Working toward gender diversity and inclusion in medicine: myths and solutions

Exploring Gender Diversity in Canadian Surgical Residency Leadership

OBJECTIVE

Studies in the United States demonstrate a low proportion of cisgender women in medical leadership. No research exists about the prevalence of transgender people in medical leadership. The objective of this study was to evaluate gender representation within Canadian surgical training leadership.

DESIGN

This study represents a survey based exploratory analysis and literature review. Associations between gender and leadership position, surgical subspecialty, years in practice and leadership role, province of work, and age were calculated using Chi squared goodness of fit and independence tests.

SETTING

The study was based out of the University of British Columbia in Vancouver and included all Canadian surgical training programs.

PARTICIPANTS

Participants were identified using the Canadian Resident Matching Service and program websites. All prospective respondents (359) were emailed an encrypted survey link.

RESULTS

The survey response rate was 65/359 responses (18%). The overall gender distribution was cis men (n = 36, 56.5%), cis women (n = 26, 40%), nonbinary (n = 1, 1.5%), agender (n = 1, 1.5%) and nonresponse (n = 1, 1.5%). Sixty-three percent of program directors were cis men, 33% were cis women and 4% were agender. Sixty-seven percent of associate program directors were cis women and 33% were cis men. Sixty-five percent of division leads were cis men, 29% were cis women, and 6% were nonbinary. There were more cis women in general surgery leadership than expected (df = 1, N = 20, x2 = 11.05, p ≤ 0.001). No statistically significant associations between gender identity/modality, leadership role, province, or age were found using chi squared tests.

CONCLUSIONS

Cis men continue to outnumber all others in surgical training leadership. More cis women than expected work in general surgery training leadership. However, these findings must be interpreted with caution considering the low survey response rate and the greater proportion of cis women respondents compared to cis women surgeons. There is a marked absence of binary-identified trans people in surgical training leadership in Canada, however a small number of nonbinary and agender people are present.

Gender trends at the annual Spanish Urologic Association (AEU) meeting: A review of AEU programmes over a 10-year period (2012-2022)

INTRODUCTION

Gender equity in urological meetings is pivotal for fostering diversity and inclusivity in the field. This study aims to evaluate the representation of Spanish urologist and regional disparities, and to assess its alignment with the demographic composition of the urological community.

MATERIALS AND METHODS

All urology meetings organized by the AEU between January 2012 and December 2022 were reviewed, including meeting information and details of the faculty. Additionally, we analysed geographic distribution of speakers across 17 different regions. Gender demographics were obtained disaggregating data by sex and year from the Organización Médica Colegial de España (OMC) and from those urologists affiliated to the AEU.

RESULTS

Analysing 52 AEU congresses held from 2012 to 2022, encompassing 3,407 speakers, the study found that 95.25% of speakers were from Spain and 89.6% were male speakers. Over the years, there was a positive trend in female speaker representation, increasing by 1.1% annually, slightly lagging the 1.8% annual rise in the number of female urologists in Spain. In specific subfields like functional, transplantation, and oncology sessions, the study revealed a higher representation of women, indicating focused efforts in these areas. Geographically, Madrid, Catalonia and Andalusia exhibited the highest representation.

CONCLUSIONS

Although there was a positive trend towards an increased participation of female urologists in Spanish urological meetings, it fails to accurately reflect the proportional increase in the number of women entering the urology profession in recent years. This study underscores the importance of ongoing efforts to ensure diverse and balanced representation in urological forum.

The Role of Obstetrics and Gynecology in Shaping Gender-diverse Leadership in Medicine

Gender inequity persists in academic medicine. This article reviews the historical context, ongoing leadership challenges, and societal biases. The persistent barriers to gender equity in leadership roles, pay, and professional recognition are considered through the lens of obstetrics and gynecology where these issues persist despite a significant presence of women in the field. The impact of gender stereotypes, the role of intersectionality, and the need for systemic change are evident. Embracing diverse leadership styles and creating inclusive pathways to leadership will help actualize the potential benefits of a gender-diverse workforce, enhancing health care outcomes and fostering innovation.

Gender diversity and healthcare performance: A quantitative analysis from the Italian health system

Unlike many other industries, which are characterized by a more significant presence of men than women, the healthcare sector has a clear majority of women. However, even if at the non-executive level, the percentage of women is extremely higher than that of men, at the executive level, this percentage is completely overturned, generating the so-called glass ceiling effect. Despite extensive research on gender diversity and its impact on financial metrics, few studies have focused on clinical measures. To bridge this research gap, the article analyzes the relationship between gender diversity and healthcare metrics. We developed an econometric model for unbalanced panel data by performing a random effect and a quantile regression analysis, which test the relationship between gender diversity and the average length of stay (LOS), controlling for structural and clinical metrics. We find that, in general, a higher percentage of women in non-executive positions is related to an increase in LOS. Conversely, a higher rate of women in executive positions is related to a lower level of LOS. Empirical evidence supports the relevance of including human resources strategies to increase the number of women at executive managerial positions. However, the study highlights also the necessity to consider how to make the public health sector positions more appealing for men.

Still a 'boys' club': a qualitative analysis of how gender affects a career in anaesthesia in Australia and Aotearoa New Zealand

Gender inequity remains an issue in anaesthesia despite increasing numbers of women training and achieving fellowship in the speciality. Women are under-represented in all areas of anaesthetic research, academia and leadership. The Gender Equity Subcommittee of the Australian and New Zealand College of Anaesthetists recently conducted a survey asking "Does gender still matter in the pursuit of a career in anaesthesia in 2022?". The survey was distributed to a randomly selected sample of 1225 anaesthetic consultants and completed by 470 respondents (38% response rate) with 793 free-text comments provided. Three overarching themes were identified: gender effects on the career and family interface; women do not fit the mould; and gender equity changes the status quo. Women respondents described a need to make a choice between career and family, which was not described by men, as well as stigmatisation of part-time work, a lack of access to challenging work and negative impacts of parental leave. Women respondents also described a sense of marginalisation within anaesthesia due to a 'boys' club' mentality, a lack of professional respect and insufficient structural supports for women in leadership. This was compounded for women from ethnically and culturally diverse backgrounds. A need for specific strategies to support anaesthetic careers for women was described as well as normalisation of flexibility in workplaces, combined with a broadening of our definition of success to allow people of all genders to experience fulfilment both at home and at work. This study is the first published qualitative data on factors affecting gender equity for anaesthetists in Australia and Aotearoa New Zealand. It highlights the need for further exploration, as well providing a foundation for changes in attitude and structural changes towards advancing gender equity.

Gender equity in The Journal of the American Dental Association: A review of the past 2 plus decades

BACKGROUND

Considering evidence of closing the gender gap in dental scholarship, this study assessed women's participation as authors, reviewers, and members of the editorial board for The Journal of the American Dental Association (JADA) from 2000 through 2022.

METHODS

The study authors downloaded author names from PubMed and retrieved names of reviewers and editorial board members from JADA's pages. The authors used Gender-API software to determine gender on the basis of first names. They used logistic regression to test for trends.

RESULTS

From January 2000 through December 2022, there were 2,935 full-length articles, 2,775 reviewers, 4 editors in chief, and 85 editorial board members. The percentage of women authors increased by 1.2% annually (95% CI, 1.03% to 1.33%), reaching 47% in 2022. First authorship increased by 2.1% annually (95% CI, 1.84% to 2.39%) and has been at more than 50% since 2016. In articles with multiple authors, there was a modest increase; second authorship increased 0.7% annually (95% CI, 0.36% to 1.09%) and last authorship by 0.7% (95% CI, 0.03% to 1.00%). Women reviewers increased 0.8% annually (95% CI, 0.68% to 0.97%), but the percentage of women on the editorial board did not increase significantly and was 41% in 2022.

CONCLUSIONS

It was anticipated that 50% of JADA authors would be women by 2024. However, women are still underrepresented on the editorial board. A comprehensive effort is needed to foster role models, provide mentorship opportunities for women, and support women's professional advancement in dental research and publications.

PRACTICAL IMPLICATIONS

Gender-based disparities affect women in dental education and clinical practice. Serving as an editorial board member, reviewer, or author can affect academic promotion and the type of scientific investigation being conducted and indirectly affects women's health outcomes.

Unveiling the gender gap in research: a bibliometric analysis of the 100 most-cited articles on food-borne pathogen outbreaks from 1990 to 2020

Introduction

Despite a recent increase in the representation of female authors in scientific literature, a significant gap persists concerning the inclusion of women in research. This necessitates the analysis of published literature from a gender perspective. This study aimed to provide gender distribution in authorship in the 100 most-cited articles on food-borne pathogen outbreaks from 1990 to 2020.

Methods

Bibliometric analysis was conducted using the Scopus database. Two reviewers were selected to search the database. We included the 100 most-cited articles on foodborne outbreak investigations. The analysis was conducted using Statistical Package for Social Sciences (SPSS) version 26 and Microsoft Excel version 2016. The citation data, including total citations, citations per year, and representation of women as first and senior authors, was analyzed in terms of frequencies, mean, median, and interquartile range. The correlation between journal impact factor and the representation of women in high-impact factor journals was determined. A p-value of <0.05 was considered significant.

Results

Most of the top-cited articles were published between 2001 and 2010 (n=47). The top 3 most-cited articles were from the USA. Of the total 100 articles, women were the first and last authors in 46% and 28% of the articles, respectively, reflecting a significant gender gap. However, the proportion of females as principal investigators gradually increased from 25% (n=10/30) to 52% (n=24/47) during the period 2001-2010 and to 92% (n=12/13) during 2011-2020. The USA had the highest number of included articles (n=48), and women were principal authors in 56% (n=27) of them. The lowest representation of women was observed in Austria, Denmark, Japan, Netherlands, New Zealand, Nigeria, Portugal, and the United Kingdom.

Conclusion

Women are under-represented in published literature on food-borne pathogen outbreaks. Although the representation of women as principal authors has recently increased, disparities still exist at the senior-author level, calling for women's advancement in academic science.

Otolaryngology residency program factors associated with female resident representation

Objective

Female representation in the field of otolaryngology is lacking. Residency is the first point at which medical school graduates specialize in a chosen field and thus represents an opportunity to recruit and train more female otolaryngologists. This study sought to identify program factors associated with greater female representation among resident physicians.

Methods

Departmental websites of all 124 otolaryngology residency programs in the United States and Puerto Rico were examined for a list of residents. For programs with a resident roster available, the genders of residents, faculty, program directors, and chairpersons were recorded. Location and city population for each program was also recorded, as was female resident representation. Programs were compared using Pearson Chi-squared univariate tests.

Results

1,632 residents and 2,605 faculty were included in the analysis of 109 programs. The median female resident representation was 40%. Programs with larger faculty sizes, more female faculty, and urban location were associated with an above-median female resident representation. Programs with a larger residency cohort approached significance regarding above-median female resident representation. Higher female faculty representation, program director gender, chairperson gender, and US region were not associated with variation in female resident representation.

Conclusions

Greater female otolaryngology residency representation was associated with programs having an urban location and greater numbers of female and total faculty. It was also likely that a larger resident cohort size may affect female resident representation. The proportions of female faculty, program director, and chairperson gender, as well as the US region, were not associated with variation in female resident gender representation.

Advancing Healthcare Equity in Nephrology: Addressing Racial and Ethnic Disparities in Research Trials and Treatment Strategies

Within the healthcare sector, especially in the field of nephrology, the matter of gender and racial inequalities continues to be a critical concern that requires immediate focus. Women, particularly those of underrepresented racial groups, face significant challenges due to a lack of representation in research studies, leading to a deficit in knowledge about how kidney diseases affect them differently. These challenges are exacerbated by systemic biases in the healthcare system, which manifest in both gender and racial dimensions, hindering access to and the quality of care for kidney diseases. Addressing these complex disparities requires a recalibration of risk stratification models to include both gender- and race-specific factors and a transformation of healthcare policies to facilitate a more inclusive and sensitive approach. Essential to this transformation is the empowerment of women of all races to actively participate in their healthcare decisions and the strengthening of support systems to help them navigate the complexities of the healthcare environment. Furthermore, education programs must be designed to be culturally competent and address the unique needs and concerns of women across different racial backgrounds. Promoting a collaborative patient-provider relationship is crucial in fostering an environment where equity, dignity, and respect are at the forefront. The path to equitable nephrology care lies in a concerted, collective action from researchers, healthcare providers, policymakers, and patients, ensuring that every individual receives the highest standard of care, irrespective of gender or race.

Examining the pedagogical practices that support cultural proficiency development in graduate health science students

BACKGROUND

Health disparities are often a function of systemic discrimination and healthcare providers' biases. In recognition of this, health science programs have begun to offer training to foster cultural proficiency (CP) in future professionals. However, there is not yet consensus about the best ways to integrate CP into didactic and clinical education, and little is known about the role of clinical rotations in fostering CP.

METHODS

Here, a mixed-methods approach was used to survey students (n = 131) from a private all-graduate level osteopathic health sciences university to gain insight into the training approaches students encountered related to CP and how these may vary as a function of academic progression. The research survey included instruments designed to quantify students' implicit associations, beliefs, and experiences related to the CP training they encountered through the use of validated instruments, including Implicit Association Tests and the Ethnocultural Empathy Inventory, and custom-designed questions.

RESULTS

The data revealed that most students (73%) had received CP training during graduate school which primarily occurred via discussions, lectures, and readings; however, the duration and students' perception of the training varied substantially (e.g., training range = 1-100 hours). In addition, while students largely indicated that they valued CP and sought to provide empathetic care to their patients, they also expressed personal understandings of CP that often fell short of advocacy and addressing personal and societal biases. The results further suggested that clinical rotations may help students attenuate implicit biases but did not appear to be synergistic with pre-clinical courses in fostering other CP knowledge, skills, and attitudes.

CONCLUSIONS

These findings highlight the need to utilize evidence-based pedagogical practices to design intentional, integrated, and holistic CP training throughout health science programs that employ an intersectional lens and empowers learners to serve as advocates for their patients and address systemic challenges.

Discrimination and dental students: What is the reality in Brazilian institutions?

INTRODUCTION

This study aimed to evaluate whether there is discrimination in the dental educational environment, assess the main reasons for the discriminatory events, and if there is an association between discriminatory episodes and sociodemographic characteristics of undergraduate dental students.

MATERIALS AND METHODS

This observational cross-sectional study was conducted with a self-administered questionnaire to students enrolled in three Brazilian dental schools. Questions included sociodemographic characteristics and the occurrence of discriminatory episodes in the dental academic environment. Descriptive analysis was performed in RStudio 1.3 (R Core Team, RStudio, Inc., Boston, USA) software and the associations were tested using Pearson's chi-square test, considering 95% confidence intervals.

RESULTS

A total of 732 dental students were included, with a response rate of 70.2%. The vast majority of students were female (66.9%), with white/yellow skin colour (67.9%), and with a mean age of 22.6 (SD 4.1) years. Sixth-eight percent of students reported having experienced some discrimination in the academic environment and most reported feeling uncomfortable with the episode. The main reasons to have been discriminated against raised by students were specific behaviour/habit, have specific moral, ethical, and aesthetic values, gender, and socioeconomic status or social class. The occurrence of discriminatory episodes was associated with female gender (p = .05), non-heterosexual sexual orientation (p < .001), studying in public institutions (p < .001), receiving an institutional scholarship (p = .018), and being in the final undergraduate cycle (p < .001).

CONCLUSION

The occurrence of discriminatory episodes was common in Brazilian dental higher education. Discriminatory situations generate traumas and psychological marks, causing a loss of diversity within the academic environment that leads to loss of productivity, creativity, and innovation. Thus, strong institutional policies against discrimination are crucial to create a healthy dental academic environment.

Examining gender bias in regional anesthesia academic publishing: a 50-year bibliometric analysis

BACKGROUND

The connection between academic career advancement and publishing research articles is important, as it can impact promotion and compensation decisions. Gender bias in academic publishing is a known issue, with studies showing low numbers in key roles in female representation. This article aims to analyze the ratio of women to men as first and last authors in the Regional Anesthesia & Pain Medicine (RAPM) journal and explore other factors such as the mentorship effect and representation in regional anesthesia associations.

MAIN BODY

We examined the RAPM articles from 1976 to 2023 evaluating the gender of first and last authors. We analyzed the trend over the years and also analyze the subset of original articles. A further analysis was conducted to analyze the relationship between the first and last author's gender. Additionally, regional anesthesia societies were contacted to gather data on the gender of their members. We included 5650 articles; most of them were first authored by men (72.9-87.7%). There was a positive trend over time for female first authorship but not for last authorship. The analysis also revealed a mentorship effect in recent years for both overall articles and the subgroup of original articles. The representation of women within regional anesthesia societies contrasted with the representation of women as last authors in original articles.

CONCLUSIONS

Our findings raise important questions about gender bias in academic publishing highlighting the need for increased representation and opportunities for women in the field of regional anesthesia.

Gender inequities in dental research publications: Findings from 20 years

BACKGROUND

The first steps towards gender equity in science are measuring the magnitude of inequity and increasing awareness of the problem.

OBJECTIVES

To describe trends in gender disparities in first and last authorship in the most cited dental publications and general dental literature over a 20-year period.

METHODS

Articles and bibliometric data were retrieved from the Scopus database for the period 1996 to 2015. Two groups of 1000 articles each were retrieved: a random sample and another sample of top-cited articles for each year. The gender of the first and last author of each publication was manually identified. When this was not possible, we used an online software platform (https://genderize.io/). Descriptive analyses identified the proportion of women first and last authors in both samples, stratifying by dental discipline and geographic region. Trends were ascertained by frequency metrics across years. Gender disparity was observed in both first and last authorship, with a larger gap being observed in the top-cited sample.

RESULTS

Women led 28.4% and 20.3% of articles in the random and top-cited samples, respectively. A similar pattern was observed for the last authorship group (22.1% and 16.1%, respectively). An increasing trend in the proportion of articles led by women over time was observed in both samples. This increase was larger in the top-cited sample (from 15.0% in 1996-2000 to 25.1% in 2015) than in the random sample (from 26.3% in 1996-2000 to 33.2% in 2011).

CONCLUSIONS

Clear gender disparities in dental research publications in the last 20 years were identified in both general and top-cited manuscripts, across dental disciplines, across countries, across first and last authorship, and over time. It is paramount that actions are taken to attract, retain and promote women in science, as well as to monitor and ensure progress towards gender equity.

Gender inequity in the medical profession: the women doctors in Spain (WOMEDS) study

BACKGROUND

The long-standing underrepresentation of women in leadership positions in medicine is well-known, but poorly documented globally. There is some evidence of the gender gap in academia, medical society leadership, or specific problems in some specialties. However, there are no investigations analyzing all medical specialties together and reporting the glass ceiling from a 360º perspective that includes positions in academia, research, professional organizations, and clinical activity. Additionally, the majority of studies have a US perspective, and we wonder if the perspective of a European country might be different. The WOmen in MEDicine in Spain (WOMEDS) project ( https://womeds.es ) aims to describe and characterize, in a systematic and detailed way, the gender bias in the medical profession in Spain in order to monitor its evolution over time and contribute to prioritizing gender policies.

METHODS

We retrieved data for the calendar years 2019-2021 from several sources and selected surveys. We built four groups of indicators to describe leadership positions in the medical profession: (i) leadership in healthcare according to specialty and region; (ii) leadership in scientific and professional bodies; (iii) academic career; and (iv) leadership in clinical research activity. As a summary measure, we reported the women ratios, calculated as the percentage of women in specific top positions divided by the percentage of women in the relevant population.

RESULTS

We found gender inequity in leadership positions in all four settings. During the observed period, only 27.6% of the heads of departments in hospitals were women compared to 61.1% of women in medical staff. Ten of the 46 medical societies grouped in the Spanish Federation of Medical Societies (FACME) (21.7%) had a women president at some point during the study period, and only 4 annual congresses had ratios of women speakers higher than 1. Women were over-represented in the lower positions and underrepresented in the top academic ones. Only 26% and 27%, respectively, of the heads of departments and deans were women. The applications for public funding for research projects are led by women only in 45% of the cases, and the budget granted to women in public calls was 24.3% lower than that of men.

CONCLUSION

In all the areas analyzed, the leadership positions are still mostly occupied by men despite the feminization of medicine in Spain. The severe gender inequity found calls for urgent interventions within a defined time horizon. Such measures must concern all levels, from national or regional regulation to changes in organizational culture or incentives in specific organizations.

Women in trauma and orthopaedics: are we losing them at the first hurdle?

INTRODUCTION

Diversity in the healthcare workforce is associated with improved performance and patient-reported outcomes. Gender disparity in Trauma and Orthopaedics (T&O) is well recognised. The aim of this study was to compare factors that influence career choice in T&O between male and female final-year students. Furthermore, the trend of representation of women in T&O over the last decade was also compared with other surgical specialities.

METHODS

An online survey of final-year students who attended nationally advertised T&O courses over a 2-year period was conducted. Data from NHS digital was obtained to assess gender diversity in T&O compared with other surgical specialities.

RESULTS

A total of 414 students from 13 UK medical schools completed the questionnaire. Compared with male students (34.2%), a significantly higher proportion of women (65.8%) decided against a career in T&O, p<0.001. Factors that dissuaded a significantly higher percentage of women included gender bias, technical aspects of surgery, unsociable hours, on-call commitments, inadequate undergraduate training and interest in another specialty (p<0.05). Motivating factors for choosing a career in T&O were similar between both sexes. T&O was the surgical specialty with the lowest proportion of women at both consultant and trainee level over the last decade.

CONCLUSION

T&O remains an unpopular career choice among women. To enhance recruitment of women in T&O, future strategies should be directed toward medical students. Universities, orthopaedic departments and societies must work collaboratively to embed culture change, improve the delivery of the undergraduate curriculum, and facilitate students' exposure to operating theatres and female role models.

Current Neurosurgical Care in Ethiopia Using the Lens of the Lancet Global Health Commission on High-Quality Health Systems

BACKGROUND

Neurosurgery is a rapidly developing specialty in Ethiopia. Previous global neurosurgery studies have highlighted the need for synchronizing workforce increase with improving quality, access, and capacity to provide neurosurgical care.

OBJECTIVE

To evaluate Ethiopia's neurosurgical system and highlight the critical interventions required for the sustained development of Ethiopian neurosurgery as part of a high-quality health system (HQHS).

METHODS

A comprehensive survey was sent to all practicing neurosurgeons. Public databases on Ethiopian census reports and current road infrastructure were used for spatial analysis of neurosurgical access.

RESULTS

The survey response rate was 90% (45/50). Most respondents were men (95.6%), aged 30 to 40 years (82%), who worked at national referral hospitals (71%). The reported annual caseload per practicing neurosurgeon was >150 cases for 40% of urban and 20% of rural neurosurgeons. Head and spine neurotrauma and tumors were the most common neurosurgical indications. Computed tomography scanner was the most widely available diagnostic equipment (62%). 76% of respondents indicated the presence of postoperative rehabilitation care at their institutions. Thirteen percent and 27% of the nation lived within a 2-hour and 4-hour driving distance from a neurosurgical center, respectively.

CONCLUSION

The results highlight the need for vital improvements in neurosurgical capacity to sustain progress toward HQHS. Promoting sustained development in all components of HQHS can be achieved by diversifying the workforce and training residency candidates committed to practicing in underserved regions. Additional strategies might include establishing a national registry for neurosurgical data and implementing policy changes conducive to improving perihospital care and other health system components.

Inclusion, Diversity, Access, and Equity in Infectious Diseases Fellowship Training: Tools for Program Directors

The Infectious Diseases Society of America (IDSA) has set clear priorities in recent years to promote inclusion, diversity, access, and equity (IDA&E) in infectious disease (ID) clinical practice, medical education, and research. The IDSA IDA&E Task Force was launched in 2018 to ensure implementation of these principles. The IDSA Training Program Directors Committee met in 2021 and discussed IDA&E best practices as they pertain to the education of ID fellows. Committee members sought to develop specific goals and strategies related to recruitment, clinical training, didactics, and faculty development. This article represents a presentation of ideas brought forth at the meeting in those spheres and is meant to serve as a reference document for ID training program directors seeking guidance in this area.

Pre- and peri-traumatic event stressors drive gender differences in chronic stress-related psychological sequelae: A prospective cohort study of COVID-19 frontline healthcare providers

Women are at heightened risk for chronic stress-related psychological sequelae (SRPS), including major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) in response to potentially traumatic events, including the COVID-19 pandemic. However, few studies have examined pre- and peri-event stressors that could account for gender differences in chronic SRPS. To address this gap, we conducted a prospective cohort study of healthcare providers (HCPs) caring for patients with COVID-19 at a large tertiary care hospital in New York City, and measured mental health risk factors and symptoms of MDD, GAD, and PTSD at baseline (April 2020) and at a 7-month follow-up (December 2020). We defined chronic SRPS as the presence of probable MDD, GAD, and/or PTSD at both timepoints. We conducted a mediation analysis to evaluate whether pre- and peri-event stressors explained women's increased risk for chronic SRPS. Among our sample of 786 HCPs, 571 (72.6%) were women. Compared with men, women were twice as likely to have chronic SRPS (18.7% vs. 8.8%, χ²[1] = 11.38, p < 0.001). However, after accounting for pre- and peri-event stressors, being a woman was no longer associated with chronic SRPS (p = 0.58). The pre- and peri-event stressors that accounted for this heightened risk among women included being in a woman-prevalent profession (specifically nursing; estimate = 0.08, SE = 0.04, p = 0.05), pre-pandemic burnout (estimate = 0.11, SE = 0.05, p = 0.04), greater family-related (estimate = 0.09, SE = 0.03, p = 0.004), infection-related (estimate = 0.06, SE = 0.02, p = 0.007), and work-related concerns (estimate = 0.11, SE = 0.03, p < 0.001), and lower leadership support (estimate = 0.07, SE = 0.03, p = 0.005). These findings can inform institutional interventions to mitigate the risk of chronic SRPS among women HCPs.

Diversity and demographics of APSA members: Understanding our identity

INTRODUCTION

There are existing healthcare disparities in pediatric surgery today. Identity and racial incongruity between patients and providers contribute to systemic healthcare inequities and negatively impacts health outcomes of minoritized populations. Understanding the current demographics of the American Pediatric Surgical Association and therefore the cognitive diversity represented will help inform how best to strategically build the organization to optimize disparity solutions and improve patient care.

METHODS

1558 APSA members were sent an anonymous electronic survey. Comparative data was collected from the US Census Bureau and the Association of American Medical Colleges. Results were analyzed using standard statistical tests.

RESULTS

Of 423 respondents (response rate 27%), the race and ethnicity composition were 68% non Hispanic White, 12% Asian American and Pacific Islander, 6% Hispanic, 5% multiracial, and 4% Black/African American. Respondents were 35% women, 63% men, and 1% transgender, androgyne, or uncertain. Distribution of sexual identity was 97% heterosexual and 3% LGBTQIA. Religious identity was 50% Christian, 22% Agnostic/Atheist, 11% Jewish, 3% Hindu, and 2% Muslim. 32% of respondents were first-generation Americans. Twenty-four different primary languages were spoken, and 46% of respondents were conversational in a second language. These findings differ in meaningful ways from the overall American population and from the population of matriculants in American medical schools.

CONCLUSION

There are substantial differences in the racial, gender, and sexual identity composition of APSA members compared with the overall population in the United States. To achieve excellence in patient care and innovate solutions to existing disparities, representation, particularly in leadership is essential.

TYPE OF STUDY

Survey; original research.

LEVEL OF EVIDENCE

Level IV.

Looking beyond parity: Gender wage gaps and the leadership labyrinth in the Canadian healthcare management workforce

It is important for health organizations to monitor progress toward gender equity and inclusion goals among health human resources. Within the Canadian healthcare management workforce, however, recent investigations are lacking. This study examines gender differences in composition and compensation among health leadership in Canada using national census data. Findings show that although women represent over half (57%) of senior managers in health and social services, the pipeline from middle management (72%) suggests persistent career barriers disproportionately affect women. Women health and social care managers' earnings averaged $0.83-.89 for every dollar that a man earned. The gender wage gap remained statistically significant, with women health managers earning 12-20% less than men, after adjusting for age, education and other characteristics. Dynamic decomposition analyses highlighted that most of the gender wage gap could not be explained within the available data-a finding attributable, at least in part, to (unmeasured and unmeasurable) gender discrimination.

A Path Toward Equity and Inclusion: Establishing a DEI Committee in a Department of Pediatrics

The Diversity, Equity, and Inclusion (DEI) committee was established in 2017 within the Department of Pediatrics at Rush University Medical Center (RUMC), an academic medical health center located on the near west side of Chicago, IL. Results from climate surveys highlighted the need for increased DEI initiatives within the department, and a renewed national reckoning on racial tensions sparked an additional sense of urgency for system-level change. This paper outlines the initial creation and ongoing efforts of the DEI committee. Information related to the structure of our committee, aims of our work, progress toward identified goals, as well as ongoing barriers is provided. Academic medical health centers are tasked not only with working and training together, but also to care for a diverse group of patients within a larger community. As such, academic medical health centers represent a unique backdrop and opportunity for individual and system-level change.

Trends in gender of first and senior authors of articles published in JMIRO

INTRODUCTION

Despite progress of women in science and medicine, women remain underrepresented in academic publication. The aim of this study was to evaluate potential gender differences in women authorship in the Journal of Medical Imaging and Radiation Oncology (JMIRO).

METHODS

Gender of the first and senior author of all articles published in JMIRO between 2012 and 2021 were examined. Changes over time and differences among groups were compared using the chi-square test.

RESULTS

In total, 1,138 articles were assessed. Women were first and senior authors on 34% and 25% of all articles respectively. The proportion of women as first author was 30%, 41% and 36% for medical imaging (MI), radiation oncology (RO) and combined MI/RO articles respectively. Similarly, the proportion of women as senior author was lower than men at 22%, 32% and 23% for MI, RO and MI/RO articles respectively. Women first authorship over the study period remained stable from 2014 (36%) to 2020 (38%); however, it decreased dramatically in 2021 to 28%. There was a trend of increasing women senior authorship from 2013 (15%) to 2017 (35%) but decreased to 23% in 2021.

CONCLUSION

Over the past 10 years of publications, one in three first authors were women and only one in four senior authors were women. The acknowledgement of this imbalance is the first step to pave the way towards addressing underlying systemic issues related to academic publication and disparities in gender and other inequities.

Redressing injustices: how women students enact agency in undergraduate medical education

This study presents descriptions of epistemic injustice in the experiences of women medical students and provides accounts about how these students worked to redress these injustices. Epistemic injustice is both the immediate discrediting of an individual's knowledge based on their social identity and the act of persistently ignoring possibilities for other ways of knowing. Using critical narrative interviews and personal reflections over an eight-month period, 22 women students during their first year of medical school described instances when their knowledge and experience was discredited and ignored, then the ways they enacted agency to redress these injustices. Participants described three distinct ways they worked to redress injustices: reclaiming why they belong in medicine, speaking up and calling out the curriculum, and uplifting one another. This study has implications for recognizing medical students as whole individuals with lived histories and experiences and advocates for recognizing medical students' perspectives as valuable sources of knowledge.

Gender Discrimination and Reporting Experiences among Academic Pediatric Faculty: A Qualitative, Single-institution Study

OBJECTIVE

Gender-harassment is well-described in academic medicine, including pediatrics. We explored academic pediatricians' qualitative descriptions of: 1) workplace gender-harassment; 2) its professional and emotional tolls; 3) barriers to and outcomes of reporting gender-harassment; and 4) tools to intervene.

METHODS

We conducted a cross-sectional, anonymous, survey-based study within a single, large pediatrics department. Surveys included demographic items, validated measures to assess prevalence of gender-harassment, and optional, free-text boxes to elaborate. Here, we present the directed content analyses of free-text responses. Two trained qualitative researchers coded participant comments to identify types of gender-harassment, its impact, and participants' experiences reporting it. Final agreement between coders was outstanding (Kappa>0.9). A secondary, inductive analysis illustrated the emotional burdens of and opportunities to interrupt gender-harassment.

RESULTS

Of 524 total faculty, 290 (55%) completed the survey and 144 (27% of total, 50% of survey-respondents) provided text-responses. This sub-cohort was predominantly white women >5 years on-faculty. Compared to the full cohort, sub-cohort participants had more commonly witnessed/experienced workplace-harassment; 92% of sub-cohort women and 52% of men endorsed fear of reporting it. Respondents described harassment by institutional staff (24% of respondents), patients/families (35%), colleagues (50%), supervisors/leadership (50%), and the system (63%). Women used stronger emotional descriptors than men (ie, "humiliated" vs "uncomfortable"). Only 19% of women (and no men) had reported witnessed/experienced harassment; 24% of those described a negative consequence and 95% noted that no changes were made thereafter.

CONCLUSIONS

This single-center study suggests gender-harassment in academic pediatrics is common. Faculty feel fear and futility reporting it.

The Impact of Patient Prejudice on Minoritized Female Physicians

Background

Patient bias and prejudice directed against physicians from diverse backgrounds is a frequent occurrence in healthcare. Female physicians have long experienced discrimination in the healthcare system based on their gender alone. The dynamic known as Patient Prejudice toward Providers (PPtP) is disproportionately affecting female physicians because it is frequently compounded by sexism.

Aim

The goal of this study was to explore the impact of PPtP on female resident and attending physicians.

Methods

Using transcribed one-on-one interviews from a larger study of PPtP affecting resident and attending physicians, ten interviews with female physicians (resident and attending) from diverse ethnic backgrounds and countries of training at a large academic medical center were analyzed. The authors independently reviewed the interviews using an iterative process within and across interviews to inductively identify repeating words, phrases, and concepts relevant to the study aim.

Results

Demographics of the ten participants included age (mean 34.6 years), ethnicity (6 Asian, 2 Hispanic, 2 African), and country of training (10% IMG vs. 90% US trained). Four of the interviewees were residents and six were attendings. Themes that emerged from the analysis included experiencing "A Gendered Continuum of Abuse," "Establishing a Higher Standard of Competency," "Overcoming the Stereotype of the White Male Physician," "The Physicality of Self Identity," and "The Need to be Protective of Minoritized Trainees." All participants agreed that these perceptions created an adverse environment at the workplace and impacted on patient care.

Conclusions

Discrimination of physicians based on their gender or their race/ethnicity has been reported. This study highlights the compounded effects of patient prejudice on female minoritized physicians. Organizations and individuals should identify and implement strategies to address the impact of PPtP and sexism in order to create an environment where all women can thrive professionally.

An Eye on Gender Equality: A Review of the Evolving Role and Representation of Women in Ophthalmology

PURPOSE

In recent decades, women have achieved greater representation in ophthalmology. Globally, women now constitute approximately 25%-30% of ophthalmologists and 35%-45% of trainees. Nevertheless, women remain under-represented in key areas, including positions of professional and academic leadership and ophthalmic surgical subspecialization. Furthermore, there is evidence that women in ophthalmology encounter more bias and discrimination across multiple domains than men, including a gender-pay gap that is wider than in many other surgical subspecialties. Women ophthalmologists and trainees report sharply differing training experiences from male peers, including fewer opportunities to operate, more bullying and harassment, less access to mentorship, and contrasting expectations around contributions to family life.

DESIGN

Perspective.

METHODS

An extensive literature search was undertaken to compile and review papers published with a focus on gender equity across ophthalmology, surgery, and medicine.

RESULTS

We identified 8 broad domains that were widely discussed: leadership, research and academics, income, surgical exposure and subspecialization, harassment, career satisfaction, mentorship, and family and marital differences. We have summarized the current research across each of these areas, and discussed possible solutions to reduce the inequities reported.

CONCLUSIONS

This review draws on current research published around representation and experiences of women in ophthalmology and suggests that there are opportunities to improve gender inequity.

Strategies for Achieving Gender Equity and Work-Life Integration in Physician-Scientist Training

Substantial gender inequities persist across academic medicine. These issues are not new: Recent evidence still points to a chilly climate for women in academic medicine, including those in physician-scientist training. The discussion for how to address gender equity and issues of work-life integration typically centers around faculty and rarely includes trainees. The authors delineate specific strategies to address gender inequity in physician-scientist training by identifying key stakeholders for implementation and proposing areas to integrate these strategies with current training timelines. Strategies discussed include multiple-role mentoring, allyship training for trainees and faculty, early implementation of professional development sessions, incorporation of childcare and family-friendly policies, and additional policies for funding bodies to prioritize gender equity practices. The goal of this article is to equip trainees and the academic community with proactive strategies to create a more equitable environment for future generations of trainees in academic medicine.

Diversity in Neurosurgical Recruitment and Training in the United States: A Systematic Review

OBJECTIVE

The benefits of diversity are particularly salient in neurosurgical training because of treatment of varied patient populations and the importance of close collaboration between trainees and attending neurosurgeons of different backgrounds. However, there is a paucity of literature that comprehensively examines diversity in neurosurgical recruitment and training. The aim of this study is to systematically review the scope of diversity in neurosurgical recruitment and training.

METHODS

PudMed, Embase, and Scopus were searched since inception to October 31, 2021. Inclusion consisted of 1) on neurosurgery training; 2) sample was medical student, resident, fellows or attending; 3) discussed diversity variable(s). This study followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

Of 1578 articles, 15 studies were included. Studies largely reported gender (n = 14) underrepresentation in neurosurgery compared with racial/ethnic diversity (n = 2) and socioeconomic status (n = 1). From studies focusing on residency match (n = 4), women medical students placed greater emphasis on mentorship, earlier clinical exposure, and program camaraderie and reputation as most important. From studies (n = 4) reporting retention and attrition, although women residents and attendings representation has increased, black, indigenous and people of color groups continue to represent <15% of studies on neurosurgical training. Studies (n = 4) discussing research suggested that women residents were more likely to have lower h-indices with fewer research grants. Studies (n = 4) describing workforce employment further showed that women and racial/ethnic minority groups were less likely to hold high academic and leadership positions. In studies (n = 4) on work-life balance, 18.5% women attendings found less career fulfillment and 20.4% would not choose to pursue neurosurgery again because of lack of protected personal time.

CONCLUSIONS

This systematic review shows the scope of studies of diversity within neurosurgery and provides impetus for efforts to expand our understanding of diversity within the field.

Effect of Coronavirus Disease-2019 on the Workload of Neonatologists

OBJECTIVE

To describe the impact of coronavirus disease-2019 (COVID-19) on the neonatology workforce, focusing on professional and domestic workloads.

STUDY DESIGN

We surveyed US neonatologists in December 2020 regarding the impact of COVID-19 on professional and domestic work during the pandemic. We estimated associations between changes in time spent on types of professional and domestic work and demographic variables with multivariable logistic regression analyses.

RESULTS

Two-thirds (67.6%) of the 758 participants were women. Higher proportions of women than men were in the younger age group (63.3% vs 29.3%), held no leadership position (61.4% vs 46.3%), had dependents at home (68.8% vs 56.3%), did not have a partner or other adult at home (10.6% vs 3.2%), and had an employed partner (88.1% vs 64.6%) (P < .01 for all). A higher proportion of women than men reported a decrease in time spent on scholarly work (35.0% vs 29.0%; P = .02) and career development (44.2% vs 34.9%; P < .01). A higher proportion of women than men reported spending more time caring for children (74.2% vs 55.8%; P < .01). Reduced time spent on career development was associated with younger age (aOR, 2.21; 95% CI, 1.20-4.08) and number of dependents (aOR, 1.21; 95% CI, 1.01-1.45). Women were more likely to report an increase in time spent time doing domestic work (aOR, 1.53; 95% CI, 1.07-2.19) and a reduction in time on self-care (aOR, 0.49; 95% CI, 0.29-0.81).

CONCLUSIONS

COVID-19 significantly impacts the neonatology workforce, disproportionately affecting younger, parent, and women physicians. Targeted interventions are needed to support postpandemic career recovery and advance physician contributions to the field.

Gender-Based Linguistic Analysis of Pediatric Clinical Faculty Evaluations

BACKGROUND

Gendered stereotypes are embedded in the culture of medicine. Women are stereotypically expected to act collaboratively and less assertively, while men are expected to act with authority and power. Whether gender-biased language is expressed in academic pediatric teaching evaluations is unknown.

OBJECTIVE

Determine whether stereotypic gender-based linguistic differences exist in resident evaluations of pediatric faculty.

METHODS

We performed a retrospective cross-sectional study of clinical faculty evaluations by pediatric residents in a single program from July 2016 to June 2019. Using Linguistic Inquiry and Word Count, responses to 2 open-ended questions were analyzed for stereotypic language. Categories were reported as a percent of total words written. Comparisons between gender groups were conducted using nonparametric Wilcoxon rank sum tests. Rates of word use within each category were analyzed using logistic regression where faculty and resident gender were included as predictor variables.

RESULTS

A total of 6436 free-text responses from 3218 unique evaluations were included. As hypothesized, evaluations of women faculty were less likely than those of men to include certain agentic language like power (odds ratio [OR] 0.9, P < .001) and insight (OR 0.9, P < .001), and research words (OR 0.6, P = .003). As expected, evaluations of women were more likely to include grindstone words, like "hardworking" (OR 1.2, P = .012). Contrary to our hypothesis, women received fewer teaching words like "mentor" (OR 0.9, P = .048) and communal words like "friendly" (OR 0.6, P = .001).

CONCLUSION

Certain stereotypic language was demonstrated in clinical teaching evaluations of pediatric faculty. These findings should be further examined to improve gender inequities in academic pediatrics.

Moving Beyond Diversity: A Scoping Review of Inclusion Initiatives in the Surgical Workforce

Addressing racial disparities within the surgical workforce is vital to provide quality care to all patients; inclusion is critical to do so. Inclusion signifies a move beyond numerical representation; tangible goals include reducing attrition and maximizing career development. The aims of this review were to (1) test whether there are academically published interventions or frameworks addressing inclusion in the surgical workforce and (2) characterize these interventions or frameworks. This review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three electronic databases (Medline, PubMed, Web of Science) were queried. Peer-reviewed full-text English-language articles focused on interventions or frameworks to achieve inclusion in the surgical workforce were considered. The initial search yielded 2243 papers; 15 met inclusion criteria. The published literature regarding interventions to achieve inclusion was sparse; the most common reasons for exclusion of full texts were papers not focused on interventions (42%; n = 51) or purely focused on diversity and representation (36%; n = 42). The most common field represented was broadly academic surgery (4/15; 47%), with seven other subspecialties represented. A small minority received funding (3/15; 20%). Common themes included systematic reform of recruitment policies and practices, increased access to targeted mentorship, gaining leadership support, and increased avenues for underrepresented faculty advancement. While limited, promising work has been undertaken through national collaboration and model institutional work. Future considerations may include incentivizing academic publication of inclusion work, increasing access to funding, and rewarding these efforts in career advancement.

MedFTs' Role in the Recruitment and Retention of a Diverse Physician Population: A Conceptual Model

Recruitment and retention of a diverse physician population across stages of medical education is essential for the success of the healthcare system. MedFTs have a unique role to play in advocacy and intervention related to the recruitment and retention of these physicians at all stages of their education and career. As MedFTs expand their influence in healthcare systems, they must ground into their fundamental theories, like systems theory and the Four World View, all while advancing in their professional competencies to attune their skills and those whom they are entrusted in training. The conceptual model, MedFTs’ Role in the Recruitment and Retention of a Diverse Physician Population, provides a framework for MedFTs to use their influence to enact change related to diversity and equity in the healthcare system. In addition, the model provides avenues for intervention and advocacy on the part of the MedFT related to each of the four worlds and their specific role(s) in the health care.

An Exploration of Gender Bias Affecting Women in Medicine

Women in medicine face barriers that hinder progress toward top leadership roles, and the industry remains plagued by the grand challenge of gender inequality. The purpose of this study was to explore how subtle and overt gender biases affect women physicians, physician leaders, researchers, and faculty working in academic health sciences environments and to further examine the association of these biases with workplace satisfaction. The study used a convergent mixed methods approach. Sampling from a list of medical schools in the United States, in conjunction with a list of each state's medical society, the authors analyzed the quantitative survey responses of 293 women in medicine. The authors conducted ordinary least squares multiple regression to assess the relationship of gender barriers on workplace satisfaction. Additionally, 132 of the 293 participants provided written open-ended responses that were explored using a qualitative content analysis methodology. The survey results showed that male culture, lack of sponsorship, lack of mentoring, and queen bee syndrome were associated with lower workplace satisfaction. The qualitative results provided illustrations of how participants experienced these biases. These results emphasize the obstacles that women face and highlight the detrimental nature of gender bias in medicine. The authors conclude by presenting concrete recommendations for managers endeavoring to improve the culture of gender equity and inclusivity.

Assessing the Prevalence of Microaggressions in Plastic Surgery Training: A National Survey

There has been increased awareness of microaggressions occurring during medical training. However, the prevalence and characteristics of microaggressions specifically in plastic surgery residency remain unknown. We aimed to fill this literature gap by conducting a nationwide survey to better understand and characterize microaggressions in plastic surgery training.

METHODS

A survey was distributed between March and May 2021 via the American Society of Plastic Surgeons Resident Representatives to 1014 integrated and 214 independent track plastic surgery trainees in the United States. Multiple Pearson's chi-square of independence and Fisher exact tests evaluated comparisons of microaggressions by sex, race, Hispanic origin, sexual orientation, and year in training. A multivariate regression analysis assessed associations between variables.

RESULTS

One hundred twenty-five participants responded to the survey (response rate: 10.2%). Of those who responded, 68.8% had experienced microaggressions in the past year. Female trainees experienced microaggressions more frequently than male trainees (P < 0.05). Asian trainees had higher odds to be a target of microaggressions compared with White trainees (P = 0.013). Nonheterosexual trainees were more likely to have experienced microaggressions compared with heterosexual trainees (P < 0.05). Independent trainees were more likely to experience microaggressions than PGY 1-2 and 3-4 integrated residents (P < 0.05).

CONCLUSIONS

Approximately seven in every 10 trainees stated that they experienced microaggressions in the past year. Females, racial minorities, sexual minorities, and independent trainees had higher odds of reporting that they experienced microaggressions. Further studies are needed to assess the implementation of strategies that address this problem to resolve inequities.

What is the Trend in Representation of Women and Under-represented Minorities in Orthopaedic Surgery Residency?

BACKGROUND

Orthopaedic surgery training programs have lagged behind other surgical specialties in increasing their representation of women and people from under-represented minority (URM) groups. Comparative data between orthopaedic surgery and other specialties are needed to help identify solutions to closing the diversity gap.

QUESTIONS/PURPOSES

(1) Which surgical specialties have the greatest representation of women residents and residents from URM groups? (2) How have the proportions of women residents and residents from URM groups changed across the surgical specialties during the past decade?

METHODS

This was a retrospective evaluation of a large, longitudinally maintained survey database. Resident data by gender and ethnicity were retrieved from the Accreditation Council for Graduate Medical Education Data Resource Books for the 2011 to 2012 through 2019 to 2020 academic years. The Accreditation Council for Graduate Medical Education database is updated annually; thus, it is the most up-to-date and complete database available for gender and ethnicity data for all surgical residents. Data were obtained and analyzed for seven different surgical specialties: orthopaedic surgery, neurosurgery, ophthalmology, otolaryngology, plastic surgery, general surgery, and urology. No sampling was necessary, and thus descriptive statistics of the data were completed. Because the entire population of residents was included for the period of time in question, no statistical comparisons were made, and the reported differences represent absolute differences between the groups for these periods. Linear regression analyses were performed to estimate the annual growth rates of women residents and residents from URM groups in each specialty.

RESULTS

Among the seven surgical specialties, representation of women residents increased from 28% (4640 of 16,854) of residents in 2012 to 33% (6879 of 20,788) in 2020. Orthopaedic surgery had the lowest representation of women residents every year, with women residents comprising 16% of residents (700 of 4342) in 2020. Among the seven surgical specialties, representation of residents from URM groups increased from 8.1% (1362 of 16,854) in 2012 to 9.7% (2013 of 20,788) in 2020. In 2020, the representation of residents from URM groups in orthopaedic surgery was 7.7% (333 of 4342). In 2020, general surgery had the highest representation of women residents (42%; 3696 of 8809) as well as residents from URM groups (12%; 1065 of 8809). Plastic surgery (1.46% per year) and general surgery (0.95% per year) had larger annual growth rates of women residents than the other specialties did. In each surgical specialty, the annual growth rate of residents from URM groups was insignificant.

CONCLUSION

During the past decade, there was only a small increase in the representation of women in orthopaedic surgery, while the representation of people from URM groups did not change. In contrast, by 2020, general surgery had become the most diverse among the seven surgical specialties. To increase diversity in our field, we need to evaluate and implement some of the effective interventions that have helped general surgery become the diverse surgical specialty that it is today.

CLINICAL RELEVANCE

General surgery has substantially reduced gender and ethnic disparities that existed in the past, while those in orthopaedic surgery still persist. General surgery residencies have implemented a holistic review of resident applications and longitudinal mentoring programs to successfully address these disparities. Orthopaedic surgery programs should consider placing less emphasis on United States Medical Licensing Examination score thresholds and more weight on applicants' non-academic attributes, and put more efforts into targeted longitudinal mentorship programs, some of which should be led by non-minority faculty.

Gender Distribution of Deans Among US Medical Schools: Towards Equity in Academic Medicine

BACKGROUND

Less than half of medical school professorships and decanal ranks are held by women. Our study investigates the gender-based geographical distribution and differences in lifetime peer-reviewed publications, H-index, and grant funding by the National Institutes of Health (NIH) of all allopathic medical school deans in the United States (US).

METHODS

A cross-sectional cohort study utilizing data from US allopathic medical school websites, PubMed, and the NIH Research Portfolio Online Reporting Tools regarding lifetime peer-reviewed publications and quantity/monetary sum of NIH grants received by medical school deans. Descriptive statistics, independent sample T-tests, and ANOVA were performed with statistical significance defined as P < 0.05.

RESULTS

Women occupied 33/157 (21.0%) dean positions overall. Compared to women, men possess higher mean number of lifetime peer-reviewed publications (112.0 vs. 55.2, P = 0.001) and H-index (43.2 vs. 25.7, P = 0.001); however, there are no differences in the mean number of NIH grants (27.5 vs. 19.1, P = 0.323) nor mean total NIH funding received ($18,931,336 vs. $14,289,529, P = 0.524). While significant differences in mean H-index between all US regions were found (P = 0.002), no significant differences exist between major US regions regarding the mean lifetime publication count (P = 0.223), NIH grants received (P = 0.200), nor total NIH funding (P = 0.824) received.

CONCLUSION

A significant discrepancy in the gender distribution, lifetime peer-reviewed publications, and H-index of allopathic medical school deans exists across the US, highlighting the need for adequate support for women in academic medicine. Greater implementation of mentorship, increased institutional support, and diversity training can improve the representation of women in medical school decanal positions.

Do mentoring programmes influence women's careers in the health and medical research sector? A mixed-methods evaluation of Australia's Franklin Women Mentoring Programme

OBJECTIVES

It is known that women are under-represented in senior positions within the health and medical research sector. The Franklin Women Mentoring Programme (Programme) is a professionally facilitated, cross-organisational initiative designed to support career development for mid-career women. The objective of this study was to evaluate Programme outcomes reported by participants 12 months following its formal conclusion.

DESIGN

Explanatory sequential mixed-methods study design using a cross-sectional survey and semi-structured interviews.

SETTING

Health and medical research institutes in Sydney, Australia.

PARTICIPANTS

Health and medical researchers from the 2018 Programme.

PRIMARY AND SECONDARY OUTCOME MEASURES

Changes in knowledge, skills, behaviours and research metrics directly attributed to Programme participation.

RESULTS

A total of 50 mentors and mentees participated in the cross-sectional survey (68% of the total cohort) and 14 mentors and mentees participated in the interviews. All reported changes to their knowledge, skills, behaviours and research metrics which were directly attributed to participation in the Programme. This included changes in knowledge and skills to be more inclusive (96% mentees, 83% mentors), resilience (88% mentees, 67% mentors), ability to have difficult workplace conversations (88% mentees, 71% mentors) and improvements in supervisory and team management (82% mentees, 75% mentors) skills. Positive impacts on promotions and grant opportunities were also reported. All evaluation participants believed this Programme was a worthwhile initiative for their workplaces to invest in.

CONCLUSION

Participation in this cross-organisational, professionally facilitated, structured mentoring programme has led to positive outcomes for mentees, as well as mentors. Reported outcomes indicate the Programme is meeting its aims to support the career development of mid-career women in health and medical research, while facilitating a more inclusive workforce.

Women Representation as First and Corresponding Authors in Neuroanesthesiology and Neurocritical Care Journals: A Retrospective Analysis

INTRODUCTION

There is limited literature on the representation of women in leading roles in neuroanesthesiology and neurocritical care academia. We aimed to determine the representation of women as first and corresponding authors in articles published in 3 dedicated journals of neuroanesthesiology and neurocritical care during last 5 years.

METHODS

Articles published in the Journal of Neurosurgical Anesthesiology, Neurocritical Care, and Journal of Neuroanaesthesiology and Critical Care between July 1, 2015 and June 30, 2020 were included in this study. The primary outcome was the proportion of women first authors, and secondary outcomes were the percentage of women corresponding authors, and representation of women as first and corresponding author by article type and country of affiliation.

RESULTS

Of the 1164 articles included in the study, 403 (34.6%) had a woman first author. Women first authorship was highest for Special Articles (5/11; 45.5%), Clinical Reports (44/113; 38.9%) and Narrative Review Articles (58/151; 38.4%) and lowest for Original Research Articles (198/597; 33.2%). Women accounted for 29.6% (344/1164) of corresponding authors across all article types. Overall, the United States and India had the highest representation of women first authors (159/403; 39.0% and 107/344; 31.0%, respectively), and India also had highest proportion of women corresponding authors (107/272; 39.3%).

CONCLUSIONS

Women were underrepresented compared with men as first author of articles published in 3 dedicated neuroanesthesiology and neurocritical care journals over the last 5 years. Women had the lowest representation as authors of Original Research Articles.