‘Interrupt, Confront, Support, Report’: Town Hall Calls for Solutions to Address Gender Bias in Surgery and Medicine

“As one of the few females on my team, I’m asked to do the unpaid administrative work that has little value in getting me promoted.”

“After performing an urgent procedure on a patient, he said, ‘they’re letting you nurses do a lot these days!’”

These are some of the responses from an informal survey of Department of Surgery faculty that lined the wall of a meeting room in the Li Ka Shing Knowledge Institute at St. Michael’s Hospital.

They illustrate the pervasive gender bias and sexism that women in surgery and medicine face, and provided a backdrop for a Surgery town hall on gender issues and career advancement.

“Bias is alive and well in 2018,” said Nancy Baxter, surgery professor and Associate Dean of Academic Affairs at the Dalla Lana School of Public Health, and one of the speakers at the town hall.

Dr. Baxter was joined by keynote speaker and Department of Medicine Chair Gillian Hawker, surgery professor Najma Ahmed, medicine professor Reena Pattani, Medicine’s Vice Chair of Mentorship, Equity and Diversity and professor Sharon Straus, and Department of Surgery Chair James Rutka.

For decades, women have made up at least 40 per cent of medical school students, and more recently women have started to outnumber men in undergraduate medicine classrooms. However, as men and women rise to more senior roles, there is an underrepresentation of women who are full professors, and fewer still who are department chairs and deans of medicine. It’s what Dr. Hawker calls “the leaky pipeline.”

“We’re going from a diverse group of residents, to less diverse junior faculty, to even less diverse senior faculty,” she said, calling attention not only to gender, but also to racial, ethnic and religious diversity.

In the Department of Surgery, career advancement for women can stall as early as medical school and women make up fewer than 30 per cent of surgery residents.

A number of factors have contributed to the gender gap, according to Dr. Hawker. These include flawed recruitment processes, informal networks that exclude women and “locker room talk” that normalizes inappropriate behaviour. She also pointed to unconscious biases that favour the career aspirations and accomplishments of men and make it harder for women to be promoted.

The Department of Medicine has been a leader within the Faculty of Medicine in this area, leading studies that offer solutions to the gender gapand combat incivility in medicine, as well as hosting the annual Summit for Women in Academic Medicine.

Data collected by the Department of Medicine illustrate that women need to have more experience and qualifications to get the same evaluations or letters of reference as their male colleagues. They also show that women have fewer mentorship opportunities, a problem that could be getting worse, according to a commentary by U of T researchers in The New England Journal of Medicine.

“Being a woman definitely negatively impacts career advancement,” Dr. Hawker said, adding that proactive steps need to be taken to recruit more diverse faculty.

“We need to aim to reflect the populations we care for.”

Dr. Baxter also pointed to sexual harassment as a major issue in medicine, which often goes unreported out of fear of reprisal, and urged bystanders and allies to speak up. Department of Medicine faculty surveys indicate that nearly 70 percent of women say at one point they have experienced harassment – a figure Dr. Baxter guesses is low.

“The standard you walk past is the standard you accept,” Dr. Baxter urged. “Interrupt, confront, support, report. It needs to be done.”

“We can give people the words they can say in situations when they witness inappropriate or unprofessional behaviour,” added Dr. Straus.

Through their research, Drs. Pattani and Straus have identified solutions to address the gender gap as well as issues that lead to harassment and unprofessional behaviour in medicine. Creating formal mentorship opportunities can be a huge step in opening doors for women to advance their careers, as well as creating allies.

Among the institutional changes that can be made to combat the gender gap in academic medicine include standardizing processes for recruitment and promotions; undergoing unconscious bias training; emphasizing mentorship; proactively tracking equity and diversity and taking deliberate steps to create an inclusive workplace.

As Chair of the Department of Surgery, Dr. Rutka acknowledged that there is a long way for the department to go.

“It’s intolerable the way it is,” he said. “We are collecting data to learn more about this issue. This has been an important and major first step.”