Last spring, my graduating medical school cohort went through the usual process to name a valedictorian. Students nominated their peers, and the class voted from a short list of candidates. This list included class presidents and prominent researchers, but there was something unusual about it: It was 70 percent men.
When we had started medical school four years earlier, we were proudly told that our class was split 50-50 between men and women, which was reflective of the applicant pool. And yet, nine of the 13 nominees were men. I was not surprised when we eventually chose one of them to be valedictorian. And while he was very deserving in his own right, I started to wonder about this phenomenon.
I have a hard time thinking that the women in our class were any less accomplished or well-spoken than the men. In fact, women took all three prizes for highest grades in our class, though not a single one of these women was nominated for valedictorian. Neither was the lack of female nominees reflective of women’s leadership within our class council or in extracurriculars.
I wish I could say that this outcome was a fluke. However, after tracking down faculty records, I learned that since 1990, only three women have been the University of Toronto’s Faculty of Medicine valedictorian (a fourth was co-valedictorian with a man). It has been a dozen years since a woman was the voice of the graduating class; the last time a woman stood as the class speaker was 2006.
The valedictorian process reflects the socialization of gender roles. Men are often encouraged to give announcements, make humourous comments, or challenge lecturers. Women are less likely to speak up in post-secondary classroom settings. Female medical students have been shown to have less self-confidence, and to believe themselves less competent in clinical settings.
Perhaps some of these dynamics were affecting my classmates’ perceptions of one another. I wonder how bias could have reflected voting patterns within our class. I wonder whether women in our class displayed different qualities of leadership, working quietly behind the scenes to enact change. Were women less likely to nominate other women out of a sense of competition? Were both men and women less likely to nominate women due to a different perception of leadership styles, or different leadership characteristics? Or perhaps, due to our large class size, gendered social status had more room to thrive.
Having been one of the few women nominated on our class’s short list, I felt a little uncomfortable bringing up the question of the skew in the nominee list with my peers. But in an era of renewed #WomeninMedicine energy, I did not want to let this pass. Only by drawing attention to these issues can we create change.
I was relieved when some other women I spoke to told me that they had noticed the skew as well, but had been hesitant to speak up. Several men were put off by the idea that it was anything more than a coincidence, and a few of them gave me push-back, suggesting that I was creating a problem that was not there. They insisted that it wasn’t systemic, just a bit of luck. The skewed nomination list was made starker by such a lacklustre response.
Gender bias has been noted across medicine, from the scarcity of female senior authors on research articles, to the lack of representation of women in academic medicine jobs, to the paucity of women in leadership positions in academic societies. Previous analysis has focused on the lack of mentorship and role modelling available to women in medicine early in their careers, the perceived effects of parenting, and challenges faced by women moving up the academic career pathway. Yet valedictorian selection takes place before many students begin families or intentionally reduce work to balance with “life.” Our gendered perceptions of leadership run deeper than what I’ve been told I should expect.
The Faculty of Medicine at the University of Toronto has worked over the last number of years to foster diversity in its student body, from publicizing its stance as allies of diverse communities within medicine (including the LGBTQ and Black communities, as well as students coming from lower socioeconomic backgrounds) to developing mentorship opportunities. It is therefore surprising that my class failed to recognize its own lack of diversity of leadership. In any case, one thing is clear: Equal representation in the classroom is not sufficient for creating equality in leadership recognition.
Change is needed in how we choose valedictorians for medical school classes, with clear selection criteria. Applicants could submit speeches, for example, and this could be the basis for deciding who will be valedictorian. A nomination process where faculty sponsors encourage students to apply could be implemented. Similarly, across medicine, active sponsorship of female trainees—advocating for, protecting, and fighting for the career advancement of these trainees—is needed to create a community that fosters women in leadership. By intentionally choosing to cultivate women, including encouraging their nomination for roles like valedictorian, we can change the face of medicine.
We are facing a reckoning in medicine. As women continue to be passed over for awards and leadership positions, it is critical that we recognize the conscious and unconscious biases that shape how these decisions are made. A more in-depth study of the role of gender inequity in medical school may help address the problem at the professional level. Close analysis of mentorship and sponsorship are necessary to correct generations of gender bias. Only by tuning into our unconscious biases around what constitutes leadership, and through sponsoring women, can we change the definition of leadership within the medical community to one that is inclusive.