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This study aimed to assess gender dynamics during Obstetrics and Gynecology (Ob/Gyn) Grand Rounds.This was an observational cohort study of Ob/Gyn Grand Rounds introductions at a large academic center. Ob/Gyn Grand Rounds introductions from December 2016 to February 2020 were included. Audio and video components of introductions for those with doctorate degrees were reviewed. Each named reference to the presenter and use of descriptors were collected. Statistical analyses included Fisher's exact test for categorical variables and Student's t-test for continuous variables.This study was completed at the University of Wisconsin in the Department of Ob/Gyn PARTICIPANTS: Ob/Gyn Grand Rounds introducers who had complete audio and video components of introductions for those with doctorate degrees.Sixty-four Grand Rounds introductions were reviewed; 57 met inclusion criteria. The majority of introducers and presenters were women. Consistent use of "doctor" was similar by men and women introducers (50% vs. 29%, p = 0.427). Assistant professors were more likely to maintain professional address during introductions, compared to associate or full professors (86% vs. 0% vs. 10%, p0.001). Trainees were less likely than faculty to be addressed professionally at any time during introductions (42% vs. 81%, p = 0.017). Descriptors were used for men and women presenters, though men received more female-gendered descriptors than women (5 vs. 1, p = 0.011). Women introducers used productivity descriptors less often than men introducers (8 [15.1%] vs. 5 [55.6%] (p = 0.015)).Use of professional address was associated with academic rank, but not gender. Men endorsed and received more descriptors emphasizing accomplishments, highlighting qualifications as an expert. Given the professional environment, all Grand Rounds presenters should be introduced using professional titles.

We previously reported that professional forms of address in speaker introductions were inconsistently used at the Society of Surgical Oncology (SSO) 2018 and 2019 annual meetings, suggesting unconscious bias in speaker introductions. We sought to better understand how speakers would like to be introduced, and if guidelines could improve consistency in speaker introductions. SSO 2021 abstract submitters received a survey regarding demographics and preferred form of address at the meeting. Respectful discourse guidelines were developed and distributed to meeting moderators. Speaker introductions were reviewed for the 2021 SSO annual meeting and were compared with the 2018 and 2019 meetings. The survey response rate was 183/347 (53%) abstract submitters, most of whom (143/183, 78%) indicated preference for a professional form of address (Doctor/Professor) during speaker introductions, which was significantly greater than those who were introduced with a professional form of address during the 2018 and 2019 meetings (351/499, 70%; Chi-square = 4.08, p = 0.043). There was no difference in speaker introduction preference based on gender or race/ethnic identification. Respectful discourse guidelines were developed and distributed to meeting moderators. During the 2021 SSO annual meeting, professional forms of address were used for 104 (84%) speakers, significantly greater than during the 2018 and 2019 meetings (Chi-square = 9.23, p = 0.002). More survey respondents preferred speaker introductions with a professional form of address than were used in prior meetings. This preference was similar across all demographic groups evaluated. Professional addresses during speaker introductions increased significantly after the distribution of guidelines encouraging consistency to decrease unconscious bias and promote an inclusive environment.

Narrative letters of recommendation (NLORs) have become key elements of the application process for residency and fellowship. The potential to inadvertently admit bias into these subjective narratives has become an area of research focus across many disciplines. In the present review, we have highlighted the current data regarding bias in NLORs. We also believe that one of the most effective methods to eliminate bias from written recommendations is to first understand that it exists. Thus, the objective measures that have been taken to identify bias in NLORs are important steps in the right direction. We have presented and reflected on the accrued data on bias in NLORs pertaining to surgical training.

Background Positive interactions that build good relationships between patients and providers demonstrate improved health outcomes for patients. Yet, racial minority patients may not be on an equal footing in having positive interactions. Stereotype threat and implicit bias in clinical medicine negatively affect the quality of care that racial minorities receive. Dermatology, one of the least racially diverse specialties in medicine, further falls short in providing patients with options for race-concordant visits, which are noted to afford improved experiences and outcomes. Objective This study aimed to analyze implicit bias and stereotype threat in a dermatology clinical scenario with the goal of identifying actions that providers, particularly those that are not racial minorities, can take to improve the quality of the clinical interactions between the minority patient and provider. Methods We illustrate a hypothetical patient visit and identify elements that are susceptible to both stereotype threat and implicit bias. We then develop an action plan that dermatologists can use to combat stereotype threat and implicit bias in the clinical setting. Results The details of an action plan to combat the effect of stereotype threat and implicit bias are as follows: 1) Invite practices that increase representation within all aspects of the patient visit (from wall art to mission statements to creating a culture that embraces difference and not just diversity); 2) employ communication techniques targeted to invite and understand the patient perspective; and 3) practice making empathic statements to normalize anxiety and foster connection during the visit. Conclusion Knowledge of stereotype threat and implicit bias and their sequelae, as well as an understanding of steps that can be taken preemptively to counteract these factors, create opportunities to improve clinical care and patient outcomes in racial minority patients.

Background Increased attention has been dedicated to gender inequity at scientific meetings. This study evaluated the gender distribution of session leaders at cardiothoracic surgery national and regional meetings. Methods This is a descriptive study of the gender of peer-selected session leaders at 4 cardiothoracic surgery organizations' annual meetings from 2015 to 2019. Session leaders included moderators, panelists, and invited discussants. Data from publicly available programs were used to generate a list of session leaders and organization leaders. The primary outcome measure was the proportion of female session leaders at annual meetings. Descriptive analyses were performed, including the Cochran–Armitage trend test for linear trends of proportions. Results A total of 679 sessions over 20 meetings were examined. Of the 3662 session leaders, 480 (13.1%) were women. The proportion of total female session leaders trended positively over time from 9.6% (56 of 581) in 2015 to 15.9% (169 of 1060) in 2019 (P = .001). Among specialty topic sessions, female session leaders were distributed as follows: adult cardiac, 6.9% (81 of 1172); congenital cardiac, 10.8% (47 of 437); and thoracic, 23.2% (155 of 668). The proportion of female session leaders trended significantly only for thoracic sessions (20.6% [21 of 102] in 2015 to 29.2% [58 of 199] in 2019; P = .02). More than one-half of the sessions (57.4%; 390 of 679) featured all-male session leadership. Conclusions Women remain underrepresented in leadership roles at cardiothoracic surgery organizational meetings. This may deter female applicants and has implications for female surgeons' career trajectories; therefore, attention must be given to the potential for unconscious bias in leadership in cardiothoracic surgery.

Simon D Taylor-Robinson,1 Paulo A De Sousa Lopes,2 Jey Zdravkov,3 Rachel Harrison4 1Department of Surgery and Cancer, Imperial College London, London, UK; 2Department of Medicine, UAI Universidad Abierta Interamericana, Buenos Aires, Argentina; 3Dean Street Sexual Health Clinic, London, UK; 4Department of South East Asian Studies, School of Oriental and African Studies, London, UKCorrespondence: Simon D Taylor-Robinson Email Str338333@gmail.comAbstract: Bullying of whatever form should have no place in the Medical Profession. Reforms to junior doctor training and reduction in working hours have helped to control most of the individual bullying which may have existed in the past. However, the complexities of institutional bullying still exist. In the United Kingdom, centralised monitoring systems, such as Athena SWAN, are designed to reward academic and medical institutions for positive steps to introduce equality and mitigate bullying. However, the reality is that such processes may be conducted in healthcare or educational establishments that have little intention to address the problem thoroughly. We report the personal experience of both individual and institutional bullying in the medical career of a medically-qualified interviewee and reflect on ways to mitigate the problem. We also consider whether unconscious bias affects our relationships with patients. In a caring medical profession, there should be no room for intolerance, unconscious bias or bullying.Keywords: bullying, institutional bullying, personal bullying, unconscious bias

With the emergence of the COVID-19 pandemic and the resurgence of the Black Lives Matter movement, Canadians are consuming more media than ever. While this development has allowed us to become more informed about the important issues surrounding us, it does mean we need to give critical thought to how we are perusing different media forms and content. This editorial shares three methods that communicators can consider employing to help avoid unconscious bias when consuming media. The editorial also introduces the five articles being featured in this issue, before closing with acknowledgement and thanks to all the people who made this publication possible. Keywords: media, unconscious bias, strategy, communication tactics

In its gender equality status, Japan lags behind the European Union (EU) and other Organisation for Economic Co-operation and Development (OECD) countries. Only 16.7 % of academic staff in national universities are women. Although there has been a slow improvement during the last 45 years, the percentage of female staff remains particularly low in the STEM (science, technology, engineering, and mathematics) fields. In 2018, female stuff accounted for only 12.3 % in agriculture, 8.7 % in science, and 6.2 % in engineering. The number of female graduate students and the number of female members of the Japanese geoscience societies have been steadily increasing since the 1998 campaign that increased the total number of graduate school places. However, low representation of females in academic job positions, as well as among the recipients of academic awards, suggests that a strong unconscious bias against women still exists in Japan. Continuing public attention to these issues is essential for the improvement of the situation.

Students from Black Minority Ethnic (BME) groups continue to experience disadvantages compared to White students in UK Higher Education (Pilkington, A. 2013. "The Interacting Dynamics of Institutio...

Objective. How do surges in female representation in public life affect media coverage? Can the media underrepresent the reality of women’s progress? If so, is the source of underrepresentation the media itself or the selectorates that brief the media? Methods. Using automatic content analysis, we study two remarkable step changes in women’s role in public life in Ireland: the 2016 elections and 2012 Olympics. Results. The increase in female participation was associated with a new and substantial gender gap in coverage, which we attribute to the media, not selectorates. Conclusion. We cannot assume that media coverage will increase proportionally as women advance in public life. The re-emergence of bias when female representation jumps may also exist outside the media in any context where there are large numbers of decisions about whether to favour males or females.

Introduction Today, women make up 56% of medical students, yet just 13% of surgical consultants – a number that has remained static since 2013. This qualitative study explored some of the barriers to female success in modern surgery. Methods Semistructured qualitative interviews were undertaken primarily with female surgical trainees to determine the barriers they face. Male trainees and training programme directors (TPDs) were also interviewed for triangulation. Results 20 interviews were performed (16 female trainees, 3 male trainees, and 1 TPD) between October 2019 and March 2020. Family pressures and becoming a mother were significant barriers for women training in surgery – a barrier that did not apply to male trainees who were fathers, often resulting in women choosing to train less than full time (LTFT). Unfortunately LTFT training presents further obstacles for female trainees. The set-up of the national training programme in surgery provides many non-gender-specific barriers, chiefly moving hospital every 6 months causing disrupted training and long commutes, disproportionately affecting females with child care responsibilities. Sexism and discrimination are still common, both from colleagues and patients. Many participants perceived inherent differences between genders in communication and methods for coping with stress. Conclusion Greater gender equality in surgery may be achieved by changes in the structure and organisation of training to reduce the tension between the professional role and the predominantly female-led role of raising children. Better equality and diversity training and awareness at all levels in surgery may help to mitigate some of the conscious and unconscious bias that still exists.

Women physicians and those from racial and ethnic groups underrepresented in medicine face unique barriers to career advancement in academic medicine, especially in specialties that lack diversity such as radiology. One such barrier is the effect of unconscious bias on the ability of faculty from these groups to find effective sponsors. Given the central role of sponsorship in career advancement, departments are called on to implement formal sponsorship programs to address inequities stemming from bias.

Simple RGC consists of a collection of ImageJ plugins to assist researchers investigating retinal ganglion cell (RGC) injury models in addition to helping assess the effectiveness of treatments. The first plugin named RGC Counter accurately calculates the total number of RGCs from retinal wholemount images. The second plugin named RGC Transduction measures the co-localisation between two channels making it possible to determine the transduction efficiencies of viral vectors and transgene expression levels. The third plugin named RGC Batch is a batch image processor to deliver fast analysis of large groups of microscope images. These ImageJ plugins make analysis of RGCs in retinal wholemounts easy, quick, consistent, and less prone to unconscious bias by the investigator. The plugins are freely available from the ImageJ update site https://sites.imagej.net/Sonjoonho/., Authors: Tiger Cross, Rasika Navarange, Joon-Ho Son, William Burr, Arjun Singh, Kelvin Zhang. Comment: These authors have contributed equally to this work. Authors: Andrew Osborne and Bart Nieuwenhuis. Comment: These authors share senior authorship and correspondence

Unconscious (or implicit) biases are learned stereotypes that are automatic, unintentional, deeply engrained, universal, and able to influence behavior. Several studies have documented the effects of provider biases on patient care and outcomes. This article provides a framework for exploring the implications for unconscious bias in surgical education and highlights best practices toward minimizing its impact. Presented is the background related to some of the more common unconscious biases and effects on medical students, resident trainees, and academic faculty. Finally, targeted strategies are highlighted for individuals and institutions for identification of biases and the means to address them.

The urban-rural imbalance between university students raises diversity challenges in many educational institutions. University leaders favor urban students’ admission because of the misconception that rural students have lower academic performance than their urban counterparts. Here, strategies to overcome diversity challenges between urban and rural students in universities have been proposed. A diversification workshop project was suggested to be delivered for the current and/or incoming students at KAU in Rabigh to improve students attitudes towards their peers (student-to-student) and faculty-to-student interactions. Project learning outcomes for an inclusive urban/rural campus were discussed to overcome differences between students and achieve campus inclusion. Reform actions highlight that students should understand others, be respectful, accept differences and avoid stereotyping and undermining others’ abilities. Two successful urban/rural models were introduced to address diversity-related problems. Leadership roles of all university parties have been explained with the suggested procedures and their frequencies according to university standards, regulation, potential budget, and funding for the proposed project to attain KAU campus homogeneity. Gender bias, racial bias, and unconscious bias are some of the difficulties that need to be recognized by university leaders. Several media/article resources were introduced to increase students/faculty awareness about rural/urban diversity.

The importance of diversity is well established and holds important implications for workplace and physician-patient relationships. Evaluation of diversity statistics within otolaryngology-head and neck surgery reveals areas of deficiency that may be improved with targeted proactive approaches. This article provides a general overview of diversity within otolaryngology, highlights key components of diversity initiatives, and provides strategies for implementation.

This past year brought the deadliest pandemic of our time and a huge social awakening and movement for racial justice. It became clear to me in late spring that I needed to learn more about structural racism, White supremacy, racial healthcare disparities, unconscious bias, and my own prejudices that govern my attitudes, values, behaviors, and decisions as a nurse leader, faculty member, board member, and a human being. To that end, I began to read, watch, and listen to both scholarly and lay journals and media that provide historical and current empirical accounts and studies of how racism and White supremacy have dominated our society, organizations, and communities in the United States for hundreds of years.

Bias is the evaluation of something or someone that can be positive or negative, and implicit or unconscious bias is when the person is unaware of their evaluation. This is particularly relevant to policymaking during the coronavirus pandemic and racial inequality highlighted during the support for the Black Lives Matter movement. A literature review was performed to define bias, identify the impact of bias on clinical practice and research as well as clinical decision making (cognitive bias). Bias training could bridge the gap from the lack of awareness of bias to the ability to recognise bias in others and within ourselves. However, there are no effective debiasing strategies. Awareness of implicit bias must not deflect from wider socio-economic, political and structural barriers as well ignore explicit bias such as prejudice.

Implicit or unconscious bias is a lens through which we see our world based on our past experiences and learned stereotypes. Within health care, this lens of bias has typically had a negative impact on patient care, particularly for marginalized populations. We sat down with 3 physicians within Kaiser Permanente East Bay to learn about their personal experiences of bias in patient care. We also discuss the importance of acknowledging bias and practicing cultural humility in order to best ally with our patients. We are hopeful our conversation with these physicians will inspire more of the same, leading to improved health care for those that have suffered from bias in the past.

This chapter explores outdoor environmental education (OEE) and opportunities for OEE educators to contribute to topographies of hope relevant to issues of social (in)justices. As the opening quote encourages, the chapter adopts a hopeful tenor to envisioning future possibilities. The chapter offers insights into social justice and OEE. The concepts of microagressions, unconscious bias, privilege, oppression, and intersectionality are reviewed with examples provided. The chapter explores the skills and growth-oriented mindset of many OEE educators and the ways in which these capacities can positively contribute to (re)landscaping future terrains. The final section offers both individual and programmatic recommendations for engaging in social activism, with a focus on intentional social justice accomplice-ship and advocacy.

BACKGROUND: Our previous studies suggest that the training history of an investigator, termed “medical academic genealogy”, influences the outcomes of that investigator’s research. Here we use meta-analysis and quantitative statistical modeling to determine whether such effects contribute to systematic bias in published conclusions. METHODS: 108 articles were identified through a comprehensive search of the high-grade glioma (HGG) surgical resection literature. Analysis was performed on the 70 articles with sufficient data for meta-analysis. Pooled estimates were generated for key academic genealogies. Monte Carlo simulations were performed to determine whether the effects attributed to genealogy alone can arise due to chance alone. RESULTS: Meta-analysis of the HGG literature without consideration for academic medical genealogy revealed that gross total resection (GTR) was associated with a significant decrease in the odds ratio (OR) for the hazard of death after surgery for both anaplastic astrocytoma (AA) and glioblastoma (AA: log [OR] = −0.04, 95% CI [−0.07 to −0.01]; glioblastoma log [OR] = −0.36, 95% CI [−0.44 to −0.29]). For the glioblastoma literature, meta-analysis of articles contributed by members of a genealogy consisting of mostly radiation oncologists revealed no reduction in the hazard of death after GTR [log [OR] = −0.16, 95% CI [−0.41 to 0.09]. In contrast, meta-analysis of published articles contributed by members of a genealogy consisting of mostly neurosurgeons revealed that GTR was associated with a significant reduction in the hazard of death [log [OR] = −0.29, 95% CI [−0.40 to 0.18]. Monte Carlo simulation revealed that the observed discrepancy between the articles contributed by the members of these two genealogies was unlikely to arise by chance alone (p

Background Gender and racial disparities in academic medicine have recently garnered much attention. Implicit Association Tests (IATs) offer a validated means of evaluating unconscious associations and preferences. This study examines the perceived role of implicit bias in faculty development in academic emergency medicine (EM). Methods EM faculty at a large urban academic medical center were invited to independently participate in a self-reflection assessment in preparation for a faculty retreat session discussing diversity, equity, and inclusion. Participants completed two IATs designed to examine gender associations (gender IAT) and race preferences (race IAT) followed by a short anonymous survey where IAT scores were recorded. The survey also captured demographic information and perceptions about the impact of gender and racial biases in faculty development. Results Forty faculty members (66%) completed the survey; 70% were male and 80% white. The majority (59%) reported gender IAT results indicating automatic male-sciences and female-liberal arts associations. Nearly half (45%) reported race IAT results indicating an automatic preference for white people. More than 70% of males reported that faculty recruitment, development, and promotion decisions were 'never' or 'seldom' affected by gender bias, while more than 80% reported racial bias 'never' or 'seldom' affects these decisions. Female faculty more frequently perceived adverse effects of unconscious gender and race biases. Conclusion Our group of academic physicians reported IAT results showing different levels of implicit bias compared to the general population. Female faculty may be both more aware of and more susceptible to the adverse effects of unconscious biases. Further study is needed to determine both the extent to which unconscious biases affect the academic workplace, as well as ways in which such unintentional forms of discrimination can be eliminated. Unconscious biases are not unique to EM. Intentional efforts to increase self-awareness of these 'blind spots' may help mitigate their impact and foster a more diverse and inclusive healthcare environment.

Fellowships are competitive training posts, often in a subspecialty area. We performed a quality assessment of potential interviewer bias on anaesthesia Fellow selection. After research locality approval, we analysed interview scores for all Fellowship applications to our department over six years. Panel interviewers participated in a structured interview process, asking a series of standardised questions to rate applicants. A mixed model analysis of total applicant rating with crossed effects of applicants and interviewers was used. A total of 94 applicants were interviewed by 27 panel members, with between two and four panel members per interview, giving a total of 329 applicant ratings. The random effect of applicants accounted for 45.8% of total variance in ratings (95% confidence intervals (CI) for intraclass correlation (ICC) 35.8%–57.2%) while interviewer effects accounted for 13.4% of total variance (95% CI for ICC 5.3%–30.0%). We found no evidence of bias for most potential sources after analysing multiple applicant and interviewer factors. After adjusting for interviewer training programme, applicants from other training programmes were rated a mean of 1.87 points lower than Australian and New Zealand College of Anaesthetists (ANZCA) applicants (95% CI 0.62–3.12, P = 0.003) and 1.84 points lower than Royal College of Anaesthetists (RCoA) applicants (95% CI 0.37–3.32, P = 0.014). After adjusting for applicant gender, female clinicians rated applicants 1.12 points higher (95% CI 0.19–2.06, P = 0.019) on average than male clinicians. The observed differences in interview scores amongst male and female clinicians and lower scores in applicants from programmes other than ANZCA/RCoA were small, and require confirmation in independent studies.

This chapter attempts to capture what teaching excellence looks and feels like for students. Our research reports on research conducted by two student authors at separate institutions. It suggests that the most crucial aspect of the student experience of ‘teaching excellence’ is a teacher's ability to build rapport and create meaningful interpersonal relationships with their students. Leanne Hunt's research was conducted with her fellow students at the University of Bradford. She outlines how, for her participants, the student–teacher rapport informed a positive learning experience which translated into a mutual understanding of excellent teaching. Widening participation, college-based HE student Hollie Shaw, now at Sheffield Hallam University, defines teaching excellence as flexible enough to respond to student learning needs, but strong enough to inspire interest in the discipline. In this chapter, we consider their separate testimonies carefully: we argue that exploring unconscious bias furthers understanding of how differences between student and teacher may compromise interpersonal relations and so student recognition of a tutor's positive and crucial role in the student experience and the implications of how one might measure this given the emphasis on proxies for teaching excellence in the TEF. We suggest breaking down unconscious bias calls for embracing differences, reflection and recognising the complexities of contemporary staff and student university lives. This chapter's exploration of staff–student partnership opens up potential for the creation of more equitable and honest learning dynamics in higher education – where a nuanced understanding of ‘teaching excellence’ can be defined, understood and evidenced within a HEI, with external bodies such as the Office for Students, and included in the Teaching Excellence Framework.

> "You have such a difficult name." > "You speak English so well!" > "Do you really eat bats?" When Faiza, an adolescent patient, is told by her doctor that her name is difficult to pronounce, she hears, “You are different, and you don’t belong.” When a patient tells Christopher, a resident, that he speaks English really well, he wonders what assumptions they have made regarding his ability to be a good physician. When Kimberly, a medical student of Chinese heritage, is asked by her patient if she eats “strange foods” during the current coronavirus disease 2019 pandemic, she feels the sting of heightened xenophobia. Although possibly seeming benign, these incidents are the definition of microaggressions, like “death by a thousand cuts.” Microaggressions, as suggested by the prefix, are not overt or grandiose displays of discrimination.1 They are inherently nuanced discriminatory remarks or behaviors stemming from unconscious bias, often unintentional on the part of the aggressor. Although we focus on racist microaggressions in this article, many groups may experience them, including differently abled individuals, sexual and gender minorities, and religious minorities.2 The subtle … Address correspondence to Shazeen Suleman, MSc, MD, MPH, FRCPC, Women and Children’s Health, Unity Health Toronto, St. Michael’s Hospital, 30 Bond St, 15 Cardinal Carter - Room 014, Toronto, ON, Canada M5B 1W8. E-mail: shazeen.suleman{at}unityhealth.to

Physicians have long incorporated gender into their diagnostic algorithms of pulmonary disease in an effort to use available clinical clues when a single confirmatory diagnostic test does not exist. Gender is thought to be a relevant patient characteristic in phenotyping lung disease with a female predominance noted in patients with adult-onset asthma and male predominance in idiopathic pulmonary fibrosis (IPF).1 2 Gender also may be of prognostic value in individual patients; severity of asthma is associated with female sex and increased mortality in interstitial lung disease (ILD) with male gender.2 3 While gender may increase diagnostic confidence, if the strength of the gender and disease association is not based on rigorously validated data, inaccurate diagnosis or underdiagnosis may result. In an earlier era, the failure to diagnose COPD in women was associated with gender bias when formally studied.4 More recently, the stereotype of the male smoker with lung cancer has been upended by the surprising data demonstrating higher lung cancer incidence rates in young women as compared with young men, not explained by differences in cigarette smoking.5 In this issue, Dr Assayag and colleagues investigate the role of gender in making a confident diagnosis of IPF, and conclude there is evidence for bias when …

The prevalence of breast cancer increases with age. Older breast cancer patients often present with locally advanced disease at presentation because mammography, which diagnosed early stage disease, is not recommended after the age of 75. In addition, they are often undertreated even when they are physically fit and have non-metastatic disease. As a result, survival is often poor. Physicians bias may be a factor in their undertreatment and lack of representation in prospective clinical trials. Physicians should be educated that chronological age is not a contraindication to curative treatment for older breast cancer patients. As a research group devoted to older cancer patients, women, and minorities, the International Geriatric Radiotherapy Group (IGRG) plans to conduct prospective trials to assess biomarkers for frailty, the controversial issue of mammography for older breast cancer patients, and the incorporation of frailty index for curative breast cancer treatment. The data obtained may help to decrease physician bias and to establish future guidelines for older breast cancer patients treatment.

In a rapidly globalizing world, high growth sectors like information technology (IT) hold the key to narrow or broaden the gulf between men and women at work. However, there is a serious underrepre...

Key content Understand that the skill of giving feedback is central to effective teaching and supervision. Communicate goals and objectives of feedback clearly from the outset. Begin feedback sessions with the learner's self-assessment. Provide feedback in a timely manner. Reinforce and correct observed behaviours. Confirm the learner's understanding and conclude with an action plan. Develop a capacity in trainees to self-reflect on their own practice and how it might be improved. Learning objectives To understand the principles of how to give effective feedback. To be familiar with the models of giving feedback. To understand why medical educators sometimes fail at giving feedback. Ethical issues Being dishonestly kind in giving feedback. Unconscious bias in providing feedback.

The numbers of women in medical school and in medical training have increased dramatically and are near 50% overall, but the number of women who advance to senior and leadership positions is not nearly this high. There are many reasons why the number of women in leadership roles in academic medicine has not kept pace with the number of women entering the field of medicine. Two popular themes are the glass ceiling (referring to an invisible barrier to advancement) and the leaky pipeline (the loss of women faculty along the path, or pipeline, to advancement). I believe that both come into play. Glass ceiling issues tend to be of two types: those related to the institutional culture and those related to problems of bias, especially unconscious bias. Leaky pipeline issues include the challenges of work-life integration and the need for leadership development for women. There are solutions to all of these challenges. These include improving institutional culture; making sure women advance as quickly as men and are paid equitably; ensuring that there are resources to help with work-life balance, related not only to family but to all aspects of life; and providing adequate mentoring and leadership training. These measures will help all faculty, as factors that hamper women's advancement may hamper men as well. Although these themes are broadly applicable, there are strategies that can address them all. We just need to be aware, and be proactive, and we will succeed in breaking the glass ceiling and patching the leaky pipeline.

Background and Objectives Gender-related differences in health care utilization for atrial fibrillation (AF) are increasingly recognized. However, large cohort data for examining gender-related differences in AF are lacking in Asian populations. Methods The Registry for Comparison Study of Drugs for Symptom Control and Complication Prevention of AF (CODE-AF Registry) is a prospective observational cohort-study that enrolled participants at 10 tertiary hospitals in South Korea. Baseline characteristics retrieved from the CODE-AF Registry were analyzed. Results A total of 6,274 patients were recruited (mean age 67±11 years, mean CHA2DS2-VASc score 2.7±1.7, 63% male, 65% paroxysmal AF) from June 2016 to April 2017. Women underwent less electric cardioversion (12.3% vs. 19.6%, p

This commentary integrates and expands on the preceding articles in this issue that document and celebrate a century of women’s achievements in the International Association for Dental Research (IADR). The increasing participation and leadership of women in dental and craniofacial research and within the IADR were viewed from the perspective of a changing culture of science. The steps that have been taken by the IADR to develop greater inclusiveness are acknowledged, and some of the challenges that remain are discussed in terms of obstacles that are most often social or cultural in origin. Comparisons are made across countries, and the social determinants that lead to differences in women’s participation are described. Recommendations are made for developing strategies to change elements of our institutional cultures that have provided advantages to some groups of researchers more than to others. The unconscious biases and a lack of commitment to diversity, equity, and inclusion that limit the participation of members of some groups limit the progress and achievements of science in general.

10503 Background: Gender bias can be reinforced through the use of gender-subordinating language and differences in the forms of address. We examined how professional titles were used during speakers’ introductions at the American Society of Clinical Oncology (ASCO) Annual Meeting. Methods: A retrospective observational study of video-archived speaker introductions at the 2017 and 2018 ASCO annual meetings was conducted. Data were extracted by mixed-gender coders. Professional address was defined as professional title followed by full name or last name. Multivariable logistic regressions were used to identify factors associated with the form of address. Results: 2511 videos were reviewed and 812 met inclusion criteria. Regarding speakers’ characteristics, 530 (65%) were non-Hispanic white (NHW), 743 (92%) held a MD or MD-PhD degree, and 484 (60%) were an associate or full professor. Female speakers were less likely to receive a professional address compared to male speakers (61% vs. 81%, p < 0.001). Female speakers were more likely to be introduced by first name only (17% vs. 3%, p < 0.001). Males were less likely to use a professional address when introducing female speakers compared to male speakers (53% vs. 80%, p < 0.01). No gender differences in professional address were observed for female introducers (p = 0.13). Male introducers were more likely to address female speakers by first name only compared to female introducers (24% vs. 7%, p < 0.01). In a multivariable regression including gender, race, degree, and academic rank, male speakers were more likely to receive a professional address compared to female speakers (OR: 2.67, 95%CI: 1.81-3.94, p < 0.01). Black speakers of both genders were less likely to receive a professional address compared to NHW (OR: 0.10, 95%CI: 0.01-0.53, p < 0.01). Female gender was a predictor for a non-professional form of address (first name only) (OR: 9.50, 95%CI: 4.38-20.62, p < 0.01). Conclusions: When introduced by men, female speakers were less likely to receive a professional address and more likely to be introduced by first name only compared to male speakers. Selective use of forms of address may strengthen gender bias; more research is needed to explore the causes of this disparity and its influence.

The term ‘decolonizing the curriculum’ is of high currency in higher education in the UK and in local students’ unions at these institutions. This article seeks to give a very brief history and context for why this is fundamental for academic institutions and what role libraries and the scholarly communication sector can play in this movement. I look at why this is so important for black, Asian and minority ethnic (BAME) and othered (otherly minoritized, e.g. disabled, LGBTQ, etc.) students and what steps some libraries have already taken. One of the themes of the UKSG 2019 Conference was ‘diversity and change’; decolonizing the curriculum is exactly that if done correctly. Two presentations from the plenary session provided a good starting point and the article touches on how decolonizing the curriculum may impact research/researchers. It concludes that there is a need for academia to now move past just identifying that there are issues about retention and progression of BAME and othered students and staff, and for both the library and information and scholarly communication sectors to act to address this now.

Although the business world has long recognized the benefits of diversity and inclusion and the effects of unconscious bias, the discourse is just now gaining traction in the medical field. In addition, many businesses have developed key initiatives to address unconscious bias in the workplace.In the medical field, diversity leads to improved health outcomes, increased access to healthcare by the underserved and more innovation. However, unconscious bias may inadvertently propagate health disparities, affect trainee evaluations, hinder faculty satisfaction and exclude populations from meaningful research.In this review, we discuss diversity, inclusion and unconscious bias in obstetrics and gynaecology, as it relates to patient care, health outcomes, medical faculty and trainees. We also discuss potential interventions that mitigate these issues.

Kymographs are graphical representations of spatial position over time, which are often used in biology to visualise the motion of fluorescent particles, molecules, vesicles, or organelles moving along a predictable path. Although in kymographs tracks of individual particles are qualitatively easily distinguished, their automated quantitative analysis is much more challenging. Kymographs often exhibit low signal-to-noise-ratios (SNRs), and available tools that automate their analysis usually require manual supervision. Here we developed KymoButler, a Deep Learning-based software to automatically track dynamic processes in kymographs. We demonstrate that KymoButler performs as well as expert manual data analysis on kymographs with complex particle trajectories from a variety of different biological systems. The software was packaged in a web-based ‘one-click’ application for use by the wider scientific community (http://kymobutler.deepmirror.ai). Our approach significantly speeds up data analysis, avoids unconscious bias, and represents another step towards the widespread adaptation of Machine Learning techniques in biological data analysis., eLife digest Many molecules and structures within cells have to move about to do their job. Studying these movements is important to understand many biological processes, including the development of the brain or the spread of viruses. Kymographs are images that represent the movement of particles in time and space. Unfortunately, tracing the lines that represent movement in kymographs of biological particles is hard to do automatically, so currently this analysis is done by hand. Manually annotating kymographs is tedious, time-consuming and prone to the researcher’s unconscious bias. In an effort to simplify the analysis of kymographs, Jakobs et al. have developed KymoButler, a software tool that can do it automatically. KymoButler uses artificial intelligence to trace the lines in a kymograph and extract the information about particle movement. It speeds up analysis of kymographs by between 50 and 250 times, and comparisons show that it is as reliable as manual analysis. KymoButler is also significantly more effective than any previously existing automatic kymograph analysis programme. To make KymoButler accessible, Jakobs et al. have also created a website with a drag-and-drop facility that allows researchers to easily use the tool. KymoButler has been tested in many areas of biological research, from quantifying the movement of molecules in neurons to analysing the dynamics of the scaffolds that help cells keep their shape. This variety of applications showcases KymoButler’s versatility, and its potential applications. Jakobs et al. are further contributing to the field of machine learning in biology with ‘deepmirror.ai’, an online hub with the goal of accelerating the adoption of artificial intelligence in biology.

Failures of large-scale software projects continue at an alarming rate; moreover processes and frameworks known to address the (well-documented) problematic issues remain under-utilized. In this paper we posit that unconscious bias, rather than incompetence or unprofessionalism, explains these trends. We present a quantitative model of personalities that makes simple, testable predictions about biases. We analyze the main biases of, in particular, software managers in this paper - and how their biases contribute to software failures. We demonstrate biases in the process of looking for software solutions through text-analysis. We analyze a popular development framework, SAFe, for how well it addresses these biases and offer modifications to the framework that should better avoid the effects from these biases.