In recent years, medicine has begun to advance at a rate that is, at times, difficult to even comprehend. The world has now seen its first birth from a transplanted uterus, an artificial pancreas, mobile stroke units, therapeutic virtual reality, an embryo with three genetic parents and more. No doubt, medicine has come far. But as we enter 2018, we are still missing the mark on gender equity.
Before I started medical school, I was blissfully unaware of the biases that still exist in medicine. I had heard people talk about them, but given that I spent much of my time with my head in a book, I hadn’t paid much attention. When I started my third-year clerkships, I began to see them more clearly.
Like many of my female colleagues, patients have interrupted me to comment on my appearance. I’ve seen patients address the male medical student in the room as the authority figure instead of the female attending. But perhaps the most blatant bias I’ve encountered was from a surgeon who lectured me and my colleague for over an hour about how women can’t “bring home the bacon, cook it for their families, and keep their husbands happy too.” His comments were a sweeping generalization of gender roles, an assumption of my sexual orientation, and a clear statement about his views towards women in the workplace. As he stood there holding my assessment form, I smiled weakly and nodded. I’m not proud of my passivity in this situation, but I have forgiven myself for struggling to navigate the enormous power differential that exists between attendings and medical students, particularly in settings where the student is being evaluated. With more experience now, I understand that there are appropriately ways I could have responded, and people I could have gone to for support.
Not all examples of bias are as obvious as this, but perhaps it is even more important to recognize subtle sexism that is pervasive and likely contributes to well-documented macro-inequities. For example, despite the fact that half of all medical school graduates are now women, they continue to earn less money (even when adjusted for factors such as reduced hours during child-rearing years) and are promoted less frequently. It is obvious at most medical conferences that women physicians are not invited to give as many keynote lectures as their male counterparts. They receive fewer recognition awards. Is it any wonder that their images are often not among their male colleagues on hospital “Walls of Honor?”
This brings up a key issue: on the first day of medical school, what would an anti-bias educational environment look like to a new class of students — more than 50 percent of whom likely come from one or more underrepresented groups? Hospitals seeking to create an excellent educational experience for its students, free of bias, should review the way they adorn the halls through which all its students walk. For women, as we learn and strive to become leaders in a field that does not yet adequately value us, what message might we consciously or unconsciously internalize? Moreover, it is not just the women who are internalizing messages — what do walls adorned with mostly male leaders say to all of our peers and our patients about who will lead in the future and who won’t? I have yet to meet a female colleague who has never been mistaken for a nurse — even after introducing herself as a doctor. It isn’t surprising that patients assume their doctor is a man because in many institutions the walls of the hospital tell them so.
I entered a contest (and was one of nine finalists) that was aimed at getting people to think about what constitutes an anti-bias learning environment in medical education. I have thought a lot about this, and I believe there are many ways in which medical schools and hospitals can begin to address this issue. In the “Walls Do Talk Challenge,” medical students were asked to take a “blank canvas” and design a wall that would support all students and patients. Competitions such as these encourage the very population that is underrepresented to take part in initiating a change.
Another option would be to consider filling the walls with artwork from the community in which the hospital serves. University Medical Center, the new hospital in New Orleans, features more than 4,000 pieces. Over ninety percent of those pieces come from Louisiana residents. The artists represent the many facets of this vibrant community. Some of the paintings were found in a coffee shop created by a young girl with autism. Others feature artists who also have work in the Smithsonian. The idea was to design an inclusive space that reflects the rich culture that the hospital exists within, and the final result has been warmly regarded by patients, students, and hospital employees.
The dean of Harvard Medical School, George Daley, MD, PhD, recently announced that he has directed a task force to focus on assessing the walls to ensure that the art displayed around campus reflects the complex history of medicine and the rich diversity of the current community. Dean Daley said, “The art that we display on our walls should make everyone feel like they belong here.” Moreover, he noted that having representative art was an important part of creating physical space where people are free to learn and work to their full potential.
There are many ways to create an anti-bias learning environment, and every student, regardless of gender, deserves to be educated in one. Solutions can be found through listening to and collaborating with the diverse members of the community. As medicine continues to shift, progress and rapidly advance, it only makes sense that hospital environments naturally evolve to reflect its ever-changing culture as well.
Sarah Smith is a physician who can be reached on Twitter @DrSarahMSmith.
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