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.
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Well written and argued Dr. Silverberg! As a male neurologist, I often see female students and resident staff knowing the answers but often not being very confident about it and speaking softly. I try and encourage them, but we do need societal change. Good luck and all the best to you and your sisters!
Medical schools have valedictorians voted on?
What’s the point of that? Seems a bit self-indulgent.
What is next, a “Dr Congeniality” award?
What was the ethnicity of the male (if in fact he identified as male) valedictorian?
How about his sexual orientation?
What was his socioeconomic status?
Was he a “legacy admission” (eg mom or dad went to the same medical school)?
So many questions.
By the way, so may other health professional trainees are highly feminized.
For example, does anyone know if valedictorians amongst registered dietitians are mainly men?
I sure wish the DIVERSITY of articles written in Healthydebate improves- I mean how many of these articles are written by physicians (irrespective of their gender identity)?
Seems likely that the best candidates were men, and the valedictorian was freely chosen by his peers. Accept it.
You sated this in the first sentence, making your whole story moot…. “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.”
It’s your fault. Why didn’t the 50% vote for women? There’s no conspiracy here, just like the mythical Gender Pay Gap.
Dr. Silverberg, I think the question you pose in this article’s title is legitimate and worthy of your research and attention; the question’s broad, the contributing factors multifactorial, and the process of reaching a definitive answer will be laborious and exhaustive. I hope you continue to look into it and eventually uncover the truth, as uncomfortable as it may be for others, or even for you.
I remember seeing a good amount of ADHD during my pediatrics rotation, and I decided to dedicate my obligatory presentation to the history of ADHD and the chronological development of the condition’s diagnostic criteria. I, like you, was inspired by a simple and broad question: “Is ADHD under-diagnosed?” One of our supervising pediatricians was thoroughly convinced that it is, but there are data that don’t exactly jive with that hypothesis: The differing number of diagnoses according to school districts in the USA, the lower rate of diagnoses in Europe as opposed to North America, the higher rate of diagnoses in single parent homes versus two parent homes, etc. Is it, in fact, an objective, genetically influenced condition that is too scarcely recognized, or is it a crutch that people are more likely to use in certain social circumstances? Is it both? Is it neither? Is it more? My presentation was only the first scratch of the surface of a very large iceberg that I intend to explore throughout my career. For now, I’m working with the hypothesis that ADHD is over-diagnosed in North America, and I’m trying my darndest to remain objective and unbiased to allow myself to be proven otherwise.
Similarly, you’ve posed interesting questions that scratch the surface of another icerbeg’s tip: Are women systematically blocked from leadership positions in medicine, or are they less likely to apply for other reasons? Is it due to lack of assertiveness? Is the lack of assertiveness objectively attributable to gender, is it because of historical chauvinism, or both? Is it because those positions do a terrible job of accommodating motherhood? Did your female classmates, in fact, vote for less women because of spitefulness and competition?
I haven’t seen much data related to your questions, and I’m sure more needs to be surfaced. Anecdotally, both of the Deans at my medical campus have been women, our class president was a woman, my residency program director is a woman, I was raised by a strong-willed, entrepreneurial mother who owns her own business, and you, Dr. Silverberg, are one of eight Ob/Gyn residents at UBC, seven of which are women. There are areas requiring improvement, no doubt, but it ain’t all bad.
Gender inequality in medicine is not one of my research interests, but I’ll keep my ears and eyes out and send people your way. I hope you’ve been well, and I hope you’ve enjoying BC.
Cheers!
Thank you for this article. No matter how glaring the inequality or stark the data is in pointing to implicit bias, there will always be people who jump in to defend the status quo. Even if that means misreading your words, ignoring the statistics or making wild assumptions about what you are saying. This can be interpreted as fragility or simply ignorance. Either way, the path to equity is littered with those who feel threatened by progress. Pay them no mind and keep up the good work!
Hear hear Michelle!
The author is now guaranteed to be in the upper echelons of society – likely 95-99% percentile in intelligence, health, work ethic and soon to be financial status. Congratulations! Life is likely to be much better for you than the vast majority of people of your city, your province, your country, the world and across the span of human history. That 2019 gender equity is focused upon the tiniest tip of elite positions freely chosen by peers is out of touch and solipsistic.
Second, let’s say you get your wish. The medical school will now make some form of ‘redress’ along the lines of gender. Why stop there? Why not race? Why not any number of the intersections of identity currently favored? Why not silent and unidentified forms of inequality like mental and physical health? Why should gender be the focus instead of other forms. Practically, the only way to do this will be to have some form of group that looks at these criteria and makes some according adjustment. Currently, the valedictorian is chosen by your classmates, your peers. Even if I agreed with the premise of equality along gender lines, do you really want to take this decision out of your classmates and have it be adjudicated by administrators? Be careful what you wish for.
In more practical terms, this comes across as someone not winning a game and complaining about the referee.
Thank you for articulating an issues that is not unique to Medicine, but a common occurrence across multiple industries and professional settings.
Thank you for your perspective, Dr. Silverberg. While I too had a male valedictorian (whom I proudly voted in support of), my medical school class president was a terrific female leader who was re-elected for all four years of our training. In my internship training site, 4 of the last 4 chief interns (elected by their peers) have been female. I believe change is happening. Thanks for continuing the discussion
Thought provoking article. Thank you for posting
Thoughtful article, thanks for writing it! The example of your class’ vote has unfortunately been the focus of many of these comments, but it is clear that you are making a much broader point. It surprising that no women have been valedictorian for 12 years and so few in the last 30 years. Thank you for bringing these statistics to light. Disclaimer: I was one of those male valedictorians and there were certainly plenty of women in our class who would have done an amazing job. Hopefully your article is a step toward bringing a better balance in future years!
Well said Dr. Silverberg. It is a complex issue and one that needs overt recognition to redress.. and no matter what, with a push towards equity, there is a necessary loss of someone else’s privilege…. which often gets perceived as persecution..
Don’t nominate people for valedictorian because they are women, nominate them if they are outstanding, truly outstanding. Un equal nominations does not automatically mean we have a case of sexism or bias. Please stop making a case for sex to be the basis for determining nomination. Women are strong and we do not need to be sponsored to climb to the top of our professions, we can climb if we want to.
Brandi, that’s true. The problem is that a lot of the time, women are outstanding but don’t “sell themselves” or “show themselves off”. They go around doing outstanding jobs that people don’t notice because we don’t necessarily bring it to others’ attention. Plus, many characteristics that are “admirable” in men (e.g. confidence, assertiveness) are looked down upon and criticized in women (e.g. they’re “bossy” or worse). The reality is that there are big, socialized differences in how men and women are expected to behave and what people are “supposed to” find impressive, and it’s all skewed towards men. And in every study they’ve done on this, we know that people can and do discriminate against themselves (e.g. women judge other women harshly, Black people judge other Black people less favourably). We need systemic changes and solutions to these problems because society is and always will be slow to change and biases are tough to address.
Right on!!!! At the BC graduation last year there were THREE valedictorians, ALL MALE!!!! As a feminist from the late 60’s I immediately reacted both verbally to my family members present and wrote and sent a letter to the Dean of Medicine, strongly criticizing this practice which I believe is ABSOLUTELY WRONG in this day and age. I received a response from the Dean, however there were no guarantees that equal representation policies would be made, in light of the fact that the student body was 50/50%.
I suggest that your article should be forwarded to the Media.
I think one important thing is being forgotten here. The medical school class at UofT is not 50:50. Almost every year since 2015 has been skewed female as high as 60 percent. What other premises are you forgetting? Is it possible that choice is a factor here? Why force female students to do something they may not want to do?
Commenting on “Our systems continue to default to men”. Do whiners ever consider Margaret Thatcher or Angela Merkel?
Making a generalized statement from two anecdotal examples does not prove a point.
Well written and compelling piece Dr Silver. I agree completely with this. Our systems continue to default to men (white men) when considering what a leader should look like. Furthermore, there are many nudges along the way that make men more visible as potential candidates (nominees) which you accurately describe in the article. In the case of nominations, I think a lot can be achieved by compelling women to support other women- if the women in the class had made a concerted effort to nominate each other this would have helped considerably. We still have a long way to go – by speaking out on healthy debate you are leading the way! Thank you.
Nominations were anonymous and the person who ended up giving the valedictorian speech was brown. There were more women in our year than men. Why they didn’t nominate each other or vote for another woman was their choice.
Sarah,
You mention that perhaps females in the class did not nominate other women for the role because of a sense of competition. I wonder if there is something to that, as part of the answer. It would be interesting to understand that better, whether, if true, that sense is nature or nurture.
I mean, it’s not like the higher ups chose this person. It was the class who votes for valedictorian. The class also has more females than males, who ultimately voted for the male. I’m blown away anyone could be upset by this.
A bit testy, are we Jake? Or perhaps just ignorant of the realities of how societal roles and expectations result in biases in how all people- women included- view different genders. The reality is that women often judge other women more harshly than they judge men, and expectations and evaluations, even if implicit, are biased in favour of men. Now, you’re a man, so this works out to your benefit. But the reality is that this isn’t the author calling herself a victim. Statistically, it’s almost impossible for men to be valedictorians year after year after year when classes in med school have been made up of female majorities for a few years now. This says something, whether you want to believe it or not, about broader social phenomena rather than “deservingness” of men (or undeservingness of women). The reality is that the exact same behaviours are perceived differently coming from a man vs. a woman. Men are still consistently rated, by all genders, to be more charismatic, more intelligent, more assertive, better speakers, etc. etc. even when evidence doesn’t bear this out. You probably don’t want to recognize it because it’s hard to come to terms with the fact that you (and I, and most men) have had things we think we’ve “worked for” actually come to us by virtue of luck and the fact that we’re men. It’s hard to accept- but are you man enough to do so?
At some point you have to look in the mirror and say “even though I’m a woman I’m not necessarily the best person for this task”
If you want to be valedictorian do something over the course of your training that makes you worthy of it.
This was a largely unhelpful response and was not in keeping with the spirit of a healthy debate. Nevertheless, you bring up some very interesting attitudes and beliefs
Firstly, any experience shared for the sake of discussion, regardless of one’s career, is not a waste. The issue at hand relates to a larger audience that includes, but is not limited to, physicians. As you know, women in film, technology, science, medicine, etc. have been empowered in recent years to share their experience of how their gender affects them in their careers. These facts have become popularized by books like Lean In by Sheryl Sandberg and are important for both men and women to recognize and acknowledge
Secondly, your response “At some point you have to look in the mirror and say “even though I’m a woman I’m not necessarily the best person for this task. If you want to be valedictorian do something over the course of your training that makes you worthy of it” is a prime example of narrow mindedness around this topic and is the type of attitude that perpetually degrades women and prevents them from achieving recognition or leadership positions, regardless of their worthiness
Thank you Dr. Silverberg for your work in sharing your experience, which rings true in many medical schools across the country
I do not pretend to believe I would have been best suited for the honour nor say so in this piece – in fact I think one of my (female) colleagues would have been an excellent choice. I do, however, believe that a number of women in my class did more than enough over the course of their training to “earn it” – the issue at hand is why they were not recognized.
Spoken like a true dude who doesn’t get it. Your attitude is the problem. Do you know how often women don’t apply for positions or awards or grants cause they don’t think they’re worthy, even if they objectively are? Do you know how often women face discrimination by virtue of their gender? How many papers, for instance, are statistically more likely to be rejected by female vs. male authors? How women are rated “aggressive” while men “assertive”, as just one example?
Women are worthy. The author’s given ample evidence of that- the fact that women are often winnings awards, are top of the class, etc. You know why people probably choose guys as valedictorians? Cause there’s a biased belief that women can’t public speak, or won’t be funny or charming or whatever. Cause women are judged as being less capable even if they’re more capable than their male counterparts. If you don’t want to accept that, that’s your problem. But since it’s your problem, why not listen and learn instead of posting unhelpful and ignorant comments? You probably got a bunch of stuff handed to you in life cause you’re a guy (I have too, and I’ve learned this after actually talking to women about these things). What you say just isn’t borne out by data.
Phil – take your own advice and stop whining about MD centric stories. Did you know there are only a few MDs on the editorial board and it’s 50 percent patients??? You cleay just see MD and troll without doing your homework or knowing anything about this site. And do you realize that you could get off your butt and submit an article rather than just trolling the hardworking people who submit stuff? I highly doubt HD is rejecting every non-MD story. They’re probably just publishing what gets pitched.
I’ve taken the liberty of rewriting your comment to hilight your hypocrisy:
“At some point you have to look in the mirror and say ‘I’m a nurse and not necessarily the best person for this task’… If you want to be ‘published on healthy debate write’ something that makes you worthy of it.”
I am starting to think, gender notwithstanding, that perhaps Healthy Debate is a forum for egocentric physicians to parse on issues of privilege.
What a waste of a forum to have so many MD-centric stories.
Hey, you don’t have to click on them or read them. But thanks for the clicks!
James, ignoring the reality of the MD-centric writing on Healthy Debate would be easy. But I am genuinely interested in Healthy Debate- this means speaking out on unconscious biases that may be present in the editorial team that allow disproportionate and inequitable representation of perspectives.
Your comment reflects greater ego centrism than this article does. Feel free to read only articles that are not about MDs only if that’s your preference
Unfortunately Tamara there is a paucity of articles by other regulated health professionals on Healthy Debate- and when there are some, it comes across as tokenism.
I am a nurse (yes, a male nurse). Power dynamics and gender issues interest me.