The Gender Gap in Diagnostic Reasoning: The Launch of Women in Diagnosis (WDx)

Smitha Ganeshan, MD MBA

Acknowledgements: Sharmin Shekarchian, MD, Emma Levine, MD, and Lindsey Shipley, MD, Daniel Minter, MD

Medicine has a gender problem. Women are less likely to become full professors or achieve leadership positions at academic medical institutions, and they receive significantly less compensation on average (even after accounting for clinical and research productivity).

Although gender inequality permeates all elements of medicine, it is particularly evident in the realm of diagnostic reasoning. Women are less likely to view themselves or be identified as skilled diagnosticians, which likely stems from the micro-moments that occur on the wards and in clinical reasoning exercises such as morning reports. Many women anecdotally feel less comfortable participating due to a perceived lack of respect for or recognition of their contributions. As a result, the barrier to participate is higher and women forgo opportunities to practice reasoning out loud in order to avoid being viewed as less competent. This apprehension may be compounded by the fact that vocal, opinionated, high-achieving women are often construed as aggressive or overly confident. A recent article found that women were underrepresented among all authorship positions in clinical problem-solving articles, which is consistent with previous studies demonstrating that women are less likely to be invited to author editorials and publish in peer-reviewed medical journals.

In everyday moments, women are inundated with microaggressions that undermine their confidence and contribute to a lack of public participation in diagnostic reasoning exercises. Patients regularly refer to female health professionals as “sweetie” or “babe” suggesting that they are less capable or do not belong. Even in formal spaces, women are more likely to be introduced by their first name alone and less likely to be referred to by their title. In diagnostic reasoning exercises and conferences, we rarely see women diagnosticians invited as the “master clinician” to solve a clinical unknown on stage. Medicine’s multifaceted legacy of sexism leads to fewer women being identified and elevated for their master diagnostic skills.

The challenges of being a woman in medicine resonate with my own and many others’ experiences. I grew up thinking that being a woman was a superpower. My mother moved across the world to the United States at the age of twenty after an arranged marriage tied her life to a man she didn’t know (but who luckily turned out to be my incredibly supportive father). Fast-forward twenty years, and she is now the CEO of two small businesses, has completed her MBA at Emory University, and takes care of three kids and her aging parents. Truly, a superwoman.

My family, teachers, and mentors shepherded me through life blissfully unaware that my gender could hinder my path. I was unaware of the role sexism would play in my professional life until my medical training. Over time, I became numb to comments about my appearance, questions about my competency (“are you even old enough to be a doctor?”), gendered feedback about how frequently I smile on rounds, or chastisements for taking initiative. These micro and macroaggressions became more difficult to endure amidst the long, stressful work hours of residency. As women progress in their careers, they must grapple with the dissonance between societal expectations (e.g., being easygoing and consensus-based) and the demands of leadership positions (e.g., decisiveness and assertiveness), which may make them more vulnerable to stereotype threat.

My experience is not unique and has been echoed by many students across health professions programs, co-residents, fellows, and faculty members. Thankfully, communities among women in medicine, allies in my residency program, and the CPSolvers, have provided a powerful antidote to the negative impacts of sexism on my personal and professional life.

In podcast episodes and virtual morning report, the CPSolvers team regularly strives to promote gender equity in diagnostic reasoning. To amplify the commitment to gender equity, the team has intentionally carved out a space for women’s voices to be heard. The new CPSolvers Women in Diagnosis Series (WDx), led by Dr. Sharmin Shekarchian, Dr. Emma Levine, and Dr. Lindsey Shipley, aims to promote, celebrate, and elevate women in diagnostic reasoning. Our hope is to create a space for women of all training levels to learn from mentors and “nerd-out” about clinical reasoning. We will also discuss issues related to barriers, access, and opportunities by sharing the skills and stories of women navigating careers in medicine. The series will consist of monthly episodes with women from the CPSolvers team and guest experts discussing topics such as the intersection of gender and race in medicine and solving clinical unknowns.  

While the CPSolvers are committed to exploring issues of gender inequity through our WDx series, we recognize that any discussion of gender inequity must recognize its deep roots in society and the multifaceted ways in which gender intersects with race, sexuality, and socioeconomic status. We hope that our collective work with WDx will bring us closer to a future in which women are regularly recognized for their master diagnostic skills and take the front stage to teach and lead the field of diagnostic reasoning. We hope that this reflective space will remind us that being a woman truly is a superpower.