Background: Physicians are expected to effect patient care by giving orders to members of a healthcare team. Because women are socialized to be less directive than men, the assertive behavior required of new physicians may be experienced differently by male and female residents. We sought to explore the effects of gender and year of training on residents' experiences and perceived ability to direct patient care. Methods: This was a mixed-methods, cross-sectional, descriptive study employing a quantitative written survey and qualitative interviews among internal medicine residents at an academic health center. Measurements included questionnaires and interviews about stress, assertiveness, and personal factors that influence their effectiveness in directing patient care. Analyses examined differences by gender and year of training. Results: One hundred residents were invited to participate; 65 returned questionnaires, and 16 of these residents were interviewed. Compared with male residents, female residents selected less assertive behaviors for clinical scenarios (p = 0.047) and were more likely to perceive gender as inhibiting their ability to influence patient care (p < 0.01). Stress associated with being assertive varied more with experience than gender. Interviews corroborated these findings and supported the complexity of gender norms for behavior for female residents in a directive leadership position. Conclusions: When compared with male peers, female residents reported more gender issues in residency and chose less assertive behaviors in clinical scenarios. Experience mitigated some gender differences. Our findings suggest that discussion of the existing research on prescriptive gender norms for behavior and leadership may be warranted in resident orientation.
To systematically review experimental evidence for interventions mitigating gender bias in employment. Unconscious endorsement of gender stereotypes can undermine academic medicine's commitment to gender equity.The authors performed electronic and hand searches for randomized controlled studies since 1973 of interventions that affect gender differences in evaluation of job applicants. Twenty-seven studies met all inclusion criteria. Interventions fell into three categories: application information, applicant features, and rating conditions.The studies identified gender bias as the difference in ratings or perceptions of men and women with identical qualifications. Studies reaffirmed negative bias against women being evaluated for positions traditionally or predominantly held by men (male sex-typed jobs). The assessments of male and female raters rarely differed. Interventions that provided raters with clear evidence of job-relevant competencies were effective. However, clearly competent women were rated lower than equivalent men for male sex-typed jobs unless evidence of communal qualities was also provided. A commitment to the value of credentials before review of applicants and women's presence at above 25% of the applicant pool eliminated bias against women. Two studies found unconscious resistance to "antibias" training, which could be overcome with distraction or an intervening task. Explicit employment equity policies and an attractive appearance benefited men more than women, whereas repeated employment gaps were more detrimental to men. Masculine-scented perfume favored the hiring of both sexes. Negative bias occurred against women who expressed anger or who were perceived as self-promoting.High-level evidence exists for strategies to mitigate gender bias in hiring.
In controlled studies, both men and women preferentially select men over women for leadership positions, even when credentials are identical and despite field studies demonstrating women's equivalent or slightly better leadership effectiveness. The assumption that men will make better leaders than women is attributed to the pervasive existence of unconscious stereotypes that characterize both men and leaders as agentic or action oriented and women as dependent. The Clinical and Translational Science Award (CTSA) from the National Institutes of Health (NIH) Roadmap is a novel, prestigious award that will place considerable power in the hands of one principal investigator-conditions that predict activation of bias in favor of selecting male leaders. The authors review research supporting this assertion. To mitigate the impact of this bias and broaden the pool of potential leaders for this transformative initiative, the authors offer the following suggestions. To academic health centers they suggest (1) internal search committees comprised of at least 35% women that establish a priori the desired qualities for the CTSA leader and broadly solicit applicants, (2) explicit specification of the full range of desirable skills of a CTSA leader, and (3) systematic efforts to increase awareness of the negative impact of unconscious gender bias on women's advancement. To the NIH they suggest (1) the new multiple principal investigator rule for the CTSA program, (2) a statement in the request for applications (RFA) encouraging diversity among principal investigators, (3) repetition in the RFA of the public NIH statement of the importance of work life balance for young investigators, and (4) constitution of study sections with at least 35% women.
