Does stereotype threat affect women in academic medicine?

Analysis of Gender Discrepancies in Leadership Roles and Recognition Awards in the Child Neurology Society

BACKGROUND AND OBJECTIVES

Gender disparities have been demonstrated across several medical specialties, including neurology. Although women have comprised most of the child neurology trainees since 2007, it is not apparent whether this demographic shift is reflected in the Child Neurology Society (CNS) awards and leadership. This study aimed to evaluate the differences in gender representation among leadership positions and award recipients within the CNS. The primary outcome measure was the total number of board of director (BOD) positions or awards given by gender each year.

METHODS

A retrospective review of publicly available data was conducted on CNS members, post-training award recipients, and BOD positions, including nomination records, from 1972 to 2023. Data abstracted were restricted to gender to preserve member and nominee anonymity. Gender identification and consensus were determined through a combination of strategies and study members. Data analysis included descriptive statistics, Pearson χ2 test, and the exact binomial test to compare gender proportions and the probability of being underrepresented in awards, leadership, and nominations over time. Data are presented according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.

RESULTS

From 1972 to 2023, women represented 29% (44/152) of the BOD positions and 26% (61/236) of post-training award recipients presented by the CNS. Despite the increase in the proportion of women in child neurology, the overall gap in gender representation in leadership positions remains broadly stable. Only 13% (4/32) of CNS presidents have been women, a significant underrepresentation (95% CI 2.3%-52%, p < 0.004), although the representation of women in nonpresidential positions increased from 2003 to 2023. Women are also underrepresented as overall awardees (95% CI 12%-38%, p < 0.00001) except for the Philip R. Dodge Young Investigator Award, which is an investigator-initiated application.

DISCUSSION

Women remain underrepresented at the highest levels of recognition in child neurology despite representing most of the field. Reasons for disparities are known to be multifactorial and likely include gender bias and structural sexism. We present several discussion topics that seek to rationalize this disparity and provide suggestions for improving diversity, equity, and inclusion for leadership roles and awards.

Curriculum reform and stereotype threat in medical education: Implications for student well-being

PURPOSE

Altering the curriculum of a program can have negative repercussions for the student experience, including peer mentorships and interclass relationships. This study investigated the effect of curriculum reform on students' emotional and social well-being in a predoctoral dental program. We explored if any of these consequences could be related to stereotype threat.

METHODS

We utilized a quasi-experimental design with two different treatments, New Curriculum Treatment (New-CT, n = 44) and Past Curriculum Treatment (Past-CT, n = 43). Quantitative data were collected through surveys to assess students' perceptions of curriculum changes and their impacts on anxiety, confidence, and clinical performance. Qualitative data were gathered via semi-structured interviews to explore personal experiences of stereotype threat and its implications on peer relationships and mentorship dynamics.

RESULTS

The findings suggest significant effects of curriculum changes on interpersonal relationships. Past-CT viewed New-CT as overconfident, while New-CT felt heightened performance pressure. Thematic and interview analyses revealed deep-rooted tensions, with New-CT feeling mistrusted and Past-CT resenting New-CT's perceived accelerated competence. Stereotype threat was identified as a key factor worsening these inter-group tensions and affecting clinical performance and relationships.

CONCLUSIONS

Curriculum changes in dental education can significantly affect students' well-being, with stereotype threat playing a critical role in these dynamics. When making changes to the structure, sequencing, or content of a program, administrators need to be aware of the potential ramifications these changes could have on students' relationships with their peers.

Women at the top: a qualitative study of women in leadership positions in emergency medicine in Canada

OBJECTIVES

For the last two decades, more than half of Canadian medical students have been women, with an increasing number of medical trainees choosing emergency medicine as their careers. Despite a proportional increase of women in full-time faculty positions in emergency medicine, women are still underrepresented in leadership. The purpose of this study is to explore the experiences of women leaders in emergency medicine to identify common themes that may have contributed to their acquisition of leadership roles.

METHODS

Participants included women emergency medicine physicians in Canada who currently or previously held a leadership position. Data were collected through semi-structured interviews. Inductive thematic analysis was performed on the interview transcripts. Transcribed data were coded and categorized into recurrent themes. A narrative summary of the most impactful themes was presented.

RESULTS

Twenty participants were interviewed. Most participants perceived career opportunities were due to chance, related to personal skill set, or required additional training. Participants highlighted the importance of mentorship and sponsorship. Gender expectations and traditional gender roles were perceived as having a negative impact on career leadership success. Participants acknowledged the need for women in leadership to empower younger generations of women to become leaders. For future emergency medicine leaders, participants suggested applying for leadership positions early, networking, and seeking mentorship. Potential supportive changes to leadership structures included explicit parental leave policies, flexible scheduling, and job sharing to encourage women leaders.

CONCLUSION

To date, there has been no Canadian specific study exploring the factors contributing to the success of women leaders in emergency medicine. This study examines career advancement of women leaders in emergency medicine and provides useful insight to those aspiring to grow their careers, as well as to mentors and sponsors of women in emergency medicine.

A Coaching-Based Leadership Program for Women Postdoctoral Fellows at the National Cancer Institute that Cultivates Self-confidence and Persistence in STEMM

Despite making strides in gender equality, women in Science, Technology, Engineering, Mathematics, and Medicine (STEMM) continue to face a persistent underrepresentation in leadership roles. In an effort to reverse this trend, the National Cancer Institute created the Sallie Rosen Kaplan (SRK) Postdoctoral Fellowship, a year-long coaching-based leadership training program. The SRK program aims to empower women to explore careers across a broad range of fields, including academia, industry, and government, and to excel in leadership positions in those fields. Analyzing a decade of data from 111 participants, we describe the positive impact of the SRK program on participant's self-reported capabilities. Increased self-confidence, improved time management and work/life balance, enhanced goal-setting and attainment skills, and strengthened communication and relationship-building abilities are highlighted as statistically significant outcomes. Moreover, the program's emphasis on coaching, mentorship, peer cohort support, and building lasting professional relationships also contributed to high ratings for satisfaction and value of the program. Successful programs like SRK can serve as a model for institutions striving to close gender gaps in leadership.

More Than a Joke: The Intersection of Gender-Based Humor and Gender Inequities Experienced by Women Department Chairs in Academic Medicine

Purpose: The purpose of this qualitative descriptive study is to describe how women academic department chairs in emergency medicine, surgery, and anesthesiology experience humor in the workplace. Method: Interviews were conducted with 35 women department chairs in academic medicine from 27 institutions that aimed to describe women's leadership emergence. The data from the primary study yielded rich and revealing themes involving participants' experiences with humor in the context of their leadership roles, justifying a secondary analysis focusing specifically on these experiences. Relevant remarks were extracted, coded, and summarized. Results: Participants discussed two broad types of humor-related experiences. First, they described how they responded to aggressive gender-based humor directed at themselves or their colleagues by tolerating it or expressing disapproval. This humor includes demeaning quips, insulting monikers, sexist jokes, and derogatory stories. Participants often did not confront this humor directly as they feared being rejected or ostracized by colleagues. Second, they described how they initiated humor to address gender-related workplace issues by highlighting gender inequalities, coping with sexual harassment and assault, and managing gender-based leadership challenges. Participants felt constrained in their own use of humor because of the need to be taken seriously as women leaders. Conclusion: Women leaders in academic medicine use humor to confront gender-related issues and experience aggressive gender-based humor in the workplace. The constraints placed on women leaders discourage them from effectively confronting this aggressive gender-based humor and perpetuating gender inequities. Eliminating aggressive gender-based humor is needed to create safe and equitable work environments in academic medicine.

Unconscious bias in speaker introductions at a national vascular surgery meeting: The impact of rank, race and gender

OBJECTIVES

Unconscious bias can impact manner of speaker introductions in formal academic settings. We examined speaker introductions at the Society of Vascular Surgeons Annual Meeting to determine factors associated with non-professional address.

METHODS

We examined speaker introductions from the 2019 SVS Vascular Annual Meeting. Professional title with either full name or last name was considered professional address. Speaker and moderator demographics were collected. Univariate and multivariate logistic regression analyses were performed to identify associations between introduction and speaker and moderator characteristics.

RESULTS

336 talks met inclusion criteria. Both speakers and moderators were more likely to be white (63.4 ​% and 65.8 ​%,p ​= ​0.92), man (75.6 ​% and 74.4 ​%,p ​= ​0.82) and full professor rank (34.5 ​% and 42.3 ​%, p ​< ​0.001). On multivariable regression, non-professional address was associated with speaker rank of trainee (OR 3.13, p ​= ​0.05) and when moderator was white (OR 2.42, p ​= ​0.03).

CONCLUSIONS

This study emphasizes the potential negative impact of unconscious bias at a national meeting for vascular surgeons and the need to mitigate this effect at the organization level.

Language Matters: Is There Gender Bias in Internal Medicine Grand Rounds Introductions?

PURPOSE

 We performed an exploratory evaluation of gender-specific differences in speakers and their introductions at internal medicine grand rounds.

METHOD

 Internal medicine grand rounds video archives from three sites between December 2013 and September 2020 were manually transcribed and analyzed using natural language processing techniques. Differences in word usage by gender were compared.

RESULTS

 Four hundred and sixty-two grand rounds held at three institutions were examined. There were 167 (34.6%) speakers who were women and 316 (65.4%) who were men. The proportion of women speakers was significantly lower than that of women in the internal medicine workforce (34.6% vs. 39.2%, p = 0.04). Among 191 external speakers, only 57 (29.8%) were women. The use of professional titles was equivalent between genders. Despite equal mention of specific achievements in both male and female speaker introductions, there was a trend toward casting female speakers as being less established.

CONCLUSION

 There is a need to adopt processes that will decrease inequities in the representation of women in grand rounds and in their introductions.

A Qualitative Exploration of the Career-Choice Journey of Women in Anesthesiology

Background

Women are underrepresented in the anesthesiology physician workforce. Additionally, recruitment of women into the specialty has been stagnant over the past 2 decades. Current evidence is lacking regarding how and why women navigate the career-exploration journey to find anesthesiology. The purpose of this study was to investigate the phenomenon of women choosing a career in anesthesiology, specifically identifying facilitators and barriers to career choice and professional identity formation.

Methods

Using constructivist grounded theory, we explored the self-reported experiences of women anesthesiology trainees, including resident physicians and senior medical students. Seven resident physicians and 4 medical students participated in the study. Through semistructured interviews, data collection, and iterative analysis, the authors identified codes and emerging themes, thereby advancing the understanding of the career-choice journeys of women anesthesiologists.

Results

Iterative analysis revealed 6 themes related to career-choice journeys for women in anesthesiology. Three emerging themes have been previously described in career-choice reviews (specialty characteristics, gender awareness, and pathway support). Additionally, 3 novel themes emerged from our study population (hidden curriculum, learning environment, and mystery behind the drape).

Conclusions

The findings of this study highlight factors and experiences that impact career-choice decisions for women who choose anesthesiology. Only in understanding the how and why of women physicians' journeys can we hope to build on this knowledge, thereby striving to develop educational, clinical, professional, and personal experiences that support women along their professional journeys to ultimately find anesthesiology.

Matching Against Men: 5 Years of Residency Match Data Show Disparities Still Exist

OBJECTIVES

Despite progress toward equal representation by sex in medical practice, women remain underrepresented in many specialties. This study sought to examine the current state of gender equality among recently graduated doctors in multiple specialties.

METHODS

Deidentified demographics, standardized examination scores, and Match results were gathered for 829 graduates. Participants were selected from an allopathic medical school between 2016 and 2020. Nineteen students (2.29%) were excluded from the study. Descriptive statistics were calculated, and χ2 tests for independence were used to compare proportions between reported sex and specialty and program Match results. One-way analysis of variance was then performed to test for differences in US Medical Licensing Examination Step 1 and Step 2 scores between sexes. P < 0.05 was considered statistically significant.

RESULTS

Of the 829 individuals studied, 44.6% were women. A significantly smaller proportion of women matched into the most competitive specialties, despite no significant difference in US Medical Licensing Examination Step 1 scores between sexes. Furthermore, there was an overall significant trend of women matching into more competitive programs for any given specialty.

CONCLUSIONS

In this study, we found that men matched into more highly competitive specialties, whereas women matched into more competitive residency program locations. Further research is needed to determine why women matched into specific specialties at lower rates than their male peers and seek to understand how sex affects the narrative of specialty choice.

Stereotype Threat and Gender Bias in Internal Medicine Residency: It is Still Hard to be in Charge

BACKGROUND

Despite similar numbers of women and men in internal medicine (IM) residency, women face unique challenges. Stereotype threat is hypothesized to contribute to underrepresentation of women in academic leadership, and exploring how it manifests in residency may provide insight into forces that perpetuate gender disparities.

OBJECTIVE

To quantify the prevalence of stereotype threat in IM residency and explore experiences contributing to that stereotype threat.

DESIGN

We used a mixed methods study design. First, we surveyed IM residents using the Stereotype Vulnerability Scale (SVS) to screen for stereotype threat. Second, we conducted focus groups with women who scored high on the SVS to understand experiences that led to stereotype threat.

PARTICIPANTS

The survey was sent to all IM residents at University of California, San Francisco (UCSF), in September-November 2019. Focus groups were conducted at UCSF in Spring 2020.

APPROACH

The survey included an adapted version of the SVS. For focus groups, we developed a focus group guide informed by literature on stereotype threat. We used a thematic approach to data analysis. The mixed methods design enabled us to draw metainferences by integrating the two data sources.

KEY RESULTS

Survey response rate was 61% (110/181). Women were significantly more likely than men to have a score indicating stereotype threat vulnerability (77% vs 0%, p < 0.001). Four themes from focus groups characterized women's experiences of gender bias and stereotype threat: gender norm tension, microaggressions and sexual harassment, authority questioned, and support and allyship.

CONCLUSIONS

Gender-based stereotype threat is highly prevalent among women IM residents. This phenomenon poses a threat to confidence and ability to execute patient care responsibilities, detracting from well-being and professional development. These findings indicate that, despite robust representation of women in IM training, further attention is needed to address gendered experiences and contributors to women's vulnerability to stereotype threat.

Feminization of the health workforce in China: exploring gendered composition from 2002 to 2020

BACKGROUND

Feminization of health workforce has been globally documented, but it has not been investigated in China. This study aims to analyze changes in the gendered composition of health workforce and explore the trend in different types of health workforce, health organizations and majors within China's health system.

METHODS

The data were collected from China Health Statistical Yearbook from 2002 to 2020. We focused on health professionals including doctors, nurses, and pharmacists in health organizations. Trend analysis was employed to examine the change in the ratio of female health workforce over 18 years. The estimated average annual percent change (AAPC) was estimated, and the reciprocals of variances for the female ratios were used as weights.

RESULTS

In China, health professionals increased from 4.7 million in 2002 to 10.68 million in 2020. Health professionals per 1000 population increased from 3.41 in 2002 to 7.57 in 2020. The ratio of female health professionals significantly increased from 63.85% in 2002 to 72.4% in 2020 (AAPC = 1.04%, 95% CI 0.96-1.11%, P < 0.001). Female doctors and pharmacists increased 4.7 and 7.9 percentage points from 2002 to 2020. Female health workers at township health centers, village clinics, centers for disease control and prevention had higher annual increase rate (AAPC = 1.67%, 2.25% and 1.33%, respectively) than those at hospital (0.70%) and community health center (0.5%). Female doctors in traditional Chinese medicine, dentistry and public health had higher annual increase rate (AAPC = 1.82%, 1.53% and 1.91%, respectively) than female clinical doctor (0.64%).

CONCLUSIONS

More women are participating in the healthcare sector in China. However, socially lower-ranked positions have been feminizing faster, which could be due to the inherent and structural gender norms restricting women's career. More collective and comprehensive system-level actions will be needed to foster a gender-equitable environment for health workforce at all levels.

Gender trends in Canadian medicine and surgery: the past 30 years

BACKGROUND

While the number of women entering medicine has steadily increased since the 1970s in Canada, the gender composition along each stage of the medical training pathway has not been comprehensively reported. We therefore sought to systematically examine the gender composition of students, residents, and practicing physicians over the past 30 years in Canada.

RESULTS

In this cross-sectional analysis of Canadian medical trainees including MD applicants (137,096 male, 169,099 female), MD students (126,422 male, 152, 967 female), MD graduates (29,413 male, 34,173 female), residents by the decade (24,425 male, 28,506 female) and practicing surgeons (total 7,457 male, 3,457 female), we find that increased female representation in medicine is not matched by representation in surgery, with the key being the specialty choice process. The likelihood of female applicants matriculating to medical school was less than male applicants in the 90s (OR 0.92, 95% CI 0.92-0.93), greater in the early 2000s (OR 1.03, 95% CI 1.03-1.04), and has since balanced out (OR 1.00, 95% CI 1.00-1.01), with medical school classes being nearly 60% female for the past two decades. Despite this, females have remained underrepresented in most surgical residency programs, with odds of female medical students entering surgical residency other than Ob/Gyn being about half that of male students (OR 0.56, 95% CI 0.44-0.71), resulting in a slow increase in practicing female surgeons of less than 0.5% per year in many surgical disciplines and projected parity decades or centuries in the future.

CONCLUSIONS

While undergraduate medical education has been majority female in Canada for nearly three decades, females remain greatly underrepresented in the physician workforce within surgical specialties. To build a representative medical workforce equipped to care for diverse patient populations, factors influencing the specialty choices of early career physicians will need to be examined and addressed.

His opportunity, her burden: A narrative critical review of why women decline academic opportunities

OBJECTIVES

This paper stems from a desire to deepen our own understanding of why women might 'say no' when allies and sponsors offer or create opportunities for advancement, leadership or recognition. The resulting disparity between representation by men and women in leadership positions, invited keynote speakers and publication counts in academic medicine is a stubborn and wicked problem that requires a synthesis of knowledge across multidisciplinary literature. Acknowledging the complexity of this topic, we selected a narrative critical review methodology to explore reasons why one man's opportunity might be a woman's burden in academic medicine.

METHODS

We engaged with an iterative process of identifying, reviewing and interpreting literature from Psychology (cognitive, industrial and educational), Sociology, Health Professions Education and Business, placing no restrictions on context or year of publication. Knowledge synthesis and interpretation were guided by our combined expertise, lived experience, consultations with experts outside the author team and these guiding questions: (1) Why might women have less time for career advancement opportunities? (2) Why do women have less time for research and leadership? (3) How are these disparities maintained?

RESULTS

Turning down an opportunity may be a symptom of a much larger issue. The power of social expectations, culture and gender stereotypes remains a resistant force against calls for action. Consequently, women disproportionately take on other tasks that are not as well recognised. This disparity is maintained through social consequences for breaking with firmly entrenched stereotypes.

CONCLUSIONS

Popular strategies like 'lean into opportunities', 'fake it till you make it' and 'overcome your imposter syndrome' suggest that women are standing in their own way. Critically, these axioms ignore powerful systemic barriers that shape these choices and opportunities. We offer strategies that allies, sponsors and peers can implement to offset the power of stereotypes.

Pro-Con Debate: Consideration of Race, Ethnicity, and Gender Is Detrimental to Successful Mentorship

Anesthesiology remains a specialty with low representation of women or members of racial and ethnic groups considered underrepresented in medicine (UiM). In the United States, women account for 33% of anesthesiology residents, while physicians identifying as Black, African American, Latinx, American Indian, or Alaska Native account for approximately 10%. Underrepresentation of these groups is even more pronounced in academic anesthesiology, especially at the senior ranks and roles, such as department chairs. Leaders in the field have recently shared recommendations for how individual departments, medical schools, hospitals, and professional organizations can create and support a more diverse anesthesiology workforce. These commentaries have often stressed the importance of mentorship for supporting women and physicians from UiM groups, including mentorship of trainees and practicing anesthesiologists seeking to advance their careers. While the value of mentorship is undisputed, it remains a matter of controversy whether race, ethnicity, or gender should be explicitly considered by mentoring programs and individual mentors. In this article, we discuss whether and how race, ethnicity, and gender should be considered in the setting of mentorship programs and the formation of individual mentoring relationships, as well as some of the potential consequences that lie therein.

A leap towards changing gender dynamics in oncology leadership - An ESSO-EYSAC initiative

Despite the importance of diversity for the success and survival of biological and social systems, women are underrepresented in leadership positions, particularly in the medical field. Data from seven internationally renowned academic associations in surgical, medical, and radiation oncology show that women's representation in leadership roles is only 11%, with no individual society exceeding 20%. Possible justifications for the underrepresentation of women include unconscious biases and societal norms. Fortunately, a notable development in the form of an increased number of women attaining leadership positions in many major professional societies has emerged over recent times, thereby reflecting a positive transformation in the direction of gender equality. The authors recommend organizational interventions such as mentorship, leadership development programs, and national-level initiatives with global collaboration. The oncology community must promote a culture of cooperation and gender equality to ensure equitable opportunities for women in all aspects of life, including professional hierarchy.

Identifying Gender-Related Differences in Graduate Medical Education with the Use of a Web-Based Professionalism Monitoring Tool

OBJECTIVES

Medical education is required to ensure a healthy training and learning environment for resident physicians. Trainees are expected to demonstrate professionalism with patients, faculty, and staff. West Virginia University Graduate Medical Education (GME) initiated a Web-based professionalism and mistreatment form ("button") on our Web site for reporting professionalism breaches, mistreatment, and exemplary behavior events. The purpose of this study was to identify characteristics in resident trainees who had a "button push" activation about their behavior to better understand ways to improve professionalism in GME.

METHODS

This West Virginia University institutional review board-approved quality improvement study is a descriptive analysis of GME button push activations from July 2013 through June 2021. We compared characteristics of all of those trainees who had specific button activation(s) about their behavior. Data are reported as frequency and percentage. Nominal data and interval data were analyzed using the χ2 and the t test, respectively. P < 0.05 was significant. Logistic regression was used to analyze those differences that were significant.

RESULTS

In the 8-year study period, there were 598 button activations, and 54% (n = 324) of the activations were anonymous. Nearly all of the button reports (n = 586, 98%) were constructively resolved within 14 days. Of the 598 button activations, 95% (n = 569) were identified as involving one sex, with 66.3% (n = 377) identified as men and 33.7% (n = 192) as women. Of the 598 activations, 83.7% (n = 500) involved residents and 16.3% (n = 98) involved attendings. One-time offenders comprised 90% (n = 538), and 10% (n = 60) involved individuals who had previous button pushes about their behavior.

CONCLUSIONS

Implementation of a professionalism-monitoring tool, such as our Web-based button push, identified gender differences in the reporting of professionalism breaches, because twice as many men as women were identified as the instigator of a professionalism breech. The tool also facilitated timely interventions and exemplary behavior recognition.

Gender differences in bullying among internal medicine residents

PURPOSE

To describe gender differences in experienced types of bullying, and resulting personal consequences, among internal medicine (IM) residents.

METHODS

Participants in this cross-sectional study included 21 212 IM trainees who completed a voluntary survey with their 2016 in-training exam that assessed bullying during residency training. The 2875 (13.6% of) trainees who reported experiencing bullying on a screening question were asked for additional details about types of bullying experienced and resulting personal consequences.

RESULTS

Female and male trainees experienced bullying at similar rates (47% versus 53%, P = .08). Gender differences were seen in both the type of bullying experienced and the resulting personal consequences. Female trainees were more likely than their male counterparts to report bullying characterized as verbal (83% versus 77%, P < .001) and sexual (5% versus 2%, P < .001), whereas male trainees were more likely to experience physical (6% versus 4%, P = .03) and "other" bullying types (27% versus 22%, P < .001). Female trainees were more likely to report negative personal consequences than male trainees, and the most common resultant sequela reported was feeling burned out (63% versus 51%, P < .001).

CONCLUSION

Gender differences exist in both the types and consequences of bullying experienced among this national sample of IM residents. These results should be considered by programs and institutions that are hoping to optimize the culture of their workplace and enhance safety in the learning environment.

Bullying in Academic Medicine: Experiences of Women Physician Leaders

PURPOSE

Bullying is defined as offenders abusing positions of authority and intentionally targeting individuals through persistent negative behaviors to impede education or career growth. This study sought to estimate the prevalence and nature of bullying experienced by women physician leaders in academic medicine.

METHOD

In this survey-based study, 547 physician graduates of an executive women's leadership training program were invited to complete a survey that measured workplace bullying in 2021. Participants were asked whether and when they had been bullied, how it impacted their careers, and remedies for bullying. Descriptive statistics were used to profile mistreatment and bullying experienced by the respondents during their professional careers and the nature of bullying. Content analysis of open-ended comments was used to describe how bullying impacted women physicians and outline recommendations for bullying prevention and mitigation.

RESULTS

The survey response rate was 64.7% (354/547). Most women (302/354 [85.3%]) had experienced mistreatment during their careers, with more than half experiencing bullying while an attending physician (198/302 [65.6%]). Many women (187/302 [61.9%]) who screened positive for mistreatment also reported that they had been bullied at work. Of these 187 respondents, 173 (92.5%) experienced bullying from men and 121 (64.7%) reporting bullying from women (effect size = 0.34, P ≤ .001), and 115 (61.5%) reported that bullies were their immediate supervisors. Qualitative findings suggested that bullying harmed individuals' career advancement, mental health, reputation, and relationships with others. Many had to change roles or leave jobs. Participants proposed that initiatives by top-level leaders, clear definitions of bullying behavior, reporting mechanisms, and upstander training for faculty and staff could mitigate bullying.

CONCLUSIONS

Most women physician leaders have experienced bullying. These results highlight the need to address bullying in academic medicine so that women can reach their full career potential.

Assessment of neurosurgical resident milestone evaluation reporting and feedback processes

OBJECTIVE

Structured performance evaluations are important for the professional development and personal growth of resident learners. This process is formalized by the Accreditation Council for Graduate Medical Education milestones assessment system. The primary aim of this study was to understand the current feedback delivery mechanism by exploring the culture of feedback, the mechanics of delivery, and the evaluation of the feedback itself.

METHODS

Face-to-face interviews were conducted with 10 neurosurgery residents exploring their perceptions of summative feedback. Coded data were analyzed qualitatively for overriding themes using the matrix framework method. A priori themes of definition of feedback, feedback delivery, and impact of feedback were combined with de novo themes discovered during analysis.

RESULTS

Trainees prioritized formative over summative feedback. Summative and milestone feedback were criticized as being vague, misaligned with practice, and often perceived as erroneous. Barriers to implementation of summative feedback included perceived veracity of feedback, high interrater variability, and the inconstant adoption of a developmental progression model. Gender bias was noted in degree of feedback provided and language used.

CONCLUSIONS

Trainee perception of feedback provided multiple areas of improvement. This paper can serve as a baseline to study improvements in the milestone feedback process and optimize learning.

Next Steps: Advocating for Women in Orthopaedic Surgery

Orthopaedic surgery is the least diverse of all medical specialties, by both sex and race. Diversity among orthopaedic trainees is the lowest in medicine, and growth in percentage representation is the lowest of all surgical subspecialties. Women comprise only 6% of orthopaedic surgeons and 16% of orthopaedic surgery trainees. This extreme lack of diversity in orthopaedics limits creative problem-solving and the potential of our profession. Women in orthopaedics encounter sexual harassment, overt discrimination, and implicit bias, which create barriers to training, career satisfaction, and success. Women are underrepresented in leadership positions, perpetuating the lack of diversity through poor visibility to potential candidates, which impedes recruitment. Correction will require a concerted effort, as acknowledged by the American Academy of Orthopaedic Surgeons leadership who included a goal and plan to increase diversity in the 2019 to 2023 Strategic Plan. Recommended initiatives include support for pipeline programs that increase diversity of the candidate pool; sexual harassment and implicit bias acknowledgement, education, and corrective action; and the active sponsorship of qualified, capable women by organizational leaders. To follow, women will lend insight from their diverse viewpoints to research questions, practice problems, and clinical conundrums of our specialty, augmenting the profession and improving patient outcomes.

Physician Identification Badges: A Multispecialty Quality Improvement Study to Address Professional Misidentification and Bias

OBJECTIVE

To evaluate whether providing resident physicians with "DOCTOR" role identification badges would impact perceptions of bias in the workforce and alter misidentification rates.

PARTICIPANTS AND METHODS

Between October 2019 and December 2019, we surveyed 341 resident physicians in the anesthesiology, dermatology, internal medicine, neurologic surgery, otorhinolaryngology, and urology departments at Mayo Clinic in Rochester, Minnesota, before and after an 8-week intervention of providing "DOCTOR" role identification badges. Differences between paired preintervention and postintervention survey answers were measured, with a focus on the frequency of experiencing perceived bias and role misidentification (significance level, α=.01). Free-text comments were also compared.

RESULTS

Of the 159 residents who returned both the before and after surveys (survey response rate, 46.6% [159 of 341]), 128 (80.5%) wore the "DOCTOR" badge. After the intervention, residents who wore the badges were statistically significantly less likely to report role misidentification at least once a week from patients, nonphysician team members, and other physicians (50.8% [65] preintervention vs 10.2% [13] postintervention; 35.9% [46] vs 8.6% [11]; 18.0% [23] vs 3.9% [5], respectively; all P<.001). The 66 female residents reported statistically significantly fewer episodes of gender bias (65.2% [43] vs 31.8% [21]; P<.001). The 13 residents who identified as underrepresented in medicine reported statistically significantly less misidentification from patients (84.6% [11] vs 23.1% [3]; P=.008); although not a statistically significant difference, the 13 residents identifying as underrepresented in medicine also reported less misidentification with nonphysician team members (46.2% [6] vs 15.4% [2]; P=.13).

CONCLUSION

Residents reported decreased role misidentification after use of a role identification badge, most prominently improved among women. Decreasing workplace bias is essential in efforts to improve both diversity and inclusion efforts in training programs.

Diversity and Inclusion in Internal Medicine Training Programs: An Unfulfilled Dream

Background

Promoting a diversified healthcare force fosters more culturally centered care, expands the approach to high-quality healthcare for poorly served populations, improves patient contentment, and broadens research agendas, all components essential to minimize healthcare imbalances. Our study reviews the trends of gender and racial disparity in Internal Medicine residency programs.

Methodology

In this retrospective analysis, we extracted data from the Accreditation Council for Graduate Medical Education’s annual Data Resource Books from 2007 to 2019. Gender was reported as males and females. Race/ethnicity was cataloged as White/non-Hispanic, Black/non-Hispanic, Hispanic, Asian or Pacific Islander, Native American/Alaskan, others, and unknown.

Results

The representation of women increased progressively, with a relative increase of 4.7% from 2007 to 2019. For race/ethnicity, the study period started from the year 2011. When averaged across the eight-year study period, 27% of the study sample were White (non-Hispanic), followed by Asian/Pacific Islanders at 21%. The representation of other races was even lower. For 36.2% of the residents, the racial data were not known and categorized as unknown racial distribution.

Conclusions

Our study reports that gender and racial/ethnic imbalance persists within the training programs of Internal Medicine. Effectual strategies should be implemented to improve access to care to the underrepresented communities, address physician shortages in different areas of the country, and strengthen our ability to address long-established disparities in healthcare and outcomes.

The Stereotype Content Model as an Explanation of Biased Perceptions in a Medical Interaction: Implications for Patient-Provider Relationship

This experimental investigation uses the stereotype content model (SCM) to explain the biases associated with the perceptions of healthcare providers and the subsequent impact of such biased perceptions. Specifically, the 2 (gender: male, female) by 2 (race: Arab, Caucasian) between-subjects experiment examined the impact of physician race and gender on people's perceptions regarding physician's communication competence, trust, and intentions to visit. The findings indicate that female physicians are considered not only warmer but also more competent than male physicians. White physicians are considered less competent overall than their minority counterparts, though no differences in perceived patient-centered communication behaviors were observed. In addition, perceived competence and warmth mediated the effect of physician gender and race (only warmth) on the perceptions of trust, physician's use of patient-centered communication, and intentions to visit. The theoretical and practical implications of the study are discussed.

Towards equitable learning environments for medical education: Bias and the intersection of social identities

CONTEXT

Medical educators are increasingly paying attention to how bias creates inequities that affect learners across the medical education continuum. Such bias arises from learners' social identities. However, studies examining bias and social identities in medical education tend to focus on one identity at a time, even though multiple identities often interact to shape individuals' experiences.

METHODS

This article examines prior studies on bias and social identity in medical education, focusing on three social identities that commonly elicit bias: race, gender and profession. By applying the lens of intersectionality, we aimed to generate new insights into intergroup relations and identify strategies that may be employed to mitigate bias and inequities across all social identities.

RESULTS

Although different social identities can be more or less salient at different stages of medical training, they intersect and impact learners' experiences. Bias towards racial and gender identities affect learners' ability to reach different stages of medical education and influence the specialties they train in. Bias also makes it difficult for learners to develop their professional identities as they are not perceived as legitimate members of their professional groups, which influences interprofessional relations. To mitigate bias across all identities, three main sets of strategies can be adopted. These strategies include equipping individuals with skills to reflect upon their own and others' social identities; fostering in-group cohesion in ways that recognise intersecting social identities and challenges stereotypes through mentorship; and addressing intergroup boundaries through promotion of allyship, team reflexivity and conflict management.

CONCLUSIONS

Examining how different social identities intersect and lead to bias and inequities in medical education provides insights into ways to address these problems. This article proposes a vision for how existing strategies to mitigate bias towards different social identities may be combined to embrace intersectionality and develop equitable learning environments for all.

Women Oncologists' Perceptions and Factors Associated With Decisions to Pursue Academic vs Nonacademic Careers in Oncology

IMPORTANCE

Women outnumber men in US medical school enrollment, but they represent less than 40% of academic oncology faculty.

OBJECTIVE

To identify the key factors associated with female oncologists' decision to pursue academic or nonacademic oncology practice and to characterize their perceptions about their current career.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional survey study was distributed through email and social media to female physicians in academic and nonacademic oncology practice in the United States. The survey was open for 3 months, from August 1 to October 31, 2020.

MAIN OUTCOMES AND MEASURES

No single primary study outcome was established because of the cross-sectional nature of the survey. Data were collected anonymously and analyzed using t tests for continuous variables and χ2 tests for categorical variables.

RESULTS

Among the 667 female respondents, 422 (63.2%) identified as academic oncologists and 245 (36.8%) identified as nonacademic oncologists. Approximately 25% of respondents reported that their spouse or partner (156 [23.5%]) and/or family (176 [26.4%]) extremely or moderately affected their decision to pursue academic practice. Academic oncologists perceived the biggest sacrifice of pursuing academics to be time with loved ones (181 [42.9%]). Nonacademic oncologists perceived the biggest sacrifice of pursuing academics to be pressure for academic promotion (102 [41.6%]). Respondents had different perceptions of how their gender affected their ability to obtain a chosen job, with 116 academic oncologists (27.6%) and 101 nonacademic oncologists (41.2%) reporting a positive or somewhat positive impact (P = .001). More than half of the women surveyed (54.6% academic oncologists [230]; 50.6% nonacademic oncologists [123]; P = .61) believed they were less likely to be promoted compared with male colleagues. Academic and nonacademic oncologists reported rarely or never having a sense of belonging in their work environment (33 [7.9%] and 5 [2.0%]; P < .001). Most respondents reported that they would choose the same career path again (301 academic oncologists [71.3%]; 168 nonacademic oncologists [68.6%]); however, 92 academic oncologists (21.9%) reported they were likely to pursue a career outside of academic oncology in the next 5 years.

CONCLUSIONS AND RELEVANCE

This survey study found that a spouse or partner and/or family were factors in the career choice of both academic and nonacademic oncologists and that female gender was largely perceived to adversely affect job promotion. Given that more than 20% of female academic oncologists were considering leaving academia, gender inequality is at high risk of continuing if the culture is not addressed.

Gender bias in resident evaluations: Natural language processing and competency evaluation

BACKGROUND

Research shows that female trainees experience evaluation penalties for gender non-conforming behaviour during medical training. Studies of medical education evaluations and performance scores do reflect a gender bias, though studies are of varying methodology and results have not been consistent.

OBJECTIVE

We sought to examine the differences in word use, competency themes and length within written evaluations of internal medicine residents at scale, considering the impact of both faculty and resident gender. We hypothesised that female internal medicine residents receive more negative feedback, and different thematic feedback than male residents.

METHODS

This study utilised a corpus of 3864 individual responses to positive and negative questions over the course of six years (2012-2018) within Yale University School of Medicine's internal medicine residency. Researchers developed a sentiment model to assess the valence of evaluation responses. We then used natural language processing (NLP) to evaluate whether female versus male residents received more positive or negative feedback and if that feedback focussed on different Accreditation Council for Graduate Medical Education (ACGME) core competencies based on their gender. Evaluator-evaluatee gender dyad was analysed to see how it impacted quantity and quality of feedback.

RESULTS

We found that female and male residents did not have substantively different numbers of positive or negative comments. While certain competencies were discussed more than others, gender did not seem to influence which competencies were discussed. Neither gender trainee received more written feedback, though female evaluators tended to write longer evaluations.

CONCLUSIONS

We conclude that when examined at scale, quantitative gender differences are not as prevalent as has been seen in qualitative work. We suggest that further investigation of linguistic phenomena (such as context) is warranted to reconcile this finding with prior work.

Objective Test Scores Throughout Orthopedic Surgery Residency Suggest Disparities in Training Experience

Diversifying clinical residencies, particularly in fields that are historically dominated by majority male (M/M) cohorts, is critical to improve both the training experiences of residents and the overall physician workforce. Orthopedic surgery in particular has low numbers of females and under-represented minorities (F/URM) at all levels of training and practice. Despite efforts to increase its diversity, this field has become more homogeneous in recent years. To highlight potential barriers and disparate training environments that may contribute to this dynamic, we present 25 years' worth of institutional data on standardized exam performance throughout residency. We report that despite starting residency with standardized exam scores that were comparable to their M/M peers, F/URM orthopedic surgery residents performed progressively worse on Orthopaedic In-service Training Exams throughout residency and had lower first pass rates on the American Board of Orthopedic Surgery Part 1. Given these findings, we propose that disparate performance on standardized test scores throughout residency could identify trainees that may have different experiences that negatively impact their exam performance. Shedding light on these underlying disparities provides opportunities to find meaningful and sustained ways to develop a culture of diversity and inclusion. It may also allow for other programs to identify similar patterns within their training programs. Overall, we propose monitoring test performance on standardized exams throughout orthopedic surgery residency to identify potential disparities in training experience; further, we acknowledge that interventions to mitigate these disparities require a broad, systems wide approach and a firm institutional commitment to reducing bias and working toward sustainable change.

State of Women in Medicine: History, Challenges, and the Benefits of a Diverse Workforce

Women in medicine have made progress since Elizabeth Blackwell: the first women to receive her medical degree in the United States in 1849. Yet although women currently represent just over one-half of medical school applicants and matriculates, they continue to face many challenges that hinder them from entering residency, achieving leadership positions that exhibit final decision-making and budgetary power, and, in academic medicine, being promoted. Challenges include gender bias in promotion, salary inequity, professional isolation, bullying, sexual harassment, and lack of recognition, all of which lead to higher rates of attrition and burnout in women physicians. These challenges are even greater for women from groups that have historically been marginalized and excluded, in all aspects of their career and especially in achieving leadership positions. It is important to note that, in several studies, it was indicated that women physicians are more likely to adhere to clinical guidelines, provide preventive care and psychosocial counseling, and spend more time with their patients than their male peers. Additionally, some studies reveal improved clinical outcomes with women physicians. Therefore, it is critical for health care systems to promote workforce diversity in medicine and support women physicians in their career development and success and their wellness from early to late career.

Building high performing teams: Opportunities and challenges of inclusive recruitment practices

Healthcare is most effectively delivered by high-performance teams, which require, not simply talent, but also diversity in their members, supported by a culture of equity that is open, supportive, and inclusive. Cognitive diversity offers a performance advantage, improving collective understanding and optimizing high-complexity problem solving. Diverse teams have been shown to outperform homogenous team, and this diversity, supplemented with equity and inclusion, yields a superior creative culture. High-performance teams rest on a foundation of standardized and inclusive recruitment practices. Standard recruitment procedures have been insufficient in broadening representation owing to the long-standing inequities and exclusion in medicine. As such, we have highlighted the opportunities for inclusive recruitment practices.

Gender Differences in Medical Specialty Decision Making: The Importance of Mentorship

INTRODUCTION

While there have been many studies reviewing factors considered by medical students in deciding on a specialty, there is a relative paucity of data in how these factors differ between males and females. The aim of this study was to determine if there are differences in how male and female medical students' value various factors in choosing a career path in medicine.

METHODS

A survey of basic demographic information and a Likert-based questionnaire addressing various factors in specialty choice was sent to all military medical students in the class of 2019.

RESULTS

The survey response rate was 30%. Amongst the students that completed the survey, 72% were male and 28% were female. The majority of students were less than 27 years old (52%) and Caucasian (76%). Female medical students placed more importance in exposure to third year clerkships (P = 0.004) and gender diversity within the specialty (P = 0.03) than their male counterparts. There was no statistical difference in opinions of significant others or family members, desire to have a family, or having a well-balanced life between female, and male medical students.

CONCLUSION

Female medical students valued exposure to third year clerkships and gender diversity more than their male colleagues when choosing a future specialty. These findings suggest that a strategic focus should be placed on mentoring female medical students in order to promote a diverse medical workforce.

Videoconferencing Etiquette: Promoting Gender Equity During Virtual Meetings

Considerable evidence has demonstrated that gender influences interactions during in-person meetings, most commonly, negatively impacting women and persons of color. Pervasive gender stereotypes about roles that were (and are) occupied by men and women lead to implicit assumptions about competency in said roles. For example, women may receive more negative verbal interruptions or nonverbal cues that undermine their authority as a leader, a stereotypically male-typed role. The coronavirus pandemic has led to the rapid rise in videoconferencing in professional interactions; however, little is known about videoconferencing etiquette and how gender bias permeates to this new setting. Although there are many benefits to the use of this technology, it has the potential to reinforce gender bias rooted in cultural and societal norms, gender stereotypes, and traditional gender roles. The well-documented implicit biases that have been shown to favor men over women during in-person meetings may translate to further gender gaps in leadership during virtual meetings. It is also possible that videoconferencing could be used to reduce gender bias, but until we have research to shine a light on this topic, this article provides 10 tips for promoting gender equity during virtual meetings.

Implicit gender-career bias in postgraduate medical training still exists, mainly in residents and in females

BACKGROUND

More and more female residents enter postgraduate medical training (PGMT). Meanwhile, women are still underrepresented in academic medicine, in leadership positions and in most surgical specialties. This suggests that female residents' career development may still be negatively impacted by subtle, often unconscious stereotype associations regarding gender and career-ambition, called implicit gender-career bias. This study explored the existence and strength of implicit gender-career bias in doctors who currently work in PGMT, i.e. in attending physicians who act as clinical trainers and in their residents.

METHODS

We tested implicit gender-career bias in doctors working in PGMT by means of an online questionnaire and an online Implicit Association Test (IAT). We used standard IAT analysis to calculate participants' IAT D scores, which indicate the direction and strength of bias. Linear regression analyses were used to test whether the strength of bias was related to gender, position (resident or clinical trainer) or specialty (non-surgical or surgical specialty).

RESULTS

The mean IAT D score among 403 participants significantly differed from zero (D-score = 0.36 (SD = 0.39), indicating bias associating male with career and female with family. Stronger gender-career bias was found in women (β_female =0 .11; CI 0.02; 0.19; p = 0.01) and in residents (β_resident 0.12; CI 0.01; 0.23; p = 0.03).

CONCLUSIONS

This study may provide a solid basis for explicitly addressing implicit gender-career bias in PGMT. The general understanding in the medical field is that gender bias is strongest among male doctors' in male-dominated surgical specialties. Contrary to this view, this study demonstrated that the strongest bias is held by females themselves and by residents, independently of their specialty. Apparently, the influx of female doctors in the medical field has not yet reduced implicit gender-career bias in the next generation of doctors, i.e. in today's residents, and in females.

Gender Disparity and Potential Strategies for Improvement in Neurology and Clinical Neurophysiology

Discrimination in the workplace when documented is illegal but is seen to still exist in some forms whether based on culture, race, or gender. Each of these disparities warrants further discussion and study because of their significant impacts on hiring decisions, career advancement, and compensation. In this article, the authors have focused their attention on gender disparity in the fields of neurology and clinical neurophysiology and shared the data currently available to them. At a time when the field of clinical neurophysiology has seen enormous growth, gender disparity in leadership and compensation remain. Despite the increasing number of women entering the fields of neurology and clinical neurophysiology, women remain underrepresented in national leadership positions. Many women physicians report experiencing gender discrimination despite increasing efforts by universities and medical centers to improve inclusivity and diversity. Equity and inclusivity are not the same and there is a disconnect between the increased numbers of women and their shared experiences in the workplace. Implicit bias undermines the ability of women to advance in their careers. For neurologists, data indicate that the latest gender pay gap is $56,000 (24%), increased from $37,000 in 2015, and is one of the largest pay gaps in any medical specialty. One third of the top 12 medical schools in the United States require that maternity leave be taken through disability coverage and/or sick benefits, and most family leave policies constrain benefits to the discretion of departmental leadership. The authors recommend strategies to improve gender disparity include institutional training to Identify and overcome biases, changes to professional organizations and national scientific meeting structure, transparency in academic hiring, promotion and compensation, and mentorship and sponsorship programs.

Are Women Disproportionately Represented in Education Compared to Other Roles in Academic Radiology?

RATIONALE AND OBJECTIVES

Women in academic medicine, and radiology specifically, are underrepresented in departmental leadership roles and achieve fewer professional metrics of success. We have observed, however, that women are more broadly represented in medical education leadership. The purpose of this study was to determine if women in academic radiology are overrepresented in educational scholarship and educational leadership compared to general research scholarship and leadership positions, and to determine if there is any difference in the distribution of women in these roles compared to internal medicine.

MATERIALS AND METHODS

We performed a PubMed search of education articles in radiology and internal medicine over the last 5 years, and the gender of the authors was determined. Data on gender for authorship of general research topics, departmental leaders, and society leadership was obtained via literature and internet searches and the data was aggregated. Representation ratios (RR of 1.0 = parity) were obtained via risk ratio calculation to compare education versus general scholarship, and the distribution of leadership roles within and between these fields.

RESULTS

Women make up 28.5% of academic radiologists and 40.1% of academic internists. A higher proportion of education articles were first authored by women than would be expected in both fields with an RR of 1.46 (p < 0.001) in radiology and 1.23 (p < 0.001) in internal medicine. This overrepresentation was significant compared to general research scholarship in both fields (p < 0.001). In both fields, women were overrepresented in the position of Medical Student Director (RR of 1.47 and 1.22, respectively). For Program Directors, women were overrepresented in radiology (RR of 1.12) and underrepresented in internal medicine (RR of 0.69-0.75). Women in radiology were overrepresented in education society leadership (RR = 1.63) compared to general society leadership (0.98, p = 0.001).

CONCLUSION

We found that women in radiology are overrepresented in authorship of education articles, and in departmental and society education leadership roles. This trend was also seen in internal medicine, suggesting that women are more broadly represented in medical education.

Acting Wisely: Eliminating Negative Bias in Medical Education-Part 1: The Fundamentals

Bias is a ubiquitous problem in human functioning. It has plagued medical decision making, making physicians prone to errors of perception and judgment. Racial, gender, ethnic, and religious negative biases infest physicians' perception and cognition, causing errors of judgment and behavior that are damaging. In Part 1 of this series of 2 papers, the authors address the problem of harmful bias, the science of cognition, and what is known about how bias functions in human perception and information processing. They lay the groundwork for an approach to reducing negative bias through awareness, reflection, and bias mitigation, an approach in which negative biases can be transformed-by education, experience, practice, and relationships-into positive biases toward one another. The authors propose wisdom as a conceptual framework for imagining a different way of educating medical students. They discuss fundamental cognitive, affective, and reflective components of wisdom-based education. They also review the skills of awareness, using debiasing strategies, compassion, fostering positive emotion, and reflection that are inherent to a wisdom-based approach to eliminating the negative effects of bias in medical education. In Part 2, the authors answer a key question: How can medical educators do better? They describe the interpersonal, structural, and cultural elements supportive of a wisdom-based learning environment, a culture of respect and inclusion in medical education.

Gender inequality in academia: Problems and solutions for women faculty in STEM

Recently there is widespread interest in women's underrepresentation in science, technology, engineering, and mathematics (STEM); however, progress toward gender equality in these fields is slow. More alarmingly, these gender disparities worsen when examining women's representation within STEM departments in academia. While the number of women receiving postgraduate degrees has increased in recent years, the number of women in STEM faculty positions remains largely unchanged. One explanation for this lack of progress toward gender parity is negative and pervasive gender stereotypes, which may facilitate hiring discrimination and reduce opportunities for women's career advancement. Women in STEM also have lower social capital (e.g., support networks), limiting women's opportunities to earn tenure and learn about grant funding mechanisms. Women faculty in STEM may also perceive their academic climate as unwelcoming and threatening, and report hostility and uncomfortable tensions in their work environments, such as sexual harassment and discrimination. Merely the presence of gender-biased cues in physical spaces targeted toward men (e.g., "geeky" décor) can foster a sense of not belonging in STEM. We describe the following three factors that likely contribute to gender inequalities and women's departure from academic STEM fields: (a) numeric underrepresentation and stereotypes, (b) lack of supportive social networks, and (c) chilly academic climates. We discuss potential solutions for these problems, focusing on National Science Foundation-funded ADVANCE organizational change interventions that target (a) recruiting diverse applicants (e.g., training search committees), (b) mentoring, networking, and professional development (e.g., promoting women faculty networks); and (c) improving academic climate (e.g., educating male faculty on gender bias).

Markers of achievement for assessing and monitoring gender equity in a UK National Institute for Health Research Biomedical Research Centre: A two-factor model

BACKGROUND

The underrepresentation of women in academic medicine at senior level and in leadership positions is well documented. Biomedical Research Centres (BRC), partnerships between leading National Health Service (NHS) organisations and universities, conduct world class translational research funded by the National Institute for Health Research (NIHR) in the UK. Since 2011 BRCs are required to demonstrate significant progress in gender equity (GE) to be eligible to apply for funding. However, the evidence base for monitoring GE specifically in BRC settings is underdeveloped. This is the first survey tool designed to rank and identify new GE markers specific to the NIHR BRCs.

METHODS

An online survey distributed to senior leadership, clinical and non-clinical researchers, trainees, administrative and other professionals affiliated to the NIHR Oxford BRC (N = 683). Participants ranked 13 markers of GE on a five point Likert scale by importance. Data were summarised using frequencies and descriptive statistics. Interrelationships between markers and underlying latent dimensions (factors) were determined by exploratory and confirmatory factor analyses.

RESULTS

The response rate was 36% (243 respondents). Respondents were more frequently female (55%, n = 133), aged 41-50 years (33%, n = 81), investigators (33%, n = 81) affiliated to the BRC for 2-7 years (39.5%, n = 96). Overall participants ranked 'BRC senior leadership roles' and 'organisational policies on gender equity', to be the most important markers of GE. 58% (n = 141) and 57% (n = 139) respectively. Female participants ranked 'organisational policies' (64.7%, n = 86/133) and 'recruitment and retention' (60.9%, n = 81/133) most highly, whereas male participants ranked 'leadership development' (52.1%, n = 50/96) and 'BRC senior leadership roles' (50%, n = 48/96) as most important. Factor analyses identified two distinct latent dimensions: "organisational markers" and "individual markers" of GE in BRCs.

CONCLUSIONS

A two-factor model of markers of achievement for GE with "organisational" and "individual" dimensions was identified. Implementation and sustainability of gender equity requires commitment at senior leadership and organisational policy level.

Women in Leadership in Urology: The Case for Increasing Diversity and Equity

There is a persistent male gender predominance in urology, especially with respect to female representation in leadership. We review the current status of women in urology leadership, discuss challenges women face in leadership positions, present the case for adopting inclusive practices that increase diversity and gender equity in urology leadership, and review the potential benefits of such an expansion. We discuss practical strategies to grow the role of women in urologic leadership, including increasing mentorship, modifying academic promotion criteria, and addressing implicit bias, while presenting a roadmap toward achieving equity and diversity at the highest ranks of urologic leadership.

Gender Differences in Patient Perceptions of Physicians' Communal Traits and the Impact on Physician Evaluations

Background: Communal traits, such as empathy, warmth, and consensus-building, are not highly valued in the medical hierarchy. Devaluing communal traits is potentially harmful for two reasons. First, data suggest that patients may prefer when physicians show communal traits. Second, if female physicians are more likely to be perceived as communal, devaluing communal traits may increase the gender inequity already prevalent in medicine. We test for both these effects. Materials and Methods: This study analyzed 22,431 Press Ganey outpatient surveys assessing 480 physicians collected from 2016 to 2017 at a large tertiary hospital. The surveys asked patients to provide qualitative comments and quantitative Likert-scale ratings assessing physician effectiveness. We coded whether patients described physicians with "communal" language using a validated word scale derived from previous work. We used multivariate logistic regressions to assess whether (1) patients were more likely to describe female physicians using communal language and (2) patients gave higher quantitative ratings to physicians they described with communal language, when controlling for physician, patient, and comment characteristics. Results: Female physicians had higher odds of being described with communal language than male physicians (odds ratio 1.29, 95% confidence interval 1.18-1.40, p < 0.001). In addition, patients gave higher quantitative ratings to physicians they described with communal language. These results were robust to inclusion of controls. Conclusions: Female physicians are more likely to be perceived as communal. Being perceived as communal is associated with higher quantitative ratings, including likelihood to recommend. Our study indicates a need to reevaluate what types of behaviors academic hospitals reward in their physicians.

Increasing Promotion of Women Faculty in Academic Medicine: Impact of National Career Development Programs

Background: Three national career development programs (CDPs)-Early and Mid-Career Programs sponsored by the Association of American Medical Colleges and the Hedwig van Ameringen Executive Leadership in Academic Medicine sponsored by Drexel University-seek to expand gender diversity in faculty and institutional leadership of academic medical centers. Over 20 years of success and continued need are evident in the sustained interest and investment of individuals and institutions. However, their impact on promotion in academic rank remains unknown. The purpose of the study is to compare promotion rates of women CDP participants and other faculty of similar institutional environment and initial career stage. Methods: The study examined retrospective cohorts of 2,719 CDP participants, 12,865 nonparticipant women, and 26,810 men, from the same institutions, with the same degrees, and first years of appointment in rank. Rates of promotion to Associate and Full Professor ranks in respective cohorts of Assistant and of Associate Professors were compared using Kaplan-Meier survival curves and log-rank tests, and logistic regression adjusting for other predictors of academic success. Results: In adjusted analyses, participants were more likely than men and non-participant women to be promoted to Associate Professor and as likely as men and more likely than non-participant women to be promoted to Full Professor within 10 years. Within 5 years, CDP participants were more likely than nonparticipant women to be promoted to Associate Professor and as likely as to be promoted to Full Professor; in the same interval, participants were promoted to both higher ranks at the same rates as men. For both intervals, nonparticipant women were significantly less likely than men to be promoted to either rank. Conclusions: The higher rates of promotion for women participating in national CDPs support the effectiveness of these programs in building capacity for academic medicine.

Gender Can Influence Student Experiences in MD-PhD Training

Background: Female physician-scientists have led major advances in medicine broadly and particularly in women's health. Women remain underrepresented in dual MD-PhD degree programs that train many physician-scientists despite gender parity among medical and biomedical research students. Materials and Methods: To explore how the training environment might be experienced differently for male and female students in one MD-PhD program, the authors analyzed gender differences in annual symposium speakers with exact binomial tests, student participation as question-askers at a weekly seminar with logistic regression, and number of publications with quasi-Poisson generalized linear models. They compared male and female students' perceptions of gender-based discrimination using a survey, including qualitative analysis of free text responses. The program consisted of 71 total students in the 2017-2018 and 2018-2019 academic years. Female students comprised 42.0% (81/191) of program matriculants from 1997 to 2019. Results: Male and female students were equally likely to present at the annual program symposium, but faculty (p = 0.001) and keynote (p = 0.012) presenters were more likely to be male. Compared with male counterparts, female students asked fewer seminar questions (p < 0.005) and female speakers received more questions (p = 0.03). Female students perceived less support and differed from men in reasons for asking or not asking seminar questions. Free text responses described repeated small acts of discrimination toward women with cumulative impact. Positive program changes followed presentation of findings to program leaders and students. Conclusions: The authors identified several aspects of one MD-PhD program that could discourage career or training persistence of female students. Increasing awareness of these issues was temporally related to positive programmatic changes.