Research Conducted in Women Was Deemed More Impactful but Less Publishable than the Same Research Conducted in Men

Promoting equity in clinical research: The role of social determinants of health

OBJECTIVE

This study aims to investigate the association between social determinants of health (SDoH) and clinical research recruitment outcomes and recommends evidence-based strategies to enhance equity.

MATERIALS AND METHODS

Data were collected from the internal clinical study manager database, clinical data warehouse, and clinical research registry. Study characteristics (e.g., study phase) and sociodemographic information were extracted. Median neighborhood income, distance from the study location, and Area Deprivation Index (ADI) were calculated. Mixed effect generalized regression was used for clustering effects and false discovery rate adjustment for multiple testing. A stratified analysis was performed to examine the impact in distinct medical departments.

RESULTS

The study sample consisted of 3,962 individuals, with a mean age of 61.5 years, 53.6 % male, 54.2 % White, and 49.1 % non-Hispanic or Latino. Study characteristics revealed a variety of protocols across different departments, with cardiology having the highest percentage of participants (46.4 %). Industry funding was the most common (74.5 %), and digital advertising and personal outreach were the main recruitment methods (58.9 % and 90.8 %).

DISCUSSION

The analysis demonstrated significant associations between participant characteristics and research participation, including biological sex, age, ethnicity, and language. The stratified analysis revealed other significant associations for recruitment strategies. SDoH is crucial to clinical research recruitment, and this study presents evidence-based solutions for equity and inclusivity. Researchers can tailor recruitment strategies to overcome barriers and increase participant diversity by identifying participant characteristics and research involvement status.

CONCLUSION

The findings highlight the relevance of clinical research inequities and equitable representation of historically underrepresented populations. We need to improve recruitment strategies to promote diversity and inclusivity in research.

"Women's work": Gender and the physician workforce

Historically, the physician professional identity and the organizational structure of Western medicine have been defined by masculine norms such as authority and assertiveness. The past five decades have seen a rapid shift in the demographics of attendees as medical schools, with equal numbers of women and men matriculants for nearly twenty years. Gender as a social, cultural, and structural variable continues to influence the physician workforce. The entry of women into medicine, has had far reaching effects on the expectations of patients, the interactions of physicians with other members of the healthcare team, and the delivery of care. Redefining the culture of medicine to accommodate the diversity of the modern workforce may benefit all physician and improve the delivery of healthcare.

Towards equal representation - A bibliometric analysis of authorships in Laboratory Medicine and Clinical Chemistry from the United States, Canada, and Europe (2005-2022)

Objectives

Although diversity has been demonstrated to benefit research groups, women remain underrepresented in most scientific disciplines, including Laboratory Medicine and Clinical Chemistry. In order to promote diversity and equality in scientific communities, understanding the gender distribution of authorship is crucial.

Methods

This study included a total of 30,268 Web of Science-listed Clinical Chemistry and Laboratory Medicine publications from the United States of America, Canada, and the member countries of the European Federation of Clinical Chemistry and Laboratory Medicine from 2005 to 2022. In addition to the publication productivity of female and male authors over time, gender-specific publication characteristics and country-specific gender distributions of authorships were examined.

Results

Overall, publications with female first authors increased by 49 % between 2005 and 2022, averaging 42 % female first authors. Eastern Europe (60 %) and Southern Europe (51 %) had particularly high proportions of female first authors. While female last authorship was the most predictive of female first authorship, with an odds ratio of 2.01 (95 % CI: 1.91-2.12, p < 0.001), only 27 % of last authors were female. Moreover, citation rate was not predictive of female first or last authorship.

Conclusion

Authorship in Clinical Chemistry and Laboratory Medicine is moving towards gender parity. This trend is more pronounced for first authors than for last authors. Further research into the citations of female authors in this discipline could be a starting point for increasing the visibility of women researchers in science. Moreover, geographical differences may provide opportunities for future research on gender parity across disciplines.

Gender as a social and structural variable: research perspectives from the National Institutes of Health (NIH)

Gender is a social and structural variable that encompasses multiple domains, each of which influences health: gender identity and expression, gender roles and norms, gendered power relations, and gender equality and equity. As such, gender has far-reaching impacts on health. Additional research is needed to continue delineating and untangling the effects of gender from the effects of sex and other biological variables. The National Institutes of Health (NIH) vision for women's health is a world in which the influence of sex and/or gender are integrated into the health research enterprise. However, much of the NIH-supported research on gender and health has, to date, been limited to a small number of conditions (e.g., HIV, mental health, pregnancy) and locations (e.g., sub-Saharan Africa; India). Opportunities exist to support transdisciplinary knowledge transfer and interdisciplinary knowledge building by advancing health-related social science research that incorporates best practices from disciplines that have well-established methods, theories, and frameworks for examining the health impacts of gender and other social, cultural, and structural variables.

Stress as a Risk Factor for Mental Disorders in a Gendered Environment

This Viewpoint discusses the value of assessing specific stressors that may vary by gender when assessing mental health to better inform our knowledge of stress effects and aid in developing better targeted, gender-informed prevention and treatment efforts in psychiatry.

Inequalities in the Evaluation of Male Versus Female Athletes in Sports Medicine Research: A Systematic Review

BACKGROUND

Female sports participation continues to rise; however, inequalities between male and female athletes still exist in many areas and may extend into medical research.

PURPOSE

The purpose of this study was to (1) compare the number of published studies evaluating male versus female athletes in various sports and (2) identify which co-ed sports currently underrepresent female athletes in the sports medicine literature.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

All nonreview research studies published from 2017 to 2021 in 6 top sports medicine journals were considered for inclusion. Sports medicine studies were included that isolated athletes, reported study outcomes specific to male and/or female patients, provided study outcomes for specific sports, and evaluated ≤3 different sports. The total number of studies reporting on male and/or female athletes were compared for all sports, and odds ratios (ORs) were calculated. Comparisons of study design, level of sports participation, outcomes assessed, and study quality were also made according to participant sex.

RESULTS

Overall, 669 studies were included the systematic review. Most studies isolated male athletes (70.7%), while 8.8% isolated female athletes and 20.5% included male and female athletes. Female athletes were more frequently studied in softball and volleyball, while male athletes were more commonly researched in baseball, soccer, American football, basketball, rugby, hockey, and Australian football. Notably, male athletes were largely favored in baseball/softball (91% vs 5%; OR = 18.2), rugby (72% vs 5%; OR = 14.4), soccer (65% vs 15%; OR = 4.3), and basketball (58% vs 18%; OR = 3.2).

CONCLUSION

Sports medicine research has favored the evaluation of male athletes in most sports, including the majority of co-ed sports. Potential reasons for this inequality of research evaluation include availability of public data and database data, financial and promotional incentives, a high percentage of male sports medicine clinicians and researchers, and sex biases in sport. While the causes of these differences are multifaceted, researchers should consider both sexes for study inclusion whenever possible, and journals should support a more balanced representation of research publications regarding male and female athletes.

Effect of a Workshop to Break the Bias Habit for Internal Medicine Faculty: A Multisite Cluster Randomized Controlled Study

PURPOSE

Recognition that cultural stereotypes can unintentionally perpetuate inequities throughout academic medicine has led to calls for "implicit bias training" without strong evidence to support these recommendations and some evidence of potential harm. The authors sought to determine the effectiveness of a single 3-hour workshop in helping department of medicine faculty overcome implicit stereotype-based bias and in improving the climate in the working environment.

METHOD

A multisite cluster randomized controlled study (October 2017 to April 2021) with clustering at the level of divisions within departments and participant-level analysis of survey responses involved 8,657 faculty in 204 divisions in 19 departments of medicine: 4,424 in the intervention group (1,526 attended a workshop) and 4,233 in the control group. Online surveys at baseline (3,764/8,657 = 43.48% response rate) and 3 months after the workshop (2,962/7,715 = 38.39% response rate) assessed bias awareness, bias-reducing intentional behavioral change, and perceptions of division climate.

RESULTS

At 3 months, faculty in the intervention vs control divisions showed greater increases in awareness of personal bias vulnerability ( b = 0.190 [95% CI, 0.031 to 0.349], P = .02), bias reduction self-efficacy ( b = 0.097 [95% CI, 0.010 to 0.184], P = .03), and taking action to reduce bias ( b = 0.113 [95% CI, 0.007 to 0.219], P = .04). The workshop had no effect on climate or burnout, but slightly increased perceptions of respectful division meetings ( b = 0.072 [95% CI, 0.0003 to 0.143], P = .049).

CONCLUSIONS

Results of this study should give confidence to those designing prodiversity interventions for faculty in academic medical centers that a single workshop which promotes awareness of stereotype-based implicit bias, explains and labels common bias concepts, and provides evidence-based strategies for participants to practice appears to have no harms and may have significant benefits in empowering faculty to break the bias habit.

Sex and gender in infection and immunity: addressing the bottlenecks from basic science to public health and clinical applications

Although sex and gender are recognized as major determinants of health and immunity, their role is rarely considered in clinical practice and public health. We identified six bottlenecks preventing the inclusion of sex and gender considerations from basic science to clinical practice, precision medicine and public health policies. (i) A terminology-related bottleneck, linked to the definitions of sex and gender themselves, and the lack of consensus on how to evaluate gender. (ii) A data-related bottleneck, due to gaps in sex-disaggregated data, data on trans/non-binary people and gender identity. (iii) A translational bottleneck, limited by animal models and the underrepresentation of gender minorities in biomedical studies. (iv) A statistical bottleneck, with inappropriate statistical analyses and results interpretation. (v) An ethical bottleneck posed by the underrepresentation of pregnant people and gender minorities in clinical studies. (vi) A structural bottleneck, as systemic bias and discriminations affect not only academic research but also decision makers. We specify guidelines for researchers, scientific journals, funding agencies and academic institutions to address these bottlenecks. Following such guidelines will support the development of more efficient and equitable care strategies for all.

Structural Sexism and Cancer Care: The Effects on the Patient and Oncologist

Despite progress toward equity within our broad social context, the domains of gender as a social, cultural, and structural variable continue to exert influence on the delivery of oncology care. Although there have been vast advances in our understanding of the biological underpinnings of cancer and significant improvements in clinical care, disparities in cancer care for all women-including cisgender, transgender, and gender diverse women-persist. Similarly, despite inclusion within the oncology physician workforce, women and gender minorities, particularly those with additional identities under-represented in medicine, still face structural barriers to clinical and academic productivity and career success. In this article, we define and discuss how structural sexism influences both the equitable care of patients with cancer and the oncology workforce and explore the overlapping challenges in both realms. Solutions toward creating environments where patients with cancer of any gender receive optimal care and all physicians can thrive are put forward.

Microaggressions, Bias, and Equity in the Workplace: Why Does It Matter, and What Can Oncologists Do?

Despite efforts to embrace diversity, women and members of racial, ethnic, and gender minority groups continue to experience bias, inequities, microaggressions, and unwelcoming atmospheres in the workplace. Specifically, women in oncology have lower promotion rates and less financial support and mentorship, and they are less likely to hold leadership positions. These experiences are exceedingly likely at the intersection of identities, leading to decreased satisfaction, increased burnout, and a higher probability of leaving the workforce. Microaggressions have also been associated with depression, suicidal thoughts, and other health and safety issues. Greater workplace diversity and equity are associated with improved financial performance; greater productivity, satisfaction, and retention; improved health care delivery; and higher-quality research. In this article, we provide tools and steps to promote equity in the oncology workplace and achieve cultural change. We propose the use of tailored approaches and tools, such as active listening, for individuals to become microaggression upstanders; we also propose the implementation of education, evaluation, and transparent policies to promote a culture of equity and diversity in the oncology workplace.

Creating work environments where people of all genders in gynecologic oncology can thrive: An SGO evidence-based review

Equality, equity, and parity in the workplace are necessary to optimize patient care across all aspects of medicine. Gender-based inequities remain an obstacle to quality of care, including within the now majority women subspecialty of gynecologic oncology. The results of the 2020 SGO State of the Society Survey prompted this evidence-based review. Evidence related to relevant aspects of the clinical care model by which women with malignancies are cared for is summarized. Recommendations are made that include ways to create work environments where all members of a gynecologic oncology clinical care team, regardless of gender, can thrive. These recommendations aim to improve equality and equity within the specialty and, in doing so, elevate the care that our patients receive.

Prospective analyses of sex/gender-related publication decisions in general medical journals: editorial rejection of population-based women's reproductive physiology

OBJECTIVE

To assess whether editorial desk rejection at general medical journals (without peer review) of two clinical research manuscripts may relate to author gender or women's physiology topics. Given evidence for bias related to women in science and medicine, and editorial board attitudes, our hypothesis was that submissions by women authors, on women's reproductive, non-disease topics received differential editorial assessment.

DESIGN

A prospective investigation of publications, author gender and topics in general medical journals in two issues following the editorial rejections of two clinical research manuscripts by five major English-language general medical journals. The rejected manuscripts (subsequently published in lower impact journals) described research funded by national granting bodies, in population-based samples, authored by well-published women scientists at accredited institutions and describing innovative women's reproductive physiology results.

SETTING

Tertiary academic medical centre.

MAIN OUTCOME MEASURES

All clinical research published in the two issues following rejection date by each of the five major general medical journals were examined for first/senior author gender. The publication topic was assessed for its gendered population relevance, whether disease or physiology focused, and its funding. Rejection letters assessed editor gender and status.

RESULTS

Women were underrepresented as original research authors; men were 84% of senior and 69% of first authors. There were no, non-disease focused publications relating to women's health, although most topics were relevant to both genders. The majority (80%) of rejection letters appeared to be written by junior-ranked women editors.

CONCLUSION

Sex/gender accountability is necessary for clinical research-based editorial decisions by major general medical journals. Suggestions to improve gender equity in general medical journal publication: (1) an editorial board sex/gender champion with power to advocate for manuscripts that are well-performed research of relevance to women's health/physiology; (2) an editorial rejection adjudication committee to review author challenges; and (3) gender parity in double-blind peer review.

A Year Into the Pandemic: An Update on Women in Science, Technology, Engineering, Math, and Medicine (STEMM)

The coronavirus pandemic revealed long-standing, unaddressed fissures in our systems, including dramatic gender inequities in science, technology, engineering, mathematics and medicine (STEMM) fields. Women have disproportionately carried the burden of child care and other caregiving responsibilities during the pandemic, and there are strong indications that the pandemic will likely exacerbate pre-existing disparities in the pipeline of women in STEMM and in leadership positions. Based on a literature review, our own experiences and the experiences of our colleagues, we review promising strategies that have been implemented by funding bodies, journals, professional societies, and colleges/universities as well as additional strategies that might be helpful for these entities to implement in order to move forward with policies in place that address gender inequities and rebuild our institutional systems better. At this moment in time, institutions should collect data on metrics such as recruitment, retention, tenure/promotion, funding, professional society membership, awards/honors, and scientific publishing. These data will be essential in determining the impact of policies on women in STEMM to ensure they are having the intended effect as well as what future actions might be necessary in an iterative process.