Overcoming gender inequity in medicine

Well aware of gender imbalance in teaching and leadership positions in medicine, Dr. Tina Mele is collaborating on research initiatives to define clear strategies for equitable sponsorship, participation and access to career advancement opportunities

By Alexandra Burza, MMJC’19

GenderEquality_880x300.jpgA research study of critical care training programs in Canada revealed that, on average, for every four critical care teaching faculty who are men, there is one woman teaching in the speciality.

As part of that 20 per cent, Dr. Tina Mele, Associate Professor, Surgery, says the low representation of women teaching in her specialty can have a cyclical impact on the next generation of woman-identifying learners.

“It’s critical for trainees, whether it’s medical students or residents, to see women doing well and succeeding in their chosen role. It signals to them that this is something they can achieve,” Mele said.

Mele grew interested in conducting research to back up what she knew to be anecdotally true from her own experiences and those of her colleagues. A member of the Canadian Association of General Surgeons – Equity and Diversity (EDI) committee, as well as the Canadian Women in Surgery Committee, she has taken part in conversations with woman-identifying surgeons across the country to identify the inequities they face.

Those conversations revealed institutional barriers, as well as personal and professional challenges that women in this speciality face, which impact career advancement and leadership opportunities.

“As I embarked on my academic career, I became more cognizant of the disparities and differences in the way women and men are promoted, and the criteria that are used,” she said, citing research published in Nature, which demonstrates women may need more high-impact research publications than their male counterparts to be promoted to the same level.

“This gender disparity certainly affects women in their academic career opportunities for leadership and promotion. That’s why it’s also important for them to have strong mentors and sponsors, of all genders, along the way.”

While role modelling sets an example of what is possible, mentorship and sponsorship refer to the active support and endorsement of woman-identifying students, trainees and junior faculty. These concepts are integral to correcting and proactively overcoming this gender imbalance from the top down.

However, while anyone can be a mentor and offer advice, sponsorship relies on leadership to recognize and select talent, and actively endorse the individual for promotion. For sponsorship to be effective in overcoming gender inequity in critical care medicine, the leaders at the institution must first be cognizant of these inequities and committed to correcting them.

As part of a three-phase study, Mele and her co-investigators reviewed existing literature detailing strategies to attract and retain woman-identifying physicians to the speciality, surveyed critical care specialists across the country, and identified how these strategies should be developed, prioritized and implemented at the institutional level.

“I’ve been part of so many EDI focus groups and I feel like we write papers, do surveys, and it gets a bit discouraging. Even though many qualified leaders have been doing this work for some time, the part that we’re missing is the implementation. This research helps define an actionable path forward,” Mele shared.

Their research identified nearly 200 unique equity and inclusion strategies grouped into four general pillars addressing: social and institutional balances with respect to recruitment, retention and promotion of faculty; equitable participation in leadership; equitable reimbursement; and an equitable culture free from discrimination and harassment.

Mele believes the biggest opportunity for growth lies in the first two pillars, which address the systemic issues and subliminal biases that create an environment in which it is intrinsically difficult for women to succeed. While issues related to discrimination and equal pay have long been dominant in conversations about gender equity, these system biases are more covert – especially to those who do not have these lived experiences.

While some barriers to equity have not been extensively researched within the Canadian context, such as the prevalence of pay inequality, the researchers outlined preventative measures to safeguard equitable treatment in those areas.

Another key finding of the research was characterizing the personal factors which impact career progression in female critical care specialists, such as an underestimation of one’s own competence. Mele postulates it is likely caused by a combination of factors related to how women are socialized and taught about their social value in what is still a largely patriarchal society.

After being approached by a surgical trainee interested in examining this phenomenon among her own peers, Mele became involved in research examining gender-based disparities in medical students’ surgical skills education.

“Women have this perceived notion that they’ve had fewer procedures, and they report feeling less confident in their technical skills. But when we compare men and women at the end of their surgical rotation, more women have an increased interest in doing surgery,” she said.

At first glance, evidence might suggest that these self-perceptions didn’t impact woman-identifying students’ desire to pursue surgery. But lower confidence and feelings of imposter syndrome are ultimately counter-productive to their development as leaders and mentors – which is integral to career advancement.

While not investigated in the scope of this study, Mele says past research has shown that there could be subconscious biases at play that could account for why women believe to have had less surgical exposure than their counterparts who are men.

“There’s evidence that says that trainees who are woman-identifying are often delegated administrative tasks at a higher rate than trainees who are man-identifying in relation to how much time they spend in the operating room.”

Mele’s research inspired her own personal development as a leader to her students and trainees. Thanks to a Faculty Development Mini Fellowship Award, she attended a three-day course at Harvard University, which taught tangible professional skills such as negotiation and networking, as well as tactics for how to effectively mentor and sponsor.

“I think this work has validated my feelings throughout my career. It provided evidence to support my perceptions. And I guess it allows me to voice my experiences, so that we can make things better in the future for other women coming through.”