Mentoring perception, scientific collaboration and research performance: is there a ‘gender gap’ in academic medicine? An Academic Health Science Centre perspective

Representation of Women Authorship in the Top 5 Transplantation Journals in the United States

BACKGROUND

In the United States, only 13% of transplant surgeons are women. We evaluated gender distribution and trends of American authorship over the past 10 y in high-impact solid organ transplantation journals to gain insight into the current status of women authorship in transplantation.

METHODS

Original articles from 2012 to 2021 from the 5 highest-impact solid organ transplantation journals were extracted from Scopus. First and last author's gender was predicted using Genderize.io. Data of first and last authors, article type and topic, location, citation, and funding metrics were analyzed. Chi-square, logistic regression, and trend tests were performed where appropriate. Statistical significance was set at <0.05.

RESULTS

Women's first and last authorship increased over time among all journals. There was an increase in women first authors in the American Journal of Transplantation and in senior women authors in Liver Transplantation and Transplantation . Significant differences in gender authorship in lung, intestine, pancreas, general, and islet cell transplantation were found. Women's last authorship was associated with 1.69 higher odds of having a woman first author when adjusting for year and journal. There was an increase in the rate of women's first and last author collaborations over the years. Women last authors had 1.5 higher odds of being funded by the National Institutes of Health over the years.

CONCLUSIONS

Despite an increase in women transplant surgeons and physicians, the gap in women authorship in transplantation persists. Women's last authorship was associated with higher odds of having a woman first author, pointing to the importance of mentorship for women joining the transplant academia.

Women Physicians in Transition Learning to Navigate the Pipeline from Early to Mid-Career: Protocol for a Qualitative Study

BACKGROUND

Women physicians face unique obstacles while progressing through their careers, navigating career advancement and seeking balance between professional and personal responsibilities. Systemic changes, along with individual and institutional changes, are needed to overcome obstacles perpetuating physician gender inequities. Developing a deeper understanding of women physicians' experiences during important transition points could reveal both barriers and opportunities for recruitment, retention, and promotion, and inform best practices developed based on these experiences.

OBJECTIVE

The aim is to learn from the experiences and perspectives of women physicians as they transition from early to mid-career, then develop best practices that can serve to support women physicians as they advance through their careers.

METHODS

Semistructured interviews were conducted with women physicians in the United States in 2020 and 2021. Eligibility criteria included self-identification as a woman who is in the process of transitioning or who recently transitioned from early to mid-career stage. Purposeful sampling facilitated identification of participants who represented diversity in career pathway, practice setting, specialty, and race/ethnicity. Each participant was offered compensation for their participation. Interviews were audio-recorded and professionally transcribed. Interview questions were open-ended, exploring participants' perceptions of this transition. Qualitative thematic analysis will be performed. We will use an open coding and grounded theory approach on interview transcripts.

RESULTS

The Ethics Review Committee of the Faculty of Health, Medicine, and Life Sciences at Maastricht University approved the study; Stanford University expedited review approved the study; and the University of California, San Diego certified the study as exempt from review. Twelve in-depth interviews of 50-100 minutes in duration were completed. Preliminary analyses indicate one key theme is a tension resulting from finite time divided between demands from a physician career and demands from family needs. In turn, this results in constant boundary control between these life domains that are inextricable and seemingly competing against each other within a finite space; family needs impinge on planned career goals, if the boundary between them is not carefully managed. To remedy this, women sought resources to help them redistribute home responsibilities, freeing themselves to have more time, especially for children. Women similarly sought resources to help with career advancement, although not with regard to time directly, but to first address foundational knowledge gaps about career milestones and how to achieve them.

CONCLUSIONS

Preliminary results provide initial insights about how women identify or activate a career shift and how they marshaled resources and support to navigate barriers they faced. Further analyses are continuing as of March 2022 and are expected to be completed by June 2022. The dissemination plan includes peer-reviewed open-access journal publication of the results and presentation at the annual meeting of the American Medical Association's Women Physicians Section.

Impact of Mentoring on Academic Career Success for Women in Medicine: A Systematic Review

PURPOSE

Research has shown that barriers to career success in academic medicine disproportionately affect women. These barriers include inadequate mentoring, which may perpetuate the underrepresentation of women in senior leadership positions. The purpose of this review was to summarize the qualitative and quantitative evidence of the impact of mentoring on women's career outcomes and to inform future interventions to support the promotion and retention of women in academic medicine.

METHOD

The authors conducted a systematic review of original research published in English-language, peer-reviewed journals through March 20, 2020. Search terms related to mentorship, women, and academic medicine. The authors searched MEDLINE, Embase, Scopus, Current Contents Connect via Web of Science, Cochrane Library, and PsycINFO. They excluded studies not specifically addressing women and those without gender-stratified outcomes. They extracted and analyzed the following data: study design, population, sample size, response rate, participant age, percentage of women, mentoring prevalence, and outcomes.

RESULTS

Of 2,439 citations identified, 91 studies met the inclusion criteria, including 65 quantitative and 26 qualitative studies. Mentoring was associated with objective and subjective measures of career success. Women perceived mentorship to be more valuable to their career development yet were more likely to report having no mentor. Additionally, women were more likely to report lower levels of research productivity, less career satisfaction, and greater barriers to promotion. Qualitative results indicated that women had less access to informal mentoring and family responsibilities had a greater effect on their career outcomes. Professional networking, female mentors, and relational aspects of mentoring were common themes.

CONCLUSIONS

This review examined gender disparities in mentoring and the impact on research productivity, promotion success, and career satisfaction for women in academic medicine. Institution-supported mentoring programs are needed to facilitate identification of appropriate mentors and promotion of a more equitable academic career environment for women.

Small female citation advantages for US journal articles in medicine

Female under-representation continues in senior roles within academic medicine, potentially influenced by a perception that female research has less citation impact. This article provides systematic evidence of (a) female participation rates from the perspective of published journal articles in 46 Scopus medical subject categories 1996–2018 and (b) gender differences in citation rates 1996–2014. The results show female proportion increases 1996–2018 in all fields and a female majority of first-authored articles in two-fifths of categories, but substantial differences between fields. A paper is 7.3 times more likely to have a female first author in Obstetrics and Gynaecology than in Orthopaedics and Sports Medicine. Only three fields had a female last author majority by 2018, a probable side effect of ongoing problems with appointing female leaders. Female first-authored research tended to be more cited than male first-authored research in most fields (59%), although with a maximum difference of only 5.1% (log-transformed normalised citations). In contrast, male last-authored research tends to be more cited than female last-authored research, perhaps due to cases where a senior male has attracted substantial funding for a project. These differences increase if team sizes are not accounted for in the calculations. Since female first-authored research is cited slightly more than male first-authored research, properly analysed bibliometric data considering career gaps should not disadvantage female candidates for senior roles.

Challenges to Professional Success for Women Plastic Surgeons: An International Survey

BACKGROUND

Female plastic surgeons face specific challenges in their careers that impact lifestyle and professional choices.

OBJECTIVE

The authors sought to delineate these specific issues further through means of an anonymous survey and to suggest areas for improvement.

METHODS

In August 2017, a link to an online email questionnaire via SurveyMonkey.com was sent to 398 women members of the International Society of Aesthetic Plastic Surgery, which included questions on demographics, surgical training, practice characteristics and preferences, leadership and professional activities, marriage and childcare, financial status, workplace sexism and sexual harassment and surgeon attitudes.

RESULTS

A total of 138 female plastic surgeons responded to the survey for a response rate of 34.7%. Critical issues most cited by respondents included work-life balance and childcare responsibilities, sexual harassment and the lack of gender parity at meetings.

CONCLUSIONS

Plastic surgery training programs, institutions and societies should acknowledge the additional challenges that female surgeons face. The greatest areas for improvement include the balance of work and family responsibilities, addressing the prevalence of sexual harassment and improved representation at scientific meetings.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Gender disparity in German neurosurgery

OBJECTIVE

Despite the rising number of women in higher education and leadership positions, the proportional rise of female neurosurgeons still lags behind these fields. This study evaluates the gender distribution in German neurosurgical departments across all career levels, and is aimed at heightening the awareness of gender disparity and the need for improving gender equality and its related opportunities.

METHODS

Data on gender distribution across all professional levels in German neurosurgical departments were obtained from departmental websites as well as by email and telephone request. Results were additionally analyzed in reference to hospital ownership type of the neurosurgical departments.

RESULTS

A total of 140 German neurosurgical departments employing 2324 neurosurgeons were evaluated. The analysis revealed a clear preponderance of men in leadership positions. Only 9 (6.3%) of 143 department heads were women, and there were only 1 (2.4%), 17 (14.5%), and 4 (12.5%) women among 42 vice-directors, 117 chief senior physicians, and 32 managing senior physicians, respectively. Senior physicians not holding a leadership position were female in 23.1%, whereas board-certified neurosurgeons not holding a senior physician position and residents were female in 33.6% and 35.0%, respectively. Of note, the highest proportion of female department heads (15.6%) was found in private hospitals.

CONCLUSIONS

The number of women in leadership positions in German neurosurgical departments is dramatically low, and with increasing leadership status gender disparity increases. Mentorship, recruitment, the perception of benefits offered by diversity and programs facilitating gender equality, job sharing, parental leave policies, and onsite childcare programs are needed to turn German neurosurgical departments into modern medical departments reflecting the gender profile of the general patient population.

Analysis of academic publishing output among 1634 successful applicants in the 2011-2018 neurosurgery residency match

BACKGROUND

Research productivity is a key criterion for applicant selection reported by residency program directors. Research volume reported on neurosurgery residency applications has risen steadily over the past decade.

OBJECTIVE

Perform retrospective bibliographic searches of successful applicants who matched into U.S. neurosurgery residency programs from 2011 to 2018, and assess the relationship between academic publishing and residency placement.

METHODS

Gender, MD/PhD status, U.S. News research ranking of medical school, and international medical graduate status (IMG) were determined for 1634 successful applicants from 2011 to 2018. Indexed publications before and after the start of residency were tabulated by Scopus®. Publication counts were stratified by first author, basic/clinical science, case reports, reviews, or other research. We then compared publishing trends across demographic variables and match cohorts.

RESULTS

Average pre-residency publications increased from 2.6 [1.7, 3.4] in 2011 to 6.5 [5.1, 7.9] in 2018. Men, PhD-holders, Top 20 and Top 40 U.S. medical school graduates, and IMGs had higher pre-residency publication counts overall. After stratifying by match cohort, however, there was no significant effect of gender on pre-residency publications. Applicants matching into residency programs with highly ranked affiliated hospitals had significantly higher pre-residency publications.

CONCLUSION

Publishing volume of successful neurosurgery applicants in the U.S. has risen recently and is associated with the stature of matched residency programs. Given the gap between verifiable and claimed research on residency applications, attention is needed to objectively evaluate research credentials in the selection process. The impending phase out of USMLE step 1 scores may increase emphasis on academic productivity.

Championing women working in health across regional and rural Australia - a new dual-mentorship model

BACKGROUND

Mentoring is a critical component of career development and job satisfaction leading to a healthier workforce and more productive outputs. However, there are limited data on mentorship models in regional areas and in particular for women aspiring to leadership positions. Mentorship programs that leverage off experienced mentors from diverse disciplines have the potential to foster the transfer of knowledge and to positively influence job satisfaction and build capacity within the context of workforce shortage.

METHODS

This study describes a dual-mentorship model of professional development for women working in health in regional and rural Australia. We present the framework and describe the evaluation findings from a 12-month pilot program.

RESULTS

Both academic and corporate mentors provided diverse perspectives to the mentees during the 12-month period. On average, corporate mentors met with mentees more often, and focused these discussions on strategy and leadership skills whilst academic mentors provided more technical advice regarding academic growth. Mentees reported an improvement in workplace interconnectedness and confidence at the completion of the program.

CONCLUSION

We developed a framework for establishing a professional mentorship program that matches women working in regional health with mentors from diverse sectors including business, government, philanthropy and health, to provide a holistic approach to improving career satisfaction, institutional productivity and supporting a diverse workforce in regional or resource-poor settings.

Turning Chutes into Ladders for Women Faculty: A Review and Roadmap for Equity in Academia

Despite significant progress in recent decades, the recruitment, advancement, and promotion of women in academia remain low. Women represent a large portion of the talent pool in academia, and receive >50% of all PhDs, but this has not yet translated into sustained representation in faculty and leadership positions. Research indicates that women encounter numerous "chutes" that remove them from academia or provide setbacks to promotion at all stages of their careers. These include the perception that women are less competent and their outputs of lesser quality, implicit bias in teaching evaluations and grant funding decisions, and lower citation rates. This review aims to (1) synthesize the "chutes" that impede the careers of women faculty, and (2) provide feasible recommendations, or "ladders" for addressing these issues at all career levels. Enacting policies that function as "ladders" rather than "chutes" for academic women is essential to even the playing field, achieve gender equity, and foster economic, societal, and cultural benefits of academia.

International and Geographic Trends in Gender Authorship within Plastic Surgery

BACKGROUND

Professional advancement in academic plastic surgery may depend on scholarly activity. The authors evaluate gender-based publishing characteristics in three international plastic surgery journals.

METHODS

A retrospective review of all articles published in 2016 in the following journals was undertaken: Plastic and Reconstructive Surgery, Journal of Plastic, Reconstructive and Aesthetic Surgery, European Journal of Plastic Surgery, Annals of Surgery, and New England Journal of Medicine. Data were collected on lead author gender (first or senior author) and differences in author gender proportions, by journal, by article topic, and by geographic location were evaluated.

RESULTS

Overall, 2610 articles were retrieved: 34.1 percent were from plastic surgery journals, 12.8 percent were from the Annals of Surgery, and 53.1 percent were from the New England Journal of Medicine. There was a lower proportion of female lead authors among plastic surgery journals compared with the Annals of Surgery and the New England Journal of Medicine (31 percent versus 39 percent versus 39 percent; p = 0.001). There were no differences in female lead author geographic location in the Annals of Surgery or the New England Journal of Medicine; within the plastic surgery journals, there were differences (p = 0.005), including a lower proportion arising from East Asia (15 percent) and a higher proportion arising from Canada (48 percent). Within plastic surgery, Plastic and Reconstructive Surgery had the lowest proportion of female lead author (p < 0.001). The proportion of female lead author varied by article topic (p < 0.001) and was notably higher in breast (45.6 percent) and lower in head and neck/craniofacial-orientated articles (25.0 percent).

CONCLUSIONS

There are gender disparities in three mainstream plastic surgery journals-Plastic and Reconstructive Surgery, the Journal of Plastic, Reconstructive and Aesthetic Surgery, the European Journal of Plastic Surgery-and there are lower proportions of lead female authorship compared with the Annals of Surgery and the New England Journal of Medicine. Further research should focus on understanding any geographic disparities that may exist.

Benefits, barriers and enablers of mentoring female health academics: An integrative review

This integrative literature review synthesizes the primary research evidence on mentoring female health academics published from 2000 to 2018, to identify the benefits, enablers and barriers to mentoring women. The need for this review is underpinned by the magnitude of change in higher education, the high number of women in health disciplines, limited progress in advancing women’s academic careers, escalating role expectations, faculty shortages and staff turnover. Data were sourced from Scopus, PubMed, EMBASE and Cumulative Index of Nursing and Allied Health Literature. Twenty-seven studies were included. Although effective mentoring facilitates personal and career development, academic craftsmanship, psychosocial support and job satisfaction, it is complicated by organizational factors and personal and relational dynamics. Enablers of mentoring are mentor availability and expertise, supportive relationships, mutuality and responsiveness. Lack of, or inadequate mentoring compromise women’s job satisfaction, career development and academic productivity. Providing female health academics access to experienced, well-connected mentors with common interests who are committed to advancing their career, is an investment in optimizing potential, promoting supportive work environments and increasing productivity and retention. Realizing the institutional potential that mentoring female health academics offers, is contingent on academic leaders valuing mentorship as faculty business and understanding the role that the contemporary academic environment plays in achieving mentoring outcomes. Further empirical and longitudinal research is needed to evaluate effective approaches for mentoring women in the contemporary academic environment.

Twelve tips to promote gender equity in international academic medicine

Gender inequity in academic medicine remains an important issue worldwide, with more female faculty entering academic medicine internationally. Some academic institutions have initiated programs and created policies to promote gender equity, but disparities remain in faculty numbers, promotions rates, research productivity and access to funding and resources. We offer 12 tips for best practices in the broad domains of faculty recruitment, retention and scholarship, promotion and leadership that institutions and individual faculty can adopt to promote gender equity. While the 12 tips form a comprehensive approach, each tip can be implemented individually depending on institutional needs and culture. Each tip includes practical advice for implementation supported by a successful example from the literature.

Compensation of Otolaryngologists in the Veterans Health Administration: Is There a Gender Gap?

OBJECTIVES/HYPOTHESIS

To determine if gender pay disparity exists amongst otolaryngologists employed by the Veterans Health Administration (VHA).

STUDY DESIGN

cross-sectional analysis.

METHODS

Board-certified otolaryngologists employed at all complex Veterans Affairs Medical Centers (VAMCs) in 2016 were identified. Salaries were collated using the Enterprise Human Resources Integration-Statistical Data Mart dataset. Additional variables, including gender, years since medical school graduation, professorship status, h-index, and geographic location were collected. A multivariate linear regression analysis was performed where salary was the primary outcome of interest and gender was accounted for as an independent predictor while controlling for professional characteristics, geographic location, and seniority.

RESULTS

Sixty-nine VHA surgical programs with an operative designation of "complex" were identified. Two hundred sixty board-certified otolaryngologists, including 197 (75.8%) men and 63 (24.2%) women, were identified. Salary data were available on 210 of these otolaryngologists. In 2016, the mean salary for male and female otolaryngologists was not significantly different ($266,707 ± $31,624 vs. $264,674 ± $27,027, P = .918) nor were salaries in early career ($243,979 ± $31,749 vs. $254,625 ± $24,558, respectively; P = .416). On multivariate linear regression analysis, number of years since graduation (P = .009) and h-index (P = .049) were independent predictors of salary, but gender, geographic location, and faculty rank were not.

CONCLUSIONS

Although the gender pay gap persists in many areas of medicine and surgery, otolaryngologists employed at complex VAMCs do not experience gender pay disparity. The use of specific and objective criteria to establish and adjust salaries can reduce and potentially eliminate gender pay disparity. These findings may help to guide institutional policies in other practice environments.

LEVEL OF EVIDENCE

2b. Laryngoscope, 129:113-118, 2019.

Network analysis of surgical innovation: Measuring value and the virality of diffusion in robotic surgery

BACKGROUND

Existing surgical innovation frameworks suffer from a unifying limitation, their qualitative nature. A rigorous approach to measuring surgical innovation is needed that extends beyond detecting simply publication, citation, and patent counts and instead uncovers an implementation-based value from the structure of the entire adoption cascades produced over time by diffusion processes. Based on the principles of evidence-based medicine and existing surgical regulatory frameworks, the surgical innovation funnel is described. This illustrates the different stages through which innovation in surgery typically progresses. The aim is to propose a novel and quantitative network-based framework that will permit modeling and visualizing innovation diffusion cascades in surgery and measuring virality and value of innovations.

MATERIALS AND METHODS

Network analysis of constructed citation networks of all articles concerned with robotic surgery (n = 13,240, Scopus®) was performed (1974-2014). The virality of each cascade was measured as was innovation value (measured by the innovation index) derived from the evidence-based stage occupied by the corresponding seed article in the surgical innovation funnel. The network-based surgical innovation metrics were also validated against real world big data (National Inpatient Sample-NIS®).

RESULTS

Rankings of surgical innovation across specialties by cascade size and structural virality (structural depth and width) were found to correlate closely with the ranking by innovation value (Spearman's rank correlation coefficient = 0.758 (p = 0.01), 0.782 (p = 0.008), 0.624 (p = 0.05), respectively) which in turn matches the ranking based on real world big data from the NIS® (Spearman's coefficient = 0.673;p = 0.033).

CONCLUSION

Network analysis offers unique new opportunities for understanding, modeling and measuring surgical innovation, and ultimately for assessing and comparing generative value between different specialties. The novel surgical innovation metrics developed may prove valuable especially in guiding policy makers, funding bodies, surgeons, and healthcare providers in the current climate of competing national priorities for investment.

Gender and international clinician educators

OBJECTIVES

To describe gender differences of international clinician educators (CEs) and leaders, and CEs' perceptions by gender of preparation, roles, rewards and factors affecting job satisfaction and retention in emerging international competency-based residency programmes.

METHODS

Cross-sectional surveys of CEs and leadership were conductedJune 2013-June 2014 at institutions that had adopted competency-based graduate medical education and were accredited by the Accreditation Council for Graduate Medical Education-International.

RESULTS

274 (76.3%) of 359 eligible participants responded; 69 (25.2%) were female. Two (18%) of 11 chief executive officers and 1 (9%) of 11 chief medical officers were women. Female CEs were younger, more likely to be single and childless. They were less likely to hold academic appointments, despite no gender differences in length of time at current institution or in current position. A greater proportion of female CEs felt they were 'never' rewarded by academic promotion. Satisfaction rates were similar between the genders. Single female CEs were five times as likely to report being 'extremely likely' to stay in the country. Female CEs with children <21 were less likely to report high likelihood of staying in academia. Marital status and children were not associated with outcomes for male CEs.

CONCLUSIONS

In the international academic medicine programmes studied, there were fewer female CEs in the pipeline and they perceived a gender gap in appointment and advancement. Stakeholders at international programmes need to develop contextualised strategies to expand entry and decrease attrition of women into CE tracks, and promote gender equity.

Analysis of ten years of publishing in Pharmacy Practice

Objective:

The aim of this study is to characterize the patterns and trends in the editorial process and features of the first decade of Pharmacy Practice, with the final goal of initiating a benchmarking process to enhance the quality of the journal.

Methods:

Metadata of all of the articles published from 2006 issue #3 to 2016 issue #2 were extracted from PubMed and complemented by a manual data extraction process on the full-text articles. Citations of these articles were retrieved from Web of Science (WOS), Scopus, and Google Scholar on August 15, 2016. The references from all of the articles published by Pharmacy Practice in 2015 were also extracted. International collaboration was explored with a network analysis.

Results:

A total of 40 issues were published in this timespan, including 349 articles, 91.1% of which were original research articles. The number of citations received by these articles varies from 809, as reported by the WOS, to the 1162 reported by Scopus and the 2610 reported by Google Scholar. The journals cited by Pharmacy Practice are mainly pharmacy journals, including Pharm Pract (Granada), Int J Clin Pharm, Am J Health-Syst Pharm, Am J Pharm Educ, and Ann Pharmacother. Only 17.3% of the articles involved international collaboration. Delays in the editorial process increased in 2013, mainly due to an increase in acceptance delay (mean=138 days).

Conclusion:

Pharmacy Practice has improved its visibility and impact over the past decade, especially after 2014, when the journal became indexed in PubMed Central. The editorial process duration is one of the weaknesses that should be tackled. Further studies should investigate if the low international collaboration rate is common across other pharmacy journals.