Understanding the Athena SWAN award scheme for gender equality as a complex social intervention in a complex system: analysis of Silver award action plans in a comparative European perspective

Building an inclusive wave in marine science: Sense of belonging and Society for Women in Marine Science symposia

Achieving gender equity is a long-standing and ubiquitous challenge in marine science. Creating equitable experiences for all genders in marine science requires recognizing scientists' intersectional identities, and how this leads to unique lived experiences of privilege and marginalization. One approach to increase equitable experiences for women in marine science is to create affinity groups where women can learn from each other, share their experiences, and provide support and mentorship. The Society for Women in Marine Science (SWMS) is one such organization, founded to amplify the work of early career women in marine science and create community, through events such as full-day symposium events. This study investigates the experiences of symposium attendees for four events held from 2018 through 2020, as reported in pre- and post-symposium surveys. We used quantitative analysis of the open-ended survey questions to examine the demographics of attendees and their fields of study. Qualitative thematic analysis identified the most effective aspects of the symposia, areas of logistical and content improvement for future symposia, and emphasized the unique challenges women in marine science experience. The majority of symposium attendees were white graduate students. Nearly all attendees identified as women, with a small number of men and non-binary individuals. Symposia attendees enjoyed opportunities for professional development and interactions with colleagues across career stages. We present recommendations for continuing to foster a sense of belonging in marine science and STEM more broadly, both specific to SWMS and transferable actions that can be applied for other affinity groups. These suggestions include empathetic event logistics, continual democratic evaluation, identity reflexivity among group leaders, and professional development activities targeted towards the unique needs of the affinity group. The positive responses received from SWMS's adaptive integration of survey results into symposia demonstrate that incorporating these recommendations and findings will help create an inclusive wave in marine science.

Perceptions of gender equity and markers of achievement in a National Institute for Health Research Biomedical Research Centre: a qualitative study

Background

The need to improve gender equity (GE) in academic medicine is well documented. Biomedical Research Centres (BRCs), partnerships between leading National Health Service (NHS) organizations and universities in England, conduct world-class translational research funded by the National Institute for Health and Care Research (NIHR). In 2011, eligibility for BRC funding was restricted to universities demonstrating sustained GE success recognized by the Athena SWAN Charter for Women in Science Silver awards. Despite this structural change, GE research in BRC settings is underdeveloped, yet critical to the acceleration of women’s advancement and leadership. To explore both women’s and men’s perceptions of GE and current markers of achievement in a BRC setting.

Methods

Thematic analysis of data from two research projects: 53 GE survey respondents’ free-text comments (34 women, 16 men), and 16 semi-structured interviews with women affiliated to the NIHR Oxford BRC.

Results

Four major themes emerged from the analysis: perceptions of the Athena SWAN Charter for Women in Science (GE policy); views on monitoring GE in BRCs; views on current markers of achievement in academia and GE; and recommendations for actions to improve GE in BRC settings. Monitoring of GE in BRCs was deemed to be important, but complex. Participants felt that current markers of achievement were not equitable to women, as they did not take contextual factors into account such as maternity leave and caring responsibilities. BRC-specific organizational policies and metrics are needed in order to monitor and catalyse GE.

Conclusions

Markers of achievement for monitoring GE in BRCs should consider contextual factors specific to BRCs and women’s career progression and professional advancement. GE markers of achievement should be complemented with broader aspects of equality, diversity and inclusion.

Factors that influence the implementation of organisational interventions for advancing women in healthcare leadership: A meta-ethnographic study

BACKGROUND

Gender inequity in healthcare leadership persists and progress is slow, with the focus firmly on problems, barriers and on requiring women themselves to adapt and compete in a system not designed for them. Women are individually burdened to advance their careers, with little effort given to addressing systemic barriers in the health sector. A recent systematic review prioritised organisational-level approaches and demonstrated effective interventions. In this meta-ethnographic study, we further this work by examining factors in implementation of organisational interventions for advancing women in leadership.

METHODS

The meta-ethnographic framework applied here follows the Noblit and Hare approach for synthesising findings and applying interpretive analysis to original research. We generated a new line-of-argument with insights for the healthcare sector. The protocol is registered (CRD42020162115) on the International Prospective Register of Systematic Reviews. Three academic databases (MEDLINE, PsycINFO, SCOPUS) were searched systematically between 2000 and 2021. Studies were analysed if they included organisational-level interventions that sought to measurably advance women in leadership. Study characteristics were extracted using a standard template for intervention details. Quality appraisal was conducted using the Critical Appraisal Skills Program tool. Data synthesis was conducted across 19 criteria of the Meta-Ethnography Reporting Guide (eMERGe).

FINDINGS

Fifteen qualitative studies were included. Analysis revealed three meta-themes that are central to successful implementation of organisational interventions that advance women in healthcare leadership: (1) leadership commitment and accountability, influenced by internal and external organisational settings, salient for long term outcomes and for developing an inclusive leadership culture; (2) intervention fit with individuals with consideration given to personal beliefs, preferences, experiences, capabilities or life circumstances, including capacity for leadership roles in their broader life context; balanced against maintaining interventional fidelity, and (3) cultural climate and organisational readiness for change, addressing traditional, conservative and constrictive perspectives on gender and leadership in health, highlighting the facilitating role of male colleagues.

INTERPRETATION

This meta-ethnographic research extends past work by integrating empirical evidence from a systematic literature review of effective organisational level interventions, with the identification of pragmatic themes to generate, implement, evaluate and embed evidence-based organisational interventions to advance women in healthcare leadership. This work can inform initiatives and policymakers to generate and implement new knowledge to advance women in healthcare leadership.

FUNDING

Epworth Health and Monash University provided scholarships for MM. HT is funded by an NHMRC / MRFF Practitioner Fellowship, JB by an NHMRC fellowship and HS by a Monash Warwick University Professorship.

The impact of working in academia on researchers' mental health and well-being: A systematic review and qualitative meta-synthesis

OBJECTIVE

To understand how researchers experience working in academia and the effects these experiences have on their mental health and well-being, through synthesizing published qualitative data.

METHOD

A systematic review and qualitative meta-synthesis was conducted to gain a comprehensive overview of what is currently known about academic researchers' mental health and well-being. Relevant papers were identified through searching electronic databases, Google Scholar, and citation tracking. The quality of the included studies was assessed and the data was synthesised using reflexive thematic analysis.

RESULTS

26 papers were identified and included in this review. Academic researchers' experiences were captured under seven key themes. Job insecurity coupled with the high expectations set by the academic system left researchers at risk of poor mental health and well-being. Access to peer support networks, opportunities for career progression, and mentorship can help mitigate the stress associated with the academic job role, however, under-represented groups in academia are at risk of unequal access to resources, support, and opportunities.

CONCLUSION

To improve researchers' well-being at work, scientific/academic practice and the system's concept of what a successful researcher should look like, needs to change. Further high-quality qualitative research is needed to better understand how systemic change, including tackling inequality and introducing better support systems, can be brought about more immediately and effectively. Further research is also needed to better understand the experiences and support needs of post-doctoral and more senior researchers, as there is a paucity of literature in this area.

TRIAL REGISTRATION

The review protocol was registered on PROSPERO (CRD42021232480).

Exploring parity in female authorship of pharmacoepidemiology articles: A case study of the Canadian Network for Observational Drug Effect Studies and its citing articles

PURPOSE

The Canadian Network for Observational Drug Effect Studies (CNODES) studies the benefits and risks of post-market drugs and evaluates its research mobilization efforts for accountability, demonstrating value, and learning. As part of these evaluation efforts, and acknowledging gender disparity in authorship across many academic disciplines, CNODES examined the relationship between gender and authorship in its own journal articles and the literature citing them.

METHODS

CNODES articles (published 2012-2017) and all citing articles were identified and extracted using Scopus. Scopus author IDs were used to extract full names and a web service (www.genderapi.com) was used to estimate gender, converting all probabilities <80% to "indeterminate." T-tests and visualizations were used to compare the proportion of females between CNODES and the citing literature.

RESULTS

Twenty-eight CNODES articles and 463 citing articles were identified. The mean number of authors per article was 9.5 in CNODES articles and 5.7 in the citing literature. CNODES articles had a female authorship rate of 36%, compared to 29% in the citing literature (7% difference, 95% CI: [1%, 13%]). There were no female authors in 14% of CNODES articles versus 36% of the citing literature. Women were first authors in 25% and corresponding authors in 14% of CNODES articles.

CONCLUSIONS

This analysis provides a benchmark and method to monitor progress in female parity in pharmacoepidemiology authorship. Further work is needed to determine and address barriers and facilitators to women's recruitment and advancement in the field of pharmacoepidemiology.

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

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

Certifying Gender Equality in Research: Lessons Learnt From Athena SWAN and Total E-Quality Award Schemes

In the past 2 decades, many Certification and Award schemes (CAS) related to gender equality, diversity and inclusion have emerged in the higher education, research and industry sectors. According to a recent report, there are as many as 113 CAS which have been identified across Europe and beyond. These CAS aim at addressing inequalities in relation to the grounds of sex, gender, race, sexual orientation, and disability among others. The high number of CAS, and their continued growth, has taken place in parallel to the shift of policies and efforts from "fixing individuals" to "fixing the system." In these schemes, gender equality is often understood as a structural, systemic challenge, with a recognition that advancing gender equality is complex and requires drivers and interventions at micro, meso and macro level. Studies focused on analysing and evaluating gender equality initiatives in higher education have been scarce, and often limited to specific schemes. This paper aims to fill this gap by providing a better understanding of the CAS landscape through comparing two of the main gender equality schemes used by research-performing organisations in Europe Athena SWAN (in the UK) and Total E-Quality Award (in Germany). Based on qualitative interviews with stakeholders across Europe and document analysis, this paper focuses on strengths, challenges faced by and the impact of these CAS. This comparative exercise highlights particular learning points that can inform potential reviews of existing schemes and/or the development of new schemes such as a Europe-wide scheme. The latter is the focus of a Horizon 2020 project entitled CASPER (Certification-Award Systems to Promote Gender Equality in Research), which aims at making recommendations to the European Commission as to the feasibility of a Europe-wide CAS for gender equality in research organisations.

Gender differences in faculty rank among academic physicians: a systematic review and meta-analysis

OBJECTIVE

Many studies have analysed gender bias in academic medicine; however, no comprehensive synthesis of the literature has been performed. We conducted a pooled analysis of the difference in the proportion of men versus women with full professorship among academic physicians.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Education Resources Information Center and PsycINFO were searched from inception to 3 July 2020.

STUDY SELECTION

All original studies reporting faculty rank stratified by gender worldwide were included.

DATA EXTRACTION AND SYNTHESIS

Study screening, data extraction and quality assessment were performed by two independent reviewers, with a third author resolving discrepancies. Meta-analysis was conducted using random-effects models.

RESULTS

Our search yielded 5897 articles. 218 studies were included with 991 207 academic physician data points. Men were 2.77 times more likely to be full professors (182 271/643 790 men vs 30 349/251 501 women, OR 2.77, 95% CI 2.57 to 2.98). Although men practised for longer (median 18 vs 12 years, p<0.00002), the gender gap remained after pooling seven studies that adjusted for factors including time in practice, specialty, publications, h-index, additional PhD and institution (adjusted OR 1.83, 95% CI 1.04 to 3.20). Meta-regression by data collection year demonstrated improvement over time (p=0.0011); however, subgroup analysis showed that gender disparities remain significant in the 2010-2020 decade (OR 2.63, 95% CI 2.48 to 2.80). The gender gap was present across all specialties and both within and outside of North America. Men published more papers (mean difference 17.2, 95% CI 14.7 to 19.7), earned higher salaries (mean difference $33 256, 95% CI $25 969 to $40 542) and were more likely to be departmental chairs (OR 2.61, 95% CI 2.19 to 3.12).

CONCLUSIONS

Gender inequity in academic medicine exists across all specialties, geographical regions and multiple measures of success, including academic rank, publications, salary and leadership. Men are more likely than women to be full professors after controlling for experience, academic productivity and specialty. Although there has been some improvement over time, the gender disparity in faculty rank persists.

PROSPERO REGISTRATION NUMBER

CRD42020197414.

Women in neurointervention, a gender gap? Results of a prospective online survey

BACKGROUND AND PURPOSE

Women's representation in medicine has increased over time yet the proportion of women practicing neurointervention remains low. We conducted an anonymous online survey through which we could explore the gender gap in neurointervention, identify potential issues, difficulties, or obstacles women might face, and evaluate if men encounter similar issues.

METHODS

An online questionnaire was designed in SurveyMonkey®. Invitation to participate was emailed through national and international neurointerventional societies as well as directly through private mailing lists to men and women working in neurointervention. Responses were collected from 10 May 2019 to 10 September 2019.

RESULTS

There were 295 complete responses, 173 (59%) male and 122 (41%) female. Most respondents (83%) fell within age categories 35-60 years, with representation from 40 countries across five continents. In all 95% were working full time, 73% had worked as a neurointerventionalist for >6 years, 77% worked in University-affiliated teaching institutions. Almost half of the respondents indicated no female neurointerventionalist worked in their center. Female respondents were younger and age-adjusted analysis was undertaken. Significantly fewer females than males were married and had children. Significantly fewer females held supervisory roles, held academic titles, and significantly less had a mentor. Females were less satisfied in their careers. More females felt they receive less recognition than colleagues of the opposite sex. Males had a greater proportion of work time dedicated to neurointervention. Similar proportions of both genders experienced bullying in work (40%-47%); however, sexual harassment was more common for females. There were no differences between genders in how they dealt with complications or their effects on mental well-being.

CONCLUSION

There are many potential reasons why women are underrepresented in neurointervention, however, the literature suggests this is not unique to our specialty. Multiple long-term strategies will be necessary to address these issues, some of which are discussed in the article.

Advancing women in healthcare leadership: A systematic review and meta-synthesis of multi-sector evidence on organisational interventions

BACKGROUND

Women are underrepresented in healthcare leadership, yet evidence on impactful organisational strategies, practices and policies that advance women's careers are limited. We aimed to explore these across sectors to gain insight into measurably advancing women in leadership in healthcare.

METHODS

A systematic review was performed across Medline via OVID; Medline in-process and other non-indexed citations via OVID; PsycINFO and SCOPUS from January 2000 to March 2021. Methods are outlined in a published protocol registered a priori on PROSPERO (CRD42020162115). Eligible studies reported on organisational interventions for advancing women in leadership with at least one measurable outcome. Studies were assessed independently by two reviewers. Identified interventions were organised into categories and meta-synthesis was completed following the 'ENhancing Transparency in REporting the synthesis of Qualitative research' (ENTREQ) statement.

FINDINGS

There were 91 eligible studies from 6 continents with 40 quantitative, 38 qualitative and 13 mixed methods studies. These spanned academia, health, government, sports, hospitality, finance and information technology sectors, with around half of studies in health and academia. Sample size, career stage and outcomes ranged broadly. Potentially effective interventions consistently reported that organisational leadership, commitment and accountability were key drivers of organisational change. Organisational intervention categories included i) organisational processes; ii) awareness and engagement; iii) mentoring and networking; iv) leadership development; and v) support tools. A descriptive meta-synthesis of detailed strategies, policies and practices within these categories was completed.

INTERPRETATION

This review provides an evidence base on organisational interventions for advancing women in leadership across diverse settings, with lessons for healthcare. It transcends the focus on the individual to target organisational change, capturing measurable change across intervention categories. This work directly informs a national initiative with international links, to enable women to achieve their career goals in healthcare and moves beyond the focus on barriers to solutions.

Promoting inclusive metrics of success and impact to dismantle a discriminatory reward system in science

Success and impact metrics in science are based on a system that perpetuates sexist and racist “rewards” by prioritizing citations and impact factors. These metrics are flawed and biased against already marginalized groups and fail to accurately capture the breadth of individuals’ meaningful scientific impacts. We advocate shifting this outdated value system to advance science through principles of justice, equity, diversity, and inclusion. We outline pathways for a paradigm shift in scientific values based on multidimensional mentorship and promoting mentee well-being. These actions will require collective efforts supported by academic leaders and administrators to drive essential systemic change.

This Essay argues that success and impact metrics in science are based on a system that perpetuates sexist and racist ‘rewards’ by prioritizing citations and impact factors; the authors advocate shifting this outdated value system to advance science through principles of justice, equity, diversity, and inclusion.

Equity/Equality, Diversity, and Inclusion (EDI) in Universities: The Case of Disabled People

The origin of equity/equality, diversity, and inclusion (EDI) initiatives at universities are rooted in the 2005 Athena SWAN (Scientific Women’s Academic Network) charter from Advance HE in the UK, which has the purpose of initiating actions that generate gender equality in UK universities. Since then, Advance HE also set up a “race charter” to deal with equality issues that are experienced by ethnic staff and students within higher education. Today “equality, diversity and inclusion” and “equity, diversity and inclusion” (from now on both called EDI) are used as phrases by universities in many countries to highlight ongoing efforts to rectify the problems that are linked to EDI of students, non-academic staff, and academic staff, whereby the focus broadened from gender to include other underrepresented groups, including disabled students, disabled non-academic staff, and disabled academic staff. How EDI efforts are operationalized impacts the success and utility of EDI efforts for disabled students, non-academic staff, and academic staff, and impacts the social situation of disabled people in general. As such, we analysed in a first step using a scoping review approach, how disabled students, non-academic staff, and academic staff are engaged with in the EDI focused academic literature. Little engagement (16 sources, some only abstracts, some abstracts, and full text) with disabled students, non-academic staff, and academic staff was found. This bodes ill for the utility of existing EDI efforts for disabled students, non-academic staff, and academic staff, but also suggests an opening for many fields to critically analyse EDI efforts in relation to disabled students, non-academic staff, and academic staff, the intersectionality of disabled people with other EDI groups and the impact of the EDI efforts on the social situation of disabled people beyond educational settings. The problematic findings are discussed through the lens of ability studies and EDI premises, as evident in EDI policy documents, EDI academic, and non-academic literature covering non-disability groups, and policy documents, such as the 2017 “UNESCO Recommendation on Science and Scientific Researchers” and the 1999 “UNESCO World Conference on Sciences” recommendations that engage with the situation of researchers and research in universities.

Gender parity in scientific authorship in a National Institute for Health Research Biomedical Research Centre: a bibliometric analysis

OBJECTIVE

Scientific authorship is a vital marker of achievement in academic careers and gender equity is a key performance metric in research. However, there is little understanding of gender equity in publications in biomedical research centres funded by the National Institute for Health Research (NIHR). This study assesses the gender parity in scientific authorship of biomedical research.

DESIGN

Descriptive, cross-sectional, retrospective bibliometric study.

SETTING

NIHR Oxford Biomedical Research Centre (BRC).

DATA

Data comprised 2409 publications that were either accepted or published between April 2012 and March 2017. The publications were classified as basic science studies, clinical studies (both trial and non-trial studies) and other studies (comments, editorials, systematic reviews, reviews, opinions, book chapters, meeting reports, guidelines and protocols).

MAIN OUTCOME MEASURES

Gender of authors, defined as a binary variable comprising either male or female categories, in six authorship categories: first author, joint first authors, first corresponding author, joint corresponding authors, last author and joint last authors.

RESULTS

Publications comprised 39% clinical research (n=939), 27% basic research (n=643) and 34% other types of research (n=827). The proportion of female authors as first author (41%), first corresponding authors (34%) and last author (23%) was statistically significantly lower than male authors in these authorship categories (p<0.001). Of total joint first authors (n=458), joint corresponding authors (n=169) and joint last authors (n=229), female only authors comprised statistically significant (p<0.001) smaller proportions, that is, 15% (n=69), 29% (n=49) and 10% (n=23) respectively, compared with male only authors in these joint authorship categories. There was a statistically significant association between gender of the last author with gender of the first author (p<0.001), first corresponding author (p<0.001) and joint last author (p<0.001). The mean journal impact factor (JIF) was statistically significantly higher when the first corresponding author was male compared with female (Mean JIF: 10.00 vs 8.77, p=0.020); however, the JIF was not statistically different when there were male and female authors as first authors and last authors.

CONCLUSIONS

Although the proportion of female authors is significantly lower than the proportion of male authors in all six categories of authorship analysed, the proportions of male and female last authors are comparable to their respective proportions as principal investigators in the BRC. These findings suggest positive trends and the NIHR Oxford BRC doing very well in gender parity in the senior (last) authorship category. Male corresponding authors are more likely to publish articles in prestigious journals with high impact factor while both male and female authors at first and last authorship positions publish articles in equally prestigious journals.

A Personal Perspective: Is Bullying Still a Problem in Medicine?

Bullying of whatever form should have no place in the Medical Profession. Reforms to junior doctor training and reduction in working hours have helped to control most of the individual bullying which may have existed in the past. However, the complexities of institutional bullying still exist. In the United Kingdom, centralised monitoring systems, such as Athena SWAN, are designed to reward academic and medical institutions for positive steps to introduce equality and mitigate bullying. However, the reality is that such processes may be conducted in healthcare or educational establishments that have little intention to address the problem thoroughly. We report the personal experience of both individual and institutional bullying in the medical career of a medically-qualified interviewee and reflect on ways to mitigate the problem. We also consider whether unconscious bias affects our relationships with patients. In a caring medical profession, there should be no room for intolerance, unconscious bias or bullying.

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.

Sex and gender analysis in knowledge translation interventions: challenges and solutions

Sex and gender considerations are understood as essential components of knowledge translation in the design, implementation and reporting of interventions. Integrating sex and gender ensures more relevant evidence for translating into the real world. Canada offers specific funding opportunities for knowledge translation projects that integrate sex and gender. This Commentary reflects on the challenges and solutions for integrating sex and gender encountered in six funded knowledge translation projects. In 2018, six research teams funded by the Canadian Institutes of Health Research’s Institute of Gender and Health met in Ottawa to discuss these challenges and solutions. Eighteen participants, including researchers, healthcare professionals, trainees and members of the Institute of Gender and Health, were divided into two groups. Two authors conducted qualitative coding and thematic analysis of the material discussed. Six themes emerged, namely Consensus building, Guidance, Design and outcomes effectiveness, Searches and recruitment, Data access and collection, and Intersection with other determinants of health. Solutions included educating stakeholders on the use of sex and gender concepts, triangulating perspectives of researchers and end-users, and participating in organisations and committees to influence policies and practices. Unresolved challenges included difficulty integrating sex and gender considerations with principles of patient-oriented research, a lack of validated measurement tools for gender, and a paucity of experts in intersectionality. We discuss our findings in the light of observations of similar initiatives elsewhere to inform the further progress of integrating sex and gender into the knowledge translation of health services research findings.

'Too male, too pale, too stale': a qualitative exploration of student experiences of gender bias within medical education

OBJECTIVE

To explore medical student perceptions and experiences of gender bias within medical education.

SETTING

Gender bias-'prejudiced actions or thoughts based on the perception that women are not equal to men'-is a widespread issue. Within medicine, the pay gap, under-representation of women in senior roles and sexual harassment are among the most concerning issues demonstrating its presence and impact. While research investigating experiences of clinicians is gaining traction, investigation of medical students' experiences is lacking. This qualitative study analyses medical students' experiences of gender bias within their education to discern any patterns to this bias. Illuminating the current state of medical education gender bias will hopefully highlight areas in which student experience could be improved. Constructivist thematic analysis was used to analyse data, informed by William's patterns of gender bias, intersectional feminism and communities of practice theory.

PARTICIPANTS

Thirty-two medical students from multiple UK medical schools participated in individual interviews. Nine faculty members were also interviewed to triangulate data.

RESULTS

Gender bias has an overt presence during medical student education, manifesting in line with William's patterns of bias, impacting career aspirations. Physical environments serve to manifest organisational values, sending implicit messages regarding who is most welcome-currently, this imagery remains 'too male, too pale…too stale'. Existing gender initiatives require careful scrutiny, as this work identifies the superficial application of positive action, and a failure to affect meaningful change.

CONCLUSIONS

Despite progress having been made regarding overt gender discrimination, implicit bias persists, with existing positive action inadequate in promoting the advancement of women. Institutions should mandate participation in implicit bias education programmes for all staff and must strive to revise the imagery within physical environments to better represent society. Gender initiatives, like Athena Scientific Women's Academic Network, also require large-scale evaluation regarding their impact, which this work found to be lacking.

A systems approach for optimizing implementation to impact: meeting report and proceedings of the 2019 In the Trenches: Implementation to Impact International Summit

Background

The In the Trenches series of cutting-edge knowledge sharing events on impact for front-line experts and practitioners provides an engagement platform for diverse stakeholders across government, research funding organizations, industry, and academia to share emerging knowledge and practical experiences. The second event of the series In the Trenches: Implementation to Impact International Summit was held in Banff, Alberta, Canada, on June 7–8, 2019. The overarching vision for the Summit was to create an engagement platform for addressing key challenges and finding practical solutions to move from implementation (i.e. putting findings into effect) to impact (i.e. creating benefits to society and the economy).

Processes and proceedings

The Summit used diverse approaches to facilitate active engagement and knowledge sharing between 80 delegates across sectors and jurisdictions. Summit sessions mostly consisted of short talks and moderated panels grouped into eight thematic sessions. Each presentation included a summary of Key Messages, along with a summary of the Actionable Insights which concluded each session. The presentations and discussions are analysed, synthesized and described in this proceedings paper using a systems approach. This demonstrates how the Summit focused on each of the necessary functions (and associated components) that should be undertaken, and combined, for effective research and innovation: stewardship and governance, securing finance, creating capacity, and producing and using research. The approach also identifies relevant challenges.

Conclusions

There is increased interest globally in the benefits that can accrue from adopting a systems approach to research and innovation. Various organizations in Canada and internationally have made considerable progress on Implementation to Impact, often as a result of well-planned initiatives. The Summit highlights the value of 1) collaboration between researchers and potential users, and 2) the adoption by funders of approaches involving an increasing range of responsibilities and activities. The Summit website (https://inthetrenchessummit.com/) will be periodically updated with new resources and information about future In the Trenches events.

How to strengthen a health research system: WHO's review, whose literature and who is providing leadership?

BACKGROUND

Health research is important for the achievement of the Sustainable Development Goals. However, there are many challenges facing health research, including securing sufficient funds, building capacity, producing research findings and using both local and global evidence, and avoiding waste. A WHO initiative addressed these challenges by developing a conceptual framework with four functions to guide the development of national health research systems. Despite some progress, more is needed before health research systems can meet their full potential of improving health systems. The WHO Regional Office for Europe commissioned an evidence synthesis of the systems-level literature. This Opinion piece considers its findings before reflecting on the vast additional literature available on the range of specific health research system functions related to the various challenges. Finally, it considers who should lead research system strengthening.

MAIN TEXT

The evidence synthesis identifies two main approaches for strengthening national health research systems, namely implementing comprehensive and coherent strategies and participation in partnerships. The literature describing these approaches at the systems level also provides data on ways to strengthen each of the four functions of governance, securing financing, capacity-building, and production and use of research. Countries effectively implementing strategies include England, Ireland and Rwanda, whereas West Africa experienced effective partnerships. Recommended policy approaches for system strengthening are context specific. The vast literature on each function and the ever-growing evidence-base are illustrated by considering papers in just one key journal, Health Research Policy and Systems, and analysing the contribution of two national studies. A review of the functions of the Iranian system identifies over 200 relevant and mostly national records; an analysis of the creation of the English National Institute for Health Research describes the key leadership role played by the health department. Furthermore, WHO is playing leadership roles in helping coordinate partnerships within and across health research systems that have been attempting to tackle the COVID-19 crisis.

CONCLUSIONS

The evidence synthesis provides a firm basis for decision-making by policy-makers and research leaders looking to strengthen national health research systems within their own national context. It identifies five crucial policy approaches - conducting situation analysis, sustaining a comprehensive strategy, engaging stakeholders, evaluating impacts on health systems, and partnership participation. The vast and ever-growing additional literature could provide further perspectives, including on crucial leadership roles for health ministries.

Athena SWAN and gender diversity: a UK-based retrospective cohort study

OBJECTIVES

To promote gender diversity and equity in higher education, Athena Scientific Women's Academic Network (SWAN) supports and recognises higher education institutions (HEI) in advancing the careers of women through charter commitment, awards, training and advocacy since 2005. Most evaluation studies, however, are based on qualitative assessments. This study sought to (1) examine the relationship between Athena SWAN accreditation/awards in the UK and gender diversity of leaders and senior academics using quantitative data from 2012/2013 to 2016/2017, and (2) explore the associations between Athena SWAN awards and university performance as measured by overall scores in global ranking systems.

DESIGN

Retrospective cohort study based on the UK HEIs.

SETTING

Higher education sector in the UK provided by the Higher Education Statistics Agency.

PARTICIPANTS

148 HEIs who provided employment data on female-to-male ratios (55% complete data) for each academic year between 2012/2013 and 2016/2017.

PRIMARY AND SECONDARY OUTCOME MEASURES

Gender diversity, defined as female representation rates of positions in managerial leadership (eg, heads of institutions, department heads) and professors. The Quacquarelli Symonds (QS) World University Rankings scores, an indicator of research, teaching, employability and internationalisation, were collected to measure university performance.

RESULTS

Gender diversity of managerial leaders and non-managerial professors at all levels of Athena SWAN status has improved over the 5 years. Linear mixed effects models identified that Athena SWAN awardees had lower female representation than non-awardees in managerial leadership positions (p<0.05), while the gap was narrowed among Silver awardees over time. Athena SWAN Charter members had increasingly higher female representation than those not in the Charter (p<0.05). Silver-award institutions ranked higher in QS rankings than Bronze-award institutions (β=11.80, p<0.05).

CONCLUSIONS

There are overall rising trends in gender diversity from 2012/2013 to 2016/2017. Athena SWAN members showed greater and faster growth in female representations. Silver awardees had greater university performance than Bronze awardees.