Guest Blog: Conflicting Goals and Role Models

I’m still on vacation (we all know how important work-life-balance is!), so this week another awesome colleague of mine, Hanne Watkins from the University of Melbourne, is filling in and reflecting on role models and conflicting goals in the male-dominated world of academia.

I had gotten pretty far in my academic career – all the way to Honours – before I had a female role model. The fact surprised me then, and troubles me now. Had I really gone through all of High School and undergrad without having a female professional to look up to?

It is also possible, however, that I did have female role models before that, but that I hadn’t realised they were female. It sounds silly when I put it like that, but I think I can explain. Prior to my Honours year, I might have had role models – teachers, writers, researchers, politicians – who I looked up to as figureheads in their respective professional and public domains, but where their gender (and mine) was irrelevant to their position as “my role model”.

But regardless. In Honours, the gender of my role model was suddenly relevant. She (let’s call her K) was a lecturer at my uni; she was smart and friendly and gave me career advice. These are all (arguably) gender-neutral activities, so I don’t want to overstate the centrality of the gender aspect of her role. Gender became salient to me, however, for two reasons. First, because K herself often talked about gender, feminism, and academia. Second, because she was over forty, single, and childless.

Going by cultural stereotypes, “forty, single, and childless” sounds like a woman’s nightmare. But K wasn’t living a nightmare. She was happy, she was an academic, she was smart and friendly and gave me career advice – and I wanted to be like her. Prior to meeting K, I had on some (mostly unconscious) level assumed that children would inevitably enter the picture at some point in my future. She freed me from that illusion, by showing me an alternative reality; a reality I wanted for myself as well, and which, thanks to her, looked achievable! Maybe it doesn’t sound like much, but at the time it was something of a revelation.

I’m not overly familiar with research on role models. But, I believe one theory suggests that for role models to “work”, you first have to have a desired goal, then you have to see someone who has achieved that goal, and then you have to perceive a “fit” between yourself and that person. (And some of the causal arrows probably go in both directions.) K ticked all the boxes. I wanted to be a childless academic in the future, K was that person now, and I was like K in that we were both female. (And, you know, smart and friendly and fond of dispensing advice. 😉 )

For a while, things were going along swimmingly.

Then, something dramatic happened: I started to want to have kids.

By that stage I had met lots of other amazing female academics, some of them older than me, some of them not; some of them with kids, some of them without. So you’d think I could find a role model among them, right?

Unfortunately, it hasn’t been that simple (surprise surprise). Thinking about the research on role models, however, has made me ponder how my predicament can be understood through the theory of role models I described above.

I have two desired goals: have children, and be an academic. I’m not willing to give up either goal, which means my combined goal is to be an academic who has children. As I said above, I have met plenty of women (and men!) who have achieved that goal. However, I wouldn’t describe any of them as my role model for this combined goal. Instead, it’s as if my goals obstinately generate their own, separate, role models.

On the one hand, I aspire to be like some awesome academics I know; whether they have children or not seems irrelevant. With some of them, I perceive a fit – they are “like me” in some ways, and so they are the ones I would call my role models, and they are the ones who inspire and motivate me.

On the other hand, I aspire to be like some awesome mothers I know; what else they do seems irrelevant. Unfortunately, with none of these do I perceive a fit – because none of them are academics. This makes me feel as if my goal of being a mother is incompatible with being an academic, even if, as I said above, I know this isn’t true.

 

So. In some ways, what I have just written is just another version of the “oh no I have conflicting goals and I will have to find a way to compromise”-dilemma. So I’m sorry that it’s old news.

However, I think the new news, to me at least, is that the theory of role models can help me understand why these goals of mine seem to conflict at such a deep level.

Sometimes, the parenting-working conflict seems to be portrayed as a matter of time-management, organisation, and communication – certainly challenging, but relatively “superficial” things. Seeing the conflict as one between competing role models, however, suggests that it’s not just a about what I might want to do to achieve my goals. It is about who I want to be.

No wonder it’s difficult.

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How Do Role Models Work?

We’ve highlighted the importance of role models in general and female role models in particular in a number of quite a few of our past posts. Research suggests that role models serve different functions and lead to different outcomes and that gender is not necessarily important for all of them. However, other studies suggest that gender does matter, especialy in domains in women are under-represented, and one reason why that might be the case is that they can change stereotypes.

STEM/M fields in general and surgery in particular are stereotypically associated with men and maleness. The first person one might imagine when thinking about a surgeon is likely to be a man and when asked to describe a surgeon, stereotypically masculine traits such as “cold” might be used. The so called Stereotype Inoculation Model developed by Nilanjala Dasgupta argues that role models might act as a “social vaccine” and inoculate against these stereotypes which prevent women from entering or staying in STEM/M fields.

She proposes that when exposed to other minority members in one’s domain (e.g. other women in surgery), minority members can identify with this person, which then leads to changes in stereotypes and a stronger identification with the field (e.g. with surgery), but also a more positive attitude towards the field, social belonging in the field, perceived threat and one’s perceptions of one’s own abilities.

Thus, while male role models might be just as effective in some regards (e.g. for learning by emulation), visible female role models in surgery are important – not just for those women already on their path to becoming surgeons, but also for those who might not have made their career choices yet.

Male and Female Role Models in Academic Medicine

The lack of female role models is often cited as one reason of the under-representation of women in various fields – surgery among them – and psychological research shows that role models can indeed be very beneficial. They can teach us how to reach our goals, demonstrate that goals are attainable and inspire us to adopt new goals. However, some women in surgery argue that role models don’t necessarily need to be female and that male role models can be just as effective.

A study by Lori Bakken suggests that it depends. Women and men in different career stages were asked about their own ability beliefs with regards to a number of skills such as scientific writing. They were further asked about who they envisioned as an expert role model while making those assessments as well as a number of questions about this role model. For example, they were asked which important qualities the expert had. Results showed that male and female participants who described a male role model did not differ in what skills they based their role model selection on. “Multiple publications”, “supportiveness” and “scientific knowledge” were most widely reported both by male and female participants. Female participants who had chosen a female expert, however, reported “problem solving abilities” and “communication skills” more frequently in comparison to men who had chosen men.

Thus, it seems that men make just as good role models for women who are looking for similar qualities in a role model as their male counterparts do. However, for those who value other qualities such as problem solving ability or communication skills, female role models might be more important.

Guest Blog: On Role Models (and Surgery as a Boyfriend)

This week, we have once again a guest post. This time, it’s by the awesome KBW, whose blog I can highly recommend. Also, we love guest posts, so if you are interested in writing one, please get in touch!

Much as changed in the near 20 years I have been in and around the medical profession and the progressive feminisation has been wonderful to see and be part of. 

There are many women in surgery, far more now than when I was a medical student and I don’t think there is any real problem with being a woman in surgery.  Some of the women in surgery I encountered early in my career had children and husbands but very few of them were living a life I aspired to. In fact, if anything they put me off and some made me feel even less welcome than the boys. I don’t know if you’ve ever seen the movie Legally Blonde, imagine that but everyone in white coats; times have changed though and we have a gradual spread of women throughout surgery, not all of whom are doing it like the men did. 

I have to acknowledge my parents input, who have an unshakeable belief (which they passed on to me) that I can do anything that I want to do. I was never expected to be slower, weaker or less at anything compared to my brothers and male cousins so not doing general surgery because I was a girl never crossed my mind. 

It was on everyone else’s mind though, when I first started popping up in theatre as a super keen student and junior house officer the animosity from some middle grade doctors and the theatre nurses was incredible, I was never expected to actually, really be a surgeon. Also, some well meaning consultants would gently suggest that maybe I would change my mind about general surgery once I had a husband and children and would I really want to work weekends and night shifts forever? Maybe I would think about doing general practice? 

We now have hordes of female medical students and junior doctors all wanting to do surgery, most of whom want to come and spend some time hanging about with me. I am aware that as the part time mummy surgeon in great shoes I have a responsibility as a role model to them.  When I was a medical student I would have run a mile from the likes of me, but this lot are sent to me by my colleagues to get “the talk”. Three things about this situation bother me, which I no doubt contribute to by seeming approachable. 

Firstly, they seem to think that my personal life and circumstances are something that they can ask all about. How do I organise my childcare? Have I encountered any discrimination problems? How do I manage to get up and dressed and organise things and get there for 0745? How much maternity leave did I take? Do I ever feel guilty about leaving my children and not making it home for bedtime? So far nobody has asked me if I had vaginal deliveries but they have gotten close. 

I don’t mind this when it is a doctor I actually know, someone who is considering embarking on a career as a surgeon but I do mind having to tell every student that comes through the department about how my kids are looked after and whether or not I have a cleaning lady (I do, twice a week in fact, so I can get to the gym on my days off and not spend the time ironing) or if I do the cooking at home. They also want to know what Mr KBW does and how we make our marriage work with our busy schedules. This seems totally irrelevant to being a surgeon and more to do with being a mummy and a wife, it amazes me that these young girls are thinking about their 35 year old selves, I certainly never did. 

The other thing that bothers me is that some are entirely focused on being discriminated against because they are a woman. This has not been my experience at all, there have been very few people (one particularly rude man who is responsible for most of the bile duct injuries within 100 miles of Bighospital) who have openly discriminated against me. 

The only real problem I’ve had because I am a woman is getting elbowed in the chest during laparoscopic surgery all the time and trying to accommodate my enormous 38 weeks pregnant abdomen at the table during laparotomies. Not that I think being female has made it easier, even if my colleagues (and so called friends) said my viva exams were dumbed down because I was the pretty girl. Maybe they were, but I knew the answers to the harder stuff as well so bollocks to them. 

Finally, not one single boy has ever especially come to me or been sent to me to discuss a career as a surgeon, perhaps they get sent to the men. 

So what do I tell these girls in “The Talk”? 

I admit there is the endless everyday sexism that all women encounter but I suspect it is not any different for women in law, the police, schools and offices. They see this on the ward round, in clinic, with my bosses and there is no point ignoring it. For example, I won a prize last month and was quite pleased about it “well done” said my boss “a lot of guys on the panel?” as he gave me a “friendly” tug on my pony tail, ho ho. This is everyday sexism, as are the patients who reply “all the better for seeing you sweetheart” when I do my rounds and enquire how they are; it used to flummox me or make me angry or embarrass me. 

This isn’t discrimination based on gender, but it is sexist behaviour. It could be demeaning if I let it demean me. So I tell the students that they will experience very little discrimination but occasional sexism but it probably isn’t any worse than in any other job. 

I tell them that they have to love surgery because it will take them away from people they love. They have to love it like a crazy obsessed stalker lady. First days at school, Christmas Day, nativity plays, family birthdays, your wedding anniversary…the list of days you won’t and can’t be there is endless. If you don’t love your job you will resent the time you spend there when you feel you should be somewhere else and that makes you a bad doctor. The hours at the computer writing papers, the long trips travelling cheaply to conferences alone, the late nights etc. 

Surgery is like a boyfriend who constantly makes you prove how much you love him and plays games with your feelings. The semi mandatory research PhD and MD degrees are like getting a tattoo of his name and just when you think he loves you, and you and he are getting on so well he will punch you in the face with a complication that makes you buckle at the knees. 

I also tell them to speak to people about it and urge them to get feedback on their hands and technical skills. Not everyone can do surgery and the sooner you realise that you have hands suited for a career as an occupational health physician the better. I also try and discourage them from being rigidly attached to a specialty very early. Better to want to be a surgeon and consider all the surgical specialties early on than having your heart set on being a head and neck cancer surgeon from the age of 19. 

Again, to use the boyfriend analogy, not many people who are determined to find and marry a blonde 6 foot welsh rugby player, 2 years older than them, with no baggage, minimal chest hair, nice feet and works as a vet in the country end up doing so (trust me on this one, I know the woman who wanted this and she is 38, lonely and miserable). So keep your options open and consider all types of surgery. 

It also helps to have role models and mentors to guide and influence you. They don’t need to be told that they are your role model, there is no need to formalise the process. Mine have been almost entirely male, there have been about four that have massively influenced my professional and personal life for either a brief period (an amazing plastic surgeon who wrote plays and was an amateur actor) or the few that have been around for most of my adult life (the great leaders). 

What most of mine have in common is a rich and varied life out with medicine; all are excellent surgeons and lead their teams well, they are well liked and respected and are exceptionally nice and clever people. These characteristics are not gender specific, as a group they probably are slightly more effusive than other male surgeons but they are all white, British, quintessential Royal College material men. There are of course a few women that have influenced me, one in particular that is about 5 years ahead of me has taught me a lot more than just how to operate and it has been interesting to watch her go from stage to stage and see the few mistakes she has made and the many things she has done right and continues to refine.

Find people you want to be like and ask them how they got there. That might be the workaholic, hugely productive university professor who spends every second at work and publishes endlessly. It might be the guy in the super flash suit whose patients love him and he works tirelessly for them. It might be the forgetful, kind hearted amazing surgeon who can teach almost anyone to do anything. 

Above all else, realise that this is a journey where there is no final destination. You will always be learning, always trying to get better, always be teaching others and trying to get better at teaching others. 

There is nothing I would rather do than my job, it is the greatest privilege and the most amazing challenge and it is super fun and makes me happy. Not many people can say that about their work, so find a role model that smiles on the way into the hospital and looks happy in theatre because that’s how you should want to feel too. 

 

20140521-211315.jpg One for the urology trainees….

The Importance of Role Models in Medical Education

Role models are important for a number of reasons. Not only can they teach us important skills, they can inspire us to reach for more ambitious goals or consider a new career path altogether as well. In medical education, they have also been linked to speciality choice, making them especially interesting with regards to the under-representation of women in surgery.

But what are medical students looking for in a role model? Who do they choose as that inspiration that might influence their career path so strongly? A study by Wright an colleagues suggests that it is not necessarily status or success, but that other attributes such as personality and competence might be more important. They also showed that role model choice was indeed related to speciality choice and that students generally chose their role model before they had made up their mind about their future speciality. This highlights, again, how important role models are for shaping our future. With regards to surgery, this may be somewhat problematic – only 63% of participants indicated that they had encountered a sufficient number of role models from that discipline (compared to an average of 87% in the other specialities). And – although the authors don’t report on it – this number is likely to be even lower for women who generally prefer female role models.

By the way, we have also discussed role models in surgery in particular before. Click here to read that post.

The Rejection of Successful Women as Role Models

Women in fields in which they are under-represented often name the lack of female role models as a barrier in their careers. Yet, research often finds that the successful women who are available are often rejected. They are seen as pushy, overly masculine and cold and generally not as someone most women can identify with – even when no information indicating these traits is given. But why is that?

A study by Parks-Stamm and colleagues suggests that this might be a strategy to protect our beliefs about our own competence. In other words, if we saw a successful woman as highly competent and on top of that as nice and likable, this might undermine our own confidence. After all, how are we supposed to compete with that? The authors tested this idea by presenting men and women with information about a highly successful woman. In some cases, this woman was described as warm and likable, whereas in other cases no such information was given. Unsurprisingly, both men and women in the former condition described her as less pushy and cold than those in the latter condition. What was interesting, however, was that those women who had been told that the successful target was warm and nice, rated their own competence as lower compared to those who were able to penalise the potential role model.

So what does this mean? Should successful women be presented as unlikable and cold? Certainly not. It is, however, important, that they are described in ways that make them seem attainable. Evidence for this claim comes from a second study by the authors in which they show that the negative effect of preventing women from penalising the role model disappears when they are given positive information about their own future success.

Do We Need Female Role Models or Do We Need Atypical Role Models?

Female role models are often thought of as a solution for the under-representation of women in certain fields such as surgery and there is indeed quite some research that backs up the fact that women make more effective role models for other women and girls. However, other research shows that this is not the whole story.

A study by Sapna Cheryan and colleagues investigated the effect of stereotypical (“nerdy”) and atypical (“normal”) computer science students on women’s interest in the field. They found that gender did not matter, but that those interacting with an atypical member showed more interest in computer science and believed that they could succeed in the field more strongly. The reason for this seemed to be that women saw the atypical computer science students as more similar to themselves.

Now, the stereotypical traits for a surgeon are certainly different than those for a computer scientist. Nevertheless, both stereotypes have more in common with traits typically associated with men (e.g. competence for computer scientists and assertiveness for a surgeon). So in a way, these findings are quite promising as they suggest that both men and women can inspire girls and women to become surgeons as long as they are seen as atypical and, more importantly, similar to oneself. This illustrates an important point about role models: We need a diverse range of role models in surgey – after all, nobody is going to be seen as similar to oneself by everyone. And if we want surgery to be a diverse field, we need to make sure that we communicate that it already is.

Gender and Mentoring in Medicine

Mentoring is an often quoted path for career success in medicine and other careers alike and there are some studies that corraborate this idea. A study by Stamm and Buddenberg-Fischer investigates this notion in the field of medicine using a Swiss sample.

In their longitudinal study they examined the influence of mentoring during specialist training and found that, indeed, having a mentor and receiving psychosocial support from a mentor during this time was related to higher career success both in objective measures such as such as academic advancements and subjective measures, as well as career satisfaction. Receiving career support from a mentor on the other hand was related to subjective and objective career success, but not to career satisfaction. With regards to gender, about  60% of men but only about 41% of women reported having a mentor during their specialist training. The authors argue that these issues could and should be resolved by formal mentoring programs. Interestingly, however, their study indicates that gender of the mentor might not be as relevant. Women and men in their study did not differ with regards to the preferred gender of their mentor.

What Makes a Good Role Model in Surgery?

We have addressed the importance of role models in previous posts (here and here). A study by Ravindra and Fitzgerald points once again at the importance of role models for becoming a surgeon. But what makes a good role model in surgery? The authors asked newly qualified graduates from a UK medical school just that and grouped the free text answers by theme.

Overall, the most important qualities mentioned by participants were being a good teacher, showing enthusiasm, being student-focused and being approachable. When grouped into attributes relating to different aspects of being a surgeon (i.e. role as a teacher, clinician, a supervisor and a person), results showed that with regards to being a teacher, the most important attributes (other than being a “good teacher” in general) cited were being student-focused, knowledgeable and patient. As a clinician, participants mentioned being caring and competent as well as good communication skills as key characteristics. Important attributes as a supervisor were “approachable”, “encouraging” and “leader” and lastly, personal attributes included “enthusiastic”, “confident” and “friendly”.

Interestingly, these attributes didn’t vary much by gender, suggesting that male and female medical students are looking for the same qualities in role models. That being said, there were gender differences in the importance of a good work-life-balance of the role model (this was perceived as being more important by women) and being encouraging (this was perceived as more important by men).

Jane Somerville on BBC Radio 4’s Desert Island Discs

This week Jane Somerville, a female cardiologist and Emeritus Professor at Imperial College London, was interviewed on BBC Radio 4. In this truly inspiring interview she talks among other things about her career, role models and being a woman in medicine in the 50s.

The episode is available online, so click here to listen.