[Featured Image: Shows three women in their professional medical uniform, holding hands and raising them in the air. Source]
When a study into professionalism on social media, originally published online in the Journal of Vascular SurgeryDecember 2019 but set for publication in their August 2020 paper edition, re-emerged into public view at the end of July, a whole host of medics, predominantly (but by no means exclusively) female surgeons, took to twitter to speak out against it, lampooning its sexist overtones.
The study[i], conducted by a team of researchers based at Boston Medical Centre and Boston University School of Medicine, was designed to identify behaviour or content on the social media accounts of vascular surgery trainees that could be deemed unprofessional – potentially damaging to the reputation either of the individual surgeon, or of the medical profession. The issue came when both the methodology of the study, as well as its criteria for ‘unprofessional behaviour’ came to light.
Three researchers (one research fellow, one research coordinator, and one medical student, all male) created neutral (read: anonymous) social media accounts and searched the Facebook, twitter, and Instagram profiles of vascular surgery trainees and recent residency graduates. To add to the somewhat creepy, stalker-like vibe, study subjects were identified from The Association of Programme Directors in Vascular Surgery directory of trainees, and none of those whose profiles and pages were searched had consented to being part of the study.
Although the list of unprofessional content being searched for included some obvious patient safety and professionalism red flags including posting identifiable and/or sensitive patient information, or clear evidence of drug use, also included as “potentially unprofessional” were the posting of views on “controversial” religious, political, or social topics such as gun control and abortion or “pictures in underwear, provocative Halloween costumes, and provocative posing in bikini/swimwear”. It was this last criterion, and its apparent fixation (seen through the use of ‘bikini’) on specifically female behaviour, that inspired the most obvious means of protest, and the response was immediate and intense.
To many, the study highlighted gender biases prevalent in medicine, and the notion that it was specifically criticising young, predominantly female surgeons on their social activities and how they dress outside of their work lives was met with outrage. The newly created hashtag #MedBikini, went viral as female (and male) surgeons and medics of all specialties posted pictures of themselves in swimwear (including bikinis), on holiday, and at parties – proof and support of “unprofessional” behaviour in their personal lives. Nina Shapiro’s Forbes article[ii] likens the movement to the 2016 #ILookLikeASurgeon, which pointed out that “yes, even bikini-clad, all-shapes-and-sizes, all-genders-regardless-of-identity can be and are surgeons”. #MedBikini, Shapiro writes, “is a trend to humanize, not deprofessionalize, women in a traditionally male profession.”
The other key concern raised about the study was the labelling of “social issues” as unprofessional, the more so because the issues labelled as controversial (gun control and abortion) are healthcare issues. As Arghavan Salles and Rena Malik, both surgeons, wrote in Scientific American[iii], “physicians have long been advocates for social causes”, as demonstrated by the #ThisIsOurLane movement fighting gun violence, as well as the fact that many have spoken out over racial disparities in healthcare outcomes during the COVID pandemic. Indeed, the Physician Charter on Professionalism[iv], authored by the American Board of Internal Medicine (ABIM) Foundation in conjunction with the Association of Chinese Professionals (ACP) and the European Federation of Internal medicine (EFIM), has, as one of its three fundamental principles, the Principle of Social Justice: that physicians should “promote justice in the healthcare system” and “work actively to eliminate discrimination”.
Incidentally, this is not the first time a study was met with similar criticism of its attitudes towards women. In 2013, Fertility Sterility, a journal which describes itself as publishing “articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause”[v], published a study rating physical attractiveness in women with and without endometriosis (an often very painful condition where tissue similar to the lining of the womb starts to grow in other places such as the ovaries and fallopian tubes[vi]). The study’s conclusion was “Women with rectovaginal endometriosis were judged to be more attractive than those in the two control groups [women without endometriosis, and women with peritoneal or ovarian endometriosis]. Moreover, they had a leaner silhouette, larger breasts, and an earlier coitarche [age of first sexual intercourse]” [vii]. It is important to note here also that the women taking part in the study had not given their consent to be judged for their attractiveness and did not know this was happening as part of their medical consultations[viii].
The publication of this study too raised both vociferous objections and questions as to how it ever received approval from an ethics review board (which it did, along with being publicly funded by the University of Milan School of Medicine). It was finally retracted at the beginning of August this year: 7 years, 7 months, and mountains of criticism after it was first published. The journal has not yet apologised, merely published the letter from the authors that requested the paper be withdrawn.
On 25th July, “Prevalence of unprofessional social media content among young vascular surgeons” was retracted from publication. The main reason given by the journal was that the authors did not have permission to use the Association’s directory of program directors and trainees (used to identify trainees for study) for conducting research. However, the journal’s editors also added, in the statement of retraction, that the criteria for judging what qualified as unprofessional behaviour contained “significant conscious and unconscious bias”, in part predicated on the subjective nature of the assessments of professionalism “based on antiquated norms”, as well as the fact that such assessments were being made by male students and trainees, supervised by a predominantly male authorship. “Professionalism has historically been defined by and for white, heterosexual men,” the editors wrote, “and does not always speak to the diversity of our workforce or our patients.”
[i] Hardouin, S. et al 2020 ‘Prevalence of unprofessional social media content among young vascular surgeons’, Journal of Vascular Surgery vol. 72, no. 2, pp 667-671
[vii] Vercellini, P. et al 2013 ‘Attractiveness of women with rectovaginal endometriosis: a case-control study’, Fertility and Sterility vol. 99, no. 1, pp 212-218