Four types of gender bias affecting women surgeons and their cumulative impact

Abstract

Women are under-represented in surgery, especially in leadership and academic roles, and face a gender pay gap. There has been little work on the role of implicit biases in women’s under-representation in surgery. Nor has the impact of epistemic injustice, whereby stereotyping influences knowledge or credibility judgements, been explored. This article reports findings of a qualitative in-depth interview study with women surgeons that investigates gender biases in surgery, including subtle types of bias. The study was conducted with 46 women surgeons and trainees of the Royal Australasian College of Surgeons. Maximum variance sampling strategies ensured a comprehensive set of perspectives. Data were analysed using iterative thematic analysis to document and classify forms of gender bias experienced by the participants, including implicit bias and epistemic injustice. It found four types of bias affecting women surgeons: (1) workplace factors such as access to parental leave and role models; (2) epistemic injustices—unfair assessments of women surgeons’ credibility by patients and colleagues; (3) stereotyped expectations that they will carry out more of surgery’s carework, such as meeting the emotional needs of patients and (4) objectification. Implicit biases arose in each category. Given that many of the biases identified in this study are small, are harmless on their own and are not necessarily under anyone’s conscious control, important questions arise regarding how they cause harm and how to address them. I draw on theoretical work on cumulative harm to answer these questions.

The unspoken reality of gender bias in surgery: A qualitative systematic review

“…The age of participants ranged from 32 to 63 years old. The included studies were conducted in eight different countries: six in the United States [24][25][26][27][28][29], four in the United Kingdom [30][31][32][33], two in Australia and New Zealand [34,35], one in Canada [36], and one in Rwanda [37]. The characteristics of the included papers are presented in Table 1.…”

“…Harassment. Female surgical residents were exclusively subjected to unwanted and unsettling incidents of sexual harassment, usually by either male colleagues, seniors, or patients [24][25][26]34,35]. Reported behaviors include inappropriate physical contact, derogatory depictions, suggestive winking and smiling at female trainees, coupled with elbow nudging [24,34,35].…”

Implicit bias, women surgeons and institutional solutions: commentary

“…Further, the paper argues that existing strategies do not adequately address the problems faced by women surgeons and cannot do so without an understanding of those wrongs as microinequities. Insights from the literature on ethics and microinequities are thought to be able to inform new strategies 1…”

Commentary on ‘Four types of gender bias affecting women surgeons, and their cumulative impact’ by Hutchison

“…The central concerns of Hutchison’s1 paper are the under-representation and unequal pay of women in surgery and the role that subtle gender biases play in explaining these phenomena. My comments will focus on how well executed and important this work is and also why we need more of it to fully understand the gravity of the situation for women in surgery and how it compares with similar situations for women in other fields.…”