Unconscious gender-directed bias remains common in healthcare overall, and in interventional specialties in particular, new data suggest. The authors say such bias may help explain why women in surgery are not advancing more quickly.
In a review of tests administered to nearly 43,000 healthcare professionals, including 131 surgeons, researchers found that male and female respondents alike “hold implicit and explicit biases associating men with careers and surgery and women with family and family medicine.” Implicit bias was defined as an unconscious belief that might lead someone to act in ways that are inconsistent with his or her explicitly stated values or opinions.
The results add to the growing body of research suggesting that medical organizations such as hospitals and medical schools should do more to promote diversity within their ranks, especially when it comes to advancing women.
“Awareness of the existence of implicit biases is an important first step toward minimizing their potential effect,” Arghavan Salles, MD, PhD, from the Section of Minimally Invasive Surgery, Department of Surgery, Washington University, St Louis, Missouri, and colleagues write in an article published online today in JAMA Network Open.
Leaders such as department chairs and section chiefs should stop questioning whether bias still exists and instead ask, “What are we doing to solve this problem? What are we doing to help women succeed in this field instead of driving them away?” Salles told Medscape Medical News.
For example, she noted that although more women are becoming surgeons, they often experience “a number of unfortunate circumstances that have to do with microaggressions or bias, and they’re often made to feel as though they’re overreacting or overly sensitive” in those situations.
One incident may not be too damaging, Salles acknowledged, “but over and over and over again, it becomes very hard to see oneself in that field. So instead of telling someone to lighten up, what we should be saying instead is, ‘that behavior is not appropriate, let’s figure out why that happened and ensure that it doesn’t happen again’.”
Salles notes that bias isn’t limited to surgery. She cites other research suggesting that residents in fields such as pediatrics and obstetrics and gynecology, as well as the general public, expect men in those specialties to be better clinicians.
In their study, the authors reviewed the results of 42,991 healthcare workers who took the gender-career Implicit Association Test (IAT) between January 1, 2006, and December 31, 2017. As part of the IAT, participants sort words appearing on one side of a computer screen into categories that appear on the other side of the screen. The test is timed and based on the assumption that concepts more closely associated by the respondent will be sorted together more quickly. The test also includes questions about explicit bias, such as, “How strongly do you associate career/family with males and females?”
Of the healthcare professionals taking the gender-career IAT, 82% were women and included participants from a variety of professions, such as nursing, dietetics, and home healthcare assistants. Their scores suggested that they held implicit (mean D score [SD], 0.41 [0.36]; Cohen d = 1.14) and explicit (mean D score, 1.43 [1.85]; Cohen d = 0.77) biases associating men with career and women with family.
To examine bias among surgeons specifically, Salles and colleagues developed a gender-specialty IAT, in which the terms “career” and “family” were replaced with the terms “surgery” and “family medicine.” The test was administered to 131 respondents, including 85 men (64.9%) and 46 (35.1%) women attending the American College of Surgeons annual meeting in October 2017.
A similar finding was obtained among surgeons for implicit (mean D score, 0.28 [0.37]; Cohen d = 0.76) and explicit (men: mean D score, 1.27 [0.39]; Cohen d = 0.93; women: mean D score, 0.73 [0.35]; Cohen d = 0.53) associating men with surgery and women with family medicine.
“There was broad evidence of consensus across social groups in implicit and explicit biases with one exception,” the authors write. “Women in healthcare (mean [SD], 1.43 [1.86]; Cohen d = 0.77) and surgery (mean [SD], 0.73 [0.35]; Cohen d = 0.53) were less likely than men to explicitly associate men with career (B coefficient, –0.10; 95% CI –0.15 to –0.04; P < .001) and surgery (B coefficient, –0.67; 95% CI, –1.21 to –0.13; P = .001) and women with family and family medicine.”
These findings are not surprising and “add to our understanding of how women are perceived in surgery and how this contributes to limiting their careers,” Fahima Dossa, MD, and Nancy N. Baxter, MD, PhD, write in an invited commentary. The results “appear to tell a clear and consistent story of ongoing gender bias in surgery that likely manifests in ways that affect the career success of women.”
However, “knowledge of these biases will not automatically translate into behavior change,” write Dossa, of the Department of Surgery, University of Toronto, and Baxter, Department of Surgery, St Michael’s Hospital, Toronto, Ontario, Canada. “A starting point for change may be acknowledging that we all carry these biases and considering how they may be affecting our perception of reality.”
Diversity can help organizations as well as individuals thrive, the study authors conclude. “Specifically, organizations with more diverse leadership are more productive and profitable,” and patients “are more satisfied with their care when it is provided by someone who looks like them.
“To improve recruitment and retention of diverse trainees, we need to better understand the factors that contribute to the underrepresentation of women.”
Salles has reported receiving honoraria from Medtronic for consulting and speaking. No other relevant financial relationships were disclosed by the study authors or editorialists.