Blueprint for change
While the issues surrounding gender bias are widespread, solutions exist to create gender equity within ObGyn. Efforts to change individual behavior and organizational culture should start with an understanding of the current environment.
Multiple studies have promoted the concept of “culture change,”26,27 which parallels a standard change process. A critical aspect of change is that individuals and organizations maintain the status quo until something prompts a desire to achieve a different way of being. As data regarding the breadth and impact of gender bias emerge and awareness is raised, there is recognition that the status quo is not achieving the goals of the department or institution. This may occur through the result of loss of physician talent, reduced access for vulnerable patient populations, or lower financial productivity.
Once change is considered, it must deliberately be pursued through a specific process. The first actionable step is to assess the existing state and then identify prior barriers to and current opportunities for success. A validated instrument that has been applied for this purpose is the Diversity Engagement Survey, a 22-item questionnaire that assesses 8 domains of organizational inclusion on a 5-point Likert scale (see TABLE).28 This tool not only provides a measure of institutional culture but also obtains characteristics of the respondents so that it additionally assesses how engaged specific groups are within the organization. Once baseline data are obtained, an action plan can be formulated and enacted. This cycle of assessment, system influences, plan, and act should be continued until the desired changes are achieved.
It is critically important to identify objective, measurable outcomes to assure that the interventions are moving the culture toward enhanced gender equity. As the ideal state is achieved, development of practices and enforceable policies help to ensure the longevity of cultural changes. Furthermore, periodic re-evaluation of the existing organizational culture will confirm the maintenance of gender equity objectives.
Solutions toward gender equity
Gender inequity may arise from societal gender roles, but it is incumbent on health care organizations to create an environment free from gender bias and gender harassment. An imperative first step is to identify the occurrence of gender discrimination.
The HITS (Hurt, Insulted, Threatened with harm, or Screamed at) screening tool has been used effectively with surgical residents to identify the prevalence of and most common types of abuse.29 This instrument could be adapted and administered to ObGyns in practice or in training. These data should inform the need for system-level antisexist training as well as enforcement of zero-tolerance policies.
Organizations have the ability to create a salary-only compensation model for physicians within the same specialty regardless of academic rank or academic productivity, which has been demonstrated to eliminate gender pay disparity.30 Additional measures to achieve gender equity involve antisexist hiring processes31 and transparency in metrics for job performance, salary, and promotion.32
While health care organizations are obliged to construct a gender-equitable culture, efforts can be made on the individual level. Implicit bias is ascribed to the unconscious attitudes and stereotypes people conclude about groups. The Implicit Association Test (IAT) is a validated instrument that provides the respondent with information about one’s own implicit biases. By uncovering gender bias “blind spots,” an individual can work to consciously overcome these stereotypes. Extending from the mental reframing required for overturning implicit biases, individuals can learn to identify and intervene in real-world situations. This concept of “being an upstander” denotes stepping in and standing up when an inappropriate situation arises33 (see “Case example: Being an upstander”). The targeted individual may not have the ability or safety to navigate through a confrontation, but an upstander might be able to assist the target with empowerment, verbalization of needs, and support.
Lastly, mentorship and sponsorship are critical factors for professional development and career advancement. Bidirectional mentorship identifies benefit for the mentee and the mentor whereby the junior faculty obtain career development and support and the senior faculty may learn new teaching or communication skills.34
A final word
As recognized advocates for women’s health, we must intentionally move toward a workplace that is equitable, safe, and dignified for all ObGyns. Ensuring gender equity within obstetrics and gynecology is everyone’s responsibility. ●
Case example: Being an upstander
Dr. Bethany Wain is attending a departmental conference and is talking with another member of her division when Dr. Joselle, her division director, approaches. He is accompanied by the Visiting Professor, an internationally reputable and dynamic man, a content expert in the field of work in which Dr. Wain is interested and has published. Dr. Joselle introduces the Visiting Professor formally, using his title of “doctor.” He then introduces Dr. Wain by her abridged first name, Beth.
As an upstander, the Visiting Professor quickly addresses Dr. Wain by her title and uses the situation as a platform to highlight the need to maintain professional address in the professional environment. He then adds that women, who are usually junior in academic rank, confer more benefit to being addressed formally and receiving visibility and respect for their work in a public forum. In this way, the Visiting Professor amplifies Dr. Wain’s work and status and demonstrates the standard of using professional address for women and men.