Challenging Sexism

Sexism text in dictionary highlighted by a pink pen.

What is sexism?

Sexism is...

prejudice or discrimination based on one's sex or gender

Sexism can affect anyone, but primarily affects women and girls

Source: United Nations

Why challenge sexism?

Several years ago at Warwick Medical School we introduced a question at the end of every block feedback for students asking if they had experienced any concerns relating to Equity, Diversity or Inclusion. This was part of our anti-racist work, however to our surprise the most common issue raised was sexism - particularly from students on clinical placements. We were reading comments such as:

“It was widely noted that the consultant would only direct teaching to the male in the room, ignoring me (the female). This went as far as answering my questions to my male clinical partner.”

“I have witnessed a lot of misogynistic behaviour [at hospital site] this block which I was not sure how to deal with... This evolved around women not 'being suitable' for specific roles.”

These reports were almost exclusively from female-identifying students.

This resource has been produced as a response to this feedback to help inform about the issue, but also to provide guidance on how you can help make a difference. You can use it in 2 ways - either work through it on your own, or it can be used as the basis for a small group teaching session. Either way, do please allow yourself time to reflect on your own experiences, reactions to the material and intentions to help change the learning and workplace culture for our students.

Professor Kate Owen

Director of Medical Studies

Prof Kate Owen

Nolan, H.A., Owen, K. Medical student experiences of equality, diversity, and inclusion: content analysis of student feedback using Bronfenbrenner’s ecological systems theory.

BMC Med Educ 24, 5 (2024). https://doi.org/10.1186/s12909-023-04986-8

What does sexism look like?

91% of women doctor respondents in the UK had experienced sexism at work with 42% feeling they could not report it.

Respondents of all genders said they felt there was an issue of sexism in the medical profession.

BMA - Sexism in medicine report
GMC - GMC responds to BMA sexism report (October 2019)
Legal - Discrimination: your rights

Sexism and sexual harassment: key information

The ACAS definition states that sexual harassment includes;

“creating an intimidating, hostile, degrading, humiliating or offensive environment for them, whether it was intended or not”.

What is sexual harrassment?

Examples include:

making sexual remarks about someone's body, clothing or appearance
asking questions about someone's sex life
telling sexually offensive jokes
making sexual comments or jokes about someone's sexual orientation or gender reassignment
displaying or sharing pornographic or sexual images, or other sexual content
touching someone against their will, for example hugging them
sexual assault or rape

What some people might consider as joking, 'banter' or part of their workplace culture can still be sexual harassment.

What is the impact of sexism?

It's important: sexism impacts on people, communities, organisations and society.

Professional impacts:

Reduced job satisfaction
Organisational withdrawal
Reduced productivity
Reduced performance

Health & Well-being

Depression
Stress
Anxiety
Reduced self esteem
Serious mental health problems

Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine.

National Academies of Sciences, Engineering, and Medicine; Policy and Global Affairs; Committee on Women in Science, Engineering, and Medicine; Committee on the Impacts of Sexual Harassment in Academia; Benya FF, Widnall SE, Johnson PA, editors. Washington (DC):National Academies Press (US); 2018 Jun 12.

How common is sexism?

It's common for medical students and doctors in training.

Female surgical trainees experience high levels of sexual misconduct

This UK study of 1704 surgical trainees revealed that:

63.3 per cent of women reported being the target of sexual harassment.

versus

23.7 per cent of men.

29.9 per cent of women had been sexually assaulted.

versus

6.9 per cent of men.

10.9 per cent of women experiencing forced physical contact for career opportunities (a form of sexual assault).

versus

0.7 per cent of men.

Christopher T Begeny, Homa Arshad, Tamzin Cuming, Daljit K Dhariwal, Rebecca A Fisher, Marieta D Franklin, Philippa C Jackson, Greta M McLachlan, Rosalind H Searle, Carrie Newlands, Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities: observational study using NHS population-derived weights,

British Journal of Surgery, Volume 110, Issue 11, November 2023, Pages 1518–1526.

Medical students' experiences

This 2023 qualitative study reveals sexism to be a common experience for medical students on placement, associated with significant impacts on learning and wellbeing. It also raises the issues of hierarchies impacting students feeling able to report.

Ibrahim D, Riley R. Female Medical Students' Experiences of Sexism during Clinical Placements: A Qualitative Study. Healthcare (Basel). 2023 Mar 31;11(7):1002.

Intersectionality

Intersectionality is a concept for understanding how aspects of a person's identities combine to create different and multiple discrimination and privilege.

Examples of these aspects are gender, race, sexuality, religion, disability or age.

There are many other intersectionality identities in addition to the protected characteristics.

Intersectionality identifies multiple factors of advantage or more commonly disadvantage & may be both empowering and oppressing.

Hussain NM, Spiers J, Kobab F, Riley R. The Impact of Race and Gender-Related Discrimination on the Psychological Distress Experienced by Junior Doctors in the UK: A Qualitative Secondary Data Analysis. Healthcare (Basel). 2023 Mar 12;11(6):834.

Sexism and sexual harassment: Learning activity

Step 1: watch

The video shows a dramatised scene between two medical students, Katie and Bhadar, and their supervising consultant surgeon. This is not an actual event, but based on real student experiences. All roles are played by actors. The video does show examples of sexist behaviour.

Step 2: reflect on questions and evidence

Now that you have watched the video please reflect on answers to the following questions.

Is there sexism or sexual harassment in the video?

There are several examples of sexism in the video.

0.44 opportunity to scrub in offered to Bhadar only
1.10 Katies wish to be a surgeon ignored
1.10 Use of language "man-up" supports the trope that "surgery is for men"
1.15 Suggestion that women should perform more menial tasks "you dont mind picking up the slack of it do you?
1.22 Sterotypical suggestion that women are better at multi-tasking (a skill which might be useful for a future surgeon)
There is no clear evidence of sexual harrassment, however the frequent use of negative gender stereotypes could be construed as producing a hostile environment.

REFLECT: Have you witnessed or experienced sexism or sexual harrassment in your place of work or study?

What gender stereotypes are seen in the video?

A gender stereotype is a generalized view or preconception about attributes or characteristics, or the roles that are or ought to be possessed by, or performed by, women and men. A gender stereotype is harmful when it limits women’s and men’s capacity to develop their personal abilities, pursue their professional careers and/or make choices about their lives.

Whether overtly hostile (such as “women are irrational”) or seemingly benign (“women are nurturing”), harmful stereotypes perpetuate inequalities. For example, the traditional view of women as care givers means that child care responsibilities often fall exclusively on women.

"Women are better at multi-tasking" Studies consistently show that this is incorrect. It is more likely that women are historically more likely to take on multiple tasks for example working, childcare and housework.

"It's not all ladies first here" The origin of this phrase is on mediaeval chivalry where men graciously gave up their right to precedence in certain circumstances- usually those which had no power or opportunity associated with them. In the modern era where we are working towards gender equality this is an outdated statement. The use of "ladies" instead of "women" is also considered by many women to be outdated, patronising and demeaning. For context, consider when you last hear a woman referring to "gentlemen"- the corresponding male term.

"Man-up"- implies that surgery is a mans job. This sterotype has had a major impact on the number of women seeking surgical careers. Currently 80% of consultant surgeons are male in the UK. There is less difference in trainees. There is evidence from two 2023 studies in JAMA that women may be safer surgeons than men.

REFLECT: Are you aware of gender stereotypes in your current workplace or learning environment? If so, what are they?

What social stereotypes are shown in the video?

Traditionally in most (but not all) societies globally women were the primary care-givers and men the primary providers. Aspects of this are still ingrained in our society today with women being more likely to take on childcare, housework and supportive tasks. This is no different in medicine as we see in the video.

This has an impact on language where attributes traditionally associated with femininity are called "soft skills" and men and women are described differently for displaying similar characteristics: Men are assertive women are stroppy or aggressive.

In the video (0.52) Katie is worried about being seen as a "Whinger" if she complains.

REFLECT: Do you think a male student would worry less about this? Are you aware of any socail stereotypes you may hold?

Top tips on changing your behaviours:

STOP: Pause to reflect on your own unconcious biases. You might like to try a Harvard Implicit Association TestLink opens in a new window

LOOK: Observe what is happening around you and speak up as an active bystander.

LISTEN: Really listen to the experiences of others. Read books and articles by women which explore their experiences of the world.

THINK: Does your organisation need to change? Can you help drive change?

What lifestyle assumptions are shown in the video?

There are no assumptions about lifestyle in the video, but it is a commonly reported issue by medical students and doctors in training, particularly regarding choice of careers and perceived fit with child-bearing and child-care.

Why might someone not want or be able to have children? There are many reasons social, biological, psychological and above all its a very personal choice.
- Even if students do want children, it is still assumed that women will take on the main childcare while men progress their careers.
- Reflect on how can assumptions impact on how people feel
15% of 18-25 year olds say they never want children (double that of 15 years ago)
More than 50% of women in the UK were child-free in 2020 - the highest ever proportion.

REFLECT: Do you make gendered assumptions about lifestyle? Is this something you experience in your own life?

Who can be an active bystander?

Being an active bystander is a role for everyone.

Active bystander strategies work in response to behaviours like sexual misconduct, harassment, racism, sexism, homophobia, transphobia, and more.

The 5 D's of active bystanding

Only intervene in a way that is safe for you.

Distract: create a distraction to interrupt the harmful behaviour and/or offer a victim opportunity to move away.
Delegate: engage others with the necessary skills, training, or authority to assist in making an intervention.
Direct: challenge the behaviour or attitudes directly if it is safe to do so.
Delayed: offer support to the person affected by the situation, signpost to support services and reporting routes.
Document: make a record of key information to aid with delegating and reporting, and/or to dissuade further harmful behaviour.

Look back at the video - which of these strategies does Bhadar use?

REFLECT: How could you use each of these if you were Bhadar?

Be an active bystander

Further training is available: Register now for the active bystander intervention course.

What might be the role of hierarchies?

Medicine is a hierarchical profession and the video clearly shows the imbalance in power between the consultant and students. Hierarchies have been repeatedly found to sustain gender and racial inequalitiesLink opens in a new window. This results in fewer women progressing in clinical academiaLink opens in a new window, becoming professors and achieving consultant level in some specialties. The video is a good example of how this happens.

In the video Katie thinks she is "going mad" and is relieved to realise "its not just me". The combination of hierarchy and sexism have an impact on her choice of career at a very early age.

We still see all-white, all-male panels (manels) at interviews and at conferences- and again we can take action on these!Link opens in a new window

Whilst the experience of older doctors may have been learning through fear and humiliation in very hierarchical teams this can change. Of course hierarchies can be positive when functioning well, providing clinical leadership and support. However when dysfunctionalLink opens in a new window they can discourage the voicing of concerns, legitimize trainee mistreatment, and create moral distress through ethical dilemmas. Such an environment endangers patient safety, undermines physician empathy, hampers learning, lowers training satisfaction, and amplifies stress, fatigue, and burnout.

REFLECT: How much have your personal values been shaped by how you were taught in the workplace? What could you do if invited to an event with a "manel"?

Consider what impact does sexism have on personal and professional identity?

In the video what impacts are there on Katie of this encounter both personally and professionally?

Women who took part in the BMA survey said that they suffer patronising comments, are being judged on their appearance, can be overlooked in their career progression or are ignored by patients and other doctors in favour of their male colleagues.

Thirty-nine per cent of women and 11% of men felt they had been discouraged from and chosen not to work in a particular medical specialty because of their gender.

41% of women cited surgery as the specialty they felt most discouraged from pursuing, while 53 per cent of men responding to the survey said this about obstetrics and gynaecology.

When it came to medical training, 44% of women told the survey they felt they had had fewer opportunities for development than their colleagues who were men, compared to just eight per cent of men when talking about women colleagues.

Meanwhile 18% of women said that they had been actively discouraged from applying for senior roles in their workplace such as GP partnership or clinical director, compared to just three per cent of men.

‘I have seen a female colleague take on and then drop a leadership position,’ a male consultant told the survey.

‘She was not supported; the position was ill defined and expectations not achievable. When she tried to resolve this, she was side-lined, so her position became untenable. She has since been overlooked for promotion whilst a male colleague has been supported over her.’

REFLECT: Has your own professional identity been impacted by discrimination or stereotyping?

Step 3: What can I do?

If you observe sexist behaviour please take action! We know that the majority of sexist behaviour and sexual harassment goes unreported as people do not believe that anything will happen in response.

Active Bystander

Be an active bystander. If you have not trained in this please sign up.

Visit the conduct-related support for all students web pages

Remember the 5 D's

Only intervene in a way that is safe for you.

Distract: create a distraction to interrupt the harmful behaviour and/or offer a victim opportunity to move away.
Delegate: engage others with the necessary skills, training, or authority to assist in making an intervention.
Direct: challenge the behaviour or attitudes directly if it is safe to do so.
Delayed: offer support to the person affected by the situation, signpost to support services and reporting routes.
Document: make a record of key information to aid with delegating and reporting, and/or to dissuade further harmful behaviour.

Report it!

This can be through the MBChB concerns process, report and support or via your own institution or workplace.

MB ChB Concerns process Report + Support

#ForAllWomenAndGirls

Ask leaders to take action and invest in promoting women’s rights and gender equality. Share International Women’s Day stories and messages on digital platforms, using the hashtag #ForAllWomenAndGirls to spark dialogue and inspire action.

Concept development and web resource design: Imogen Davies, Kate Owen, Cath Fenn.

Film script development and production: Imogen Davies, Catherine Bennett, Emily Unwin, Ben Robinson @ Zebra Digital

Thank you to Sam Cook and staff at George Eliot Hospital who made filming possible.

Thank you to Esther David-West, MB ChB Digital Education Intern who provided valuable feedback.

Contacts:

Prof Kate Owen Dr Imogen Davies I.Davies.3@warwick.ac.uk