I came across a very recent news piece that shows what’s happening generally with women in medicine and medical education here in Canada. The Ontario Physicians College has failed to protect eight women after they complained about gender discrimination by a specific physician in a Toronto hospital (Glauser, 2023). The case started in 2018. It was finally taken up in 2023 by the Superior Court, which unanimously decided that the Ontario College of Physicians and Surgeons failed in investigating the case.
These eight women have been trying for six years to prove their case of gender discrimination. What’s even more shocking is that these women refused to reveal their identities, fearing the consequences of being identified. They feared revenge.
Surely this is not the only case. Indeed, a quick search of Twitter for ‘EDI’ will yield many similar stories, either told by physicians about themselves or what they witnessed happening to a colleague. Stories that range from those who deny altogether that there is a pay gap regardless of the evidence to more horrid stories of “clear threats”. In a tweet by Dr. Christine Gibson commenting on the news piece I mentioned earlier, she calls our attention to a Black colleague who was threatened by a male doctor who hung a noose in the operating room. The noose has been part of America’s dark history of racial violence, symbolizing the lynching of another human being, “a deplorable act of brutality, along with unbound fear and hatred towards African Americans” (Elassar, 2020). The same doctor was nevertheless promoted after this incident.
In response to such individual, structural, and systemic biases, I was curious about either the College’s anti-discrimination or Equity, Diversity, and Inclusion (EDI) policy. On the College’s website, I could not find a policy per se. All I found was a statement in the About section to announce their commitment to equity, diversity, and inclusion with plenty of educational resources and even a podcast. On the same page there is an EDI report that summarizes the organization’s efforts to achieve EDI. The report also mentions that an EDI policy is being developed, with expected completion by the end of 2023. The report goes on to explain the importance of facing structural racism and systematic biases and how these factors lead to disparities in care based on race, ethnicity, etc. It even mentions that the organization’s council and committee receive mandatory EDI training. The repot mentions that they also provide staff training through different activities like “EDI Lunch and (Un)Learn Series.”
This professional organization is ostensibly seeking to change its internal culture to be more inclusive and equitable. The numbers and testimonies cited in the report sound very promising. And the report in general paints a very positive image of the College, which makes one wonder why this is not reflected on the ground. With all these internal efforts, shouldn’t we see an impact on how the organization handles discrimination complaints? Why would the eight women mentioned earlier decide to conceal their identities and remain anonymous? Why did leadership not protect and defend these women?
In the case of these eight women, we are so far just talking about gender discrimination or sexism. However, their case raises more concerns than just being a woman and the inequities, harm, and fear they must tolerate as a result. What if we added more layers, such as race, religion, or sexual orientation, to gender. Let’s try this:
a Black + woman,
an Indigenous + woman,
a Black + Muslim + woman,
an Indigenous + woman + a different sexual orientation,
a Muslim + Arab + woman + wearing a hijab, etc.
I cannot imagine the situation of women with such different identities in the context of these eight women. The more minority markers you add to a woman, the heavier the burden and the more vulnerable they become (Rezaiefar, 2022). When gender intersects with race, religion, or sexual orientation, the situation becomes more complex. That is why intersectionality as a lens is extremely important whenever we speak about minorities’ experiences and EDI initiatives (Henry et al., 2017).
I do not have definitive answers in response to such questions. However, I do think EDI should not be limited to mandatory awareness-focused educational content for leadership and staff; this is just one piece of the puzzle. Here in Canada, we can try to learn from other countries that have similar social structures and were able to take big strides to EDI. New Zealand and Australia, for example, have many initiatives within government that seem to offer more effective strategies and practices. Summarizing some of the recommendations of initiatives in New Zealand and Australia, facing discrimination and racism requires a reform of organizations:
- Changes in human resources policies, procedures, and agreements;
- Internal and external accountability measures (ongoing monitoring, evaluation, and audits);
- Inclusive structures, processes & policies;
- Developing inclusive leadership & leadership accountability;
- Employees’ collective/shared responsibility;
- Education and training;
- Investment in systematic inquiry to understand the structures that lead to inequity; and
- Use of an intersectional lens to decide funding and support for staff needs.
(Australian Research Council; Commonwealth Bank, 2022; Commonwealth of Australia (Department of Health), 2021; New Zealand Foreign Affairs and Trade; NSW Local Government Multicultural Network; The University of Western Australia)
These levels of accountability and reform will help educate people unable to admit that there is a pay gap. Perhaps the same people would then stop a doctor from threatening his black colleague. Maybe such education would have better informed that doctor and the system that forced eight women to go to the Supreme Court to get justice without revealing their identity.
Over the last few years, I have developed a great interest in EDI work and the use of intersectionality as a lens. This is not only because I belong to a minority group and I can relate to all these issues, but also because of my experience in two projects that looked at inequities faced by two different groups. The first project was on underrepresented women in medical education and the other one was on decolonizing an organization and achieving equity for Indigenous peoples. I developed a passionate interest in the topic and would love to consider these elements in my PhD research. I am generally interested in the idea of power imbalance and empowering either women, minorities, or patients. My PhD research will focus on programmatic assessment in medical education, specifically in Competence by Design (CBD), which is the new mandated educational shift in medical education across Canada. While the aim of this programmatic assessment is to help provide more constructive feedback to learners and foster the idea of assessment for learning rather than assessment of learning, it may also help in identifying struggling learners as early as possible. While I initially neither intended nor thought about integrating EDI into this idea, I now contemplate integrating EDI into my research. I think about exploring programmatic assessment and how it impacts female minorities in medical education, including whether it helps in identifying struggling students early enough to help them achieve success.
Australian Research Council. Australian research council innovate reconciliation action plan May 2022 to April 2024. Australian Research Council. https://bit.ly/3JlltyX
Commonwealth Bank. (2022). Reconciliation action plan. Commonwealth Bank. https://bit.ly/3JbdlRK
Commonwealth of Australia (Department of Health). (2021). Innovate: Reconciliation action plan. Commonwealth of Australia (Department of Health). https://bit.ly/3mVYF1z
CPSO. Equity, diversity, and inclusion 2022. CPSO. https://bit.ly/3Lqz4bg
Elassar, A. (202, June 23). Why the noose is such a potent symbol of hate. CNN. https://cnn.it/408NzV7
Glauser, W. (2023, February 10). Ontario Physicians College failed to properly investigate gender discrimination, improper billing complaint, court rules. The Globe and Mail. https://tgam.ca/3TgwxlE
Henry, F., Dua, E., James, C. E., Kobayashi, A., Li, P., Ramos, H., & Smith, M. S. (2017). The equity myth: Racialization and indigeneity at Canadian universities. UBC Press New Zealand Foreign Affairs and Trade. Diversity and inclusion strategy (2018-2028). New Zealand Foreign Affairs and Trade. https://bit.ly/42hJ3Wj
NSW Local Government Multicultural Network. National anti-racism framework submission by the NSW local government multicultural network. NSW Local Government Multicultural Network. https://bit.ly/3mXYcvt
Rezaiefar, P., Abou-Hamde, Y., Naz, F., Alborhamy, Y. S., & LaDonna, K. A. (2022). “Walking on eggshells”: experiences of underrepresented women in medical training. Perspectives on Medical Education, 1-8. The University of Western Australia. Diversity equity and inclusion strategy. The University of Western Australia. https://bit.ly/3YQYpy2