Current challenges for plant biology research in the Global South.

In an attempt to address the large inequities faced by the plant biology communities from the Global South (i.e. countries located around the tropics and the Southern Hemisphere) at international conferences, this Viewpoint is the reflexive thinking arising from the concurrent session titled 'Arabidopsis and its translational research in the Global South' organized at the International Conference of Arabidopsis Research 2023 (ICAR 2023) in Chiba, Japan in June 2023. Here, we highlight the main obstacles plant biology communities in the Global South face in terms of knowledge production, as measured by the unequal production and citation of publications, investigating and advancing local plant genomics and biodiversity, combating disparities in gender and diversity, and current initiatives to break isolation of scientists.

The challenges, opportunities and future of comparative physiology in the Global South: perspectives of early-career researchers.

Researchers in the Global South (GS, developing countries) make valuable contributions to the field of comparative physiology, but face economic and scientific disparities and several unique challenges compared with colleagues in the Global North (developed countries). This Perspective highlights some of the challenges, knowledge gaps and disparities in opportunity faced by GS researchers, especially those at early-career stages. We propose collaborative solutions to help address these issues, and advocate for promoting investment and cultural and societal change for a more inclusive research community. Additionally, we highlight the role of GS researchers in contributing expert knowledge on local biodiversity and the environment; this knowledge can help to shape the future of comparative physiology, allowing us to achieve a better understanding of the evolution of physiological mechanisms and to develop innovative solutions to environmental and biomedical challenges. With this Perspective, we hope to highlight the need to foster a more diverse, equitable and inclusive research landscape in comparative physiology; one that empowers GS scientists to address the global challenges associated with biodiversity loss, climate change and environmental pollution.

Current practices and perspectives on clerkship grading in obstetrics and gynecology.

BACKGROUND: Clerkship grades in obstetrics and gynecology play an increasingly important role in the competitive application process to residency programs. An analysis of clerkship grading practices has not been queried in the past 2 decades in our specialty. OBJECTIVE: This study aimed to investigate obstetrics and gynecology clerkship directors' practices and perspectives in grading. STUDY DESIGN: A 12-item electronic survey was developed and distributed to clerkship directors with active memberships in the Association of Professors of Gynecology and Obstetrics. RESULTS: A total of 174 of 236 clerkship directors responded to the survey (a response rate of 73.7%). Respondents reported various grading systems with the fewest (20/173 [11.6%]) using a 2-tiered or pass or fail system and the most (72/173 [41.6%]) using a 4-tiered system. Nearly one-third of clerkship directors (57/163 [35.0%]) used a National Board of Medical Examiners subject examination score threshold to achieve the highest grade. Approximately 45 of 151 clerkship directors (30.0%) had grading committees. Exactly half of the clerkship directors (87/174 [50.0%]) reported requiring unconscious bias training for faculty who assess students. In addition, some responded that students from groups underrepresented in medicine (50/173 [28.9%]) and introverted students (105/173 [60.7%]) received lower evaluations. Finally, 65 of 173 clerkship directors (37.6%) agreed that grades should be pass or fail. CONCLUSION: Considerable heterogeneity exists in obstetrics and gynecology clerkship directors' practices and perspectives in grading. Strategies to mitigate inequities and improve the reliability of grading include the elimination of a subject examination score threshold to achieve the highest grade and the implementation of both unconscious bias training and grading committees.

"But what do you really think?" Nurses' contrasting explicit and implicit attitudes towards people with disabilities using the implicit association test.

AIMS: To investigate how nurses' implicit and explicit attitudes towards people with disabilities (PWD) compare to (1) other healthcare providers and (2) non-healthcare providers. METHOD: We present an analysis of secondary data from the publicly available disability Implicit Association Test (IAT). We compare the explicit and implicit attitudes towards PWD for (1) nurses (n = 24,545), (2) other healthcare providers (n = 57,818) and (3) non-healthcare providers (n = 547,966) for a total of 630,238 respondents, between 2006 and 2021. DATA SOURCES: We use publicly available data for the Disability IAT from Open Science Framework repository of Project Implicit available at https://osf.io/tx5fi/. REPORTING: STROBE checklist. RESULTS: There is a distinct contrast between nurses' explicit and implicit attitudes. While nurses have more positive explicit attitudes towards PWD compared to other groups, they also have more negative implicit attitudes towards PWD. As such there is a contrast between nurses' stated (explicit) attitudes and their unconscious (implicit) attitudes towards PWD. Further, we find that implicit bias towards PWD-among all groups-has not improved over the 15 year period of our sample. CONCLUSIONS: We present a contrast between nurses' explicit and implicit attitude towards PWD compared to non-healthcare providers. We posit that implicit bias is driven by a combination of workload and stress which drives nurses to unconscious modes of thinking more frequently. IMPLICATIONS: We discuss three potential tools for improved educational praxis regarding treatment of PWD; (1) more PWD service user involvement, (2) the use of mindfulness techniques to reduce stress and (3) the use of patient contact simulation to promote education and understanding. PATIENT OR PUBLIC CONTRIBUTION: There is no patient or public contribution.

Needs of human resource professionals in implicit bias and disability inclusion training: A focus group study.

BACKGROUND: Research investigating the implicit bias of employers towards individuals with disabilities emphasizes the importance of increased attention to implicit bias in the workplace. Previous research supports the use of trainings to promote awareness and education of implicit and explicit bias toward people with disabilities among employers. OBJECTIVE: The purpose of the current study was to better understand employers' stigmatizing attitudes toward individuals with disabilities and develop effective strategies to increase awareness and knowledge related to these negative attitudes. METHODS: Two focus groups of HR professionals were conducted to investigate guidelines and content areas that should be included in training. Data was analyzed using qualitative content analysis (QCA) methodology. RESULTS: Researchers identified four major themes regarding guidelines for training development: 1) educational information on implicit and explicit bias, 2) disability inclusion information and strategies, 3) consideration of multiple learning modalities, and 4) case studies. CONCLUSION: Training interventions incorporating these needs and preferences of HR professionals may more effectively increase awareness of implicit bias in the workplace. Sharing evidence regarding implicit and explicit bias, along with current information on disability inclusion, while using varied instructional strategies may lead to a reduction in disability-related stigma and discrimination in the workplace.

Addressing Bias in the Occupational Therapy Admissions Process.

This study investigated the impact of a workshop in reducing unconscious bias in admissions committee members of an occupational therapy program to determine if workshop participation increased the number of underrepresented students in the program. A convenience sample of 50 committee members was used. A Wilcoxon matched pairs signed rank test indicated a significant increase in the post-test survey question scores. A chi-square test of independence revealed a significant increase in the number of students in the program from underrepresented groups. These results suggest that an online workshop can reduce perceived bias and increase diversity in an occupational therapy program.

A Female Career in Research.

After a long career at the National Center for Health Statistics, I retired and joined the Stanford Prevention Research Center as an unpaid associate. I was once described by a former US Food and Drug Administration commissioner as "one of the great epidemiologists." The chair of the Harvard nutrition department, speaking on National Public Radio, once described my research as "rubbish." Both may be exaggerations. Here I address some of the events that led to these contrasting descriptions. I also address the extent to which the so-called Matilda effect may have influenced my career. Are women in science on an equal footing with men? The Matilda effect suggests not. Unlike the Matthew effect for scientists, whereby those of higher prestige accrue a disproportionate share of recognition and rewards, the Matilda effect proposes that women scientists are systematically undervalued and underrecognized. I could never get a faculty job and was often treated like an underling. Nonetheless I persevered to publish highly cited research on several high-profile and sometimes controversial topics. Though overt sexism in science and workplaces has diminished over the course of my career, progress toward eliminating unconscious bias has been slower. The Matthew and Matilda effects are still powerful forces that distort incentives and rewards in science.

Diversity Training Goals, Limitations, and Promise: A Review of the Multidisciplinary Literature.

In this review, we utilize a narrative approach to synthesize the multidisciplinary literature on diversity training. In examining hundreds of articles on the topic, we discovered that the literature is amorphous and complex and does not allow us to reach decisive conclusions regarding best practices in diversity training. We note that scholars of diversity training, when testing the efficacy of their approaches, too often use proxy measures for success that are far removed from the types of consequential outcomes that reflect the purported goals of such trainings. We suggest that the enthusiasm for, and monetary investment in, diversity training has outpaced the available evidence that such programs are effective in achieving their goals. We recommend that researchers and practitioners work together for future investigations to propel the science of diversity training forward. We conclude with a roadmap for how to create a more rigorous and relevant science of diversity training.

Matters of the Heart: Examining Motivating Factors and Unconscious Bias in the Adult Cardiothoracic Anesthesiology Fellowship.

OBJECTIVES: The purpose of this study was to identify barriers to improving diversity within adult cardiothoracic anesthesiology (ACTA) and to provide possible strategies that could be implemented by evaluating the demographics of current ACTA fellows, examining motivating factors to pursue the sub-specialty, and assessing perceptions of unconscious biases during their application process and training. DESIGN: A survey was created by the authors and distributed electronically by the Society of Cardiovascular Anesthesiologists to the ACTA Fellows from April to June 2022. SETTING: A multicenter survey. PARTICIPANTS: Recent 2021 to 2022 ACTA fellows. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 68 fellows were included in the analytical sample; 37.3% were women, and 58.2% were men. Half of the participants in the sample were White race (47%), 26% were Asian, 8% Hispanic or Latinx, 5% Black, and 2% were Pacific Islander or Native Hawaiian. Most fellows indicated that the complexity of cases and/or competency in transesophageal echocardiography was "very important" in their motivating factor (74.0%). When examining sex differences, female fellows reported (p value <0.05) that their experience was impacted negatively by sex and was more often treated with less respect and courtesy. There were no statistically significant differences in perceived discrimination by race and/or ethnicity. CONCLUSIONS: This study identified several motivators to pursue ACTA and the perceptions of unconscious biases during the fellowship. Female fellows felt unconscious bias and a negative impact against them due to sex. Due to the small number of undergraduate enrollments, the results should be interpreted cautiously. Additionally, this provides support to complete further studies. Implicit bias training is one strategy that can be implemented to decrease unconscious bias experienced by ACTA fellows.

"You have to strive very hard to prove yourself": experiences of Black nursing students in a Western Canadian province.

OBJECTIVES: This study explored the experiences of Black students in two western Canadian undergraduate nursing programs. METHODS: Using a qualitative focused ethnography design grounded in critical race theory and intersectionality, participants were recruited using purposive and snowball sampling. Data were collected through individual interviews, and a follow-up focus group. Data were analyzed using collaborative-thematic analysis team approaches. RESULTS: n=18 current and former students participated. Five themes emerged: systemic racism in nursing, precarious immigrant context, mental health/well-being concerns, coping mechanisms, and suggestions for improvement. CONCLUSIONS: An improved understanding of Black student experiences can inform their recruitment and retention. Supporting Black students' success can potentially improve equity, diversity, and inclusivity in nursing education programs and/or their representation in the Canadian nursing workforce. IMPLICATIONS FOR AN INTERNATIONAL AUDIENCE: The presence of a diverse nursing profession is imperative to meet the needs to provide more quality and culturally competent services to diverse population.

[The female urologist in 2022, where are we?] / La femme urologue en 2022 : où en est-on ?

There are still significant disparities between the sexes even if we are now witnessing a feminization of the urological profession. Women's roles in historically male-dominated services still vary widely based on inherent gender biases. Interventions to minimize the gender gap in urology should not constitute a form of positive discrimination in favor of minorities but on the contrary a form of positive action to eliminate the obstacles present that block the acceptance of women or their promotion. Recognizing the factors responsible for gender disparities remains a key step towards improving equity in still male-dominated fields such as urology.

Diversity in radiology: the right thing to do, the smart thing to do.

In the 10-year period between the last two U.S. population censuses there have been significant changes in the U.S. population demography. The changes in self-reporting of racial and ethnic identity afforded by the most recent U.S. population census in 2020 have given citizens the opportunity to be represented in ways that truly reflect how they wish to be identified. At the same time, the diversity of the health care workforce in radiology has not reflected a similar change. While there have been small incremental changes for underrepresented groups (African Americans/Blacks, Hispanic ethnicity, and the group American Indian/Alaska Native/Native Hawaiian/Pacific Islander), these changes have not kept pace with the ever-changing demographics of the U.S. population. Part of the answer for these very modest gains must lie with our selection processes for identifying potential candidates from underrepresented in medicine groups (URiM) for acceptance to our medical schools, residency programs and employment opportunities as practicing physicians and faculty members. While the strategies employed have had some measure of success, our best efforts to increase diversity in our specialty, and in medicine in general, are being undermined by our biases and our traditional methods for identifying talents.

Differential attainment and recruitment to Intensive Care Medicine Training in the UK, 2018-2020.

BACKGROUND: Differences exist among doctors in examination performance, clinical and academic career progression, and prevalence of performance assessment by professional regulatory bodies. Some of these differences have been reported in relation to individual characteristics. The purpose of this study is to establish whether any specific individual characteristics are associated with performance in selection for entry into specialty training in Intensive Care in the United Kingdom. METHODS: We evaluated data of 509 candidates from the national recruitment rounds of 2018/19 and 2019/20. The outcome evaluated was "success at interview". Variables reaching statistical significance at univariate logistic regression analysis were fed in the multivariable analysis to identify independent predictors of success, with additional exploratory analyses performed, where indicated. RESULTS: The candidates' median age was 31.5 (interquartile range, IQR 30-33.7) years, 324 (63.7%) were male, 256 (50.3%) not married/in civil partnership, 6 (1.2%) pregnant. The majority (316, 62.1%) were White British, 99 (19.5%) of Asian background, other ethnicities represented less than 20% of the sample. Of the 509 candidates, 155 (30.5%) were Atheist, 140 (27.5%) Christian; most were heterosexual (440, 86.4%); 432 (84.9%) reported no disability, while 4 (0.8%) had a minor and 1 (0.2%) had a major disability; 432 (84.9%) candidates held a UK medical degree; 77 (15.1%) a non-UK degree. At univariate logistic regression analysis (LRA) multiple factors were found to be associated with a lower likelihood of success, the strongest being an international medical graduate (IMG, holding a non-UK medical degree); others were increasing age, male gender, being married, Asian or mixed ethnicity, specific religious beliefs (Buddhism, Islam and Hinduism). After feeding all factors significant at univariate analysis, the only two retained as independent predictors at multivariable regression were Asian ethnicity and holding a non-UK degree. Asian UK graduates success rate was 92.7%, comparable to the national average of 92.3%, the Asian IMGs success rate was significantly lower, at 45.5%. CONCLUSIONS: As the imbalances seen within the candidates of Asian background are explained by considering the country of primary medical training, the variations in performance is likely to reflect differences in training systems and understanding of the UK NHS.

A survey of implicit bias training in physician assistant and nurse practitioner postgraduate fellowship/residency programs.

BACKGROUND: There has been renewed focus on advancing inclusivity within organized medicine to reduce health disparities and achieve health equity by addressing the deleterious effects of implicit bias in healthcare and clinical outcomes. It is well documented that negative implicit attitudes and stereotypes perpetuate inequity in healthcare. The aim of this study is to investigate implicit bias training in postgraduate physician assistant (PA) and nurse practitioner (NP) education; describe delivery of content to trainees; and detail program directors' attitudes toward this type of training. Although there is research examining implicit bias training in physician residency education, there are no published studies on implicit bias training in postgraduate PA and NP postgraduate residency/fellowship programs. METHOD: A non-experimental, descriptive study was designed to obtain information via survey from members of the Association of Postgraduate Physician Assistant Programs (APPAP). RESULTS: The response rate was 41%. The majority of respondents (76%) felt that PA and NP postgraduate programs should include implicit bias instruction. Educational strategies used by PA and joint PA/NP postgraduate programs or their sponsoring institution to deliver implicit bias content to trainees include: implicit bias training modules (50%), facilitated group discussions (36%), invited speaker on implicit bias (33%), case studies on implicit bias (16%), and implicit association test (10%); however, 30% of postgraduate programs do not provide implicit bias training to PA and/or NP trainees. Barriers to implementing implicit bias training expressed by some postgraduate programs include: uncertainty in how to incorporate implicit bias training (16%); lack of strategic alignment with training program or sponsoring institution (13%); time constraints (10%); financial constraints (6%); lack of access to content experts (6%); and unfamiliarity with evidence supporting implicit bias training (6%). CONCLUSION: The present study sheds some light on the current state of implicit bias training in PA and joint PA/NP postgraduate residency/fellowship programs. While the majority of programs offer some sort of implicit bias training, there is a need to standardize this training in PA and joint PA/NP postgraduate education curricula using an actionable framework.

Letters of recommendation: Nuanced bias or useful affirmation?

Narrative letters of recommendation (NLORs) have become key elements of the application process for residency and fellowship. The potential to inadvertently admit bias into these subjective narratives has become an area of research focus across many disciplines. In the present review, we have highlighted the current data regarding bias in NLORs. We also believe that one of the most effective methods to eliminate bias from written recommendations is to first understand that it exists. Thus, the objective measures that have been taken to identify bias in NLORs are important steps in the right direction. We have presented and reflected on the accrued data on bias in NLORs pertaining to surgical training.

Ensuring medication safety for consumers from ethnic minority backgrounds: The need to address unconscious bias within health systems.

Medication safety remains a pertinent issue for health systems internationally, with patients from ethnic minority backgrounds recognized at increased risk of exposure to harm resulting from unsafe medication practices. While language and communication barriers remain a central issue for medication safety for patients from ethnic minority backgrounds, increasing evidence suggests that unconscious bias can alter practitioner behaviours, attitudes and decision-making leading to unsafe medication practices for this population. Systemwide, service and individual level approaches such as cultural competency training and self-reflections are used to address this issue, however, the effectiveness of these strategies is not known. While engagement is proposed to improve patient safety, the strategies currently used to address unconscious bias seem tokenistic. We propose that including consumers from ethnic minority backgrounds in design and delivery of the education programs for health professionals, allocating extra time to understand their needs and preferences in care, and co-designing engagement strategies to improve medication related harm with diverse ethnic minority groups are key to mitigating medication related harm arising as a result of unconscious bias.

Race and the Ivory Tower: An Antiracism Exercise for an Undergraduate Neuroscience Classroom.

This article details an antiracism exercise completed in an introductory undergraduate neuroscience class. Students completed an online pre-class multimedia module entitled "Race and the Ivory Tower" covering racism in science and medicine, the neuroscience behind bias, and the impact of race and racism on health outcomes. The module included two videos, one podcast, and a peer-reviewed journal article, alongside several optional additional resources written for both academic and lay audiences. After completing the module, students participated in an open-ended online discussion followed by an anonymous survey to elicit feedback on the exercise. As a continuation of the antiracism exercise, students researched and reported on the work of a Black or nonwhite Hispanic/Latino scientist for a final project later in the semester. Sixty-eight of 69 students participated in the discussion, and the majority discussed the neuroscience of bias and public health effects of racism. Most students also discussed the importance of the module contents or further questions that they would explore. Sixty of 69 students answered the anonymous survey, where most students reported a better understanding of racism after interacting with the content. Additionally, most students felt better prepared to discuss racism in science and medicine and more able to identify unconscious bias. Finally, students reported that they enjoyed the module contents and online discussion. Overall, this exercise effectively introduced students to the ongoing challenge of racism in science and medicine through both scientific and sociological lenses. Students recognized the collective importance of the content, which was our goal as they represent the future leaders in neuroscience and medicine and should be equipped to address leading issues within their field.

Unconscious Bias in Speaker Introductions at a Surgical Oncology Meeting: Hierarchy Reigns Over Gender.

BACKGROUND: Recent reviews of medical conferences have shown that women were less likely to receive a formal introduction compared with men. We examined speaker introductions at the Society of Surgical Oncology (SSO) annual meeting to determine whether similar biases exist within our organization. METHODS: An observational study of video-archived speaker introductions at the 2018 and 2019 SSO annual meetings was conducted. Professional address was defined as professional title followed by full name or last name. Multivariable logistic regression was used to identify factors associated with form of address. RESULTS: There were 499 speaker introductions reviewed. Speakers included 290 (58%) men and 238 (49%) post-graduate trainees (residents and fellows). A non-professional form of address was used to introduce 148 (30%) speakers and was most often used for post-graduate trainees (33%). Full professors were more likely than junior faculty to introduce speakers with a non-professional form of address (37% of full professors vs 18% of assistant professors, p < 0.001). In multivariable regression analysis these findings persisted. Trainees were 2.8 times more likely to receive a non-professional form of address (p = 0.003). Use of a non-professional introduction did not significantly vary by the speaker's nor the introducer's gender. CONCLUSIONS: Residents and fellows were more likely to receive a non-professional form of address, and the likelihood of this increased with rising seniority of the introducer. The manner of speaker introduction did not vary by gender in our organization. More research is needed to explore the influence of these disparities on academic advancement for the next generation of surgical oncologists.

Achieving Equity in Informed Consent: A Culturally-Informed Perspective for the Consideration and Consent of Minority Patients for Electroconvulsive Therapy.

Electroconvulsive therapy (ECT) is highly efficacious to treat severe depression in older adults. Yet, patients of ethnic and racial minorities are consistently underrepresented amongst those who receive ECT across all age groups. One strong hypothesis to explain this disparity is that minority patients are less likely to trust medical professionals and are therefore less likely to consent for ECT. Increasing participation of depressed, elderly, minority patients is uniquely challenging. Senior minority individuals have survived decades of medical and social injustices that no other demographic, specifically younger minorities or clinically-matched Caucasian peers, can truly comprehend from a first-hand perspective. This article provides a perspective based in cultural translational science to conversations of informed consent for ECT that removes our self-imposed stigma against discussing past and ongoing injustices with minority patients. Reducing disparities to geriatric minorities through equity of informed consent means that clinicians must validate the unique minority experience in medicine as it pertains to agreeing to a treatment modality as emotionally, socially, and historically laden as ECT.

Strategies to Mitigate Clinician Implicit Bias Against Sexual and Gender Minority Patients.

BACKGROUND: Implicit bias is an ingrained, unconscious cultural stereotype that can negatively affect a person's interactions with members of stigmatized groups, including sexual and gender minorities. Clinician implicit biases may negatively impact the quality of patient care. METHODS: This article uses 4 case scenarios to illustrate how implicit bias among psychiatrists and other clinicians can affect patient-clinician communication and diminish the quality of health care provided to sexual and gender minority people. We offer strategies for clinicians to recognize, challenge, and address implicit bias. DISCUSSION: Through continuing education, self-reflection, and practice, psychiatrists and other clinicians can improve communication and foster more affirming care experiences for their sexual and gender minority patients, with the goal of addressing and ultimately eliminating sexual and gender minority health disparities.