Purpose Despite sincere commitment to egalitarian, meritocratic principles, subtle gender bias persists, constraining women’s opportunities for academic advancement. The authors implemented a pair-matched, single-blind, cluster-randomized, controlled study of a gender bias habit-changing intervention at a large public university. Method Participants were faculty in 92 departments or divisions at the University of Wisconsin-Madison. Between September 2010 and March 2012, experimental departments were offered a gender bias habit-changing intervention as a 2.5 hour workshop. Surveys measured gender bias awareness; motivation, self-efficacy, and outcome expectations to reduce bias; and gender equity action. A timed word categorization task measured implicit gender/leadership bias. Faculty completed a worklife survey before and after all experimental departments received the intervention. Control departments were offered workshops after data were collected. Results Linear mixed-effects models showed significantly greater changes post-intervention for faculty in experimental vs. control departments on several outcome measures, including self-efficacy to engage in gender equity promoting behaviors (P = .013). When ≥ 25% of a department’s faculty attended the workshop (26 of 46 departments), significant increases in self-reported action to promote gender equity occurred at 3 months (P = .007). Post-intervention, faculty in experimental departments expressed greater perceptions of fit (P = .024), valuing of their research (P = .019), and comfort in raising personal and professional conflicts (P = .025). Conclusions An intervention that facilitates intentional behavioral change can help faculty break the gender bias habit and change department climate in ways that should support the career advancement of women in academic medicine, science, and engineering.

Background-Previous studies suggest that erythrocyte membranes from intraplaque hemorrhage into the necrotic core are a source of free cholesterol and may become a driving force in the progression of atherosclerosis. We have shown that MRI can accurately identify carotid intraplaque hemorrhage and precisely measure plaque volume. We tested the hypothesis that hemorrhage into carotid atheroma stimulates plaque progression. Methods and Results-Twenty-nine subjects (14 cases with intraplaque hemorrhage and 15 controls with comparably sized plaques without intraplaque hemorrhage at baseline) underwent serial carotid MRI examination with a multicontrast weighted protocol (T1, T2, proton density, and 3D time of flight) over a period of 18 months.

Background and Purpose-MRI is able to quantify carotid plaque size and composition with good accuracy and reproducibility and provides an opportunity to prospectively examine the relationship between plaque features and subsequent cerebrovascular events. We tested the hypothesis that the characteristics of carotid plaque, as assessed by MRI, are possible predictors of future ipsilateral cerebrovascular events. Methods-A total of 154 consecutive subjects who initially had an asymptomatic 50% to 79% carotid stenosis by ultrasound with Ն12 months of follow-up were included in this study. Multicontrast-weighted carotid MRIs were performed at baseline, and participants were followed clinically every 3 months to identify symptoms of cerebrovascular events. Results-Over a mean follow-up period of 38.2 months, 12 carotid cerebrovascular events occurred ipsilateral to the index carotid artery. Cox regression analysis demonstrated a significant association between baseline MRI identification of the following plaque characteristics and subsequent symptoms during follow-up: presence of a thin or ruptured fibrous cap (hazard ratio, 17.0; PՅ0.001), intraplaque hemorrhage (hazard ratio, 5.2; Pϭ0.005), larger mean intraplaque hemorrhage area (hazard ratio for 10 mm 2 increase, 2.6; Pϭ0.006), larger maximum %lipid-rich/necrotic core (hazard ratio for 10% increase, 1.6; Pϭ0.004), and larger maximum wall thickness (hazard ratio for a 1-mm increase, 1.6; Pϭ0.008). Conclusions-Among patients who initially had an asymptomatic 50% to 79% carotid stenosis, arteries with thinned or ruptured fibrous caps, intraplaque hemorrhage, larger maximum %lipid-rich/necrotic cores, and larger maximum wall thickness by MRI were associated with the occurrence of subsequent cerebrovascular events. Findings from this prospective study provide a basis for larger multicenter studies to assess the risk of plaque features for subsequent ischemic events. (Stroke. 2006;37:818-823.)

The National Science Foundation and others conclude that institutional transformation is required to ensure equal opportunities for the participation and advancement of men and women in academic science, technology, engineering, mathematics, and medicine (STEMM). Such transformation requires changing the habitual attitudes and behaviors of faculty. Approaching implicit bias as a remediable habit, we present the theoretical basis and conceptual model underpinning an educational intervention to promote bias literacy among university faculty as a step toward institutional transformation regarding gender equity. We describe the development and implementation of a Bias Literacy Workshop in detail so others can replicate or adapt it to their setting. Of the 220 (167 faculty and 53 nonfaculty) attendees from the initial 17 departments/divisions offered this workshop, all 180 who completed a written evaluation found the workshop at least “somewhat useful” and 74% found it “very useful.” Over 68% indicated increased knowledge of the workshop material. Of the 186 participants who wrote a commitment to engage in new activities to promote gender equity, 87% incorporated specific workshop content. Twenty-four participants were interviewed 4–6 months after attending the workshop; 75% of these not only demonstrated increased bias awareness, but described plans to change—or had actually changed—behaviors because of the workshop. Based on our sample of faculty from a Midwestern university, we conclude that at least one third of STEMM faculty who are invited will attend a 2.5-hr Bias Literacy Workshop, that nearly all will find it useful, and that most will complete a written commitment to promoting gender equity. These findings suggest that this educational intervention may effectively promote institutional change regarding gender equity.

Purpose To systematically review experimental evidence for interventions mitigating gender bias in employment. Unconscious endorsement of gender stereotypes can undermine academic medicine's commitment to gender equity. Method The authors performed electronic and hand searches for randomized controlled studies since 1973 of interventions that affect gender differences in evaluation of job applicants. Twenty-seven studies met all inclusion criteria. Interventions fell into three categories: application information, applicant features, and rating conditions. Results The studies identified gender bias as the difference in ratings or perceptions of men and women with identical qualifications. Studies reaffirmed negative bias against women being evaluated for positions traditionally or predominantly held by men (male sex-typed jobs). The assessments of male and female raters rarely differed. Interventions that provided raters with clear evidence of job-relevant competencies were effective. However, clearly competent women were rated lower than equivalent men for male sex-typed jobs unless evidence of communal qualities was also provided. A commitment to the value of credentials before review of applicants and women's presence at above 25% of the applicant pool eliminated bias against women. Two studies found unconscious resistance to “antibias” training, which could be overcome with distraction or an intervening task. Explicit employment equity policies and an attractive appearance benefited men more than women, whereas repeated employment gaps were more detrimental to men. Masculine-scented perfume favored the hiring of both sexes. Negative bias occurred against women who expressed anger or who were perceived as self-promoting. Conclusions High-level evidence exists for strategies to mitigate gender bias in hiring.

The purpose of this in vivo MRI study was to quantify changes in atherosclerotic plaque morphology prospectively and to identify factors that may alter the rate of progression in plaque burden. Sixtyeight asymptomatic subjects with ≥50% stenosis, underwent serial carotid MRI examinations over an 18 month period. Clinical risk factors for atherosclerosis, and medications were documented prospectively. The wall and total vessel areas, matched across time-points, were measured from cross-sectional images. The normalized wall index (NWI = wall area / total vessel area), as a marker of disease severity, was documented at baseline and at 18 months. Multiple regression analysis was used to correlate risk factors and morphological features of the plaque with the rate of progression/ regression.On average, the wall area increased by 2.2%/year (P=0.001). Multiple regression analysis demonstrated that statin therapy (P=0.01) and a normalized wall index >0.64 (P=0.001) were associated with a significantly reduced rate of progression in mean wall area. All other documented risk factors were not significantly associated with changes in wall area. Findings from this study suggest that increased normalized wall index and the use of statin therapy are associated with reduced Address for Correspondence: Thomas S. Hatsukami, MD VA Puget Sound Health Care System Surgery and Perioperative Care (112)

Purpose Recent guidelines for the Medical Student Performance Evaluation (MSPE) have standardized the “dean’s letter.” The authors examined MSPEs for linguistic differences according to student or author gender. Method This 2009 study analyzed 297 MSPEs for 227 male and 70 female medical students applying to a diagnostic radiology residency program. Text analysis software identified word counts, categories, frequencies, and contexts; factor analysis detected patterns of word categories in student–author gender pairings. Results Analyses showed a main effect for student gender (P=.046) and a group difference for the author–student gender combinations (P=.048). Female authors of male student MSPEs used the fewest “positive emotion” words (P=.006). MSPEs by male authors were shorter than those by females (P=.014). MSPEs for students ranked in the National Resident Matching Program contained more “standout” (P=.002) and “positive emotion” (P=.001) words. There were no differences in the author–gender pairs in the proportion of students ranked, although predominant word categories differed by author and student gender. Factor analysis revealed differences among the author–student groups in patterns of correlations among word categories. Conclusions MSPEs differed slightly but significantly by student and author gender. These differences may derive from societal norms for male and female behaviors and the subsequent linguistic interpretation of these behaviors, which itself may be colored by the observer’s gender. Although the differences in MSPEs did not seem to influence students’ rankings, this work underscores the need for awareness of the complex effects of gender in evaluating students and guiding their specialty choices.

The purpose of this paper is to explore new perspectives about difficulties academicians may have communicating with clinicians, obtaining subjects, and gaining compliance for their research. Sackett et al1 defined evidence-based medicine (EBM) as an integration of best research evidence, clinical expertise, and patient values. However, Guyatt et al2 places clinical observation and experience last in the evidence hierarchy with the randomized controlled trial held as the standard for clinical intervention. The hierarchical discourse of medical knowledge produces opposition rather than collaboration between researcher, clinician, and patient. Foucault gave new perspectives describing how power circulates through individuals within organizational discourse.3 Drawing on literature and experience, this paper describes how the hierarchical model of power in the research community obstructs new areas of knowledge, and how clinicians create resistance. Alleviating perceptions of dominance and creating connections produces cohesion within medical communities.