Gender Bias in Diagnostic Radiology Resident Selection, Does it Exist?

Women in leadership matters: Achieving diversity in radiology residency recruitment

RATIONALE AND OBJECTIVES

To assess whether academic radiology departments and residency programs with efforts toward supporting and augmenting Diversity, Equity, and Inclusion (DEI) are associated with a higher proportion of residents from diverse backgrounds.

MATERIALS AND METHODS

Program Directors within the Radiology Residency Education Research Alliance were surveyed to gather information about program characteristics, incorporation of diversity in resident recruitment, the sponsoring department's commitment to efforts at expanding diversity, and a summary of their current and past residents, staff and faculty members (academic years 2020 and 2023) with respect to a list of diversity characteristics.

RESULTS

Survey response rate was 51 %. Sixty-three percent (15/24) of participating programs have departmental committees dedicated to DEI work; 46 % (11/24) of programs' departments have a Vice Chair for DEI. Sixty percent (15/24) of programs use their social media accounts to advertise their DEI programming efforts. Ninety-six percent (23/24) of programs participating in the survey use diversity factors to select candidates for their program. Women Leadership was associated with above-median diversity of residents and faculty.

CONCLUSION

This study of radiology residency programs encourages a more prominent role for women in leadership positions within academic radiology departments to drive diversity and inclusion efforts.

Dear Program Director: An Evaluation of Implicit Bias in Letters of Recommendation for Neurosurgery Residency

BACKGROUND AND OBJECTIVES

Despite comprising half of medical students, women represent only 29.6% of neurosurgery applicants and 17% of residents, suggesting a "leak" in the career pipeline for women neurosurgeons. Surveys persistently show that neurosurgery programs identify United States Medical Licensing Examination (USMLE®) Step 1 score and letters of recommendation (LORs) as the most important factors in selecting applicants to interview. A previous study in neurosurgery found no differences in LORs. However, multiple studies in other specialties have demonstrated implicit gender bias in LORs, which may influence resident selection. Our objective is to evaluate neurosurgery residency LORs for evidence of implicit gender bias.

METHODS

Retrospective analysis of LORs for interviewed neurosurgery applicants at a single institution during the 2014 to 2020 National Residency Matching Program (NRMP®) match cycles. Letters were evaluated using Linguistic Inquiry & Word Count (LIWC) software (Pennebaker Conglomerates), and additional applicant data were obtained from candidate applications. LIWC (Pennebaker Conglomerates) output data included custom dictionary categories and terms that were analyzed using Prism 10 and Rstudio.

RESULTS

Two hundred eighteen applications were reviewed for a total of 827 letters. LIWC (Pennebaker Conglomerates) analysis showed significant differences in word count (331 vs 297, difference = 34, 95% CI: 9-61, P = .008). LORs for applicants who were men were more likely to mention Alpha Omega Alpha Honor Medical Society (1.17 vs 0.778, difference = 0.4, 95% CI: 0.13-0.67, P = .023). USMLE® Step 1 scores were significantly lower for women (241 vs 247, difference = 6, 95% CI: 2-10, P = .004). There was no significant difference between letters for men and women for all categories evaluated in the linguistic evaluation.

CONCLUSION

LORs are vital to the neurosurgical residency application process. The data exhibit some differences between the men and women applicants but few differences in their LORs, consistent with the results of the previous neurosurgical study.

A trend, analysis, and solution on women's representation in diagnostic radiology in North America: a narrative review

Despite the demonstrated benefits of gender diversity in medicine, women in Radiology in North America are still underrepresented. We reviewed the literature to highlight the current status of women in Radiology in North America, identify the underlying causes of the gender gap, and provide potential strategies to close this gap. We conducted a narrative literature review using the terms ("Gender Disparity" OR "Gender Inequality") AND ("Radiology Department" OR "Radiology Residency"), searching data from April 2000 to April 2022 in Ovid Medline, Embase, PubMed, and Scopus. Our results indicate that Radiology in North America lacks gender diversity in its subspecialties, academic leadership, and research productivity, which the COVID-19 pandemic has further exacerbated. Challenges stemming from a dearth of women role models, limited preclinical contact, and a high rate of burnout contribute to the current gender inequality. Several complementary and supplementary steps can enhance gender diversity in Radiology. These include increasing education and exposure to Radiology at earlier stages and optimizing mentorship opportunities to attract a more diverse pool of talent to the discipline. In addition, supporting resident parents and enhancing the residency program's culture can decrease the rate of burnout and encourage women to pursue careers and leadership positions in Radiology.

Trends in gender, race, and ethnic diversity among prospective physical medicine and rehabilitation physicians

BACKGROUND

As the proportion of women and individuals who are underrepresented in medicine slowly rises, disparities persist in numerous arenas and specialties. In physical medicine and rehabilitation (PM&R), there is a continued need to focus on diversity among trainees. This study aims to evaluate diversity among PM&R applicants and residents over the past 6 years.

OBJECTIVE

To describe the demographic trends in PM&R over the last 6 years and compare those findings with trends in other specialties.

DESIGN

Surveillance.

SETTING

Analyses of national databases from self-reported questionnaires.

PARTICIPANTS

The study consists of 126,833 medical school matriculants, 374,185 resident applicants, and 326,134 resident trainees over the last 6 years.

MAIN OUTCOME MEASURES

Self-reported demographic data from the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education were analyzed for medical school matriculants, PM&R applicants, and current residents for the cycles of 2014-2015 to 2019-2020. The data were then comparatively reviewed between PM&R and other medical specialties.

RESULTS

In the 6 cycles evaluated, women accounted for 36%-39% of PM&R residents, but 47%-48% in non-PM&R specialties. Women applicants to the PM&R specialty averaged 34.4% over the 6 years analyzed, which was the fourth lowest of the 11 specialties examined. Black or African American and Hispanic, Latino, or of Spanish Origin populations each accounted for only 6% of PM&R residents. PM&R demonstrated a noticeably higher proportion of White (62.1% vs. 60.3%) and an observably lower proportion of Black or African American (6.0% vs. 7.1%) and Hispanic, Latino, or of Spanish Origin (6.3% vs. 7.9%) residents compared with non-PM&R specialties.

CONCLUSION

There is underrepresentation of women and multiple racial and ethnic minority groups in the field of PM&R from applicants to trainees demonstrating a need to improve recruitment efforts.

USMLE Step 2 CK Scores and Radiology Residency Applications: Does it Affect Diversity in Selection of Trainees?

RATIONALE AND OBJECTIVES

As residency programs in diagnostic radiology aspire to broaden trainee diversity, reliance on certain criteria may affect the selection of candidates from underrepresented groups. With the conversion of reporting of the United States Medical Licensing Examination (USMLE) Step 1 scores to pass/fail, programs may rely more on numerical USMLE Step 2 Clinical Knowledge (CK) scores. The purpose of our investigation is to assess the effects of Step 2 CK scores on the selection of underrepresented minority (URM) and female candidates.

MATERIALS AND METHODS

Applications from United States senior allopathic medical students to a radiology residency program from the 2021-2023 National Residency Matching Program cycles were analyzed. Subjects were classified as male or female and URM or non-URM by self-identification. Step 2 CK scores were compared and the use of cutoff scores was examined for disparate effects.

RESULTS

1017 subjects fulfilled the entry criteria. There were 721 males and 296 females, with 164 URM and 853 non-URM candidates. Comparing males to females, there was no significant difference in the mean score (p = 0.21) and no disparate effects of cutoff scores. There was a significant difference between the mean score of URM versus non-URM candidates of eight points (p < 0.00011). The use of cutoffs showed a disparate effect on URM candidates with a cutoff score of 250 (average score for 2022 matched applicants) excluding 71% of URM candidates while excluding only 46% of non-URM candidates.

CONCLUSION

Reliance on USMLE Step 2 CK scores to screen applications for radiology residency can disadvantage URM candidates. Females are not adversely affected.

Views of Diagnostic Radiology Residency Program Directors Regarding Methods to Increase Female and Under-Represented in Medicine Residents: A Cross-sectional Study

RATIONALE AND OBJECTIVES

Diagnostic radiology remains one of the least diverse medical specialties. Recent reports have found that the number of female and under-represented in medicine (URiM) residents have not increased despite efforts to increase representation over the last decade. Given the critical role of residency program directors in selecting diverse applicants, this study was performed to identify which strategies were most preferred to increase the number of female and/or URiM residents by directors of diagnostic radiology residency training programs.

MATERIALS AND METHODS

This was an anonymous, cross-sectional study of diagnostic radiology residency program directors that included a survey about program characteristics, demographics, and strategies to increase the number of female and/or URiM residents.

RESULTS

The questionnaire was submitted to 181 potential participants with a 19.9% response rate. The most preferred strategies to increase diversity involved directly recruiting medical students, promoting mentorship, increasing the number of diverse teaching faculty, and unconscious bias training. The least supported strategies included deemphasizing exam scores, accepting more international graduates, accepting a minimum number of female and/or URiM applicants, and de-identifying applications. Female and/or URiM program directors indicated a statistically significant preference for medical student recruitment and providing an opportunity to discuss workplace issues for female and/or URiM trainees (p < 0.05).

CONCLUSION

Diagnostic radiology residency program directors endorsed a wide variety of strategies to increase diversity. Recruitment of female and/or URiM medical students and promoting the number of diverse faculty members and mentorship of trainees by these faculty appear to be the most preferred strategies to increase female and/or URiM residents. Female and/or URiM program directors placed a greater importance on recruiting diverse applicants and supporting safe discussion of workplace issues faced by female and/or URiM radiology residents.

Effect of teleconferencing variables on faculty impression of mock residency applicants

Purpose

The objective of this study was to assess how teleconferencing variables influence faculty impressions of mock residency applicants.

Methods

In October 2020, we conducted an online experiment studying five teleconferencing variables: background, lighting, eye contact, internet connectivity, and audio quality. We created interview videos of three mock residency applicants and systematically modified variables in control and intervention conditions. Faculty viewed the videos and rated their immediate impression on a 1-10 scale. The effect of each variable was measured as the mean difference between the intervention and control impression ratings. One-way analysis of variance (ANOVA) was performed to assess whether ratings varied across applicants. Paired-samples Wilcoxon signed-rank tests were conducted to assess the significance of the effect of each variable.

Results

Of 711 faculty members who were emailed a link to the experiment, 97 participated (13.6%). The mean ratings for control videos were 8.1, 7.2, and 7.6 (P < .01). Videos with backlighting, off-center eye contact, choppy internet connectivity, or muffled audio quality had lower ratings when compared with control videos (P < .01). There was no rating difference between home and conference room backgrounds (P = .77). Many faculty participants reported that their immediate impressions were very much or extremely influenced by audio quality (60%), eye contact (57%), and internet connectivity (49%).

Conclusions

Teleconferencing variables may serve as a source of assessment bias during residency interviews. Mock residency applicants received significantly lower ratings when they had off-center eye contact, muffled audio, or choppy internet connectivity, compared to optimal teleconferencing conditions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44186-022-00053-w.

Can the use of deception be justified in medical education research? A point/counterpoint and case study

Deception is a common feature of behavioral research design, although not commonly employed in the medical literature. It can promote scientific validity but is ethically controversial because it compromises subject autonomy and incurs additional costs.  In this Point/Counterpoint monograph, we review the nature of deception in research and present arguments for and against its ethical use as a research methodology in behavioral studies.  We describe the necessary guidelines, safeguards, and oversight, when deceptive methodology is considered, and report our experiences and lessons learned from conducting a multi-institutional audit study that relied upon deception of academic radiology faculty.

Female Representation on Radiology Journal Editorial Boards Around the World: Geographical Differences and Temporal Trends

RATIONALE AND OBJECTIVES

We examined the status of women's representation on radiology journal editorial boards around the world and evaluated temporal trends in female board representation.

MATERIALS AND METHODS

Data on the gender of editorial board members, deputy editors, and editors-in-chief of top general radiology journals from the United States and from five continents outside North America was collected, based on listings in mastheads of each journal at 5-year intervals from 1998 to 2018. Female editorial board representation was compared to female membership in national professional radiology organizations and national physician registries.

RESULTS

One of 42 editors-in-chief (2.4%), 24 of 135 deputy editors (17.8%), and 345 of 2545 (13.6%) editorial board members were female for the 20-year period. The overall percentage of female editorial board members increased from 9.7% (41 of 423) in 1998 to 17.0% (97 of 569) in 2018 (p < 0.0001). In 2018, women were less represented on the editorial boards than female professional society membership for all geographic regions except Australia/New Zealand; this difference reached statistical significance in Korea, Brazil, Europe, and China. Female editorial board representation ranged from 11.3% to 33.3%, with no significant difference between the United States (21.5%) and other countries.

CONCLUSION

Although the proportion of female editorial board members of radiology journals worldwide has increased over the past two decades, female editorial board composition generally underrepresents the percentage of female radiologists. Editorial board female representation does not differ significantly between the United States and other countries.

Equal pay for equal work in radiology: Expired excuses and solutions for change

The gender pay gap is not a problem of the past. Women continue to receive less pay for equal work and radiology is one of four medical specialties with the largest gender pay gap. Numerous social factors contribute to the gender pay gap; however, radiology can close the gender pay gap through intentional strategies, including acknowledging the gender pay gap, eliminating bias and minority taxes through progressive compensation and parental leave models, devaluing overwork, developing longitudinal mentorship and sponsorship, and demanding transparent institutional policies. Patient care and overall organizational success will improve when the barriers resulting in the gender pay gap are eliminated.

Does Objective Scoring of Applications for Radiology Residency Affect Diversity?

RATIONALE AND OBJECTIVES

It is important to recognize if reliance on certain factors in applications affects selection of trainees from under-represented groups. Our purpose is to determine if objective scoring of radiology residency applications based on quantifiable data regarding academic performance, United States Medical Licensing Examination (USMLE) scores and research productivity affects selection of female and under-represented minority (URM) candidates.

MATERIALS AND METHODS

We reviewed 502 applications from three successive match cycles from United States allopathic medical students. Each application was scored for academic performance, USMLE results and research productivity determining an overall score. The scores of males were compared to females and URM were compared to non-URM candidates. USMLE cutoff scores were evaluated for disparate effects.

RESULTS

There were 348 male, 154 female, 73 URM and 429 non-URM candidates. For male versus female applicants, there was no significant difference in mean academic performance, USMLE Step 2 Clinical Knowledge and research productivity scores. Males had higher mean USMLE Step 1 (p = 0.005) and overall candidate scores (p = 0.02). Between URM and non-URM candidates there was no significant difference in academic performance. Non-URM applicants had higher mean USMLE Step 1 (p = 0.008), USMLE Step 2 (p = 0.002), research productivity (p = 0.001) and overall scores (p = 0.02). Use of USMLE cutoff scores demonstrated disparate effects on female and URM candidates.

CONCLUSION

Objective scoring of applications and use of USMLE cutoff scores can disadvantage candidates from underrepresented groups. Screening filters can affect the diversity of candidate pools for radiology residency.

Otolaryngology residency selection: are we doing it right?

PURPOSE OF REVIEW

This article will provide an overview of recent disruptions to the otolaryngology residency match process and conclude with questions and resources that can guide future selection system design.

RECENT FINDINGS

During the implementation of the single accreditation system, the loss of osteopathic programs, reduction of osteopathic leadership positions, and lack of interest in Osteopathic Recognition represent serious threats to the profession; this has implications for the distribution of the otolaryngology workforce, plausibly decreasing healthcare access in less-populated communities. Next, the impacts of COVID-19 reverberated throughout the application process, including the reduction/elimination of away rotations, modification of application requirements, conversion to virtual interviews, and initiation of preference signaling. Soon, the transition to pass/fail scoring for the United States Medical Licensing Exam Step 1 could stimulate a paradigm shift, with a heightened emphasis on holistic review.

SUMMARY

The last two match cycles have been the most dynamic and unpredictable in decades. Out of the commotion, the otolaryngology community has an opportunity for a fresh start, combining insights from past literature with recent articles compiled for this review. Moving forward, it will be advantageous to approach residency selection as a well-executed quality improvement project, requiring continuous assessment and adjustment.

The Relationship Between Applicant Gender and Internal Medicine Residency Interview Scores

BACKGROUND

Gender inequity is widespread in academic medicine, including in the promotion, academic recognition, and compensation of female faculty.

OBJECTIVE

To assess whether these inequities extend to the GME intern selection process, this study examines differences in the interview scores assigned to male and female applicants at one large internal medicine residency program.

METHODS

Subjects include 1399 applicants who completed 3099 interviews for internship positions for the Brigham and Women's Hospital internal medicine residency in Electronic Residency Application Service (ERAS) cycles 2015-2016, 2017-2018, 2018-2019, and 2019-2020. Unadjusted and multivariable linear regressions were used to assess the simultaneous effect of applicant gender, interviewer gender, and applicant academic characteristics on pre-interview, post-interview, and change in interview scores.

RESULTS

Our analysis included 3027 interviews (97.7%) of 1359 applicants (97.1%). There were no statistically significant differences in the interview scores assigned to female versus male applicants. This was true across pre-interview scores (difference = 0.03, P = .61), post-interview scores (difference = 0.00, P = .98), and change in interview scores (difference = 0.01, P = .24) as well as when adjusting for the baseline academic characteristics of both male and female applicants. This was also true when analyzing individual application years, individual residency tracks, and accounting for the gender of the faculty interviewers.

CONCLUSIONS

The findings do not support the presence of gender inequity in the interview scores assigned to male and female applicants included in this study.

Evidence of Specialty-Specific Gender Disparities in Resident Recruitment and Selection

BACKGROUND

Specialty-specific gender disparities are multifactorial, yet one area that is lacking from this discussion is the impact of recruitment and selection.

OBJECTIVE

Customized data reports were utilized to compare trends in the gender representation of applicants and residents within 11 surgical and medical specialties between 2013 and 2018.

METHODS

Applicant data was obtained from the Electronic Residency Application Service (ERAS) and resident data from the Accreditation Council for Graduate Medical Education (ACGME). Eleven specialties with the highest number of applications per applicant were included (dermatology, emergency medicine, general surgery, neurological surgery, obstetrics and gynecology [OB/GYN], orthopedic surgery, otolaryngology, plastic surgery, radiation oncology, radiology, urology). A Cochran-Armitage trend test assessed for changes in the proportion of females within the total applicant group and the corresponding matched resident group. A t test was utilized to compare the mean proportion of females for ERAS and ACGME data.

RESULTS

Otolaryngology, plastic surgery, radiation oncology, and urology had no significant changes over the study period. Dermatology, general surgery, and orthopedic surgery demonstrated increased gender diversity in applicants over time, while OB/GYN demonstrated decreased gender diversity. General surgery and neurological surgery showed increased gender diversity in resident representation over time. Emergency medicine and radiology had increased gender diversity, and OB/GYN had decreased gender diversity in matched residents compared to applicants.

CONCLUSIONS

Our findings provide baseline data, but also illustrate evident gaps in our understanding and attempts to improve gender diversity. A multifaceted approach to obtaining and assessing data from all stages of residency recruitment and selection is necessary to support these efforts.

National Survey to Assess Gender, Racial, and Ethnic Differences Among Radiology Residency Applicants Regarding Factors Impacting Program Selection

RATIONAL AND OBJECTIVES

Radiology has one of the lowest female representation rates in medicine and recruiting female residents is a challenge for some residency programs. There is limited understanding of gender differences among residency applicants during program selection. The study objective is to investigate which program factors were considered most important by radiology residency applicants and to assess for differences by gender, race and ethnicity.

MATERIALS AND METHODS

An anonymous survey was distributed electronically to diagnostic and interventional radiology residency programs in the US and Canada via the Association of Program Coordinators in Radiology (APCR). Residents were asked to evaluate the importance of 30 factors during evaluation of residency programs using a 5-point Likert scale (1 = not important, 5 = extremely important).

RESULTS

370 residents and 1 fellow completed the survey. Of the respondents, 269 were male (72.5%) and 101 were female (27.2%). The most important factors to respondents during program selection were program culture (4.42), geographic location (4.17), fellowship placement (4.14), and imaging and/or procedure volume (3.98). There was a significant difference between male and female respondents in the importance of program culture (p = 0.002), composition of current residents (p = 0.007), percentage of current female residents (p < 0.0001), program size (p = 0.047), call schedule (p = 0.025), percentage of female faculty (p < 0.0001), faculty ethnic and racial diversity (p < 0.0001), resident ethnic and racial diversity (p < 0.0001), which female respondents ranked more highly.

CONCLUSION

Applicants consider many factors during residency program selection. Program culture, geographic location, fellowship placement and imaging and/or procedural volume were most important. There were significant differences by gender, race and ethnicity in importance of several factors.

Systematic review of specialist selection methods with implications for diversity in the medical workforce

PURPOSE

There is growing concern that inequities in methods of selection into medical specialties reduce specialist cohort diversity, particularly where measures designed for another purpose are adapted for specialist selection, prioritising reliability over validity. This review examined how empirical measures affect the diversity of specialist selection. The goals were to summarise the groups for which evidence is available, evaluate evidence that measures prioritising reliability over validity contribute to under-representation, and identify novel measures or processes that address under-representation, in order to make recommendations on selection into medical specialties and research required to support diversity.

METHOD

In 2020-1, the authors implemented a comprehensive search strategy across 4 electronic databases (Medline, PsychINFO, Scopus, ERIC) covering years 2000-2020, supplemented with hand-search of key journals and reference lists from identified studies. Articles were screened using explicit inclusion and exclusion criteria designed to focus on empirical measures used in medical specialty selection decisions.

RESULTS

Thirty-five articles were included from 1344 retrieved from databases and hand-searches. In order of prevalence these papers addressed the under-representation of women (21/35), international medical graduates (10/35), and race/ethnicity (9/35). Apart from well-powered studies of selection into general practice training in the UK, the literature was exploratory, retrospective, and relied upon convenience samples with limited follow-up. There was preliminary evidence that bias in the measures used for selection into training might contribute to under-representation of some groups.

CONCLUSIONS

The review did not find convincing evidence that measures prioritising reliability drive under-representation of some groups in medical specialties, although this may be due to limited power analyses. In addition, the review did not identify novel specialist selection methods likely to improve diversity. Nevertheless, significant and divergent efforts are being made to promote the evolution of selection processes that draw on all the diverse qualities required for specialist practice serving diverse populations. More rigorous prospective research across different national frameworks will be needed to clarify whether eliminating or reducing the weighting of reliable pre-selection academic results in selection decisions will increase or decrease diversity, and whether drawing on a broader range of assessments can achieve both reliable and socially desirable outcomes.

Radiology resident selection factors predict resident performance

PURPOSE

To determine selection factors that predict radiology resident performance.

METHODS

59 consecutive radiology residents from 2002 to 2015 were ranked on performance during residency. Correlations and multiple regression analyses were performed to predict resident performance from the following selection factors: United States Medical Licensing Exam (USMLE) Step 1 score, medical school rank, Alpha Omega Alpha (AOA) membership, honors in clinical rotations, Medical Student Performance Evaluation (MSPE), and interview score. Results were compared against predictions from Match rank position.

RESULTS

Five selection factors showed significant or marginally significant correlations with resident performance (r = 0.2 to 0.3). The interview score was not significantly correlated. A multiple regression model comprised of the USMLE Step 1 score, medical school rank, AOA membership, and interview score predicted resident performance, with an adjusted R² of 0.19. The interview score was included in the model but did not achieve statistical significance. Match rank did not predict resident performance, with an R² of 0.01.

CONCLUSIONS

A multiple regression model comprised of the USMLE Step 1 score, medical school rank, and AOA membership predicted radiology resident performance and may assist with resident selection.

Analysis of Gender Disparity in US and Canadian Radiology Residency Programs

BACKGROUND

Equity, diversity, and inclusion in academic radiology are a work in progress and although the gender gap has decreased, there remains a paucity of studies examining female representation among radiology trainees over the past decade.

OBJECTIVE

The aim of our undertaking was to evaluate gender parity in United States (US) and Canadian radiology residency programs and to suggest future directions to improve female representation MATERIALS AND METHODS: Retrospective analysis of publicly available data on radiology residents from the US and Canada was performed from 2007to 2019. Data on diagnostic radiology residents was collected from the Accreditation Council for Graduate Medical Education for the US and the Canadian Post M.D. Education Registry for Canada. Statistical tests including regression and ANOVA were used to study the gender proportions from 2007to 2019.

RESULTS

There has been little progress in bridging the gender gap in the last 12 years. The proportion of female residents pursuing radiology has remained at an average of 26.74% (n = 1,238of 4,629) in US programs and 31.78% (n = 28 of88) in Canadian programs. The average change in the percentage of female residents was 0.0% per year (P = 0.0) for US programs and -2.9% per year (P = 0.3) for Canadian programs.

DISCUSSION

Despite a higher proportion of females in North American medical schools, gender disparity persists among radiology residents. More research is needed to identify barriers limiting female representation and improve gender parity across North American radiology programs.

Is Empowerment of Female Radiologists Still Needed? Findings of a Systematic Review

Considering that radiology is still a male-dominated specialty in which men make up more than two thirds of the workforce, this systematic review aimed to provide a comprehensive overview of the current role of women in radiological imaging, focusing on the main aspects such as career progression, leadership, academic practice, and perceived discrimination. Three electronic databases were searched up to 21 October 2020. To identify additional records, weekly automatic email alerts were set up on PubMed until December 2020 and reference lists of key studies and included papers were screened. Two reviewers independently performed the search, study selection, quality appraisal, data extraction, and formal narrative synthesis. In case of disagreement, a third reviewer was involved. Across the 61 included articles, women worked more often part-time and held fewer positions of power in hospitals, on editorial boards, and at the academic level (associate and full professors). Women were less often in relevant positions in scientific articles, had fewer publications, and had a lower H-index. Discrimination and sexual harassment were experienced by up to 40% and 47% of female radiologists, respectively. Our study highlights that women in radiology are still underrepresented and play a marginal role in the field, struggling to reach top and leading positions.

The Influence of Applicant and Reviewer Gender on Resident Selection for Internal Medicine

BACKGROUND

While gender bias in medicine, including physician training, has been well described, less is known about gender bias in the selection process for post graduate residency training programs. This analysis reviews the potential role of gender on resident selection for an internal medicine residency program.

METHODS

File review and interview overall and component scores were analyzed based on the gender of the applicant. File review scores were further analyzed based on the reviewer's gender.

RESULTS

Women applicants scored higher than men applicants on their file review. There were no differences in any one component score except for leadership in art. Women file reviewers scored applicants higher than men file reviewers, but there was no difference between gender scores. There was no difference in overall or component interview scores between men or women applicants. Scoring did not impact the expected rank performance of applicants based on gender at any stage of the selection process.

CONCLUSIONS

While higher scores were observed in women applicants upon their file review, and women reviewers provided higher file review scores, this did not appear to impact the expected number of women and men applicants at each stage of the applicant process. This suggests a potential lack of gender bias at these stages of applicant selection.

Applicant gender and matching to first-choice discipline: a cross-sectional analysis of data from the Canadian Resident Matching Service (2013-2019)

BACKGROUND

Previous studies examining potential sex and gender bias in the Canadian Resident Matching Service (CaRMS) match have had conflicting results. We examined the results of the CaRMS match over the period 2013-2019 to determine the potential association between applicants' gender and the outcome of matching to their first-choice discipline.

METHODS

In this cross-sectional analysis, we determined the risk of matching to one's first-choice discipline in CaRMS by applicant gender and year, for all Canadian medical students who participated in the first iteration of the R-1 match for the years 2013 to 2019. We analyzed data in 3 categories of disciplines according to CaRMS classifications: family medicine, nonsurgical disciplines and surgical disciplines. We excluded disciplines with fewer than 10 applicants.

RESULTS

Match results were available for 20 033 participants, of whom 11 078 (55.3%) were female. Overall, female applicants were significantly more likely to match to their first-choice discipline (relative risk [RR] 1.03, 95% confidence interval [CI] 1.02-1.04). After adjustment for match year and stratification by discipline categories, we found that female applicants were more likely to match to family medicine as their first choice (RR 1.04, 95% CI 1.03-1.05) and less likely to match to a first-choice surgical discipline (RR 0.95, 95% CI 0.91-1.00) than their male peers. There was no significant difference between the genders in matching to one's first-choice nonsurgical discipline (RR 1.01, 95% CI 0.99-1.03).

INTERPRETATION

These results suggest an association between an applicant's gender and the probability of matching to one's first-choice discipline. The possibility of gender bias in the application process for residency programs should be further evaluated and monitored.

Effect of sex on specialty training application outcomes: a longitudinal administrative data study of UK medical graduates

OBJECTIVES

To examine sex differences in the specialty training recruitment outcomes of UK medical graduates; and whether sex differences were explained by prior academic attainment and previous fitness to practise (FtP) declarations.

DESIGN

Retrospective longitudinal cohort study.

SETTING

Administrative data on entrants to all UK medical schools from the UK Medical Education Database.

PARTICIPANTS

10 559 doctors (6 155; 58% female) who entered a UK medical school in 2007 or 2008 and were eligible to apply for specialty training by 2015.

PRIMARY OUTCOME MEASURE

Odds of application, offer and acceptance to any specialty training programme, and on to each of the nine largest training programmes, adjusting for sex, other demographics, prior academic attainment, FtP declaration and medical school.

RESULTS

Across all specialties, there were no sex differences in applications for specialty training, but women had increased odds of getting an offer (OR=1.40; 95% CI=1.25 to 1.57; p<0.001) and accepting one (OR=1.43; 95% CI=1.19 to 1.71; p<0.001). Seven of the nine largest specialties showed significant sex differences in applications, which remained after adjusting for other factors. In the adjusted models, Paediatrics (OR=1.57; 95% CI=1.01 to 2.46; p=0.046) and general practice (GP) (OR=1.23; 95% CI=1.03 to 1.46; p=0.017) were the only specialties to show sex differences in offers, both favouring women. GP alone showed sex differences in acceptances, with women being more likely to accept (OR=1.34; 95% CI=1.03 to 1.76; p=0.03). Doctors with an FtP declaration were slightly less likely to apply to specialty training overall (OR=0.84; 95% CI=0.71 to 1.00; p=0.048) and less likely to accept an offer to any programme (OR=0.71; 95% CI=0.52 to 0.98; p=0.036), after adjusting for confounders.

CONCLUSIONS

Sex segregation between medical specialties is due to differential application, although research is needed to understand why men are less likely to be offered a place on to GP and Paediatrics training, and if offered GP are less likely to accept.

Authorship and Impact of Gender-Specific Research in Major Radiology Journals

PURPOSE

The purpose of this study is to quantify the relationship between author gender and publication topic, as well as the impact of gender-related research.

METHODS

We reviewed all original research publications in Radiology, American Journal of Roentgenology, and Academic Radiology from 2011 through 2015. For each article, we recorded the gender of all authors and the last author H-index, years in practice, and academic rank. The total citations and citation rate (citations per year) were calculated for each article. Articles were categorized as gender-neutral, women's health, or men's health.

RESULTS

There were 1,934 publications involving 11,657 authors. Women represented 30% of first, 25% of last, and 28% of all authors. There were 1,596 (83%) gender-neutral, 276 (14%) women's health, and 61 (3%) men's health articles. Women's health articles were associated with a female first (odds ratio [OR] = 5.0, P < .001) and last author (OR = 6.4, P < .001), as well as more female authors (male = 1.4, female = 3.6, P < .001). Men's health articles were associated with a male first (OR = 2.6, P = .004) and last author (OR = 2.2, P = .03). There were significantly more citations for men's (43.5 ± 54.9, P < .001) and women's health (27.6 ± 37.5, P < .008) articles than gender-neutral articles (21.9 ± 28.9). Similarly, the article citation rate was higher for men's (10.6 ± 11.3, P < .001) and women's health (6.8 ± 8.5, P = .004) articles than gender-neutral publications (5.3 ± 7.0).

CONCLUSION

Radiology researchers publish more often on topics related to their own gender. Furthermore, men's and women's health research generates more citations than gender-neutral research.

Collaboration Metrics Among Female and Male Researchers: A 5-Year Review of Publications in Major Radiology Journals

RATIONALE AND OBJECTIVES

Women are under-represented in radiology, but the implications of this under-representation are poorly understood. Therefore, the purpose of this study was to determine if articles published by women in major radiology journals were more collaborative.

MATERIALS AND METHODS

Following an institutional review board exemption, we reviewed all original research articles in Radiology, in the American Journal of Roentgenology, and in Academic Radiology from 2011 to 2015. For each article, the gender of the first and the last authors and proxy measures of collaboration were recorded, including the total number of authors, female authors, departments, and institutions. Nominal logistic regression analysis was used to test for associations while controlling for confounders.

RESULTS

There were 1934 articles analyzed. Female first and last authors represented 30.2% (585 of 1934) and 24.4% (473 of 1934) of the articles, respectively. A female first author was associated with more female last authors (36% vs 20%, P < .001), total female authors (2.9 vs 1.2, P < .001), and departments (3.3 vs 3.0, P < .001). Similarly, a female last author was associated with more female first authors (44% vs 26%, P = .001), total female authors (3.1 vs 1.2, P < .001), departments (3.5 vs 3.0 P < .001), and institutions (2.3 vs 1.9, P = .006). Each additional female author increased the mean number of institutions by 0.33 and departments by 0.46 on linear regression. First- or last-author gender was not associated with total authors (P = .17).

CONCLUSIONS

Original research articles published with a female first or last author were associated with more departments and institutions, but not with the total number of authors, suggesting that women engage in some metrics of more collaborative research.

Analysis of the 1990-2007 neurosurgery residency match: does applicant gender affect neurosurgery match outcome?

OBJECTIVE With nearly half of graduating US medical students being female, it is imperative to understand why females typically make up less than 20% of the neurosurgery applicant pool, a number that has changed very slowly over the past several decades. Organized neurosurgery has strongly indicated the desire to overcome the underrepresentation of women, and it is critical to explore whether females are at a disadvantage during the residency application process, one of the first steps in a neurosurgical career. To date, there are no published studies on specific applicant characteristics, including gender, that are associated with match outcome among neurosurgery resident applicants. The purpose of this study is to determine which characteristics of neurosurgery residency applicants, including gender, are associated with a successful match outcome. METHODS De-identified neurosurgical resident applicant data obtained from the San Francisco Fellowship and Residency Matching Service for the years 1990-2007 were analyzed. Applicant characteristics including gender, medical school attended, year of application, United States Medical Licensing Exam (USMLE) Step 1 score, Alpha Omega Alpha (AOA) status, and match outcome were available for study. RESULTS Of the total 3426 applicants studied, 473 (13.8%) applicants were female and 2953 (86.2%) were male. Two thousand four hundred forty-eight (71.5%) applicants successfully matched. USMLE Step 1 score was the strongest predictor of match outcome with scores > 245 having an OR of 20.84 (95% CI 10.31-42.12) compared with those scoring < 215. The mean USMLE Step 1 score for applicants who successfully matched was 233.2 and was 210.8 for those applicants who did not match (p < 0.001). Medical school rank was also associated with match outcome (p < 0.001). AOA status was not significantly associated with match outcome. Female gender was associated with significantly lower odds of matching in both simple (OR 0.59, 95% CI 0.48-0.72) and multivariate analyses (OR 0.57, 95% CI 0.34-0.94 CI). USMLE Step 1 scores were significantly lower for females compared to males with a mean score of 230.1 for males and 221.5 for females (p < 0.001). There was no significant difference in medical school ranking or AOA status when stratified by applicant gender. CONCLUSIONS The limited historical applicant data from 1990-2007 suggests that USMLE Step 1 score is the best predictor of match outcome, although applicant gender may also play a role.

Diversity Matters in Academic Radiology: Acknowledging and Addressing Unconscious Bias

To meet challenges related to changing demographics, and to optimize the promise of diversity, radiologists must bridge the gap between numbers of women and historically underrepresented minorities in radiology and radiation oncology as contrasted with other medical specialties. Research reveals multiple ways that women and underrepresented minorities can benefit radiology education, research, and practice. To achieve those benefits, promising practices promote developing and implementing strategies that support diversity as an institutional priority and cultivate shared responsibility among all members to create inclusive learning and workplace environments. Strategies also include providing professional development to empower and equip members to accomplish diversity-related goals. Among topics for professional development about diversity, unconscious bias has shown positive results. Unconscious bias refers to ways humans unknowingly draw upon assumptions about individuals and groups to make decisions about them. Researchers have documented unconscious bias in a variety of contexts and professions, including health care, in which they have studied differential treatment, diagnosis, prescribed care, patient well-being and compliance, physician-patient interactions, clinical decision making, and medical school education. These studies demonstrate unfavorable impacts on members of underrepresented groups and women. Learning about and striving to counteract unconscious bias points to promising practices for increasing the numbers of women and underrepresented minorities in the radiology and radiation oncology workforce.

Ethnic and Gender Diversity in Radiology Fellowships

PURPOSE

The purpose of the study is to assess ethnic and gender diversity in US radiology fellowship programs from 2006 to 2013.

MATERIALS AND METHODS

Data for this study was obtained from Journal of the American Medical Association supplements publications from 2005 to 2006 to 2012-2013 (Gonzalez-Moreno, Innov Manag Policy Pract. 15(2):149, 2013; Nivet, Acad Med. 86(12):1487-9, 2011; Reede, Health Aff. 22(4):91-3, 2003; Chapman et al., Radiology 270(1):232-40, 2014; Getto, 2005; Rivo and Satcher, JAMA 270(9):1074-8, 1993; Schwartz et al., Otolaryngol Head Neck Surg. 149(1):71-6, 2013; Simon, Clin Orthop Relat Res. 360:253-9, 1999) and the US census 2010. For each year, Fisher's exact test was used to compare the percentage of women and under-represented minorities in each Accreditation Council for Graduate Medical Education (ACGME)-certified radiology fellowship to the percentage of women and under-represented minorities in (1) all ACGME-certified radiology fellowships combined, (2) radiology residents, (3) ACGME-certified fellows in all of medicine combined, (4) ACGME-certified residents in all of medicine combined, and (5) graduating medical students. Chi-Squared test was used to compare the percentage of women and under-represented minorities and the 2010 US census.

RESULTS

p < 0.05 was used as indicator of significance. Interventional radiology and neuroradiology demonstrated the highest levels of disparities, compared to every level of medical education. Abdominal and musculoskeletal radiology fellowships demonstrated disparity patterns consistent with lack of female and URM medical graduates entering into radiology residency.

CONCLUSION

All radiology fellowships demonstrated variable levels of gender and ethnic disparities. Outreach efforts, pipeline programs, and mentoring may be helpful in addressing this issue.