A workplace environment conducive to success includes equal access to resources and opportunities, work-life integration, freedom from gender discrimination and sexual harassment, and supportive leadership. With focused leadership that is accountable for actionable interventions through measurable outcomes, it is possible to create an equitable, safe, and dignified workplace for all ObGyns.
Recently, obstetrics and gynecology has become the only surgical specialty in which a majority of practitioners are women. Since the 1990s, women in ObGyn have composed the majority of trainees, and 2012 marked the first year that more than half of the American College of Obstetricians and Gynecologists (ACOG) Fellows in practice were women.1
Despite the large proportion of women within the specialty, ongoing gender-based inequities continue. Many of these inequities are rooted in our pervasive societal views of behavioral norms based on biologic or perceived sex, otherwise known as “gender,” roles.2 The cultural gender role for men embodies characteristics that are bold, competitive, decisive, analytical; qualities for women include modesty, nurturing, and accommodating in interactions with others. Such male-typed traits and behaviors are termed “agentic” because they involve human agency, whereas female-typed traits and behaviors are termed “communal.”3
Gender biases remain widespread, even among health care providers.4 When gender roles are applied to medical specialties, there is an assumption that women tend toward “communal” specialties, such as pediatrics or family practice, whereas men are better suited for technical or procedural specialties.5 ObGyn is an outlier in this schema because its procedural and surgical aspects would characterize the specialty as “agentic,” yet the majority of ObGyn trainees and physicians are women.
Biases related to gender impact many aspects of practice for the ObGyn, including:
- surgical education and training
- the gender wage gap
- interpersonal interactions and sexual harassment
- advancement and promotion.
Surgical education and training
The message that desirable characteristics for leadership and autonomy are aligned with masculinity is enforced early in medical culture, and it supports the ubiquity of deep-seated stereotypes about gender roles in medicine. For example, the language used for letters of recommendation for women applying to residency and fellowship highlight communal language (nurturing, warm), whereas those for men more typically use agentic terms (decisive, strong, future leader).6 During ObGyn surgical training, women residents receive more negative evaluations than men from nurses throughout training, and they report spending more effort to nurture these relationships, including changing communication in order to engage assistance from nurses.7
Similarly, women trainees receive harsher and more contradictory feedback from attending physicians.8 For example, a woman resident may be criticized for failing to develop independence and execute complete plans for patient care; later, she might be labeled as “rogue” and told that she should engage with and seek input from supervising faculty when independently executing a treatment plan.
Even when attempting to apply feedback in the operating room, women trainees are afforded less surgical autonomy than men trainees.9 These factors contribute to lower surgical confidence in women trainees despite their having the same technical skills as men, as measured by the Fundamentals of Laparoscopic Surgery skills exam.10
Continue to: The gender wage gap...