This limitation negatively impacts overall progress and growth of the gastroenterology field in general.5 The gender imbalance at conferences doesn’t only affect speakers, either. It also impacts attendees. When women do not see themselves represented in conference leadership, they may be less inclined to participate.5 In fact, one study found that as attendees, men ask twice as many questions as women.14 Additionally, the gender composition of conference organizers directly affects the gender composition of panels, with all-male organizers more likely to select all-male panels.15
Addressing Workplace Dynamics
Nearly half of all surgical trainees in the United States report experiencing harassment during training.16 It is likely, according to the authors, that other procedural, male-dominated fields — like gastroenterology — experience similar incidence rates.5
Egregious behavior, like unwanted touching, can be easy to identify. The problem, though, is often more subtle: telling jokes laden with sexual innuendo, referencing the anatomy of a colleague, patient, or staff member, or holding extracurricular activities that are likely to exclude women.5 Referring to female colleagues by their first names during grand rounds or in smaller group settings is yet another example of subtle microagressions.5 This lack of formality, the authors note, can subtly undermine the rank of a female physician and affect how their medical or endoscopic competence is perceived.5
It is crucial to address and stop sexual harassment and unprofessional behavior. However, there does exist a risk for overreaction, where colleagues decline to interact, fearing false accusations or uncomfortable situations. While some men have gone to extremes, such as not traveling with or having dinner alone with women in professional settings, these reactions may ultimately limit networking and advancement opportunities for female trainees.5
Gastroenterology Best Practices
In order to facilitate adoption of their recommendations, Dr Rabinowitz and colleagues have laid out best practices for each category,5 outlined below.
Best Practices for the Endoscopy Suite:
· Educate trainees that for some, a hands-on approach may be an effective method for learning endoscopy.
· Engage in discussions about comfort with hands-on learning before the start of a case or rotation.
· Be clear about the types of physical contact involved in endoscopy education.
· Empower trainees to invite attending physicians into their personal space during a case. This invitation is one-time only; trainees may state discomfort with physical contact at any time.
Best Practices for Industry:
· In both clinical practice and hospital settings, endoscopy leadership must set clear behavioral expectations for equal and appropriate treatment of both male and female endoscopists with industry partners.
· Unconscious bias training is an effective tool in combatting unequal treatment of women in medicine; it may be beneficial in an endoscopy setting.
· Endoscopists of both genders should have equal representation and purchasing power in negotiations with industry partners. This equality should be made clear to industry representatives at the onset of and throughout negotiations.
· Female endoscopists should be actively recruited to participate and lead research opportunities.
Best Practices for Academic Medicine:
· Unconscious bias training should be offered to any gastroenterologist with decision-making authority within gastroenterology departments and academic institutions.
· Academic funding should represent equal pay for equal work for gastroenterologists of both genders.
· Representation matters: Gastroenterology departments should be evaluated at an institutional level based on gender, diversity, and inclusion with regard to hiring and promoting faculty members.
· The opportunity to serve as conference organizers, speak on panels, or serve as keynote speakers should be equally available to both men and women with equivalent levels of academic expertise and achievement.
Best Practices for Office Relationships:
· In public settings, refer to female colleagues by their formal titles unless explicitly requested to do otherwise.
· Avoid comments or jokes with sexual innuendo. These types of comments should not be tolerated in professional environments.
· Include networking opportunities, and make them equally available to, both sexes.
· Don’t overcorrect. It’s not necessary to avoid private, one-on-one interactions with women.
· Both male and female gastroenterologists should actively seek out opportunities to mentor female trainees and junior colleagues.
Conclusions and Looking Forward
Despite the current challenges, progress is possible, although it will require thoughtful effort.5 Fundamental to these efforts are the development and implementation of principles of professionalism and respect, regardless of gender, race, ethnicity, sexual orientation, or religion.
More research is needed to identify how women in the field can be best supported. Current research17 has identified why women are not choosing to enter surgical fields; similar research should be done to assess why women are not choosing to enter gastroenterology.5 Factors that lead to challenges for women within the field should also be identified.5
“As more women join the field, we can continue to amplify female voices and experiences in order to better advocate for gender equity,” Dr Rabinowitz and colleagues wrote.5 “Women in positions of seniority can offer support and guidance to junior female trainees and colleagues.”
“We strongly believe that addressing these issues will benefit not only women in the field, but will also strengthen the science, education, and practice of gastroenterology,” the researchers concluded.5
- Spector ND, Overholser B. Examining gender disparity in medicine and setting a course forward. JAMA Netw Open. 2019;2(6):e196484.
- Weaver AC, Wetterneck TB, Whelan CT, Hinami K. A matter of priorities? Exploring the persistent gender pay gap in hospital medicine. J Hosp Med. 2015;10(8):486.490.
- Gesensway D. Gender gap in hospital medicine: Do women have the same opportunities? Today’s Hospitalist. https://www.todayshospitalist.com/gender-gap-in-hospital-medicine-do-women-have-the-same-opportunities/. Published March 2016. Accessed December 19, 2019.
- Murphy B. These medical specialties have the biggest gender imbalances. American Medical Association. https://www.ama-assn.org/residents-students/specialty-profiles/these-medical-specialties-have-biggest-gender-imbalances. Published October 1, 2019. Accessed December 19, 2019.
- Rabinowitz LG, Anandasabapathy S, Sethi A, Siddiqui UD, Wallace MB, Kim MK. Addressing gender in gastroenterology: Opportunities for change [published online September 6, 2019]. Gastrointest Endosc. doi: 10.1016/j.gie.2019.08.039.
- Pololi LH, Brennan RT, Civian JT, Shea S, Brennan-Wydra E, Evans AT. Us, too. Sexual harassment within academic medicine in the United States [published online July 11, 2019]. Am J Med. doi: 10.1016/j.amjmed.2019.06.031.
- Fitzgerald CA, Smith RN, Luo-Owen X, et al. Screening for harassment, abuse, and discrimination among surgery residents: An EAST multicenter trial. Am Surg. 2019;85(5):456-461.
- Nayaar A, Scarlet S, Strassle PD, et al. A national survey of sexual harassment among surgeons. Presented at: the 15th Annual Academic Surgical Congress; February 4-6, 2019; Houston, TX. Abstract 85.06.
- Schwartz LM, Woloshin S. Medical marketing in the United States, 1997-2016. JAMA. 2019;321(1):80-96.
- Grande D. Limiting the influence of pharmaceutical industry gifts on physicians: Self-regulation or government intervention? J Gen Intern Med. 2010;25(1):79-83.
- Harvin G. Review of musculoskeletal injuries and prevention in the endoscopy practitioner. J Clin Gastroenterol. 2014;48(7):590-594.
- Oliveira DFM, Ma Y, Woodruff TK, Uzzi B. Comparison of National Institutes of Health grant amounts to first-time male and female principal investigators. JAMA. 2019;321(9):898-900.
- Sege R, Nykiel-Bub L, Selk S. Sex differences in institutional support for junior biomedical researchers. JAMA. 2015;314(11):1175-1177.
- Hinsley A, Sutherland WJ, Johnston A. Men ask more questions than women at a scientific conference. PLoS One. 2017;12(10):e0184434.
- Casadevall A, Handelsman J. The presence of female conveners correlates with a higher proportion of female speakers at scientific symposia. MBio. 2014;5(1):e00846-13.
- National Academies of Sciences, Engineering, and Medicine. Sexual harassment of women: Climate, culture, and consequences in medicine. 2018. Washington, DC: The National Academies Press. doi: 10.17226/24994
- Peel JK, Schlachta CM, Alkhamesi NA. A systematic review of the factors affecting choice of surgery as a career. Can J Surg. 2018;61(1):58-67.