Is Empowerment of Female Radiologists Still Needed? Findings of a Systematic Review

A trend, analysis, and solution on women's representation in diagnostic radiology in North America: a narrative review

Despite the demonstrated benefits of gender diversity in medicine, women in Radiology in North America are still underrepresented. We reviewed the literature to highlight the current status of women in Radiology in North America, identify the underlying causes of the gender gap, and provide potential strategies to close this gap. We conducted a narrative literature review using the terms ("Gender Disparity" OR "Gender Inequality") AND ("Radiology Department" OR "Radiology Residency"), searching data from April 2000 to April 2022 in Ovid Medline, Embase, PubMed, and Scopus. Our results indicate that Radiology in North America lacks gender diversity in its subspecialties, academic leadership, and research productivity, which the COVID-19 pandemic has further exacerbated. Challenges stemming from a dearth of women role models, limited preclinical contact, and a high rate of burnout contribute to the current gender inequality. Several complementary and supplementary steps can enhance gender diversity in Radiology. These include increasing education and exposure to Radiology at earlier stages and optimizing mentorship opportunities to attract a more diverse pool of talent to the discipline. In addition, supporting resident parents and enhancing the residency program's culture can decrease the rate of burnout and encourage women to pursue careers and leadership positions in Radiology.

Towards a More Inclusive Future: A Comprehensive Assessment of Gender Diversity in Nuclear Medicine Education, Training and Workforce

The field of nuclear medicine has undergone remarkable advances, particularly with the introduction of new devices, radionuclides for imaging and therapy, new clinical applications, and emergence of medical evidence. As this dynamic field continues its rapid expansion, there is an urgent need to increase the number of well-trained professionals globally. Consequently, advocating for nuclear medicine as a thriving field of study and work for women becomes paramount in ensuring the establishment of a robust workforce capable of meeting the growing demands. True gender equality will only be achieved when there is equal representation across the spectrum of the nuclear medicine professions, including nuclear medicine technologists, radiopharmacists, radiochemist, medical physicists, nuclear medicine physicians, administrators, academics, and leaders. Currently, the workforce exhibits an imbalance, with females predominating among nuclear medicine technologists, while the number of female physicians, and those in leadership positions remains comparatively lower. There are various factors which contribute to the existing inequities. Societal expectations often impose traditional gender roles that somehow discourage women from pursuing a career in the science, technology, and mathematics (STEM) fields, including nuclear medicine. Additionally, prevailing unequal work conditions and gender biases within the workplace can create barriers that hinder women's professional growth and development. Ways of addressing inequalities includes ensuring female participation at all levels of education and training and promoting the field at undergraduate level in medical school. Mentorship programs have demonstrated great success in guiding and supporting women at various stages of their careers. Therefore, there is a need for their expansion and enhancement. Furthermore, female role models play a pivotal role in shattering gender stereotypes and inspiring other women to pursue careers in nuclear medicine and its related fields. By addressing the existing imbalances and fostering an environment that actively encourages and supports women, we can harness the full potential of all professionals, thus ensuring the ongoing progress and advancement of nuclear medicine.

Workplace violence in radiology: results of a systematic review

BACKGROUND

Workplace violence (WPV) is a growing issue in health care with far-reaching consequences for health workers' physical and psychological well-being. While some medical specialities like emergency medicine have always been considered at higher risk for WPV, several studies have also reported its occurrence in radiology.

AIMS

This systematic review aimed to comprehensively synthesize the types of WPV in radiology, its psychological impact, and the underlying risk and protective factors.

METHODS

We searched five electronic databases (PubMed, Web of Science Core Collection, Scopus, PsycINFO and CINAHL) and additional literature, including grey literature, and established weekly search alerts. Two reviewers independently conducted all methodological steps, involving a third reviewer in case of disagreement.

RESULTS

Of the 12 205 retrieved records, 103 full-text articles were evaluated, and 15 studies were included. Across studies, verbal aggression, sexual harassment (mostly against women) and physical violence were experienced by up to 100%, 85% and 46% of health workers, respectively. Perpetrators were patients and patients' caregivers, followed by co-workers. Victims suffered from various psychological symptoms, such as anxiety (22%-54%), fear (6%-39%), depression (32%) and repeated disturbing memories (21%). Risk factors included female gender, understaffing, worker inexperience, poor communication and lengthy waiting times. Social support and security personnel presence were among the identified protective factors.

CONCLUSIONS

Health workers are at high risk of experiencing WPV in the radiological setting, with a strong psychological impact. Radiological departments should create a safe healthcare environment that actively manages the identified risk factors and offers psychological support to affected workers.

Are Academic Emergency Radiologists Systematically Disadvantaged Compared With Diagnostic Radiology Subspecialty Counterparts When It Comes to Promotion?

PURPOSE

The aim of this study was to assess academic rank differences between academic emergency and other subspecialty diagnostic radiologists.

METHODS

Academic radiology departments likely containing emergency radiology divisions were identified by inclusively merging three lists: Doximity's top 20 radiology programs, the top 20 National Institutes of Health-ranked radiology departments, and all departments offering emergency radiology fellowships. Within departments, emergency radiologists (ERs) were identified via website review. Each was then matched on career length and gender to a same-institutional nonemergency diagnostic radiologist.

RESULTS

Eleven of 36 institutions had no ERs or insufficient information for analysis. Among 283 emergency radiology faculty members from 25 institutions, 112 career length- and gender-matched pairs were included. Average career length was 16 years, and 23% were women. The mean h indices for ERs and non-ERs were 3.96 ± 5.60 and 12.81 ± 13.55, respectively (P < .0001). Non-ERs were twice as likely as ERs (0.21 versus 0.1) to be associate professors at h index < 5. Men had nearly 3 times the odds of advanced rank compared with women (odds ratio, 2.91; 95% confidence interval, 1.02-8.26; P = .045). Radiologists with at least one additional degree had nearly 3 times the odds of advancing rank (odds ratio, 2.75; 95% confidence interval, 1.02-7.40; P = .045). Each additional year of practice increased the odds of advancing rank by 14% (odds ratio, 1.14; 95% confidence interval, 1.08-1.21; P < .001).

CONCLUSIONS

Academic ERs are less likely to achieve advanced rank compared with career length- and gender-matched non-ERs, and this persists even after adjusting for h index, suggesting that academic ERs are disadvantaged in current promotions systems. Longer term implications for staffing and pipeline development merit further attention as do parallels to other nonstandard subspecialties such as community radiology.

A Problem of Gender Representation: Adapting the Bechdel Test to Evaluate the Social Media Presence of Radiology Residency Programs

RATIONALE AND OBJECTIVES

Social media serves as recruitment tools for residency programs, allowing programs to "brand" themselves in an era of virtual interviews. For female applicants, viewing their gender represented on Instagram may influence their pursuit of a program. Our study's goal is to quantify how female-presenting professionals are represented on radiology residency (RR) Instagram pages, as these are increasingly important platforms for resident recruitment.

MATERIALS AND METHODS

The Bechdel test is a well-known measure of the representation of women in fiction that requires at least 2 women speak to each other about a topic other than a man. We modified this test to evaluate the portrayal of female-presenting professionals on public Instagram galleries of RR programs. For a photo to pass our test, female-presenting persons are shown physically together, without male-presenting professionals, and in a professional setting. To compare gender depiction, a Male Bechdel Test was also used. RR Instagram pages were identified using the Fellowship and Residency Electronic Interactive Database Access (n = 87) and examined with an adapted framework approach to count female and male-presenting individuals in 1044 images. Results were assessed using paired t-tests and a chi-square with McNemar's test.

RESULTS

Approximately 50% of the RR Instagrams passed the Male Bechdel Test while only 21.3% passed the Female Bechdel Test, a significant difference in gender representation (χ²(1) = 13.255, P = 0.022). Paired sample t-tests revealed that RR Instagram pages are significantly more likely to feature male-presenting professionals in a professional setting (P < 0.0001), feature them with other male-presenting professionals (P = 0.001), and feature them without female-presenting professionals (P = 0.003).

CONCLUSION

Our results suggest female-presenting radiologists are under-represented on the Instagram profiles of RR programs. While this reflects the dearth of females in this field, programs may improve gender inclusion by more prominently displaying females on social media. This may assist in recruiting minority applicants.

Navigating the glass labyrinth: Addressing gender diversity in Australian and New Zealand representative radiology leadership

INTRODUCTION

Gender inequity among representative leadership in Clinical Radiology is a global issue, with the lack of gender diversity in leadership even more marked when compared to workforce representation. Women leaders face a disproportionate magnitude of seen and unseen challenges to leadership engagement and progression when compared to men (a 'glass labyrinth'), which is likely contributing to this discrepancy. The aim of the study was to examine and reflect on the state of gender diversity in representative leadership within the RANZCR Faculty of Clinical Radiology.

METHODS

Review of the 2021 Royal Australian and New Zealand College of Radiologists (RANZCR) Board, Clinical Radiology Faculty Council and local Branch Committees with regard to the numbers of women and men in representative roles.

RESULTS

In 2021, the RANZCR Board had no women representatives from Clinical Radiology (one woman representative from Radiation Oncology). 1/5 Clinical Radiology Faculty Council office Bearers were women. Local Branch Committees had 16.3% (13/80) women representatives. Three branches (the NSW, ACT and Victorian branches) had no women representatives. There were no women Committee Chairs, Branch Secretaries or Treasurers, with 2/7 Branch Education Officers women.

CONCLUSION

The issues underpinning gender inequality in representative leadership are complex and diverse, resulting in disproportionate losses of women radiologists along the leadership pathway compared to men. Unconscious biases, including assumptions of inferior capability, capacity and credibility among women radiologist leaders, create unique challenges at organisational, institutional and personal levels. Change cannot be achieved by passive momentum alone: concrete initiatives and active engagement are required. To improve leadership diversity, strategies must be multifaceted and supported at an organisational level.

Diversity in Radiology: Current Status and Trends Over the Past Decade

Background There have been growing efforts nationally and institutionally toward diversity in radiology. Purpose To analyze sex and racial and ethnic diversity over time (2010-2019) for the various levels of the U.S. academic radiology physician workforce in context of the available pipeline of medical students and trainees. Materials and Methods Data on sex and race and ethnicity were collected among medical school applicants, graduates, radiology residency applicants, residents, and different levels of academic radiology faculty. All trainee data were obtained from two time points, 2010-2011 and 2019-2020. Radiology faculty data were collected from 2010 to 2019. The sex and racial and ethnic composition at each academic level was compared between 2010 and 2019 using the χ² test and a significance level of P < .05. Results In 2019, the percentage of female faculty among radiology instructors was 38% (251 of 655); assistant professors, 31% (1503 of 4801); associate professors, 28% (600 of 2161); professors, 22% (424 of 1901); and department chairs, 17% (37 of 220). The proportion of female faculty increased from 2010 to 2019, with the greatest relative increase in percentages among the more senior faculty positions. However, the proportion of female department chairs has only increased from 13% (27 of 203) in 2010 to 17% (37 of 220) in 2019. Across training levels, the most abrupt change in composition of female trainees occurred from medical school matriculates (52%, 11 160 of 21 614) to radiology residency applicants (29%, 656 of 2274), which largely stayed unchanged from 2010 to 2019. The proportion of Black or African American department chairs was 5% (10 of 220) in 2019, which was higher compared with that of assistant professor, associate professor, and professor levels for Black or African American faculty (3% [130 of 4949], 2% [41 of 2208], and 2% [35 of 1924], respectively), with proportions of Hispanic faculty at 5% (240 of 4949), 4% (96 of 2208), and 3% (60 of 1924), respectively. These proportions have not changed since 2010. Conclusion Identifying and addressing reasons for the low proportion of female radiology residency applicants despite a highly diverse pool of medical students would be key to increasing female representation in the field. The low representation of African American and Hispanic individuals in academic radiology is seen at all levels and has not changed much over time. Efforts to increase diversity may need to be focused toward the medical school and residency application levels. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Pandharipande and Shah in this issue.

Diversity and perception of equity and respect in the Society of Skeletal Radiology (SSR)

PURPOSE

To assess the perception of equity and respect in the workplace and within the SSR. We hypothesized that responses would differ by gender and minorities underrepresented in medicine (URiM) status.

METHODS

An electronic survey was sent to 1,531 SSR members between January 2020 and March 2020 to determine perception of equity and respect. Descriptive statistics were calculated, and analysis of differences in response by gender/minority status was performed using the Fisher's exact test. The study was exempt from IRB approval.

RESULTS

There were 176 responses (11.5%). Most respondents (61.9%) were between 30 and 50 years. Members identified as male (M) in 74.4%, as female (F) in 25.0%, and as "other" in 0.6%. URiM comprised 9.1% of members. Women worked more commonly in academia (p = 0.005), had the perception of unequal opportunities for leadership positions within the institution (p = 0.006), and emphasized the importance of having a mentor of the same gender (p = 0.001). URiM members were less likely to hold a leadership position (p = 0.1, trend), had a perception of unequal opportunities for leadership positions within the institution (p = 0.06, trend), and reported the importance of having a mentor of the same race (p = 0.06, trend). There were no significant differences between gender or URiM status and perception of the SSR to provide an inclusive environment and leadership opportunities (p ≥ 0.39).

CONCLUSION

While survey participation was limited and potentially biased, respondents perceived that women and minorities have fewer opportunities and are treated with lower regard in the workplace compared to male, non-minority colleagues.