Emergency medicine is not alone; gender-based exclusion has been described in other medical subspecialties and at multiple training levels.^6,7 Female medical students reported a broad range of discriminatory behaviors from male attendings, such as failing to make eye contact, employing only male pronouns when referring to physicians, and disproportionately encouraging male students compared to their female counterparts. Medical students even reported that these smaller actions disrupted learning more than blatant harassment and discrimination.⁸

Studies show gendered stereotypes adversely affect women’s work performance.^9,10 Repeated comments that reinforce gender stereotypes, either blatant or subtle, exert a substantial force that influences not only women’s training but also their identity as doctors. One study found that female medical trainees did not feel equipped to navigate unprofessional behavior from male superiors. As a result, the women experienced guilt and resignation that this would become a part of their professional identity.⁷

Personal relationships built early in our medical careers lay the foundation for our professional trajectory. In studies of gender gaps in academic medicine, bias in the workplace is often cited as a limiting factor for career advancement.¹¹ If jocularity and a sense of camaraderie are restricted to our male colleagues from the start of training, this could have downstream career effects.

Even though seemingly subtle, repeated comments and acts of gender discrimination add up to a substantial force that causes women to question their legitimacy and place in medicine, affecting both their careers and their identities as women and physicians.

Let’s Take Action

How do we fix this? We propose three immediate actions for leadership in our field:

1. Implement bias intervention training and discussions. Bias interventions can occur on both an individual and institution-wide scale. Attendings can incorporate their own awareness of gender bias to reduce the impact of implicit bias on resident evaluations.¹² Residency programs should incorporate data-driven implicit bias education into their lectures and grand rounds. A randomized controlled trial of bias interventions found that faculty members trained to acknowledge and actively disrupt their own bias habits were better able to promote gender equity.¹³

2. Work to increase the ratio of women faculty members and create mentorship programs for female residents. A narrative review of studies on women in academic medicine found that a lack of mentorship constitutes a significant barrier for many women who wish to pursue an academic career.¹¹ Seeing women in positions of leadership inspires other women and helps create an environment supportive of female physicians and trainees. Inviting female lecturers and speakers and creating mentorship and networking events for women are also structured ways for programs to support their female residents.