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Gender Equity in the Department of Medicine

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The Department of Medicine (at the University of Calgary and Alberta Health Services) official and public release of the Gender Equity Task Force summary report.

September 10, 2019

Published in: Health & Medicine
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Gender Equity in the Department of Medicine

  1. 1. On Behalf of: The Gender Equity Task Force Aleem Bharwani (Co-Chair), Shannon Ruzycki (Co-Chair), Hanan Bassyouni, Brenda Hemmelgarn, Kirstie Lithgow, Kara Nerenberg, Doreen Rabi, Maitreyi Raman Shannon Ruzycki Aleem Bharwani Summary Report September 10, 2019
  2. 2. Gender Equity in the Department of Medicine | 01 Foreword A 2018 report by the US National Academies of Science, Engineering, and Medicine identified gender discrimination and sexual harassment as enduring problems in scientific fields, especially in medicine. Inequity and harassment and are interdependent processes, and it is no coincidence that harassment is rife in environments that foster gender disparities in opportunity, compensation and advancement. Concurrent with that 2018 report, the leading biomedical journals have published editorials and opinion pieces on sexual harassment in academic medicine. Regular readers of the New England Journal of Medicine, Lancet, JAMA and the CMAJ over the past two years will have noted the emphasis that these journals have placed on the topic. Similarly themed articles have appeared in Nature and Science. As the Department Head for Medicine, it seemed naive to think that Calgary would somehow be exempt from what is clearly a prevalent and pervasive problem in other major academic healthcare centres in North America and around the world. My reading of the published evidence suggested not, but we had no objective data regarding the Department of Medicine. It was on that background that I commissioned Dr Aleem Bharwani, Vice Chair (Strategy) of the Department of Medicine, to undertake this task. Dr Bharwani selected Dr Shannon Ruzycki to co-chair a Department of Medicine Gender Equity Task Force. They undertook a rigorous review of gender disparity and harassment within the Department; this report represents the culmination of that work. Aleem and Shannon, along with their colleagues on the Task Force are to be congratulated on producing an outstanding, methodologically sound and comprehensive report. I believe that this report places the Department of Medicine at the forefront of academic Departments across Canada in not only recognizing and identifying the systemic problem of gender discrimination and harassment in healthcare, but also in proposing specific ways for us to address the issues that have been identified. Rather than being reactive, I see that we are being proactive in measuring the extent of the problem as we strive to create a work environment that is inclusive, transparent and psychologically safe for all Department members. Building this type of open workplace culture will ensure improved job satisfaction and teamwork, result in better physician retention, and distinguish Calgary as a preferred destination for residency training and as a place to practice medicine. Richard Leigh, MBChB PhD FRCPC Professor and Head, Department of Medicine
  3. 3. Gender Equity in the Department of Medicine | 02 Executive Summary In response to growing gender equity concerns in medicine, Chair Dr Richard Leigh tasked Vice Chair Dr Aleem Bharwani to craft a strategy to understand and address this important matter. Consequently, Dr Bharwani struck a Gender Equity Task Force selecting to co-chair with Dr Shannon Ruzycki. The Task Force consulted extensively and broadly, including social scientists in gender studies, psychology, and sociology, legal and economics scholars, and provincial and federal government policymakers. The Task Force embraced several key principles in approaching this work: The law is the absolute minimum standard; the Department and its members must adhere to human rights and employment laws. However, our goal is to produce an equitable environment that is more than merely ‘non-criminal’. In pursuit of an equitable environment, we acknowledge the supreme role of both policies and social norms. Equity is distinguished from equality: equality suggests all people be treated identically despite intrinsic differences. In contrast, equity aspires to equal access to opportunity, considering intrinsic differences between individuals. The objective of equity is to remove barriers that are experienced differentially by individuals; for example, if a woman must work harder or endure more suffering to achieve the same outcome as a man colleague, this may be equal but not equitable. Gender-based differences fall along biological and social causal dimensions, whether it be the potential to bear children, or a societal structure that imposes differential expectations and therefore unique time and workload burdens. These gendered factors mean that each faculty member’s path is different. Although the Department didn’t create these differences, they influence the career and life trajectories of Department of Medicine members; addressing gender disparities may improve quality of life, academic productivity, and clinical performance for Department of Medicine members. Over a 16-month period, the Gender Equity Task Force conducted a rigorous mixed methods study exploring the lived experience of Department members. The quantitative strand was a survey using the Culture Conducive to Women’s Academic Success, a tool used to measure culture towards women (response rate 37.0% (n=144/389)). This was followed by a qualitative stream consisting of one-hour semi-structured interviews offered to all Department members (n=28).
  4. 4. Gender Equity in the Department of Medicine | 03 In summary, the results identified a gender gap in perceptions and experiences of gender inequity which was amplified by a generation gap: Women rated the culture of the Department significantly less favourable for women than did men. Senior faculty members viewed the Department more favourable to women than did junior faculty. Overall the experiences of inequity by junior women faculty were most different from the perceptions of equity by senior men in the Department. These findings represent a striking gap in empathy and understanding among Department members. This gap is further explicated by persistent, consistent, and contemporary examples of either illegal or legal but unacceptable forms of discrimination, almost exclusively disadvantaging women members of the Department of Medicine. Examples of inequity fell into four categories: exclusion; harassment and discrimination; career advancement and leadership culture; parenthood and caregiving. Exclusion: Women reported exclusion from formal workplace conversations, especially those with leaders or about leadership opportunities. Women reported exclusion from informal social events where either mentoring occurred, or career opportunities were discussed. At times, these informal Department events occurred at inappropriate venues where exclusion of women was implied by choice of location. Women reported experiencing exclusionary language in the workplace, specifically due to their gender. Women reported being excluded from decisions impacting their career, where terms were dictated to them without consultation. Exclusion Harassment & Discrimination Career & Leadership Parenthood & Caregiving
  5. 5. Gender Equity in the Department of Medicine | 04 Harassment and Discrimination: Women reported contemporary examples of verbal and physical abuse, including comments about physical appearance and unwanted physical contact. This abuse originated from patients, allied health, team members as well as physician colleagues including other Department members. Women reported lack of safe reporting mechanisms; power differentials and fear of retribution left women feeling helpless or resigned. Career Advancement and Leadership Culture: Women reported that leadership culture cannot be disentangled from individual leadership behaviours. Respondents provided examples of maladaptive leadership behaviours that were tolerated or promoted in the Department of Medicine at the expense of vulnerable groups. It was felt that we reinforce a leadership culture stewarded by traditional ‘male’ characteristics, which privilege a more hierarchical, and at times command and control leadership style. Women expressed preference for a collaborative or consensus-oriented leadership culture. Women reported that they were unaware of the formal mechanisms or felt there were no safe mechanisms to provide feedback on these behaviours to leadership; as such, women felt that leaders may be unaware of the impact of certain behaviours. Parenthood and Caregiving: Women reported experiencing intentionally and unintentionally discriminatory language in the workplace, specifically due to their parental status. Women articulated that a lack of awareness about work integration challenges of pregnancy, parenthood, and caregiving has limited adaptability and flexibility of the Department of Medicine. Women experienced indirect and direct criticism for being mothers. Empathy Gap: In general, men interviewees perceived that the Department had achieved equality for men and women; this was a stark contrast to the experiences relayed by most women interviewees. This finding further emphasised the results of the quantitative strand of results. There is an experiential and understanding gap between genders, amplified by a generation gap.
  6. 6. Gender Equity in the Department of Medicine | 05 Our local experience is not unique to the Department. On the contrary, this experience is consistent with decades of peer reviewed literature. Consequent to these findings, the Task Force proposed a suite of interventions. Action to improve gender-based disparities in the Department of Medicine was endorsed by the Medical Staff Executive Council (MSEC), comprising all Division Heads, Alberta Health Services site leaders, and the Department of Medicine Chair, Deputy Chairs and Vice Chairs. An MSEC subcommittee, chaired by Dr. Jayna Holroyd-Leduc, Deputy Department Chair, was convened with intentional inclusion of a diverse representation of Department members and leaders. The finalized recommendations are evidence-based, expert-informed, and were developed with input from Department of Medicine members. They include programmes and policies aimed to encourage humanistic leadership, effective intergroup communication, and accountability for both intentional and unintentional behaviours. Clear, unambiguous guidelines will be drafted to remove any grey areas about appropriate behaviour. Over time, we expect this line of appropriateness may shift, and so too will the guidelines. The Department of Medicine commits to actively eliminate the measurable gender gap in our Department of Medicine within the next 5 years. Though we are deeply disheartened by these findings, we are proud of the Chair, of MSEC, Alberta Health Services and University of Calgary leadership for supporting the work of this Task Force to continue freely, unabated, and without censorship. We were free to build trust on our own terms with members and leaders alike. As a result, members are beginning to more openly discuss gendered issues in the Department: a small but significant step forward towards the Department of Medicine being a magnet centre for workplace inclusion. Aleem Bharwani, MD MPP FRCPC Shannon Ruzycki, MD MPH FRCPC
  7. 7. Gender Equity in the Department of Medicine | 06 Table of Contents Foreword Executive Summary Table of Contents Preamble Data Summary Quantitative Summary Qualitative Summary Task Force Recommendations Recommendation: Stage of Development Gender Equity Fact Sheet Literature Review Timeline APPENDIX: MSEC Gender Equity Action Plan 01 02 06 07 09 11 21 24 25 27 29
  8. 8. Gender Equity in the Department of Medicine | 07 Preamble This report summarises 16 months of inquiry, drawing evidence from peer reviewed literature, institutional reports, and mass media coverage, as well as consultation with field experts, including provincial and federal governments, University of Calgary campus scholars, Alberta Health Services executive, medical associations, and social media. In addition, we conducted primary research within our Department of Medicine, consisting of a survey (37.0% response rate) and semi-structured interviews (n=28). Rationale for query: Newly appointed Vice Chair, Strategy, for the Department of Medicine, Dr Aleem Bharwani, and Department of Medicine Chair, Dr Richard Leigh, felt gender equity was a necessary and important strategic initiative. Dr Bharwani assembled a Task Force, co-chaired with Dr Shannon Ruzycki; the Task Force structured a formal mixed methods study to better understand our local context, mindful that challenges within our Department cannot be disentangled from our broader societal milieu. Principles: The Task Force relied on the following ten guiding principles. Department members are citizens of the Department; citizenship implies an intertwined fate among those in their community. All citizens must be treated equitably, and all citizens must be aware of how they influence, intentionally or unintentionally, others in their community. The Canadian Charter of Rights and Freedoms is law. Law is the minimum acceptable standard. The Department may have its own standards and norms that represent our expectations of and responsibilities to one another, that exceed the minimal standard of law. Standards of justice and fairness differentiate equality, parity, and equity. Equality implies everyone should be treated the same regardless of context. Parity, or an exact numerical distribution of men and women in leadership positions, is not the goal of equity. In contrast, equity recognizes biologic and social differences between genders; the goal of equity is not sameness but fairness. This implies fostering equal access to opportunity despite those differences and embracing those differences as strengths in our Department. Biology is not grounds for exclusion; intrinsic biological differences should justify unique policies. Societal expectations of women influence workplace expectations of women, which in turn reinforces societal expectations. The Department of Medicine should role model equity in our institution and in society. 1 | 2 | 3 | 4 | 5 | 6 |
  9. 9. Gender Equity in the Department of Medicine | 08 Change cannot arise only through change in policy or culture. Both are required for sustainable reduction in gender inequities. Through both policy and culture, we explore how to unseat complacency and regulate behaviours falling outside our shared norms and laws. History and memory powerfully influence human experience. Documentation of history is never neutral. We have a responsibility to be honest and transparent about negative or constructive findings, but not devoid of context nor reality of positive contributions in our Department’s history. Resolution of one inequity may result in a new inequity to another group. We endeavour to measure, minimize, and remedy the impact of unintended consequences of programs and policies intended to reduce gender inequity. Last, we acknowledge the business case that inclusive diversity enhances productivity, independent of morality. Gender equity is good for the Department, and overall, good for Department members themselves. Equity improves productivity. Strengths: The Task Force consulted extensively and broadly. Advisors included social scientists with expertise gender studies, psychology, and sociology, as well as legal and economics scholars. Provincial and federal government policymakers advised on standards and best practises. Main campus, corporate, and community practitioners suggested an array of effective interventions. Internally, through our Alberta Innovates hackathon, support from the Strategic Partnerships and Community Engagement office, as well as the Women’s Resource Centre on main campus and our active and engaged Task Force, we gained a richer and more nuanced understanding of the landscape, issues, successes and failures. Future directions: Given time constraints, we focused on academically oriented clinical faculty regardless of compensation model. We also had difficulty recruiting men onto the Task Force, who frequently commented that this is a time for women to be heard. Further assessment is needed to explore the experiences of full-time clinical faculty members, men, non-binary genders, non-traditional parents, and visible and non-visible minority groups. 7 | 8 | 9 | 10 |
  10. 10. Gender Equity in the Department of Medicine | 9 Quantitative Data Summary SURVEY METHODS: We conducted an anonymous survey of Department of Medicine members using the Culture Conducive to Women's Academic Success (CCWAS) score, an instrument designed to measure culture toward women in academic institutions. The CCWAS has 45 items across four domains: equal access; work-life balance; freedom from gender bias; and supportive leadership. Responses are indicated on a 4-point Likert scale (Strongly Disagree to Strongly Agree with no neutral option). Higher scores indicate that the respondent perceives a more positive culture for women. The CCWAS of a medical Department correlates with the experience of work-family conflict of its women members; women members of Departments with positive cultures report less conflict even when controlling for hours worked compared to women in Departments with negative cultures. The survey included a free text response to collect any comments that Department of Medicine members felt important. SURVEY RESULTS: The response rate was 37.0% (n=144/389); 61% of respondents were women (n=88). Women Department of Medicine members had a response rate that was twice that for men Department of Medicine members (51.5% (n=88/171) compared with 25.7%, (n=56/218), p<0.001). Women respondents rated the culture of the Department of Medicine significantly less favourable for women than did men respondents (p<0.001). The difference in rating of Department of Medicine culture for women between men and women respondents was significant across all four domains of the CCWAS. Figure 1. Women in the Department of Medicine rated the culture toward women as significantly less favourable than the ratings by men in the Department of Medicine (mean score 136.8 versus 168.2; p<0.001; higher scores indicate better equity; maximum score is 225). Of note, even the lowest rating of the culture toward women given by a man in the Department of Medicine (CCWAS 123) was higher than the first quartile score given by women (CCWAS 116), indicating that more than 25% of women in the Department rated the culture less favourable than any single man. 45 65 85 105 125 145 165 185 205 225 More equitable Less equitable Women TotalCCWAS Men
  11. 11. Gender Equity in the Department of Medicine | 10 There was no difference in scores between participants with and without children. Compared to junior faculty, senior faculty viewed the Department of Medicine as more favorable to women, suggesting important generational differences (p<0.05). Interpretation: The low response rate of men Department of Medicine members may suggest that they feel that responding to a survey about gender equity is a low priority or it may signal that that men Department of Medicine members are not comfortable contributing to the discussion of gender equity. The high response rate of women Department of Medicine members suggests that this issue is a priority for women and that women Department of Medicine members want to contribute their experiences and opinions on this subject and feel the Department of Medicine leadership will listen. In order to advance gender equity, both men and women Department of Medicine members must be engaged. Men Department of Medicine members overestimate the experience of their women colleagues as more equitable. Women Department of Medicine members did not feel that they had equal access to the same resources available to their men colleagues, and yet the men Department of Medicine members perceived equal access between genders. Since men currently make up the majority of the Department of Medicine and Department of Medicine senior positions, it is critically important that men are aware of the experiences of women faculty members.
  12. 12. Gender Equity in the Department of Medicine | 11 Qualitative Data Summary INTERVIEW METHODS: Department of Medicine members were invited to participate in one-on-one, confidential semi-structured interviews, conducted by a research assistant external to the Department. 28 interviews, including 22 women and 6 men were performed. All Department of Medicine members were invited to participate, and interviews were conducted with every person who contacted the research team. Interviewees were asked to define gender equity, if they wanted to discuss any survey questions, and their perspectives on a wide range of proposed interventions. INTERVIEW RESULTS: Exclusion Informal social events: Many concerns were raised that social exclusion of women Department of Medicine members prevents access to opportunity. Participants named these opportunities as the informal mentorship and networking that occurs for men physicians in places where women physicians are either not invited or not welcome, including at sporting events and some shockingly inappropriate venues. Figure 2. Inequities reported by women Department of Medicine members fell into two major categories: Parenthood & Caregiving and Leadership & Promotion. These inequities were mediated by two main experiences: Harassment & Discrimination and Exclusion. Exclusion Harassment & Discrimination Career & Leadership Parenthood & Caregiving I |
  13. 13. Gender Equity in the Department of Medicine | 12 While some of these events are not intentionally exclusive, multiple participants explicitly named numerous informal social events where only men physicians are invited by men Department of Medicine members in leadership and hiring positions. This allows differential and discriminatory access to mentorship, sponsorship, and networking opportunities that perpetuate male-dominated culture in the Department of Medicine. Social events that are open to any gender of physician but are held in unsafe spaces for women, such as at adult-only venues, are also considered exclusionary. Not only do certain events exclude women from developmental opportunities in medicine, intentional exclusion signals to women Department of Medicine members that they are different and less valued than their men colleagues. The message sent to women Department of Medicine members is that even when included, their opinions and contributions are less than men colleagues. Most informal social events are not egregious. Many social events, though informal and casual, perpetuate a differential access to opportunity based on gender. GFT superiority: There is ongoing tension between scheduling formal Department events during business hours, which may be easier for parents, GFT, and academic physicians, and holding formal events during non-business hours, which may be preferable for fee-for-service or clinical Department members. Lack of adaptability creates unintentional exclusion of particular groups. “Guys are going to [inappropriate venue] with the preceptors at some conference and of course you’re not going to go. We’re here at a professional conference.” - Woman “Most of the time I can’t attend grand rounds with my schedule because I’d lose [number of] patients every morning which I can’t afford to do.” -Woman “I can [outperform] any guy in [specific sport] yet I was never involved in the [specific sport] tournaments organized by my programme.” - Woman
  14. 14. Gender Equity in the Department of Medicine | 13 Racial intersectionality: Audible and visible minority women expressed concern that they were additionally disadvantaged in medicine. Harassment and Discrimination Sexual: All women interview participants provided contemporary personal examples of harassment and sexist language from patients, allied healthcare professionals, colleagues, and other Department of Medicine members. The majority of women participants reported unprofessional, unsolicited comments about their physical appearance. Participants emphasized that seemingly positive comments about age or physical appearance are not compliments, but instead highlight that women physicians are different and are not the "typical" physician. Women respondents explained that comments signal that they must earn trust and respect from patients whereas this trust and respect is given to men physicians on basis of gender alone. Note: Many comments experienced are in violation of the Charter and expose the Department of Medicine. There are multiple current examples from across Canada of women physicians suing their health systems due to harassment, intimidation and discrimination. II | “I’m female with an accent and I think that is a big barrier for many people to see me as someone that you could trust and that you can support. I found [building relationships] difficult.” - Woman “My Division Head once commented on my figure and this left me in a vulnerable position. Who was I to speak with about this?” - Woman
  15. 15. Gender Equity in the Department of Medicine | 14 Ineffective or absent reporting mechanisms: Many participants highlighted the lack of an external mechanism for reporting harassment and discrimination, resulting in unfettered power Department leaders. Examples of harassment and discrimination included lack of negotiation, lack of mediation, lack of alternative, and lack of arbitration. Respondents felt that the only alternative to silence in the face of harassment or intimidation of female Department of Medicine members by current leadership would be ‘blacklisting’. The impact of potential retaliation on reporting of harassment in discrimination cannot be understated; Department of Medicine members do not feel safe discussing these incidents with leadership. Career Advancement and Leadership Culture Conditional optimism: Many women and men expressed optimism that the recent work of the Department of Medicine to address inequity will be effective. Several comments were made that a change in culture began with a change in the Department of Medicine Chair, but that these valuable efforts and successes need to be better conveyed to the members. There were several comments that overall, the Department of Medicine is a safe and equitable place. Many follow-up comments stressed that the Department of Medicine should avoid complacency. III | “There’s no where you can really go if you wanted to report something. Where would you go and what would happen? I’d be blacklisted and targeted. So why would I do that, I’ll just make my life more difficult. So you just sort of suck it up, either continue to keep fighting which takes a lot of energy or you just do your work, go home, and enjoy your family.” - Woman “Nothing ever happens with these things, there's no punishment for this behaviour. It's been acceptable and rewarded in many situations.” - Woman
  16. 16. Gender Equity in the Department of Medicine | 15 Definition of equity: Men and women interview respondents agreed that the goal of equity should not be numerical parity but rather to identify and remove differential barriers experienced by women in medicine, adapt structures to meet the needs of parents, and create space for differences in leadership styles to be acknowledged and rewarded. Leadership culture: Several women commented that both themselves and their women colleagues are not interested in traditional leadership roles because these positions don’t represent their value systems. The current system was said to undervalue collaborative behaviours or behaviours that promote social capital. Current leadership structures were said to prioritize power and authority at the expense of integrity, consensual decision making, and service. Several comments articulated a need to change policies and culture; absence of one prevents success of the other. It was shared that rather than training women to lead like men (referring to traditional leadership approaches), both men and women leaders should embrace an alternative collectivist leadership style. “I’ve worked at many medical centers and I would say that this Department of Medicine is doing stalwart work at achieving gender equity than many other places, there are women visibly in positions of leadership in our Department. - Man “It doesn’t have to be 50/50 on every front because I think that’s a silly quota, irrespective of which gender is more represented. There needs to be absolute fairness, respect.” - Woman “Currently leadership is about power rather than system improvement.” - Woman
  17. 17. Gender Equity in the Department of Medicine | 16 Exclusionary or harassing leadership behaviours: The current leadership culture was noted to make it particularly unappealing to women, including sexist language, active exclusion of women from discussions, and conflict-oriented problem solving on committees. Inadequate leadership mentoring: Some women respondents felt they are not selected or trained for leadership roles despite seeming accomplished and having vision. Several comments were made about improving succession planning in leadership and including women in that succession planning. Desire for greater citizenship behaviours: Comments were made about promoting citizenship behaviour as a pre-emptive tool. The empathy and understanding gap between genders, amplified by generations is a root cause for many of the issues raised. Some comments articulated the challenge of raising awareness and believability for experiences that cannot easily be proved. It was felt that by reducing workplace toxicity, the Department could re-orient member time and energy towards greater societal challenges. “People think that doctors are like the kindest people and the most empathic people… we mostly are to our patients but to each other we are evil, and not very supportive, I have friends that are being spat on, [*distress in voice*], in meetings, and being told ‘Stop taking it so personal’ and it’s like: you’re asking a fact, I’m giving you a fact.” - Woman Note: ‘Spat on’ was described as someone yelling with sufficient aggression that with each ‘t’ or ‘p’ sound, the individual was spat on “It would be nice for women to talk to other women: How do you deal with work life balance? What are your tips for kind of getting through these few rough years? life stuff but also career stuff.” - Woman
  18. 18. Gender Equity in the Department of Medicine | 17 Complacency: Some comments raised the concern that while there are good role models for equity, diversity, and inclusion at the highest levels of the Department of Medicine, Alberta Health Services and University of Calgary leadership, a counterculture of discrimination and harassment exists with the Department of Medicine and is reinforced by lack of intervention by leadership. Many comments mention an additional lack of action from peers; people witness discrimination and harassment but do nothing. Parenthood and Caregiving Maternal Harassment and Discrimination: Respondents reported parental discrimination, including variable or complete lack of support for pregnancies, maternity leaves, and return to work as parents. Multiple participants expressed that, despite the expectation to return to work quickly after delivery, there is a lack of space for pumping, storage of breast milk, and support for ongoing breastfeeding from men colleagues. In addition, the Department events and scheduling don’t accommodate return to work with young children. IV | “I looked at the potential workload that she would have before delivering, and I just simply didn’t assign her to [heavy clinical] work rotations. Upon reflection, it was well intentioned, but I probably [shouldn’t have done that] without engaging in a discussion [with the female colleague].” - Man “When it comes down a few levels of leadership, those middle level people need to stand up to individuals that are behaving inappropriately and cut it off.” - Woman “We are working for our CV, not working for ourselves. We’re not working for something bigger and greater.” - Woman
  19. 19. Gender Equity in the Department of Medicine | 18 [more than one colleagues experienced this; this example from 2017] Paternal Exclusion: Some younger men reported that they have not been provided the same evolving opportunities for parental support that women receive. “[I was told] women who [are] more focused, tend to take shorter mat leaves. I left feeling like I better take a short mat leave because I don’t want to be perceived as someone who’s just not as focused. I don’t think it was intended that way but left with a bit of pressure to make sure I don’t stay away too long.” - Woman “As a father, I found the Department of Medicine not as supportive as I was expecting. No one said anything when my baby was born.” - Man [from open text box in survey] “[Men] are injured and hurt by the very dominant male patriarchy. [To fight against it] is seen as turning on their own” - Man “You don’t need a full-time position – your husband is working.” - Woman
  20. 20. Gender Equity in the Department of Medicine | 19 Maternal Exclusion: Many women felt although there was active dialogue about parenthood-related work changes, there was little action. Women felt inadequately supported and on occasion, actively discouraged, when planning or announcing a pregnancy. Participants reported extreme stress, lack of colleague support, and a high workload when planning clinical or academic coverage for maternity leaves. Women also reported challenges finding childcare when returning to work and found a lack of structural support while breastfeeding at work. Women universally reported that they returned to work earlier than desired after giving birth and uniformly performed unpaid clinical and academic work on maternity leave. “A lot of us end up working through our maternity leaves, unpaid, to keep projects going. We all accept that’s what [we have to] do." - Woman Empathy Gap Gender Misperceptions: Women Department of Medicine members repeatedly stated that their men colleagues had little insight into the challenges that they faced. These challenges have been reported numerous times in the literature, indicating that lack of insight from men into challenges faced by women colleagues is a systemic, pervasive, long-standing issue that impedes progress in gender equity. Several comments were made that exposure is required to understand differences. Several younger men (and many women) suggested men don’t understand women perspectives. There were comments that reinforced the ‘perception of understanding’ vs ‘actually understanding’. Thematically, participants felt this isn’t about political correctness for the sake of political correctness but empathy for the other person, and trust that their experiences are real. V | “Just because you have a daughter doesn’t mean you understand the female perspective.” - Woman
  21. 21. Gender Equity in the Department of Medicine | 20 Moral Hazard: Many men, often more senior, did not see gender inequity as a concern. A commonly shared belief was that physicians receive “equal pay for equal work” and that this is evidence of gender equity; these men stated that women who achieve less do so because they work or deserve less. Some men expressed discontent with having to cover maternity leaves. Several men articulated overemphasis of gender and race issues. “If you asked somebody, 'Have you got proof this is what’s happening?' The answer would likely be no, unless they know an individual circumstance and then you always find someone else who has an individual circumstance where it isn’t the case. There’s always the gender card that people can play, just like the racist (sic) card that people can play or whatever card you want to play if it suits their needs” - Man …
  22. 22. Gender Equity in the Department of Medicine | 21 Task Force Recommendations PROGRAMMES Implement training programmes for members with initial priority to titled clinical, educational or research leaders o Implicit bias training o Respect in the Workplace training Create opportunities for members to share gender-related experiences, challenges and allying opportunities within their Divisions o Gamification techniques in Divisional and Departmental meetings Create a fund to support a range of networking groups o ‘Women in Medicine’ group o Other women in medicine subgroups o Male allies group o Other new male or mixed groups [ie young men; LBGT; older men; adopting or planned adoption] Develop a Departmental knowledge management strategy for gender equity a. Annual best evidence audit b. Quarterly grand rounds; quarterly Divisional rounds on gender equity (regarding providers or patients) Facilitate sponsorship and mentorship a. Department of Medicine CV Catalogue to scan skills and interests b. Executive leadership training c. Long range succession planning d. Align with Department of Medicine -wide mentoring interventions Blind all applications where feasible o Begin blinding of IMRP CaRMS Address historical bias excluding women and other minorities in medicine o Commemorate with artwork celebrating historic female icons in science and medicine next to Hippocrates VI | V | IV | III | II | I | VII |
  23. 23. Gender Equity in the Department of Medicine | 22 POLICIES Improve accessibility of grand rounds and Divisional rounds o Streaming or podcasting Develop and enforce specific disclosure mechanisms o Annual report to membership and Department of Medicine Chair by Division chairs on inclusion, diversity and equity data o Annual report to membership from Department of Medicine Chair on inclusion, diversity and equity data o ‘Equity and Inclusion Disclosure’ requirement for all local and visiting speakers and lecturers (re: training received) Develop a reporting mechanism and severity scale for harassment and discrimination o Define and enforce a zero tolerance policy using input from the Department of Medicine membership o Match penalties for discrimination and harassment to severity of event o Publicly articulate anonymized penalties and violations Acknowledge necessity of Departmental oversight o Appoint a Department of Medicine Chief of Staff with a role in succession planning, faculty development and identification, and as a resource for equity, diversity and inclusion considerations Develop parenthood position statement and policies o Compensation for parents on parental leave o Mechanism to predict and manage schedule requests o Accommodations for adoptions o Physical infrastructure to facilitate breastfeeding on site o ‘Stop the Clock’ option for new faculty who want to pursue children before pursuing additional training (after fellowship) or GFT academic roles o Support for onsite or ‘near-site’ childcare through UCalgary, Alberta Health Services or childcare firms X | XI | XII | VIII | IX |
  24. 24. Gender Equity in the Department of Medicine | 23 Implement or develop routine measurement and evaluation tools o Harassment and intimidation (all Department members) o 360 degree assessments (leaders) o Citizenship behaviour (all Department members) o Metrics and benchmarks of inclusion, diversity and equity (Division and Department) Develop a code of conduct to articulate equitable conduct in Department of Medicine for both members or leaders o Develop in consultation with Department of Medicine membership XIII | XIV |
  25. 25. Gender Equity in the Department of Medicine | 24 Implicit Bias Training Respect in the Workplace Training Application Blinding Gamification Women in Medicine Group Other Women Subgroups Male Ally group Other Groups Annual Best Evidence Audit Quarterly GE Div/Dept Rounds DOM CV Catalogue Executive Leadership Training Long Range Succession Planning Application Blinding IMRP Commemorative Art Annual GE Report by Division Chiefs Annual GE Report by DOM Chair Speaker Disclosure Policy and Template Harassment Scale DOM Chief of Staff Compensation Plan for Parental Leave Mechanism to Manage Maternity Scheduling Requests Adoption Accommodation Policy Breastfeeding Infrastructure ‘Stop the Clock’ Policy Onsite or Nearby Child Care Harassment E&M Tool 360 Leadership E&M Tool Citizenship E&M Tool General GE E&M Tool Code of Conduct Recommendation Development Stages Development Stage Monetary Cost HR Cost Timeline Minor Minor Moderate Minor - Minor Minor Minor Minor - Minor - Minor Moderate - Minor Minor Minor Moderate Moderate - Minor Minor-Moderate - - Moderate Moderate Minor Moderate Moderate High - - - - $$ $ $ $ $ - $ $ - $$ (Crowdsource) - - - $ $$ - - - $$ - +/- $$$$ $$ +/- $ $$ $$ $$ Ready for pilot Literature review and draft proposal completed Literature review completed and stakeholders engaged Literature review completed Identified as a need area during assessment Active < 1 year 1-2 years 2-3 years 2-5 years (OR) Variable (AMHSP)
  26. 26. Gender Equity in the Department of Medicine | 25 Gender Disparities in Medicine Fact Sheet Harassment & Discrimination • A 2018 report on sexual harassment by the National Academies of Sciences, Engineering and Medicine found that more than 50% of female academics and 20-50% of trainees experience sexual harassment.1 • Medicine had the highest rates of sexual harassment of all STEM fields.1 • Sexual and gender-based discrimination is similarly well-described and highly prevalent in Canada.2,3,4,5,6 Parenthood • About 80% of female physicians will become mothers during their careers.7 • One quarter of female physicians report being explicitly discouraged from pregnancy by a colleague.8 • 15% of surgical program directors self-report that they advise female trainees not to pursue pregnancy and one-third stated that motherhood negatively impacts a residency program but fatherhood does not.9 • Pregnancy-related complications occur at higher rates in physicians than in non-physicians, and 20% of pregnancy physicians miss medical appointments due to work.10,11 • Most female physicians perform involuntary, unpaid work while on maternity leave and most return to work sooner than desired due to work.11 • Parenthood has a negative effect on career progress for physicians and this effect is greater for female physicians than male physicians.12 Leadership & Advancement • 80% of Alberta Health Services senior leadership, 53% of the AMA Board of Directors, and 69% of the CMA Board of Directors are male.13-15 • 88% of Canadian medical school deans are male.16 • 42% of Canadian physicians are female.17 • Female internists earn less than men regardless of whether they are generalists, hospitalists, or subspecialists.18 • Gender differences in salary exist in mid-career academic physicians, even after adjustment for differences in specialty, institutional characteristics, academic productivity, academic rank, work hours, and other factors.19 • When controlling for age, experience, specialty, and research productivity, women still don’t achieve the same rates of medical school leadership.20-21 • When CIHR reviewers primarily assessed the science (compared to when they assess the PI), there were no longer a statistically significant difference between success rates for male and female principal investigators.22
  27. 27. Gender Equity in the Department of Medicine | 26 1. Benya FF, Widnall SE, Johnson PA, et al. Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine. The National Academies Collection: Reports funded by National Institutes of Health. Washington (DC)2018. 2. Cook DJ, Griffith LE, Cohen M, Guyatt GH, O'Brien B. Discrimination and abuse experienced by general internists in Canada. J Gen Intern Med. 1995;10(10):565-72 3. LeFort S. Issues related to intimidation, bullying, harassment and sexual harassment in the Faculty of Medicine, Memorial University: Unit Assessment Report. 2018 4. Pattani R, Marquez C, Dinyarian C, Sharma M, Bain J, Moore JE, et al. The perceived organizational impact of the gender gap across a Canadian department of medicine and proposed strategies to combat it: a qualitative study. BMC Med. 2018;16(1):48 5. Grant M. Medical student's rape conviction first of its kind in Calgary. CBC News. 2018. 6. Susan P Phillps JW, Stephan Imbeau, Tanis Quaife, Deanna Hagan, Marion Maar. Sexual harassment of Canadian Medical Students: a national survey. Lancet. 2019. 7. Stentz N.C. GKA, Perkins E, DeCastro Jones R., Jagsi R. Fertility and childbearing among American female physicians. Journal of Women's Health. 2016;25(10):1059-61. 8. Pearson ACS, Dodd SE, Kraus MB, Ondecko Ligda KM, Hertzberg LB, Patel PV, et al. Pilot Survey of Female Anesthesiologists' Childbearing and Parental Leave Experiences. Anesth Analg. 2018. 9. Sandler BJ, Tackett JJ, Longo WE, Yoo PS. Pregnancy and Parenthood among Surgery Residents: Results of the First Nationwide Survey of General Surgery Residency Program Directors. J Am Coll Surg. 2016;222(6):1090-6 10. Walsh A, Gold M, Jensen P, Jedrzkiewicz M. Motherhood during residency training: challenges and strategies. Can Fam Physician. 2005;51:990-1. 11. Merchant SJ, Hameed SM, Melck AL. Pregnancy among residents enrolled in general surgery: a nationwide survey of attitudes and experiences. Am J Surg. 2013;206(4):605-10. 12. Phillips SP, Richardson B, Lent B. Medical faculty's views and experiences of parental leave: a collaborative study by the Gender Issues Committee, Council of Ontario Faculties of Medicine. J Am Med Womens Assoc (1972). 2000;55(1):23-6 13. Services AH. Female Physician Leaders in Alberta Health Services. 2018. 14. Canadian Medical Association: Board of Directors. https://www.cma.ca/cma-board-directors 15. Alberta Medical Association: Meet the Board. https://www.albertadoctors.org/leaders-partners/leaders/board/meet-the-board 16. Glauser W. Rise of women in medicine not matched by leadership roles. CMAJ News. March 26 2018. 17. CMA Data and Reports: https://www.cma.ca/En/Pages/canadian-physician-statistics.aspx 18. Read S, Butkus R, Weissman A, Moyer DV. Compensation Disparities by Gender in Internal Medicine. Ann Intern Med.;169:658–661. 19. Jagsi R, Griffith KA, Stewart A, Sambuco D, DeCastro R, Ubel PA. Gender differences in the salaries of physician researchers. JAMA. 2012;307:2410-7. 20. Jena AB, Khullar D, Ho O, Olenski AR, Blumenthal DM. Sex Differences in Academic Rank in US Medical Schools in 2014. JAMA 2015; 314: 1149–58 21. Ly DP, Seabury SA, Jena AB. Differences in incomes of physicians in the United States by race and sex: observational study. BMJ. 2016; 353:i2923. 22. Witteman H, Hendricks, M, Strauss S, Tannenbaum, C. Are gender gaps due to evaluations of the applicant or the science? A natural experiment of a national funding agency. The Lancet. 2019;393;10171; 531-540. Harassment&DiscriminationLeadership&AdvancementParenthood
  28. 28. Gender Equity in the Department of Medicine | 27 Literature Review Timeline Peer reviewed literature demonstrates persistent and consistent disparities between physicians that disadvantage women physicians. Sexual harassment in medical training1 . Sexual harassment poll of physicians2 . Experiences of woman in cardiothoracic surgery4 . Gender discrimination in academic medical careers7 . Compensation and advancement of woman in academic medicine8 . Discrimination and abuse experienced by general internists in Canada3 . Gender discrimination and sexual harassment in medical education6 . Motherhood during resident training: challenges and strategies9 . Workplace discrimination: experience of practicing physicians10 . The $16,819 pay gap for newly practicing physicians: men earning more than women12 . The male-female gap in physician earnings13 . What is a breast surgeon worth?15 Gender-based discrimination related to professional advancement among physicians16 . Gender-based discrimination during surgical training17 . Bullying, discrimination and sexual harassment in surgery18 . Physician mothers experiences of workplace discrimination23 . Gender and balance of parenthood and professional life24 . Patterns of disrespectful behavior at an academic medical center25 . Women in decanal roles in US medical schools26 . Gender equity in leadership of medical societies27 . Harassment & Discrimination Leadership & Academia Compensation Women in the radiology profession5 . Gender imbalance in academic medicine: female authorship in the UK11 . “I’m too used to it”: female medical students experiences14 . Equal work for unequal pay: the gender reimbursement gap for healthcare providers19 . Inequities in academic compensation by gender20 . Sexual harassment and discrimination experiences of academic medical faculty21 . The gender gap in Italian academic medicine: still a glass ceiling22 . Sexual harassment of Canadian medical students28 . The gender pay gap in Canadian academia29 . Differences in early career operative experiences among pediatric urologists30 . 1992 1996 2000 2004 2008 2012 2016 2018 2014 2010 2006 2002 1994 1998
  29. 29. Gender Equity in the Department of Medicine | 28 1. Komaromy M, Bindmand AB, Haber RJ, Sande MA. Sexual harassment in medical training. New England Journal of Medicine. 1993;328:322-6. 2. Association AM. Sexual harrassment poll of physicians. AMA Member Matters Newsletter. 1993. 3. Cook DJ, Griffith LE, Cohen M, Guyatt GH, O'Brien B. Discrimination and abuse experienced by general internists in Canada. J Gen Intern Med. 1995;10(10):565-72. 4. Dresler CM, Padgett DL, MacKinnon SE, Patterson GA. Experiences of women in cardiothoracic surgery. A gender comparison. Arch Surg. 1996;131(11):1128-34; discussion 35. 5. Deitch CH, Sunshine JH, Chan WC, Shaffer KA. Women in the radiology profession: data from a 1995 national survey. AJR Am J Roentgenol. 1998;170(2):263-70. 6. Lois Nora MM, Sue Foss, Terry Stratton, Amy Murphy-Spencer, Ruth-Marie Fincher, Deborah German, David Seiden, Donald Witzke. Gender discrimination and sexual harassment in medical education: perspectives gained by a 14-school study. Academic Medicine. 2002;77(12):1226-34. 7. Phyllis L. Carr LS, Rosalind Barnett, Cheryl Caswell, Thomas Inui. A “ton of feathers”: gender discrimination in academic medical careers and how to manage it. Journal of Women’s Health. 2003;12(10):1009-21. 8. Ash AS, Carr PL, Goldstein R, Friedman RH. Compensation and advancement of women in academic medicine: is there equity? Ann Intern Med. 2004;141(3):205-12. 9. Walsh A, Gold M, Jensen P, Jedrzkiewicz M. Motherhood during residency training: challenges and strategies. Can Fam Physician. 2005;51:990-1. 10. Coombs AA, King RK. Workplace discrimination: experiences of practicing physicians. J Natl Med Assoc. 2005;97(4):467-77. 11. Sidhu R, Rajashekhar P, Lavin VL, Parry J, Attwood J, Holdcroft A, et al. The gender imbalance in academic medicine: a study of female authorship in the United Kingdom. J R Soc Med. 2009;102(8):337-42. 12. Lo Sasso AT, Richards MR, Chou CF, Gerber SE. The $16,819 pay gap for newly trained physicians: the unexplained trend of men earning more than women. Health Aff (Millwood). 2011;30(2):193-201. 13. Theurl E, Winner, H. The male–female gap in physician earnings: evidence from a public health insurance system. Health Econ. 2010;20(10). 14. Babaria P, Abedin S, Berg D, Nunez-Smith M. "I'm too used to it": a longitudinal qualitative study of third year female medical students' experiences of gendered encounters in medical education. Soc Sci Med. 2012;74(7):1013-20. 15. Manahan E, Wang L, Chen S, Dickson-Witmer D, Zhu J, Holmes D, et al. What is a Breast Surgeon Worth? A Salary Survey of the American Society of Breast Surgeons. Ann Surg Oncol. 2015;22(10):3257-63. 16. Yasukawa K, Nomura K. The perception and experience of gender-based discrimination related to professional advancement among Japanese physicians. Tohoku J Exp Med. 2014;232(1):35-42. 17. Bruce AN, Battista A, Plankey MW, Johnson LB, Marshall MB. Perceptions of gender-based discrimination during surgical training and practice. Med Educ Online. 2015;20:25923. 18. Crebbin W, Campbell G, Hillis DA, Watters DA. Prevalence of bullying, discrimination and sexual harassment in surgery in Australasia. ANZ J Surg. 2015;85(12):905-9. 19. Desai T, Ali S, Fang X, Thompson W, Jawa P, Vachharajani T. Equal work for unequal pay: the gender reimbursement gap for healthcare providers in the United States. Postgrad Med J. 2016;92(1092):571-5. 20. Freund KM, Raj A, Kaplan SE, Terrin N, Breeze JL, Urech TH, et al. Inequities in Academic Compensation by Gender:A Follow-up to the National Faculty Survey Cohort Study. Acad Med. 2016;91(8):1068-73. 21. Jagsi R, Griffith KA, Jones R, Perumalswami CR, Ubel P, Stewart A. Sexual Harassment and Discrimination Experiences of Academic Medical Faculty. JAMA. 2016;315(19):2120-1. 22. Larese Filon F, Paniz E, Prodi A. The gender gap in Italian academic medicine from 2005 to 2015: still a glass ceiling. Med Lav. 2019;110(1):29-36. 23. Halley MC, Rustagi AS, Torres JS, Linos E, Plaut V, Mangurian C, et al. Physician mothers' experience of workplace discrimination: a qualitative analysis. BMJ. 2018;363:k4926. 24. Hill EK, Stuckey A, Fiascone S, Raker C, Clark MA, Brown A, et al. Gender and the Balance of Parenting and Professional Life among Gynecology Subspecialists. J Minim Invasive Gynecol. 2018. 25. Pattani R, Marquez C, Dinyarian C, Sharma M, Bain J, Moore JE, et al. The perceived organizational impact of the gender gap across a Canadian department of medicine and proposed strategies to combat it: a qualitative study. BMC Med. 2018;16(1):48. 26. Schor NF. The Decanal Divide: Women in Decanal Roles at U.S. Medical Schools. Acad Med. 2018;93(2):237-40. 27. Silver JK, Ghalib R, Poorman JA, Al-Assi D, Parangi S, Bhargava H, et al. Analysis of gender equity in leadership of physician-focused medical specialty societies, 2008-2017. JAMA Intern Med. 2019;179(3):433-5. 28. Susan P Phillps JW, Stephan Imbeau, Tanis Quaife, Deanna Hagan, Marion Maar. Sexual harassment of Canadian Medical Students: a national survey. Lancet. 2019. 29. Bessma Momani ED, Kira Williams. More than a pipeline problem: evaluating the gender pay gap in Canadian academia from 1996-2016. Canadian Journal of Higher Education. 2019;49(1). 30. Suson KD, Wolfe-Christensen C, Elder JS, Lakshmanan Y. Differences in early career operative experiences among pediatric urologists. J Pediatr Urol. 2018;14(4):333 e1- e7.
  30. 30. Gender Equity in the Department of Medicine | 29 Appendix MSEC Department of Medicine Gender Equity Action Plan DOM Gender Equity Action Plan June 2019 This Action Plan is in response to the 2019 DOM Gender Equity Report. Specifically, this action plan focuses on addressing the programme and policy recommendations contained within the report. This Action Plan was developed by a representative committee from within the DOM Leadership team. The committee was chaired by Dr. Holroyd-Leduc and the members included Drs. Bharwani, Ruzycki, Muruve, Reimche, Mintz, and Flemons. In order to help implement the identified goals, the DOM will form an Equity and Diversity Working group. This working group will be co-Chaired by Dr. Holroyd-Leduc (Deputy Department Head - Academic) and Dr. Ruzycki (Associate Director of Physician Wellness and Vitality), and its membership will include 1-2 representatives from each of the divisions within the DOM. Membership on the working group will be open to all genders, and efforts will be taken to recruit a working group that reflects the diversity within the DOM at large. Goals within this Action Plan were divided into 4 categories: Current State – relevant programmes/policies already in place within the DOM Short Term Goal – to be put into place within the next year Mid Term Goal – to be put into place within the next 1-3 years Long Term Goal – targeted within the next 5 years Calgary Zone
  31. 31. Gender Equity in the Department of Medicine | 30 PROGRAMME FOCUS Recommendation #1: Implement training programmes for members with initial priority to titled clinical, educational or research leaders Action Plan: Implicit Bias Training: • CURRENT STATE: Search and Selection committee members for university positions (GFT; leadership) have to do implicit bias training as part of committee membership, and there are criteria that the committee has to follow in order to minimize inequities. Several DOM leaders have already completed implicit bias training. • SHORT TERM GOAL: All Deputy Department Heads, Vice-Chairs, Directors, Associate Directors, Division Heads, Divisional Site Leads, Program Directors, Associate Program Directors, and Chief Residents will complete Implicit Bias training, if they have not done so already. • LONG TERM GOAL: All DOM members will complete Implicit Bias training. Respect in the Workplace Training • CURRENT STATE: All DOM members are required to complete the UofC or AHS Respect in the Workplace training and the AHS Indigenous Health training (module 1). Recommendation #2: Create opportunities for members to share gender-related experiences, challenges and allying opportunities within their divisions. Action Plan: • MID TERM GOAL: Each DOM division will hold a facilitated retreat in order to start to discuss these gender-related issues. These retreats will include empathy training. Following the retreat, each division will determine how to regularly incorporate these discussions into future division events.
  32. 32. Gender Equity in the Department of Medicine | 31 Recommendation #3: Create a fund to support a range of networking groups Action Plan: • CURRENT STATE: The DOM has held 2 DOM Women in Medicine events in the past 18 months (Women in Medical Leadership; Women and Imposter Phenomenon). The last event was held in collaboration with the AMA Well Doc program. The plan is to continue to hold events 1-2 times per year on topics of particular relevance to female DOM members. Other groups are free to form, and the DOM will provide support as able in facilitating their events if the group’s terms of reference are consistent with the DOM goal of promoting equity and diversity. • MID TERM GOAL: DOM to sponsor a session on “How to be an Effective Ally” Recommendation #4: Develop a departmental knowledge management strategy for gender equity Action Plan: • SHORT TERM GOAL: A DOM Equity and Diversity Working group will be formed that includes 1-2 members from each division. The DOM Equity and Diversity Working group will help ensure the various parts of the DOM Equity and Diversity Action plan are implemented. Membership on the working group will be open to all genders, and efforts will be taken to recruit a working group that reflects the diversity within the DOM at large. • SHORT TERM GOAL: The DOM will hold 3-4 DOM Grand Rounds each year on topics related to gender and diversity within the healthcare work environment. The topics and speakers will be chosen by the DOM Equity and Diversity Working group. Recommendation #5: Facilitate sponsorship and mentorship Action Plan: • CURRENT STATE: The DOM has a promotion mentorship program in place already (for both GFT and clinical promotions). • CURRENT STATE: There are a number of leadership training opportunities currently available to DOM members (e.g. CSM Leadership program; UofC PLUS program; CMA Joule courses: AHS Leadership training; Harvard Leadership courses)
  33. 33. Gender Equity in the Department of Medicine | 32 • SHORT TERM GOAL: DOM CV Catalogue to be piloted, with plan to launch more broadly if pilot is successful. This is a tool that can be searched by CARE pillar categories in order to help DOM members find mentors/sponsors or identify more senior DOM members to contact for advice or coaching. Recommendation #6: Blind all applications where feasible Action Plan: • (NOTE: Blinding of IMRP CaRMS applications is currently not feasible) • CURRENT STATE: DOM has a written policy requiring that all DOM/division leadership positions be distributed/advertised so that all DOM/division members are aware of and can apply for these positions. There is also a clear hiring process to follow if more than one individual applies for a DOM/divisional leadership position. This process is consistent with UofC hiring policies that focus on minimizing inequities. POLICY FOCUS Recommendation #1: Improve accessibility of grand rounds and divisional rounds Action Plan: • CURRENT STATE: All DOM Grand Rounds are currently video-conferenced and podcasted (consent from the speaker is acquired before the podcast is released). • SHORT TERM GOAL: All divisional meetings will include video-conference/teleconference +/- podcast options. • SHORT TERM GOAL: All division members, without exceptions, will be invited to and included in their respective divisional rounds, meetings and events in an effort to encourage an environment of inclusiveness.
  34. 34. Gender Equity in the Department of Medicine | 33 Recommendation #2: Develop and enforce specific disclosure mechanisms Action Plan: • SHORT TERM GOAL: All presenters at DOM rounds will be asked to include a disclosure slide outlining attempts they have taken to ensure inclusivity/bias reduction in their presentation. A standardized “Equity and Inclusion Disclosure” slide template will be provided to all presenters. • SHORT TERM GOAL: As part of the DOM Annual Report, each division will be asked to provide statistics by gender (male; female; non-binary) for new hires, promotions, parental leaves, leadership roles (DOM level - deputy dept heads, dept vice-chairs, directors, associated directors, program directors, associate program directors, site leads, other divisional level leaders; University level; AHS level). Recommendation #3: Develop a reporting mechanism and severity scale for harassment and discrimination Action Plan: • SHORT TERM GOALS: The DOM will provide information on the DOM Website about the details around how to report harassment and discrimination using the current AHS and UofC processes. Individuals can also go to their Division Head, Dr. Leigh or Dr. Holroyd-Leduc with concerns. • LONG TERM GOAL: The DOM will explore and attempt to put into place an online system where anonymized complaints are stored (date stamped) and, once a critical number of complaints against one person are received based on severity of the complaint(s), all those who submitted a complaint are notified and asked if they want to file a formal complaint. (There is software (Callisto) currently available in the U.S., however it is not currently available in Canada). The DOM Equity and Diversity Working group will be tasked to look into this further.
  35. 35. Gender Equity in the Department of Medicine | 34 Recommendation #4: Acknowledge necessity of departmental oversight Action Plan: • CURRENT STATE: Dr. Holroyd-Leduc currently supports Dr. Leigh around issues of succession planning and faculty development. Dr. Holroyd-Leduc, with the support of Drs. Barnabe, Ruzycki, Bharwani and Leigh, will be the DOM individual to take the lead on issues related to equity, diversity and inclusion. Recommendation #5: Develop parenthood position statement and policies Action Plan: • CURRENT STATE: The DOM Career Adaptation Guideline is already in place. Overall, the DOM supports flexibility around career planning/development, including issues related to paternity leave, as much as is possible within current university and AHS structures/policies/procedures. • SHORT TERM GOAL: The DOM will help support career development of trainees who are not able to go to another institute to pursue further training before being hired onto faculty. This will include supporting “Virtual Fellowships” with distance mentoring as able. • SHORT TERM GOAL: Division Heads or their delegate(s) will meet (or offer to meet) with all trainees within their training programs to discuss career planning. • SHORT TERM GOAL: Drs. Ruzycki and Bharwani are advocating for the physical infrastructure to facilitate breastfeeding (i.e. lactation pods). A request has gone to AHS leadership. If there is no response from AHS, DOM will take on a leadership role in providing this resource, and rally other departments to contribute to addressing this issue. The goal is to have pods at all five acute care hospitals, Sheldon Chumir and Richmond Road. The DOM also supports woman who chose to breastfeed in public spaces.
  36. 36. Gender Equity in the Department of Medicine | 35 Recommendation #6: Implement or develop routine measurement and evaluation tools Action Plan: • CURRENT STATE: Dr. Bharwani and others are working on a 360 tool, based on prior leader ship development needs assessments. The next phase will involve understanding, modifying and refining this 360 tool, in an effort to promote an equitable, civil leadership culture. The goal will be to develop and refine a tool that prevents known gender-bias inherent in current leadership evaluation assessments. • LONG TERM GOAL: The DOM Equity and Diversity Working group will be tasked to develop metrics and benchmarks of inclusion, diversity and equity within the DOM, as well has ways to evaluate citizenship behaviour of DOM members. Recommendation #7: Develop a code of conduct to articulate equitable conduct in DOM for both members or leaders Action Plan: • MID TERM GOAL: The DOM Equity and Diversity Working group will be tasked to draft a Code of Conduct regarding equitable conduct in the DOM. The developed Code of Conduct will be approved by MSEC as an amendment to existing AHS and U of Calgary Codes of Conduct, and then distributed to all DOM members.

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