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• W2912641884 abstract "Women's representation in science and medicine has slowly increased over the past few decades. However, this rise in numbers of women, or gender diversity, has not been matched by a rise in gender inclusion. Despite increasing representation, women still encounter bias and discrimination when compared with men in these fields across a variety of outcomes, including treatment at school and work, hiring, compensation, evaluation, and promotion. Individual and systemic biases create unwelcome environments for women, particularly for those who additionally identify with other traditionally devalued groups (eg, women of colour). This Review draws on several decades of research in the field of management and its cognate disciplines to identify five myths that continue to perpetuate gender bias and five strategies for improving not only the number of women in medicine, but also their lived experiences, capacity to aspire, and opportunity to succeed. We argue for a move away from a singular focus on interventions aimed at targeting individual attitudes and behaviour to more comprehensive interventions that address structural and systemic changes. Women's representation in science and medicine has slowly increased over the past few decades. However, this rise in numbers of women, or gender diversity, has not been matched by a rise in gender inclusion. Despite increasing representation, women still encounter bias and discrimination when compared with men in these fields across a variety of outcomes, including treatment at school and work, hiring, compensation, evaluation, and promotion. Individual and systemic biases create unwelcome environments for women, particularly for those who additionally identify with other traditionally devalued groups (eg, women of colour). This Review draws on several decades of research in the field of management and its cognate disciplines to identify five myths that continue to perpetuate gender bias and five strategies for improving not only the number of women in medicine, but also their lived experiences, capacity to aspire, and opportunity to succeed. We argue for a move away from a singular focus on interventions aimed at targeting individual attitudes and behaviour to more comprehensive interventions that address structural and systemic changes. The year 2017 marked the first time in history when the number of women enrolling in US medical schools exceeded the number of men.1Association of American Medical CollegesMore women than men enrolled in U.S. medical schools in 2017.https://news.aamc.org/press-releases/article/applicant-enrollment-2017/Date: Dec 18, 2017Date accessed: September 14, 2018Google Scholar When this historic cohort of female medical students enters the workforce, what kind of work environment will they encounter? Despite the record numbers of women entering fields across science, technology, engineering, mathematics (STEM), and medicine,2Bowley R A snapshot of progress among women in the workforce.https://blog.linkedin.com/2018/march/6/a-snapshot-of-progress-among-women-in-the-workforceDate: March 6, 2018Date accessed: September 14, 2018Google Scholar women continue to experience disadvantage, discrimination, and gender-based violence in their home and work lives,3Bohnet I What works: gender equality by design. The Belknap Press of Harvard University Press, Cambridge, MA2016Crossref Google Scholar, 4Eagly AH Carli LL Through the labyrinth: the truth about how women become leaders. Harvard Business Review Press, Boston, MA2007Google Scholar, 5Heilman ME Gender stereotypes and workplace bias.Res Organ Behav. 2012; 32: 113-135Crossref Scopus (582) Google Scholar, 6Parker K Funk C Gender discrimination comes in many forms for today's working women.http://www.pewresearch.org/fact-tank/2017/12/14/gender-discrimination-comes-in-many-forms-for-todays-working-women/Date: Dec 14, 2017Date accessed: September 14, 2018Google Scholar, 7WHOViolence against women.http://www.who.int/news-room/fact-sheets/detail/violence-against-womenDate: Nov 29, 2017Date accessed: September 14, 2018Google Scholar, 8World BankWomen, business and the law 2018. World Bank Group, Washington, DC2018Crossref Google Scholar, 9UN WomenDiscrimination against women persists around the globe hampering development.http://www.unwomen.org/en/news/stories/2012/7/discrimination-against-women-persists-around-the-globe-hampering-developmentDate: July 5, 2012Date accessed: November 16, 2018Google Scholar a reality that is too often amplified for women of colour, of low socioeconomic status and social class, and of advanced age, and women who do not identify as heterosexual, are disabled, or belong to other traditionally devalued groups.10Dasgupta N Stout JG Girls and women in science, technology, engineering, and mathematics: STEMing the tide and broadening participation in STEM careers.Policy Insights Behav Brain Sci. 2014; 1: 21-29Crossref Scopus (256) Google Scholar, 11Duncan C Loretto W Never the right age? Gender and age-based discrimination in employment.Gend Work Organ. 2004; 11: 95-115Crossref Scopus (294) Google Scholar, 12Hunter ML “If you're light you're alright”: light skin color as social capital for women of color.Gend Soc. 2002; 16: 175-193Google Scholar, 13Ortiz SY Roscigno VJ Discrimination, women, and work: processes and variations by race and class.Sociol Q. 2009; 50: 336-359Crossref Scopus (57) Google Scholar, 14Sanchez-Hucles JV Davis DD Women and women of color in leadership: complexity, identity, and intersectionality.Am Psychol. 2010; 65: 171-181Crossref PubMed Scopus (196) Google Scholar, 15Shields SA Gender: an intersectionality perspective.Sex Roles. 2008; 59: 301-311Crossref Scopus (872) Google Scholar, 16Williams JC Multhaup M Mihaylo S Why companies should add class to their diversity discussions.https://hbr.org/2018/09/why-companies-should-add-class-to-their-diversity-discussionsDate: Sept 5, 2018Date accessed: September 18, 2018Google Scholar In medicine, these inequities manifest for women as everyday experiences of sexism, which includes exposure to sexist jokes in class; sexual harassment by clinicians, faculty, or patients; weaker reference letters than men for medical school faculty applications; lower income than men; channelling into lower paid areas of medicine such as family practice; and a decreased likelihood of being addressed by one's professional title than men.17Beagan B Micro inequities and everyday inequalities: ‘race,’ gender, sexuality and class in medical school.Can J Sociol. 2001; 26: 583-610Crossref Scopus (48) Google Scholar, 18Files JA Mayer AP Ko MG et al.Speaker introductions at internal medicine grand rounds: forms of address reveal gender bias.J Womens Health (Larchmt). 2017; 26: 413-419Crossref PubMed Scopus (157) Google Scholar, 19Glauser W Why are women still earning less than men in medicine?.CMAJ. 2018; 190: E664-E665Crossref PubMed Scopus (4) Google Scholar, 20Sanfey H Crandall M Shaughnessy E et al.Strategies for identifying and closing the gender salary gap in surgery.J Am Coll Surg. 2017; 225: 333-338Summary Full Text Full Text PDF PubMed Scopus (38) Google Scholar, 21Trix F Psenka C Exploring the color of glass: letters of recommendation for female and male medical faculty.Discourse Soc. 2003; 14: 191-220Crossref Scopus (314) Google Scholar, 22Williams J Phillips KW Hall EV Double jeopardy? Gender bias against women of color in science.https://worklifelaw.org/publications/Double-Jeopardy-Report_v6_full_web-sm.pdfDate: Jan, 2014Date accessed: November 1, 2018Google Scholar While we may be making progress on the numbers—an increase in gender diversity—true progress on improving women's sense of belonging and inclusion is critically lagging. The disconnect between diversity and inclusion is not unique to medicine. This inability to see the problem as beyond merely the number of women in the field occurs in a wide variety of academic and professional domains.23Nishii LH The benefits of climate for inclusion for gender-diverse groups.Acad Manage J. 2012; 56: 1754-1774Crossref Scopus (503) Google Scholar, 24Roberson QM Disentangling the meanings of diversity and inclusion in organizations.Group Organ Manag. 2006; 31: 212-236Crossref Scopus (439) Google Scholar, 25Shore LM Randel AE Chung BG Dean MA Holcombe Ehrhart K Singh G Inclusion and diversity in work groups: a review and model for future research.J Manage. 2011; 37: 1262-1289Crossref Scopus (776) Google Scholar, 26Tienda M Diversity ≠ inclusion: promoting integration in higher education.Educ Res. 2013; 42: 467-475Crossref PubMed Scopus (89) Google Scholar In this Review, we offer insights from decades of research on diversity and inclusion in the fields of management and its cognate disciplines, including psychology, sociology, and economics, to propose suggestions for improving not only the number of women in medicine, but also their lived experiences, capacity to aspire, and opportunity to succeed. We acknowledge that most of this work has been done in Europe and North America and therefore might not be generalisable to all contexts. Moreover, any effective intervention would have to be tailored not only to country cultures and laws, but also to the specific organisations and departments in which these interventions are being made. Thus, the solutions proposed here should not be viewed as general fixed principles, but rather as a starting point for making more localised change. We start by debunking five myths that are commonly encountered when examining diversity and inclusion practices, and conclude by offering five research-supported solutions to bring about equity by design, an approach that we argue is particularly well suited to the medical field. Diversity and inclusion policies and practice are becoming nearly ubiquitous in organisational settings. Finding an organisation or institution without a written statement outlining their commitment to diversity is now rare, and billions of dollars each year are used in the efforts to increase the representation of women and minorities.27Kaiser CR Major B Jurcevic I Dover TL Brady LM Shapiro JR Presumed fair: ironic effects of organizational diversity structures.J Pers Soc Psychol. 2013; 104: 504-519Crossref PubMed Scopus (208) Google Scholar, 28Kang SK DeCelles KA Tilcsik A Jun S Whitened résumés: race and self-presentation in the labor market.Adm Sci Q. 2016; 61: 469-502Crossref Scopus (190) Google Scholar To create lasting change and to prevent the current focus on diversity and inclusion from becoming another ineffectual trend in management, it is important to ensure that efforts are evidence-based and do not rely on common myths that might instead perpetuate the problems they are trying to solve. The five myths uncovered in this Review are not mutually exclusive—often being intertwined or potentially conflicting—but represent the most common (albeit inaccurate) assumptions people make about achieving diversity and inclusion. The first myth that should be debunked is the idea that bias is a problem unique to only a few individuals: namely the racists, sexists, and bigots among us.29Chugh D The person you mean to be: confronting bias to build a better workplace and world.1st edn. Harper Business, New York, NY2018Google Scholar However, research on the human brain and how it makes sense of the world suggests not only that all of us are biased, but that we must be biased to survive.30Macrae CN Milne AB Bodenhausen GV Stereotypes as energy-saving devices: a peek inside the cognitive toolbox.J Pers Soc Psychol. 1994; 66: 37-47Crossref Scopus (685) Google Scholar, 31Macrae CN Bodenhausen GV Social cognition: thinking categorically about others.Annu Rev Psychol. 2000; 51: 93-120Crossref PubMed Scopus (877) Google Scholar Cognitive biases and heuristics are shortcuts that allow us to interact meaningfully with people, objects, and tasks without having to exhaust our insufficient attentional resources to decipher every sensory signal.32Fiske ST Lin M Neuberg SL The continuum model: ten years later.in: Chaiken S Trope Y Dual-process theories in social psychology. Guilford Press, New York, NY1999: 231-254Google Scholar, 33Macrae CN Bodenhausen GV Social cognition: categorical person perception.Br J Psychol. 2001; 92: 239-255Crossref Scopus (187) Google Scholar Whenever you encounter a person, for example, your brain rapidly engages in a series of calculations to interpret that person's relevance to you by placing them within a social category.32Fiske ST Lin M Neuberg SL The continuum model: ten years later.in: Chaiken S Trope Y Dual-process theories in social psychology. Guilford Press, New York, NY1999: 231-254Google Scholar The first automatic calculations regard age, race, and gender.34Brewer MB Lui LN The primacy of age and sex in the structure of person categories.Soc Cogn. 1989; 7: 262-274Crossref Google Scholar, 35Ridgeway CL Framed before we know it: how gender shapes social relations.Gend Soc. 2009; 23: 145-160Crossref Scopus (433) Google Scholar, 36Schneider DJ The psychology of stereotyping. Guilford Press, New York, NY2004Google Scholar Because of this perceptual primacy, gender has come to frame the way we see the world; it is an implicit or unconscious bias that serves as a foundation upon which stereotypes, expectations, and norms have been created.37Greenwald AG Banaji MR Implicit social cognition: attitudes, self-esteem, and stereotypes.Psychol Rev. 1995; 102: 4-27Crossref PubMed Scopus (3868) Google Scholar Social categorisation is an inevitable part of our perceptual experience, such that the stereotypes we hold about different social groups will alter our perceptions of, and reactions to, individual group members.33Macrae CN Bodenhausen GV Social cognition: categorical person perception.Br J Psychol. 2001; 92: 239-255Crossref Scopus (187) Google Scholar Further, when it comes to devaluing women's contributions in masculinised settings, women can be just as biased as men, meaning that people of all gender identities can perpetuate gender bias in organisations.5Heilman ME Gender stereotypes and workplace bias.Res Organ Behav. 2012; 32: 113-135Crossref Scopus (582) Google Scholar, 38Ellemers N Rink F Derks B Ryan MK Women in high places: when and why promoting women into top positions can harm them individually or as a group (and how to prevent this).Res Organ Behav. 2012; 32: 163-187Crossref Scopus (105) Google Scholar Rejecting the idea that only some people are biased is a crucial first step to personally engaging with the problem of discrimination so as to bring about change. Most of the efforts made to minimise bias in organisations has focused on controlling or eradicating the biases that exist in our minds. Implicit bias training is an example of such efforts. Testing for implicit bias via the Implicit Association Test (IAT)39Greenwald AG McGhee DE Schwartz JL Measuring individual differences in implicit cognition: the implicit association test.J Pers Soc Psychol. 1998; 74: 1464-1480Crossref PubMed Scopus (7323) Google Scholar has become commonplace, and has risen in popularity along with implicit bias or diversity training. Despite the millions of dollars spent on administering the IAT and training people to act without bias, the evidence that this kind of training actually changes organisational outcomes is scarce.40Oswald FL Mitchell G Blanton H Jaccard J Tetlock PE Predicting ethnic and racial discrimination: a meta-analysis of IAT criterion studies.J Pers Soc Psychol. 2013; 105: 171-192Crossref PubMed Scopus (443) Google Scholar, 41Singal J Psychology's favorite tool for measuring racism isn't up to the job.https://www.thecut.com/2017/01/psychologys-racism-measuring-tool-isnt-up-to-the-job.htmlDate: Jan 11, 2017Date accessed: September 22, 2018Google Scholar More commonly, diversity training (especially when done alone and not in combination with other organisational interventions) has produced a host of unintended consequences.42Dobbin F Kalev A Why diversity programs fail.https://hbr.org/2016/07/why-diversity-programs-failDate: July 1, 2016Date accessed: September 22, 2018Google Scholar It has been shown to be associated with reduced diversity,43Kalev A Dobbin F Kelly E Best practices or best guesses? Assessing the efficacy of corporate affirmative action and diversity policies.Am Sociol Rev. 2006; 71: 589-617Crossref Scopus (1123) Google Scholar worsened behaviour toward minority co-workers,44Sanchez JI Medkik N The effects of diversity awareness training on differential treatment.Group Organ Manag. 2004; 29: 517-536Crossref Scopus (63) Google Scholar and the creation of the illusion of fairness such that those who claim to have experienced discrimination are less likely to be believed.27Kaiser CR Major B Jurcevic I Dover TL Brady LM Shapiro JR Presumed fair: ironic effects of organizational diversity structures.J Pers Soc Psychol. 2013; 104: 504-519Crossref PubMed Scopus (208) Google Scholar Instructing people to avoid the use of stereotypes can paradoxically lead to increased activation of those stereotypes,45Macrae CN Bodenhausen GV Milne AB Jetten J Out of mind but back in sight: stereotypes on the rebound.J Pers Soc Psychol. 1994; 67: 808-817Crossref Scopus (627) Google Scholar and attempts to increase the awareness of stereotype prevalence can inadvertently normalise stereotyping and discrimination (such as, if everyone uses stereotypes it must be okay).46Duguid MM Thomas-Hunt MC Condoning stereotyping? How awareness of stereotyping prevalence impacts expression of stereotypes.J Appl Psychol. 2015; 100: 343-359Crossref PubMed Scopus (123) Google Scholar Eradicating these innate human biases is difficult and likely to be impossible. Although educating people about these biases and providing education on how to recognise them is an important first step, we must go further to create systems and environments in which bias and stereotyping are either less likely to become initiated, or are prevented from resulting in discrimination even when they are active. The representation of women across a variety of STEM fields and within medicine has been slowly increasing, albeit at different rates within these fields and across nations.47Hill C Corbett C St Rose A Why so few? Women in science, technology, engineering, and mathematics.https://eric.ed.gov/?id=ED509653Date: 2010Date accessed: September 22, 2018Google Scholar, 48Miller DI Eagly AH Linn MC Women's representation in science predicts national gender-science stereotypes: evidence from 66 nations.J Educ Psychol. 2015; 107: 631-644Crossref Scopus (244) Google Scholar If we look to the research on child development and psychology, girls perform to an equal or better standard than boys in STEM topics, and report high interest in pursuing careers in STEM.49Halpern DF Benbow CP Geary DC Gur RC Hyde JS Gernsbacher MA The science of sex differences in science and mathematics.Psychol Sci Public Interest. 2007; 8: 1-51Crossref PubMed Scopus (646) Google Scholar, 50Hyde JS Lindberg SM Linn MC Ellis AB Williams CC Gender similarities characterize math performance.Science. 2008; 321: 494-495Crossref PubMed Scopus (595) Google Scholar, 51Pomerantz EM Altermatt ER Saxon JL Making the grade but feeling distressed: gender differences in academic performance and internal distress.J Educ Psychol. 2002; 94: 396-404Crossref Scopus (303) Google Scholar, 52Spelke ES Sex differences in intrinsic aptitude for mathematics and science?: a critical review.Am Psychol. 2005; 60: 950-958Crossref PubMed Scopus (440) Google Scholar Therefore, the pipeline of female trainees and candidates itself is healthy. The real problem is brought about by the pressures that push women out of the pipeline.18Files JA Mayer AP Ko MG et al.Speaker introductions at internal medicine grand rounds: forms of address reveal gender bias.J Womens Health (Larchmt). 2017; 26: 413-419Crossref PubMed Scopus (157) Google Scholar, 20Sanfey H Crandall M Shaughnessy E et al.Strategies for identifying and closing the gender salary gap in surgery.J Am Coll Surg. 2017; 225: 333-338Summary Full Text Full Text PDF PubMed Scopus (38) Google Scholar, 21Trix F Psenka C Exploring the color of glass: letters of recommendation for female and male medical faculty.Discourse Soc. 2003; 14: 191-220Crossref Scopus (314) Google Scholar, 53Carnes M Bartels CM Kaatz A Kolehmainen C Why is John more likely to become department chair than Jennifer?.Trans Am Clin Climatol Assoc. 2015; 126: 197-214PubMed Google Scholar, 54Hall W Schmader T Aday A Croft E Decoding the dynamics of social identity threat in the workplace: a within-person analysis of women's and men's interactions in STEM.Soc Psychol Personal Sci. 2018; (published online May 2.)DOI:10.1177/1948550618772582Crossref Scopus (27) Google Scholar, 55Hall W Schmader T Aday A Inness M Croft E Climate control: the relationship between social identity threat and cues to an identity-safe culture.J Pers Soc Psychol. 2018; 115: 446-467Crossref PubMed Scopus (33) Google Scholar, 56Moss-Racusin CA Dovidio JF Brescoll VL Graham MJ Handelsman J Science faculty's subtle gender biases favor male students.Proc Natl Acad Sci USA. 2012; 109: 16474-16479Crossref PubMed Scopus (1765) Google Scholar, 57Shapiro JR Williams AM The role of stereotype threats in undermining girls' and women's performance and interest in STEM fields.Sex Roles. 2012; 66: 175-183Crossref Scopus (264) Google Scholar, 58Steinpreis RE Anders KA Ritzke D The impact of gender on the review of the curricula vitae of job applicants and tenure candidates: a national empirical study.Sex Roles. 1999; 41: 509-528Crossref Scopus (475) Google Scholar Research shows that discrimination exists against women at each stage of professional life, from recruitment and selection, to recommendation, evaluation, promotion, training, and compensation.3Bohnet I What works: gender equality by design. 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One of the most commonly cited explanations that people provide for rejecting diversity initiatives is that their organisations are meritocratic.78Thomas KM Mack DA Montagliani A The arguments against diversity: are they valid?.in: Stockdale MS Crosby FJ The psychology and management of workplace diversity. Blackwell Publishing, Malden, MA2004: 31-51Google Scholar The arguments are that if women were equally qualified, they would be hired and promoted, and that any diversity initiatives aimed at righting the imbalance would compromise quality. 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• W2912641884 title "Working toward gender diversity and inclusion in medicine: myths and solutions" @default.
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