Gender Disparities Among Academic Vitreoretinal Specialists in the United States With Regard to Scholarly Impact and Academic Rank

Background and objective While men outnumber women in the specialty of ophthalmology in general, the subspecialty of vitreoretinal surgery in particular has the highest percentage of men across all ophthalmic subspecialties. This study aimed to analyze the gender disparities regarding the publication productivity and academic rank of academic vitreoretinal specialists in the United States (US). Methods This cross-sectional study evaluated 116 ophthalmology residency programs in the US participating in the 2022 San Francisco Match. The academic vitreoretinal faculty from each ophthalmology residency program was included. The information on gender, academic rank, and publication activity in terms of the h-index were collected from institutional websites, the Scopus database, and the National Library of Medicine PubMed website. Results A total of 467 academic vitreoretinal specialists were identified. Among them, 345 (73.9%) were men, and 122 (26.1%) were women (p<0.001). When the academic ranks were analyzed, a higher number of men (43.8%) were found to hold the rank of full professor as compared to women. Furthermore, a higher number of women (47.5%) were found to hold the rank of assistant professor as compared to their male colleagues. Regarding the number of publications, in all academic rank categories, women had a significantly lower number of publications compared to men (p<0.001). Men also had a higher publication productivity or scholarly impact [h-index=15.2 ± 0.82 standard error of the mean (SEM)] compared to women (h-index=12.8 ± 0.99 SEM) (p=0.0004). Higher h-index correlated with higher academic rank, from assistant professor through full professor (p<0.001). Conclusion The field of vitreoretinal surgery has significantly fewer women compared to men, with women producing fewer publications and having less scholarly impact. H-index and total number of publications are also associated with a higher academic rank. Furthermore, full professors are more likely to be men, while assistant professors are more likely to be women. Future efforts should be aimed at reducing the gender disparity in vitreoretinal surgery.

Is the Glass-Ceiling Higher Than We Think? Sex Disparity Trends in Physician Executive Positions and Academic Plastic Surgery

INTRODUCTION

Advanced levels of professorship and executive positions are considered markers of success in medical academia. Despite sex parity in medical school graduates, sex disparities within positions of power remain unequal. The purpose of this study was to analyze sex composition at different levels of leadership at multiple academic, highly ranked institutions.

METHODS

Hospital executives and academic plastic surgery faculty were identified through an internet-based search of all Accreditation Council for Graduate Medical Education-accredited plastic surgery integrated and independent residency training programs. Institutions from the U.S. News 2018-19 Top 20 Best Hospitals Honor Roll and Beckers Review 2018: 100 Great Hospitals in America were also included. Information on board of directors/trustees (BOD), administrators, and plastic surgery faculty with focus on title, sex, degree, specialty, and academic rank was collected from departmental and hospital websites. Duplicate institutions were excluded.

RESULTS

Data on chief executive officers (CEOs)/presidents (n = 275) and BOD members (n = 5347) from 153 medical institutions were analyzed. Physicians consisted of 40.7% (n = 112) of CEOs/presidents, of which 10.7% (n = 12) were surgeons, and 15.6% (n = 835) of the BOD membership. Female physicians in executive roles were disproportionally low, consisting of 5% (n = 14) of CEOs/presidents, reaching significance (P = 0.033).Sex representation within plastic surgery departments demonstrated similar trends. Women comprised 18.3% of the overall plastic surgery faculty (n = 1441). Significant differences between mean male and female plastic surgeons (8.2 vs 1.84, P = <0.001) were observed. In addition, female plastic surgeons represented only 26.3% of all assistant professors (P = <0.001), 18.75% of total associate professors (P = <0.001), and 7.8% of full professors (P = <0.001).

CONCLUSIONS

Although women are increasingly pursuing careers in medicine and surgery, the data suggest that there remains a paucity of female physicians in top leadership roles. At the departmental level, female plastic surgeons are also underrepresented. At the executive level, men make up over 88% of physician CEOs at the highest-ranked medical institutions. This study further highlights the need for the development of educational, mentorship, and career pathways to further improve female representation in positions of power within academia.

Cross-sectional analysis of women in neurosurgery: a Canadian perspective

OBJECTIVE

Although the past decades have seen a steady increase of women in medicine in general, women continue to represent a minority of the physician-training staff and workforce in neurosurgery in Canada and worldwide. As such, the aim of this study was to analyze the experiences of women faculty practicing neurosurgery across Canada to better understand and address the factors contributing to this disparity.

METHODS

A historical, cross-sectional, and mixed-method analysis of survey responses was performed using survey results obtained from women attending neurosurgeons across Canada. A web-based survey platform was utilized to collect responses. Quantitative analyses were performed on the responses from the study questionnaire, including summary and comparative statistics. Qualitative analyses of free-text responses were performed using axial and open coding.

RESULTS

A total of 19 of 31 respondents (61.3%) completed the survey. Positive enabling factors for career success included supportive colleagues and work environment (52.6%); academic accomplishments, including publications and advanced degrees (36.8%); and advanced fellowship training (47.4%). Perceived barriers reported included inequalities with regard to career advancement opportunities (57.8%), conflicting professional and personal interests (57.8%), and lack of mentorship (36.8%). Quantitative analyses demonstrated emerging themes of an increased need for women mentors as well as support and recognition of the contributions to career advancement of personal and family-related factors.

CONCLUSIONS

This study represents, to the authors' knowledge, the first analysis of factors influencing career success and satisfaction in women neurosurgeons across Canada. This study highlights several key factors contributing to the low representation of women in neurosurgery and identifies specific actionable items that can be addressed by training programs and institutions. In particular, female mentorship, opportunities for career advancement, and increased recognition and integration of personal and professional roles were highlighted as areas for future intervention. These findings will provide a framework for addressing these factors and improving the recruitment and retention of females in this specialty.

Patient Satisfaction Ratings of Male and Female Residents Across Subspecialties

BACKGROUND

Females currently comprise approximately 50% of incoming medical students yet continue to be underrepresented in certain medical subspecialties.

OBJECTIVE

To assess whether gender plays a role in patients' perception of physician competency among different specialties.

METHODS

We administered surveys at 2 academic medical centers to patients who were stable, cognitively aware, and indicated English as their primary language. Survey questions evaluated communication, medical expertise, and quality of care.

RESULTS

A total of 4222 surveys were collected. Females comprised around half (n = 2133, 50.7%) of evaluated residents. First-year (n = 1647, 39%) and second-year (n = 1416, 33.5%) residents were assessed most frequently. Internal medicine conducted the most surveys (n = 1111, 23.6%), whereas head and neck surgery conducted the least (n = 137, 3.24%). There was no statistically significant difference between patients' perception of male and female residents of the same year in overall communication skills, medical expertise, and quality of medical care. Female residents outperformed their male counterparts on specific questions evaluating the communication of treatment plans, patient education, and patient satisfaction (P < .001, P = .03, P = .04, respectively). Unsurprisingly, patients' perceptions of residents' overall communication skills, medical expertise, and quality of medical care significantly improved when comparing more experienced residents to newer residents.

CONCLUSION

There is no difference between overall communication, medical expertise, and quality of care between sexes, and across subspecialties. Though gender inequalities currently exist most starkly in practitioners in surgical subspecialties, women in surgical residencies were much better communicators than their male counterparts, but still perceived to have similar levels of medical expertise and quality of care.

Pioneer Female Orthopedic Surgeons as Role Models

Maud Forrester-Brown in the United Kingdom (1921), Marika Daniilidou in Greece (1932), Ruth Jackson in the United States (1932), Loris Figgins in Australia (1957), and Evalina Burger in South Africa (1993) all chose to specialize in orthopedics. Although there are dynamic female leaders in orthopedic surgery, the field continues to present obstacles to women. Role models, mentors, and exposure to the field have been lacking for women. Although improvements have occurred in the past few decades, further changes are necessary to attract, develop, and retain qualified female candidates. [Orthopedics. 2020; 43(1):e8-e14.].

Impact of a Hands-on Pre-Clinical Neurosurgery Elective Course on Second-Year Medical Student Interest and Attitudes

INTRODUCTION

Medical student involvement opportunities and educational experiences with surgical residents during medical school have been shown to increase the chance of students deciding to specialize in surgical specialties. This study aims to determine the effect of a neurosurgery elective during the second preclinical year on student interest and opinion of neurosurgery.

METHODS

Thirty-nine students completed opinion-based surveys and factual knowledge quizzes during a neurosurgical elective course over 3 iterations, which included lecture and skills lab instruction. Pre- and post-course surveys used the Likert scale, with a score of 1 corresponding to the most negative opinion and a score of 10 corresponding to the most positive opinion, in order to measure various aspects including interest in neurological surgery, understanding of the field, and perception of female inclusion in the field. Weekly pre- and post-lecture quizzes assessed practical knowledge of neurosurgical topics.

RESULTS

A higher percentage of students rated neurosurgery highly as a career possibility (⩾8/10 interest level) post-course (58.6%) compared to pre-course (45.7%). Post-course, students reported a significantly increased mean understanding of neurosurgery on the Likert scale compared to pre-course (6.1 ± 1.7 vs 4.4 ± 2.0; P = .001). Knowledge based-content assessment revealed a significant increase in overall correct answers after lectures (mean_pre = 3.85, mean_post = 5.05, P = .001). Inclusion of female instructors in the second and third iteration of the course resulted in a significant increase in students' perception of female inclusion in the field of neurosurgery (7.6 compared to 5.6, P = .01).

CONCLUSIONS

Early exposure to subspecialties may assist in making important career decisions. The implementation of this neurosurgical elective improved medical students' perception of the field and enhanced knowledge of the lectures and procedures. This study can be used as a framework for implementation of this curriculum at other institutions.

Women of the American Otological Society

OBJECTIVE

To describe the history of women in the American Otological Society (AOS).

METHODS

Biographies of the early women of the AOS were compiled through review of the AOS transactions, their published scholarship, newspaper articles, and memorials. Interviews were conducted with the only two women to have led the society and also with former colleagues and family members of pioneering AOS women members who are no longer with us. The evolving gender composition of the society over time was researched from AOS membership lists and compared with data on surgical workforce composition from multiple sources such as the Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, American Medical Association, and the American Academy of Otolaryngology-Head and Neck Surgery.

RESULTS

Although American women specialized in otology as far back as 1895, the first woman to be invited to join the AOS as Associate member in 1961 was Dorothy Wolff, PhD. The first female full member was otologic surgeon LaVonne Bergstrom, M.D., who was elected in 1977, 109 years after the foundation of the Society. As of 2017, only two women have served as AOS President. The first was Aina Julianna Gulya, M.D., who took office during the 133rd year in 2001. At the time of the sesquicentennial (2017), 7.5% of AOS members are women including three of eight who serve on the AOS Council. This compares with 15.8% of women among the otolaryngology workforce and a growing 10.9% representation among those who have earned subcertification in neurotology.

CONCLUSION

Gender disparities remain in the AOS, but both participation and scholarly contributions by women in otology have grown substantially since the society's inception 150 years ago, and particularly in the 21st century. Increasing the presence of women in leadership provides role models and mentorship for the future.

Academic output of German neurosurgical residents in 35 academic neurosurgery residency programs

BACKGROUND

The scientific activity of neurosurgeons and neurosurgery residents as measured by bibliometric parameters is of increased interest. While data about academic output for neurosurgeons in the USA, the UK, and Canada have been published, no similar results for German neurosurgical residents exist. Within this study, we aim to evaluate the academic output of German neurosurgery residents in 35 academic residency programs.

METHODS

Data for each resident were collected from the departmental websites, Pubmed, and Scopus. Further analyses evaluated the relationship between publication productivity, sex, and academic degree (Dr. med.).

RESULTS

Data from 424 neurosurgery residents were analyzed. A total of 1222 publications were considered. A total of 355 (29%) of the 1222 publications were first-author publications. The average number of publications per resident was 2.9; the average h-index and m-quotient was 1.1 and 0.4, respectively. There was a statistically significant difference in academic output and h-index among neurosurgical residents with a doctoral degree compared with residents without such degree (5.3 vs. 1.3, p < 0.0001 and 2.0 vs. 0.5, p < 0.0001).

CONCLUSION

This is the very first study evaluating the academic output of neurosurgical residents in academic neurosurgical departments in Germany.

Improving medical student recruitment to neurosurgery

OBJECTIVE

Neurosurgery seeks to attract the best and brightest medical students; however, there is often a lack of early exposure to the field, among other possible barriers. The authors sought to identify successful practices that can be implemented to improve medical student recruitment to neurosurgery.

METHODS

United States neurosurgery residency program directors were surveyed to determine the number of medical student rotators and medical students matching into a neurosurgery residency from their programs between 2010 and 2016. Program directors were asked about the ways their respective institutions integrated medical students into departmental clinical and research activities.

RESULTS

Complete responses were received from 30/110 institutions. Fifty-two percent of the institutions had neurosurgery didactic lectures for 1st- and 2nd-year medical students (MS1/2), and 87% had didactics for MS3/4. Seventy-seven percent of departments had a neurosurgery interest group, which was the most common method used to integrate medical students into the department. Other forms of outreach included formal mentorship programs (53%), lecture series (57%), and neurosurgery anatomy labs (40%). Seventy-three percent of programs provided research opportunities to medical students, and 57% indicated that the schools had a formal research requirement. On average, 3 medical students did a rotation in each neurosurgery department and 1 matched into neurosurgery each year. However, there was substantial variability among programs. Over the 2010-2016 period, the responding institutions matched as many as 4% of the graduating class into neurosurgery per year, whereas others matched 0%-1%. Departments that matched a greater (≥ 1% per year) number of medical students into neurosurgery were significantly more likely to have a neurosurgery interest group and formal research requirements. A greater percentage of high-matching programs had neurosurgery mentorship programs, lecture series, and cadaver training opportunities compared to the other institutions.

CONCLUSIONS

In recent decades, the number of applicants to neurosurgery has decreased. A major deterrent may be the delayed exposure of medical students to neurosurgery. Institutions with early preclinical exposure, active neurosurgery interest groups, research opportunities, and strong mentorship recruit and match more students into neurosurgery. Implementing such initiatives on a national level may increase the number of highly qualified medical students pursuing neurosurgery.

Understanding the Experiences of Obstetrics and Gynaecology Residents Who Take Parental Leave During Training in Canada: A Needs Assessment

OBJECTIVE

This study sought to identify and understand the barriers and supports associated with taking parental leave during obstetrics and gynaecology residency training in Canada, with the aim of helping to direct parental leave policies.

METHODS

Participants were recruited by social media, program directors, and through the SOGC. The study included a short demographic questionnaire and a semistructured qualitative interview in person, by either telephone or videoconference. The interviews were recorded, transcribed, and anonymized. Descriptive thematic analysis using the constant comparative method of grounded theory was performed on each transcript by two independent investigators. Codes were applied to each sentence of the transcript to identify the main idea in the text segment. Once coding was complete the investigators looked for relationships among codes to define themes. Data collection continued until a saturation of themes was reached.

RESULTS

Fifteen participants from across Canada completed the study. The most significant challenges surrounding parental leave during residency included breastfeeding, difficulty on return to work (skill loss, time management, examination preparation), and work-life balance. The major supports noted included family, colleagues and mentors, adequate childcare, and program flexibility surrounding the leave. Participants' suggestions for alleviating the stressors included a gradual return to work and careful planning surrounding returning rotation.

CONCLUSION

Trainees identified formal program supports, non-surgical or core initial rotation back, and a gradual return to work as important areas to address in policies surrounding resident parental leave during Canadian obstetrics and gynaecology training.

Status of Otorhinolaryngology as Specialty of Choice Among Female Medical Graduates

Specialty choices among medical graduates have undergone changes over time. We aimed to analyze status of otorhinolaryngology as specialty of choice among female medical graduates and factors affecting it. A total of 123 female medical graduates were surveyed during their internship over a period of 1 year in a tertiary-care hospital. Each intern was assessed using a questionnaire at the end of otorhinolaryngology rotation. The survey included nine questions about future career choices with special focus on ENT as a choice for specialization. Questions on choice of specialty, reason for choice, quality of undergraduate teaching and clinical postings were included. The post graduation specialty choices in descending order are Medicine, Pediatrics, Surgery, Obstetrics and Gynecology, Dermatology, Ophthalmology, Radiology, ENT, Anesthesia, Psychiatry followed by Physiology, Anatomy and Biochemistry. Among surgical branches most popular choice was General Surgery followed by Obstetrics and Gynecology, Ophthalmology, ENT and Orthopedics in descending order. Reason for the choice included advice from family and friends. Forty two interns (34.2%) followed advice of senior colleagues, 42 (34.2%) followed advice of relatives in the medical field, 25 (20.3%) took advice of non-medico parents while 14 (11.3%) followed their peer group. Regarding the opinion on the quality of undergraduate teaching and clinical postings, both were rated good by the majority. Otorhinolaryngology is less preferred than other general surgery, Obstetrics and Gynecology and ophthalmology by female medical graduates among surgical disciplines. Possible reasons and ways to improve status of Otorhinolaryngology are discussed.

Influence of training institution on academic affiliation and productivity among plastic surgery faculty in the United States

BACKGROUND

Educational processes that encourage a career in academic plastic surgery remain unclear. The authors' study aim was to examine the impact of training institution on the pursuit of a career in academic plastic surgery.

METHODS

Academic plastic surgery faculty (n = 838) were identified through an Internet-based search of all 94 Accreditation Council for Graduate Medical Education-accredited residency and fellowship training programs. Academic productivity was determined by number of peer-reviewed publications and Scopus h-index. Linear and logistic regression analyses were performed to determine the correlation between attributes after adjusting for the clustering of surgeons within programs.

RESULTS

In the United States, 39 percent of plastic surgeons in academic practice are trained in only 11 programs, 30 percent of faculty remained at training institutions, and 39 percent were affiliated with a private practice model. Faculty from frequently represented training programs were more likely to pursue fellowship training (OR, 1.32; 95 percent CI, 1.00 to 1.75), have higher h-indices (9.0 versus 5.4; p < 0.001), and have a greater number of peer-reviewed articles (46.6 versus 24.3; p < 0.001). Higher h-indices were correlated with male sex (7.1 versus 4.7; p < 0.001), fellowship training (7.3 versus 6.1; p < 0.05), and no private practice affiliation (5.2 versus 7.8; p < 0.001). Female surgeons represented 14.1 percent of academic plastic surgeons, were younger based on the median year of board certification (2005 versus 2000; p < 0.05), and were more likely to be on the tenure track (66.9 percent versus 57.2 percent; p < 0.05) and at the assistant professor level (73.1 percent versus 43.6 percent; p < 0.05).

CONCLUSION

Identification of educational processes that encourage a career in academic practice may improve resident mentorship and resident interest in academic plastic surgery.

Attrition rates in neurosurgery residency: analysis of 1361 consecutive residents matched from 1990 to 1999

OBJECT

The objective of this study is to determine neurosurgery residency attrition rates by sex of matched applicant and by type and rank of medical school attended.

METHODS

The study follows a cohort of 1361 individuals who matched into a neurosurgery residency program through the SF Match Fellowship and Residency Matching Service from 1990 to 1999. The main outcome measure was achievement of board certification as documented in the American Board of Neurological Surgery Directory of Diplomats. A secondary outcome measure was documentation of practicing medicine as verified by the American Medical Association DoctorFinder and National Provider Identifier websites. Overall, 10.7% (n=146) of these individuals were women. Twenty percent (n=266) graduated from a top 10 medical school (24% of women [35/146] and 19% of men [232/1215], p=0.19). Forty-five percent (n=618) were graduates of a public medical school, 50% (n=680) of a private medical school, and 5% (n=63) of an international medical school. At the end of the study, 0.2% of subjects (n=3) were deceased and 0.3% (n=4) were lost to follow-up.

RESULTS

The total residency completion rate was 86.0% (n=1171) overall, with 76.0% (n=111/146) of women and 87.2% (n=1059/1215) of men completing residency. Board certification was obtained by 79.4% (n=1081) of all individuals matching into residency between 1990 and 1999. Overall, 63.0% (92/146) of women and 81.3% (989/1215) of men were board certified. Women were found to be significantly more at risk (p<0.005) of not completing residency or becoming board certified than men. Public medical school alumni had significantly higher board certification rates than private and international alumni (82.2% for public [508/618]; 77.1% for private [524/680]; 77.8% for international [49/63]; p<0.05). There was no significant difference in attrition for graduates of top 10-ranked institutions versus other institutions. There was no difference in number of years to achieve neurosurgical board certification for men versus women.

CONCLUSIONS

Overall, neurosurgery training attrition rates are low. Women have had greater attrition than men during and after neurosurgery residency training. International and private medical school alumni had higher attrition than public medical school alumni.

Gender differences in promotion and scholarly impact: an analysis of 1460 academic ophthalmologists

OBJECTIVES

In recent years, gender differences in academic promotion have been documented within surgical fields. To the best of our knowledge, gender discrepancies in association with scholarly productivity have not been well assessed among academic ophthalmologists. Because research productivity is strongly associated with academic career advancement, we sought to determine whether gender differences in scholarly impact, measured by the h-index, exist among academic ophthalmologists.

DESIGN

Academic rank and gender were determined using faculty listings from academic ophthalmology departments. h-index and publication experience (in years) of faculty members were determined using the Scopus database.

SETTING

Academic medical center.

RESULTS

From assistant professor through professor, the h-index increased with subsequent academic rank (p < 0.001), although between chairpersons and professors no statistical difference was found (p > 0.05). Overall, men had higher h-indices (h = 10.4 ± 0.34 standard error of mean) than women (h = 6.0 ± 0.38 standard error of mean), a finding that was only statistically significant among assistant professors in a subgroup analysis. Women were generally underrepresented among senior positions. When controlling for publication range (i.e., length of time publishing), men had higher h-indices among those with 1 to 10 years of publication experience (p < 0.0001), whereas women had scholarly impact equivalent to and even exceeding that of men later in their careers.

CONCLUSION

Women in academic ophthalmology continue to be underrepresented among senior faculty. Although women surpass men in scholarly productivity during the later stages of their careers, low scholarly impact during the earlier stages may impede academic advancement and partly explain the gender disparity in senior academic positions.

Gender differences in successful National Institutes of Health funding in ophthalmology

OBJECTIVE

To determine whether gender differences in individual National Institutes of Health (NIH) awards and in funding totals exist in ophthalmology, and to further characterize whether factors such as experience, academic rank, and terminal degree play a role.

DESIGN

A retrospective review of awards granted to primary investigators (PIs) in ophthalmology departments from 2011 through the present was conducted. PIs were classified by gender, degree, experience, and academic position. The NIH funding database was used to gather award data.

SETTING

Academic medical center.

RESULTS

Men had higher mean NIH awards ($418,605) than their female colleagues ($353,170; p = 0.005) and had higher total funding per PI (p = 0.004). Men had statistically higher awards at the level of assistant professor than their female counterparts (p < 0.05). A gender difference was statistically significant and most marked among researchers holding an MD (or equivalent) degree. When controlled for publication experience, men had higher NIH awards throughout their careers, although this difference only reached statistical significance on comparison of faculty with 10 or fewer years of experience.

CONCLUSIONS

Male PIs receiving grants since 2011 had higher awards than their female colleagues did, most markedly among PIs in the earlier portions of their career. Differences in gender representation among senior faculty and in positions of leadership in academic ophthalmology may be partially a result of disparities in research output, as scholarly productivity is an important component of the academic advancement process in ophthalmology.

Research productivity and gender disparities: a look at academic plastic surgery

OBJECTIVES

The h-index has utility in examining the contributions of faculty members by quantifying both the amount and the quality of research output and as such is a metric in approximating academic productivity. The objectives of this study were (1) to evaluate the relationship between h-index and academic rank in plastic surgery and (2) to describe the current gender representation in academic plastic surgery to assess whether there are any gender disparities in academic productivity.

DESIGN

The h-index was used to evaluate the research contributions of plastic surgeons from academic departments in the United States.

RESULTS

There were 426 (84%) men and 79 (16%) women in our sample. Those in higher academic ranks had higher h-index scores (p < 0.0005). There was a significant difference in overall mean h-index by gender, where the mean scores were 9.0 and 6.0 for men and women, respectively (p = 0.0005). When analyzed by academic rank, there was a significant difference in academic productivity between men and women in assistant and associate professor positions (6.4 vs 5.1, respectively; p = 0.04).

CONCLUSIONS

The h-index is able to objectively and reliably quantify academic productivity in plastic surgery. We found that h-indices increased with higher academic rank, and men had overall higher scores than their female colleagues. Adoption of this metric as an adjunct to other objective and subjective measures by promotions committees may provide a more reliable measure of research relevance and academic productivity in academic plastic surgery.

Regional Differences in Gender Promotion and Scholarly Productivity in Otolaryngology

Objectives

To identify whether regional differences exist in gender disparities in scholarly productivity and faculty rank among academic otolaryngologists.

Study Design and Setting

Academic otolaryngologists’ bibliometric data analyses.

Methods

Online faculty listings from 98 otolaryngology departments were organized by gender, academic rank, fellowship training status, and institutional location. The Scopus database was used to assess bibliometrics of these otolaryngologists, including the h-index, number of publications, and publication experience.

Results

Analysis included 1127 otolaryngologists, 916 men (81.3%) and 211 women (18.7%). Female faculty comprised 15.4% in the Midwest, 18.8% in the Northeast, 21.3% in the South, and 19.0% in the West ( P = .44). Overall, men obtained significantly higher senior academic ranks (associate professor or professor) compared to women (59.8% vs 40.2%, P < .0001). Regional gender differences in senior faculty were found in the South (59.8% men vs 37.3% women, P = .0003) and Northeast (56.4% men vs 24.1% women, P < .0001) with concomitant gender differences in scholarly impact, as measured by the h-index (South, P = .0003; Northeast, P = .0001). Among geographic subdivisions, female representation at senior ranks was lowest in the Mid-Atlantic (22.0%), New England (30.8%), and West South Central (33.3%), while highest in Pacific (60.0%) and Mountain (71.4%) regions. No regional gender differences were found in fellowship training patterns ( P-values > .05).

Conclusion

Gender disparities in academic rank and scholarly productivity exist most notably in the Northeast, where women in otolaryngology are most underrepresented relative to men at senior academic ranks and in scholarly productivity.

A gender-based comparison of academic rank and scholarly productivity in academic neurological surgery

The number of women pursuing training opportunities in neurological surgery has increased, although they are still underrepresented at senior positions relative to junior academic ranks. Research productivity is an important component of the academic advancement process. We sought to use the h-index, a bibliometric previously analyzed among neurological surgeons, to evaluate whether there are gender differences in academic rank and research productivity among academic neurological surgeons. The h-index was calculated for 1052 academic neurological surgeons from 84 institutions, and organized by gender and academic rank. Overall men had statistically higher research productivity (mean 13.3) than their female colleagues (mean 9.5), as measured by the h-index, in the overall sample (p<0.0007). When separating by academic rank, there were no statistical differences (p>0.05) in h-index at the assistant professor (mean 7.2 male, 6.3 female), associate professor (11.2 male, 10.8 female), and professor (20.0 male, 18.0 female) levels based on gender. There was insufficient data to determine significance at the chairperson rank, as there was only one female chairperson. Although overall gender differences in scholarly productivity were detected, these differences did not reach statistical significance upon controlling for academic rank. Women were grossly underrepresented at the level of chairpersons in this sample of 1052 academic neurological surgeons, likely a result of the low proportion of females in this specialty. Future studies may be needed to investigate gender-specific research trends for neurosurgical residents, a cohort that in recent years has seen increased representation by women.

Gender disparities in scholarly productivity within academic otolaryngology departments

OBJECTIVE

To examine whether there are gender disparities in scholarly productivity within academic otolaryngology departments, as measured by academic rank and the h-index, a published, objective measure of research contributions that quantifies the number and significance of papers published by a given author.

STUDY DESIGN AND SETTING

Analysis of bibliometric data of academic otolaryngologists.

METHODS

Faculty listings from academic otolaryngology departments were used to determine academic rank and gender. The Scopus database was used to determine h-index and publication range (in years) of these faculty members. In addition, 20 randomly chosen institutions were used to compare academic otolaryngologists to faculty members in other surgical specialties.

RESULTS

Mean h-indices increased through the rank of professor. Among academic otolaryngologists, men had significantly higher h-indices than women, a finding also noted on examination of faculty members from other specialties. Men had higher research productivity rates at earlier points in their career than women did. The productivity rates of women increased and equaled or surpassed those of men later in their careers. Men had higher absolute h-index values at junior academic ranks. Women academic otolaryngologists of senior rank had higher absolute h-indices than their male counterparts.

CONCLUSIONS

The h-index measures research significance in an objective manner and indicates that although men have higher overall research productivity in academic otolaryngology, women demonstrate a different productivity curve. Women produce less research output earlier in their careers than men do, but at senior levels, they equal or exceed the research productivity of men.

Neurosurgical rotations or clerkships in US medical schools

OBJECT

Medical student exposure to neurosurgery is limited. To improve the educational interactions between neurosurgeons and medical students as well as neurosurgical medical student rotations or clerkships (NSCs) we must first understand the current status.

METHODS

Two questionnaires were sent, one to every neurosurgery course coordinator or director at each US neurosurgery residency program (99 questionnaires) and one to the associated parent medical school dean's office (91 questionnaires), to assess the current status of NSCs and the involvement of neurosurgeons at their respective institutions.

RESULTS

We received responses from 86 (87%) of 99 neurosurgery course coordinators or directors and 64 (70%) of 91 medical school deans' offices. Most NSCs do not have didactic lectures (53 [62%] of 86 NSCs), provide their medical students with a syllabus or educational handouts (53 [62%] of 86), or have a recommended/required textbook (77 [90%] of 86). The most common method of evaluating students in NSCs is a subjective performance evaluation. Of 64 medical school deans, 38 (59%) felt that neurosurgery should not be a required rotation. Neurosurgical rotations or clerkships are primarily offered to students in their 4th year of medical school, which may be too late for appropriate timing of residency applications. Only 21 (33%) of 64 NSCs offer neurosurgery rotations to 3rd-year students.

CONCLUSIONS

There is significant room for improvement in the neurosurgeon-to-medical student interactions in both the NSCs and during the didactic years of medical school.

The future of neurosurgery: a white paper on the recruitment and retention of women in neurosurgery

PREFACE

The leadership of Women in Neurosurgery (WINS) has been asked by the Board of Directors of the American Association of Neurological Surgeons (AANS) to compose a white paper on the recruitment and retention of female neurosurgical residents and practitioners.

INTRODUCTION

Neurosurgery must attract the best and the brightest. Women now constitute a larger percentage of medical school classes than men, representing approximately 60% of each graduating medical school class. Neurosurgery is facing a potential crisis in the US workforce pipeline, with the number of neurosurgeons in the US (per capita) decreasing.

WOMEN IN THE NEUROSURGERY WORKFORCE

The number of women entering neurosurgery training programs and the number of board-certified female neurosurgeons is not increasing. Personal anecdotes demonstrating gender inequity abound among female neurosurgeons at every level of training and career development. Gender inequity exists in neurosurgery training programs, in the neurosurgery workplace, and within organized neurosurgery.

OBSTACLES

The consistently low numbers of women in neurosurgery training programs and in the workplace results in a dearth of female role models for the mentoring of residents and junior faculty/practitioners. This lack of guidance contributes to perpetuation of barriers to women considering careers in neurosurgery, and to the lack of professional advancement experienced by women already in the field. There is ample evidence that mentors and role models play a critical role in the training and retention of women faculty within academic medicine. The absence of a critical mass of female neurosurgeons in academic medicine may serve as a deterrent to female medical students deciding whether or not to pursue careers in neurosurgery. There is limited exposure to neurosurgery during medical school. Medical students have concerns regarding gender inequities (acceptance into residency, salaries, promotion, and achieving leadership positions). Gender inequity in academic medicine is not unique to neurosurgery; nonetheless, promotion to full professor, to neurosurgery department chair, or to a national leadership position is exceedingly rare within neurosurgery. Bright, competent, committed female neurosurgeons exist in the workforce, yet they are not being promoted in numbers comparable to their male counterparts. No female neurosurgeon has ever been president of the AANS, Congress of Neurological Surgeons, or Society of Neurological Surgeons (SNS), or chair of the American Board of Neurological Surgery (ABNS). No female neurosurgeon has even been on the ABNS or the Neurological Surgery Residency Review Committee and, until this year, no more than 2 women have simultaneously been members of the SNS. Gender inequity serves as a barrier to the advancement of women within both academic and community-based neurosurgery.

STRATEGIC APPROACH TO ADDRESS ISSUES IDENTIFIED

To overcome the issues identified above, the authors recommend that the AANS join WINS in implementing a strategic plan, as follows: 1) Characterize the barriers. 2) Identify and eliminate discriminatory practices in the recruitment of medical students, in the training of residents, and in the hiring and advancement of neurosurgeons. 3) Promote women into leadership positions within organized neurosurgery. 4) Foster the development of female neurosurgeon role models by the training and promotion of competent, enthusiastic, female trainees and surgeons.