P < 0.001). There was a correlation between greater explicit preference for women in a leading role and greater implicit bias toward women in a supporting role (ρ = 0.40; P < 0.001). Women surgeons and shoulder and elbow specialists had less implicit bias that women have supporting roles.

CONCLUSION

The observation that musculoskeletal surgeons have an explicit preference for women in leading roles in medicine but an implicit bias that they have supporting roles-more so among men surgeons-documents the gap between expressed opinions and ingrained mental processing that is the legacy of the traditional "roles" of women in medicine and surgery. To resolve this gap, we will need to be intentional about promotion of and emersion in experiences where the leader is a woman.

LEVEL OF EVIDENCE

III.

Trends in Mohs surgery fellowship directors

The purpose of this study is to illustrate demographic trends among Mohs Micrographic Surgery (MMS) Fellowship Directors. Our search was constructed from the 2022 to 2023 Mohs Micrographic Surgery Fellowship Directory on the Accreditation Council for Graduate Medical Education (ACGME) website. Datapoints gathered included: age, sex, residency/fellowship training location, time since training completion until FD appointment, length in FD role, and personal research H-index. We identified 77 FDs, of which all 77 were included in this study. The mean age was 55.5 years; 55 (71.4%) were men and 20 (26.0%) were women. Most of the FDs who completed the survey did not self-report ethnicity or race, so these measures were not included. The top residency institutions that produced the most FDs were Cleveland Clinic (n = 4), Mayo Clinic (n = 4), New York University Medical Center (NYU, n = 4), and University of California-Los Angeles (UCLA, n = 4); the top fellowship institutions were NYU (n = 7), UCLA (n = 5), Cleveland Clinic (n = 4), and Geisinger Medical Center (n = 4). The mean H-index was 15.9, the mean number of peer-reviewed publications was 71, and the mean time from training completion until FD appointment was 10 years. Our results indicate that a majority of FDs are men (71.4%) and that FDs are more likely to have graduated from certain residency and fellowship programs.

Time for a Gut Check: A Qualitative Study of Proposed Interventions to Address Gender Inequality in Gastroenterology

Background

Gender inequalities persist in medicine, particularly in some speciality fields where fewer women are employed. Although previous research has suggested potential interventions to broadly address gender inequality in medicine, no research has focused on interventions in the field of gastroenterology. The purpose of this research was to engage women in the field of gastroenterology in Canada, to identify interventions with potential to be effective in addressing gender inequality.

Methods

A World Café was hosted in 2019 to discuss gender inequality and interventions in gastroenterology. Twelve women employed in the field of gastroenterology (i.e. physicians, nurses, research staff, and trainees) were purposively recruited and participated in the event. The discussion rounds were audio-recorded, transcribed, and thematic analyses was conducted using Braun and Clarke's principles.

Results

Three key themes identifying potential interventions to address gender inequality in gastroenterology were generated: (1) Education; (2) Addressing institutional structures and polices; and 3) Role modelling and mentorship. Participants indicated that interventions should target various stakeholders, including both women and men in gastroenterology, young girls, patients, and administrators.

Conclusion

Many of the interventions identified by participants correspond with existing research on interventions in general medicine, suggesting that institutional changes can be made for maximum effectiveness. Some novel interventions were also identified, including publicizing instances of gender parity and supporting interventions across the educational and professional lifecourse. Moving forward, institutions must assess their readiness for change and evaluate existing policies, programs, and practices for areas of improvement.

Factors influencing gender preference towards surgeons among Jordanian adults: an investigation of healthcare bias

Studies investigating gender bias against female surgeons yielded conflicting results ranging from neutrality to a clear preference towards male surgeons. Yet, such bias remains understudied within Middle Eastern nations. We aimed to assess preferences of surgeons' gender among Jordanians and explore reasons for possible gender bias across different surgical specialties. A total of 1708 respondents were examined using a cross-sectional, self-administered questionnaire to evaluate the gender preferences of surgeons, characteristics associated with preferred surgeon's gender, and surgeon's preference in certain specialties. Nearly 52.0% of participants had no gender preference for surgeons. Among those with a preference, 75.7% preferred male surgeons while 24.3% preferred female surgeons. Reputation, knowledge, and experience were the most important factors when choosing a surgeon. Male surgeons were viewed as more trustworthy, knowledgeable, experienced, and communicative. Female surgeons were dominantly perceived as more compassionate, cooperative, and prone to listen. Male respondents were 5 times more likely to choose a surgeon of similar gender (OR 5.687; CI 3.791-8.531). Male surgeons were favored for cardiovascular and orthopedic surgeries. Similarly, female surgeons were favored in gynecological and obstetric surgeries, plastic surgeries, and breast surgeries. Female gender (OR 6.193; CI 4.077-9.408), living outside Amman (OR 1.517; CI 1.066-2.160), and being married (OR 2.504; CI 1.601-3.917) were all significant positive predictors of preferring female surgeons. Our findings highlight differences in gender preference and perception of surgeons among Jordanian adults.

Impact of gender inequality on the educational and career development of young epileptologists in Italy: A survey of the Young Epilepsy Section - Italian chapter

OBJECTIVE

The Young Epilepsy Section-Italian chapter (YES-I) is the Italian section of the International League Against Epilepsy (ILAE)-YES. It was founded in 2019 with the aim of increasing the involvement of young epileptologists within scientific associations and facilitating their educational training. The Education and Career Task Force designed a survey on the impact of gender inequality on the educational and professional growth of young epileptologists.

METHODS

The survey was proposed via QR code during the 43rd National Congress of the Italian League Against Epilepsy (Padua, 8-10 June 2022), and subsequently distributed via email until 7th September 2022.

RESULTS

Of the respondents, 73.6% were female. Of note, 51% of the entire sample answered that they found "no impact" of gender on educational activities (64.3% male against 46.1% female). Only 10% of women stated they have seen very much gender-related inequality in their education or career. However, the majority of our cohort (66%) thought that gender had a negative impact on progression within a scientific society, as well as in female leadership roles in clinical practice (67.9%). Furthermore female medical staff received little work recognition (56.6%). Lastly, 83% of responders did not have children, and only 37.7% declared their colleagues to be empathic in relation to absences for family emergencies.

CONCLUSIONS

Lack of awareness of the gender inequality issue might explain inconsistencies in the findings of our survey. Despite the remarkable progress of women rights over the last century, our survey suggests that disparities in academic and decision-making roles exist also in the epileptology field.

Professional Development in Health Sciences: Scoping Review on Equity, Diversity, Inclusion, Indigeneity, and Accessibility Interventions

INTRODUCTION

Equity, diversity, inclusion, indigeneity, and accessibility (EDIIA) are critical considerations in the formation of professional development (PD) programs for health care workers. Improving EDIIA competency in health care serves to enhance patient health, staff confidence and well-being, delivery of care, and the broader health care system. There is a gap in the literature as to the efficacy of EDIIA-based PD programs and their individual components. The present article will review available quantitative data pertaining to EDIIA-based PD programs for health care workers as well as their effectiveness.

METHODS

A scoping review of articles published in the EBSCOhost, MEDLINE, PubMed, EMBASE, and CINAHL databases was performed. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

RESULTS

A total of 14,316 references were identified with 361 reaching full-text review. A final 36 articles were included in the scoping review with 6552 total participants (72.9% women; 26.9% men; 0.2% nonbinary). EDIIA-based PD interventions were developed around the topics of culture ( n = 22), gender ( n = 11), sexual orientation ( n = 9), indigeneity ( n = 6), race ( n = 6), ableism ( n = 1), and ageism ( n = 1).

DISCUSSION

Despite an increased interest in developing EDIIA-based PD curricula for health care workers, there are glaring disparities in the quality of care received by marginalized and equity-seeking populations. The present scoping review delineated key features which were associated with increased quantitative efficacy of EDIIA-based PD training programs. Future work should focus on large-scale implementation and evaluation of these interventions across health care sectors and levels of training.

The Presence of Implicit Gender Bias in Colon and Rectal Surgery Residency Letters of Recommendation

BACKGROUND

Selection for colorectal surgery residency relies on letters of recommendation for assessment of candidates' strengths and weaknesses. It is unclear whether this process incorporates implicit gender bias.

OBJECTIVE

This study aimed to assess the presence of gender bias in letters of recommendation for colorectal surgery residency.

DESIGN

Mixed methods assessment of the characteristics described within the blinded letters of the 2019 application cycle to a single academic residency.

SETTINGS

Academic medical center.

PATIENTS

Blinded letters from the 2019 colorectal surgery residency application cycle.

INTERVENTIONS

Characteristics of the letters were qualitatively and quantitatively analyzed.

MAIN OUTCOME MEASURES

Association of gender with the presence of descriptors within the letters.

RESULTS

A total of 111 applicants, 409 letter writers, and 658 letters were analyzed. Forty-three percent of applicants were female. Female and male applicants had an equal mean number of positive (5.4 vs 5.8; p = 0.10) and negative (0.5 vs 0.4; p = 0.07) attributes represented. Female applicants were more likely to be described as having poor academic skills (6.0 vs 3.4%; p = 0.04) and possessing negative leadership qualities (5.2% vs 1.4%; p < 0.01) than male applicants. Male applicants were more likely to be described as kind (36.6% vs 28.3%; p = 0.03), curious (16.4% vs 9.2%; p = 0.01), possessing positive academic skills (33.7% vs 20.0%; p < 0.01), and possessing positive teaching skills (23.5% vs 17.0%; p = 0.04).

LIMITATIONS

This study analyzed a single year of applications to an academic center and may not be generalizable.

CONCLUSIONS

There are differences in the qualities used to describe female versus male applicants in colorectal surgery residency application letters of recommendation. Female applicants were more often described in negative academic terms and possessing negative leadership qualities. Males were more likely to be described as kind, curious, academically impressive, and possessing good teaching skills. The field may benefit from educational initiatives to reduce implicit gender bias in letters of recommendation. See Video Abstract at http://links.lww.com/DCR/C191 .

LA PRESENCIA DE SESGO DE GNERO IMPLCITO EN LAS CARTAS DE RECOMENDACIN DE RESIDENCIA EN CIRUGA DE COLON Y RECTO

ANTECEDENTES:La selección para la residencia en cirugía colorrectal se basa en cartas de recomendación para la evaluación subjetiva de las fortalezas y debilidades de los candidatos. No está claro si este proceso incorpora un sesgo de género implícito.OBJETIVO:Evaluar la presencia de sesgo de género en las cartas de recomendación para la residencia en cirugía colorrectal.DISEÑO:Evaluación de métodos mixtos de las características descritas dentro de las cartas selladas del ciclo de solicitud de 2019 a una sola residencia académica.ENTORNO CLÍNICO:Centro médico académico.PACIENTES:Cartas selladas del ciclo de solicitud de residencia en cirugía colorrectal de 2019.INTERVENCIONES:Las características de las cartas se determinaron utilizando medidas cualitativas y cuantitativas.PRINCIPALES MEDIDAS DE VALORACIÓN:Asociación del género con la presencia de descriptores dentro de las cartas.RESULTADOS:Hubo 111 solicitantes, 409 escritores de cartas y se analizaron 658 cartas. El 43% de los solicitantes eran mujeres. Los solicitantes masculinos y femeninos tenían el mismo promedio de atributos positivos (5,4 frente a 5,8; p = 0,10) y negativos (0,5 frente a 0,4; p = 0,07) representados. Las solicitantes femeninas tenían más probabilidades de ser descritas como con deficientes habilidades académicas (6,0 frente a 3,4%, p = 0,04) y poseían cualidades de liderazgo negativas (5,2% frente a 1,4%; p < 0,01) en comparacion con los solicitantes masculinos. Los solicitantes masculinos tenían más probabilidades de ser descritos como amables (36,6 % frente a 28,3%; p = 0,03), curiosos (16,4% frente a 9,2%; p = 0,01), que poseían habilidades académicas positivas (33,7 % frente a 20,0%; p < 0,01), y habilidades docentes positivas (23,5% vs 17,0%; p = 0,04).LIMITACIONES:Este estudio analizó un solo año de solicitudes a un centro académico y puede no ser generalizable.CONCLUSIÓN:Existen diferencias en las cualidades utilizadas para describir a los solicitantes femeninos versus masculinos en las cartas de recomendación de solicitud de residencia en cirugía colorrectal. Las candidatas femeninas se describieron con mayor frecuencia en términos académicos negativos y poseían cualidades de liderazgo negativas. Los hombres eran más propensos a ser descritos como amables, curiosos, académicamente impresionantes y con buenas habilidades docentes. El campo puede beneficiarse de iniciativas educativas para reducir el sesgo de género implícito en las cartas de recomendación. Consulte Video Resumen en http://links.lww.com/DCR/C191 . (Traducción-Dr. Ingrid Melo ).

Gender equity in the scientific nursing journals indexed in Journal Citation Reports: A cross-sectional study

Background

Scientific activity has been connected to the proven inequality between women and men. To examine the state of gender equality in nursing research by analyzing the representation of male and female as editors and as authors of articles published in scientific journals.

Method

A cross-sectional study was carried out between September-2019 and May-2020. All the scientific publications published in 115 nursing journals indexed in the Journal Citation Reports in the years 2008, 2013, and 2017 were chosen as analysis units. The main variables studied were gender of the “journal editor”; gender of the “first author”, “last author”, “corresponding author”, and “first author in funded articles”. Descriptive and inferential analysis was performed.

Results

The proportion of male editors in 2008, 2013, and 2017 was 23.3, 19, and 18.5% respectively, with a male/female ratio of 1:3, 1:4 and 1:5. Male editors are mainly found in the journals of the first quartile (Q1 = 33.8%, ratio1:2), compared to the journals of the fourth quartile (Q4 = 6.6%, ratio1:14), p &lt; 0.01. The male authorship position was “last author” (30.9%, ratio1:2), “corresponding author” (23.3%, ratio 1:3), “first author” (22.1%, ratio 1:4) and “first author in funded articles” (21.8%, ratio 1:4). Furthermore, in 19.5%, of the articles there were more male authors. The percentage of articles with male authorship increased from 2008 to 2017, “first author” (21.1–23.4%; p &lt; 0.01), “last author” (30.0–31.1%; p = 0.22), “corresponding author” (22.5–24.2; p = 0.01), and “first author in funded articles” (18.1–25.9%; p &lt; 0.001).

Conclusions

Men are over-represented in the editor role in the most prestigious nursing journals. There are a higher proportion of male authors in the main positions of authorship.

Resident Operative Autonomy and Attending Verbal Feedback Differ by Resident and Attending Gender

Objectives

This study tests the null hypotheses that overall sentiment and gendered words in verbal feedback and resident operative autonomy relative to performance are similar for female and male residents.

Background

Female and male surgical residents may experience training differently, affecting the quality of learning and graduated autonomy.

Methods

A longitudinal, observational study using a Society for Improving Medical Professional Learning collaborative dataset describing resident and attending evaluations of resident operative performance and autonomy and recordings of verbal feedback from attendings from surgical procedures performed at 54 US general surgery residency training programs from 2016 to 2021. Overall sentiment, adjectives, and gendered words in verbal feedback were quantified by natural language processing. Resident operative autonomy and performance, as evaluated by attendings, were reported on 5-point ordinal scales. Performance-adjusted autonomy was calculated as autonomy minus performance.

Results

The final dataset included objective assessments and dictated feedback for 2683 surgical procedures. Sentiment scores were higher for female residents (95 [interquartile range (IQR), 4-100] vs 86 [IQR 2-100]; P < 0.001). Gendered words were present in a greater proportion of dictations for female residents (29% vs 25%; P = 0.04) due to male attendings disproportionately using male-associated words in feedback for female residents (28% vs 23%; P = 0.01). Overall, attendings reported that male residents received greater performance-adjusted autonomy compared with female residents (P < 0.001).

Conclusions

Sentiment and gendered words in verbal feedback and performance-adjusted operative autonomy differed for female and male general surgery residents. These findings suggest a need to ensure that trainees are given appropriate and equitable operative autonomy and feedback.

Programmatic engagement in diversity, equity, and inclusion in U.S. vascular surgery training programs

OBJECTIVE

Given the diversity of populations that modern healthcare professionals treat, there has been an increasing call for academic medical centers to ensure that they themselves are diverse and inclusive. Historically, this has been measured by the composition of the workforce in terms of protected categories such as race/ethnicity, gender, and disability. However, these broad categories have only poorly reflected the actual ability of organizations to engage with a diverse workforce and patient population. The diversity and engagement survey (DES) is a specifically constructed and validated instrument designed to measure the integration of diversity, equity, and inclusion (DEI) within academic medical centers. The goal of the present study was to use the DES with vascular surgery program directors, to determine the predictors of low DEI in vascular surgery training programs.

METHODS

An anonymous electronic survey was sent to all program directors and assistant program directors of vascular surgery training programs (residencies and fellowships) in the United States (n = 280). The survey consisted of 18 sections with 53 questions regarding details of the respondent, demographics, programmatic information, including information on faculty and trainee diversity, the resources available to enhance DEI within the program, institutional attitudes toward employees, and the DES itself. The total score from the DES section was used to the stratify institutions, which were classified as low DEI if in the bottom 25% percentile of the overall scores or as high DEI if scoring higher. Univariate analysis was used to determine whether any important differences were present in the demographics or survey responses between the institutions scoring as low vs high DEI. Multivariate logistic regression was also performed using the demographic variables and responses to the survey questions to determine their relationship to DEI status.

RESULTS

There were a total of 102 complete responses to the survey (36.4% response rate). The proportion of women was higher (66.67%) than the men (33.30%) in the low DEI cohort, although women were only 28.4% of the overall cohort. A statistically significant difference was found between the high and low DEI institutions in the proportion of those who had responded yes, no, or preferred not to disclose whether they had experienced discrimination or hurtful comments (P < .001) with 71% of the respondents in the low DEI institutions reporting this experience compared with only 11% in high DEI institutions. Multivariate analysis also demonstrated that non-male gender (odds ratio, 5.10; P = .034) and experiences of discrimination (odds ratio, 6.51; P = .024) were associated with low DEI institutions.

CONCLUSIONS

Non-male program directors and those who had experienced discrimination at their institution were significantly more likely to find that their institution had low DEI.

What Is in a Name? Exploring Perceptions of Surname Change in Hiring Evaluations in Academia

The motherhood penalty reflects inequalities in the workplace based on caregiver status. A number of factors have been identified as potential triggers of motherhood penalty effects, such as becoming pregnant or taking maternity leave. However, little is known as to whether these effects could also be triggered by more subtle cues that may signal potential changes in caregiver status. The current study investigated the impact of surname change visible on publication lists in academics’ Google Scholar profiles on evaluations of competence, commitment, work–family balance, hiring, and promotion likelihood. Contrary to the predictions in our preregistration, the findings showed that women who have changed their surname received more favourable evaluations compared to those who did not. In addition, female participants favoured female academics who have changed their surname compared to those who did not and this was mediated by higher perceived competence and commitment scores. These findings were interpreted through the lens of social role theory and the role prioritisation model, suggesting that behaviours that are consistent with gendered expectations are evaluated more favourably.

Educating Engineering Students to Address Bias and Discrimination Within Their Project Teams

What training should engineering students receive to enable them to contribute to reducing bias, discrimination and the persistent lack of diversity in engineering? Collaboration is central to professional engineering work and, consequently, teamwork and group projects are increasingly present in engineering curricula. However, the influence of unconscious bias on interactions within teams can negatively affect women and underrepresented groups and is now recognised as an important engineering ethics issue. This paper describes a workshop designed to enable engineering students to work equitably in diverse teams. Key features of the workshop include (1) the emotionally safe, empowering and warm environment created, (2) the creation of opportunities for students to discuss and apply the issues raised to their own engineering projects, and (3) the opportunities to practice the use of both proactive and reactive strategies to address bias and discrimination in teams. The evaluation of the workshop suggests that engineering students regarded both onsite and online formats as providing useful skills that they intended to apply in practice. Follow-up evaluations suggest that the workshop leads to behavioural change, especially the use of proactive teamwork strategies intended to reduce the impact of unconscious bias.

Gender Bias in the Evaluation of Surgical Performance: Results of a Prospective Randomized Trial

OBJECTIVE

The study aims to determine the influence of trainee gender on assessments of coronary anastomosis performance.

SUMMARY OF BACKGROUND DATA

Understanding the impact of gender bias on the evaluation of trainees may enable us to identify and utilize assessment tools that are less susceptible to potential bias.

METHODS

Cardiothoracic surgeons were randomized to review the video performance of trainees who were described by either male or female pronouns. All participants viewed the same video of a coronary anastomosis and were asked to grade technique using either a Checklist or Global Rating Scale (GRS). Effect of trainee gender on scores by respondent demographic was evaluated using regression analyses. Inter-rater reliability was assessed using the Cronbach's alpha.

RESULTS

103 cardiothoracic surgeons completed the Checklist (trainee gender: male n=50, female n=53) and 112 completed the GRS (trainee gender: male n=56, female n=56). For the Checklist, male cardiothoracic surgeons who were in practice <10 years ( P = 0.036) and involved in training residents ( P = 0.049) were more likely to score male trainees higher than female trainees. The GRS demonstrated high inter-rater reliability across male and female trainees by years and scope of practice for the respondent (alpha >0.900) when compared to the Checklist assessment tool.

CONCLUSIONS

Early career male surgeons may exhibit gender bias against women when evaluating trainee performance of coronary anastomoses. The GRS demonstrates higher interrater reliability and robustness against gender bias in the assessment of technical performance than the Checklist, and such scales should be emphasized in educational evaluations.

A Noisy Theory of Asking for Help That Explains why Many Feel Underwhelmed With the Help They Receive

Employees often feel that the help they receive at work is inadequate. Whereas previous research explains this empirical finding by referencing stereotypes or poor communication, we suggest an alternative that does not rely on biased agents: disappointment with received help may arise due to self-selection and regression to the mean. Before asking for help, employees assess whether their co-workers have the time and ability to respond. Consistent with regression to the mean, extreme beliefs are often followed by less extreme outcomes. However, employees with inflated beliefs are more likely to ask for help than employees with low or modest beliefs. Therefore, the subset of employees who act will have overly optimistic expectations, expectations that are unlikely to be met once co-workers respond. Apart from challenging conventional wisdom, this article also integrates chance and self-selection perspectives into the ongoing dialogue of help-seeking. Implications for future research, theory, and practice are discussed.

Plain Language Summary

This article presents a theory explaining the following empirical regularity: employees often feel let down with the help they receive at work. Prior research explains this effect by referencing errors in communication or cognition. We propose a simple, alternative mechanism, such that cognitive biases or communication mishaps need not be present for the pattern to emerge. Suppose employees ask for help based on a noisy signal of colleague potential—that is, a perception of whether co-workers have the motivation and ability to resolve the issue. Employees who believe potential is high will be more likely to ask for help than employees who believe potential is low. Due to regression to the mean, extreme beliefs will likely be followed by less extreme received help (in either direction). But not every employee asks for help. Only those with sufficiently high beliefs send a request—and it is those employees who have a greater chance of holding inflated assessments. Among those who ask, then, received help will appear underwhelming. Apart from challenging conventional wisdom, this article also integrates chance and self-selection perspectives into the ongoing dialogue of help-seeking. Implications for future research, theory, and practice are discussed.

A mixed-methods evaluation of unconscious racial bias training for NHS senior practitioners to improve the experiences of racially minoritised students

OBJECTIVE

The degree awarding gap indicates that racially minoritised higher education students receive lower degree classifications relative to their white peers. While the reasons for this are complex, research suggests that educator and practitioner attitudes and behaviour towards racially minoritised students are a significant contributing factor. This preregistered study evaluates the effectiveness of unconscious racial bias training (URBT) to enhance National Health Service senior practitioner's recognition of how racial inequalities negatively impact racially minoritised students.

DESIGN

A mixed-methods study with a pretest and post-test design was conducted in the higher education and healthcare practice environment.

METHODS

Forty-nine NHS senior practitioners completed a 4-hour URBT workshop with activities focusing on activating stereotypes, exploring differences between unconscious and implicit bias, discussing the development of bias, and reflecting on student experiences of prejudice, harassment and discrimination. They completed pre- and post- quantitative measures that assessed the effectiveness of URBT and changes in racial competency, awareness and perceptions of unconscious racial bias. Qualitative measures explored the usefulness and perceived applications of URBT, and a 1-month follow-up assessed further how it had been applied within practice.

RESULTS

Participants reported positive evaluations of URBT, higher perceived racial competency, awareness and perceptions of racial bias (ps<0.001, dz>0.35). After 1 month, key themes from qualitative responses suggested that participants had increased self-awareness and were exploring how to set up mentoring and working groups, change recruitment and progression processes, and diversify the taught curriculum.

CONCLUSIONS

URBT may be one effective strategy to enhance awareness and encourage reflections of racial bias. We discuss how reducing racial inequalities requires a multifaceted approach that affords upfront conversations about systemic racism, implements effective initiatives, policies and procedures, and engages in continuous evaluation.

Gender and Racial Bias in Letters of Recommendation for Orthopedic Surgery Residency Positions

OBJECTIVE

The primary purpose of this study was to retrospectively analyze letters of recommendation written for medical students applying to orthopedic residency for implicit race and gender bias. The secondary purpose was to determine if the presence of bias was influenced by the gender of the letter writer.

DESIGN

This was a retrospective institutional review board (IRB) approved study. All letters of recommendation received in the years 2016 to 2018 were deidentified and analyzed using the Linguistics Inquiry and Word Count (LIWC) 2015 software. Independent variables in our analysis were applicant gender and applicant race. Dependent study variables included the summary and characteristic variables of a letter of recommendation, which are word count, analytic, clout, authenticity, tone, and positive and negative emotion word categories. Separate analyses were completed by gender of the letter writer as well.

SETTING

Institution: Temple University Hospital, Philadelphia, Pennsylvania.

PARTICIPANTS

Medical students applying to Temple University Hospital Orthopaedic Surgery Program from 2016 to 2018. A total of 2113 applicants were included in the study.

RESULTS

Female, Asian and underrepresented minority applicants' letters were more likely to have a higher word count. In our subset analysis by gender of letter writer, when the letter writer was male, Asian applicants' letters were more likely to convey analytical thinking and authenticity. When the letter writer was male, male applicants scored higher for authenticity. Letters written by female attendings demonstrated no significant difference for male or female applicants in terms of composite variables or word categories.

CONCLUSIONS

Our study shows that letters of recommendation for orthopedic surgery residency positions are likely to contain some degree of bias. Further studies are required to fully characterize the degree and magnitude of bias in letters of recommendation and whether the findings of our study are significant enough to contribute to the difference in socioeconomic demographics between orthopedic residents and society at large.

[Feminization of urology and glass ceiling: Survey of women urologists in France]

INTRODUCTION

Urology has long remained the least feminized specialty. The objective of this study was to assess the demographic characteristics of female urologists and their feelings in terms of discrimination.

MATERIAL

The survey consisted of a questionnaire of 12 questions, sent by mailing to all female urologists, a first time in May 2016 (n=84), then a second time in January 2020 (n=98). The anonymized answers were analyzed and compared in order to assess the evolution over the last 4 years. The participation rate was 46.4% in 2016 (n=39 respondents) and 50% in 2020 (n=49 respondents).

RESULTS

The majority of women worked full time (73.5%), with a hospital (38.8%), liberal (46.9%) or mixed (14.3%) activity. Their main theme was women's urology (57.1%). In 2020, 59.2% of respondents had encountered difficulties related to their status as women during their career and 28.1% difficulties related to motherhood. Female urologists in private practice were significantly less concerned than their counterparts with hospital or mixed activity (43.5% versus 73.1%, P=0.035). Women felt that they were underrepresented in association committees at 95.9% (vs. 82.1% in 2016) and in university positions at 79.6% (vs. 89.7% in 2016). Finally, 91.8% were in favor of the creation of an association of women urologists (vs. 53.8% in 2016).

CONCLUSION

Women urologists may encounter difficulties related to their status as women during their professional career. Between 2016 and 2020, there is an increase in the feeling of under-representation within association committees and an increase in the need to federate.

NIVEAU DE PREUVE

III, étude rétrospective cas-témoins.

The time is now: addressing implicit bias in obstetrics and gynecology education

Obstetrician-gynecologists can improve the learning environment and patient care by addressing implicit bias. Accumulating evidence demonstrates that racial and gender-based discrimination is woven into medical education, formal curricula, patient-provider-trainee interactions in the clinical workspace, and all aspects of learner assessment. Implicit bias negatively affects learners in every space. Strategies to address implicit bias at the individual, interpersonal, institutional, and structural level to improve the well-being of learners and patients are needed. The authors review an approach to addressing implicit bias in obstetrics and gynecology education, which includes: (1) curricular design using an educational framework of antiracism and social justice theories, (2) bias awareness and management pedagogy throughout the curriculum, (3) elimination of stereotypical patient descriptions from syllabi and examination questions, and (4) critical review of epidemiology and evidence-based medicine for underlying assumptions based on discriminatory practices or structural racism that unintentionally reinforce stereotypes and bias. The movement toward competency-based medical education and holistic evaluations may result in decreased bias in learner assessment. Educators may wish to monitor grades and narratives for bias as a form of continuous educational equity improvement. Given that practicing physicians may have little training in this area, faculty development efforts in bias awareness and mitigation strategies may have significant impact on learner well-being.

Gender Disparities in Academic Pain Medicine: A Retrospective, Cross-Sectional Bibliometric Analysis

PURPOSE

This study was conducted to characterize the gender disparities within academic pain management departments in the United States, specifically focusing on its relation to research and academic leadership. This will allow for targeted improvements in efforts made to reduce gender gaps within academic pain medicine.

METHODS

This is a retrospective, cross-sectional analysis study evaluating pain management faculty of various positions at academic institutions across the United States. We utilized publicly available data on faculty positions and sex to analyze research impact, H-index, number of publications and citations through bibliometric and linear regression analysis.

RESULTS

Our analysis found that female faculty had significantly less research output to male faculty. The three research measurement indices used in this study including H-index, number of publications, and number of citations were significantly lower in females than in males among associate and full professor faculty ranking. Multivariable analysis did not display any significant disparities of research output at the division director and department chair level.

DISCUSSION

As in many areas of medicine, there continues to be a significant gender disparity in academic pain management departments, particularly with regard to leadership positions and research impact within the field. Our study found that female pain physicians had a significantly less research output based on the three variables of H indices, number of publications, and number of citations compared to their male counterparts. This has been shown to have the impact on discrepancies in female faculty ranking. Interestingly, these variables were not significantly different between male and female faculty members of the same level of leadership except for program director. There are various contributory reasons for these disparities, including implicit biases, lack of mentorship, and familial obligations. Addressing some of these factors can help narrow the schism and promote greater gender equality within academic pain management.

Brief online implicit bias education increases bias awareness among clinical teaching faculty

PROBLEM AND PURPOSE

Healthcare provider implicit bias influences the learning environment and patient care. Bias awareness is one of the key elements to be included in implicit bias education. Research on education enhancing bias awareness is limited. Bias awareness can motivate behavior change. The objective was to evaluate whether exposure to a brief online course, Implicit Bias in the Clinical and Learning Environment, increased bias awareness.

MATERIALS AND METHODS

The course included the history of racism in medicine, social determinants of health, implicit bias in healthcare, and strategies to reduce the impact of implicit bias in clinical care and teaching. A sample of U.S. academic family, internal, and emergency medicine providers were recruited into the study from August to December 2019. Measures of provider implicit and explicit bias, personal and practice characteristics, and pre-post-bias awareness measures were collected.

RESULTS

Of 111 participants, 78 (70%) were female, 81 (73%) were White, and 63 (57%) were MDs. Providers held moderate implicit pro-White bias on the Race IAT (Cohen's d = 0.68) and strong implicit stereotypes associating males rather than females with 'career' on the Gender-Career IAT (Cohen's d = 1.15). Overall, providers held no explicit race bias (Cohen's d = 0.05). Providers reported moderate explicit male-career (Cohen's d = 0.68) and strong female-family stereotype (Cohen's d = 0.83). A statistically significant increase in bias awareness was found after exposure to the course (p = 0.03). Provider implicit and explicit biases and personal and practice characteristics were not associated with an increase in bias awareness.

CONCLUSIONS

Implicit bias education is effective to increase providers' bias awareness regardless of strength of their implicit and explicit biases and personal and practice characteristics. Increasing bias awareness is one step of many toward creating a positive learning environment and a system of more equitable healthcare.

Estimating Implicit and Explicit Gender Leadership Bias among Primary Healthcare Professionals in Saudi Arabia

(1) Background: Women have become more influential and powerful; however, implicit bias continues to plague organizations when it comes to women in leadership positions. This study examines the implicit and explicit biases that favor men as leaders among Saudi Arabian primary healthcare professionals. (2) Methods: A secure, web-based survey was administered to primary healthcare professionals. The survey included questions about leadership as well as an Implicit Association Test (IAT) for implicit gender bias. (3) Results: Out of 690 eligible, 448 respondents completed the survey, representing a response rate of 65%. Male residents had a mean IAT score of 0.27 (SD 0.31) and females 0.12 (SD 0.29), both favoring males in leadership roles, and the difference was statistically significant. There was a significant association between gender and gender IAT. In the explicit bias, gender, education, gender of the current manager, and being manager were associated with the gender explicit bias. Explicit bias favoring males in leadership roles was associated with increased implicit bias favoring males in leadership roles. (4) Conclusions: This study found that explicit and implicit gender bias is present among primary healthcare professionals favoring men in leadership positions held by both men and women.

Navigating the leaky pipeline: Do stereotypes about parents predict career outcomes in academia?

The motherhood penalty seemingly reflects a preference to hire female professionals who are not parents compared to mothers, however, little is known about whether this effect is attributable to parent stereotypes per se. Study 1 assessed the content of the parent-academia stereotypes of 180 individuals working in Education and revealed stronger stereotypical associations of fathers with academia than mothers. Study 2 investigated what parent-academia stereotypes predict in terms of endorsements for hiring men versus women in a mock hiring task set in an academic context. Academics (N = 112) evaluated mock job candidates for an Assistant Professor post while the gender, parental status and leave status of the candidates were manipulated. The findings showed that parents were significantly less likely to be endorsed to be hired than non-parents, regardless of gender. Parent-academia stereotypes led to biased hiring recommendations, such that a greater endorsement of parent-academia stereotypes predicted a reduced likelihood to endorse hiring parents compared to non-parents. Implications for reducing parent stereotypes in academic contexts are discussed.

Linguistic Differences by Gender in Letters of Recommendation for Female Pelvic Medicine and Reconstructive Surgery Fellowship Applicants From 2010 to 2020

IMPORTANCE

Linguistic differences suggestive of gender bias have been detected in letters of recommendation (LOR) for female and male residency and fellowship program applicants within multiple medical specialties.

OBJECTIVE

The aim of the study was to determine whether linguistic differences exist in LOR for female and male physicians applying to female pelvic medicine and reconstructive surgery (FPMRS) fellowship.

STUDY DESIGN

A retrospective analysis of FPMRS fellowship applications submitted to a university-affiliated academic center from 2010 to 2020 was performed. Linguistic Inquiry and Word Count, a text analysis software, was used to characterize the linguistic content of letters. Multivariable analysis was used to compare letter characteristics with applicant and letter writer demographics.

RESULTS

Of 306 applications reviewed, 221 (72.2%) applicants were female and 85 (27.8%) were male. Of the 1,062 letters analyzed, 457 (43.0%) were written by female letter writers, 586 (55.2%) by males, and 19 (1.8%) were a combination. Multivariable analysis controlling for race, Step 1 score, and letter writer gender demonstrated more frequent use of affiliation words for female applicants compared with males (3.1% ± 0.3 vs. 2.9% ± 0.3, P = 0.02). No additional differences were noted in average letter length or all other linguistic categories analyzed. Multiple differences were detected between writing styles of female and male letter writers, including average letter length, use of multiple word categories, and use of communal (relationship-oriented) language. Data were stratified into 2-year periods and no longitudinal trends in linguistic differences were detected.

CONCLUSIONS

No linguistic differences, suggestive of gender bias, were found between female and male applicants to FPMRS fellowship.

Anti-Indigenous bias of medical school applicants: a cross-sectional study

BACKGROUND

Structural and interpersonal anti-Indigenous racism is prevalent in Canadian healthcare. The Truth and Reconciliation Commission calls on medical schools to address anti-Indigenous bias in students. We measured the prevalence of interpersonal anti-Indigenous bias among medical school applicants to understand how the medical school selection process selects for or against students with high levels of bias.

METHODS

All applicants to a single university in the 2020-2021 admissions cycle were invited to participate. Explicit anti-Indigenous bias was measured using two sliding scale thermometers. The first asked how participants felt about Indigenous people (from 0, indicating 'cold/unfavourable' to 100, indicating 'warm/favourable') and the second asked whether participants preferred white (scored 100) or Indigenous people (scored 0). Participants then completed an implicit association test examining preferences for European or Indigenous faces (negative time latencies suggest preference for European faces). Explicit and implicit anti-Indigenous biases were compared by applicant demographics (including gender and racial identity), application status (offered an interview, offered admission, accepted a position), and compared to undergraduate medical and mathematics students.

RESULTS

There were 595 applicant respondents (32.4% response rate, 64.2% cisgender women, 55.3% white). Applicants felt warmly toward Indigenous people (median 96 (IQR 80-100)), had no explicit preference for white or Indigenous people (median 50 (IQR 37-55), and had mild implicit preference for European faces (- 0.22 ms (IQR -0.54, 0.08 ms)). There were demographic differences associated with measures of explicit and implicit bias. Applicants who were offered admission had warmer feelings toward Indigenous people and greater preference for Indigenous people compared to those were not successful.

CONCLUSIONS

Medical school applicants did not have strong interpersonal explicit and implicit anti-Indigenous biases. Outlier participants with strong biases were not offered interviews or admission to medical school.

Faculty diversity, equity, and inclusion in academic dentistry: Revisiting the past and analyzing the present to create the future

AIM

In 2021, NIDCR published the landmark report "Oral Health in America." It described that while oral health-related research and care has seen amazing progress, oral health inequities and lack of oral care for large segments of the US population have not improved. This situation plus the predicted increase of the diversification of the US population requires decisive actions to ensure that future dentists will be optimally prepared to provide the best possible care for all patients. A diverse dental educator workforce plays a crucial role in obtaining this goal. The objectives of this document were threefold. Aim 1 was to analyze past and current trends in the diversity and inclusion of historically underrepresented ethnic/racial (HURE) and marginalized (HURM) dental faculty members. Aim 2 focused on reviewing best practices and challenges related to achieving dental faculty and leadership diversity and inclusion. Aim 3 was to develop recommendations for increasing the diversity and inclusion of dental faculty in the present and future.

METHODS

An analysis of ethnicity/race and gender faculty data collected by the American Dental Education Association (ADEA) in 2011-2012 and 2018-2019 showed that achieving faculty diversity and inclusion has been an ongoing challenge, with limited success for faculty from HURE backgrounds. In order to create this much-needed change, best practices to increase the applicant pool, change recruitment strategies, and develop solid retention and promotion efforts were described. Research discussing the challenges to creating such changes was analyzed, and strategies for interventions were discussed.

CONCLUSION

In conclusion, evaluations of efforts designed to create a more diverse and inclusive work force is crucial. Institutions must evaluate their diversity data, practices utilized, and the policies implemented to determine whether the desired outcomes are achieved. Only then will the future dental workforce be optimally prepared to provide the best possible care for all patients in the United States.

The Informative Process Model as a New Intervention for Attitude Change in Intractable Conflicts: Theory and Empirical Evidence

Peacemaking is especially challenging in situations of intractable conflict. Collective narratives in this context contribute to coping with challenges societies face, but also fuel conflict continuation. We introduce the Informative Process Model (IPM), proposing that informing individuals about the socio-psychological processes through which conflict-supporting narratives develop, and suggesting that they can change via comparison to similar conflicts resolved peacefully, can facilitate unfreezing and change in attitudes. Study 1 established associations between awareness of conflict costs and conflict-supporting narratives, belief in the possibility of resolving the conflict peacefully and support for pursuing peace among Israeli-Jews and Palestinians. Studies 2 and 3 found that exposure to IPM-based original videos (vs. control) led Israeli-Jews to deliberation of the information presented, predicting acceptance of the IPM-based message, which, in turn, predicted support for negotiations. Study 3 also found similar effects across IPM-based messages focusing on different conflict-supporting themes. We discuss the implications to attitude change in intractable conflicts.

Ten actions to achieve gender equity among intensivists: the French Society of Intensive Care (FICS) model

In our recent survey, we aimed to collect information on perceived inequity as well as professional and personal fulfillment among women intensivists in France. For the 371 respondents out of the 732 persons who received the survey, the findings were unequivocal: for one-third of the respondents, being a woman was considered as an obstacle to careers or academic advancement, and for two thirds, pregnancy was viewed as a barrier to their career advancement. Gender discrimination had been experienced by 55% of the respondents. In 2019, to promote and achieve gender equity in the French Intensive Care Society (FICS), ten actions were initiated and are detailed in the present manuscript together with supporting data: (1) creation of a working group: the FEMMIR group; (2) promotion of mentorship; (3) implementation of concrete sponsorship; (4) transparency and public reporting of gender ratios in editorial boards; (5) workshops dedicated to unconscious gender bias; (6) workshops dedicated to improved women assertiveness; (7) role models; (8) creation of educational/information programs for young intensivists; (9) development of research on gender inequity and, as a perspective; and (10) development of a wide-ranging program. This review is aimed at providing a toolbox of organizational best practices designed to achieve gender equity. It is particularly important to share promising practical action engaged in our FEMMIR group with other concerned professionals around the world.

Linguistic Differences by Gender in Letters of Recommendation for Minimally Invasive Gynecologic Surgery Fellowship Applicants

OBJECTIVE

Various surgical specialties have reported gender bias in letters of recommendation (LOR). We aimed to determine if linguistic differences exist in LOR for female and male physicians applying to Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS).

DESIGN

Retrospective cohort study including application cycles 2019 and 2020.

SETTING

Academic university hospital.

PARTICIPANTS

FMIGS applicants.

RESULTS

Applicant demographic and baseline data included age, race, gender, geographical region of residency training, Step 1 and 2 scores, number of research and volunteer activities, Alpha Omega Alpha and Gold Humanism status and number of LOR, as well as the gender and academic rank of the letter writer. The Linguistic Inquiry and Word Count software, a validated text analysis program, was used to characterize LOR linguistic content. A total of 118 applications, including 391 letters, were analyzed. Seventy-six (64.4%) applicants were female and 42 (35.6%) were male. Most female applicants were white (46% vs. 36%, p = 0.04), had Alpha Omega Alpha status (13% vs. 0%, p = 0.01), higher Step 2 scores (239.7 vs. 230.4, p < 0.01), and more service activities (7.7 vs. 4.7, p < 0.01), compared to male applicants. Male applicants were more likely to graduate from international medical schools (45% vs. 16%, p < 0.01). Female authors wrote 159 LOR, and male authors wrote 232. Following multivariable analysis controlling for race, Step 1 score and letter writer gender, no significant differences in average LOR word count for female and male applicants (406.7 ± 24.2 words vs. 340.1 ± 35.4 words), or differences in Linguistic Inquiry and Word Count linguistic categories existed.

CONCLUSIONS

Although Baseline differences were noted between female and male FMIGS applicants, no differences in LOR length or linguistic categories were noted. These results likely reflect the impact of female predominance and increased efforts to address gender bias within Obstetrics and Gynecology.

Supporting Midcareer Women Faculty in Academic Medicine Through Mentorship and Sponsorship

Midcareer women faculty face unique career challenges that may benefit from mentorship and sponsorship, yet such programs focused on the needs of this career phase are scarce in academic medicine. Many midcareer faculty require intentional and individual career planning to choose a path from the broad array of options in academic medicine. Ambiguous promotion criteria, increased workloads because of service or citizenship tasks, and a lack of sponsorship are among the barriers that inhibit midcareer faculty's growth into the high-visibility roles needed for career advancement. In addition, issues faced by women midcareer faculty members may be further exacerbated by barriers such as biases, a disproportionate share of family responsibilities, and inequities in recognition and sponsorship. These barriers contribute to slower career growth and higher attrition among women midcareer faculty and ultimately an underrepresentation of women among senior leadership in academic medicine. Here, we describe how a mentoring program involving individuals (eg, mentors, mentees, and sponsors) and departments/institutions (eg, deans and career development offices) can be used to support midcareer faculty. We also provide recommendations for building a mentoring program with complementary support from sponsors targeted toward the specific needs of women midcareer faculty. A robust midcareer mentoring program can support the career growth and engagement of individual faculty members and as a result improve the diversity of academic medicine's highest ranks.

Gender bias in sports medicine: an international assessment of sports medicine physicians' perceptions of their interactions with athletes, coaches, athletic trainers and other physicians

OBJECTIVES

To evaluate the difference between female and male sports medicine physicians regarding disrespectful attitudes and sexual harassment perceived from athletes, coaches, physicians, athletic trainers (ATs) and organisations/administrations.

METHODS AND STUDY DESIGN

anonymous survey was distributed to sports medicine physicians practicing in 51 countries. χ² analysis was used to detect differences between female and male sports medicine physicians and logistic regression analysis was used to determine the independent variables that affect disrespectful attitudes and sexual harassment from sports participants.

RESULTS

1193 sports medicine physicians (31.9% female) participated from 51 countries. The survey revealed that female physicians, compared with male physicians, perceive significantly more disrespect or have their judgement questioned more by the following categories: male and female athletes, male and female coaches, female physicians with more years of experience, male physicians (regardless of years of experience), male and female ATs and organisation/administrations (all p<0.05). The only category where the frequency of disrespect was perceived equally by male and female physicians was during their interactions with female physicians who have the same or lesser years of experience. Female sports medicine physicians noted more sexual harassment than male physicians during interactions with male athletes, coaches, ATs and physicians (all p<0.001). In the logistic regression, gender was a related factor for perceiving disrespect, especially from male coaches (OR=2.01) and physicians with more years of experience (OR=2.18).

CONCLUSIONS

Female sports medicine physicians around the world experience disrespectful attitudes, questioning of their judgement and are sexually harassed significantly more often than male counterparts.

Explicit and Implicit Gender-Related Stereotyping in Transgender, Gender Expansive, and Cisgender Adults

Little is known about gender-related stereotyping among transgender and gender expansive adults. Using the Ambivalent Sexism Inventory (AIS; Glick & Fiske, 1996), we examined explicit gender attitudes in 3298 cisgender, transgender, and gender expansive respondents designated female at birth (FAB; n = 1976 cisgender, n = 108 transgender, n = 188 gender expansive) and male at birth (MAB; n = 922 cisgender, n = 52 transgender, n = 52 gender expansive). In order to learn more about implicit gender-related stereotyping, a subset of 822 participants (FAB; n = 445 cisgender, n = 32 transgender, n = 51 gender expansive. MAB; n = 254 cisgender, n = 21 transgender, n = 19 gender expansive) completed the gender-leadership Implicit Association Test (IAT; Dasgupta & Asgari, 2004). Cisgender men scored significantly higher than all other groups on hostile sexism, but patterns of endorsement for benevolent sexism and implicit attitudes were more nuanced, with cisgender women and gender expansive FAB often scoring significantly below other groups. We observed that transgender men and transgender women, along with cisgender men and gender expansive MAB, moderately endorsed essentialist views regarding differences between men and women (i.e., complementary gender differentiation). These data reveal novel patterns of gender-related stereotyping, with some corresponding to sex designated at birth and others corresponding to current gender identification. Together, these findings suggest that one's experienced gender, designated sex at birth, and the intersection between them may relate to gender stereotyping, underscoring the importance of including transgender and gender expansive individuals in this research.

Words Matter: Examining Gender Differences in the Language Used to Evaluate Pediatrics Residents

BACKGROUND

Gender disparities in academic medicine continue to be pervasive. Written evaluations of residents may provide insight into perceptions of residents by faculty, which may influence letters of recommendation for positions beyond residency and reinforce perceived stereotype threat experienced by trainees.

OBJECTIVE

To examine language used in faculty evaluations of pediatrics residents to determine if there are differences in language used with respect to gender of resident.

DESIGN/METHODS

All faculty evaluations of residents in 3 consecutive intern classes from 2016 to 2018 were collected and redacted for name and gender identifiers. We performed a qualitative analysis of written comments in 2 mandatory free text sections. The study team initially coded text collectively, generating a code book, then individually to apply the coding scheme. Next, evaluations were unblinded to gender. Code applications were aggregated by resident, and frequencies of code application by resident were compared by standardized mean differences to detect imbalances between genders.

RESULTS

A total of 448 evaluations were analyzed: 88 evaluations of 17 male residents, and 360 evaluations of 70 female residents. Codes more frequently applied to women included "enthusiasm," and "caring," while codes more frequently applied to men included "intelligence," and "prepared." A conceptual model was created to reflect potential impacts of these differences using a lens of social role theory.

CONCLUSIONS

We identified differences in the way male and female residents are evaluated by faculty, which may have negative downstream effects on female residents, who may experience negative self-perception, differential development of clinical skills, and divergent career opportunities as a result.

Physician Identification Badges: A Multispecialty Quality Improvement Study to Address Professional Misidentification and Bias

OBJECTIVE

To evaluate whether providing resident physicians with "DOCTOR" role identification badges would impact perceptions of bias in the workforce and alter misidentification rates.

PARTICIPANTS AND METHODS

Between October 2019 and December 2019, we surveyed 341 resident physicians in the anesthesiology, dermatology, internal medicine, neurologic surgery, otorhinolaryngology, and urology departments at Mayo Clinic in Rochester, Minnesota, before and after an 8-week intervention of providing "DOCTOR" role identification badges. Differences between paired preintervention and postintervention survey answers were measured, with a focus on the frequency of experiencing perceived bias and role misidentification (significance level, α=.01). Free-text comments were also compared.

RESULTS

Of the 159 residents who returned both the before and after surveys (survey response rate, 46.6% [159 of 341]), 128 (80.5%) wore the "DOCTOR" badge. After the intervention, residents who wore the badges were statistically significantly less likely to report role misidentification at least once a week from patients, nonphysician team members, and other physicians (50.8% [65] preintervention vs 10.2% [13] postintervention; 35.9% [46] vs 8.6% [11]; 18.0% [23] vs 3.9% [5], respectively; all P<.001). The 66 female residents reported statistically significantly fewer episodes of gender bias (65.2% [43] vs 31.8% [21]; P<.001). The 13 residents who identified as underrepresented in medicine reported statistically significantly less misidentification from patients (84.6% [11] vs 23.1% [3]; P=.008); although not a statistically significant difference, the 13 residents identifying as underrepresented in medicine also reported less misidentification with nonphysician team members (46.2% [6] vs 15.4% [2]; P=.13).

CONCLUSION

Residents reported decreased role misidentification after use of a role identification badge, most prominently improved among women. Decreasing workplace bias is essential in efforts to improve both diversity and inclusion efforts in training programs.

Diversity Practices for Hiring the New Graduate Nurse

A multistep selection process was established to assist in securing top talent while achieving diversity objectives for a nurse residency program. The selection process incorporated objective scoring tools, diverse panel interviews, unconscious bias training, and standardized interview questions to decrease unconscious and implicit bias. As a result, the entry-level nursing workforce has become more diversified by race, gender, age, and academic training.