Ethical Incorporation of Artificial Intelligence into Neurosurgery: A Generative Pretrained Transformer Chatbot-Based, Human-Modified Approach

INTRODUCTION

Artificial intelligence (AI) has become increasingly used in neurosurgery. Generative pretrained transformers (GPTs) have been of particular interest. However, ethical concerns regarding the incorporation of AI into the field remain underexplored. We delineate key ethical considerations using a novel GPT-based, human-modified approach, synthesize the most common considerations, and present an ethical framework for the involvement of AI in neurosurgery.

METHODS

GPT-4, ChatGPT, Bing Chat/Copilot, You, Perplexity.ai, and Google Bard were queried with the prompt "How can artificial intelligence be ethically incorporated into neurosurgery?". Then, a layered GPT-based thematic analysis was performed. The authors synthesized the results into considerations for the ethical incorporation of AI into neurosurgery. Separate Pareto analyses with 20% threshold and 10% threshold were conducted to determine salient themes. The authors refined these salient themes.

RESULTS

Twelve key ethical considerations focusing on stakeholders, clinical implementation, and governance were identified. Refinement of the Pareto analysis of the top 20% most salient themes in the aggregated GPT outputs yielded 10 key considerations. Additionally, from the top 10% most salient themes, 5 considerations were retrieved. An ethical framework for the use of AI in neurosurgery was developed.

CONCLUSIONS

It is critical to address the ethical considerations associated with the use of AI in neurosurgery. The framework described in this manuscript may facilitate the integration of AI into neurosurgery, benefitting both patients and neurosurgeons alike. We urge neurosurgeons to use AI only for validated purposes and caution against automatic adoption of its outputs without neurosurgeon interpretation.

Advances in pediatric acute kidney injury pathobiology: a report from the 26th Acute Disease Quality Initiative (ADQI) conference

BACKGROUND

In the past decade, there have been substantial advances in our understanding of the pathobiology of pediatric acute kidney injury (AKI). In particular, animal models and studies focused on the relationship between kidney development, nephron number, and kidney health have identified a number of heterogeneous pathophysiologies underlying AKI. Despite this progress, gaps remain in our understanding of the pathobiology of pediatric AKI.

METHODS

During the 26th Acute Disease Quality Initiative (ADQI) Consensus conference, a multidisciplinary group of experts discussed the evidence and used a modified Delphi process to achieve consensus on recommendations for opportunities to advance translational research in pediatric AKI. The current state of research understanding as well as gaps and opportunities for advancement in research was discussed, and recommendations were summarized.

RESULTS

Consensus was reached that to improve translational pediatric AKI advancements, diverse teams spanning pre-clinical to epidemiological scientists must work in concert together and that results must be shared with the community we serve with patient involvement. Public and private research support and meaningful partnerships with adult research efforts are required. Particular focus is warranted to investigate the pediatric nuances of AKI, including the effect of development as a biological variable on AKI incidence, severity, and outcomes.

CONCLUSIONS

Although AKI is common and associated with significant morbidity, the biologic basis of the disease spectrum throughout varying nephron developmental stages remains poorly understood. An incomplete understanding of factors contributing to kidney health, the diverse pathobiologies underlying AKI in children, and the historically siloed approach to research limit advances in the field. The recommendations outlined herein identify gaps and outline a strategic approach to advance the field of pediatric AKI via multidisciplinary translational research.

The Impact of Gender Diversity on Excellence in Pathology Research and Education

In this editorial, we inspect the critical role of gender diversity within the domain of pathology and its consequential impact on research innovation and clinical outcomes. The editorial commences with a historical overview of gender disparities in pathology, acknowledging advancements toward gender parity while highlighting persistent impediments to full inclusivity. The discourse emphasizes the intrinsic value of integrating diverse gender perspectives in research, illustrating how such inclusivity catalyzes innovation, mitigates research biases, and elevates the standard of patient care through a more comprehensive understanding of the field of pathology. Key barriers to gender diversity in pathology are systematically analysed, including disproportionate clinical burdens, time allocation conflicts due to societal roles, restricted access to specialized training, financial limitations, inadequate support networks, workplace discrimination, and the challenge of balancing family responsibilities with professional aspirations. We propose strategic interventions to address these barriers, advocating for increased awareness, diversity-focused training programs, and mechanisms for recognizing and rewarding the contributions of underrepresented genders in the field. Furthermore, we highlight exemplary initiatives that have successfully promoted gender diversity, such as the Johns Hopkins Pathology Department's outreach program, and the role of professional organizations, notably the American Society for Investigative Pathology and its "Women in Pathology" community, is discussed as pivotal in celebrating and advancing women's contributions to the field of pathology. In conclusion, we suggest that dismantling gender bias is imperative for realizing the full potential of pathology as a discipline. The editorial argues for a systemic embrace of gender diversity and inclusivity as fundamental to fostering research innovation, enhancing clinical practice, and ultimately improving patient outcomes. This scholarly examination calls for a concerted effort within the pathology community to integrate diverse perspectives, thereby enriching the field and contributing to the advancement of medical science.

Children in ethnically diverse classrooms and those with cross-ethnic friendships excel at understanding others' minds

This study examined the link between classroom ethnic diversity, cross-ethnic friendships, and children's theory of mind. In total, 730 children in the United Kingdom (54.7% girls, 51.5% White) aged 8 to 13 years completed measures of theory of mind in 2019/2020. Controlling for verbal ability, executive function, peer social preference, and teacher-reported demographic characteristics, greater classroom ethnic diversity provided opportunities for cross-ethnic friendships, and children with cross-ethnic friendships performed better than peers without cross-ethnic friendships on theory of mind. These results extend accounts of intergroup contact by using direct assessments of children's theory of mind and advance social accounts of theory of mind by demonstrating how experiences outside the family are linked with theory of mind.

Self- and Other-Orientation in High Rank: A Cultural Psychological Approach to Social Hierarchy

PUBLIC ABSTRACT

Social hierarchy is one fundamental aspect of human life, structuring interactions in families, teams, and entire societies. In this review, we put forward a new theory about how social hierarchy is shaped by the wider societal contexts (i.e., cultures). Comparing East Asian and Western cultural contexts, we show how culture comprises societal beliefs about who can raise to high rank (e.g., become a leader), shapes interactions between high- and low-ranking individuals (e.g., in a team), and influences human thought and behavior in social hierarchies. Overall, we find cultural similarities, in that high-ranking individuals are agentic and self-oriented in both cultural contexts. But we also find important cross-cultural differences. In East Asian cultural contexts, high-ranking individuals are also other oriented; they are also concerned about the people around them and their relationships. We close with a call to action, suggesting studying social hierarchies in more diverse cultural contexts.

Five questions on improving diversity, equity and inclusion in UK bioscience research or "How can UK bioscience be changed so that those from marginalised groups can thrive?"

Diversity, equity, and inclusion play pivotal roles in advancing science and innovation by fostering a rich and supportive environment that benefits both individuals and society. UK bioscience research units are still on a journey towards being inclusive, and existing research on effecting changes in diversity, equity, and inclusion has yet to make an impact at the scale needed to transform the sector, leaving many to wonder How can UK bioscience be changed so that those from marginalised groups can thrive? This paper considers some of the questions that arise in addressing this, discusses what we already know and what we do not, and in doing so outlines a research agenda that aims to find out what works to effect diversity, equity and inclusion in UK bioscience.

Using Group Concept Mapping to Explore Medical Education's Blind Spots

PHENOMENON

All individuals and groups have blind spots that can lead to mistakes, perpetuate biases, and limit innovations. The goal of this study was to better understand how blind spots manifest in medical education by seeking them out in the U.S.

APPROACH

We conducted group concept mapping (GCM), a research method that involves brainstorming ideas, sorting them according to conceptual similarity, generating a point map that represents consensus among sorters, and interpreting the cluster maps to arrive at a final concept map. Participants in this study were stakeholders from the U.S. medical education system (i.e., learners, educators, administrators, regulators, researchers, and commercial resource producers) and those from the broader U.S. health system (i.e., patients, nurses, public health professionals, and health system administrators). All participants brainstormed ideas to the focus prompt: "To educate physicians who can meet the health needs of patients in the U.S. health system, medical education should become less blind to (or pay more attention to) …" Responses to this prompt were reviewed and synthesized by our study team to prepare them for sorting, which was done by a subset of participants from the medical education system. GCM software combined sorting solutions using a multidimensional scaling analysis to produce a point map and performed cluster analyses to generate cluster solution options. Our study team reviewed and interpreted all cluster solutions from five to 25 clusters to decide upon the final concept map.

FINDINGS

Twenty-seven stakeholders shared 298 blind spots during brainstorming. To decrease redundancy, we reduced these to 208 in preparation for sorting. Ten stakeholders independently sorted the blind spots, and the final concept map included 9 domains and 72 subdomains of blind spots that related to (1) admissions processes; (2) teaching practices; (3) assessment and curricular designs; (4) inequities in education and health; (5) professional growth and identity formation; (6) patient perspectives; (7) teamwork and leadership; (8) health systems care models and financial practices; and (9) government and business policies.

INSIGHTS

Soliciting perspectives from diverse stakeholders to identify blind spots in medical education uncovered a wide array of issues that deserve more attention. The concept map may also be used to help prioritize resources and direct interventions that can stimulate change and bring medical education into better alignment with the health needs of patients and communities.

Change the People or Change the Policy? On the Moral Education of Antiracists

While those who take a "structuralist" approach to racial justice issues are right to call attention to the importance of social practices, laws, etc., they sometimes go too far by suggesting that antiracist efforts ought to focus on changing unjust social systems rather than changing individuals' minds. We argue that while the "either/or" thinking implied by this framing is intuitive and pervasive, it is misleading and self-undermining. We instead advocate a "both/and" approach to antiracist moral education that explicitly teaches how social structures influence ideas about race and how ideas about race shape, sustain, and transform social structures. Ideally, antiracist moral education will help people see how social change and moral progress depend on the symbiotic relations between individuals and structures. We articulate a conception of "structure-facing virtue" that exemplifies this hybrid approach to illuminate the pivotal role moral education plays in the fight for racial justice.

Blind spots in medical education: how can we envision new possibilities?

As human beings, we all have blind spots. Most obvious are our visual blind spots, such as where the optic nerve meets the retina and our inability to see behind us. It can be more difficult to acknowledge our other types of blind spots, like unexamined beliefs, assumptions, or biases. While each individual has blind spots, groups can share blind spots that limit change and innovation or even systematically disadvantage certain other groups. In this article, we provide a definition of blind spots in medical education, and offer examples, including unfamiliarity with the evidence and theory informing medical education, lack of evidence supporting well-accepted and influential practices, significant absences in our scholarly literature, and the failure to engage patients in curriculum development and reform. We argue that actively helping each other see blind spots may allow us to avoid pitfalls and take advantage of new opportunities for advancing medical education scholarship and practice. When we expand our collective field of vision, we can also envision more "adjacent possibilities," future states near enough to be considered but not so distant as to be unimaginable. For medical education to attend to its blind spots, there needs to be increased participation among all stakeholders and a commitment to acknowledging blind spots even when that may cause discomfort. Ultimately, the better we can see blind spots and imagine new possibilities, the more we will be able to adapt, innovate, and reform medical education to prepare and sustain a physician workforce that serves society's needs.

Why Antibias Interventions (Need Not) Fail

There is a critical disconnect between scientific knowledge about the nature of bias and how this knowledge gets translated into organizational debiasing efforts. Conceptual confusion around what implicit bias is contributes to misunderstanding. Bridging these gaps is the key to understanding when and why antibias interventions will succeed or fail. Notably, there are multiple distinct pathways to biased behavior, each of which requires different types of interventions. To bridge the gap between public understanding and psychological research, we introduce a visual typology of bias that summarizes the process by which group-relevant cognitions are expressed as biased behavior. Our typology spotlights cognitive, motivational, and situational variables that affect the expression and inhibition of biases while aiming to reduce the ambiguity of what constitutes implicit bias. We also address how norms modulate how biases unfold and are perceived by targets. Using this typology as a framework, we identify theoretically distinct entry points for antibias interventions. A key insight is that changing associations, increasing motivation, raising awareness, and changing norms are distinct goals that require different types of interventions targeting individual, interpersonal, and institutional structures. We close with recommendations for antibias training grounded in the science of prejudice and stereotyping.

Minority salience and the overestimation of individuals from minority groups in perception and memory

Our minds are tuned to the uncommon or unexpected in our environment. In most environments, members of minority groups are just that—uncommon. Therefore, the cognitive system is tuned to spotting their presence. Our results indicate that individuals from minority groups are salient in perception, memory, and visual awareness. As a result, we consistently overestimate their presence—leading to an illusion of diversity: the environment seems to be more diverse than it actually is, decreasing our support for diversity-promoting measures. As we try to make equitable decisions, it is important that private individuals and decision-makers alike become aware of this biased perception. While these sorts of biases can be counteracted, one must first be aware of the bias.

Our cognitive system is tuned toward spotting the uncommon and unexpected. We propose that individuals coming from minority groups are, by definition, just that—uncommon and often unexpected. Consequently, they are psychologically salient in perception, memory, and visual awareness. This minority salience creates a tendency to overestimate the prevalence of minorities, leading to an erroneous picture of our social environments—an illusion of diversity. In 12 experiments with 942 participants, we found evidence that the presence of minority group members is indeed overestimated in memory and perception and that masked images of minority group members are prioritized for visual awareness. These findings were consistent when participants were members of both the majority group and the minority group. Moreover, this overestimated prevalence of minorities led to decreased support for diversity-promoting policies. We discuss the theoretical implications of the illusion of diversity and how it may inform more equitable and inclusive decision-making.

Seeking justice, equity, diversity and inclusion in pediatric nephrology

Inequity, racism, and health care disparities negatively impact the well-being of children with kidney disease. This review defines social determinants of health and describes how they impact pediatric nephrology care; outlines the specific impact of systemic biases and racism on chronic kidney disease care and transplant outcomes; characterizes and critiques the diversity of the current pediatric nephrology workforce; and aims to provide strategies to acknowledge and dismantle bias, address barriers to care, improve diversity in recruitment, and strengthen the pediatric nephrology community. By recognizing historical and current realities and limitations, we can move forward with strategies to address racism and bias in our field and clinical practices, thereby cultivating inclusive training and practice environments.

The Diversity Gap: When Diversity Matters for Knowledge

Can diversity make for better science? Although diversity has ethical and political value, arguments for its epistemic value require a bridge between normative and mechanistic considerations, demonstrating why and how diversity benefits collective intelligence. However, a major hurdle is that the benefits themselves are rather mixed: Quantitative evidence from psychology and behavioral sciences sometimes shows a positive epistemic effect of diversity, but often shows a null effect, or even a negative effect. Here we argue that to make progress with these why and how questions, we need first to rethink when one ought to expect a benefit of cognitive diversity. In doing so, we highlight that the benefits of cognitive diversity are not equally distributed about collective intelligence tasks and are best seen for complex, multistage, creative problem solving, during problem posing and hypothesis generation. Throughout, we additionally outline a series of mechanisms relating diversity and problem complexity, and show how this perspective can inform metascience questions.

Managing Team Conscientiousness Diversity: The Role of Leader Emotion-Regulation Knowledge

Team members may vary in the degree to which they are self-motivating, diligent, and organized, but effects of such conscientiousness diversity are poorly understood. We propose that conscientiousness diversity effects depend on the team leader’s knowledge about managing negative affective responses—that is emotion regulation knowledge. Data of two time-lagged team studies show that for teams with leaders with lower emotion-regulation knowledge, conscientiousness diversity was negatively associated with team satisfaction (Study 1 and 2), team cohesion and information elaboration (Study 2), which in turn influenced team performance (Study 2). These negative relationships reversed in teams with leaders with higher emotion-regulation knowledge.

Why Do Firms Fail to Engage Diversity? A Behavioral Strategy Perspective

The persistent failure of organizations to engage diversity—to employ a diverse workforce and fully realize its potential—is puzzling, as it creates labor-market inefficiencies and untapped opportunities. Addressing this puzzle from a behavioral strategy as arbitrage perspective, this paper argues that attractive opportunities tend to be protected by strong behavioral and social limits to arbitrage. I outline four limits—cognizing, searching, reconfiguring, and legitimizing (CSRL)—that deter firms from sensing, seizing, integrating, and justifying valuable diversity. The case of Moneyball is used to illustrate how these CSRL limits prevented mispriced human resources from being arbitraged away sooner, with implications for engaging cognitive diversity that go beyond sports. This perspective describes why behavioral failures as arbitrage opportunities can persist and prescribes strategists, as contrarian theorists, a framework for formulating relevant behavioral and social problems to solve in order to search for and exploit these untapped opportunities.

Global Leaders for Global Teams: Leaders with Multicultural Experiences Communicate and Lead More Effectively, Especially in Multinational Teams

In an era of globalization, it is commonly assumed that multicultural experiences foster leadership effectiveness. However, little research has systematically tested this assumption. We develop a theoretical perspective that articulates how and when multicultural experiences increase leadership effectiveness. We hypothesize that broad multicultural experiences increase individuals’ leadership effectiveness by developing their communication competence. Because communication competence is particularly important for leading teams that are more multinational, we further hypothesize that individuals with broader multicultural experiences are particularly effective when leading more versus less multinational teams. Four studies test our theory using mixed methods (field survey, archival panel, field experiments) and diverse populations (corporate managers, soccer managers, hackathon leaders) in different countries (Australia, Britain, China, America). In Study 1, corporate managers with broader multicultural experiences were rated as more effective leaders, an effect mediated by communication competence. Analyzing a 25-year archival panel of English Premier League soccer managers, Study 2 replicates the positive effect of broad multicultural experiences using a team performance measure of leadership effectiveness. Importantly, this effect was moderated by team national diversity: soccer managers with broader multicultural experiences were particularly effective when leading teams with greater national diversity. Study 3 (digital health hackathon) and Study 4 (COVID-19 policy hackathon) replicate these effects in two field experiments, in which individuals with varying levels of multicultural experiences were randomly assigned to lead hackathon teams that naturally varied in national diversity. Overall, our research suggests that broad multicultural experiences help leaders communicate more competently and lead more effectively, especially when leading multinational teams.

Welcome to Be Like Us: Expectations of Outgroup Assimilation Shape Dominant Group Resistance to Diversity

We propose a theoretical framework for when and why members of dominant groups experience threat and express intolerant attitudes in response to social change. Scholarship on symbolic threat suggests that the detection of intergroup differences in values and norms is sufficient to elicit negative intergroup attitudes. Building on this theory, we argue that the experience of threat is actually shaped by prospective beliefs about difference (i.e., expectations of whether outgroups will assimilate to ingroup norms over time or not). Across two studies and two accompanying pilots, we show how outgroup assimilation expectation shapes dominant groups' experiences of threat, specifically as it relates to their ability to define the norms of their superordinate category (prototypicality threat). We observe that members of dominant groups are surprisingly tolerant of both social change and intergroup difference in the present, so long as they expect outgroup assimilation in the future.

Sousa S, Diele-Viegas LM. Why we shouldn’t blame women for gender disparity in academia: perspectives of women in zoology

The following letter, from a network of women zoologists, is a reply to the article of AlShebli et al. (2020), which suggests that female protégés reap more benefits when mentored by men and concludes that female mentors hinder the success of their female protégés and the quality of their impact. This contribution has two parts. First, we highlight the most relevant methodological flaws which, in our opinion, may have impacted the conclusions of AlShebli et al. (2020). Second, we discuss issues pertaining to women in science, bring a perspective of Women in Zoology and discuss how current diversity policies are positively changing our field.

Women leaders' views on demand-side strategies

Purpose

The purpose of this paper is to examine female leaders' attitudes toward demand-side strategies to close the gender-leadership gap and discuss implications for organizations.

Design/methodology/approach

This article describes the process of knowledge co-creation that took place using an engaged scholarship epistemology over 23 interviews with North American women in senior leadership roles.

Findings

Five key themes related to women leaders' attitudes toward demand-side strategies are discussed. Some felt uncertain or opposed toward these strategies, whereas others supported them. Support for these strategies was dependent on perceptions of backlash regarding the implementation of these strategies and the participants' career stage. Finally, participants acknowledged that demand-side strategies are insufficient in isolation and require additional organizational supports.

Research limitations/implications

These findings enhance our understanding and provide theoretical refinement of the mechanisms that drive female leaders' reactions to demand-side strategies to close the gender-leadership gap.

Practical implications

Participants advocated for certain practices to be considered when organizations contemplate the adoption of demand-side strategies. Importantly, participants advocated that the implementation of demand-side strategies would be insufficient unless organizations encourage greater dialogue regarding the gender-leadership gap, that top management support more gender inclusive leadership, and that male colleagues act as allies for women in leadership.

Originality/value

This article extends past research and theory by integrating the pragmatic perspectives of successful female leaders with previous empirical evidence to illustrate different reactions to demand-side strategies and ways for organizations to manage those in their efforts to close the gender-leadership gap.

Measuring and Resolving LGBTQ Disparities in STEM

LGBTQ people have pioneered major scientific advances, but they face challenges in STEM that ultimately waste human talent and hinder scientific progress. Growing evidence suggests that LGBTQ people in STEM are statistically underrepresented, encounter non-supportive environments, and leave STEM at an alarming rate. Potential factors driving LGBTQ disparities in STEM include bias and discrimination, misalignments of occupational interests with STEM stereotypes, and STEM norms of impersonality that isolate LGBTQ people. LGBTQ retention shares common psychological processes with female and racial minority retention such as STEM identification and belonging. The key barrier to better understanding and addressing LGBTQ challenges in STEM is the lack of sexual orientation or gender identity (SO/GI) demographic data on the U.S. STEM workforce. Policy recommendations include (a) adding SO/GI measures to federal STEM-census surveys; (b) broadening agencies’ definition of underrepresented groups to include LGBTQ people; and (c) incorporating LGBTQ identity into accountability systems and diversity programs at STEM institutions.

Proceedings from the Neurotherapeutics Symposium on Neurological Emergencies: Shaping the Future of Neurocritical Care

Effective treatment options for patients with life-threatening neurological disorders are limited. To address this unmet need, high-impact translational research is essential for the advancement and development of novel therapeutic approaches in neurocritical care. "The Neurotherapeutics Symposium 2019-Neurological Emergencies" conference, held in Rochester, New York, in June 2019, was designed to accelerate translation of neurocritical care research via transdisciplinary team science and diversity enhancement. Diversity excellence in the neuroscience workforce brings innovative and creative perspectives, and team science broadens the scientific approach by incorporating views from multiple stakeholders. Both are essential components needed to address complex scientific questions. Under represented minorities and women were involved in the organization of the conference and accounted for 30-40% of speakers, moderators, and attendees. Participants represented a diverse group of stakeholders committed to translational research. Topics discussed at the conference included acute ischemic and hemorrhagic strokes, neurogenic respiratory dysregulation, seizures and status epilepticus, brain telemetry, neuroprognostication, disorders of consciousness, and multimodal monitoring. In these proceedings, we summarize the topics covered at the conference and suggest the groundwork for future high-yield research in neurologic emergencies.

Open science, communal culture, and women's participation in the movement to improve science

Science is rapidly changing with the current movement to improve science focused largely on reproducibility/replicability and open science practices. Through network modeling and semantic analysis, this article provides an initial exploration of the structure, cultural frames of collaboration and prosociality, and representation of women in the open science and reproducibility literatures. Network analyses reveal that the open science and reproducibility literatures are emerging relatively independently with few common papers or authors. Open science has a more collaborative structure and includes more explicit language reflecting communality and prosociality than does reproducibility. Finally, women publish more frequently in high-status author positions within open science compared with reproducibility. Implications for cultivating a diverse, collaborative culture of science are discussed.

Science is undergoing rapid change with the movement to improve science focused largely on reproducibility/replicability and open science practices. This moment of change—in which science turns inward to examine its methods and practices—provides an opportunity to address its historic lack of diversity and noninclusive culture. Through network modeling and semantic analysis, we provide an initial exploration of the structure, cultural frames, and women’s participation in the open science and reproducibility literatures (n = 2,926 articles and conference proceedings). Network analyses suggest that the open science and reproducibility literatures are emerging relatively independently of each other, sharing few common papers or authors. We next examine whether the literatures differentially incorporate collaborative, prosocial ideals that are known to engage members of underrepresented groups more than independent, winner-takes-all approaches. We find that open science has a more connected, collaborative structure than does reproducibility. Semantic analyses of paper abstracts reveal that these literatures have adopted different cultural frames: open science includes more explicitly communal and prosocial language than does reproducibility. Finally, consistent with literature suggesting the diversity benefits of communal and prosocial purposes, we find that women publish more frequently in high-status author positions (first or last) within open science (vs. reproducibility). Furthermore, this finding is further patterned by team size and time. Women are more represented in larger teams within reproducibility, and women’s participation is increasing in open science over time and decreasing in reproducibility. We conclude with actionable suggestions for cultivating a more prosocial and diverse culture of science.

Anti-racist actions and accountability: not more empty promises

Purpose

The current piece summarizes five critical points about racism from the point of view of Black scholars and allies: (1) Black people are experiencing exhaustion from and physiological effects of racism, (2) racism extends far beyond police brutality and into most societal structures, (3) despite being the targets of racism, Black people are often blamed for their oppression and retaliated against for their response to it, (4) everyone must improve their awareness and knowledge (through both formal education and individual motivation) to fight racism and (5) anti-racist policies and accountability are key to enact structural reformation.

Findings

The first three of these points detail the depths of the problem from the perspectives of the authors and the final two lay out a call to action.

Practical implications

This viewpoint is the joint effort of 14 authors who provided a unified perspective.

Originality/value

This was one of the most original experiences the authors have had – working with 13 former/current students on joint perspectives about police brutality and racism more generally. The authors thank for the opportunity.

Culture and Business: How Can Cultural Psychologists Contribute to Research on Behaviors in the Marketplace and Workplace?

Cultural psychology has great potential to expand its research frameworks to more applied research fields in business such as marketing and organizational studies while going beyond basic psychological processes to more complex social practices. In fact, the number of cross-cultural business studies has grown constantly over the past 20 years. Nonetheless, the theoretical and methodological closeness between cultural psychology and these business-oriented studies has not been fully recognized by scholars in cultural psychology. In this paper, we briefly introduce six representative cultural constructs commonly applied in business research, which include (1) individualism vs. collectivism, (2) independence vs. interdependence, (3) analytic vs. holistic cognition, (4) vertical vs. horizontal orientation, (5) tightness vs. looseness, and (6) strong vs. weak uncertainty avoidance. We plot the constructs on a chart to conceptually represent a common ground between cultural psychology and business research. We then review some representative empirical studies from the research fields of marketing and organizational studies which utilize at least one of these six constructs in their research frameworks. At the end of the paper, we recommend some future directions for further advancing collaboration with scholars in the field of marketing and organizational studies, while referring to theoretical and methodological issues.

OKC-enabled online knowledge integration: role of group heterogeneity and group interaction process

Purpose

Online knowledge integration has been an important concern of the online knowledge community as it can lead to various positive outcomes of online knowledge coproduction. This paper identifies online knowledge integration factors by considering group heterogeneity and group interaction process.

Design/methodology/approach

Based on the categorization-elaboration model (CEM) and interactive team cognition (ITC) theory, a research model that reflects the antecedent's factors and mediating factors of online knowledge integration was developed and empirically examined based on data collected from 2,339,836 data extracted from Wikipedia.

Findings

Group interaction process plays an essential mediator role in online knowledge integration. Group knowledge heterogeneity negatively influences online knowledge integration and group experience heterogeneity positively, and they both positively promote online knowledge integration through group interaction process with different paths.

Research limitations

Our research concerns the OKC context in one setting (Wikipedia). We expect that the results will generalize to other OKC platforms.

Practical implications

The findings of the study could assist the online knowledge community's organizers to understand the motivational mechanisms of online knowledge integration. Group interaction process could be regarded as the key role to promote group wisdom and maintain group independence.

Social implications

We advance the understanding of the online knowledge integration and gain a richer understanding of the importance of group interaction independence for online knowledge integration based on the agreement of group wisdom. It suggested keeping group interaction independence is an important aspect for highly online knowledge integration among heterogeneity groups.

Originality/value

This study extends CEM and ITC theory to the domain of knowledge integration context and finds the mechanism between group heterogeneity and online knowledge integration by introducing the group interaction process.

International migration, cross-cultural interaction, and the development of personal wisdom

Drawing on semi-structured in-depth interviews with Romanian immigrants in Ontario, Canada, conducted between 2014 and 2018, this article explores how the experiences acquired by the Romanian immigrants through migration and multicultural intercourse facilitate the development of personal wisdom. We show how our research participants perceived these geographical processes of migration and place-based multiethnic cohabitation to account for their growing wiser than their earlier selves. Specifically, we organize the description of these perceptions into three interrelated themes: (1) changes in perspective, (2) the learning of new things, and (3) the role of place in fostering wisdom. Against this background, the article also highlights the boundary conditions within which these processes may or may not foster the development of wisdom, acknowledging that not all migratory and multicultural experiences lead to prosocial and adaptive outcomes. Our discussion of these boundary conditions with the research participants coalesced into five recurrent themes: (1) adaptation to the new environment and social system, (2) the role of the host environment as a boundary condition, (3) the problem of unmet expectations, (4) the magnitude of the cultural shocks, and (5) the language barrier. Bearing the complex politics of these boundary conditions in mind, we argue that the experience of international migration and subsequent cross-cultural interaction can be usefully understood as a ‘fertile ground’ for the flourishing of personal wisdom, which itself can act as an individual and collective resource for cohabitation in multicultural settings.

Gender in Science, Technology, Engineering, and Mathematics: Issues, Causes, Solutions

The landscape of gender in education and the workforce has shifted over the past decades: women have made gains in representation, equitable pay, and recognition through awards, grants, and publications. Despite overall change, differences persist in the fields of science, technology, engineering, and mathematics (STEM). This Viewpoints article on gender disparities in STEM offers an overarching perspective by addressing what the issues are, why the issues may emerge, and how the issues may be solved. In Part 1, recent data on gaps in representation, compensation, and recognition (awards, grants, publications) are reviewed, highlighting differences across subfields (e.g., computer science vs biology) and across career trajectories (e.g., bachelor's degrees vs senior faculty). In Part 2, evidence on leading explanations for these gaps, including explanations centered on abilities, preferences, and explicit and implicit bias, is presented. Particular attention is paid to implicit bias: mental processes that exist largely outside of conscious awareness and control in both male and female perceivers and female targets themselves. Given its prevalence and persistence, implicit bias warrants a central focus for research and application. Finally, in Part 3, the current knowledge is presented on interventions to change individuals' beliefs and behaviors, as well as organizational culture and practices. The moral issues surrounding equal access aside, understanding and addressing the complex issues surrounding gender in STEM are important because of the possible benefits to STEM and society that will be realized only when full participation of all capable and qualified individuals is guaranteed.

Gender Disparities Within US Army Orthopedic Surgery: A Preliminary Report

INTRODUCTION

Women account for approximately 15% of the active duty US Army, and studies show that women may be at an increased risk of musculoskeletal injury during sport and military training. Nationally, the field of orthopedic surgery comprises 14% women, lagging behind other surgical fields. Demographics for US Military orthopedic surgeons are not readily available. Similarly, demographic data of graduating medical students entering Military Medicine are not reported. We hypothesize that a gender disparity within military orthopedics will be apparent. We will compare the demographic profile of providers to our patients and hypothesize that the two groups are dissimilar. Secondarily, we examine the demographics of military medical students potentially entering orthopedics from the Uniformed Services University of the Health Sciences (USUHS) or the Health Professions Scholarship Program.

METHODS

A census was formed of all US Army active duty orthopedic surgeons to include staff surgeons and residents, as well as US Army medical student graduates and orthopedic patients.

RESULTS

There are 252 Army orthopedic surgeons and trainees; 26 (10.3%) are women and 226 (89.7%) are men. There were no significant demographic differences between residents and staff. Between 2014 and 2017, the 672 members of the USUHS graduating classes included 246 Army graduates. Of those, 62 (25%) were female. Army Health Professions Scholarship Program graduated 1,072 medical students, with women comprising 300 (28%) of the group. No statistical trends were seen over the 4 yr at USUHS or in Health Professions Scholarship Program. In total, 2,993 orthopedic clinic visits during the study period were by Army service members, 23.6% were women.

CONCLUSION

There exists a gender disparity among US Army orthopedic surgeons, similar to that seen in civilian orthopedics. Gender equity is also lacking among medical students who feed into Army graduate medical education programs. The gender profile of our patient population is not reflected by that of providers. Because patients prefer providers of the same gender, this is a limitation to patient satisfaction and access to care for musculoskeletal injuries. Further study is underway to identify perceptions and potential causes of these disparities, including the critical perspective of our patients. In addition to the inherent benefits offered by diversity (e.g., expanding the talent pool and more perspectives for decision-making), ultimately it affords a greater ability to maintain a fit and ready force.

Understanding Diversity Ideologies From the Target's Perspective: A Review and Future Directions

We present a review of the diversity ideologies literature from the target's perspective. In particular, we focus on how diversity ideologies—beliefs or organizational practices with regards to how to approach diversity—affect racial minorities' and women's self-perceptions and experiences at work. This review suggests that a diversity aware ideology (i.e., multiculturalism) is more beneficial than a diversity blind ideology (i.e., colorblindness) for racial-ethnic minorities (e.g., better performance outcomes; more psychological engagement, inclusion, and workplace satisfaction; more positive leadership self-perceptions; and reduced perceptions of bias and turnover intentions). In contrast, for women, gender-blindness is associated with more positive outcomes than gender awareness (e.g., enhanced self-confidence, pro-active behaviors and leadership emergence). Importantly, multiculturalism and gender-blindness can both produce negative side effects for racial minorities and women, respectively, which highlights the importance of developing approaches to address the shortcomings of these conventional ideologies. We discuss the implications and offer recommendations for future research.

Double Trouble: How Being Outnumbered and Negatively Stereotyped Threatens Career Outcomes of Women in STEM

Masculine work contexts form an important source of social identity threat for working women. But what aspect of masculine work contexts is most threatening to women’s gender identity at work: A numerical majority of male colleagues (i.e., numerical male dominance), working in a profession in which women are negatively stereotyped (i.e., normative male dominance), or the combination? The current study aimed to disentangle these two aspects of masculine work contexts by testing its combined impact on the experience of gender identity threat among women and men who work in the STEM sector (i.e., Science, Technology, Engineering and Mathematics). A field study was conducted among women (N = 177) and men (N = 630) graduates holding an academic degree in a STEM educational program. Respondents either worked in- or outside the STEM sector (i.e., stronger vs. weaker gender stereotype) and estimated the ratio of men to women in their direct work environment. Results from a Structural Equation Model demonstrated that women in STEM face double trouble: The combination of working almost solely with male colleagues (being outnumbered) and working in the technical sector (where women are negatively stereotyped) predicted the highest levels of experienced gender identity threat, particularly among women who highly identified with their gender group. Gender identity threat, in turn, negatively predicted women’s work engagement and career confidence. Men did not face double trouble: Their experience of gender identity threat was not related to working in a masculine STEM sector. Importantly, considering that the women in this sample already hold a degree in STEM, and have proven their competence in STEM and resilience to gender stereotypes, this research reveals how in naturalistic work settings, prevailing social identity threats continue to affect women’s professional careers.

Applying Conflict Management Strategies to the Pediatric Operating Room

Effective communication is essential in today's health care environment, and poor communication can lead to conflict among health care providers. Differences in cultures and beliefs can further incite conflict among health care team members, families, and patients. Pediatric patient care has a higher potential for conflict because decision-making responsibilities are shared among patients, parents/guardians, and clinicians. It is important to understand the phases and types of conflict because each conflict situation requires a different approach to optimize management. Equally important is an understanding of styles used by individuals to manage conflict. The Thomas-Kilmann Conflict Mode Instrument and the Dutch Test for Conflict Handling are 2 validated tools used to assess conflict management styles. The different styles include competing/forcing, collaborating/problem solving, compromising, avoiding, and yielding/accommodating. A successful physician should be able to identify the phases and types of conflict to use the conflict management approach most suitable for the given conflict.There are several techniques for managing conflict in the pediatric operating room. Acknowledging and managing one's own emotions during conflict is a pivotal first step toward diffusing the situation. Active listening is an important communication skill that improves team dynamics. Aligning the interests of the parties involved in conflict will encourage collaborative problem solving. Cultural competency training can improve communication and conflict management skills. Effective conflict management through formal education of all perioperative team members can lead to improved communication and teamwork and better patient outcomes.