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Equity:

Defining, Exploring, and Sharing Best Practices for Equity in Academic Medicine

Diana Lautenberger, M.A. Director for Women in Medicine & Science, Program Leader for the Group on Women in Medicine & Science (GWIMS) Association of American Medical Colleges

Ashleigh Moses, M.A. Program Specialist for the Group on Women in Medicine and Science Association of American Medical Colleges

GWIMS Toolkit field of academic medicine by challenging socially academic medicine by field of through individual constructed notions of practices that reflection and identifying institutional best can lead to a more inclusive institutional climate. •further equality amongst individuals throughout the To Goal

GWIMS Toolkit Individuals will revisit the notion of equity Individuals will reflection upon their personal praxis of equity Reflect upon institutional practices and disparities amongst men and women faculty inclusion and allyship Institutional Climate: facilitation of Institutional faculty support potential progress. Define areas within institutions for Identify institutional best practices that advance all faculty. • • • • • • • Objectives

GWIMS Toolkit The social dichotomy that separates that The social dichotomy Someone who identifies as the gender of the they sex the gender of the Someone who identifies as Ways of constituting knowledge, together with the In this context, refers to (listed In this context, below), without experience or empirical understanding. : were assigned at birth. were assigned at A priori Allyship: heteronormative persons who fully support the rights of marginalized communities, exercises respect for all gender . in opposition agents of identities, and acts to Binaries (gender binary): male and gender into male and female dictates behavior. The dichotomy places people into unrealistic categories of and emotionless; women are weak men are strong behavior (e.g. and emotional). Cisgender: Discourse: social practices forms of subjectivity and power relations which inhere in such knowledge and relations between them (Marinucci, 2010). Key Terminology • • • • •

GWIMS Toolkit by their , ures must often be available ures must to “Equal enjoyment by women and men of socially “Equal women enjoyment by and men of How a person labels their gender. “the process of being fair to women and men. To Not to be confused with gender is the socially sex, Example: When you assume a person is based on their appearance, you have identified them not their sex. . : valued goods, opportunities, resources and rewards… Achieving ensure that gender equality requires women’s to decision-making at private and public resources levels, and access to are no longer both women weighted and men so that in men’s favor, in productive and reproductive can fully participate as equal partners life” (UNFPA, 2005). Gender Equity: strategies and meas ensure fairness, women’s historical and social disadvantages that compensate for prevent women and men from otherwise operating on a level playing equality” (UNFPA, field. Equity leads to 2005). Gender identity: Gender: of categorization constructed system of individuals along a spectrum ultimately that typically masculine and feminine characteristics of make up an individual’s self-expression and identity. • • • •

GWIMS Toolkit able to all other sexualities. e of gendered pronouns such as identity erasure for members of Language that avoids reinforcing avoids Language that profoundly essentialist account of gender, gender, profoundly essentialist account of the assumption that everyone is heterosexual assumption that the The short hand for addressing , , bisexual, The short hand for addressing lesbian, gay, gender binarisms through the us gender binarisms through the he/she, her/him. (Safe Zone Project). Gender-neutral language: Hegemonic binary: coalescence the to The hegemonic binary refers and sexuality. sex, two fundamentally distinct and sexuality into exactly sex, gender, of natural kinds: women and men (Marinucci, 2010). : LGBTQA: trans*, questioning/, asexual/ally/ advocate communities. questioning/queer, trans*, and that is prefer and that Heteronormativity is a cause of (Safe identities disallows nuanced and marginalized communities, Zone Project). • • • •

GWIMS Toolkit ndividual. Due to its historical on has at their disposal is not embraced or used by all the type of intimate attraction one feels for others, often Social is distributed amongst all people capital that An umbrella term describing any individual describing any who does not An umbrella term any person who self-identifies as a man. The is often term A person’s as male, female, or . anatomical status labeled based on the gender relationship between the person and the people to (Safe Zone they are attracted Project) Men: and gender, reinforcing the a combination a person’s sex used as of and gender are sex hegemonic false notion that binary through the the same concepts. Privilege: where the amount that every pers Queer: identify as a cisgender, heterosexual i Sex: Sexuality: dependent upon their identity. dependent upon their it is use as a derogatory term, members of the LGBTQ community. • • • • •

GWIMS Toolkit ify as the sex they were ify as the sex they a priori. dentity. Identity is constructed dentity. a person’s sex and gender which a person’s the notion that the formulation of individual is often represented with the feminism is often any person who self-identifies as a . The term is The term a woman. any person who self-identifies as any person that does not ident any person that Trans*: Trans*: assigned at birth. assigned at feminism: of Waves depending level of swell on the and retreat waves that metaphor of feminist intervention (Marinucci, 2010). enthusiasm and need for Social construction: Women: ultimately reinforces the hegemonic binary through it’s same sex and gender are the false notion that promulgation the of concepts. often used as a combination of often identities takes place as people relate to one another. How place as people one another. identities takes relate to others how well as as themselves individuals understand understand them informs individual i as people and does not exist interact • • • •

GWIMS Toolkit are not to be conflated Sexuality Sex Identity Identity Gender/Gender with an individual’s should instead be understood as identity but aspects of an individual’s identity that intersect to inform an individual’s understanding of themselves and those around them.* Sex, gender/gender identity, and sexuality gender/gender identity, Sex, and aspects of identity that that there are far more experiences *We recognize identity but for the purposes of this toolkit, we are limiting inform an individual’s this toolkit to the scope of gender, sex, and . Key Concepts

GWIMS Toolkit . fluidity, or self-identification. The a priori Female Male Women Men Feminine Masculine Male-oriented Woman-oriented Heteronormativity divides all people into two Heteronormativity Sex Gender Sexuality Moving Away from Hegemonic Binarisms to Holistic Identity Formation Hegemonic Binary: the hegemonic groups-either men or women. binary women In and men are restricted to socially constructed and systemically enforced allow nuance, do not for identities that chart below outlines the hegemonic binarism as it applies to men and assumes all identity exists women. It

GWIMS Toolkit for equal Equality given opportunities advancement, development, and success. •are individuals all Equality can only be hat everyone is granted unbiased and hat is Equity everyone has equal access to opportunities and treated without bias or impartiality • ensuring that Equity is not to be conflated with equality. equality. not to be conflated with Equity is The process of equality through experienced in the wake of equity. t equity entails ensuring first, impartial access to participation in opportunities, and second, all 2005) all individuals. (UNFPA, to offered are opportunities

GWIMS Toolkit flattening binarisms and instead fosters an environment of unbiased treatment and support. An equitable environments allow for the recognition and acknowledgement of a variety of pluralistic and intersectional identities. climates of inclusion, , and mutual respect. • holistic understanding A of identities that denies • engaging An allyship that fosters and What does Equity Look Like?

GWIMS Toolkit emplation of ’s methods emplation of s presence in spaces that had that in spaces s presence ophies to advance a plurality of plurality a advance ophies to e, and equal distribution of the law. the and equal distribution of e, Focus was highly concentrated on the socio- on the Focus was highly concentrated Whereas, first and second wave feminism were first Whereas, Women’s suffrage was the key focus at this time. While defining the third wave of feminism is problematic, it primarily characterized by a cont producing and reproducing identities through socialized of More focus has been placed on norms and practices. , inclusion, and rhetoric, allyship (Baumgardner & Richards, 2000; Marinucci, 2010; Walker, 1995) . Third wave: women’ on getting primarily focused economic status of women with particularly emphasis on the roles the women with particularly emphasis on of economic status of reproductive justice, workforc previously third wave denied feminism is about using them; those same feminist inroads and philos marginalized communities. First wave: Second wave: • • • How did we get here? A brief Summary of Feminist History

GWIMS Toolkit Women have been bombarded with gender since have Women their initial presence in the medical field (discriminatory actions including, but not limited a lack of career advancement to: opportunities, lack of recognition, sexual lack of harassment, isolation in the workplace, decreased institutional trust, which professional has resulted in a lack of confidence, etc.) understanding what gender discrimination looks like in their daily & 2003; Horn, 2014; Pololi, Cooper, lives (Barbaria, 2009; Carr, 2010; White, 2012). Carr, . How this has Manifested in Academic Medicine Lack of Understanding in the Nuances of Gender Discrimination

GWIMS Toolkit male counterparts (Barbaria, male counterparts Abedin, & Nunez-Smith, 2009; Williams, 2015). Microagressions are identified the day women from begin working in the medical limited field. Women are often by attending’s inclination result in situations where in traditional gender roles that them cast to close relationships the isolated from are women medical students nurses, be assumed to develop with attendings, male students experience diminished go above and career ambition, and need to experienced by is not beyond that Lack of Understanding in the Nuances of Gender Discrimination . How this has Manifested in Academic Medicine

GWIMS Toolkit Because there are few women in leadership positions of instances academic medicine, women who report throughout gender discrimination are often faced with the challenge of reporting to the very men they view as perpetrating the 2003). discrimination (Carr, male dominated hierarchies in of The production and reification institutional of a lack academic medical organizations only fuels trust and reinstills harmful, traditionally held notions that women can’t succeed in academic medicine (Barbaria, 2009; Carr, 2003; Levine, 2013). . . Hegemonic Hierarchical Organizational Structures How this has Manifested in Academic Medicine

GWIMS Toolkit ildren at home, is to deny the Women’s issues in academic medicine have been conflated Erasure of women and diversity from search committees allows for the proliferation of systemic heteronormative values in the academic medical workforce. with familial issues. There has been a focus on improving family with familial There has been a focus issues. women ending resources for as a means to gender paint women’s discrimination in the work place. However, to is solely experience in academic medicine as one that complicated by the presence of ch as well identity of, as the hardships faced by women who may have children not have chosen to yet equally academic medicine the field of contributed to and to expand access to the field for others (Carr, 2003; Rich, 1994). . . Conflation with Familial Issues Familial Conflation with Lack of Women Serving on Search Committees Lack of How this has Manifested in Academic Medicine

GWIMS Toolkit The faced by women threat of confirming negative gendered can lead to underperformance and workplace anxiety. This process is usually reproduced in academic medical environments through the lack of female representation in leadership positions, the tokenization of women in typically male-dominated continued conscription of specialties, and the all women passive, and communal individuals as nurturing, (Burgess, Joseph, van Ryan, Carnes, 2012). . Threat How this has Manifested in Academic Medicine

GWIMS Toolkit unconscious bias because it “Unconscious bias refers to social stereotypes about certain demographics or groups of people individuals that outside form of their own conscious awareness. Social scientists argue that people have some degree of most stems from our natural tendency to make associations to help us 2009). social worlds” (Corrice, organize our . Unconscious Bias How this has Manifested in Academic Medicine

GWIMS Toolkit Actionable Steps to Equality

GWIMS Toolkit When we discuss “women” in academic medicine we cannot When we discuss conflate white, assume heteronormative practices that cisgender, women’s identities with all women’s identities. include ALL women “women” we must When we discuss regardless of their sex, gender, sexuality, race, and socio- economic status. – Are we assuming heteronormative gender identities when we discuss women in medicine? We must expand the conversation of women in medicine to self-identified orientation, sexual various include women of women, women of color, and women of marginalized socio- economic status. . . Explicating our use of the term “women” Explicating our use of the term • Individual Reflection on our Person Praxis

GWIMS Toolkit Allyshipcelebrates variation among individuals be that must expand climates and cultures of to emphasized in equity efforts inclusion expand inclusionary method to and equality. A key in the workplace is through gender neutral language, efforts identifying actions and language assume heteronormativity, that colleagues discuss workplace and creating spaces for to concerns and perceptions in a progressive thoughtful manner. . Are you reinstilling limiting binarisms through language, action, or isolation? • Individual Reflection on our Person Praxis

GWIMS Toolkit Equitable/diverse speakers for events and informational and events for Equitable/diverse speakers meetings promotion/administrative leadership/Deanship Pathways for . . •promotion for expectations Clear • professional development Providing opportunities for •positions faculty into re-entry Planning •networking opportunities diverse equitable and Providing • training and agreements Mentorship • planning Career •committees search Equitable/diverse Institutional Practices

GWIMS Toolkit ons that make efforts to expand ons that make efforts opment as leaders or aspiring Clear reporting information and pathways An example: The Women’s Achievement Social held by Wake Forest School of Medicine’s Office of Women in Medicine and as efforts their recognized for are Science where women faculty mentors as well as their devel development leaders at their institution through faculty programming. . . equity standards medicine •academic in accomplishments women’s Rewarding/Acknowledging • Re-entry strategies Career • instituti Rewarding/acknowledging •of diversity and equality statements institutional •Offices WIMS/Diversity Developing Institutional Practices

GWIMS Toolkit Academic Medicine’s collection on Women in Medicine and Science Zone Project The Safe Academic Medicine: The Pipeline of and Pathways to The State Leadership E-Learning Seminar: What You Don't Know: The Science of in the Search and Unconscious To Do About it Bias and What Recruitment Process Women’s Specialty Women in Science Association for Climate Changes to Institutional Implementing Curricular and Improve Health Care Individuals for Who Are LGBT, Gender Born with DSD Nonconforming, or The UN Population Fund • • • • • • • • Additional Resources

GWIMS Toolkit oes Stereotypes Threat Affect Women in oes Manifesta: Young Women, Feminism, Manifesta: Young he Intersection of Race and Sex: A Black A and Sex: he Intersection of Race sults from sults a Qualitative Study. Acad Med. ffect of Gender on the Clinical Clerkship the Clinical ffect of Gender on C, Inui T. A ‘Ton of Feathers’: Gender onscious Bias in Faculty and Leadership onscious Bias . New York: Farrar, Straus and Giroux. ISBN. New 978-0-374-52622-1 Babaria P, Abedin S, Nunez-Smith M. The E of Experiences Female Medical Students: Re 2009 Jul;84(7):859-66. doi: 10.1097/ACM.0b013e3181a8130c. PubMed PMID: 19550176. (2000). Amy Baumgardner, Jennifer; Richards, and the Future Burgess DJ, Joseph A, van Ryn M, carnes M. D Academic Medicine? Medicine. 2012; 87(4):506-512. doi: 10.1097/ACM.0b013e318248f718. Carr, PL, Szalacha L, Barnett R, Caswell to in Academic Medical Careers and How Manage Discrimination It. Journal of Women’s Health 2003; 12 (10):1009-1018. in Brief: Corrice, April “Analysis Unc at (2009). Accessed Literature Review” Recruitment: A https://www.aamc.org/download/102364/data/aibvol9no2.pdf Crenshaw, Kimberle (1989). Demarginalizing t Doctrine, and Antiracist Politics. Feminist Critique of Antidiscrimination The University of Chicago Legal Forum 140:139-167. References

GWIMS Toolkit rrison RA. "A good career choice for rrison RA. "A sitions at U.S. Medical Schools” (2015). periences: a multi-institutional qualitative periences: february2015theunderrepresentationofwome aezer, Claudia L, Sloane, Rae Ann. The Ann. L, Claudia Sloane, Rae aezer, mate Connection between Queer and mate Connection ne. Donald School J Ultrasound Obstetne. Donald School Gynecol . New York: Vintage Books, 1983. Vintage York: . New sadvantage and Faculty Experiences in Feminism Is Queer: The Inti Feminism Women, Race & Class & Women, Race . London: Zed Books, 2010. Accessed at https://www.aamc.org/download/425020/data/ Davis, Angela Y. Davis, Angela Y. Medici Academic in Gender Bias Horn KV. 2014; 8(1):97-99 The in Brief: A. “Analysis Bunton, Sarah Claudia, M, Raezer, Diana Lautenberger, Po Leadership in Underrepresentation of Women ninleadershippositionsa.pdf M, R Valerie M, Dandar, Diana Lautenberger, Levine RB, Mechaber Cayea Reddy ST, HF, D, Ha women": female medical students' mentoring ex Acadstudy. Med. 2013 Apr;88(4):527-34. doi: 10.1097/ACM.0b013e31828578bb. PubMed PMID: 23425983. Marinucci, Mimi. Feminist Theory Race, Di L, Cooper LA, Carr P. Pololi Medicine. J Gen Intern Academic Med. 2010 Dec;25(12):1363-9. Status of Women in Academic Medicine (2014). Accessed at Accessed (2014). Medicine Academic in Status of Women https://www.aamc.org/members/gwims/statistics/

GWIMS Toolkit Blood, Bread, and The Safe Zone Harvard Business Frequently Asked PS. Gender-related differences PS. Gender-related in the differences resources/frequently-asked-questions-about- medical school deanships. Acaddeanships. medical school Med. 2012 es-pushing-women-out-of-stem>. . United Nations Population Fund, 2005. Web. 28 Apr. Apr. 28 . United Nations Population Fund, 2005. Web. tions about Gender Equality." tions about Gender Equality." Pushing Women Out of STEM." Women Pushing To Be Real: Telling the Truth and Changing the Face of the Face and Changing the Truth Telling Real: Be To . New York: Anchor Books. ISBN York: . New 978-0-385-47262-3. . Harvard Business Review, 24 Mar. 2015. Web. 02 June 2015. 2015. Web. 24 Mar. Harvard Business Review, . . . Norton Paperback: New York 1994. York . Norton Paperback: New 2015. Accessed at http://www.unfpa.org/ Questions about Gender Equality Rich, Adrienne. "Compulsory Heterosexuality and Lesbian Existence" Rich, Poetry Asked Ques "Frequently UNFPA. gender-equality “ Project]." [The Safe Zone Action Taking for Learning & Resources Project (1995). Rebecca Walker, Feminism White FS, McDade H, Morahan Yamagata S, pathway to and characteristics of U.S. Aug;87(8):1015-23. doi: 10.1097/ACM.0b013e31825d3495. PubMed PMID: 22722362. Williams, John C. "The 5 Review

GWIMS Toolkit needed to deal with the needed to development seminars for number of leadership and number thcare environments. Additionally, resources for women in academic ent and organizational performance leader for one of the 23 professional of the 23 professional for one leader al Science and Art History from the the overall strategy and manages unteers as a free-lance art educator of art educator as a free-lance unteers ience (GWIMS). Ms. Lautenberger lty Forward Engagement Survey to Engagement lty Forward & Science, Program for Leader & Science, and a Masters in art education from the a Masters in art education and of American Medical Colleges (AAMC), to succeed as learn the skills needed development for the AAMC. Responsible Medicine and Science to promote gender equity and the advancement of the advancement equity and gender for women in medicine and science in medicine and for women addition to working with GWIMS, to working Ms. addition eums and community organizations lty aimed at aspiring leaders, department chairs, department at aspiring leaders, lty aimed ilitates two professional ilitates two professional them with leadership skills them with leadership S, Ms. Lautenberger led a led S, Ms. Lautenberger implementation, she oversaw two leadership Diana Lautenberger, M.A. Diana Lautenberger, Director for Women in Medicine (GWIMS) & Science the Group on Women in Medicine Colleges of American Medical Association Diana Lautenberger, M.A., is director initiatives and serves as the group program at the Association groups development and Sc the Group on Women in Medicine to related the AAMC’s initiatives leads and science. She sets women in medicine for the Group on Women in operations equitable working environments and develop faculty to mid-career women junior and leaders in academic medicine. Prior to her role with GWIM and for curriculum design development programs for facu deans to equip and associate medicine to advance their careers. In Lautenberger develops and fac engagement initiatives aimed at faculty impending changes of the academic and heal improvement strategies. a B.A. in Politic received Ms. Lautenberger University of Redlands in Redlands, CA Corcoran College of Art + Design. She vol all ages for various DC area mus she managed the operations of the Facu operations she managed the promote knowledge around faculty engagem Authors

GWIMS Toolkit he Association of he University of for women throughout Studies from t and Medicine at t t young women on issues relating to stitutional groups and leadership. campus organizer with the Feminist done by women nation-wide to advance advancement resources young women leaders in their local communities and n in Medicine & Science (GWIMS) as organizing collaboration amongst in amongst as organizing collaboration . Moses facilitates the work being ialist for the Group on Women in Science Science and a Masters in Gender Race he AAMC, Ashleigh worked as a national pare time she moderates discussion amongs onments and develop career Before becoming a staff member at t Majority Foundation to advance the work being done by institutions. a B.A. in Political Ms. Moses received American Medical Colleges (AAMC). Ms work envir inclusive equitable and academic medicine and science, as well Alabama in Tuscaloosa, AL. In her s advocacy and allyship. Association of American Medical Colleges of American Medical Association Ashleigh Moses, M.A. Program for the Group on Wome Specialist Ashleigh Moses, M.A., is Program Spec

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