A recent article in this journal by Katrina Hutchison exposes and addresses the cumulative effects of implicit bias on women in surgery. We doubt that there is a single woman in any surgical field who has not experienced both implicit and explicit bias. Many of the issues facing women in surgery seem to be mirrored in both the developed and developing countries. There is little literature describing the exact situation in Africa. South African government institutions have made a concerted effort to improve the representation of minorities in business, education and the health sector. In the hospital setting, hiring is done by means of a quota system based on demographics within that particular sector. This has also resulted in a number of unforeseen epistemic biases. This policy-driven ‘forced’ hiring of female candidates also led to feelings of doubt in the candidates themselves about their merits and competence and capabilities. This epistemic bias can then filter down, feeding the already prevalent imposter syndrome and confidence issues felt by many female surgical trainees. Not only do we need to aim to change the culture in surgical departments by changing the image of the ‘stereotypical surgeon’, we need to extend this message out into our training institutions, communities and peoples’ homes. We believe that this is the only way to change a culture steeped in implicit bias, to be more inclusive of women and other minority groups and shed the assumption that they are lesser.
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Contributors Both authors were involved in the development of the content for this response.
Funding Dr Wall’s contribution to this work is partially supported by the Fogarty International Center (FIC), NIH Common Fund, Office of Strategic Coordination, Office of the Director (OD/OSC/CF/NIH), Office of AIDS Research, Office of the Director (OAR/NIH), National Institute of Mental Health (NIMH/NIH) of the National Institutes of Health under Award Number D43TW010131. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
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