Gender-gap in training for Assertiveness: Does it have a place in Psychiatry and in clinical practic

Gender-gap in training for Assertiveness: Does it have a place in Psychiatry and in clinical practice?

As a female British psychiatrist of ethnic minority background, I consider myself as an honest, assertive feminist who strongly advocates for patient care. My feedback? I am “too aggressive”, and I need to be more “delicate” in my communication.

In Leadership teaching, junior doctors are taught to display confidence, assertiveness, and the ability to raise safety concerns to their seniors. However, women have found that when behaving assertively, they are stereotyped as being “unlikeable”, “dominating” and “aggressive”. Gender bias at work is still frequently occurring and no profession is immune, including psychiatry.

 

I am a Core Trainee Psychiatrist, passionately advocating for human rights and mental health. I am part of the executive committee for the Royal College of Psychiatrists’ Women’s Mental Health Special Interests Group. I am a leader of Geopsychiatry, an NGO (non-governmental organisation) which studies the impact of war conflict, climate change, public health issues, globalisation and foreign policy on mental health. I have written articles, such as the need for women leadership in the UN, and how COVID-19 unmasked the ongoing pandemic of gender-based violence.

 

As I write this article, I remember some of the feedback I have received for giving honest opinions about uncomfortable situations I experienced at work.

There was a patient who was grossly racist towards me, and a male colleague said that I was “wasting my time reporting to the police”. I was hurt and offended by his suggestion, as he clearly didn’t experience the trauma of that abuse. I told him that I respect myself to report the hate crime. I went as far as to question his self-respect if he didn’t choose to report a hate crime towards him, to the police. I’ll admit I was angry and hurt at the time, but I felt I had to justify my pain.

However, my response was reported to my Clinical Supervisor, and I was deemed “too aggressive” in my reply and viewed as having “difficulty interacting with colleagues”.

In other cases, I have questioned my senior colleagues when I have concerns about patients’ wellbeing. At the time of the discussion, I advocated for the patient’s safety and best interests. My feedback? I was being “difficult” in my encounter.

I am described as “too emotive” in my emails, or “hypervigilant” in stressful situations “amongst colleagues”.

It seems that whatever I do, I can do nothing right. As a gender equity advocate, I am told to go against everything I stand for — I have to lower my voice, reduce my space, and stand aside.

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Women + Confidence = Aggressive; Man + Confidence = Assertiveness

In early 2021, an article was published on sharing leadership lessons from successful women medicine. It was shared that assertive women would have to make adjustments to earn respect.

Dr. Sharon Gustowski an osteopathic doctor based in Texas (USA) said that she learned “how to lower the tone of (her) voice and smile more to not come off as controlling”. As a young adult, she was deemed independent and assertive; as a doctor, she was alienated from her peers and came across as “snobby” and unfriendly”. To be heard in certain male-dominated atmospheres, we are advised that assertive women may have to “adjust facial expressions, hand movements, volume and tone”.

Dr Candace Walkley, an internal medicine doctor in the USA, was advised that she was perceived as a “go-getter” and it created tension, therefore creating interference with communication and expectations. She referred that being assertive is having “a sword with two sides”. The experiences can help shape your leadership skills to better assess and control yourself in interaction, but it comes with a “few bumps in the road” with co-workers and colleagues.

An Inspire the Mind blog by a female medical student on “The Future is Feminist: tackling gender inequalities in psychiatric medicine and practice” highlighted the implicated biases towards women and their behaviour as “more irrational and hyperbolised”. The blog astutely states that equal representation of women within a professional field won’t automate a definite power of changing attitudes towards women.

Arwa Mahdawi, author of Strong Female Lead: Lessons from Women of Power, said that having more female leaders is not necessarily a good thing…if the female leaders are still following patriarchal leadership. Instead, leadership should be cultivated into thinking of what we have been trained to think of as “female behaviour.”

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There is no doubt that conflict can occur frequently in any workplace. However, the sense of feeling discriminated and isolated at work whilst tacking sexism can leave assertive female doctors at the risk of developing depression, anxiety, and worsening burnout. At worst, the female doctors leave the training programme due to unhappiness and having a sense of systemic gender discrimination at work.

In my experience, it was dehumanising when it was put to me that my assertiveness is a symptom of “being mentally unwell”.

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Gender — Discrimination via feedback can harm the doctors’ mental health

In a BMJ article, a psychiatric trainee Rory Conn, said that all doctors need to be assertive… but we are rarely told how to acquire it.

A BMA study in August 2021, showed that 9 out of 10 female doctors experience sexism at work. Yet, when we assert ourselves and lay boundaries in our job, the backlash may result in poor feedback in portfolios and difficulty to progress career-wise. Tackling the impact of structural discrimination does take time, but instead, it’s easier to blame the “assertiveness issue” than the actual systemic issue.

We are profusely taught about leadership and time management, but this doesn’t hide the wide training gap between male and female doctors, especially in gender-stereotyped feedbacks.

The urgency for ingrained assertiveness training and feminist thinking in Psychiatry will subsequently help narrow the leadership gap between male and female doctors acquiring senior roles.

If we want to put an end to the sexism in female doctors’ career progression, we need “assertiveness training” platforms in our training programmes, encouragement of feminist thinking in Psychiatry, and tackling systemic prejudices.

Only then, will Psychiatry training be more inclusive for future practices.

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