Do the portraits hanging in medical schools hurt women and minorities?

Our powerful subconscious minds are processing information that we don’t even realize we are taking in, so to achieve gender equity we must actively uncover things that are unintentionally promoting stereotypes.

For example, we know that if we want to promote a gender equitable environment that putting portraits of men on the walls of the classrooms would not be ideal. Even if there were one or two women in the mix, this type of tokenism contributes to persistent sexism and gender disparities. Indeed, decorating our medical school educational facilities — entrances, classrooms, lectures halls and teaching hospitals — with portraits of mostly men who are mostly white, is not supportive of women in medicine or our diverse student body — greater than 50 percent of whom currently come from one or more underrepresented groups.

As an academic physician who is frequently invited to be a “visiting professor” and lecture at institutions throughout the U.S., I have seen many walls firsthand. For example, at a recent white coat event that took place in a medical school lecture hall auditorium that I was visiting, I watched a first-year class of medical students receive their physician coats for the first time in a ceremony that their parents and loved ones attended. I compared the larger than life paintings on the wall with the smaller real students — the majority of whom were clearly women and/or men of color. I thought to myself about how far we have come since I was a new medical student, and I was proud of my profession and colleagues. But I also knew that as much as we say we welcome them all to the profession, the walls are telling our future doctors a different story. It doesn’t matter how excited, anxious or distracted the students are, every one of their brains will take in the environment, including the walls.

For some, what the walls are saying may empower them. For others, the walls may be suggesting that they aren’t good enough, they are an imposter (imposter syndrome is common among medical students), or they’ll never be a leader. I knew, too, that not only were the walls speaking to these future physicians, but they were talking to their parents as well. The dean addressed the parents sitting in the audience and asked for questions. One father, a black man, raised his hand and asked how many students failed out of medical school. The dean responded by saying that once students get in, they do everything possible to keep them in. This is true — once a student is in medical school, the fail rate is very low. However, the spoken words were not intuitive as the walls may have told this worried father a different story. None of the images looked like his daughter. Neither did the dean.

Here’s what the dean didn’t say to this concerned father:

Per the research, your daughter will probably make it through medical school.But compared to her male colleagues she’s likely to make less money for similar work (so paying off her huge medical school debts will take longer). She will have fewer opportunities for promotion (especially at the highest levels), and she will experience more symptoms of burnout (that she may internalize as her own fault but really may be due to systemic implicit bias issues because she is not valued as much as some of her peers).

Teachers “must learn to recognize and eliminate gender bias, because it can limit students’ ambitions and accomplishments,” states Timothy Frawley, EdD in “Gender Bias in the Classroom: Current Controversies and Implications for Teachers.” Dr. Frawley is an expert in gender bias in childhood education, and he and others have provided some excellent guidance in anti-bias curriculum that focuses on ways to avoid or dispel stereotypes that unintentionally support racism, sexism, ableism, homophobia and other forms of discrimination. Those of us in academic medicine, particularly medical education, are responsible for educating some of the brightest people in the world about how to prevent disease and equitably deliver exceptional health care to those who suffer from injury or illness, and it is our responsibility to focus on inclusion at every level of their education. We simply cannot justify any physical environment, no matter how small or out of the way the space is, that unintentionally promotes stereotypes and may be a barrier to gender equity in our physician workforce.

What would the walls look like in an optimal learning environment? Although no wall can say it all, the “walls of honor” spaces could be used to focus on learning, wellness, healing, diversity, and inclusion or future innovation. Let’s consider those who we are honoring with the portraits — would they want the buildings and classrooms and lecture halls to be the most supportive and inclusive learning environment? One could argue that most these portraits are of men who are or were tireless and empathic leaders. Whether they are living or not, I wonder what would they think if they realized that their images might be a barrier to progressive diversity and inclusion.

Honor walls are commonplace in many higher learning institutions and may inadvertently be contributing to a kyriarchy — social constructs that reinforce dominance and oppression. Perhaps we are unintentionally unraveling some of the important work that our esteemed childhood educator colleagues are doing regarding providing inclusive learning environments for children. Maybe it is time to take a closer look at their important work and focus ours on enhancing it as their students become our students.

Moreover, since those of us in graduate medical education receive students from colleges and universities throughout the U.S. and internationally, it seems reasonable to engage the deans, presidents, and others at these institutions and ask them to consider how their students may be entering our medical schools with stereotypes learned and reinforced before they reach us. We must work together to educate our way out of learned stereotypes that are contributing to the evidence-based workforce disparities, as these are slowing advances in medicine and science and discouraging more than half of the best and brightest minds.

Julie Silver a physiatrist and director, cancer rehabilitation, Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, MA.  She can be reached on Twitter @juliesilvermd.

Image credit: Shutterstock.com

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