A Cross-sectional Review of Cardiothoracic Surgery Department Chairs and Program Directors

Revolutionizing thoracic surgery education: a bibliometric analysis of the past decade's literature

OBJECTIVES

Thoracic surgery is a complex field requiring advanced technical skills and critical decision-making. Surgical education must evolve to equip trainees with proficiency in new techniques and technologies.

METHODS

This bibliometric analysis systematically reviewed 113 articles on thoracic surgery skills training published over the past decade, retrieved from databases including Web of Science. Publication trends, citation analysis, author and journal productivity, and keyword frequencies were evaluated.

RESULTS

The United States contributed the most publications, led by pioneering institutions. Simulation training progressed from basic to sophisticated modalities and virtual reality emerged with transformative potential. Minimally invasive techniques posed unique learning challenges requiring integrated curricula.

CONCLUSION

Ongoing investments in educational research and curriculum innovations are imperative to advance thoracic surgery training through multidisciplinary strategies. This study provides an evidentiary foundation to optimize training and address the complexities of modern thoracic surgery.

Gender Disparity in Non-ACGME (Accreditation Council for Graduate Medical Education) Otolaryngology Fellowship Leadership

OBJECTIVE

Women are underrepresented among practicing otolaryngology physicians with increasing disparities in leadership roles and higher levels of professional attainment in academic medicine. The purpose of this study is to determine the gender gap among fellowship directors within specific otolaryngology subspecialties, and how this compares to disparities among all academic appointments held by otolaryngologists. Additionally, we seek to better understand how years practiced, H-index, professorship status, and academic productivity differ between men and women in fellowship director roles.

DESIGN

Cross-sectional. Publicly available data from non-ACGME accredited otolaryngology fellowships was collected from department websites and Doximity including gender, years of practice, and professor status of fellowship directors. Scopus was used to find H-index for identified fellowship directors. Fisher's Exact tests were used to determine if significant gender disparity existed between each fellowship and academic otolaryngology as whole. H-index and years of practice were plotted for men and women comparing the slope of lines of best fit as a measure of academic productivity.

SETTING

Non-ACGME accredited otolaryngology fellowships in the US.

PARTICIPANTS

Fellowship directors in non-ACGME accredited otolaryngology fellowships.

RESULTS

Among 174 fellowship positions in our analysis, head and neck (17.3% women), laryngology (17.2% women), rhinology (5.7% women), and facial plastics (8.1% women) had significantly lower overall women representation compared to academic otolaryngology (36.6% women) (p < 0.05). As fellowship directors, women were significantly more productive than men given years practiced and H-index (p = 0.008).

CONCLUSIONS

Gender disparities among otolaryngologists are amplified in the role of fellowship directors compared to broader academic otolaryngology. This is true despite women in these roles demonstrating higher academic productivity.

Trends in Mohs surgery fellowship directors

The purpose of this study is to illustrate demographic trends among Mohs Micrographic Surgery (MMS) Fellowship Directors. Our search was constructed from the 2022 to 2023 Mohs Micrographic Surgery Fellowship Directory on the Accreditation Council for Graduate Medical Education (ACGME) website. Datapoints gathered included: age, sex, residency/fellowship training location, time since training completion until FD appointment, length in FD role, and personal research H-index. We identified 77 FDs, of which all 77 were included in this study. The mean age was 55.5 years; 55 (71.4%) were men and 20 (26.0%) were women. Most of the FDs who completed the survey did not self-report ethnicity or race, so these measures were not included. The top residency institutions that produced the most FDs were Cleveland Clinic (n = 4), Mayo Clinic (n = 4), New York University Medical Center (NYU, n = 4), and University of California-Los Angeles (UCLA, n = 4); the top fellowship institutions were NYU (n = 7), UCLA (n = 5), Cleveland Clinic (n = 4), and Geisinger Medical Center (n = 4). The mean H-index was 15.9, the mean number of peer-reviewed publications was 71, and the mean time from training completion until FD appointment was 10 years. Our results indicate that a majority of FDs are men (71.4%) and that FDs are more likely to have graduated from certain residency and fellowship programs.

Authorship Trends and Disparities in Cardiothoracic Surgery

BACKGROUND

Previous investigations have revealed significant gender disparities in the academic arenas of cardiothoracic surgery. However, the status of gender representation in cardiothoracic publications has not been well described. This study aimed to evaluate authorship trends by gender in two high-impact cardiothoracic surgical journals.

METHODS

In this bibliometric analysis, PubMed was searched for articles published in The Annals of Thoracic Surgery and the Journal of Thoracic and Cardiovascular Surgery from 2010 to 2021. The web-based application Genderize.io was used to classify names of first and last authors as men vs women. The Cochran-Armitage trend test and multivariable logistic regression were used to evaluate authorship per year and the association of first and last author gender, respectively.

RESULTS

Among 14,443 articles, 16.7% had women first authors and 8.1% had women last authors. The proportion of articles written by women authors increased, rising from 12.6% to 21.1% (P < .0001) for first and 5.4% to 11.5% (P < .0001) for last authors. Papers written with women as first author were associated with 2.0 higher odds of having a woman as last author (95% CI, 1.7-2.3; P < .0001). The mean number of last author publications was higher for men than for women (2.4 vs 1.7, P < .0001).

CONCLUSIONS

Over the past decade, despite a welcomed increase in women authorship in high-impact journals in cardiothoracic surgery, women represent a small proportion of published authors. Women first authors are more likely to publish with women last authors, demonstrating the impact of same-gender collaborations while emphasizing a need for cross-gender mentorship.

Racial, Ethnic, and Gender Diversity Among Academic Surgical Leaders in the US

Importance

Surgical department chairs remain conspicuously nondiverse despite the recognized importance of diverse physician workforces. However, the extent of diversity among non-chair leadership remains underexplored.

Objective

To evaluate racial, ethnic, and gender diversity of surgical department chairs, vice chairs (VCs), and division chiefs (DCs) in the US.

Design, Setting, and Participants

For this cross-sectional study, publicly accessible medical school and affiliated hospital websites in the US and Puerto Rico were searched from January 15 to July 15, 2022, to collect demographic and leadership data about surgical faculty. Two independent reviewers abstracted demographic data, with up to 2 additional reviewers assisting with coding resolution as necessary. In all, 2165 faculty were included in the analyses.

Main Outcomes and Measures

Proportions of racial, ethnic, and gender diversity among chairs, VCs, and DCs in general surgery and 5 surgical specialties (neurosurgery, obstetrics and gynecology, ophthalmology, orthopedics, and otolaryngology).

Results

A total of 2165 faculty (1815 males [83.8%] and 350 females [16.2%]; 109 [5.0%] African American or Black individuals; 347 [16.0%] Asian individuals; 83 [3.8%] Hispanic, Latino, or individuals of Spanish origin; and 1624 [75.0%] White individuals as well as 2 individuals [0.1%] of other race or ethnicity) at 154 surgical departments affiliated with 146 medical schools in the US and Puerto Rico were included in the analysis. There were more males than females in leadership positions at all levels-chairs (85.9% vs 14.1%), VCs (68.4% vs 31.6%), and DCs (87.1% vs 12.9%)-and only 192 leaders (8.9%) were from racial or ethnic groups that are underrepresented in medicine (URiM). Females occupied more VC than chair or DC positions both overall (31.6% vs 14.1% and 12.9%, respectively) and within racial and ethnic groups (African American or Black females, 4.0% VC vs 1.5% chair and 0.6% DC positions; P < .001). URiM individuals were most commonly VCs of diversity, equity, and inclusion (DEI, 51.6%) or faculty development (17.9%). Vice chairs of faculty development were split equally between males and females, while 64.5% of VCs for DEI were female. All other VCs were predominantly male. Among DC roles, URiM representation was greatest in transplant surgery (13.8%) and lowest in oral and maxillofacial surgery (5.0%). Except for breast and endocrine surgery (63.6% female), females comprised less than 20% of DC roles. Nearly half of DCs (6 of 13 [46.2%]) and VCs (4 of 9 [44.4%]) had no female URiM leaders, and notably, no American Indian, Alaska Native, or Native Hawaiian or Other Pacific Islander individuals were identified in any surgical leadership positions.

Conclusions and Relevance

While it is unclear whether promotion from VC to chair or from DC to chair is more likely, these findings of similar gender distribution between chairs and DCs suggest the latter and may partially explain persistent nondiversity among surgical chairs. Female and URiM surgical leaders are disproportionately clustered in roles (eg, VCs of DEI or faculty development) that may not translate into future promotion to department chairs.

Gynecologic oncology fellowship leadership trends by gender

Our objective was to examine the educational, research, and leadership trends among gynecologic oncology (GYO) fellowship program directors (PD) and how these vary by gender. PDs were identified using the Society of Gynecologic Oncology Fellowship Directory. Surveys were sent to PDs' emails to obtain information about demographics, education, and research background. Publicly available data and institutional biographies were used to supplement primary survey data for incomplete responses or survey non-responders. Scopus was used to determine the h-index and number of publications and citations for each PD. Parametric data were compared using unpaired two-tailed t-tests. Chi-square and Fisher's exact tests were performed for categorical data. The significance level was p < 0.05. Approximately one-half of PDs were female (50.8%). Female PDs had a younger mean age than male PDs (46.4 years vs 51.9 years, p = 0.0014). The average overall h-index was 22 (SD = 14.5) and the average number of publications was 71.2 (SD = 63.3). The average h-index was higher in male PDs than females (27.8 vs 16.3, p = 0.0012), as were the number of publications (97.3 vs 45.8, p = 0.0008). Differences exist among GYO PDs by gender. While research productivity may be reflective of age, gender-based equity in research time should be further explored.

Cross-sectional Evaluation of Neurotology Fellowship Directors: A Present-day Snapshot of Leadership

Objective

To identify demographic, training, and career trends of neurotology fellowship directors (FDs).

Study Design

Cross-sectional study.

Setting

United States.

Subjects

All 26 neurotology FDs identified using the American Neurotology Society (ANS) ACGME Accredited Neurotology Fellowship Program Directory, accessed November 2021.

Main Outcome Measures

Data were collected via CVs, institutional biographies, and emailed questionnaires. Data collected includes age, gender, race and ethnicity, residency and fellowship training institution, time since training completion until FD, length of time as FD, and Hirsch-index (h-index).

Results

Twenty-six FDs were identified, and 17/26 (65.4%) FDs responded to the questionnaire. The majority (23/26; 88.5%) were male. The mean age of male and female FDs was 56 versus 47 years, respectively. Of the 17 that responded to the survey, 82.4% (14/17) self-identified as Caucasian. The mean h-index was 25.4. Older age correlated with a higher h-index (r = 0.46, P = 0.019). The duration (mean ± SD, years) from fellowship graduation to FD appointment was 10.7 ± 8.1 and 6.3 ± 4.8 from institutional hire. Six (23.1%) FDs had secondary graduate degrees, and 9 (34.6%) held a leadership position at a national otolaryngology organization.

Conclusion

This observational study assesses demographic data on current neurotology FDs in the United States with an analysis of gender disparities. The objective measures identified can provide a baseline for growth in FD leadership.

Women in leadership positions in European neurosurgery - Have we broken the glass ceiling?

Introduction

The proportion of male neurosurgeons has historically been higher than of women, although at least equal numbers of women have been entering European medical schools. The Diversity Committee (DC) of the European Association of Neurosurgical Societies (EANS) was founded recently to address this phenomenon.

Research question

In this cross-sectional study, we aimed to characterize the status quo of female leadership by assessing the proportion of women heading European neurosurgical departments.

Material and methods

European neurosurgical departments were retrieved from the EANS repository. The gender of all department chairs was determined via departmental websites or by personal contact. The proportion of females was stratified by region and by type of hospital (university versus non-university).

Results

A total of 41 (4.3%) female department chairs were identified in 961 neurosurgery departments in 41 European countries. Two thirds (68.3%) of European countries do not have a female neurosurgery chair. The highest proportion of female chairs was found in Northern Europe (11.1%), owing to four female chairs in a relatively small number of departments (n = 36). The proportions were considerably smaller in Western Europe (n = 17/312 (5.5%)), Southern Europe (n = 14/353 (4.0%)) and Central and Eastern Europe (n = 6/260 (2.3%)) (p = 0.06). The distribution of female chairs in university (n = 19 (46.3%)) versus non-university departments (n = 22 (53.7%)) was even.

Discussion and Conclusion

There is a significant gender imbalance with 4% of all European neurosurgery departments headed by women. The DC intends to develop strategies to support equal chances and normalize the presence of female leaders in European neurosurgery.

The phenotype of pathology residency program directors

Pathology residency programs vary greatly across the United States. To the authors' knowledge, little is formally known about the "phenotype" or career pathways of pathology residency program directors (PDs). PDs, former PDs (FPDs), and associate PDs (APDs) were surveyed, aiming to address whether or not dominant phenotypes or pathways to graduate medical education leadership exist. Several trends emerged including: 76% Whites, 70% females, 15% MD/PhDs, and more junior faculty (33% being <5 years in practice, another 24% being in practice <10 years, and 41% assistant professors at time of first PD/APD appointment). Anatomic and clinical pathology-certified individuals represented 79%. Sixty-two percent of respondents were on a nontenure employment track, with only 18% indicating tenure track. For subspecialty focus, cytopathology (25%), transfusion medicine (16%), and hematopathology (14%) represented the most common subspecialties practiced. A majority (65%) had served as a chief resident during residency, and most (61%) of PDs had served as APDs first. Most (60%) had not served as fellowship director. Most (65%) had not participated in any education leadership training, with 27% having participated in certificate programs or other educational professional development. Thematic analysis of perceived key criterion in selection for the role was passion for education, demeanor, emotional intelligence, and willingness to serve the department. This information may influence training or experience pursued by individuals aspiring to pathology graduate medical education leadership, inform chairs on qualities to look for, and supplement future educational sessions of the Association of Pathology Chairs Program Directors Council.

Trends in Leadership Among Neurosurgical Oncology Fellowships

OBJECTIVE

To examine current neurosurgical oncology leadership trends and provide a guide for those interested in obtaining fellowship directorship, we investigated fellowship director (FD) demographic, educational, and leadership characteristics.

METHODS

The American Association of Neurological Surgeons Academic Fellowship Directory and Committee on Advanced Subspecialty Training websites were reviewed for current U.S. program FDs for which data were collected using online resources and surveys.

RESULTS

In total, 23 FDs (20 male and 3 female) were represented whose mean age was 52.4 years (standard deviation = 8.7). Our analysis found 65% of current neurosurgical oncology FDs to be singularly trained in neurosurgical oncology, with 8.7% possessing multiple fellowships and 34.8% possessing additional degrees. Fellowship programs producing the most FDs were University of Texas MD Anderson (4), Memorial Sloan Kettering (3), and University of Miami (2). FDs possessed an average of 148 publications, 6423 citations, and an h-index of 33.9. H-index had a high-positive correlation with age and time from residency graduation but not duration of FD appointment. Among survey respondents, 91.7% reported membership and 75% reported leadership positions among national academic societies, whereas 66.7% reported holding journal-editorial positions. The mean age of FD appointment was 46.8 years, with a mean time from fellowship completion to FD appointment of 10.0 years.

CONCLUSIONS

Through the characterization of current leaders in the field, we provide valuable information with regards to training location trends, research productivity goals, career timelines, and target journal/national academic society involvement worth consideration among young trainees when making career decisions and plans.

Demographics and characteristics of leadership at allergy and immunology fellowships in the U.S. as of 2022

Background: The subspecialty of allergy and immunology (AI) has grown tremendously since the first fellowship programs were developed nearly 80 years ago; however, there is little information with regard to the demographic characteristics and trends in training of fellowship directors (FDs). Objective: Our goal was to analyze the demographic characteristics and pathways in training that have led FDs to advance in the field and train the next generation of allergists and immunologists. Methods: We created a list of all current AI fellowship programs and FDs within the United States. Specific biographical, training, and research information was collected via an Internet search and questionnaire responses. The data were recorded and analyzed in a spreadsheet and unpaired t-tests were performed between male versus female groups for H - index comparison to establish if there was a statistically significant difference. Results: There were 84 total AI fellowship programs with 84 FDs. Forty-one FDs (48.8%) were men and 43 FDs (51.2%) were women; mean age was 51.1 years; and the average age at appointment for men was 45.7 years and for women was 41.4 years, with a statistically significant difference (p = 0.02). Self-reported race and ethnicity (77.4% response rate [n = 65]) were as follows: 55.4% white (n = 36), 23.1% Asian (n = 15), 6.2% biracial (n = 4), 7.7% Middle Eastern (n = 5), 4.6% Hispanic (n = 3), and 3.1% Black (n = 2). The average Hirsch-index (h-index) for FDs was 14.2, with an average of 42.1 publications and 1532.2 citations. The difference between the h-index for the men and for the women was statistically significant, being 17.8 and 11.2 respectively, with p = 0.0143. Conclusion: In AI FDs, women were adequately represented, and men and women were hired at similar ages. There was a statistically significant difference in research output (estimated by the h-index) between men and women. This suggests that research output did not limit women in being appointed as FDs.

So You Want to be a Program Director? Career Paths of Colon and Rectal Surgery Residency Program Directors

BACKGROUND

The trajectory of colon and rectal surgery residency program director (PD) career paths has not been well described, leaving those who aspire for the position with minimal guidance. The goal of this study is to characterize their career paths in the United States. By understanding their experiences, the path to train and educate the next generation of colon and rectal surgeons as a PD will be better illuminated.

STUDY DESIGN

This study was an anonymous, cross-sectional survey of all junior and senior colon and rectal surgery residency PDs in the United States during April and May of 2022. PDs were divided into junior and senior PDs. Results were compared using 2-sided independent t-tests and Kruskall-Wallis tests.

RESULTS

Of 65 colon and rectal surgery PDs, 48% (31/65) completed the survey which encompassed demographics, leadership, education, research, and time utilization. Participants were primarily white and male, although increased female representation was identified among the junior PDs (50%). Junior PDs were also more likely to hold associate or assistant professor positions at time of appointment (p = 0.01) and a majority of all PDs (64%) previously or currently held a leadership position in a national or regional surgical association. When appointed, senior PDs reported increased teaching time.

CONCLUSIONS

This multi-institutional analysis of colon and rectal surgery residency PDs identified a trend towards equal gender representation and diversity amongst upcoming junior PDs. All respondents were appointed to PD from within the institution. Other key experiences included previous leadership roles and associate or assistant professor positions at time of appointment. While it is impossible to create a single recommended template for every aspiring colon and rectal surgery educator to advance to a PD position, this study provides guideposts along that career path.

Global Makeup of Cardiothoracic Surgeons as Represented by Our Major Societies and Associations

BACKGROUND

Prior efforts to capture the cardiothoracic surgery community rely on survey data with potentially biased or low response rates. Our goal is to better understand our community by assessing the membership directories from The Society of Thoracic Surgeons (STS), American Association for Thoracic Surgery (AATS), European Association for Cardio-Thoracic Surgery (EACTS), and Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS).

METHODS

Membership data were obtained from membership directories. Data for STS and EACTS were supplemented by the associations from their internal databases. The inclusion criterion was active membership; trainees and wholly incomplete profiles were excluded.

RESULTS

A total of 12 053 membership profiles were included (STS, 6365; EACTS, 3661; AATS, 1495; ASCVTS, 532). Membership is 7% female overall (EACTS, 9%; STS, 6%; AATS, 5%; ASCVTS, 3%), with a median age of 57 years (STS, 60 years; EACTS, 52 years). All societies had a broad scope of practice including members who practiced both adult cardiac and thoracic (20% overall), but most members practiced adult cardiac (31% overall; ASCVTS, 48%; AATS, 36%; EACTS, 30%; STS, 28%) and were in the late stage of their careers.

CONCLUSIONS

We present the makeup of our 4 major societies. We are global with a diversity of careers but concerning factors that require immediate attention. The future of our specialty depends on our ability to evolve, to promote the specialty, to attract trainees, and to include and promote female surgeons. It is crucial that we wake up to these issues, change the narrative, and create action on both individual and leadership levels.

Training Characteristics, Academic Accomplishments, and Motivation of Current Program Directors in Physical Medicine and Rehabilitation

ABSTRACT

This study aimed to report the training characteristics, academic accomplishments, and motivation of current US academic physical medicine and rehabilitation program directors.A 22-question survey was developed and disseminated via email in May 2020 to 91 current residency program directors who are members of the Association of Academic Physiatrists Residency Fellowship Program Director Committee. Follow-up emails were sent 2 and 4 wks after initial distribution, and the survey was closed after 6 wks in June 2020. Data collected were deidentified. Descriptive analysis was performed.Response rate was 49.5% (45/91); 64.4% of program directors were men, and 35.6% were women. Of the respondents, 75.4% were White/Caucasian, 6.7% were Hispanic/Latinx, 15.6% were Asian, and 2.2% were Black/African American. Moreover, 56% (9/16) of female program directors vs. 0% (0/29) of male program directors reported experiencing sex discrimination in the workplace.Four percent of program directors were full professors in physical medicine and rehabilitation when first appointed, 17% were associate professors, and 72% were assistant professors. Thirty-four percent of program directors had at least six peer-reviewed publications when first appointed.This survey provides insight to the training characteristics, accomplishments, and motivation of current program directors for physiatrists aspiring to enter these ranks and highlights the underrepresentation of women/minorities among leadership positions in physical medicine and rehabilitation.

Gender Bias in the Evaluation of Surgical Performance: Results of a Prospective Randomized Trial

OBJECTIVE

The study aims to determine the influence of trainee gender on assessments of coronary anastomosis performance.

SUMMARY OF BACKGROUND DATA

Understanding the impact of gender bias on the evaluation of trainees may enable us to identify and utilize assessment tools that are less susceptible to potential bias.

METHODS

Cardiothoracic surgeons were randomized to review the video performance of trainees who were described by either male or female pronouns. All participants viewed the same video of a coronary anastomosis and were asked to grade technique using either a Checklist or Global Rating Scale (GRS). Effect of trainee gender on scores by respondent demographic was evaluated using regression analyses. Inter-rater reliability was assessed using the Cronbach's alpha.

RESULTS

103 cardiothoracic surgeons completed the Checklist (trainee gender: male n=50, female n=53) and 112 completed the GRS (trainee gender: male n=56, female n=56). For the Checklist, male cardiothoracic surgeons who were in practice <10 years ( P = 0.036) and involved in training residents ( P = 0.049) were more likely to score male trainees higher than female trainees. The GRS demonstrated high inter-rater reliability across male and female trainees by years and scope of practice for the respondent (alpha >0.900) when compared to the Checklist assessment tool.

CONCLUSIONS

Early career male surgeons may exhibit gender bias against women when evaluating trainee performance of coronary anastomoses. The GRS demonstrates higher interrater reliability and robustness against gender bias in the assessment of technical performance than the Checklist, and such scales should be emphasized in educational evaluations.

The phenotype of academic pathology chairs

Academic pathology departments across the United States vary greatly in terms of size, clinical workloads and research activity. It is therefore not surprising that their chairs may be an equally diverse group. However, to our knowledge, little is formally known about the "phenotype" (academic credentials, leadership background, and subspecialty focus) or career pathways of these individuals. Using a survey tool, this study sought to determine whether or not dominant phenotypes or trends. Several predominant findings emerged including: race (80% Whites), gender (68% males), dual degrees (41% MD/PhDs), years in practice (56% being in practice >15 years at time of first chair appointment), rank upon appointment (88% holding the rank of professor), and funded research (67% holding research funding). While Anatomic and Clinical Pathology (AP/CP) certified chairs represented 46% of the cohort, 30% were AP-only and another 10% were Anatomic Pathology and Neuropathology (AP/NP) certified. For subspecialty focus, neuropathology (13%) and molecular pathology (15%) were disproportionately represented compared to the general population of pathologists. Previous leadership roles on the path to chairmanship included vice chair (41%), division chief (39%), residency program director (29%), or fellowship director (27%). Many (41%) had not participated in any formal business or leadership training. This information may influence training or experience pursued by individuals aspiring to academic pathology leadership. It also highlights the challenges of suboptimal diversity in race and gender, as well as the professional backgrounds of academic pathology chairs and may suggest consideration of alternate pathways to leadership.

Trends in leadership at breast surgical oncology fellowships

Introduction

Breast surgical oncology is a defined sub-specialty of general surgery that focuses on the surgical management of breast disease and malignancy within a multidisciplinary context. The fellowship directors (FD) that lead these programs have been selected for their abilities. As programs do research to ensure proper training for the next generation of breast surgical oncologists, we wanted to look into the FDs responsible for their training.

Methods

The Breast Surgical Oncology care program list was compiled via the Society of Surgical Oncology and American Society of Breast Surgeons Accredited programs (n = 60). The demographic information that was of interest included, but was not limited to, gender, age, ethnicity/background, past residency training, past fellowship training, year graduated from residency and fellowship, year since graduation to FD appointment, time at institution till FD appointment, and Hirsch index (h-index).

Results

Data were collected on all 60 FDs. The average age of FDs was 52 years old, 27% of FDs are men and 73% of FDs are women. The average H-index, number of publications, and number of citations were 19, 67, and 2648, respectively. The mean graduation year from residency was 2003, and from fellowship was 2006; with a mean of 9 years post fellowship graduation until becoming an FD. The most frequently attended residency was Rush (n = 4), and the most common fellowships were Memorial Sloan Kettering (n = 8), MD Anderson Cancer Center (n = 7), and John Wayne Cancer Institute (n = 4). Nine of the FDs stayed at the same institution after doing both residency and fellowship there (15%).

Conclusion

This is the first study to examine the demographics of those in FD positions in Surgical Breast Oncology, which is a relatively young fellowship. We found that FDs in Breast Surgical Oncology are defined by their high output of research. This qualification may be why the average age, and the number of years to FD are higher compared to other specialties where this research has been undertaken. Initial evaluation of FDs suggest more diversity in this field is needed. Further insight into the leaders training our next generation of surgeons is warranted.

Current and Temporal Trends in Otolaryngology Department Chair Appointment

OBJECTIVE

This cross-sectional study aims to characterize current otolaryngology-head and neck surgery department chairs and division chiefs and evaluate whether there have been significant changes in the occupants of these positions over time.

METHODS

All permanent department chairs or division chiefs at allopathic ACGME-accredited otolaryngology residency programs (n = 109) were identified and academic and professional information were collected using publicly available websites.

RESULTS

After excluding 12 department chairs due to interim status, 97 chairs and chiefs (81 chairs and 16 chiefs) were included with mean and median current term length of 9 ± 8 and 7 ± 5 years, respectively (range = 0-35 years). The most commonly completed fellowship in the group was head and neck oncologic surgery (42%). Seventy-seven percent of chairs previously held a faculty position within their institution. Seventy-one percent did not complete residency or fellowship training at their current institution. The average time between completing training and being appointed chair was 15.5 ± 7.7 years. Those appointed within the last 6 years (n = 47) had more years of experience than those appointed previously (18.0 ± 7.2 vs. 13.1 ± 7.4 years, p = 0.002). The number of female chairs remains low (n = 9), and despite an increasing number of women being appointed in recent years, the most recent group of appointees did not demonstrate a significant increase in female appointment (4% vs. 15%, p = 0.065).

CONCLUSIONS

A very large proportion of otolaryngology-head and neck surgery department chairs are internally recruited from their home institution. Most chairs are male, and head and neck oncologic surgery is the most common subspecialty.

LEVEL OF EVIDENCE

NA Laryngoscope, 133:1356-1360, 2023.

What are the academic and demographic characteristics of orthopaedic spine surgery division chiefs?

Background

To our knowledge no analysis of academic orthopedics division chiefs (DC) exists in the current orthopedic literature. Serving as a Division Chief may be a career milestone or an opportunity to lead and transition to additional leadership roles. Our objective is to answer the following questions (1) Are there academic characteristics common to Spine divisions chiefs? (2) Are there demographic characteristics common to Spine division chiefs? (3) Do most Spine division chiefs train at certain fellowships?

Methods

Allopathic residency program websites were used to locate DC and Division Co-Chiefs (DCC). Academic characteristics evaluated included: H-index, academic rank, number of degrees, additional leadership titles, the availability of fellowship training and service as past/current society president and participation in travelling fellowships. Demographic characteristics including gender and race were collected. Years since completions of fellowship and which fellowship program the DC/DCC trained at were collected.

Results

102 DC/DCC were identified and had an average H-index of 22.1. The majority (48%) had an academic rank of Professor, 29% Associate Professor, 16% Assistant Professor and 8% rank could not be identified. 45% had additional leadership positions within their department and 18% had additional graduate degrees. Two institutions had designations of co-chiefs. The majority (57%) offered spine fellowships at their institution. The majority of DC were males (99%) and White (72.5%). On average the DC/DCC were 19.5 years past their fellowship completion. 19% participated in at least one travelling fellowship and 14% served as a president of a Spine or Orthopaedic Society.

Conclusions

Spine surgery division chiefs are 99% male, with a rank of Professor and trained at select fellowship programs. Nearly half of spine surgery division chiefs held concurrent administrative roles in the department and 14% have served as President of a spine or Orthopaedic society. There is room to Improve on the gender and ethnic/racial diveristy of spine surgery division chief leadership.

Demographics and Academic Productivity of Cardiothoracic Imaging Fellowship Program Directors in the United States: A Cross-Sectional Review

Background

In this study, we aimed to assess current demographics, measures of academic productivity, and other objective leadership characteristics among United States cardiothoracic imaging fellowship directors (FDs).

Methodology

A survey was sent to active members listed in the Society of Thoracic Radiology Cardiothoracic Imaging Fellowship Directory. Demographic, post-graduate training, and scholarly activity data were collected, including, but not limited to, age, sex, residency and fellowship training institutions, time since training completion until FD, length of time as FD, and Hirsch-index (h-index) to measure research activity.

Results

We identified 53 FDs from 50 cardiothoracic imaging fellowship programs. Of these, 31 (58.5%) were male and 22 (41.5%) were female with an average age of 48.5 years (standard deviation (SD) = 8.4, range = 35-67). There was no statistically significant difference between the mean age of male and female FDs (47.5 vs 50.2 years, p = 0.2811). The mean age of appointment to the FD role was 41.8 years. On average, FDs graduated from residency in 2005 and 2007 for fellowships. Most attended allopathic medical schools (52/53, 98.1%). The average Scopus h-index was 15.7 (SD = 17.4). Gender-wise comparison of mean h-indices revealed 16.2 for males and 15 for females, with no statistically significant difference between the two groups (p = 0.81). Ten (18.9%) FDs and 20 (37.7%) FDs were at the same location they completed residency and fellowship training, respectively.

Conclusions

This cross-sectional study shows the present demographics within the cardiothoracic radiology FD position. This field of radiology is observed to have FDs with research productivity that is comparable with other medical specialties. Some radiology residency and fellowship programs were shown to produce more FDs than others; however, we were not able to identify causality. Program directors appear to be selected from a familiar pool of applicants, and ultimately FDs are being replaced by individuals with similar distinctions. Overall, this research into cardiothoracic radiology FDs demographics and research productivity can add to the current body of literature on FDs in various medical specialties. It is important to continue to reflect on medical leadership as the field continues to advance.

Orthopaedic Foot and Ankle Surgery Leadership Trends: A Cross-Sectional Study of Fellowship Directors and Division Chiefs

Background: In orthopaedic surgery departments, foot and ankle fellowship directors are tasked to create a robust clinical curriculum for trainees, while division chiefs manage the division's delivery of patient care. The primary aim of this study was to describe characteristics of foot and ankle surgery fellowship directors and division chiefs in an effort to recognize trends or disparities in leadership traits. Methods: The American Orthopaedic Foot and Ankle Society (AOFAS) fellowship directory for 2021 to 2022 was reviewed for AOFAS-recognized fellowship programs in the United States. Between March 2021 and June 2021, 48 fellowship directors and 23 publicly recognized division chiefs were administered an electronic survey to collect demographic, educational, and professional data. Univariate and bivariate statistical analyses were performed. Results: A total of 42 of the 48 (87.5%) fellowship directors and 18 of the 23 (78.3%) division chiefs responded to the questionnaire. Of the 48 fellowship directors, 45 (93.8%) were male, 43 (89.6%) identified as Caucasian, their average age at leadership appointment was 42.6 ± 7.5 (range, 32-70) years, and the average time between fellowship graduation and leadership appointment was 9.9 ± 7.8 (range, 0-36) years. Of the 23 chiefs, 22 (95.7%) were male, 20 (87.0%) identified as Caucasians, their average age at leadership appointment was 41.7 ± 7.8 (range, 32-53) years, and the average time between fellowship graduation and leadership appointment was 9.8 ± 6.8 (range, 2-21) years. The average H-index for the chiefs was greater than that of the fellowship directors (18.4 vs 13.4, P = .0373) when controlling for years of training>. Conclusion: The majority of current leaders identify as middle-age Caucasian males, demonstrate high research productivity, and have attended a select number of the same residency and fellowship training programs. By demonstrating the lack of diversity within foot and ankle surgery leadership, this study serves as a call to action for making inclusivity a priority.Levels of Evidence: Level IV: Cross-sectional study.

Training Characteristics, Academic Accomplishments, and Motivation of Current Chairs in Physical Medicine and Rehabilitation

OBJECTIVE

The aim of the study was to report the training characteristics, academic accomplishments, and motivation of current United States academic physical medicine and rehabilitation chairs.

DESIGN

The authors developed a 23-question survey that was disseminated via e-mail to 86 current chairs who were members of the Chairs Council from the Association of Academic Physiatrists in May 2020. Follow-up e-mails were sent 2 and 4 wks after the initial distribution, and the survey closed after 6 wks in June 2020. The data collected were deidentified. Descriptive analysis was performed.

RESULTS

Forty-nine chair responses were received, which had a response rate of 60%. A total of 69.4% of the chairs (32 of 49) were men and 30.6% (17 of 49) were women. A total of 75.5% (37 of 49) were White/Caucasian, 12.2% (6 of 49) Hispanic/Latinx, 10.2% (5 of 49) Asian, and 2% (1 of 49) were Black/African American. A total of 8.2% of the chairs (4 of 49) reported having a disability. Sixty-seven percent of the female chairs (10 of 15) reported experiencing gender discrimination in the workplace versus 3% of male chairs (1 of 34). Twenty-nine percent of the chairs were full professors in physical medicine and rehabilitation when first appointed, 57.1% associate professors, and 6% assistant professors. A total of 73.5% of the chairs had served as a reviewer for a peer-reviewed publication. Fifty-two percent of the chairs had a leadership role in a national physical medicine and rehabilitation organization. Fifty-eight percent of the chairs had at least 16 peer-reviewed publications when first appointed.

CONCLUSIONS

This survey provides insight to the training characteristics, accomplishments, and motivation of current chairs for physiatrists aspiring to enter these ranks. It also highlights the underrepresentation of women and minorities among leadership positions in physical medicine and rehabilitation.

Hitting the Books: A Nationwide Analysis of Advanced Degrees in Academic Plastic Surgery Faculty

OBJECTIVE

Plastic surgery is one of the most competitive and innovative fields in medicine. The role of the academic plastic surgeon continues to grow beyond clinical care, and many surgeons have pursued advanced degrees (AD) to expand their professional skillset. We present an analysis of ADs of academic plastic surgery faculty in the USA, with consideration of timing of AD attainment.

METHODS

All academic plastic surgery faculty members were identified from plastic surgery program websites, as recognized by the American Council of Academic Plastic Surgeons. ADs were defined as additional degrees beyond the primary medical degree. Outcomes included timing of AD attainment, residency rankings, institutional standings, and research productivity.

RESULTS

949 faculty members were identified, and 167 had ADs. The most common ADs were PhD (30%), MS/MSc (18%), and MBA/EMBA (17%). Timing of AD attainment was available for 146 faculty members (84.7%). Having an AD before residency was associated with matching into higher-tiered and integrated residency programs (both p < 0.05). For attending physicians, having an AD was associated with more journal editorial board positions, more publications, higher H-index, receiving NIH funding, and median number of NIH grants (adjusted for years in practice, all p<0.05). Institutional analysis revealed that employing more faculty with an AD was associated with having an integrated residency program, higher residency research ranking, and higher tier integrated residency (all p < 0.05).

CONCLUSION

ADs are growing in popularity in academic plastic surgery and are temporally associated with specific advantages in terms of residency placement, research productivity, and institutional standing.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Women in academic surgery over the last four decades

Objective

As the number of female medical students and surgical residents increases, the increasing number of female academic surgeons has been disproportionate. The purpose of this brief report is to evaluate the AAMC data from 1969 to 2018 to compare the level of female academic faculty representation for surgical specialties over the past four decades.

Design

The number of women as a percentage of the total surgeons per year were recorded for each year from 1969–2018, the most recent year available. Descriptive statistics were performed. Poisson regression examined the percentage of women in each field as the outcome of interest with the year and specialty (using general surgery as a reference) as two predictor variables.

Setting

Data from the American Association of Medical Colleges (AAMC).

Participants

All full-time academic faculty physicians in the specialties of obstetrics and gynecology (OB/GYN), general surgery, ophthalmology, otolaryngology (ENT), plastic surgery, plastic surgery, urology, neurosurgery, orthopaedic surgery and cardiothoracic surgery as per AAMC records.

Results

The percentage of women in surgery for all specialties evaluated increased from 1969 to 2018 (OR 1.04, p<0.001). Compared with general surgery, the rate of yearly percentage change increased more slowly in neurosurgery (OR 0.84; P = .004), orthopaedic surgery (OR 0.82; P = .002), urology (OR 0.59; P < .001), and cardiothoracic surgery (OR 0.38; P < .001). There was no significant difference in the rate of yearly percentage change for plastic surgery (OR 1.01; P = .840). The rate of yearly percentage change increased more rapidly in OB/GYN (OR 2.86; P < .001), ophthalmology (OR 1.79; P < .001) and ENT (OR 1.70; P < .001).

Conclusions

Representation of women in academic surgery is increasing overall but is increasing more slowly in orthopaedic surgery, neurosurgery, cardiothoracic surgery and urology compared with that in general surgery. These data may be used to inform and further the discussion of how mentorship and sponsorship of female students and trainees interested in surgical careers may improve gender equity in the future.