Comparison of National Institutes of Health Grant Amounts to First-Time Male and Female Principal Investigators

COVID-19 Threatens Progress Toward Gender Equity Within Academic Medicine

Women remain underrepresented within academic medicine despite past and present efforts to promote gender equity. The authors discuss how the COVID-19 pandemic could stymie progress toward gender parity within the biomedical workforce and limit the retention and advancement of women in science and medicine. Women faculty face distinct challenges as they navigate the impact of shelter-in-place and social distancing on work and home life. An unequal division of household labor and family care between men and women means women faculty are vulnerable to inequities that may develop in the workplace as they strive to maintain academic productivity and professional development without adequate assistance with domestic tasks and family care. Emerging data suggest that gender differences in academic productivity may be forthcoming as a direct result of the pandemic. Existing gender inequities in professional visibility, networking, and collaboration may be exacerbated as activities transition from in-person to virtual environments and create new barriers to advancement. Meanwhile, initiatives designed to promote gender equity within academic medicine may lose key funding due to the economic impact of COVID-19 on higher education. To ensure that the gender gap within academic medicine does not widen, the authors call upon academic leaders and the broader biomedical community to support women faculty through deliberate actions that promote gender equity, diversity, and inclusion. The authors provide several recommendations, including faculty needs assessments; review of gender bias within tenure-clock-extension offers; more opportunities for mentorship, sponsorship, and professional recognition; and financial commitments to support equity initiatives. Leadership for these efforts should be at the institutional and departmental levels, and leaders should ensure a gender balance on task forces and committees to avoid overburdening women faculty with additional service work. Together, these strategies will contribute to the development of a more equitable workforce capable of transformative medical discovery and care.

Do senior faculty members produce fewer research publications than their younger colleagues? Evidence from Ph.D. granting institutions in the United States

The aging of the professoriate throughout the end of the twentieth century and the early years of the 2000′s (both before and after the end of mandatory retirement in the United States, ca. 1994) has become a source of concern for some scholars and research administrators, who posit that the “greying” of the academy results in lower research activity and a decline in scientific advancement. Some published opinions concur that senior scholars’ research programs do not keep pace with those of their younger colleagues, but little quantitative evidence has been presented to evaluate that claim. In this study, we quantify senior faculty publication activity in six broad fields, comparing their publication rates to their younger colleagues across four modes of knowledge dissemination: journal articles, conference proceedings, books, and book chapters. Career publication activity does not follow the “peak and decline” pattern described in earlier studies. In most fields, journal article publication rates do not decline substantively with age (and in some cases article publication rates are higher among senior scholars), conference proceeding publication rates tend to decline with age, while book and chapter publication rates increase markedly with age. Overall, senior scholars maintain publishing activity levels and tend to shift their focus to the development and evolution of ideas through the publication of longer-format works as books and book chapters.

Need for Awareness and Training in Women's Gastrointestinal Health: A Call to Action

Women's gastrointestinal (GI) health is a topic that is not well understood nor taught in most training programs. In this article, we highlight the importance of proper training in women's GI health among gastroenterologists and fellows, and identify some common conditions to provide the best possible treatment for their female patients.

Gender Disparity in the Authorship of Biomedical Research Publications During the COVID-19 Pandemic: Retrospective Observational Study

BACKGROUND

Gender imbalances in academia have been evident historically and persist today. For the past 60 years, we have witnessed the increase of participation of women in biomedical disciplines, showing that the gender gap is shrinking. However, preliminary evidence suggests that women, including female researchers, are disproportionately affected by the COVID-19 pandemic in terms of unequal distribution of childcare, elderly care, and other kinds of domestic and emotional labor. Sudden lockdowns and abrupt shifts in daily routines have had disproportionate consequences on their productivity, which is reflected by a sudden drop in research output in biomedical research, consequently affecting the number of female authors of scientific publications.

OBJECTIVE

The objective of this study is to test the hypothesis that the COVID-19 pandemic has had a disproportionate adverse effect on the productivity of female researchers in the biomedical field in terms of authorship of scientific publications.

METHODS

This is a retrospective observational bibliometric study. We investigated the proportion of male and female researchers who published scientific papers during the COVID-19 pandemic, using bibliometric data from biomedical preprint servers and selected Springer-Nature journals. We used the ordinary least squares regression model to estimate the expected proportions over time by correcting for temporal trends. We also used a set of statistical methods, such as the Kolmogorov-Smirnov test and regression discontinuity design, to test the validity of the results.

RESULTS

A total of 78,950 papers from the bioRxiv and medRxiv repositories and from 62 selected Springer-Nature journals by 346,354 unique authors were analyzed. The acquired data set consisted of papers that were published between January 1, 2019, and August 2, 2020. The proportion of female first authors publishing in the biomedical field during the pandemic dropped by 9.1%, on average, across disciplines (expected arithmetic mean yest=0.39; observed arithmetic mean y=0.35; standard error of the estimate, Sest=0.007; standard error of the observation, σx=0.004). The impact was particularly pronounced for papers related to COVID-19 research, where the proportion of female scientists in the first author position dropped by 28% (yest=0.39; y=0.28; Sest=0.007; σx=0.007). When looking at the last authors, the proportion of women dropped by 7.9%, on average (yest=0.25; y=0.23; Sest=0.005; σx=0.003), while the proportion of women writing about COVID-19 as the last author decreased by 18.8% (yest=0.25; y=0.21; Sest=0.005; σx=0.007). Further, by geocoding authors' affiliations, we showed that the gender disparities became even more apparent when disaggregated by country, up to 35% in some cases.

CONCLUSIONS

Our findings document a decrease in the number of publications by female authors in the biomedical field during the global pandemic. This effect was particularly pronounced for papers related to COVID-19, indicating that women are producing fewer publications related to COVID-19 research. This sudden increase in the gender gap was persistent across the 10 countries with the highest number of researchers. These results should be used to inform the scientific community of this worrying trend in COVID-19 research and the disproportionate effect that the pandemic has had on female academics.

Value of peer mentoring for early career professional, research, and personal development: a case study of implementation scientists

Effective mentoring is a key mechanism propelling successful research and academic careers, particularly for early career scholars. Most mentoring programs focus on models pairing senior and early career researchers, with limited focus on peer mentoring. Peer mentoring may be especially advantageous within emerging areas such as implementation science (IS) where challenges to traditional mentoring may be more prevalent. This special communication highlights the value of peer mentoring by describing a case study of an early career IS peer mentoring group. We delineate our curriculum and structure; support and processes; and products and outcomes. We highlight important group member characteristics to consider during group formation and continuation. The group's long-term (6 years) success was attributed to the balance of similarities and differences among group members. Members were in a similar career phase and used similar methodologies but studied different health topics at different institutions. Group members gave and received instrumental and psychosocial support and shared resources and knowledge. Peer mentoring can serve an important function to provide emotional, logistical, and professional development support for early career scholars. Our case study highlights strategies to foster peer mentoring groups that provide a generalizable blueprint and opportunity for improved outcomes for early career professionals.

Representation of Female Faculty at US Medical Schools and Success in Obtaining National Institutes of Health Funding, 2008-2018

This cross-sectional study assesses the representation and success of female faculty at US medical schools and their success in obtaining funding from the National Institutes of Health (NIH) between 2008 and 2018.

Organizational behavior among academic medical school faculty

The study of organizational behavior in an academic medical school setting has many variables for consideration, including fragmentation, responsibilities, professionalism, burnout, and gender. In this Commentary, the author highlights some major factors affecting osteopathic physicians who practice in an academic setting, to bring to the attention of the medical community some of the inherent problems with modern academic medical education structure.

Representation of Women on National Institutes of Health Study Sections

This cross-sectional study examines the proportion of women represented on National Institutes of Health study sections and whether there is an association with research funding levels.

Academic Productivity Differences by Gender and Child Age in Science, Technology, Engineering, Mathematics, and Medicine Faculty During the COVID-19 Pandemic

Background: Due to the COVID-19 pandemic, most faculty in science, technology, engineering, mathematics, and medicine (STEMM) began working from home, including many who were simultaneously caring for children. The objective was to assess associations of gender and parental status with self-reported academic productivity before (i.e., mid-January to mid-March 2020) and during the pandemic (i.e., mid-March to mid-May 2020). Materials and Methods: STEMM faculty in the United States (N = 284, 67.6% women, 57.0% with children younger than the age of 18 years living at home) completed a survey about the number of hours worked and the frequency of academic productivity activities. Results: There was no significant difference in the hours worked per week by gender (men, M [standard deviation, SD] = 45.8 [16.7], women = 43.1 [16.3]). Faculty with 0-5-year-old children reported significantly fewer work hours (33.7 [13.9]) compared to all other groups (No children = 49.2 [14.9], 6-11 years old = 48.3 [13.9], and 12-17 years old = 49.5 [13.9], p < 0.0001). Women's self-reported first/corresponding author's and coauthor's article submissions decreased significantly between the two time periods; men's productivity metrics did not change. Faculty with 0-5-year-old children completed significantly fewer peer review assignments, attended fewer funding panel meetings, and submitted fewer first authors' articles during the pandemic compared to the previous period. Those with children aged 6 years or older at home or without children at home reported significant increases or stable productivity. Conclusions: Overall, significant disparities were observed in academic productivity by gender and child age during the pandemic and if confirmed by further research, should be considered by academic institutions and funding agencies when making decisions regarding funding and hiring as well as promotion and tenure.

Results of a portfolio approach to intramural research funding at an academic medical center

In response to stagnant Federal grant funding levels and to catalyze early stage or high-risk research not currently supported by the NIH, many academic medical centers (AMCs) provide supplemental intramural funding to faculty investigators. However, it can be challenging to decide how to deploy these funds for maximum impact. We conducted a retrospective, descriptive analysis to explore trends in applications and awards associated with an institution-wide intramural funding center at a major U.S. AMC. From 2010 to 2017, the Brigham Research Institute at Brigham and Women's Hospital awarded a total of 354 grants totaling over $9 million to affiliated researchers through six distinct and complementary grant programs. The number of applicants remained essentially stable, despite expansion of the funding program portfolio. Distribution of applicants and awardees by academic rank and gender generally reflected that of medical school faculty at large. This descriptive analysis demonstrates interest in a diverse range of intramural funding programs among AMC faculty, and a lack of overt rank or gender bias in the programs' awardees. However, it highlights the institution's need to better understand the amount of residual unmet demand for intramural funding; the degree to which underrepresented constituencies can and should be actively supported; and the "return on investment" of these grants.

Gender Disparities in Authorships and Citations in Transplantation Research

Background.

Over the past decades, there has been a rapid change in the gender ratio of medical doctors, whereas gender differences in academia remain apparent. In transplantation research, a field already understaffed with female doctors and researchers, there is little published data on the development in proportion, citations, and funding of female researchers over the past years.

Methods.

To evaluate the academic impact of female doctors in transplantation research, we conducted a bibliometric analysis (01 January 1999 to 31 December 2018) of high-impact scientific publications, subsequent citations, and funding in this field. Web of Science data was used in combination with software R-Package “Gender,” to predict gender by first names.

Results.

For this study, 15 498 (36.2% female; 63.8% male) first and 13 345 (30.2% female; 69.8% male) last author gender matches were identified. An increase in the percentage of female first and last authors is seen in the period 1999–2018, with clear differences between countries (55.1% female authors in The Netherlands versus 13.1% in Japan, for example). When stratifying publications based on the number of citations, a decline was seen in the percentage of female authors, from 34.6%–30.7% in the first group (≤10 citations) to 20.8%–23.2% in the fifth group (>200 citations), for first (P < 0.001) and last (P = 0.014) authors, respectively. From all first author name-gender matches, 6574 (41.6% female; 58.4% male, P < 0.001) publications reported external funding, with 823 (35.5% female; 64.5% male, P = 0.701) reported funding by pharmaceutical companies and 1266 (36.6% female; 63.4% male, P < 0.001) reporting funding by the National Institutes of Health.

Conclusions.

This is the first analysis of gender bias in scientific publications, subsequent citations, and funding in transplantation research. We show ongoing differences between male and female authors in citation rates and rewarded funding in this field. This requires an active approach to increase female representation in research reporting and funding rewarding.

Seven decades of chemotherapy clinical trials: a pan-cancer social network analysis

Clinical trials establish the standard of cancer care, yet the evolution and characteristics of the social dynamics between the people conducting this work remain understudied. We performed a social network analysis of authors publishing chemotherapy-based prospective trials from 1946 to 2018 to understand how social influences, including the role of gender, have influenced the growth and development of this network, which has expanded exponentially from fewer than 50 authors in 1946 to 29,197 in 2018. While 99.4% of authors were directly or indirectly connected by 2018, our results indicate a tendency to predominantly connect with others in the same or similar fields, as well as an increasing disparity in author impact and number of connections. Scale-free effects were evident, with small numbers of individuals having disproportionate impact. Women were under-represented and likelier to have lower impact, shorter productive periods (P < 0.001 for both comparisons), less centrality, and a greater proportion of co-authors in their same subspecialty. The past 30 years were characterized by a trend towards increased authorship by women, with new author parity anticipated in 2032. The network of cancer clinical trialists is best characterized as strategic or mixed-motive, with cooperative and competitive elements influencing its appearance. Network effects such as low centrality, which may limit access to high-profile individuals, likely contribute to the observed disparities.

Gender Disparity in Awards in General Surgery Residency Programs

IMPORTANCE

Women are disproportionately underrecognized as award winners within medical societies. The presence of this disparity has not been investigated in training programs.

OBJECTIVE

To determine the presence of a gender disparity in award winners in general surgery residency programs.

DESIGN, SETTING, AND PARTICIPANTS

In this retrospective survey study, 32 geographically diverse academic and independent general surgery residency programs were solicited for participation. The 24 participating programs (75.0%) submitted deidentified data regarding the gender distribution of residents and trainee award recipients for the period from July 1, 1996, to June 30, 2017. Data were analyzed from September 11, 2017, to December 21, 2018.

EXPOSURES

Time and the proportion of female trainees.

MAIN OUTCOMES AND MEASURES

The primary outcome was the percentage of female award winners. A multilevel logistic regression model accounting for the percentage of female residents in each program compared the odds of a female resident winning an award relative to a male resident. This analysis was repeated for the first and second decades of the study. Award winners were further analyzed by type of award (clinical excellence, nonclinical excellence, teaching, or research) and selection group (medical students, residents, or faculty members).

RESULTS

A total of 5030 of 13 760 resident person-years (36.6%) and 455 of 1447 award winners (31.4%) were female. Overall, female residents were significantly less likely to receive an award compared with male residents (odds ratio [OR], 0.44; 95% CI, 0.37-0.54; P < .001). During the first decade of the study, female residents were 70.8% less likely to receive an award compared with male residents (OR, 0.29; 95% CI, 0.19-0.45; P < .001); this improved to 49.9% less likely in the second decade (OR, 0.50; 95% CI, 0.42-0.61; P < .001). Female residents were less likely to receive an award for teaching (OR, 0.33; 95% CI, 0.26-0.42; P < .001), clinical excellence (OR, 0.44; 95% CI, 0.31-0.61; P < .001), or nonclinical excellence (OR, 0.69; 95% CI, 0.48-0.98; P = .04). No statistical difference was observed for research award winners (OR, 0.76; 95% CI, 0.42-1.12; P = .17). The largest discrepancies were observed when award recipients were chosen by residents (OR, 0.23; 95% CI, 0.14-0.39; P < .001) and students (OR, 0.32; 95% CI, 0.25-0.42; P < .001) compared with faculty members (OR, 0.52; 95% CI, 0.42-0.66; P < .001).

CONCLUSIONS AND RELEVANCE

This study found that female residents were significantly underrepresented as award recipients. These findings suggest the presence of ongoing implicit bias in surgery departments and training programs.

Addressing Gender Equity in Senior Leadership Roles in Translational Science

Inequities for women exist across many leverage points of an academic career in science, technology, engineering, mathematics, and medicine (STEMM) disciplines, ranging from poorer success rates at promotion, reduced grant success, and a lower likelihood of invited conference presentations, to a propensity to undertake the lion's share of academic service roles. Moreover, an almost intractable salary gap exists, along with a stark under-representation of women in senior scientific leadership roles, widespread throughout the United States, United Kingdom, Europe, and Australia. Numerous factors have been put forward as contributors to this disparity, including the notions that these inequities are a result of a pipeline issue and that women are less qualified or have less experience than men, implicit bias, a lack of flexibility in the work place, a lack of role models, the use of biased measures of success for promotion, and the lack of equitable parental leave programs. In this viewpoint, we address factors shown to contribute to the lack of women in leadership roles. Specifically, we look at systemic barriers, parental and carer leave, and domestic barriers, and we present solutions to address these barriers across an individual's professional and personal life. For women to achieve equity in senior scientific leadership roles, we believe that barriers across all facets of life need to be addressed and that the important contributions that women make and have made to STEMM need to be recognized.

Gender, women, and the future of tobacco control

Purpose

This paper aims to provide a gendered analysis of the WHO Framework Convention on Tobacco Control (FCTC) benchmarked upon the global commitments to women’s health and well-being in the UN Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and the Beijing Declaration and Platform for Action. It reviews evidence of the global consequences of neglecting women’s tobacco use and health, as well as analyzes persistent issues related to sex and gender that compromise the efficacy of tobacco control and science. Actionable recommendations are made to the Conference of the Parties to the FCTC and other key stakeholders.

Design/methodology/approach

This paper draws upon empirical studies, literature reviews and global health data at the varying intersections of gender, sex, tobacco and global health.

Findings

The global tobacco control framework and its implementation by state governments have been largely gender blind to date with dire health and economic consequences, including inequitable positive outcomes for men compared to women, and an increase in women’s smoking with associated morbidity and mortality. Gender equitable progress in combatting the tobacco epidemic will not be possible without resolving the gender bias, stigmatization, sexism and lack of intersectionality that plague tobacco control policy, research and interventions for cessation and harm reduction.

Originality/value

This paper provides an updated global overview of current trends in women’s tobacco use and comprehensively details the persistent structural barriers in tobacco control and science that limit their capacity to effectively analyze and address tobacco use and its impact on women.

Practice composition and sex differences in physician income: observational study

OBJECTIVE

To assess whether differences in income between male and female physicians vary according to the sex composition of physician practices.

DESIGN

Retrospective observational study.

SETTING

US national survey of physician salaries, 2014-18.

PARTICIPANTS

18 802 physicians from 9848 group practices (categorized according to proportion of male physicians ≤50%, >50-75%, >75-90%, and >90%).

MAIN OUTCOME MEASURES

Sex differences in physician income in relation to the sex composition of physician practices after multivariable adjustment for physician specialty, years of experience, hours worked, measures of clinical workload, practice type, and geography.

RESULTS

Among 11 490 non-surgical specialists, the absolute adjusted sex difference in annual income (men versus women) was $36 604 (£29 663; €32 621) (95% confidence interval $24 903 to $48 306; 11.7% relative difference) for practices with 50% or less of male physicians compared with $91 669 ($56 587 to $126 571; 19.9% relative difference) for practices with at least 90% of male physicians (P=0.03 for difference). Similar findings were observed among surgical specialists (n=3483), with absolute adjusted sex difference in annual income of $46 503 ($42 198 to $135 205; 10.2% relative difference) for practices with 50% or less of male physicians compared with $149 460 ($86 040 to $212 880; 26.9% relative difference) for practices with at least 90% of male physicians (P=0.06 for difference). Among primary care physicians (n=3829), sex differences in income were not related to the proportion of male physicians in a practice.

CONCLUSIONS

Among both non-surgical and surgical specialists, sex differences in income were largest in practices with the highest proportion of male physicians, even after detailed adjustment for factors that might explain sex differences in income.

Challenges to successful research careers in neurology: How gender differences may play a role

There has been a substantial rise in the number of women pursuing careers in neurology. However, research has shown that women in neurology have high rates of burnout with gender disparities in burnout and attrition in the field. Recently, there was a call from the NIH, including the National Institute of Neurological Disorders and Stroke, asking for input on factors that may limit or discourage grant applications from women. As the recipients of the highly coveted NIH career mentored awards (K awards) in headache medicine, we applaud the NIH for asking for gender-specific feedback and for raising awareness of research showing that female faculty on the Research Track are at an increased risk of departure. Using the NIH model for the Responsible Conduct of Research and the tenant of Nurturing the Fertile Environment, we discuss specific challenges in academic research that may contribute to gender differences in neurology research success. Although the rate of women conducting NIH-funded migraine research increased from 23% to 41% over the last 10 years, more women are currently in training compared with independence, with 6/6 of the NIH training grants but only 12/36 of the NIH research-level grants, held by women in fiscal years 2017-2019. We suggest concrete solutions to these challenges to ensure the success of women in research reaching independence.

Leading from Behind: Paucity of gender equity statements and policies among professional surgical societies

BACKGROUND

The availability and utility of public statements and policies on gender equity from professional surgical societies has not been studied.

METHODS

Professional surgical society websites were searched for publicly available statements and policies related to gender equity. These were compiled and assessed for critical components.

RESULTS

Publicly available statements/policies were published in every surgical society, though few pertained specifically to gender. Nearly all were recently written or revised. The most common statement/policy addressed discrimination and harassment. The only policies/statements that reliably contained all four key components pertained to professional conduct at national meetings. All policies that provided consequences also contained specific reporting processes.

CONCLUSIONS

Gender equity statements and policies are deficient among professional surgical societies. Prioritization of publicizing statements/policies that describe the challenges and provide potential solutions to well-documented gender inequities within surgical fields allows professional societies to promote a diverse and equitable workforce.

Gender Differences in Faculty Rank and Leadership Positions Among Hematologists and Oncologists in the United States

PURPOSE:

Gender disparity persists in academic medicine. Female faculty are underrepresented in leadership positions and have lower research output. We studied gender differences in faculty rank and departmental leadership and contributing factors among academic hematologists and oncologists in the United States.

METHODS:

For clinical faculty at 146 hematology or oncology fellowship programs listed in the Fellowship and Residency Electronic Interactive Database, we collected data on demographics, academic rank, and research output using the Doximity and Scopus databases. We compared unadjusted characteristics of men and women by using 2-sided t tests and χ2 tests where appropriate. To predict probability of full professorship or leadership position among men versus women, we performed multivariable logistic regression analysis adjusted for clinical experience in years, number of publications, h-index, clinical trial investigator status, National Institutes of Health funding, and workplace ranking (top 20 v not).

RESULTS:

Two thousand one hundred sixty academic hematologists and oncologists were included. Women composed 21.9% (n = 142) of full professors, 35.7% (n = 169) of associate professors, and 45.4% (n = 415) of assistant professors. Thirty percent (n = 70) of departmental leaders were women. Female faculty, compared with male faculty, had a lower mean h-index (12.1 v 20.9, respectively; P < .001) and fewer years of professional experience since fellowship (10 v 16 years, respectively; P < .001). After adjusting for duration of clinical experience, academic productivity, and workplace ranking, the odds of obtaining professorship (odds ratio [OR], 1.05; 95% CI, 0.71 to 1.57; P = .85) or divisional leadership (OR, 0.57; 95% CI, 0.20 to 1.58; P = .28) for female physicians were not different compared with male physicians.

CONCLUSION:

Gender disparity exists in senior ranks of academic hematology and oncology; however, gender is not a significant predictor in achieving professorship or department leadership position.

Pathways for Recruiting and Retaining Women and Underrepresented Minority Clinicians and Physician Scientists Into the Radiation Oncology Workforce: A Summary of the 2019 ASTRO/NCI Diversity Symposium Session at the ASTRO Annual Meeting

Diversifying the radiation oncology workforce is an urgent and unmet need. During the American Society of Radiation Oncology (ASTRO) 2019 Annual Meeting, ASTRO's Committee on Health Equity, Diversity, and Inclusion (CHEDI) and the National Cancer Institute (NCI) collaborated on the ASTRO-NCI Diversity Symposium, entitled "Pathways for Recruiting and Retaining Women and Underrepresented Minority Clinicians and Physician Scientists Into the Radiation Oncology Workforce." Herein, we summarize the presented data and personal anecdotes with the goal of raising awareness of ongoing and future initiatives to improve recruitment and retention of underrepesented groups to radiation oncology. Common themes include the pivotal role of mentorship and standardized institutional practices – such as protected time and pay parity – as critical to achieving a more diverse and inclusive workplace.

Assessment of the Prevalence of Medical Student Mistreatment by Sex, Race/Ethnicity, and Sexual Orientation

IMPORTANCE

Previous studies have shown that medical student mistreatment is common. However, few data exist to date describing how the prevalence of medical student mistreatment varies by student sex, race/ethnicity, and sexual orientation.

OBJECTIVE

To examine the association between mistreatment and medical student sex, race/ethnicity, and sexual orientation.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study analyzed data from the 2016 and 2017 Association of American Medical Colleges Graduation Questionnaire. The questionnaire annually surveys graduating students at all 140 accredited allopathic US medical schools. Participants were graduates from allopathic US medical schools in 2016 and 2017. Data were analyzed between April 1 and December 31, 2019.

MAIN OUTCOMES AND MEASURES

Prevalence of self-reported medical student mistreatment by sex, race/ethnicity, and sexual orientation.

RESULTS

A total of 27 504 unique student surveys were analyzed, representing 72.1% of graduating US medical students in 2016 and 2017. The sample included the following: 13 351 female respondents (48.5%), 16 521 white (60.1%), 5641 Asian (20.5%), 2433 underrepresented minority (URM) (8.8%), and 2376 multiracial respondents (8.6%); and 25 763 heterosexual (93.7%) and 1463 lesbian, gay, or bisexual (LGB) respondents (5.3%). At least 1 episode of mistreatment was reported by a greater proportion of female students compared with male students (40.9% vs 25.2%, P < .001); Asian, URM, and multiracial students compared with white students (31.9%, 38.0%, 32.9%, and 24.0%, respectively; P < .001); and LGB students compared with heterosexual students (43.5% vs 23.6%, P < .001). A higher percentage of female students compared with male students reported discrimination based on gender (28.2% vs 9.4%, P < .001); a greater proportion of Asian, URM, and multiracial students compared with white students reported discrimination based on race/ethnicity (15.7%, 23.3%, 11.8%, and 3.8%, respectively; P < .001), and LGB students reported a higher prevalence of discrimination based on sexual orientation than heterosexual students (23.1% vs 1.0%, P < .001). Moreover, higher proportions of female (17.8% vs 7.0%), URM, Asian, and multiracial (4.9% white, 10.7% Asian, 16.3% URM, and 11.3% multiracial), and LGB (16.4% vs 3.6%) students reported 2 or more types of mistreatment compared with their male, white, and heterosexual counterparts (P < .001).

CONCLUSIONS AND RELEVANCE

Female, URM, Asian, multiracial, and LGB students seem to bear a disproportionate burden of the mistreatment reported in medical schools. It appears that addressing the disparate mistreatment reported will be an important step to promote diversity, equity, and inclusion in medical education.

Mind the gap: Gendered publication trends in oncology

BACKGROUND

Investigating scientific publication trends in the field of oncology may highlight opportunities for improved representation, mentorship, collaboration, and advancement for women.

METHODS

We conducted a bibliometric analysis of Annals of Surgical Oncology; Cancer; International Journal of Radiation Oncology, Biology, Physics (IJROBP); JAMA Oncology; and Journal of Clinical Oncology in 1990, 2000, 2010, and 2017. Full name and degree credentials per author role (ie, first or senior author), article type, publication year, and citation metrics were collected. First names were used to identify author gender.

RESULTS

Across 9189 articles, female representation rose between 1990 and 2017 (first authors: 17.7% in 1990, 36.6% in 2017; senior authors: 11.7% in 1990, 28.5% in 2017). For the 50 most cited articles per year, women comprised a smaller percent of first (26.5%) and senior (19.9%) authors. The average citation count was higher for male first (44.8 per article) and senior (47.1) authors compared to female first (39.7) and senior (44.1) authors. With male senior authors, the first author was more likely male (71.4% male; 25.0% female); with female senior authors, first authors were 50.2% male and 47.6% female. IJROBP had the lowest total female representation among first (25.1%) and senior (16.7%) authors. Women had more MDs with Masters degrees, whereas men held more MDs only and more MDs with PhDs.

CONCLUSION

Despite positive trends, substantial gendered differences in oncology publications persist. Fostering more women in oncology research will benefit female representation at many levels of academia and improve productivity, collaboration, and recruitment, especially in technical fields such as radiation and surgical oncology.

A decade of decline: Grant funding for researchers with disabilities 2008 to 2018

Recent data highlights an imbalance in research grant success among groups underrepresented within the biomedical workforce, including racial/ethnic minorities and women. However, there is no data on grant success for researchers with disabilities.

For these analyses, aggregate data on self-reported disability status for National Institute on Health (NIH) research grant applicants and awardees was obtained from 2008 to 2018, including disability category: mobility/orthopedic, hearing, visual disabilities, and other disabilities. The percentage of applications and awards, as well as grant success rates (% of applicants receiving awards), by Principal Investigators (PIs) disability status were calculated. Data was desegregated, and logistic models determined trend of applicants reporting disability over time. The percentage of NIH grant applicants with PIs reporting a disability significantly declined from 1.9% in 2008, to 1.2% in 2018 (p<0.001). Data on grant awardees was similar, 1.9% of awards in 2008, declining to 1.2% in 2018 (p<0.001) had PIs reporting a disability. Across all years, the percentage of applications and awards with PIs reporting visual disabilities was lower than the percentage reporting mobility/orthopedic, or hearing disabilities (16.5%, 34.2%, and 37.8% in 2008, respectively). Overall grant success rates differed by disability status (27.2% for those reporting disability vs 29.7% in those reporting no disability, p<0.001). The lowest overall grant success rate was among PIs reporting unknown disability status or who withheld this status (18.6%). These results underscore the underrepresentation of researchers with disabilities among grant applicants and awardees, and indicate lower grant success rates among PIs reporting disabilities.

Turning Chutes into Ladders for Women Faculty: A Review and Roadmap for Equity in Academia

Despite significant progress in recent decades, the recruitment, advancement, and promotion of women in academia remain low. Women represent a large portion of the talent pool in academia, and receive >50% of all PhDs, but this has not yet translated into sustained representation in faculty and leadership positions. Research indicates that women encounter numerous "chutes" that remove them from academia or provide setbacks to promotion at all stages of their careers. These include the perception that women are less competent and their outputs of lesser quality, implicit bias in teaching evaluations and grant funding decisions, and lower citation rates. This review aims to (1) synthesize the "chutes" that impede the careers of women faculty, and (2) provide feasible recommendations, or "ladders" for addressing these issues at all career levels. Enacting policies that function as "ladders" rather than "chutes" for academic women is essential to even the playing field, achieve gender equity, and foster economic, societal, and cultural benefits of academia.

Is there a gender gap in chemical sciences scholarly communication?

Characterisation of gender differences throughout peer-review publication process as revealed by thorough analysis of Royal Society of Chemistry submissions, publications and citation data.

The Royal Society of Chemistry is committed to investigating and addressing the barriers and biases which face women in the chemical sciences. The cornerstone of this is a thorough analysis of data regarding submissions, review and citations for Royal Society of Chemistry journals from January 2014 until July 2018, since the number and impact of publications and citations are an important factor when seeking research funding and for the progression of academic career. We have applied standard statistical techniques to multiple data sources to perform this analysis, and have investigated whether interactions between variables are significant in affecting various outcomes (author gender; reviewer gender; reviewer recommendations and submission outcome) in addition to considering variables individually. By considering several different data sources, we found that a baseline of approximately a third of chemistry researchers are female overall, although this differs considerably with Chemistry sub-discipline. Rather than one dominant bias effect, we observe complex interactions and a gradual trickle-down decrease in this female percentage through the publishing process and each of these female percentages is less than the last: authors of submissions; authors of RSC submissions which are not rejected without peer review; authors of accepted RSC publications; authors of cited articles. The success rate for female authors to progress through each of these publishing stages is lower than that for male authors. There is a decreasing female percentage when progressing through from first authors to corresponding authors to reviewers, reflecting the decreasing female percentage with seniority in Chemistry research observed in the “Diversity landscape of the chemical sciences” report. Highlights and actions from this analysis form the basis of an accompanying report to be released from the Royal Society of Chemistry.

Inequity and Women Physicians: Time to Change Millennia of Societal Beliefs

Gender inequities date back thousands of years, with women expected to be caregivers at home and men expected to be leaders with occupations outside the home. In more recent history, women have trained in various professions, including medicine. Although the number of female physicians has risen consistently over the past several decades and half of US medical students now are women, gender inequities persist and are due, at least in part, to implicit (unconscious) biases held by doctors, other health care professionals, and patients and their families. Implicit biases negatively affect women in their medical careers and contribute to slower advancement, less favorable evaluations, underrepresentation in leadership positions, fewer invited lectures, lower salaries, impostor syndrome, and burnout. Despite efforts to address gender biases, studies in academic medical centers indicate no major change over a 20-year span. Management of implicit gender bias at the organizational level is imperative. Strategies include implicit bias training for doctors and other staff; development of a transparent and equitable compensation plan; and transparent processes for promotion and hiring, mentorship, and sponsorship of women physicians for grand rounds, lectureships, committees, leadership positions, and awards. Achievement of equity for women physicians requires effort and ultimately a culture change. Gender equity in the medical profession will lead to improved physician wellness, retention of women physicians, and improved access to and quality of health care.

Gender of presenters at orthopaedic meetings reflects gender diversity of society membership

Objective

To quantify the number of women presenters and their roles at national meetings across all orthopaedic sub-specialties.

Methods

A retrospective review of annual meeting programs for 2008 and 2017 from ten North American orthopaedic societies was conducted.

Results

A statistically significant increase was seen in the proportion of women presenting at society annual meetings between 2008 and 2017 (p < 0.0001). Women were more often authors presenting abstracts (p < 0.0001)) and less frequently faculty/instructors (p = 0.0051) and moderators/chairs (p = 0.0003) when compared to men.

Conclusion

Men continue to hold a higher proportion of more respected roles within orthopaedic academia.

Women in Pediatrics: Progress, Barriers, and Opportunities for Equity, Diversity, and Inclusion

Gender bias and discrimination have profound and far-reaching effects on the health care workforce, delivery of patient care, and advancement of science and are antithetical to the principles of professionalism. In the quest for gender equity, medicine, with its abundance of highly educated and qualified women, should be leading the way. The sheer number of women who comprise the majority of pediatricians in the United States suggests this specialty has a unique opportunity to stand out as progressively equitable. Indeed, there has been much progress to celebrate for women in medicine and pediatrics. However, many challenges remain, and there are areas in which progress is too slow, stalled, or even regressing. The fair treatment of women pediatricians will require enhanced and simultaneous commitment from leaders in 4 key gatekeeper groups: academic medical centers, hospitals, health care organizations, and practices; medical societies; journals; and funding agencies. In this report, we describe the 6-step equity, diversity, and inclusion cycle, which provides a strategic methodology to (1) examine equity, diversity, and inclusion data; (2) share results with stakeholders; (3) investigate causality; (4) implement strategic interventions; (5) track outcomes and adjust strategies; and (6) disseminate results. Next steps include the enforcement of a climate of transparency and accountability, with leaders prioritizing and financially supporting workforce gender equity. This scientific and data-driven approach will accelerate progress and help pave a pathway to better health care and science.

Dissecting disparity: improvements towards gender parity in leadership and on the podium within the Canadian Orthopaedic Association

Objectives

The purpose of this paper was to analyse the 15-year trend of women in leadership roles within the Canadian Orthopaedic Association (COA). This included not only leadership positions at the committee level in the association but also the more visible podium positions in the annual meeting programme: research podium and poster presentations, session moderators, panellists and faculty.

Methods

Data on the numbers of male and female members were gathered from COA membership records for the most recent 5 years (2014–2018), as well as for 10 years previous (2009) and 15 years previous (2004). Male and female representation on COA committees, as well as the number of presenters at the annual meeting was calculated. Descriptive data were generated to compare the changes in gender representation over time.

Results

In Canada, in 2018, 11.2% of orthopaedic surgeons were female. Within the COA, 17.6% of the members are female, with active female surgeons comprising 11.6% of the total membership. The largest increase in representation of women within the COA is in the trainee category which is 25.3% female. At the 2018 annual meeting, 25% of the attendees were women, with 22% of all podium appearances by women. Not including research presentations, women participated as faculty in 11% of the appearances at the 2018 annual meeting.

Conclusion

In conclusion, gender parity is not yet a reality in Canadian orthopaedics; however, the number of females in leadership roles and on the podium is consistent with the current gender diversity within the COA membership. Further efforts will be required to improve gender diversity as well as to encourage female medical students to consider orthopaedics as a specialty. The availability of female role models that are visible on the podium and in leadership positions may be one strategy to encourage the journey toward gender parity.

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.

Understanding and addressing gender equity for women in neurology

Despite the fact that the percentages of women among physicians and neurologists have been rising, gender-related disparities in numerous metrics persist, notably in compensation, promotion, funding, recognition, leadership, publishing, and speaking. Simultaneously, women working in academia, including medicine, face high rates of sexual harassment. Leaders of all health care-related organizations must accept the moral and ethical imperative to expeditiously address both gender-related discrimination and harassment (inclusive of but not limited to sexual harassment) of women in medicine. At this unique time in history, there is an opportunity for leaders in neurology to strategically accelerate efforts to address workforce gender disparities and ensure harassment-free training and work environments. Leaders will have to plan an intentional path forward, using a systematic process, metrics, and strategies unique to their own organizations, to overcome barriers to an equitable and safe work environment for women. Moreover, leaders in 4 gatekeeper organizations—medical schools/academic medical centers, funding agencies, journals, and medical societies—must hold each other accountable for gender equity as their own success and financial return on investment is dependent on the efforts of those in the other categories. In short, the path forward is to focus on ethical principles and behavior when it comes to addressing workforce gender disparities for women in medicine.

Sex differences in academic rank in allergy/immunology

BACKGROUND

Female physicians are significantly less likely than male physicians to be full professors, even after accounting for age, experience, specialty, and measures of research and clinical productivity.

OBJECTIVE

We sought to evaluate sex differences in academic rank in the allergy and immunology workforce.

METHODS

We used a cross-sectional physician data set containing the allergist's sex, age, years since residency, faculty appointment, authored publications, National Institutes of Health (NIH) funding, clinical trial investigation, and Medicare reimbursement to investigate sex differences in the academic allergy and immunology workforce using multilevel logistic regression models.

RESULTS

Among 507 academic allergists (9.3% of practicing US allergists in 2014), 323 (63.7%) were men, and 184 (36.3%) were women. Female allergists were younger (47.9 vs 56.9 years, P < .001), had fewer total (12.5 vs 28.7, P < .001) and first/last author (8.0 vs 21.5, P < .001) average publications, were less likely to have NIH funding (13.0% vs 23.5%, P = .004), were less frequently a clinical trial investigator (10.3% vs 16.1%, P = .07), and generated less average annual Medicare revenue ($44,000 vs $23,000, P = .10). Of 152 (30.0%) full professors, 126 (82.9%) were male, and 26 (17.0%) were female. After multivariable adjustment, rates of full professorship among female and male allergists were not significantly different (absolute adjusted difference for female vs male allergists, 6.0%; 95% CI, -8.3% to 20.2%).

CONCLUSIONS

Among allergists with US medical school faculty appointments, men and women were similarly likely to be full professors after accounting for factors influencing promotion. Underlying differences in research productivity and NIH funding not explained by age differences alone warrant additional investigation.