Gender inequality in research: does UK trainee-led research herald an equal future?

Abstract

Editor—For more than 100 yr, feminist advocacy has been forging change. Pushing for progression to gender equality has proved to be justified; gender diversity increases productivity, innovation, decision-making, and employee retention and satisfaction.1Geordan S. Jansen M. Williams K. et al.Gender equality in science, medicine and global health: where are we at and why does it matter?.Lancet. 2019; 393: 560-569Abstract Full Text Full Text PDF PubMed Scopus (186) Google Scholar Yet gender inequality, particularly in the fields of medicine and science, remains despite the large body of evidence highlighting gender equality as one of the most important determinants of health and economic development.1Geordan S. Jansen M. Williams K. et al.Gender equality in science, medicine and global health: where are we at and why does it matter?.Lancet. 2019; 393: 560-569Abstract Full Text Full Text PDF PubMed Scopus (186) Google Scholar The Royal College of Anaesthetists 2015 workforce census reported that 32% of anaesthetic consultants in the UK,2The Royal College of Anaesthetists Medical workforce census report 2015. The Royal College of Anaesthetists, London2016Google Scholar and 48% of practising doctors in total, are female.3General Medical Council The state of medical education and practice in the UK – the workforce report 2019. General Medical Council, London2019Google Scholar As 55% of UK medical graduates are now female,3General Medical Council The state of medical education and practice in the UK – the workforce report 2019. General Medical Council, London2019Google Scholar the proportion of female consultant and trainee anaesthetists is expected to continue to increase as graduates approach specialty training. Despite this, women are still underrepresented in positions of academia and research leadership in anaesthetics in the UK. The most recent data from the Medical Schools Council's UK clinical academic survey show that female senior clinical academics in anaesthesia are significantly underrepresented.4The Medical Schools Council Survey of medical clinical academic staffing levels 2018. The Medical Schools Council, London2018Google Scholar The survey identified that in 2018, only four (14.8%) anaesthetics professors and five (22.7%) anaesthetics senior lecturers were female; this proportion has not changed significantly over the last 10 yr of surveyed data; however, the proportion of females in more junior academic positions has improved from 39% in 2008 to 46% in 2018.4The Medical Schools Council Survey of medical clinical academic staffing levels 2018. The Medical Schools Council, London2018Google Scholar Whilst there is limited contemporary public information on the sex of non-clinical anaesthesia academics, in 2019 the UK National Institute of Academic Anaesthesia (NIAA) database of researchers showed only 24 (21.6% of total) UK-based female researchers were listed.5The National Institute of Academic Anaesthesiawww.niaa.org.ukDate accessed: December 12, 2019Google Scholar The proportion of males in leadership positions within the NIAA is high, with female academics making up 36% of its leadership Board.5The National Institute of Academic Anaesthesiawww.niaa.org.ukDate accessed: December 12, 2019Google Scholar In addition, women remain less likely to publish papers or collaborate internationally compared with their male counterparts.1Geordan S. Jansen M. Williams K. et al.Gender equality in science, medicine and global health: where are we at and why does it matter?.Lancet. 2019; 393: 560-569Abstract Full Text Full Text PDF PubMed Scopus (186) Google Scholar Positive work is being carried out within the UK to raise the profile of gender inequality in research and seek out change to contributory institutional factors, but the issue remains. The question as to why is often debated, but likely includes multiple factors unrelated to ability, including bias, culture, and the differential effects of work and family demands.1Geordan S. Jansen M. Williams K. et al.Gender equality in science, medicine and global health: where are we at and why does it matter?.Lancet. 2019; 393: 560-569Abstract Full Text Full Text PDF PubMed Scopus (186) Google Scholar For female anaesthetists in training, a paucity of UK women in academic posts and research leadership positions has historically constrained enthusiasm and perceived prospects of a consultant career involving research. However, with the increasing numbers of female researchers visibly leading large studies, along with the progressively popular and more accessible research methodology of ‘citizen science’, research input from female trainees is on the increase, represented by a growing female cohort of early career researchers. Generational differences in perception of gender inequality, with younger generations of both sexes being more likely to acknowledge and support action to rectify underrepresentation, are also driving widespread change, as the younger generation moves into leadership roles with influence.6Ruzycki S.M. Freeman G. Bharwani A. Brown A. Association of physician characteristics with perceptions and experiences of gender equity in an academic internal medicine department.JAMA Netw Open. 2019; 2: e1915165Crossref PubMed Scopus (28) Google Scholar Correspondingly, the UK anaesthetic training institution Research and Audit Federation of Trainees (RAFT)7Research and Audit Federation of Traineeshttps://www.raftrainees.comDate accessed: December 12, 2019Google Scholar has evolved a more balanced representation of gender equality in both research involvement and leadership positions. RAFT is a collaborative UK-wide trainee-led research group that brings together multiple regional anaesthetic trainee-led research networks (TRNs). With a defined leadership structure and committee, it holds a number of roles: facilitating national trainee-led projects, supporting TRNs to improve education and access to research, promoting a collaborative model of UK anaesthetics research, and providing opportunities to complete research-related aspects of the anaesthetic training curriculum.7Research and Audit Federation of Traineeshttps://www.raftrainees.comDate accessed: December 12, 2019Google Scholar Developed in 2013, it has gone on to deliver large UK-wide studies, including the 2018 Drug Allergy Labels in the Elective Surgical population study, currently the largest-ever consenting anaesthetic study in the UK, with 500 local investigators at 214 sites recruiting 21 000 patients and 5000 anaesthetists.8RAFT and the power of citizen science. Royal College of Anaesthetists Bulletin, May 2019: 115Google Scholar It has also provided a collaborative model for anaesthetists in training to reproduce in other countries. Across the UK, there are 21 regional TRNs, contributing to trainees' development of non-clinical skills in leadership, organisation, education, and collaboration. These TRNs also have a committee structure with most appointing a chair or co-chair role, although some have adopted a less formal hierarchy or rotate roles regularly. The RAFT committee is currently composed of 50% females, with the roles of chair and vice-chair being held by women. In 2019, the RAFT network surveyed the TRNs to identify the proportion of female involvement, and found that the male to female mix on committees was approximately 50% around the UK, with 48% (10/21) of TRN chairs being female. This differs from the advent of RAFT, and the first TRNs earlier this decade, where males were overrepresented. Trainee-led anaesthesia research groups are benefiting from positive change in gender equality, both in research involvement and leadership roles, and appear to be doing so at a more rapid pace than the wider research community. The 50% male to female split is more reflective of the proportion of practising female doctors in the UK,3General Medical Council The state of medical education and practice in the UK – the workforce report 2019. General Medical Council, London2019Google Scholar and likely close to the current proportion of female anaesthetists considering that the census data are from 2015.2The Royal College of Anaesthetists Medical workforce census report 2015. The Royal College of Anaesthetists, London2016Google Scholar The reason for this equal sex representation is potentially multifactorial, and in part, from the identified cultural changes and awareness of inequality within anaesthetic academia at large. General changes specific to training likely play a role, most notably the more rapid succession through training to positions of trainee seniority (the UK has a 7-yr anaesthetic training programme), compared with the relatively longer ascent to seniority within a consultant's career, allowing a brisker change in demographics. Improvements in training choices, after the ‘Enhancing Junior Doctors’ Working Lives' initiative launch in 2017 by Health Education England,9Health Education EnglandEnhancing working Lives 2019 progress report. Health Education England, Leeds2019Google Scholar have modernised the dynamic and access to less than full-time training within the UK. Such change has potentially updated the social norms of childcare provision whilst providing women with more flexibility and choice within their training, making leadership roles increasingly feasible. Additionally, the younger generation of the anaesthetic workforce has developed in an environment that is increasingly intolerant of inequality and discrimination, whether related to gender, ethnicity, or sexual orientation, and as such, are conceivably more fearless and ambitious in fulfilling their potential in all aspects of their careers, regardless of their personal characteristics. The Athena SWAN Charter10Athena SWAN Charterwww.ecu.ac.uk/equality-charters/athena-swanDate accessed: December 12, 2019Google Scholar has also influenced the environment positively by highlighting the issues of gender inequality at an institutional level, and promoting positive change through clear guidance with formal and public assessment. As its implementation approaches its 15-yr anniversary with 164 institutional members, the majority of trainee anaesthetists will have received their medical training in institutions with Athena SWAN awards. This is reflected by RAFT and a number of TRNs endorsing the Charter's good practice initiatives for committee recruitment, including actively considering and negating barriers to females applying for roles, managing meeting times to minimise impact on child care provision, encouraging less than full-time trainee involvement, welcoming junior trainees without prior research or leadership experience, communication of opportunities to all trainees irrespective of previous contact or involvement, and maintaining a welcoming, fair and transparent process for recruitment and output. As this cohort of trainees' progress to their consultant careers, we envisage an increasing group of female researchers with leadership experience, who will continue to expand the numbers of female anaesthetic academics whilst becoming role models and mentors for future trainees. Contribution to the conception, drafting, and revision of this submission: KS, HE. KS and HE are Chair and Vice Chair of the Research and Audit Federation of Trainees (RAFT), respectively. No other conflict of interests to declare.