Women's role in neurosurgical research: is the gender gap improving?

Does gender disparity exist in neurosurgery training? Evidence from a nationwide survey from Pakistan

Gender disparities are prevalent in the neurosurgical field, particularly for female trainees, despite the growing demand for neurosurgeons. The situation is bleaker in low-and middle-income countries, where gender disparities among neurosurgical trainees have not been evaluated. We aimed to gauge the gender differences in opportunities and perceptions of neurosurgery training in Pakistan by comparing responses between males and females. A nationwide web-based survey was conducted in Pakistan, covering 22 College of Physicians and Surgeons of Pakistan (CPSP) accredited neurosurgery training programs. Convenience sampling was used with a pilot-tested questionnaire. Data analysis was performed using SPSS version 26. A total of 120 trainees participated in our survey. The mean age of the participants was 30.4 ± 4.1 years, with 29.2% females and 70.8% males. Concerns about gender equity were more among females (34.3%) than males (27.1%). Poor work-life balance was reported by more females (34.3%) than males (30.6%). Burnout due to working hours was strongly agreed by more females (54.3%) than males (35.3%). More females (40%) acknowledged sufficient mentorship opportunities versus males (25%). Female respondents (65.7%) worked 50-100 hours per week, less than males (69.4%). Satisfaction with surgical exposure was lower among females (2.9%) compared to males (18.8%). More females reported access to teaching courses (82.9% vs. 77.6% males) and neurosurgical conferences (85.7% vs. 80.0% males), cadaver workshops (17.1% vs. 12.9% males), morbidity and mortality meetings (88.6% vs. 82.4% males), case-based sessions (82.9% vs. 75.3% males), and radiology discussions (82.9% vs. 74.1% males). Our study highlights substantial gender gaps in neurosurgical training, concerns over working hours, burnout, mentorship, work-life balance, and gender equity. These findings underscore the necessity for interventions to rectify these disparities and foster gender equity in neurosurgical training.

Women in neurosurgery in Peru: current situation and representation

The participation of women in neurosurgery in Peru began in 1974 with the first Peruvian female neurosurgeon, who was accepted into a residency program with the condition of not getting married during her training. Nowadays, the conditions are more just, and there is greater equality of opportunities between men and women, but the numbers show that the differences have not yet been fully equalized. As evidence of this, it has been observed that only 17% of the residency positions offered in 2022 were filled by women, and there has been reduced participation of female neurosurgeons in the Peruvian Society of Neurosurgery. This article discusses the importance of tracking and promoting stories of Peruvian female neurosurgeons and calls for research in the area of women in neurosurgery in latin countries, like Peru.

Gender-Based Disparities in Academic Productivity Arise During Neurosurgery Residency: A Systematic Review

BACKGROUND

Although female neurosurgery residents are increasing, women remain underrepresented in academic leadership.

OBJECTIVES

To assess academic productivity differences between male and female neurosurgery residents.

METHODS

We used the Accreditation Council for Graduate Medical Education records to obtain 2021-2022 recognized neurosurgery residency programs. Gender was dichotomized into male/female by male-presenting/female-presenting status. Extracted variables included degrees/fellowships from institutional websites, number of preresidency and total publications from PubMed, and h -indices from Scopus. Extraction occurred from March to July 2022. Residency publication number and h- indices were normalized by postgraduate year. Linear regression analyses were conducted to assess factors associated with numbers of in-residency publications. P < .05 was considered statistically significant.

RESULTS

Of 117 accredited programs, 99 had extractable data. Information from 1406 residents (21.6% female) was successfully collected. 19 687 and 3261 publications were evaluated for male residents and female residents, respectively. Male and female residents' median preresidency publication numbers did not significantly differ (M:3.00 [IQR 1.00-8.50] vs F:3.00 [IQR 1.00-7.00], P = .09), nor did their h -indices. However, male residents had significantly higher median residency publications than female residents (M:1.40 [IQR 0.57-3.00] vs F:1.00 [IQR 0.50-2.00], P < .001). On multivariable linear regression, male residents (odds ratio [OR] 2.05, 95% CI 1.68-2.50, P < .001) and residents with more preresidency publications (OR 1.17, 95% CI 1.16-1.18, P < .001) had higher likelihood of publishing more during residency, controlling for other covariates.

CONCLUSION

Without publicly available, self-identified gender designation for each resident, we were limited to review/designate gender based on male-presenting/female-presenting status from gender conventions of names/appearance. Although not an ideal measurement, this helped show that during neurosurgical residency, male residents publish significantly more than female counterparts. Given similar preresidency h- indices and publication records, this is unlikely explained by differences in academic aptitude. In-residency gender barriers to academic productivity must be acknowledged and addressed to improve female representation within academic neurosurgery.

Gender equity of authorship in pulmonary medicine over the past decade

BACKGROUND

Gender disparity in authorship broadly persists in medical literature, little is known about female authorship within pulmonary medicine.

METHODS

A bibliometric analysis of publications from 2012 to 2021 in 12 journals with the highest impact in pulmonary medicine was conducted. Only original research and review articles were included. Names of the first and last authors were extracted and their genders were identified using the Gender-API web. Female authorship was described by overall distribution and distribution by country/region/continent and journal. We compared the article citations by gender combinations, evaluated the trend in female authorship, and forecasted when parity for first and last authorship would be reached. We also conducted a systematic review of female authorship in clinical medicine.

RESULTS

14,875 articles were included, and the overall percentage of female first authors was higher than last authors (37.0% vs 22.2%, p<0.001). Asia had the lowest percentage of female first (27.6%) and last (15.2%) authors. The percentages of female first and last authors increased slightly over time, except for a rapid increase in the COVID-19 pandemic periods. Parity was predicted in 2046 for the first authors and 2059 for the last authors. Articles with male authors were cited more than articles with female authors. However, male-male collaborations significantly decreased, whereas female-female collaborations significantly increased.

CONCLUSIONS

Despite the slow improvement in female authorship over the past decade, there is still a substantial gender disparity in female first and last authorship in high-impact medical journals in pulmonary medicine.

Academic Activities of Female Neurosurgeons in All Branch Meetings of the Japan Neurosurgical Society

This study aims to evaluate the academic activities of female neurosurgeons at all branch meetings of the Japan Neurosurgical Society and identify related issues they encountered. The programs of all seven branch meetings of the Japan Neurosurgical Society (Hokkaido, Tohoku, Kanto, Chubu, Kinki, Chugoku/Shikoku, and Kyushu) were used to determine the number of presentations and chairpersons by sex. The covered period was from January 2008 to December 2020, which was available for viewing during the survey. Of note, only the Kinki branch used data from January 2008 to December 2019. The Neurologia Medico-chirurgica (NMC), the journal of the Japan Neurosurgical Society, was also reviewed to identify publication achievements during the same period. In all seven branches, the percentage of presentations given by female physicians increased from 7.9% in 2008 to 9.6% in 2020 (p < 0.05).Conversely, the percentage of female chairpersons in all branch meetings did not change over time and it was significantly lower (1.1%) than that of female presenters (7.9%) for all branch meetings combined in over 13 years (p < 0.01). In the NMC, the number of articles with female physicians as first authors did not increase or decrease over the years. We conclude that efforts to smoothly promote female neurosurgeons as chairpersons and increase the number of female first authors are necessary to facilitate their academic activities.

Equity in neurosurgery: a worldwide survey of women neurosurgeons

OBJECTIVE

The global neurosurgery workforce does not have a defined stance on gender equity. The authors sought to study and characterize the demographic features of the international women neurosurgery community and to better understand the perceptions and reflections of their neurosurgical careers. The objective was to define and characterize the workplace inequities faced by the global women neurosurgeon community.

METHODS

A 58-item cross-sectional survey was distributed to the global women neurosurgery community. The survey was distributed via an online and mobile platform between October 2018 and December 2020. Responses were anonymized. The authors utilized chi-square analysis to differentiate variables (e.g., career satisfaction) between various groups (e.g., those based on academic position). The authors calculated 95% CIs to establish significance.

RESULTS

Among 237 respondents, approximately 40% were between the ages of 26 and 35 years. Within their respective departments, 45% identified themselves as the only woman neurosurgeon in their practice. Forty-three percent stated that their department supported women neurosurgeons for leadership roles. Seventy-five percent of respondents were members of organized neurosurgery professional societies; of these, 38% had been involved in leadership roles. Almost 60% of respondents postponed their decision to get pregnant because of resident or work-related influences.

CONCLUSIONS

This survey provides international feedback for characterizing and understanding the experiences of women neurosurgeons worldwide. Future research should aim to understand all neurosurgeons' experiences throughout the pipeline and career life cycle of neurosurgery in order to improve the field of neurosurgery.

Women in Neurosurgery: A PRISMA-Compliant Systematic Review of Where We Stand and a Pilot Study on How to Move Forward

BACKGROUND

Surgical specialties struggle to recruit women. In this study, the authors performed a systematic review to describe progress of women in neurosurgery and highlight areas where further research is needed.

METHODS

PubMed, Embase, and Cochrane Library were queried with "women in neurosurgery" OR "female neurosurgeon," and publications with empiric research were included. Bias was assessed on the basis of study designs.

RESULTS

We found 127 papers, and 36 met inclusion criteria. Much of this research is recent-85% has been published within the past 3 years. These papers detail differences between genders and examine possible causes, but they do not test interventions to remedy inequities. The authors designed an intervention focusing on medical students' perceptions of gender issues within neurosurgery. A seminar was designed with 2 objectives: inform medical students about changes within neurosurgery and introduce them to a female neurosurgery attending who could serve as a potential future mentor. Student attitudes were assessed before and after the seminar by survey. Fourteen students completed both surveys: 10 females and 4 males.

CONCLUSIONS

The 1-hour seminar significantly reduced the mean perceived difficulty to enter neurosurgery from 4.4 to 4.1 (P = 0.014); additionally, the mean perceived additional difficulty for career advancement faced by women in neurosurgery decreased from 3.6 to 2.8 (P = 0.026). Much research has gone into documenting the advancement and potential impediments for women in neurosurgery. Less research has tested solutions. Our pilot was small and susceptible to bias, but given that some results achieved significance, it merits more rigorous study.

Representation of female neurosurgeons as abstract authors at neurological surgery conferences

OBJECTIVE

Female neurosurgeon representation has increased, but women still represent only 8.4% of neurosurgeons in the US. Women are significantly underrepresented as authors in neurosurgical and spine journals, a key indicator of professional success in academic medicine. In this study, the authors aimed to assess the gender diversity of first and last authors of accepted abstracts at neurosurgical conferences in 2015 and 2019.

METHODS

Annual meeting abstracts for 2015 and 2019 of the American Association of Neurological Surgeons (AANS), Congress of Neurological Surgeons (CNS), and pediatrics, spine, stereotactic and functional surgery, and cerebrovascular AANS/CNS subspecialty sections were obtained and analyzed for gender. Partial data were obtained for tumor and pain sections. Composite gender data were obtained from the societies. Percentage differences were calculated using comparison of proportions testing.

RESULTS

Overall, female neurosurgeons accounted for only 8.3% of first and 5.8% of last authors, and 7.2% of authors overall. The pediatrics section had the highest proportion of female neurosurgeons as first (13.7%) and last (12.4%) abstract authors, while the spine section had the lowest proportions of female neurosurgeon first (4.6%) and last (2.0%) authors. Qualitatively, a higher proportion of women were first authors, while a higher proportion of men were last authors. Overall, there was no significant change in female neurosurgeon authorship between 2015 and 2019. With regard to society demographics, female neurosurgeons accounted for only 6.3% of AANS membership. The pediatrics section had the highest proportion of female neurosurgeons at 18.1% and the stereotactic and functional surgery section had the lowest of the subspecialty sections (7.6%). While female neurosurgeons represented 12.6% of spine section membership, they represented only 4.7% of first authors (-7.9% difference; p < 0.0001) and 2.4% of last authors (-10.2% difference; p < 0.0001). For the 2019 cerebrovascular section, female neurosurgeons were underrepresented as presenting authors (5.8%) compared with their membership representation (14.8%, -9.0% difference; p = 0.0018).

CONCLUSIONS

Despite an increase in the number of female neurosurgeons, there has not been a corresponding increase in the proportion of female neurosurgeons as abstract authors at annual neurosurgery conferences, and female neurosurgeons remain underrepresented as authors compared with their male colleagues.

Gender Distribution & Rank of Authorship in Surgical Literature

BACKGROUND

Authorship of surgical literature is important for the career advancement of surgeons, and gender disparities in authorship may hinder the representation and leadership of women within academic surgery. The aim of this systematic review and meta-analysis was to evaluate the gender distribution of first, senior, and overall authorship in peer-reviewed surgical journal studies across all surgical specialties to determine if disparities exist.

METHODS

PubMed, EMBASE, and Google Scholar databases were searched for studies investigating the gender distribution of authorship of surgical literature published before December 10th, 2021. Meta-analysis was performed and Cohen's Q test for heterogenous effects was used to determine whether random or fixed-effects models were appropriate.

RESULTS

Fifteen studies investigating gender distribution of authorship met inclusion, which included a total of 136,627 pooled studies. The meta-analysis demonstrated the meta-proportion of first authorship for women to be 20.6% (95% CI: 13.9, 28.2), the meta-proportion of senior authorship for women to be 11.9% (95% CI: 6.6, 18.5), and the meta-proportion of overall authorship for women to be 23% (95% CI: 16.2, 30.7). In addition, the proportion of senior authorship for women was found to be significantly lower than the proportion of overall authorship for women (11.9% versus 23.0%, P = .0106).

CONCLUSION

There is a significantly smaller proportion of women who are first, senior, and overall authors in surgical literature compared to their colleagues who are men. Sustainable and effective solutions aimed at improving the representation of women surgeons in surgical research and research leadership are necessary.

Women in neurosurgery: perspectives from a developing country; Turkey

Although at least half of medical students are women, neurosurgery is not often preferred by women, and the proportion of female neurosurgeons who can participate in the academic platform is very low. In this study, we aimed to show the role of female neurosurgeons in the Turkish Neurosurgical Society and to describe the number and the location of female neurosurgeons in Turkey. We examined the age, academic rank, years of work in the profession, membership rate in society subgroups, h-index parameters, and relationships of certificated female neurosurgeons registered in the Turkish Neurosurgical Society. We examined gender rate differences between society subgroups using chi-square tests. A P value < 0.05 was considered statistically significant. According to the year-end 2020 data of the Turkish Neurosurgery Society, 94 (5.5%) of the 1699 neurosurgery specialists registered in Turkey are women. There are currently 94 board-certified female neurosurgeons between the ages of 31 and 92 years; 10 are full professors (10.6%), 16 are associate professors (17%), 5 are assistant professors (5.3%), and 63 are neurosurgery specialist physicians (67%). Female neurosurgeons are present among six of the subfields categorized by the Turkish Neurosurgical Society: 7 in pediatric neurosurgery (11.47%); 8 in spinal and peripheral nerve surgery (2.4%); 3 in neurovascular surgery (2.02%); 7 in functional neurosurgery (5.8%); 11 in neuroanatomy (9.2%); and 23 in neurooncology (6.9%). The number of female neurosurgeons in Turkey continues to grow each year. To increase the proportion of women in this field, it is important to support female neurosurgeons and enable them to take on more tasks.

Female Participation in Academic European Neurosurgery-A Cross-Sectional Analysis

The study aims to provide data on authors’ gender distribution with special attention on publications from Europe. Articles (October 2019–March 2020) published in three representative neurosurgical journals (Acta Neurochirurgica, Journal of Neurosurgery, Neurosurgery) were analyzed with regard to female participation. Out of 648 publications, 503 original articles were analyzed: 17.5% (n = 670) of the 3.821 authors were female, with 15.7% (n = 79) females as first and 9.5% (n = 48) as last authors. The lowest ratio of female first and last authors was seen in original articles published in the JNS (12.3%/7.7% vs. Neurosurgery 14.9%/10.6% and Acta 23.0/11.5%). Articles originated in Europe made up 29.8% (female author ratio 21.1% (n = 226)). Female first authorship was seen in 20.7% and last authorship in 10.7% (15.3% and 7.3% were affiliated to a neurosurgical department). The percentages of female authorship were lower if non-original articles (n = 145) were analyzed (11.7% first/4.8% last authorships). Female participation in editorial boards was 8.0%. Considering the percentages of European female neurosurgeons, the current data are proportional. However, the lack of female last authors, the discrepancy regarding non-original articles and the composition of the editorial boards indicate that there still is a structural underrepresentation and that females are limited in achieving powerful positions.