Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities: observational study using NHS population-derived weights.

BACKGROUND: This observational study, paired with National Health Service (NHS) workforce population data, examined gender differences in surgical workforce members' experiences with sexual misconduct (sexual harassment, sexual assault, rape) among colleagues in the past 5 years, and their views of the adequacy of accountable organizations in dealing with this issue. METHODS: This was a survey of UK surgical workforce members, recruited via surgical organizations. RESULTS: Some 1704 individuals participated, with 1434 (51.5 per cent women) eligible for primary unweighted analyses. Weighted analyses, grounded in NHS England surgical workforce population data, used 756 NHS England participants. Weighted and unweighted analyses showed that, compared with men, women were significantly more likely to report witnessing, and be a target of, sexual misconduct. Among women, 63.3 per cent reported being the target of sexual harassment versus 23.7 per cent of men (89.5 per cent witnessing versus 81.0 per cent of men). Additionally, 29.9 per cent of women had been sexually assaulted versus 6.9 per cent of men (35.9 per cent witnessing versus 17.1 per cent of men), with 10.9 per cent of women experiencing forced physical contact for career opportunities (a form of sexual assault) versus 0.7 per cent of men. Being raped by a colleague was reported by 0.8 per cent of women versus 0.1 per cent of men (1.9 per cent witnessing versus 0.6 per cent of men). Evaluations of organizations' adequacy in handling sexual misconduct were significantly lower among women than men, ranging from a low of 15.1 per cent for the General Medical Council to a high of 31.1 per cent for the Royal Colleges (men's evaluations: 48.6 and 60.2 per cent respectively). CONCLUSION: Sexual misconduct in the past 5 years has been experienced widely, with women affected disproportionately. Accountable organizations are not regarded as dealing adequately with this issue.

This research examined sexual misconduct occurring in surgery in the UK, so that more informed and targeted actions can be taken to make healthcare safer for staff and patients. A survey assessed individuals' experiences with being sexually harassed, sexually assaulted, and raped by work colleagues. Individuals were also asked whether they had seen this happen to others at work. Compared with men, women were much more likely to have seen sexual misconduct happening to others, and to have it happen to them. For example, most women (63.3 per cent) experienced being sexually harassed by colleagues, as did some men (23.7 per cent). Women also experienced being sexual assaulted by colleagues far more often than men (29.9 per cent of women, 6.9 per cent of men). These findings show that women and men in the surgical workforce are living different realities. For women, being around colleagues is more often going to mean witnessing, and being a target of, sexual misconduct. Individuals were also asked whether they thought healthcare-related organizations were handling issues of sexual misconduct adequately; most did not think they were. The General Medical Council (GMC) received the lowest evaluations. Only 15.1 per cent of women regarded the GMC as adequate in their handling of sexual misconduct. Men's evaluations were higher, although the GMC was still regarded as adequate by less than half of men (48.6 per cent). Evaluations of National Health Service Trusts were rated similarly low. Only 15.8 per cent of women evaluated them as adequate (44.9 per cent of men). The results of this study have implications for all stakeholders, including patients. Sexual misconduct was commonly experienced by respondents, representing a serious issue for the profession. There is a widespread lack of faith in the UK organizations responsible for dealing with this issue. Those organizations have a duty to protect the workforce, and to protect patients.

"Fitting in whilst standing out": Identity flexing strategies of professional British women of African, Asian, and Caribbean ethnicities.

Introduction: Professional British women of African, Asian, and Caribbean (AAC) ethnicities contend with unique challenges and experiences in the workplace. These challenges are often due to experiences that occur at the intersection of gender and ethnic identity, thus many professional white British women (of Anglo-Saxon decent), do not face the same challenges. AAC women are more often discriminated against, excluded from informal networks, and their contributions credited to someone else. We take an intersectional theoretical approach to better understand both the disadvantaged experiences and the possible advantaged experiences that British AAC women face, based on their experiences as AAC individuals, as women and as AAC women. The study seeks to 'give voice' to the experiences of AAC professional women, due to the limited amount of scholarship that adequately considers their workplace experiences. We consider the ways that their identity produces qualitatively different experiences determined by the context, by the nature of interpersonal encounters or by both the context and interpersonal encounters. Methods: We conduct real-time online written interviews and utilize thematic template analysis to understand whether AAC women strategically flex identity at work. We present four major themes. These are (1) the benefits of identity flexing, (2) the role of specific stereotypes, (3) context specific opportunities, and (4) the costs of identity flexing. We draw on literature that suggests that AAC women's identity experiences are not exclusively oppressive. Results: We find that unique experiences, occurring at the intersection of facets of identity may also yield forms of relative advantage, wherein individuals are able to adaptively leverage opportunities. Our results demonstrate that where the facets of one's identity are more varied, there might be more chance that the particular identity will be valued in a given social context. As a result, the individual may try to assimilate with certain identity groups (through flexing), as the context directs. Discussion: Nevertheless, engaging in identity flexing strategies has costs for women's well-being, such as needing to perform increased amounts of emotional labor and heightened feelings of frustration. Overall, these costs (as well as benefits), evidence the complex nature of identity flexing and the likely negative well-being implications that could ensue for the individual.

Gender expectations, socioeconomic inequalities and definitions of career success: A qualitative study with university students.

Higher Education (HE) is seen as a tool to create job opportunities and enhance individuals' quality of life. Research demonstrates that students' expectations of career success in HE are an important predictor of their motivation and academic attainment. However, there is a lack of clarity about how career success is defined and whether individuals perceive that their experiences (e.g., gender) may be associated with these definitions. In online written interviews with 36 university students in the United Kingdom, we examine how students define career success and how they perceive their identity (gender, socioeconomic status) experiences underpinning these definitions. We analysed three main definitional themes: (a) career success as personal development, (b) career success as individual mobility, and (c) lack of clarity about what career success is. Findings suggest that gender and socioeconomic experiences had an important role in students' understanding of career success, especially for students from disadvantaged backgrounds. Indeed, in the intersection of gender and socioeconomic status, inequalities persist: female students anticipated difficulties in terms of work-life balance and gender stereotypes that constrained their career success definitions. Moreover, family experiences were important to understand students' definitions of career success, particularly for disadvantaged socioeconomic groups. The current research sheds light on an important paradox in HE organisations: while students tend to define career success in relatively individualistic ways, such as individual mobility, financial success, or personal development, it was clear that their social identities (e.g., gender, socioeconomic status) and related experiences played an important role in creating definitions of career success. This further implies that when universities encourage a perception of career success as individual mobility, for example, having better job opportunities, or by espousing the belief that higher education and/or professional sectors are truly meritocratic-this will not always align with, and may create tension for, students from disadvantaged groups.

Disentangling the nuances of diversity ideologies.

Objectives: Minoritized racial groups typically report greater psychological engagement and safety in contexts that endorse multiculturalism rather than colorblindness. However, organizational statements often contain multiple (sub)components of these ideologies. This research broadens our understanding of diversity ideologies in the real-world by: (1) mapping out the content of real-world organizational diversity ideologies, (2) identifying how different components tend to cluster in real-world statements, and (3) presenting these statements to minoritized group members (Study 2) to test how these individual components and clusters are perceived (e.g., company interest, value fit). Methods: 100 US university statements and 248 Fortune 500 company statements were content coded, and 237 racially minoritized participants (Mage = 28.1; 51.5% female; 48.5% male) rated their psychological perceptions of the Fortune 500 statements. Results: While universities most commonly frame diversity ideologies in terms of value-in-equality, companies focus more on value-in-individual differences. Diversity rationales also differ between organizations, with universities focusing on the moral and business cases almost equally, but companies focusing on the business case substantially more. Results also offered preliminary evidence that minoritized racial group members reported a greater sense of their values fitting those of the organization when considering organizations that valued individual and group differences. Conclusion: These are some of the first studies to provide a nuanced examination of the components and clusters of diversity ideologies that real-world organizations are using, ultimately with implications for how we move forward in studying diversity ideologies (to better reflect reality) and redesigning them to encourage more diverse and inclusive organizations.

Gender and social class inequalities in higher education: intersectional reflections on a workshop experience.

Research about the experiences of underrepresented groups in higher education (HE) demonstrates the persistence of challenges, despite policies and institutional strategies to promote inclusion. Diversity and inclusion policies have been part of the HE agenda for several decades, yet most policies and interventions focus on (a) a given, isolated identity experience (e.g., based solely on gender, social class, or ethnicity) rather than more intersectional approaches to identity; and (b) top-down interventions that do not include participants insights in their design. In this paper, we report a case study of a workshop with students at an elite university that drew on an intersectional approach to social identities (IASI), specifically, looking at gender and social class. We explore three key themes: (a) the importance of group processes, (b) the use of visual techniques, and (c) the institutional tensions and the (de)politicisation of social psychology research. Reflecting on this case study we argue that approaches to identity and inclusion in HE can benefit from intersectionality beyond the use of multi and overlapping identity and social group categories. We argue that research in this space is not neutral and needs to acknowledge researchers' position about (a) inclusion and diversity, (b) perceptions of participants in research, and (c) the motivation and aims of institutions where the research is conducted. Finally, we discuss the theoretical and practical implications of integrating an intersectional approach within social identity research in HE when focusing on underrepresented groups.

Overestimating women's representation in medicine: a survey of medical professionals' estimates and their(un)willingness to support gender equality initiatives.

OBJECTIVE: Amidst growing numbers of women in certain areas of medicine (eg, general practice/primary care), yet their continued under-representation in others (eg, surgical specialties), this study examines (1) whether medical professionals mistakenly infer that women are now broadly well represented, overestimating women's true representation in several different areas and roles; and (2) whether this overestimation of women's representation predicts decreased support for gender equality initiatives in the field, in conjunction with one's own gender. DESIGN: Cross-sectional survey. SETTING: UK-based medical field. PARTICIPANTS: 425 UK medical consultants/general practitioners and trainees (ST/CT1+/SHO/Registrar); 47% were female. MAIN OUTCOME MEASURES: Estimates of women's representation in different areas/roles within medicine, examined as a composite estimate and individually; and a multi-item measure of support for gender-based initiatives in medicine. RESULTS: Medical professionals tended to overestimate women's true representation in several different areas of medicine (general practice, medical specialties, surgical specialties) and in various roles (consultants/general practitioners, trainees, medical school graduates). Moreover, these erroneous estimates predicted a decreased willingness to support gender-based initiatives, particularly among men in the field: composite overestimation*respondent gender interaction, B=-0.04, 95% CI -0.07 to -0.01, p=0.01. Specifically, while female respondents' (over)estimates were unrelated to their level of support (B=0.00, 95% CI -0.02 to 0.02, p=0.92), male respondents' tendency to overestimate the proportion of women in medicine predicted lower support for gender-based initiatives (B=-0.04, 95% CI -0.06 to -0.02, p<0.001). CONCLUSIONS: While some progress has been made in gender representation in the medical field, this research illustrates that there are still barriers to gender equality efforts and identifies who within the field is focally maintaining these barriers. It is those individuals (particularly men) who overestimate the true progress that has been made in women's representation who are at highest risk of undermining it.

Reaching the top but not feeling on top of the world: Examining women's internalized power threats.

More and more women are breaking the glass ceiling to obtain positions of power. Yet with this rise, some women experience threats to their power. Here we focus on women's perceived threats to the stability of their power and the degree to which women feel they do not deserve their power positions, as reflected in their impostor feelings. The present research identifies key workplace characteristics that are associated with these internalized power threats with survey data collected among 185 women in high-power positions. We find that negative workplace experiences (i.e., gender discrimination, denigrating treatment, lack of cultural fit, and lack of mentoring) are associated with a greater sense of power threat, which in turn relates to adverse workplace outcomes (i.e., reduced job satisfaction and increased emotional exhaustion and opting-out intentions). With this unique sample of high-powered women, our findings help illustrate the forces that make women experience power as precarious, thereby shedding light on the disadvantages these women face. We provide suggestions on how to reduce women's internalized power threats.

Dietary behaviour as a form of collective action: A social identity model of vegan activism.

Adopting plant-based, or vegan, diets can have a number of benefits, including mitigating climate change, promoting animal welfare, or improving public health. In the current research, we use social psychological theory to better understand what motivates vegans to engage in collective action on behalf of this social group - that is, what motivates individuals to promote, or encourage others to adopt, a vegan lifestyle. We develop and test a Social Identity Model of Vegan Activism, which highlights the roles of individuals' social identities, sense of efficacy, emotions and moral convictions in fostering collective action. In two pre-registered studies, the first with self-identified vegans from Australia and the UK (N = 351), and the second with self-identified vegans from the UK and the US (N = 340), we found that individuals more frequently engaged in vegan activism (i.e., actions to promote vegan lifestyles) when they had stronger moral convictions (i.e., deontological or consequentialist), greater collective efficacy (i.e., beliefs that vegans can make a positive difference), anger (i.e., when thinking about the reasons why they are vegan), and identification (both with vegans, and with animals). Deontological and consequentialist moral convictions had significant indirect effects on vegan activism via different mediators. We conclude by discussing the implications and importance of studying dietary behavior from a social identity perspective, including its ability to help explain how and why individuals become motivated to not only adopt a certain (e.g., vegan) lifestyle themselves, but to also 'act collectively' on behalf of that shared group membership (e.g., promote vegan-friendly behaviors). We also highlight some key insights for policy makers and campaigners aiming to promote plant-based diets.

Identity-Related Factors Protect Well-Being Against Stigma for Transgender and Gender Non-Conforming People.

Relatively little is known about identity-related resilience factors associated with well-being among transgender and gender non-conforming (TGNC) people. Drawing upon theory on stigma-related stress and resilience and work examining group identification as a buffer against discrimination, the aim of the current study was to model perceived discrimination, transgender identification, and gender identity affirmation as predictors of well-being for TGNC people. We also tested whether the positive association between gender identity affirmation and well-being might be explained by the benefits affirmation has for individual self-concept clarity. Participants were 105 TGNC individuals (42% transgender male, 39% transgender female, 19% other gender non-conforming [e.g., non-binary]) recruited through online forums and support groups in the UK and North America who completed an online survey including self-report measures of key constructs. Results from structural equation models demonstrated that: (1) experiences of discrimination were associated with lower well-being overall, but having a stronger transgender identity moderated this association; (2) after adjustment for discrimination and transgender identification, experiences of gender identity affirmation were independently associated with greater well-being for TGNC people. Secondary analyses demonstrated that gender identity affirmation was linked to well-being through reinforcing a strong, internalized sense of clarity about individual self-concept. Results are discussed in terms of the implications for TGNC health and well-being, particularly with regard to the need for supportive, identity-affirming social environments.

Unhealthy closets, discriminatory dwellings: The mental health benefits and costs of being open about one's sexual minority status.

RATIONALE: With a concealable stigmatized identity, sexual minorities not only face discrimination but the burden of deciding when to be open about their sexuality. What are the mental health costs and benefits to openness about sexual minority status? On the one hand, openness fosters integration within the LGBTQ + community (yielding downstream benefits), but it also heightens perceptions of discrimination towards oneself and the group at large (yielding downstream costs for mental health). OBJECTIVE: Previous research has focused on openness as reflecting either a cost or a benefit to sexual minorities' mental health, resulting in apparent conflict. We propose an integrated view of openness as leading to both costs and benefits that work in tandem to steer mental health. METHODS: In two pre-registered studies with nearly 4000 ethnically diverse, sexual minority participants, we propose a theoretically-driven serial mediation model to test opposing mediating mechanisms that operate on subjective wellbeing and mental health. Specifically, we determine how the relationship between openness about sexual minority status fosters LGBTQ + identity importance, community integration, and perception of discrimination. RESULTS: Being more (vs. less) open strengthens LGBTQ identity importance, facilitating integration in the LGBTQ + community, which benefits mental health. However, openness and strengthened identity importance simultaneously prompt increased perceptions of discrimination, the burden of which adversely affects mental health. Together these opposing forces explain the weak association between greater openness and mental health - an association that indicates, overall, that openness does have a net benefit for LGBTQ + individuals' mental health. CONCLUSIONS: By identifying opposing mechanisms that underlie the relationship between openness and mental health, we have provided a more integrated perspective on the role that openness plays on sexual minorities' mental health. Openness is associated with stronger group identity importance, greater community integration, and heightened perception that the group (and self) face discrimination.

Being treated fairly in groups is important, but not sufficient: The role of distinctive treatment in groups, and its implications for mental health.

Organizations and other groups often recognize the importance of members treating each other in a fair (dignified, unbiased) manner. This type of treatment is key to fostering individuals' sense of belonging in the group. However, while a sense of belonging is important, individuals also need to be shown that they have some distinct value to the group-enabling them to not only "fit in" but also "stand out." Building from research on fair treatment, we explicate another form, distinctive treatment, whereby others show interest and appreciation for an individual's more distinguishing, group-relevant qualities. In six studies using multiple methods (e.g., experimental, longitudinal) and in multiple types of groups (work organizations, student communities, racial/ethnic minority groups), we show that fair and distinctive treatment play fundamentally different roles-shaping individuals' perceived belonging versus intragroup standing, respectively-and with downstream benefits for mental health (less anxiety, fewer depressive symptoms). Overall, this illustrates that promoting fair treatment in groups is important, but not sufficient. Experiencing distinctive treatment is also key. Each type of treatment provides unique social evaluative information that fosters a healthy sense of self. This research further indicates that distinctive treatment may be a vital yet overlooked element to promoting diversity and inclusion in groups, as it provides a path for recognizing and appreciating, and thus encouraging, a diversity of ideas, insights, knowledge and skills that individuals bring to the group.

Contextualizing the Impostor "Syndrome".

The impostor "syndrome" refers to the notion that some individuals feel as if they ended up in esteemed roles and positions not because of their competencies, but because of some oversight or stroke of luck. Such individuals therefore feel like frauds or "impostors." Despite the fact that impostor feelings are often linked to marginalized groups in society, to date, research predominantly approaches this phenomenon as an issue of the individual: pointing toward individuals for the roots and solutions of the "syndrome." Drawing from a rich body of social and organizational psychology research, in this perspectives piece, we propose a shift in how scholars conceptualize and empirically examine this phenomenon. Instead of framing the insecurities of individuals belonging to marginalized groups solely as a problem that arises within these individuals, we argue that it is critical for future research to consider the important role of the environment in eliciting their impostor feelings as well. By doing so, we can address the contextual roots of individuals' impostor feelings, and offer more structural and effective solutions.

The influence of cognitive decline on well-being in old age.

This study addressed the hypothesis that late life cognitive decline leads to loss of well-being. Participants are older persons from the Rush Memory and Aging Project. Beginning in 2001, they underwent annual clinical evaluations that included detailed cognitive performance testing and a 10-item self-report measure of purpose in life, an aspect of well-being. Initial analyses involved 1,049 individuals who were without dementia at baseline and followed a mean of 5.0 years. The intercepts and slopes of global cognition and purpose were positively correlated, and level of cognition at a given evaluation predicted level of purpose at the subsequent evaluation, consistent with the study hypothesis. Purpose also predicted subsequent cognition. These findings persisted in analyses that excluded mild cognitive impairment or controlled for time varying levels of depressive symptoms or disability. To see whether cognitive decline's correlation with purpose differed from its correlation with other aspects of well-being, we conducted additional analyses on a subgroup of 560 persons without dementia who completed a multidimensional measure of well-being once between 2008 and 2011. More rapid cognitive decline in the period preceding well-being assessment (M = 5.5 years, SD = 2.8) was associated with lower level of nearly all aspects of well-being (5 of 6 measures), but the extent of the association varied across well-being dimensions and was stronger for purpose than for self-acceptance and autonomy. The results support the hypothesis that cognitive aging leads to diminished well-being, particularly aspects such as purpose in life that involve behavioral regulation.

Vulnerability to stress, anxiety, and development of dementia in old age.

OBJECTIVE: To identify the components of the neuroticism trait most responsible for its association with cognitive decline and dementia in old age. DESIGN: Longitudinal clinical-pathologic cohort study. SETTING: Chicago metropolitan area. PARTICIPANTS: A total of 785 older persons without dementia completed standard self-report measures of six components of neuroticism and then had annual clinical evaluations for a mean of 3.4 years and brain autopsy in the event of death. MEASUREMENTS: Incidence of clinically diagnosed Alzheimer disease (AD), change in global and specific cognitive functions, and postmortem measures of plaques and tangles, cerebral infarction, and Lewy bodies. RESULTS: During follow-up, 94 individuals developed AD. Higher levels of anxiety and vulnerability to stress were associated with increased risk of AD and more rapid decline in global cognition, with no effects for the other four trait components. In analyses of specific cognitive systems, neuroticism subscales were related to decline in episodic memory, working memory, and perceptual speed, but not in semantic memory or visuospatial ability. No component of neuroticism was related to the neuropathologic lesions most commonly associated with late-life dementia. CONCLUSIONS: Neuroticism's association with late-life dementia mainly reflects vulnerability to stress and anxiety and their correlation with decline in the ability to process and retain new information.