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From panels to posters, women confront unconscious biases in the #MeToo era
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The lengthy list of recent sexual harassment and assault allegations that spawned the recent #MeToo and #TimesUp movements spurred new conversations across disciplines, and medicine is no exception. According to an ABC News-Washington Post poll conducted in October and reported in The New England Journal of Medicine, more than half of U.S. women have experienced “unwanted and inappropriate sexual advances” at some point in their lives.
But while overt examples of harassment or assault initially grabbed the headlines, the discussion has since expanded to include a renewed focus on gender inequality and unconscious gender biases. In both academic and clinical medicine, including endocrinology, such biases remain all too common, according to experts, and those biases are often on display at medical meetings and conferences.
“We all have unconscious biases, and it’s impossible not to,” Carolyn Becker, MD, associate professor of medicine and master clinician educator in the division of endocrinology, diabetes and hypertension at Brigham and Women’s Hospital and Harvard Medical School, told Endocrine Today. “It’s hardwired into our brains from the early days of humans. It’s the way we make sense of the world, and it helps us navigate through the world. The problem is when it becomes systematic and institutionalized.”
For many clinicians and researchers attending meetings, biases abound, but they can be subtle, according to Elaine M. Pelley, MD, clinical associate professor in the division of endocrinology, diabetes and metabolism at University of Wisconsin School of Medicine and Public Health.
“No one says, ‘I’m looking for a panel of all white men,’” Pelley told Endocrine Today. “But often it’s, ‘Oh, let’s ask so-and-so to participate; he’d be great.’ And there is nothing wrong with that person, and he is a great panelist. We’re not getting bad panels this way. We’re getting unbalanced panels.”
Creating connections
Pelley said the problem stems from a systemic lack of connections for underrepresented minorities, including women.
“Event organizers tend to reach out to people they know personally or who are well known when inviting participants,” Pelley said. “If the people you know look mostly like you, that reinforces the problem of underrepresentation in terms of gender or race. If you’re not connected, then it is hard to get connected, because biases shape who gets thought of and who gets invited. Basically, you can’t become somebody until someone who is somebody knows who you are.”
Speaking at the fourth annual women’s leadership luncheon at last year’s American Association of Clinical Endocrinologists Annual Scientific and Clinical Congress in May, Ann Danoff, MD, steering committee chair of the upcoming Endocrine Society Annual Meeting, said there has been progress in the number of women entering medical school; 72% of endocrine trainees are now women. Yet, many women across specialties often have a shared experience of feeling disenfranchised, she said.
It is an issue she has worked to address at this year’s ENDO meeting, taking place March 17-20 in Chicago.
“It’s important for attendees to be mindful ... that we do all carry unconscious bias with us, and to ask people to try to be mindful of that as they attend this meeting,” Danoff, chief of medical service at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia, told Endocrine Today. “Lots of women are endocrinologists. As they’re reviewing abstracts and looking at posters and hearing talks, is any of it being filtered through any sort of unconscious gender or underrepresented minority bias? With panels, are people calling the women on the panels by their first names and the men by their last names? We have a lot of work to do still.”
Subtle differences in language and behavior when addressing men vs. women persist on the medical conference circuit, Becker said.
“A woman will give a talk, and then there is a question-and-answer period, and a male from the audience will get up and say, ‘That was a lovely presentation,’” Becker said. “When it’s a man presenting, it’s ‘That was brilliant.’
“When people are getting up and asking questions, there are many more men rather than women asking those questions,” Becker said. “If you’re the only women participating on a panel and all men are getting up, it sets the woman at a disadvantage. It sounds like little things, but it is off-putting. I’m not saying that happens all the time, but it is still happening.”
For some, child care responsibilities, which still tend to disproportionately fall on women, can complicate the ability to commit to even attending a conference, Pelley said, setting the stage for gender imbalance.
“There’s an aspect of women being more likely to say no, even when they are asked to present or come to a conference,” Pelley said. “I recently read about one conference that started providing child care, and suddenly, they had more women investigators attending.
“Our strong drive to separate our personal selves from our professional selves has tended to make everyone feel that issues such as caregiving responsibilities are irrelevant to this discussion, Pelley said. “But, it may be shaping who is able to travel to these events. If you can’t travel, you can’t meet people, and you can’t start making a name for yourself. No one comes to your office and says, ‘Hey, do you want to be involved in national initiatives?’ You have to go.”
Creating awareness
Becker said it is important for meeting attendees to be aware that biases exist not only in research and clinical practice, but in the way meetings are run.
“I often do a thought experiment when at a conference,” Becker said. “I’ll think, ‘How would this feel for me if I were a person of color in this situation?’ It’s good for people to try to empathize with people different from themselves and recognize that areas that are not comfortable for them are perhaps inherently biased, and just be aware of it.”
Pelley agreed.
“When attendees look at a poster or attend a presentation from someone who fits a certain demographic, a good test is to try to force yourself to imagine what you might have thought if that poster or presentation came from someone who was of a different demographic,” Pelley said. “Everyone can benefit from reflecting as to whether the fact that something came out of the mouth of an older, white man is somehow, unconsciously, making them give it more credibility than something from someone who is less stereotypically authoritative in our culture.”
“You can’t change things until you recognize them,” Becker said. “If you are a moderator and someone on the panel is interrupting or cutting off anyone, it’s your job as a moderator to say, ‘No, that’s not OK.’ We all have to take responsibility.”
Another complicating factor lies in some of the research data presented at meetings, Becker said. Despite concerted efforts to recruit minority populations, including women, for drug trials and clinical studies, large disparities remain.
“When looking at a research abstract or hearing an oral presentation or poster, ask yourself, ‘What is the population here?’” Becker said. “How generalizable is this to other genders, races, etc? So much of our research is done on whites.”
Even with efforts to recognize biases in research and medicine, changing mindsets can be difficult, according to Becker, which is why it is important to start with changing behaviors.
“It’s always put back on the woman to learn how to negotiate better, to learn how to speak up, to learn how to do this or that,” Becker said. “I’m tired of that. I think some of that is needed, but it’s up to the men to start looking beyond themselves and start realizing that we need everyone to be included and heard.
“Part of why we have universal guidelines, starting with HIV treatment and now with how you screen for things, is so that everyone is treated equally,” Becker said. “Even if we can’t change people’s underlying assumptions, we can say, ‘You must leave those at the door.’ When presenting research, you must treat everyone with respect and without judgment. If we focus on behavior, maybe, over time, we can start affecting the hard wiring that we all carry with us.” – by Regina Schaffer
Reference:
Jagsi R. N Engl J Med. 2018;doi:10.1056/NEJMp1715962.
For more information:
Carolyn Becker, MD, can be reached at cbbecker@partners.org.
Ann Danoff, MD, can be reached at ann.danoff@va.gov.
Elaine M. Pelley, MD, can be reached at emp@medicine.wisc.edu.
Disclosures: Becker, Danoff and Pelley report no relevant financial disclosures.