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• W2912183952 abstract "A woman physician meets with the department chairperson and colleagues to discuss her project ideas. The group agrees that they have transformative potential. The chairperson says to her in front of the group, “With your looks and my brain, we'll be a great team.” Unable to muster a response to him, she laughs uncomfortably and changes the subject. Several weeks later, the physician presents a patient case at medical rounds. A new colleague mistakes her for a medical student and after realizing the mistake comments, “As a woman, you should be grateful to look so young!” As the physician's career progresses, she finds herself questioning her ability to lead projects and defers applying for career opportunities because she feels underqualified. This case vignette highlights an example of gender bias. While versions of these encounters have played out across the globe with growing attention to overt gender bias in the workplace, the more subtle forms of bias—the micro-inequities—are equally important to identify and correct to support women's advancement in medicine. Unconscious, or implicit, biases are stereotypes or associations outside of conscious awareness that may lead to a negative evaluation of a person on the basis of irrelevant characteristics, such as gender or race.1FitzGerald C Hurst S Implicit bias in healthcare professionals: a systematic review.BMC Med Ethics. 2017; 18: 19Crossref PubMed Scopus (868) Google Scholar Research demonstrates that health care professionals exhibit similar levels of unconscious associations—both positive and negative—as the wider population, and that these biases may influence the quality of care administered.1FitzGerald C Hurst S Implicit bias in healthcare professionals: a systematic review.BMC Med Ethics. 2017; 18: 19Crossref PubMed Scopus (868) Google Scholar, 2Dehon E Weiss N Jones J Faulconer W Hinton E Sterling S A systematic review of the impact of physician implicit racial bias on clinical decision making.Acad Emerg Med. 2017; 24: 895-904Crossref PubMed Scopus (181) Google Scholar Unconscious bias becomes entrenched in hierarchies of training and clinical practice, insidiously takes root in the workplace, and creates a culture of disadvantage for women in academic medicine. Evidence suggests that unconscious bias regarding gender and race impacts both medical school admissions and workforce recruitment and retention.3Johnson TJ Ellison AM Dalembert G et al.Implicit bias in pediatric academic medicine.J Natl Med Assoc. 2017; 109: 156-163Crossref PubMed Scopus (35) Google Scholar Gender bias is particularly salient when women apply for positions historically occupied by men, and they experience negative stereotypes in the hiring process;4Isaac C Lee B Carnes M Interventions that affect gender bias in hiring: a systematic review.Acad Med. 2009; 84: 1440-1446Crossref PubMed Scopus (133) Google Scholar such biases may contribute to gender-discordant leadership and hinder women's success. Inequities—differences that are systemic, avoidable, and unjust—rise from unconscious biases related to gender, age, race, ethnicity, religion, class, occupation, and sexual orientation and identity, which may be intertwined and difficult to separate. There is robust literature on gender inequities in academic medicine,5Westring A McDonald JM Carr P Grisso JA An integrated framework for gender equity in academic medicine.Acad Med. 2016; 91: 1041-1044Crossref PubMed Scopus (62) Google Scholar, 6Bates C Gordon L Travis E et al.Striving for gender equity in academic medicine careers: a call to action.Acad Med. 2016; 91: 1050-1052Crossref PubMed Scopus (117) Google Scholar, 7Rochon PA Davidoff F Levinson W Women in academic medicine leadership: has anything changed in 25 years?.Acad Med. 2016; 91: 1053-1056Crossref PubMed Scopus (100) Google Scholar and is primarily focused on macro-inequities—often structural or systemic in nature—such as gender-discordant leadership, unequal compensation, or lack of flexibility for care-giving responsibilities outside of work. One striking example is the salary gap between women and men physicians in US public medical schools, even accounting for age, experience, specialty, faculty rank, research productivity, and clinical revenue.8Jena AB Olenski AR Blumenthal DM Sex differences in physician salary in US public medical schools.JAMA Intern Med. 2016; 176: 1294-1304Crossref PubMed Scopus (399) Google Scholar Less obvious, but equally important, is how micro-inequities influence academic culture and women's career trajectories. Micro-inequities are small events that are often ephemeral, hard to prove, covert, unintentional, frequently unrecognized by the perpetrator, and occur wherever people are perceived to be “different.”9Rowe M Micro-affirmations and micro-inequities.J Int Ombudsman Assoc. 2008; 1: 45-48Google Scholar Similarly, micro-aggressions, often applied to racial inequities, are brief and commonplace verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative attitudes toward people of color.10Sue DW Capodilupo CM Torino GC et al.Racial microaggressions in everyday life: implications for clinical practice.Am Psychol. 2007; 62: 271-286Crossref PubMed Scopus (2666) Google Scholar When micro-inequities and micro-aggressions infiltrate a workplace, they negatively affect how people perceive their potential to thrive at work. Research has shown that women's performance on math tests decreases when they are reminded of their gender.11Spencer SJ Steele CM Quinn DM Sterotype threat and women's math performance.J Exp Soc Psycho. 1999; 35: 4-28Crossref Scopus (2044) Google Scholar Women in academic medicine reported greater vulnerability to negative stereotypes, more sensitivity to rejection, and more recognition of their gender than male counterparts.12Fassiotto M Hamel EO Ku M et al.Women in academic medicine: measuring stereotype threat among junior faculty.J Womens Health. 2016; 25: 292-298Crossref PubMed Scopus (47) Google Scholar In regard to inclusion within academic departments, women reported lower relative potential compared with colleagues, and lower sense of belonging than men.12Fassiotto M Hamel EO Ku M et al.Women in academic medicine: measuring stereotype threat among junior faculty.J Womens Health. 2016; 25: 292-298Crossref PubMed Scopus (47) Google Scholar First steps are to recognize when these micro-inequities and micro-aggressions occur, name them, and hold people accountable. The subtle everyday norms and practices within the workplace make it difficult to name gender bias explicitly.13Soklaridis S Kuper A Whitehead CR Ferguson G Taylor VH Zahn C Gender bias in hospital leadership: a qualitative study on the experiences of women CEOs.J Health Organ Manag. 2017; 31: 253-268Crossref PubMed Scopus (16) Google Scholar We may fail to address micro-inequities out of fear of repercussions, lack of understanding, or acceptance of them as workplace norms. Furthermore, it can be challenging for both targeted individuals and bystanders to find appropriate language to respond to micro-aggressions in the moment. Building awareness of unconscious bias and micro-inequities sensitizes all individuals—recipients, allies and bystanders—to the power of spoken and unspoken language in our daily interactions. Case-based unconscious bias trainings address underlying micro-inequities, potential impact on both the recipient and workplace, and solutions.14Cornell UniversityDiversity training tackles unconscious bias and micro-inequities.http://adi.cornell.edu/2015/04/30/diversity-training-tackles-unconscious-bias-and-micro-inequities/Date: 2015Date accessed: February 24, 2018Google Scholar In addition to identifying micro-inequities, trainings should focus on activating cognitive “system 2” reactions (slower, deliberative, controlled thinking) in response to micro-inequities and overcoming cognitive “system 1” reactions (rapid, intuitive, impulsive, and error-prone thinking), so that people can catch themselves prior to or immediately after a micro-inequity occurs.15Kanheman D Thinking Fast and Slow. Farrar, Straus and Giroux, New York2013Google Scholar A cluster randomized-controlled trial demonstrated that a workshop on gender bias awareness within an academic department resulted in faculty reporting improvement in gender-equity-promoting behaviors, greater perception of fit and value, and comfort in raising personal and professional conflicts.16Carnes M Devine PG Baier Manwell L et al.The effect of an intervention to break the gender bias habit for faculty at one institution: a cluster randomized, controlled trial.Acad Med. 2015; 90: 221-230Crossref PubMed Scopus (325) Google Scholar However, efforts should be sustained throughout the department or institution and at every aspect of the employment life cycle, such as staff orientations, annual meetings, and leadership trainings.17Ross H Diversity best practices: proven strategies for addressing unconscious bias in the workplace.https://www.cookross.com/docs/UnconsciousBias.pdfDate: 2008Date accessed: February 10, 2019Google Scholar In addition to identifying micro-inequities, another solution is to transform workplace culture through micro-affirmations, defined as small acts, which are often ephemeral and hard-to-see, often unconscious efforts to help others succeed.9Rowe M Micro-affirmations and micro-inequities.J Int Ombudsman Assoc. 2008; 1: 45-48Google Scholar Micro-affirmations recognize and validate individuals in ways that empower them to thrive in an environment where they may feel marginalized.9Rowe M Micro-affirmations and micro-inequities.J Int Ombudsman Assoc. 2008; 1: 45-48Google Scholar When applied in the workplace, micro-affirmations foster inclusion and support for people who may feel unwelcome or invisible.18Powell C Demetriou C Fisher A Micro-affirmations in academic advising: small acts, big impact.https://dus.psu.edu/mentor/2013/10/839/Date: 2013Date accessed: February 10, 2019Google Scholar When micro-affirmations become frequent, intentional practices, they communicate to others that they are welcome, visible, and capable of performing.18Powell C Demetriou C Fisher A Micro-affirmations in academic advising: small acts, big impact.https://dus.psu.edu/mentor/2013/10/839/Date: 2013Date accessed: February 10, 2019Google Scholar When academic culture improves, everyone benefits; however, groups with less power, such as women and people of color, gain the most in relation to inclusion and advancement.19Pololi LH Civian JT Brennan RT Dottolo AL Krupat E Experiencing the culture of academic medicine: gender matters, a national study.J Gen Intern Med. 2013; 28: 201-207Crossref PubMed Scopus (184) Google Scholar Cumulative micro-affirmations have the potential to foster individual and collective growth and allow everyone to thrive. Examples of micro-affirmations include:9Rowe M Micro-affirmations and micro-inequities.J Int Ombudsman Assoc. 2008; 1: 45-48Google Scholar•Appreciative inquiry: “What is something you are working on that you are excited about?”•Recognition and validation of experiences and feelings: “I know that not getting the grant is a disappointment or having a patient complication is challenging.”•Reinforcing and rewarding positive behaviors: “Congratulations on your publication!” Departments can develop academic incentive plans to reward faculty members for teaching, administrative, and research productivity.•Intentional inclusion in professional settings (meetings, conferences, presentations) and information networks: “There is an upcoming prestigious meeting that I think you should attend. I'll forward your name to the organizers.”•Introducing team members by name and role: “This is Dr. _____, a resident working on your care team.”•Diverse representation in public spaces: departments or institutions can ensure that portraits of successful women and people of color are displayed in meeting spaces. In addition, critical actors—individuals who lead workplace culture transformation through role modeling and encouraging others to advance gender equity—are pivotal to spreading and sustaining micro-affirmations.20Helitzer DL Newbill SL Cardinali G Morahan PS Chang S Magrane D Changing the culture of academic medicine: critical mass or critical actors?.J Womens Health. 2017; 26: 540-548Crossref Scopus (45) Google Scholar The case vignette demonstrates the power of gender-based micro-inequities to prevent women from achieving their full potential by eroding their self-confidence at work. As a call to action, recipients and bystanders of gender micro-inequities need to identify when they occur, make the underlying biases explicit, and take a stand against the inappropriate nature of these micro-inequities. Everyone is responsible for holding each other accountable to ensure gender-equitable communication and action. Further, all members in the workplace should strive to make micro-affirmations an intentional practice. Only then will we begin to dissolve deeply-rooted gender biases entrenched in academic medicine and create a culture of optimal engagement and performance for all." @default.
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• W2912183952 title "Creating a Culture of Micro-Affirmations to Overcome Gender-Based Micro-Inequities in Academic Medicine" @default.
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