Disparity in Leadership in Neurosurgical Societies: A Global Breakdown

Role and contributions of women in revolutionizing neurosurgery

We owe it to the women neurosurgeons for paving the way to a more gender-inclusive world of medicine. Their dedication and sacrifices have led them and their followers to scale unimaginable heights in terms of administrative positions, leadership, and academics. In today's scenario, it is safe to say that society has progressed considerably. Past years have seen an uprise in the number of females enrolling in a medical degree programme however, this proportion is highly distorted when it comes to specialties such as Neurosurgery. This disparity seems to be evolving and leveling out in all specialties, as more and more women are stepping out of their comfort zone and challenging the established standards of the society. It is with the collective efforts of all stakeholders and women that we see more women not only choosing such specialties which were previously uncharted terrain, but also leading organizations globally and excelling on the administrative and academic fronts. Veteran female surgeons have revolutionized neurosurgery and its subspecialties in unimaginable ways and the present as well as the future generation neurosurgeons continue to take inspiration from them and follow their footsteps. This paper has put together the contributions of female neurosurgeons in various subspecialties of neurosurgery as well as giving an account of the leadership and administrative positions served by women. We also shed light on the role of women as an academician and a researcher.

Differential Time-To-Promotion Trajectories Among Female and Male Neurosurgeons Contribute to Gender Disparities in Academic Rank Achievement

OBJECTIVE

Despite the increasing representation of females in neurosurgical training, the fraction of female to male neurosurgeons decreases dramatically as faculty rank (Assistant, Associate, or Full Professor) increases. To assess this discrepancy, we quantified self-reported time-to-promotion trajectories for female and male neurosurgeons holding academic appointments.

METHODS

In this cross-sectional institutional review board (IRB)-approved study, 147 female and 84 male neurosurgeons currently holding faculty positions in the US were contacted via email and invited to complete an anonymous, standardized survey. Respondents provided the calendar year of postgraduate training completion, promotion to different faculty ranks, geographic region of current practice (Western, Midwest, Southern, Northeast), and practice subspecialty.

RESULTS

The response rate was 44.2% for females and 59.5% for males, with 114 participants included (65 female, 49 male). On average, female neurosurgeons required 25% longer to become an Associate Professor (P = 0.017), 34% longer to become a Full Professor (P = 0.004), 37% longer for promotion from Assistant to Associate Professor (P < 0.001), and 32% longer from Assistant to Full Professor (P = 0.012). Promotion timelines did not vary by region or specialty among male and female cohorts. Linear regressions revealed that female neurosurgeons with more recent training completion experienced shorter time-to-promotion to Associate and Full Professor compared to females of earlier generations (P = 0.005 and 0.001, respectively), while male timelines remained stable.

CONCLUSIONS

This study identifies a significant delay in time-to-promotion for female neurosurgeons compared to their male counterparts. Investigation and standardization of promotion timelines are necessary to ensure meaningful representation gains from the increased number of women entering neurosurgical training.

Advancing neurosurgical education in the age of online learning and global knowledge sharing: impact of Cerebrovascular Q&A webinar series

Background

The Seattle Science Foundation created the Cerebrovascular Q&A series as a free web-based tool to educate physicians and physicians-in-training about cerebrovascular and endovascular neurosurgery across geographical boundaries and different levels of training.

Objective

This study aims to assess the educational impact and clinical implications of the Cerebrovascular Q&A webinar series, hosted by the Seattle Science Foundation.

Methods

A digital anonymous, self-administered survey was sent to the live webinar participants. The survey contained questions about the socio-demographic characteristics of the participants, their perception of the content of the webinar series, and its impact on academic and clinical practice. The data collected from the Survey-Monkey platform was exported to Microsoft Excel which was used to perform all statistical analyses. The viewer metrics on Zoom and YouTube were also analyzed to understand trends observed among a diverse global cohort of participants.

Result

A total of 2,057 people hailing from 141 countries had registered for the Cerebrovascular Q&A series. The response rate to the questionnaire was 12.63% (n = 260). Respondents hailed from 65 countries, of which the majority were from India (13.46%, n = 35) and United States (11.15%, n = 29). Most of the participants were male (82.69%, n = 215), while only 15.77% (n = 41) were female. The maximum number of participants were neurosurgery attendings (36.65%, n = 92) followed by neurosurgeons undergoing fellowship training (24.70%, n = 62) and students who were currently in residency training (15.54%, n = 39). 75.97% (n = 196) heard of the Cerebrovascular Q&A series through the emails from Seattle Science Foundation. 21.5% (n = 56) learned about the webinar series through social media. 75% of participants reported that the webinar content was advanced and comprehensive, and the selection of speakers was relevant. 63.08% (n = 164) found the webinars sparked innovative research ideas. Additionally, 55% (n = 143) reported changes in their clinical practice based on the acquired knowledge.

Conclusion

The findings from this study reveal that webinar-based medical education in cerebrovascular neurosurgery is highly effective and influential. Web-based platforms and social media present a potent strategy to overcome barriers, emphasizing the need for targeted efforts to engage more women in medicine and neurosurgery recruitment.

Current Trends in Subspecialty Fellowship Training for 1691 Academic Neurological Surgeons

OBJECTIVE

Neurosurgical subspecialty fellowship training has become increasingly popular in recent decades. However, few studies have evaluated recent trends in postgraduate subspecialty education. This study aims to provide a detailed cross-sectional analysis of subspecialty fellowship training completion trends and demographics among U.S. academic neurosurgeons.

METHODS

Academic clinical faculty (M.D. or D.O.) teaching at accredited neurosurgery programs were included. Demographic, career, and fellowship data were collected from departmental physician profiles and the American Association of Neurological Surgeons (AANS) membership database. Relative citation ratio scores were retrieved using the National Institutes of Health iCite tool.

RESULTS

This study included 1691 surgeons (1756 fellowships) from 125 institutions. The majority (79.13%) reported fellowship training. Fellowship completion was more common among recent graduates (residency year >2000), as was training in multiple subspecialties (P < 0.0001). Spine was the most popular subspecialty (16.04%), followed by pediatrics (11.18%), and cerebrovascular (9.46%). The least common were trauma/critical care (2.52%) and peripheral nerve (1.26%). Spine, neuroradiology, and endovascular subspecialties grew in popularity over time. Pediatrics and spine were the most popular for females and males, respectively. Epilepsy and cerebrovascular had the most full professors, while endovascular and spine had the most assistant professors. Stereotactic/functional and epilepsy had the most Ph.Ds. Fellowship training correlated with higher weighted, but not mean, relative citation ratio scores among associate (P = 0.002) and full professors (P = 0.005).

CONCLUSIONS

There is an emerging proclivity for additional fellowship training among young neurosurgeons, often in multiple subspecialties. These findings are intended to help guide professional decision-making and optimize the delivery of postgraduate education.

Trends in Racial and Gender Profiles of United States Academic Emergency Medicine Faculty: Cross-Sectional Survey From 2007 to 2018

BACKGROUND

Numerous studies have reported existing disparities in academic medicine. The purpose of this study was to assess racial and gender disparity in academic emergency medicine (EM) faculty positions across the United States from 2007 to 2018.

OBJECTIVE

The primary objective was to identify the racial and ethnic and gender distributions across academic ranks in EM. The secondary objective was to describe the racial and gender proportions across different tenure tracks and degrees.

METHODS

We conducted a retrospective analysis using data from the Association of American Medical Colleges. Simple descriptive statistics and time series analysis were employed to assess the trends and relationship between race and gender across academic rank, type of degree, and tenure status.

RESULTS

When averaged, 75% of all faculty members were White physicians and 67.5% were male. Asian faculty members showed an increased representation in the lower academic ranks and underrepresented minority groups demonstrated a small increase. Asian faculty members demonstrated a significantly increasing trend at the level of instructor (t = 0.02; p = 0.034; 95% CI 0.05-1.03). Female faculty members showed a significantly decreasing trend over the study period (t = -0.01; p < 0.001; 95% CI 0.68-0.75). White academic physicians and male faculty members made up most of all degree types and tenure categories.

CONCLUSIONS

Despite an increase in proportional representation, the underrepresentation of female faculty members and those from minority groups persists in emergency medicine. Further studies are needed to identify and address the root causes of these differences.

Women in Neurosurgery: A PRISMA-Compliant Systematic Review of Where We Stand and a Pilot Study on How to Move Forward

BACKGROUND

Surgical specialties struggle to recruit women. In this study, the authors performed a systematic review to describe progress of women in neurosurgery and highlight areas where further research is needed.

METHODS

PubMed, Embase, and Cochrane Library were queried with "women in neurosurgery" OR "female neurosurgeon," and publications with empiric research were included. Bias was assessed on the basis of study designs.

RESULTS

We found 127 papers, and 36 met inclusion criteria. Much of this research is recent-85% has been published within the past 3 years. These papers detail differences between genders and examine possible causes, but they do not test interventions to remedy inequities. The authors designed an intervention focusing on medical students' perceptions of gender issues within neurosurgery. A seminar was designed with 2 objectives: inform medical students about changes within neurosurgery and introduce them to a female neurosurgery attending who could serve as a potential future mentor. Student attitudes were assessed before and after the seminar by survey. Fourteen students completed both surveys: 10 females and 4 males.

CONCLUSIONS

The 1-hour seminar significantly reduced the mean perceived difficulty to enter neurosurgery from 4.4 to 4.1 (P = 0.014); additionally, the mean perceived additional difficulty for career advancement faced by women in neurosurgery decreased from 3.6 to 2.8 (P = 0.026). Much research has gone into documenting the advancement and potential impediments for women in neurosurgery. Less research has tested solutions. Our pilot was small and susceptible to bias, but given that some results achieved significance, it merits more rigorous study.

National Institutes of Health: Gender Differences in Radiology Funding

RATIONALE AND OBJECTIVE

Radiology has traditionally remained one of the most male-dominated specialties, although a higher proportion of women are now beginning to occupy roles as academic radiologists than their male counterparts. The present study investigated trends in National Institutes of Health (NIH) funding within Diagnostic Radiology stratified by gender, and correlated with measures of academic output, including h-index.

MATERIALS AND METHODS

Data on funding was obtained from the online NIH Research Portfolio Online Reporting Tools Expenditure and Results for fiscal years 2016-2019, and information regarding each Principal Investigator (PI) was obtained from the Scopus database and departmental websites. Mann-Whitney U tests were performed on collected data for statistical comparison of continuous variables.

RESULTS

Of the 2929 grants included in this analysis, 1789 (61.07%) were awarded to male PIs and 1140 (38.9%) to female PIs.  Among PIs holding a PhD degree, male PIs had a higher mean grant amount ($619,807.00) compared to female PIs ($158,486.00).

CONCLUSION

Although female representation within academic radiology has been increasing, the mean NIH grants awarded to women is less than that awarded to men. Reasons for this are numerous and may include differential prioritization of career objectives among men and women, although such rationalization is inevitably speculative in nature. Significant gender differences in NIH funding were seen at the PhD level, and the strongest correlation between NIH funding and academic output was observed for the h-index of female PIs. These results underscore the fact that women are ostensibly being held to a higher academic standard than men in terms of funding decisions.

Sticky Floor and Glass Ceilings in Academic Medicine: Analysis of Race and Gender

Purpose This paper examines the changes in the representation of women and racial minorities in academic medicine, compares the proportion of minorities in medicine and the general United States (US) population, and discusses potential explanations for observed trends. Methods A retrospective cross-sectional analysis of the Association of American Medical Colleges (AAMC) database was done and used to collect data on the gender and race of physicians in academic medicine. Data was collected for instructors, assistant professors, associate professors, full professors, and chairpersons from 2007 to 2018, and trends were presented. Results White physicians represented most academic physicians at every academic level, peaking in proportion at 82.74% of chairpersons and were lowest at the level of instructor at 59.30%. A similar distribution existed when gender was compared, with men comprising 84.67% of chairpersons and forming the majority at levels of full, associate, and assistant professors. However, most physicians at the level of instructors are women at 55.44%. Conclusions Though women and racial minorities have gained greater representation in academic medicine over the past decade, high-level academic positions are not as accessible to them. Existing efforts of advocacy for women and minority races have proven fruitful over the past decade, but much more work needs to be done.

Sticky Floor, Broken Ladder, and Glass Ceiling in Academic Obstetrics and Gynecology in the United States and Canada

Objective

To evaluate the gender proportion in academic obstetrics and gynecology faculty across the United States and Canada and further assess any gender differences in academic ranks, leadership positions, and research productivity.

Methods

Obstetrics and gynecology programs were searched from the Fellowship and Residency Electronic Interactive Database (FREIDA) (n=145) and the Canadian Resident Matching Service (CaRMS) (n=13) to compile a database of gender and academic profiles of faculty physicians with Medical Doctorate (MD) or Doctors of Osteopathic Medicine (DO) degrees. Elsevier's Scopus was used to gather individual research metrics for analysis, and the data were analyzed using Strata v14.2 (StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP).

Results

Among 3556 American and 689 Canadian Obstetrics and Gynaecology physicians, women comprised 60.9% and 61.4%, respectively. Among physicians with professorships, women physicians comprised 36.2% and 35.8% in the United States and Canada, respectively. When examining the gender proportion of physicians in leadership roles, women comprised 52.2% and 56.1% in the United States and Canada, respectively. The h-index between men and women physicians showed a significant difference overall in both the United States (p<0.001) and Canada (p<0.001), indicating that men have higher academic output.

Conclusion

Although the overall proportion of women academic staff physicians in Obstetrics and Gynaecology is higher than the proportion of men, there are more men who had a full professor rank. Men also had higher academic productivity.

Discrimination of residents during neurosurgical training in Mexico: Results of a survey prior to SARS-CoV-2

Background:

Recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic represents an important negative impact on global training of neurosurgery residents. Even before the pandemic, discrimination is a challenge that neurosurgical residents have consistently faced. In the present study, we evaluated discriminatory conditions experienced by residents during their neurosurgical training in Mexico before the SARS-CoV-2 pandemic.

Methods:

An electronic survey of 18 questions was sent among residents registered in the Mexican Society of Neurological Surgery (MSNS), between October 2019 and July 2020. Statistical analysis was made in IBM SPSS Statistics 25. The survey focused on demographic characteristics, discrimination, personal satisfaction, and expectations of residents.

Results:

A response rate of 50% (132 of 264 residents’ members of MSNS) was obtained and considered for analysis. Median age was 30.06 ± 2.48 years, 5.3% (n = 7) were female and 16.7% (n = 22) were foreigners undergoing neurosurgical training in Mexico. Approximately 27% of respondents suffered any form of discrimination, mainly by place of origin (9.1%), by gender (8.3%) or by physical appearance (6.1%). About 42.9% (n = 3) of female residents were discriminated by gender versus 6.4% (n = 8) of male residents (P = 0.001); while foreign residents mentioned having suffered 10 times more an event of discrimination by place of origin compared to native Mexican residents (36.4% vs. 3.6%, P < 0.001).

Conclusion:

This manuscript represents the first approximation to determine the impact of discrimination suffered by residents undergoing neurosurgical training in Mexico before the SARS-CoV-2 pandemic.

Gender disparities among medical students choosing to pursue careers in medical research: a secondary cross-sectional cohort analysis

BACKGROUND

Though the proportion of women in medical schools has increased, gender disparities among those who pursue research careers still exists. In this study, we seek to better understand the main factors contributing to the existing gender disparities among medical students choosing to pursue careers in medical research.

METHODS

A secondary cross-sectional cohort analysis of previously published data was conducted using a 70-item survey that was sent to 16,418 medical students at 32 academic medical centers, and was IRB exempt from the need for ethical approval at the University of Illinois at Chicago and the University of Pennsylvania. Data was collected from September 2012 to December 2014. Survey results were analyzed using chi-square tests and Cramer's V to determine gender differences in demographic characteristics (training stage, race/ethnicity, marital status, parental status, financial support, and parental career background), career sector choice, career content choice, specialty choice, foreseeable career obstacles, and perceptions about medical research careers.

RESULTS

Female respondents were more likely to be enrolled in MD-only programs, while male respondents were more likely to be enrolled in MD/PhD programs. More male students selected academia as their first-choice career sector, while more female respondents selected hospitalist as their first-choice career sector. More female respondents identified patient care and opportunities for community service as their top career selection factors, while more male respondents identified research and teaching as their top career selection factors. Student loan burden, future compensation, and work/life balance were the most reported obstacles to pursuing a career in medical research.

CONCLUSIONS

There are many factors from a medical student's perspective that may contribute to the existing gender disparities in pursuing a career in medical research. While much progress has been made in attracting nearly equal numbers of men and women to the field of medicine, active efforts to bridge the gap between men and women in medical research careers are needed.

Gender disparity in dermatologic society leadership: A global perspective

BACKGROUND

In the last half-century, there has been increased representation of women in medicine. Despite this increase, there continues to be underrepresentation of women in medical leadership positions. The objective of this study was to investigate the phenomenon of gender disparity in the leadership of professional societies of dermatology worldwide.

METHODS

Online databases were used to extract the names of global dermatologic societies. Individual society websites were accessed to obtain information on executive members. Data not available on society websites were obtained through internet searches. Scopus was used to obtain H-indexes and other bibliometric outcomes.

RESULTS

Our data collection spanned 92 countries, with 1733 society leaders identified and information available for 1710. In North America, Europe, Asia, Australia, and the Middle East, women were in a minority in dermatology professional society leadership. In South America, Central America, and Africa, women were in a slight majority. Across all professional societies, the role of president was more frequently held by men (n = 95) as opposed to women (n = 75). Female leaders were less likely to hold concurrent academic positions as deans/chairpersons/directors (83.33%) than their male counterparts (92.06%). The median H-index of female leaders (9) was lower than that of men (14).

CONCLUSION

Gender disparity exists in leadership positions in professional dermatology societies. Cultural/continental specific factors should be explored further. Enhancement of institutional support, mentorship, and sponsorship for female dermatologists should be encouraged.

Leadership gender disparity in the fifty highest ranking North American universities: Thematic analysis under a theoretical lens

BACKGROUND

Despite changes in the discourse around gender distributions within academic leadership, women continue to be under-represented in academia. Our study aims to identify the extent of gender disparity in the academic leadership in the top 50 North American universities and to critically analyse the contributing factors through a comprehensive theoretical framework.

METHODS

We adopted the theoretical framework of leadership continuum model. A retrospective analysis of the gender of the leadership ranks was conducted between December 2018 and March 2019 for the top 50 universities in North America (2019 Quacquarelli Symonds World University Ranking system). The leadership hierarchy was classified into six tiers.

RESULTS

A total of 5806 faculty members from 45 US and five Canadian universities were included. Women were overall less likely to be in a senior leadership role than men (48.7% vs 51.3%; p value=0.05). Women accounted for fewer positions than men for resident/chancellor (23.8% vs 76.2%; p value<0.001), vice-president/vice-chancellor (36.3% vs 63.7%; p value<0.001), vice provost (42.7% vs 57.3%; p value=0.06), dean (38.5% vs 61.5%; p value<0.001) and associate dean (48.2% vs 51.8%; p-value=0.05). Women however were in a greater proportion in the assistant dean positions (63.8% vs 36.2%; p value<0.001).

CONCLUSION

Leadership gender imbalance is trans-organisational and transnational within the top 50 universities of North America and progressively widens towards the top leadership pyramid. This correlates with the lack of women leadership progress and sustainability in later cycles of the leadership continuum model (beyond assistant dean).

Women in Neurosurgery Around the World: A Systematic Review and Discussion of Barriers, Training, Professional Development, and Solutions

BACKGROUND

Women have been a minority in neurosurgery since the foundation of the specialty. Women who choose to pursue neurosurgery or advance in their career must overcome various obstacles. In this article, we discuss the proportion of women in neurosurgery globally and the obstacles they face, as well as the solutions being implemented.

METHODS

A systematic review of studies concerning international women in neurosurgery was conducted. Article inclusion was assessed based on relevance to women of neurosurgery, geographic region, date, and classification (rates/data, barriers, or solutions).

RESULTS

From the specified search, 127 articles were retrieved, and 27 met the inclusion criteria. Of the total, 25 countries were represented and discussed in the articles. Primary classification of articles resulted in 50 for data/rates, 22 for barriers, and 17 for possible solutions.

DISCUSSION

Despite cultural differences among unique regions of the globe, women face similar challenges when pursuing neurosurgery, such as difficulty advancing their careers, balancing duties at work and at home, meeting social and cultural expectations, and finding support and mentorship. Encouragingly, measures are already being implemented worldwide to allow women to fulfill their multiple other roles through maternity leave policies, increasing their access to mentors, and enabling promotions throughout their careers.

CONCLUSIONS

With the shortage of neurosurgeons in many regions of the world, the recruitment of female neurosurgeons plays a vital role in meeting those demands. Our cultures and professional societies should celebrate their inclusion and promotion and accommodate the complex role of women as neurosurgeons, mothers, partners, scientists, and leaders.

Gender Differences in Research Project Grants and R01 Grants at the National Institutes of Health

Objectives The National Institutes of Health (NIH), which is the world's largest funding source for research, offers various types of competitive grants depending on the duration, research type, and budget. The Research Project Grant (RPG) is the oldest mechanism for grant allocation that is used by the NIH. In this study, we explored the gender trends of NIH RPGs and R01 grants over the last two decades. Methods By utilizing the NIH Research Portfolio Online Reporting Tool (RePORT), data for gender were extracted, and the percentage of women as RPGs Investigators, R01-equivalent grant including R01 type 1 and type 2 grant awardees, from 1998 to 2019 were tabulated. The absolute change was calculated. Results From 1998 to 2019, the percentage of female RPG awardees has increased. However, the success rates for female RPG applicants have decreased during the same period. The funding and success rates for new R01 awards have been similar for both men and women, but women have been less successful at the renewal of R01-equivalent awards. Conclusion Gender disparity exists in awardees of higher RPGs, including the R01 award. This highlights the need for further actions to ensure gender parity in grant allocations at the NIH.

Social Perception and Academic Trends on Women in the Field of Neurosurgery: A Bibliometric Analysis

BACKGROUND

The ongoing trend of societal evolution in contemporary civilization has allowed increased inclusion of heterogenous identity groups into fields, such as neurosurgery, where certain groups have traditionally been underrepresented. In regard to the field of neurosurgery, the increasing recognition of the disparities faced by women is illustrated by a growing body of academic literature.

METHODS

We conducted a bibliometric analysis querying the PubMed, Web of Science, Scopus, and Embase databases for articles on women in neurosurgery using the MeSH terms "woman," "women," "gender," neurosurgery," neurological surgery," and "neurosurgeon." Articles were excluded if they did not concern societal impact of nonmale population in the context of neurosurgery. Total citations, mean citations per year, publishing journal information, and author demographics were abstracted from included reports. Associations between abstracted continuous variables were evaluated using the Pearson correlation coefficient. Derived P values < 0.05 were taken as significant.

RESULTS

A total of 49 articles were included. Total numbers of citations per report were positively associated with mean citations per year (r = 0.7289, P = 0.0253), the latter of which was slightly negatively associated with the age of the report (r = -0.0413, P = 0.0009). Age of publication year was found to be negatively correlated with the number of reports published per year (r = -0.648, P = 0.0066). Total citations per reports were significantly correlated with increased numbers of citations during the last completed calendar year (2019: r = 0.8956, P = 0.0397).

CONCLUSIONS

Recognition in societal evolutionary trends as evidenced by academic activity has shown increased focus on the explicit and intrinsic biases faced by women in neurosurgery. Recent years have seen significant increases in published reports concerning the subject, as well as rising academic impact per a given report. This phenomenon is speculated to continue, and understanding to broaden as societal perception continues to develop.

Emergency Medicine Journal Editorial Boards: Analysis of Gender, H-Index, Publications, Academic Rank, and Leadership Roles

INTRODUCTION

Our goal in this study was to determine female representation on editorial boards of high-ranking emergency medicine (EM) journals. In addition, we examined factors associated with gender disparity, including board members' academic rank, departmental leadership position, h-index, total publications, total citations, and total publishing years.

METHODS

In this retrospective study, we examined EM editorial boards with an impact factor of 1 or greater according to the Clarivate Journal Citations Report for a total of 16 journals. All board members with a doctor of medicine or doctor of osteopathic medicine degree, or international equivalent were included, resulting in 781 included board members. We analyzed board members' gender, academic rank, departmental leadership position, h-index, total publications, total citations, and total publishing years.

RESULTS

Gender disparity was clearly notable, with men holding 87.3% (682/781) of physician editorial board positions and women holding 12.7% (99/781) of positions. Only 6.6% (1/15) of included editorial board chiefs were women. Male editorial board members possessed higher h-indices, total citations, and more publishing years than their female counterparts. Male board members held a greater number of departmental leadership positions, as well as higher academic ranks.

CONCLUSION

Significant gender disparity exists on EM editorial boards. Substantial inequalities between men and women board members exist in both the academic and departmental realms. Addressing these inequalities will likely be an integral part of achieving gender parity on editorial boards.

Women Neurosurgeons in Academic and Other Leadership Positions in the United States

OBJECTIVE

To provide the status of women neurosurgeons (WNS) in academic faculty and/or leadership positions in neurosurgery in the United States.

METHODS

Neurosurgery academic programs were defined as having an Accreditation Council for Graduate Medical Education (ACGME) neurosurgery residency program (NSRP). Using a Google search, gender, academic rank, postgraduate degrees, academic and clinical titles, and subspecialty were recorded for each neurosurgery faculty. Officer gender was recorded for the top 7 neurosurgery U.S. organizations, 7 subspecialty sections, and 50 state neurosurgical societies.

RESULTS

WNS were faculty at 77% (89/115) of ACGME NSRPs and constituted 10% of the workforce (186/1773). WNS residents were in 92% of ACGME NSRPs and constituted 19% of the workforce (293/1515). Two NSRPs (8%) had neither WNS faculty nor WNS residents. Of NSRPs without WNS faculty, 52% (13/25) had a faculty size >10. WNS accounted for 3% of NSRP chair positions. Academic rank of WNS faculty was lower than academic rank of men neurosurgeons faculty (P < 0.05). WNS faculty had a higher number of postgraduate degrees (P < 0.05). Pediatrics was the most common subspecialty (30%) among WNS. Over time, WNS held 1% of the leadership positions within the top 7 U.S. neurosurgery organizations and 7% within the 7 subspecialty sections. Over the past 20 years, 28% (14/50) of U.S. state neurosurgical societies had WNS serve as president.

CONCLUSIONS

In 2020, the gender gap for U.S. WNS faculty and residents still exists. By providing informed benchmarks, our study might help neurosurgery organizations, medical school leadership, hiring committees, editors, and conference speakers to plan their next steps.

Gender Disparity in Radiology Society Committees and Leadership in North America and Comparison With Other Continents

PURPOSE

To evaluate gender distribution in radiology professional society leadership positions. Our study intends to assess and compare the gender distribution among leadership roles and professional society committee memberships of the radiology societies and seek an understanding of potential associations between gender, academic research metrics, institutional academic rank, and leadership roles.

METHODS

We identified radiology professional society committee members to assess relative gender composition in 28 radiology societies in North America, Europe, and Australia/New Zealand. The research metrics were obtained from the SCOPUS database and demographics and institutional affiliation through institutional websites' internet searches. Gender distribution by academic ranks and other discontinuous variables were analyzed using the Chi-Square test. Wallis tests.

RESULTS

Of the 3011 members of society committees, 67.9% were male, and 32.1% female. Among all the society members, the data showed that the proportion of committee members holding leadership positions was comparable between males (25.7%) and females (22.5%). However, when we did a subgroup analysis and disaggregated the data by leadership positions, we noted that among those who held the leadership positions, the proportion of males was more significant (n = 526, 70.7%) compared to females (n = 218, 29.3%). Overall, males had higher median publications, citations, H-indices, and active years of research (P< 0.0001). At all university academic ranks, men outnumbered females (P = 0.0015, Chi-square 15.38), with the most considerable disparity at the rank of professor (71.9% male, 28.1% female, P = 0.0003).

CONCLUSION

There was male predominance amongst committee members in radiology societies. Our study found no significant differences between those in leadership positions, suggesting that once a member of a committee, females are equally likely as males to attain leadership positions. Analysis of committee members' academic rank and committee leaders demonstrated underrepresentation of females at higher academic ranks, and males overall had higher research metrics than females.

Equity, Diversity, and Inclusion in Academic American Surgery Faculty: An Elusive Dream

BACKGROUND

In the context of shifting population demographics in the United States, a diverse workforce in health care can lead to improved patient outcomes and enhance access to culturally competent care for minorities. The objective of this study was to analyze and quantify the relationship of gender, race, and academic rank, tenure status, and degree in American academic surgical faculty.

MATERIALS AND METHODS

A 12-y retrospective cross-sectional analysis of the data from the Association of American Medical Colleges was performed. The distribution of race and gender across academic ranks, tenure, and degree types were recorded from 2007-2018. Simple descriptive statistics and chi-square analysis was used to analyze the time trends and association between gender and race across academic rank, tenure status, and degree types.

RESULTS

When averaged over the 12 y of this study, there were significantly more whites (69.8%) and males (74.5%) among the academic surgery faculty compared with other races and females, respectively (P value <0.05). Asians and females experienced the greatest increase in proportional representation across all academic ranks with an absolute increase of 7% and 5% in full professor, 5% and 6% in associate professor, and 7% and 3% in chairperson (P value <0.05), respectively. No significant association was observed between gender and race with tenure status or degree type.

CONCLUSIONS

Female and Asians are increasing in proportional representation; however, racial and gender disparities remain prevalent at higher academic ranks and positions of leadership, especially among black and Hispanic academic surgeons.

Fellowship, gender, and scholarly productivity: trends among academic neurosurgeons in the US

OBJECTIVE

Current data on fellowship choice and completion by neurosurgical residents are limited, especially in relation to gender, scholarly productivity, and career progression. The objective of this study was to determine gender differences in the selection of fellowship training and subsequent scholarly productivity and career progression.

METHODS

The authors conducted a quantitative analysis of the fellowship training information of practicing US academic neurosurgeons. Information was extracted from publicly available websites, the Scopus database, and the Centers for Medicare and Medicaid Services Open Payments website.

RESULTS

Of 1641 total academic neurosurgeons, 1403 (85.5%) were fellowship trained. There were disproportionately more men (89.9%) compared to women (10.1%). A higher proportion of women completed fellowships than men (p = 0.004). Proportionally, significantly more women completed fellowships in pediatrics (p < 0.0001), neurooncology (p = 0.012), and critical care/trauma (p = 0.001), while significantly more men completed a spine fellowship (p = 0.012). Within those who were fellowship trained, the academic rank of professor was significantly more commonly held by men (p = 0.001), but assistant professor was held significantly more often by women (p = 0.017). The fellowships with the largest mean h-indices were functional/stereotactic, pediatrics, and critical care/trauma. Despite more women completing neurooncology and pediatric fellowships, men had significantly greater h-indices in these subspecialties compared to women. Women had more industry funding awards than men in pediatrics (p < 0.0001), while men had more in spine (p = 0.023).

CONCLUSIONS

Women were found to have higher rates for fellowship completion compared with their male counterparts, yet had lower scholarly productivity in every subspecialty. Fellowship choice remains unequally distributed between genders, and scholarly productivity and career progression varies between fellowship choice.

Assessing the Gap in Female Authorship in Neurosurgery Literature: A 20-Year Analysis of Sex Trends in Authorship

BACKGROUND

Publications are considered a major factor for advancement in academia. An effort has been made to study authorship trends in neurosurgery publications. The objective of this study was to investigate authorship trends in the neurosurgery literature for the last 20 years (1998-2018).

METHODS

Articles for the years 1998, 2008, and 2018 were extracted from Neurosurgery, Journal of Neurosurgery, and World Neurosurgery for this retrospective study. Only original articles, case reports, and review articles were included. The gender of the first, senior, and corresponding author was determined. Subspecialty topic, type of paper, geographic origin of articles, and the number of citations for each article were also collected.

RESULTS

A total of 3912 articles were included. The number of articles, the total number of authors, and nonexperimental studies increased in the successive decades. A total of 744 women (19.0%) were first authors and 520 (13.3%) were senior authors of their respective publications. A decreasing trend (P < 0.05) was noted between female first authors and male senior authors over time. All 3 journals showed an increasing pattern of female authorships across the 2 decades.

CONCLUSIONS

A rapid rise in female authorship positions in particular and authorship positions in general demonstrates the diversity that is slowly burgeoning to cater to perspectives and issues that require a multidimensional approach in neurosurgery. Increasing linkages among researchers in neurosurgery on a global scale are evident by the increase in multinational collaborations. Expansive efforts are needed at institutional and individual levels to eradicate sex-based pitfalls that hinder excellence in neurosurgery research.

Pregnancy and parental leave among neurosurgeons and neurosurgical trainees

OBJECTIVE

Despite recently heightened advocacy efforts relating to pregnancy and family leave policies in multiple surgical specialties, no studies to date have described female neurosurgeons' experiences with childbearing. The AANS/CNS Section of Women in Neurosurgery created the Women and Pregnancy Task Force to ascertain female neurosurgeons' experiences with and attitudes toward pregnancy and the role of family leave policies.

METHODS

A voluntary online 28-question survey examined the pregnancy experiences of female neurosurgeons and perceived barriers to childbearing. The survey was developed and electronically distributed to all members of the American Association of Neurological Surgeons and Congress of Neurological Surgeons who self-identified as female in February 2016. Responses from female resident physicians, fellows, and current or retired practicing neurosurgeons were analyzed.

RESULTS

A total of 126 women (20.3%) responded to the survey; 57 participants (49%) already had children, and 39 (33%) planned to do so. Participants overwhelmingly had or planned to have children during the early practice and senior residency years. The most frequent obstacles experienced or anticipated included insufficient time to care for newborns (47% of women with children, 92% of women planning to have children), discrimination by coworkers (31% and 77%, respectively), and inadequate time for completion of board requirements (18% and 51%, respectively). There was substantial variability in family leave policies, and a minority of participants (35%) endorsed the presence of any formal policy at their institution. Respondents described myriad unique challenges associated with pregnancy and family leave.

CONCLUSIONS

Pregnancy and family leave pose significant challenges to the recruitment, retention, and advancement of women in neurosurgery. It is thus imperative to promote clear family leave policies for trainees and practitioners, address discrimination surrounding these topics, and encourage forethought and flexibility to tackle obstacles inherent in pregnancy and the early stages of child rearing.

Prevalence of Gender Disparity in Professional Societies of Family Medicine: A Global Perspective

Introduction

Gender disparity in academic and organizational settings has been the topic of numerous studies, which have attributed under representation of females within medicine to both individual and institutional reasons. The main objective of our study was to assess gender disparity in leadership positions in committees of professional societies of family medicine (FM).

Methods

In this cross-sectional observational study, we collected publicly available information from 3 major FM societies (College of Family Physicians of Canada, the Royal Australian College of General Practitioners, and the World Organization of Family Doctors) and also collected the academic/leadership information for each committee member, including bibliometric parameters of their research productivity.

Results

In total, our sample size was 960 and composed of 58% men (556) and 42% women (404). There was a significant difference found in all the research productivity variables. Men had a greater number of publications, number of citations, years since first publication, years of active research, and had a larger h-index.

Conclusion

In conclusion, gender disparity within FM societies is less significant compared to other professional medical societies and creating an environment that supports women and supports research can aid in achieving gender parity.

Gender Disparity in Leadership Positions of General Surgical Societies in North America, Europe, and Oceania

Background 

Despite the number of female medical-school applicants reaching an all-time high and the increasing number of females in surgical training, males retain an overwhelming majority in senior surgical academic positions and formal leadership positions. This study aims to better understand the extent of and influences for gender disparity in general surgical societies throughout North America, Europe, and Oceania. 

Methods 

Data collection for this retrospective cross-sectional study took place between June and December 2017. Committee and subcommittee members from the eight selected general surgical societies that met the inclusion criteria (n = 311) were compiled into an Excel spreadsheet in which the data was recorded. Analyzed metrics included university academic ranking, surgical society leadership position, h-index, number of citations, and total publications. SCOPUS database (Elsevier, Amsterdam, Netherlands) was used to generate author metrics, and STATA version 14.0 (StataCorp, College Station, TX) was used for statistical analysis.

Results

Overall, 83.28% of members of the entities we studied were male and 16.72% were females. Males had significantly higher representation than females in all societies (Pearson chi² = 29.081; p-value = 0.010). Females were underrepresented in all society leadership positions and university academic rankings. Male members had a higher median h-index, more number of citations, and more total publications.

Conclusions

The composition of the general surgical societies included in this study demonstrated significant gender disparity. Female inclusivity initiatives and policies must be initiated to promote greater research productivity and early career opportunities for female surgeons in the specialty of general surgery.

Gender disparity within academic Canadian urology

INTRODUCTION

Increasing female matriculation into medical school has shown an increase in women training in academic urology, but gender disparity still exists within this male-dominated field. This study aims to evaluate publication productivity and rank differences of Canadian female and male academic urologists.

METHODS

The Canadian Residency Matching Service (CaRMS) was used to compile a list of 12 Canadian accredited urology programs. Using each institution's website, faculty members' names, genders, academic positions, and leadership ranks were noted. SCOPUS^© was consulted to tabulate the number of documents published, citations, and h-index of each faculty member. To account for temporal bias associated with the h-index, the m-quotient was also computed.

RESULTS

There was a significantly higher number of men (164, 88.17%) among academic faculty than women (22, 11.83%). As academic rank increased, the proportion of female urologists decreased. Overall, male urologists had higher academic ranks, h-index values, number of publications, and citations (p=0.038, p=0.0038, p=0.0011, and p=0.014, respectively). There was an insignificant difference between men and women with respect to their m-quotient medians (p=0.25).

CONCLUSIONS

There is an increasing number of women completing residency in urology, although there are disproportionally fewer female urologists at senior academic positions. Significant differences were found in the h-index, publication count, and citation number between male and female urologists. When using the m-quotient to adjust for temporal bias, no significant differences were found between the gender in terms of academic output.

Gender Representation at Neurological Surgery Conferences

BACKGROUND

Women constitute a minority (9.2%) of academic neurosurgeons. We previously found that women in academic medicine are disadvantaged in funding and career advancement opportunities. We hypothesized that women are also underrepresented at neurosurgical society conferences.

METHODS

Programs from the 2014-2018 meetings of the Congress of Neurological Surgeons (CNS), American Association of Neurological Surgery (AANS), and North American Skull Base Society (NASBS) were analyzed. Demographic data, including name, gender, and geographic region of practice, were collected for speaker, moderator, or leadership positions. χ² statistical analysis was performed for difference in gender representation across all opportunity spots.

RESULTS

In the period 2014-2018, there was no female presidents or honored guest at any academic meetings analyzed; 53.8% of executive committees comprised all men. Women often constituted a minority (<15%) of speakers and moderators at CNS, AANS, and NASBS meetings: speakers (% female, range), 8.6 (5.5-11.7), 13.6 (10.1-19.7), and 10.5 (5.6-16.6); moderators (% female, range), 7.8 (0-14.3), 23.0 (81.3-91.3), and 13.0 (8.6-18.7). Conference panels frequently comprised all men (58% CNS, 20.7% AANS, 61% NASBS). χ² analysis found a disparity in male and female participation across all opportunity spots (P = 0.002). Additionally, female participants are often repeated, decreasing total number of unique women participating. There was no significant increase in female participation across the study period.

CONCLUSIONS

In 2014-2018, underrepresentation of women in national neurosurgical conferences either matched or exceeded the baseline gender disparity seen in academic neurosurgery. We discussed potential causes of and strategies to address these findings.