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Estimating Implicit and Explicit Gender Bias Among Health Care Professionals and Surgeons

Educational Objective
To understand the presence and extent of implicit bias among health professionals
1 Credit CME
Key Points

Question  Do surgeons and health care professionals hold implicit or explicit biases regarding gender and career roles?

Findings  A review of 42 991 Implicit Association Test records and a cross-sectional study of 131 surgeons provided evidence of implicit and explicit gender bias. Data suggest that health care professionals and surgeons hold implicit and explicit biases associating men with careers and surgery and women with family and family medicine.

Meaning  This work contributes an estimate of the extent of implicit gender bias within medicine; awareness of bias, such as through an Implicit Association Test, is an important first step toward minimizing its potential effect.

Abstract

Importance  The Implicit Association Test (IAT) is a validated tool used to measure implicit biases, which are mental associations shaped by one’s environment that influence interactions with others. Direct evidence of implicit gender biases about women in medicine has yet not been reported, but existing evidence is suggestive of subtle or hidden biases that affect women in medicine.

Objectives  To use data from IATs to assess (1) how health care professionals associate men and women with career and family and (2) how surgeons associate men and women with surgery and family medicine.

Design, Setting, and Participants  This data review and cross-sectional study collected data from January 1, 2006, through December 31, 2017, from self-identified health care professionals taking the Gender-Career IAT hosted by Project Implicit to explore bias among self-identified health care professionals. A novel Gender-Specialty IAT was also tested at a national surgical meeting in October 2017. All health care professionals who completed the Gender-Career IAT were eligible for the first analysis. Surgeons of any age, gender, title, and country of origin at the meeting were eligible to participate in the second analysis. Data were analyzed from January 1, 2018, through March 31, 2019.

Main Outcomes and Measures  Measure of implicit bias derived from reaction times on the IATs and a measure of explicit bias asked directly to participants.

Results  Almost 1 million IAT records from Project Implicit were reviewed, and 131 surgeons (64.9% men; mean [SD] age, 42.3 [11.5] years) were recruited to complete the Gender-Specialty IAT. Healthcare professionals (n = 42 991; 82.0% women; mean [SD] age, 32.7 [11.8] years) held implicit (mean [SD] D score, 0.41 [0.36]; Cohen d = 1.14) and explicit (mean [SD], 1.43 [1.85]; Cohen d = 0.77) biases associating men with career and women with family. Similarly, surgeons implicitly (mean [SD] D score, 0.28 [0.37]; Cohen d = 0.76) and explicitly (men: mean [SD], 1.27 [0.39]; Cohen d = 0.93; women: mean [SD], 0.73 [0.35]; Cohen d = 0.53) associated men with surgery and women with family medicine. There was broad evidence of consensus across social groups in implicit and explicit biases with one exception. Women in healthcare (mean [SD], 1.43 [1.86]; Cohen d = 0.77) and surgery (mean [SD], 0.73 [0.35]; Cohen d = 0.53) were less likely than men to explicitly associate men with career (B coefficient, −0.10; 95% CI, −0.15 to −0.04; P < .001) and surgery (B coefficient, −0.67; 95% CI, −1.21 to −0.13; P = .001) and women with family and family medicine.

Conclusions and Relevance  The main contribution of this work is an estimate of the extent of implicit gender bias within surgery. On both the Gender-Career IAT and the novel Gender-Specialty IAT, respondents had a tendency to associate men with career and surgery and women with family and family medicine. Awareness of the existence of implicit biases is an important first step toward minimizing their potential effect.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: May 15, 2019.

Published: July 5, 2019. doi:10.1001/jamanetworkopen.2019.6545

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2019 Salles A et al. JAMA Network Open.

Corresponding Author: Arghavan Salles, MD, PhD, Section of Minimally Invasive Surgery, Department of Surgery, Washington University in St Louis, 4901 S Euclid Ave, Ste 920, St Louis, MO 63108 (sallesa@wustl.edu).

Author Contributions: Drs Salles and Lai had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Salles, Awad, Goldin, Lai.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Salles, Goldin, Lai.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Salles, Goldin, Lai.

Administrative, technical, or material support: Salles, Lee.

Supervision: Salles, Awad.

Conflict of Interest Disclosures: Dr Salles reported receiving honoraria from Medtronic plc for consulting and speaking. Dr Lai reported serving as the director of research for Project Implicit. No other disclosures were reported.

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