Implicit bias in medicine: Individual-level interventions may disempower vs. empower

For more than two decades, institutions seeking to address gender and other inequities have used the concept of implicit bias (IB) and implicit association testing (IAT) to welcome more diversity in their ranks (FitzGerald, et al, 2019).

There is some evidence to suggest these efforts have been effective in raising individual and collective awareness of implicit gender bias, and have encouraged individuals to take action to reduce those biases (Carnes, et al, 2015; Payne & Gawronski, 2015; Girod, et al, 2016). However, the focus on individuals has produced minimal overall improvements in gender equity, particularly in the workplace (Bezrukova, et al, 2016). Indeed, the emphasis on individual-level interventions may distract from the need to implement system-level reforms necessary for progress (Pritlove, et al, 2019).

When it comes to IB and IAT enhancing equity in the workplace, there are numerous limitations (FitzGerald, et al, 2019; Bezrukova, et al, 2016; Pritlove, et al, 2019). However, the ways that these interventions can actually disempower women are discussed much less frequently.

For instance, by making individuals the root of the problem and site of the solution, we ignore the deeply political and historical issues that guide system-level operations in ways that produce and reproduce gender inequity.

We can see this in the masculinized nature of many employment spheres, including the organization of healthcare systems (e.g. meritocratic principles, hierarchical ranking of healthcare providers like doctors vs. nurses, and so on), as well as in the written and unwritten policies that situate women as the primary unpaid caregivers for children and elders, with implications for their involvement in the employment sphere (Pritlove, et al, 2019; Morgan, et al, 2018). Through IAT and other individual-level interventions, people are primed to accept more responsibility in changing norms, but lack the power to make those changes at a system-level. By asking individuals to behave in more equitable ways, while neglecting hegemonic and patriarchal structures, we are setting them up for failure (Pritlove, et al, 2019).

Another problem is that IAT interventions are often targeted at predominantly white, heterosexual men, whose gender identity aligns with their biological sex. These interventions, therefore, are further financial investments in men’s “awakening,” rather than women’s advancement. When we do invest in women, the focus tends to be on “fixing” women, grooming them for success in what remain masculine employment structures. For example, women’s leadership programs provide women with tools to be “effective” leaders (Hopkins, et al, 2008). It’s a charge that carries a number of assumptions with it, including that women’s difficulty climbing ladders hinges on a lack of capacity, training, or the characteristics necessary for success.

It’s important to recognize that many forms of leadership training favor stereotypical male traits (e.g., authority, decisiveness, and completion of tasks vs. collaboration, empathy, and consensus-driven decision-making) (Vial & Napier, 2018; Gutiérrez y Muhs, 2012).

Instead of teaching women skills deemed critical on the individual level, the better approach might be to question why masculine norms have been permitted to define leadership in the first place. Then, more focus could be placed on providing greater opportunities to redefine the concept in ways that promote greater diversity of skills.

Finally, not all women in the workforce are similarly marginalized (Gutiérrez y Muhs, 2012). So, strategies to empower must account for the individualized nature of a woman’s experience, as gender intersects with race, ethnicity, class, identity, and countless combinations thereof. The ways in which these intersections impact oppression is overlooked in IB and IAT interventions (Pritlove, 2019), projecting instead the experiences of predominantly white, heterosexual women. Adopting a universal approach to women’s experiences may empower women who belong to the dominant group. For the rest, their voices and struggles are often silenced. 

Currently, feminist theories are largely absent from conversations about gender equity in medicine, the inclusion of which are necessary for producing meaningful and lasting change (Sharma, 2019). According to many feminist theories, empowerment relies on an individual’s opportunity to challenge and contribute to change in existing power relations and on gaining greater control over the sources of power (Cornwall, 2016). Providing women with opportunities to contribute to system-level changes, rather than focusing exclusively on individual-interventions, can only enhance their sense of empowerment, and offer more opportunities for inclusive and diverse workplaces.