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    3 Comments for this article
    Intersectional thinking is not only about "minorities"
    Derya Aydin, MD | Medical Editor
    Very interesting article! Only in the Conclusions I stumbled over this sentence:
    "It is important to also intentionally study the effects of bias on individuals who hold more than one minority identity, such as black or Hispanic women."
    I warmly welcome an intersectional approach in the fight against discrimination, that looks at different kinds of "-isms" like Racism, sexism or classism and also looks on how they are connected.
    Still this sentence got it kind of wrong: Women are not in a minority, but they make up around 50% of the world's population. Same as Caucasians do not represent the
    majority of the world's population. It is not only about being in a minority, but about being in a group that is given less power or chance to speak up. This might lead to the misrepresentation of these groups, e.g. in media, and might make us feel as if they were a minority. But in fact they are not.

    Kind regards,
    Derya Aydin
    Implicit bias affects care - treatment choices, pain meds etc
    David Egilman, MD, MPH | Alpert School of Medicine
    Implicit bias affects care - treatment choices, pain meds etc. Physician gender and race differences affect treatment options offered to different genders and races. It's not all about us; it's about patients.

    Medical school admission criteria are biased against social skills and empathy. You cannot teach empathy; it takes a huge effort to impact on implicit bias and as far as I know no medical school deals with this in the 'curriculum.'
    How One Deals Personally with Gender Bias is Critical
    Thomas Hubert, Ph.D. | Patient and consumer of medical services.
    The article seems fairly to document the presence of gender bias, which exists alongside--or mixed with--other biases, as one commenter noted. The question to my mind is how to deal with it.

    The issue for my doctor daughter is at present primarily with patients--colleagues are another matter-- in a midwestern state, some of whom have trouble with seeing her as the surgeon on the case. Her strategy going forward is going to be to inform them clearly upfront that she is indeed the surgeon who will be performing the operation on their child. My thought to her was that
    that in and of itself might not be enough. How that presentation is made could be crucial, that is as to how clearly the message gets across. (And as I told her, you may have to tell them more than once.) Some folks are slow on the uptake.

    But in addition to simply stating the facts of the matter, again the way one does it is critical. Margaret Thatcher upon becoming Prime Minister, I'm told, got some voice coaching to lower her voice a few degrees when speaking publicly. Apparently it was effective.

    My bottom line point is that one has to use every ploy in the playbook and then maybe add some of your own as well. Then you, as a woman, a minority, a minority woman (whatever the case may be), then you stand a better chance of winning through and in the process serving your patients and your institution more effectively. In short, some of the burden of operating (in both senses of the word) effectively in a gender-bias environment has got to be taken on (owned) by those most affected by gender bias, without waiting for someone else to intervene, although that might be helpful too.
    CONFLICT OF INTEREST: I have a daughter in the medical field.
    Original Investigation
    Medical Education
    July 5, 2019

    Estimating Implicit and Explicit Gender Bias Among Health Care Professionals and Surgeons

    Author Affiliations
    • 1Section of Minimally Invasive Surgery, Department of Surgery, Washington University in St Louis, St Louis, Missouri
    • 2Medical student, School of Medicine, Washington University in St Louis, St Louis, Missouri
    • 3Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri
    JAMA Netw Open. 2019;2(7):e196545. doi:10.1001/jamanetworkopen.2019.6545
    Key Points español 中文 (chinese)

    Question  Do surgeons and health care professionals hold implicit or explicit biases regarding gender and career roles?

    Findings  A review of 42 991 Implicit Association Test records and a cross-sectional study of 131 surgeons provided evidence of implicit and explicit gender bias. Data suggest that health care professionals and surgeons hold implicit and explicit biases associating men with careers and surgery and women with family and family medicine.

    Meaning  This work contributes an estimate of the extent of implicit gender bias within medicine; awareness of bias, such as through an Implicit Association Test, is an important first step toward minimizing its potential effect.


    Importance  The Implicit Association Test (IAT) is a validated tool used to measure implicit biases, which are mental associations shaped by one’s environment that influence interactions with others. Direct evidence of implicit gender biases about women in medicine has yet not been reported, but existing evidence is suggestive of subtle or hidden biases that affect women in medicine.

    Objectives  To use data from IATs to assess (1) how health care professionals associate men and women with career and family and (2) how surgeons associate men and women with surgery and family medicine.

    Design, Setting, and Participants  This data review and cross-sectional study collected data from January 1, 2006, through December 31, 2017, from self-identified health care professionals taking the Gender-Career IAT hosted by Project Implicit to explore bias among self-identified health care professionals. A novel Gender-Specialty IAT was also tested at a national surgical meeting in October 2017. All health care professionals who completed the Gender-Career IAT were eligible for the first analysis. Surgeons of any age, gender, title, and country of origin at the meeting were eligible to participate in the second analysis. Data were analyzed from January 1, 2018, through March 31, 2019.

    Main Outcomes and Measures  Measure of implicit bias derived from reaction times on the IATs and a measure of explicit bias asked directly to participants.

    Results  Almost 1 million IAT records from Project Implicit were reviewed, and 131 surgeons (64.9% men; mean [SD] age, 42.3 [11.5] years) were recruited to complete the Gender-Specialty IAT. Healthcare professionals (n = 42 991; 82.0% women; mean [SD] age, 32.7 [11.8] years) held implicit (mean [SD] D score, 0.41 [0.36]; Cohen d = 1.14) and explicit (mean [SD], 1.43 [1.85]; Cohen d = 0.77) biases associating men with career and women with family. Similarly, surgeons implicitly (mean [SD] D score, 0.28 [0.37]; Cohen d = 0.76) and explicitly (men: mean [SD], 1.27 [0.39]; Cohen d = 0.93; women: mean [SD], 0.73 [0.35]; Cohen d = 0.53) associated 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. 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.

    Conclusions and Relevance  The main contribution of this work is an estimate of the extent of implicit gender bias within surgery. On both the Gender-Career IAT and the novel Gender-Specialty IAT, respondents had a tendency to associate men with career and surgery and women with family and family medicine. Awareness of the existence of implicit biases is an important first step toward minimizing their potential effect.