User login
AUSTIN, TEX. – Women are making progress in equal representation and leadership within the field of forensic psychiatry, but gender parity remains elusive, according to a presentation at the annual meeting of the American Academy of Psychiatry and the Law.
In the presentation, Kelly L. Coffman, MD, MPH, assistant professor of psychiatry and associate program director of the forensic psychiatry fellowship at Emory University, Atlanta, and Helen M. Farrell, MD, a lecturer at Harvard Medical School, Boston, discussed gender bias in the field and in medicine at large.
After reviewing a handful of Supreme Court cases since the 1970s establishing women’s rights to equal opportunities and harassment-free workplaces, Dr. Farrell noted a recent commentary in the New England Journal of Medicine illustrating the challenges women still face. In that commentary, Reshma Jagsi, MD, a professor of radiation oncology at the University of Michigan, Ann Arbor, and director of the Center for Bioethics and Social Sciences in Medicine, shared her own #MeToo experience within the context of such harassment narratives throughout academic medicine (N Engl J Med. 2018;378:209-11).
Harassment found in medicine
Dr. Jagsi had published a study in 2016 on workplace sexual harassment in medicine that surveyed 1,066 recipients of career development grants from the National Institutes of Health (JAMA. 2016;315:2120-1). The average age of respondents was 43 years, and 46% of respondents were women.
While only 22% of men reported perceiving gender bias in their careers, 70% of women reported such bias. Similarly, 66% of women said they had experienced gender bias in their careers, compared with 10% of men (P less than .001). Women also were substantially more likely to have experienced sexual harassment (30% vs. 4%).
Most women (92%) reporting those experiences described sexist remarks or behavior, 41% experienced unwanted sexual advances, and 9% experienced coercive advances.
“Although a lower proportion reported these experiences than in a 1995 sample, the difference appears large given that the women began their careers after the proportion of female medical students exceeded 40%,” Dr. Jagsi and her colleagues reported in the study.
The effects of those experiences were not minor: Among women who reported harassment, 59% said their confidence as professionals took a hit, and 47% said those experiences hurt their career advancement.
Women still underrepresented
One factor in those high rates might be the extent of existing power differentials: Women remain underrepresented in medical leadership despite accounting for more than half of all enrollees in U.S. medical schools in 2017, according to the Association of American Medical Colleges (AAMC). Female enrollment in medical schools hovered around 40% in the mid-90s, yet in 2015, the AAMC reported that women held 37% of all U.S. medical school faculty positions and 20% of full professorships.
“There’s also a large discrepancy in terms of specialties,” said Dr. Farrell, also a staff psychiatrist at Beth Israel Deaconess Medical Center, Boston. “Women tend to go into fields like pediatrics and ob.gyn. at much higher rates than men, and there are very low rates of women going into surgical fields like neurosurgery and orthopedics.”
Dr. Farrell then zeroed in on the field of forensic psychiatry in particular and various ways to consider how gender bias might manifest: opportunities for exposure to forensics in residency; fellowship applications vs. acceptances; experience in court; publications; invitations to present; large- and small-scale organizational leadership representation; and job placement across the settings of clinics, academics, prisons/institutions; and experience in private practice. Then there’s the perception of female forensic psychiatrists in court.
“There’s a really big question about the difference between how men and women are perceived by attorneys who hire us as experts, and by judges and juries in terms of our credibility when we’re testifying,” Dr. Farrell said.
Picking up where Dr. Farrell left off, Dr. Coffman noted that women always have faced an uphill battle – particularly within forensic psychiatry.
“Forensic psychiatry really is the global intersection of medicine, the criminal justice system, and the law – and traditionally, all three of these fields have really been male dominated,” Dr. Coffman said. “We were often told that women should not go into careers like medicine and the law, because if they work too hard, they might ruin their reproductive potential. They were also thought of as being weak and unable to handle seeing blood.”
Fortunately, however, she added: “That’s very different from how we think about things today.” For example,
Gender perceptions matter
Those numbers show progress, though “we’re a little bit behind the trends,” Dr. Coffman said. One reason for this probably is rooted in implicit biases that shape a person’s thinking, without a conscious realization of the sexist ideas about gender roles that have been internalized.
She presented two descriptions of an individual to make her point: one an accomplished scientist, tax attorney, and major political figure, and one a loving parent with a reputation for “always being well-coiffed and tastefully dressed.” Both depictions describe Margaret Thatcher, the first woman to become prime minister of the United Kingdom.
“There’s that real disconnect between the woman and the role, and that that’s where the prejudice lives,” Dr. Coffman said. “The greater the mismatch you see, the greater potential for prejudice.”
Research backs up those assertions. Dr. Coffman shared findings from a study that compared how male and female doctors introduced one another as speakers (J Womens Health [Larchmt]. 2017 May;26[5]:413-9).
Across 321 forms of address, women were more likely to use professional titles when “introducing any speaker during the first form of address, compared with male introducers (96.2% vs. 65.6%).” When the researchers drilled deeper, they found that women introduced others using their professional titles 97.8% of the time (45/46), while men used professional titles to introduce 72.4% of the time (110/152). A disparity was found in mixed-gender introductions: Women used professional titles when introducing men 95% of the time (57/60), but men did the same with women 49.2% of the time (31/63).
Research on perceptions of women as expert witnesses in court is more complicated. In one experiment, for example, mock jurors read a written summary of a civil case where the expert’s opinion was written by either a male or female automobile engineer. The jurors reached the same verdict just as often with female as male engineers – but awarded higher damages when the engineer was a woman.
But that was a written experiment. In similar research where mock jurors viewed video summaries involving cross-examination of a forensic mental health expert, men were found to be more “likable, believable, trustworthy, confident, and credible” than were women.
This and other research underscore a common dilemma for women, Dr. Coffman said: balancing the expectation of being warm and the need to appear competent – both of which can help and harm the way in which women are perceived. But the reality of perception sometimes can surprise.
She pointed to the double-edged sword of eye contact as an example: “If you don’t make eye contact, then you’re perceived as being weak. But if you make too much eye contact, then you’re perceived as being aggressive. So you really can’t win, right?”
Yet the women remained cautiously optimistic, especially noting the large proportion of men attending the session itself.
“It really takes everybody working together to keep the conversation going, finding out where women want to flourish and bloom, and having people to champion us and support that,” Dr. Farrell said.
Dr. Coffman and Dr. Farrell had no relevant conflicts of interest. They will be presenting an expanded version of the presentation at the International Academy of Law and Mental Health meeting in July 2019 in Rome.
AUSTIN, TEX. – Women are making progress in equal representation and leadership within the field of forensic psychiatry, but gender parity remains elusive, according to a presentation at the annual meeting of the American Academy of Psychiatry and the Law.
In the presentation, Kelly L. Coffman, MD, MPH, assistant professor of psychiatry and associate program director of the forensic psychiatry fellowship at Emory University, Atlanta, and Helen M. Farrell, MD, a lecturer at Harvard Medical School, Boston, discussed gender bias in the field and in medicine at large.
After reviewing a handful of Supreme Court cases since the 1970s establishing women’s rights to equal opportunities and harassment-free workplaces, Dr. Farrell noted a recent commentary in the New England Journal of Medicine illustrating the challenges women still face. In that commentary, Reshma Jagsi, MD, a professor of radiation oncology at the University of Michigan, Ann Arbor, and director of the Center for Bioethics and Social Sciences in Medicine, shared her own #MeToo experience within the context of such harassment narratives throughout academic medicine (N Engl J Med. 2018;378:209-11).
Harassment found in medicine
Dr. Jagsi had published a study in 2016 on workplace sexual harassment in medicine that surveyed 1,066 recipients of career development grants from the National Institutes of Health (JAMA. 2016;315:2120-1). The average age of respondents was 43 years, and 46% of respondents were women.
While only 22% of men reported perceiving gender bias in their careers, 70% of women reported such bias. Similarly, 66% of women said they had experienced gender bias in their careers, compared with 10% of men (P less than .001). Women also were substantially more likely to have experienced sexual harassment (30% vs. 4%).
Most women (92%) reporting those experiences described sexist remarks or behavior, 41% experienced unwanted sexual advances, and 9% experienced coercive advances.
“Although a lower proportion reported these experiences than in a 1995 sample, the difference appears large given that the women began their careers after the proportion of female medical students exceeded 40%,” Dr. Jagsi and her colleagues reported in the study.
The effects of those experiences were not minor: Among women who reported harassment, 59% said their confidence as professionals took a hit, and 47% said those experiences hurt their career advancement.
Women still underrepresented
One factor in those high rates might be the extent of existing power differentials: Women remain underrepresented in medical leadership despite accounting for more than half of all enrollees in U.S. medical schools in 2017, according to the Association of American Medical Colleges (AAMC). Female enrollment in medical schools hovered around 40% in the mid-90s, yet in 2015, the AAMC reported that women held 37% of all U.S. medical school faculty positions and 20% of full professorships.
“There’s also a large discrepancy in terms of specialties,” said Dr. Farrell, also a staff psychiatrist at Beth Israel Deaconess Medical Center, Boston. “Women tend to go into fields like pediatrics and ob.gyn. at much higher rates than men, and there are very low rates of women going into surgical fields like neurosurgery and orthopedics.”
Dr. Farrell then zeroed in on the field of forensic psychiatry in particular and various ways to consider how gender bias might manifest: opportunities for exposure to forensics in residency; fellowship applications vs. acceptances; experience in court; publications; invitations to present; large- and small-scale organizational leadership representation; and job placement across the settings of clinics, academics, prisons/institutions; and experience in private practice. Then there’s the perception of female forensic psychiatrists in court.
“There’s a really big question about the difference between how men and women are perceived by attorneys who hire us as experts, and by judges and juries in terms of our credibility when we’re testifying,” Dr. Farrell said.
Picking up where Dr. Farrell left off, Dr. Coffman noted that women always have faced an uphill battle – particularly within forensic psychiatry.
“Forensic psychiatry really is the global intersection of medicine, the criminal justice system, and the law – and traditionally, all three of these fields have really been male dominated,” Dr. Coffman said. “We were often told that women should not go into careers like medicine and the law, because if they work too hard, they might ruin their reproductive potential. They were also thought of as being weak and unable to handle seeing blood.”
Fortunately, however, she added: “That’s very different from how we think about things today.” For example,
Gender perceptions matter
Those numbers show progress, though “we’re a little bit behind the trends,” Dr. Coffman said. One reason for this probably is rooted in implicit biases that shape a person’s thinking, without a conscious realization of the sexist ideas about gender roles that have been internalized.
She presented two descriptions of an individual to make her point: one an accomplished scientist, tax attorney, and major political figure, and one a loving parent with a reputation for “always being well-coiffed and tastefully dressed.” Both depictions describe Margaret Thatcher, the first woman to become prime minister of the United Kingdom.
“There’s that real disconnect between the woman and the role, and that that’s where the prejudice lives,” Dr. Coffman said. “The greater the mismatch you see, the greater potential for prejudice.”
Research backs up those assertions. Dr. Coffman shared findings from a study that compared how male and female doctors introduced one another as speakers (J Womens Health [Larchmt]. 2017 May;26[5]:413-9).
Across 321 forms of address, women were more likely to use professional titles when “introducing any speaker during the first form of address, compared with male introducers (96.2% vs. 65.6%).” When the researchers drilled deeper, they found that women introduced others using their professional titles 97.8% of the time (45/46), while men used professional titles to introduce 72.4% of the time (110/152). A disparity was found in mixed-gender introductions: Women used professional titles when introducing men 95% of the time (57/60), but men did the same with women 49.2% of the time (31/63).
Research on perceptions of women as expert witnesses in court is more complicated. In one experiment, for example, mock jurors read a written summary of a civil case where the expert’s opinion was written by either a male or female automobile engineer. The jurors reached the same verdict just as often with female as male engineers – but awarded higher damages when the engineer was a woman.
But that was a written experiment. In similar research where mock jurors viewed video summaries involving cross-examination of a forensic mental health expert, men were found to be more “likable, believable, trustworthy, confident, and credible” than were women.
This and other research underscore a common dilemma for women, Dr. Coffman said: balancing the expectation of being warm and the need to appear competent – both of which can help and harm the way in which women are perceived. But the reality of perception sometimes can surprise.
She pointed to the double-edged sword of eye contact as an example: “If you don’t make eye contact, then you’re perceived as being weak. But if you make too much eye contact, then you’re perceived as being aggressive. So you really can’t win, right?”
Yet the women remained cautiously optimistic, especially noting the large proportion of men attending the session itself.
“It really takes everybody working together to keep the conversation going, finding out where women want to flourish and bloom, and having people to champion us and support that,” Dr. Farrell said.
Dr. Coffman and Dr. Farrell had no relevant conflicts of interest. They will be presenting an expanded version of the presentation at the International Academy of Law and Mental Health meeting in July 2019 in Rome.
AUSTIN, TEX. – Women are making progress in equal representation and leadership within the field of forensic psychiatry, but gender parity remains elusive, according to a presentation at the annual meeting of the American Academy of Psychiatry and the Law.
In the presentation, Kelly L. Coffman, MD, MPH, assistant professor of psychiatry and associate program director of the forensic psychiatry fellowship at Emory University, Atlanta, and Helen M. Farrell, MD, a lecturer at Harvard Medical School, Boston, discussed gender bias in the field and in medicine at large.
After reviewing a handful of Supreme Court cases since the 1970s establishing women’s rights to equal opportunities and harassment-free workplaces, Dr. Farrell noted a recent commentary in the New England Journal of Medicine illustrating the challenges women still face. In that commentary, Reshma Jagsi, MD, a professor of radiation oncology at the University of Michigan, Ann Arbor, and director of the Center for Bioethics and Social Sciences in Medicine, shared her own #MeToo experience within the context of such harassment narratives throughout academic medicine (N Engl J Med. 2018;378:209-11).
Harassment found in medicine
Dr. Jagsi had published a study in 2016 on workplace sexual harassment in medicine that surveyed 1,066 recipients of career development grants from the National Institutes of Health (JAMA. 2016;315:2120-1). The average age of respondents was 43 years, and 46% of respondents were women.
While only 22% of men reported perceiving gender bias in their careers, 70% of women reported such bias. Similarly, 66% of women said they had experienced gender bias in their careers, compared with 10% of men (P less than .001). Women also were substantially more likely to have experienced sexual harassment (30% vs. 4%).
Most women (92%) reporting those experiences described sexist remarks or behavior, 41% experienced unwanted sexual advances, and 9% experienced coercive advances.
“Although a lower proportion reported these experiences than in a 1995 sample, the difference appears large given that the women began their careers after the proportion of female medical students exceeded 40%,” Dr. Jagsi and her colleagues reported in the study.
The effects of those experiences were not minor: Among women who reported harassment, 59% said their confidence as professionals took a hit, and 47% said those experiences hurt their career advancement.
Women still underrepresented
One factor in those high rates might be the extent of existing power differentials: Women remain underrepresented in medical leadership despite accounting for more than half of all enrollees in U.S. medical schools in 2017, according to the Association of American Medical Colleges (AAMC). Female enrollment in medical schools hovered around 40% in the mid-90s, yet in 2015, the AAMC reported that women held 37% of all U.S. medical school faculty positions and 20% of full professorships.
“There’s also a large discrepancy in terms of specialties,” said Dr. Farrell, also a staff psychiatrist at Beth Israel Deaconess Medical Center, Boston. “Women tend to go into fields like pediatrics and ob.gyn. at much higher rates than men, and there are very low rates of women going into surgical fields like neurosurgery and orthopedics.”
Dr. Farrell then zeroed in on the field of forensic psychiatry in particular and various ways to consider how gender bias might manifest: opportunities for exposure to forensics in residency; fellowship applications vs. acceptances; experience in court; publications; invitations to present; large- and small-scale organizational leadership representation; and job placement across the settings of clinics, academics, prisons/institutions; and experience in private practice. Then there’s the perception of female forensic psychiatrists in court.
“There’s a really big question about the difference between how men and women are perceived by attorneys who hire us as experts, and by judges and juries in terms of our credibility when we’re testifying,” Dr. Farrell said.
Picking up where Dr. Farrell left off, Dr. Coffman noted that women always have faced an uphill battle – particularly within forensic psychiatry.
“Forensic psychiatry really is the global intersection of medicine, the criminal justice system, and the law – and traditionally, all three of these fields have really been male dominated,” Dr. Coffman said. “We were often told that women should not go into careers like medicine and the law, because if they work too hard, they might ruin their reproductive potential. They were also thought of as being weak and unable to handle seeing blood.”
Fortunately, however, she added: “That’s very different from how we think about things today.” For example,
Gender perceptions matter
Those numbers show progress, though “we’re a little bit behind the trends,” Dr. Coffman said. One reason for this probably is rooted in implicit biases that shape a person’s thinking, without a conscious realization of the sexist ideas about gender roles that have been internalized.
She presented two descriptions of an individual to make her point: one an accomplished scientist, tax attorney, and major political figure, and one a loving parent with a reputation for “always being well-coiffed and tastefully dressed.” Both depictions describe Margaret Thatcher, the first woman to become prime minister of the United Kingdom.
“There’s that real disconnect between the woman and the role, and that that’s where the prejudice lives,” Dr. Coffman said. “The greater the mismatch you see, the greater potential for prejudice.”
Research backs up those assertions. Dr. Coffman shared findings from a study that compared how male and female doctors introduced one another as speakers (J Womens Health [Larchmt]. 2017 May;26[5]:413-9).
Across 321 forms of address, women were more likely to use professional titles when “introducing any speaker during the first form of address, compared with male introducers (96.2% vs. 65.6%).” When the researchers drilled deeper, they found that women introduced others using their professional titles 97.8% of the time (45/46), while men used professional titles to introduce 72.4% of the time (110/152). A disparity was found in mixed-gender introductions: Women used professional titles when introducing men 95% of the time (57/60), but men did the same with women 49.2% of the time (31/63).
Research on perceptions of women as expert witnesses in court is more complicated. In one experiment, for example, mock jurors read a written summary of a civil case where the expert’s opinion was written by either a male or female automobile engineer. The jurors reached the same verdict just as often with female as male engineers – but awarded higher damages when the engineer was a woman.
But that was a written experiment. In similar research where mock jurors viewed video summaries involving cross-examination of a forensic mental health expert, men were found to be more “likable, believable, trustworthy, confident, and credible” than were women.
This and other research underscore a common dilemma for women, Dr. Coffman said: balancing the expectation of being warm and the need to appear competent – both of which can help and harm the way in which women are perceived. But the reality of perception sometimes can surprise.
She pointed to the double-edged sword of eye contact as an example: “If you don’t make eye contact, then you’re perceived as being weak. But if you make too much eye contact, then you’re perceived as being aggressive. So you really can’t win, right?”
Yet the women remained cautiously optimistic, especially noting the large proportion of men attending the session itself.
“It really takes everybody working together to keep the conversation going, finding out where women want to flourish and bloom, and having people to champion us and support that,” Dr. Farrell said.
Dr. Coffman and Dr. Farrell had no relevant conflicts of interest. They will be presenting an expanded version of the presentation at the International Academy of Law and Mental Health meeting in July 2019 in Rome.
REPORTING FROM THE AAPL ANNUAL MEETING