Exploring female otolaryngologists' experiences with gender bias and microaggressions: a cross sectional Canadian survey.

Gender bias is behavior that shows favoritism towards one gender over another. Microaggressions are defined as subtle, often unconscious, discriminatory, or insulting actions that communicate demeaning or negative attitudes. Our objective was to explore how female otolaryngologists experience gender bias and microaggressions in the workplace. Anonymous web-based cross-sectional Canadian survey was distributed to all female otolaryngologists (attendings and trainees) using the Dillman's Tailored Design Method from July to August of 2021. Quantitative survey included demographic data, validated 44-item Sexist Microaggressions Experiences and Stress Scale (MESS) and validated 10-item General Self-efficacy scale (GSES). Statistical analysis included descriptive and bivariate analysis. Sixty out of 200 participants (30% response rate) completed the survey (mean age 37 ± 8.3 years, 55.0% white, 41.7% trainee, 50% fellowship-trained, 50% with children, mean 9.2 ± 7.4 years of practice). Participants scored mild to moderate on the Sexist MESS-Frequency (mean ± standard deviation) 55.8 ± 24.2 (42.3% ± 18.3%), Severity 46.0 ± 23.9 (34.8% ± 18.1%), Total 104.5 ± 43.7 (39.6% ± 16.6%) and high on GSES (32.7 ± 5.7). Sexist MESS score was not associated with age, ethnicity, fellowship-training, having children, years of practice, or GSES. In the sexual objectification domain, trainees had higher frequency (p = 0.04), severity (p = 0.02) and total MESS (p = 0.02) scores than attendings. This was the first multicenter, Canada-wide study exploring how female otolaryngologists experience gender bias and microaggressions in the workplace. Female otolaryngologists experience mild to moderate gender bias, but have high self-efficacy to manage this issue. Trainees had more severe and frequent microaggressions than attendings in the sexual objectification domain. Future efforts should help develop strategies for all otolaryngologists to manage these experiences, and thereby improve the culture of inclusiveness and diversity in our specialty.

Hu AC ，Nguyen K ，Meyer TK 《Journal of Otolaryngology-Head & Neck Surgery》

Behind the Mask: An Exploratory Assessment of Female Surgeons' Experiences of Gender Bias.

Barnes KL ，Dunivan G ，Sussman AL ，McGuire L ，McKee R ... -  《-》

State of Gender-Based Microaggressions Among Surgeons and Development of Simulation Workshops for Addressing Microaggressions for Surgical Trainees and Students.

Microaggressions are statements or actions taken in a discriminatory manner. Microaggressions can be subtle or explicit, intentional or unintentional, but regardless of the type of microaggressions, it is important to identify and address them, as they are linked to physician burnout and add to levels of depression, anxiety, and stress. In this study, we evaluated the prevalence, quality, and impacts of gender-based microaggressions on surgeons and surgical trainees using simulation-based education. Further, we plan to iteratively develop more simulation sessions based on the findings of this study. We used simulation-based education to develop and implement microaggression scenarios. Those scenarios were performed by standardized patients (trained actors) who demonstrated the different microaggression situations previously seen at the workplace and wards. Published tools to address gender-based microaggressions were outlined in preparation (prebrief) for a discussion of recorded simulations. A debrief of developing potential resolutions as learners and future allies and how similar microaggressions may have been perpetuated in our own careers followed each scenario. Additionally, an 11-item survey was developed based on validated surveys of sexist and Microaggressions Experience and Stress Scale and disseminated through email listservs and social media links. Data collection occurred from November to December 2022. When surveyed after the workshop, 100% of participants (n = 6) said that they would recommend this session to follow colleagues, and 100% completely agreed the content of the simulation was relevant to their future practice. Further, 100% of participants agreed or completely agreed that their ability to perform these tasks (addressing microaggressions) has improved after this course. Most respondents to the disseminated survey (n = 147) were vascular surgeons (95/147; 64.6%) and identified as White (93/147; 63.3%), and as women (142/147; 96.6%). Most were identified as targets of gender-based microaggressions (128/147; 87.1%) and or silent witnesses to such microaggressions (87/147; 59.2%). However, there were reports of having a perpetrator of a microaggression (2/147; 1.4%), a nonsilent witness (3/147; 2.0%), or having no target, witness, or perpetrator (3/147; 2.0%). Of the quality of microaggressions, the most common impacts were when the targeted individual attempted to hide their emotions to not appear too emotional (described in the literature as "leaving gender at the door") (32/147; 21.8%), were told that women no longer experience discrimination (25/147; 17.0%), and were asked when one would have children (24/147; 16.3%). The most stressful types of microaggressions were ones in which male peers were the only ones receiving recognition for work (55/147; 37.4%), targets were told women no longer experience discrimination (49/147; 33.3%), and in which men spoke about women in degrading terms regarding their gender or on topics related to their gender (35/147; 23.8%). Qualitative responses to the survey included comments remarking on the relevancy and prevalence of gender-based microaggressions, reasons for silence, the personal and professional impacts (e.g., pay equity) of microaggressions and gender bias, and future areas of work to address bias in medicine. Given the prevalence of microaggressions seen in surgery, especially among vascular surgeons, future steps include discussion of how techniques can be developed and applied to other types of microaggressions (e.g., due to race/ethnicity, sexuality, disability, religion), implementation of future workshops that address intersectionality in scenarios and potentially virtual sessions to increase accessibility to these types of training options for learners at other institutions.

Lee YS ，Campany M ，Fullerton S ，Malik R ，Dorsey C ，Mercado D ，Allen A ，Erben Y ... -  《-》

Prevalence and Nature of Sexist and Racial/Ethnic Microaggressions Against Surgeons and Anesthesiologists.

Sudol NT ，Guaderrama NM ，Honsberger P ，Weiss J ，Li Q ，Whitcomb EL ... -  《-》

Gender Bias Experiences of Female Surgical Trainees.

Medical schools now average approximately 50% female students, yet a disproportionate number of women continue to choose nonsurgical over surgical specialties. Once in training, studies indicate that pervasive gender stereotypes, sexism and harassment negatively affect female surgeons. The aim of this study is to describe female surgeons' experiences with gender bias and microaggressions in the workplace during residency and fellowship training, and understand if differences exist in the experiences of trainees in male-dominant vs female-dominant surgical specialties. A mixed methods approach was used to explore the experiences of female surgical trainees. Participants were recruited from all surgical disciplines at an academic center. Initially, focus groups were used to explore themes that trainees face related to gender bias. A trained moderator conducted all focus groups, which were audio recorded and transcribed. Qualitative analysis of de-identified transcripts was performed to identify emerging themes. We then created an online survey using the validated 44-question Sexist Microaggression Experiences and Stress Scale to assess frequency and psychologic impact of these events with additional questions developed from the focus groups. The survey was sent to all female residents and fellows at one academic institution. University of New Mexico Hospital, a tertiary care academic medical center. Fifteen female surgical trainees participated in focus groups. Thirty-three female surgical trainees participated in the online survey. Two focus groups including 15 female trainees were conducted, revealing 4 themes: Exclusion, Adaptation, Increased effort, and Development of Resilience Strategies. All participants had experienced gender bias or discrimination during medical school or surgical training. The quantitative survey had a 66% response rate (33/50 female trainees). Significant differences were found in the experience of female trainees in male-dominant vs female-dominant specialties, with those in male-dominant fields often reporting more frequent, severe, and stressful microaggression experiences. When describing how gender bias would affect their future in medicine, trainees in male-dominant specialties were more likely to report that due to gender bias, they "may leave medicine/retire early" (33% vs 6%, p = 0.040) and that they "would not recommend my profession to trainees or family members" (40% vs 6%, p = 0.015)." Female surgical trainees continue to experience gender bias. A culture of sexism leads to physical and social adaptations to fit into the role of surgeon. Participants expressed significant effort to sustain this level of adaptation, leading to fatigue and creation of resilience mechanisms. The environment in which a trainee operates (male-dominant vs female-dominant) significantly impacts their experience. Those experiencing more bias were less likely to recommend their specialty and reported plans to leave medicine earlier. Culture change across institutions and system-level interventions are necessary to create meaningful and sustainable change that improves the experience of female surgical trainees.

Barnes KL ，McGuire L ，Dunivan G ，Sussman AL ，McKee R ... -  《-》