Upon reading the article by Gawad and colleagues1 we have suggestions to the authors, and the CJS readership who plan on conducting similar studies, to increase the inclusivity of their methods for evaluating gender, race, and ethnicity. We ask the authors to consider how adopting our methods would impact their primary outcomes.
The article aims to describe the gender and visible minority (VM) status of recently hired Canadian academic surgeons. Gender was ascertained by reviewing photos/pronouns or member checking. Gender was categorized into “male” or “female,” which is reductively binary, and does not include people who identify as nonbinary, agender, or other genders. Pronouns and physical appearance are common ways to express gender, but are unreliable indicators of gender identity and not a proxy for an individual’s internal “sense of being a woman, a man, both, neither, or anywhere along the gender spectrum.” 2 The interchangeable use of male and man (similarly female and woman) throughout the article conflates gender identity with language typically reserved for sex (which may be either sex assigned at birth or current legal sex).
We suggest a more reliable, valid, and ethical approach to determine gender is through self-reporting. Survey measures that ask people to self-identify their current gender identity (how someone identifies with a variety of response options)4 and their gender modality (the relationship between someone’s current gender identity and the one that they were assigned at birth) allows for the differentiation and disaggregation of cisgender and transgender people). You can, for example, determine gender modality using a 2-step method, where sex assigned at birth is compared with current reported gender identify, to identify concordance (indicating cis modality) and discordance (indicating trans modality).4
Similarly, VM status was determined by observing physical characteristics and categorized into “yes” or “no.” We understand that the authors argue that perception is more influential on hiring patterns than actual identity. However, it is more important to document population diversity accurately, while respecting participants’ autonomy in reporting their identities.3 Self-reported measures of race and/or ethnicity also do not rely on the authors’ perceptions of who is racialized. In fact, visible minority categorization “may not be congruent with one’s visibility as racialized, especially for Indigenous or multiracial individuals.”5
Adopting these methods in future studies will improve the accuracy and reliability of results. Furthermore, conducting research in a manner that explicitly includes and allows for the identification of all people is of critical importance, not only to support inclusive efforts in career acquisition and advancement, but also so physicians represent their patients, which is crucial for creating health equity for all.
Footnotes
Competing interests: None declared.
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