Gender Equity In Medicine Research Articles

(035) WOMEN IN PROSTHETIC UROLOGY: MENTORSHIP, SPONSORSHIP, AND CAREER ADVANCEMENT

Abstract Introduction Mentorship is a dynamic, reciprocal personal relationship in which a more experienced member of the organization (mentor), acts as a guide, role model, teacher, and sponsor of a less experienced person (mentee). Sponsorship involves the mentor making a personal investment in the advancement of the mentee. Women currently in and looking to enter prosthetic urology are not afforded the same quality or quantity of these dynamic relationships compared to men. Objective The goals of this manuscript are to discuss obstacles and barriers faced by women in prosthetic urology, highlight the benefits of mentorship and sponsorship in advancing the careers of women in this field, and provide recommendations for creating a more inclusive and supportive environment for women to excel in prosthetic urology. Methods Six authors carefully reviewed full-text, published articles related to the climate of [women in urology], [prosthetic urology], and available [mentorship], [sponsorship], and [leadership], and data from the 2022 American Urologic Association (AUA) census. Thirty-two sources were included. Results Urology and specifically, prosthetic urology, has a long history of being male-prominent. Several factors play into this truth, including gender roles, societal influences, implicit biases, medical history, and a lack of early exposure, mentorship, and sponsorship. Despite strides made in gender equity in medicine, women remain underrepresented in urology making up only 11.6% of practicing urologists in the United States. In subspecialties such as prosthetic urology, women make up even less of the pool. These factors also contribute to the lack of women in leadership positions. As of 2023, women occupy just 3 of the 13 board member positions and 7 of the 29 committee chair positions in the SMSNA. Conclusions Implementing successful mentorship involves recognizing the gender disparities that exist in prosthetic urology, having male mentors and sponsors, and breaking the traditional mentor-mentee hierarchies. Additionally, mentees can foster effective mentorship by establishing SMART goals and getting involved in women affinity groups. By creating an inclusive, diverse environment that not only welcomes, but mentors, and sponsors women, prosthetic urology can harness its full potential. Disclosure No.

Impostor Phenomenon and Impact on Women Surgeons: A Canadian Cross-Sectional Survey.

This project aims to characterize the extent and nature of impostor phenomenon (IP) among women surgeons in Canada. IP is well documented among medical professionals and trainees. It is known to have significant impacts on mental health and career trajectory. We conducted a cross-sectional survey of self-identifying women who have completed a surgical residency and currently or most recently practiced in Canada. Among 387 respondents, 98.7% have experienced IP. Median IP score corresponded to frequent impostor feelings or high impostorism. Self-doubt affects most women surgeons for the first time during training. It tends to be most intense in the first 5 years of practice and lessens over time. One hundred twelve (31.5%) surgeons experience self-doubt in the operating room (OR). Due to self-doubt, 110 (28.4%) respondents preferred to work with a more experienced assistant in the OR, whereas 40 (10.4%) stated that they would only operate with an experienced assistant. Few surgeons take on less OR time due to self-doubt (29 [7.5%]), but 60 (16.5%) take on fewer complex cases due to self-doubt. A small but important number of surgeons (11 [2.8%]) had given up operating altogether due to self-doubt. Due to feelings of self-doubt, 107 (21.4%) respondents were hesitant to take on a leadership role in the workplace. IP is a nearly universal experience among women surgeons and is influential in their professional lives. This study contributes to scientific knowledge that can advance gender equity in medicine and leadership.

Gender equity in medicine, artificial intelligence, and other articles in this issue

Gender equity in medicine, artificial intelligence, and other articles in this issue

Decoding the Reference Letter: Strategies to Reduce Unintentional Gender Bias in Letters of Recommendation.

There is a growing body of literature on gender bias in letters of recommendation (LORs) in academic medicine and the negative effect of bias on promotion and career advancement. Thus, increasing knowledge about gender bias and developing skills to mitigate it is important for advancing gender equity in medicine. This workshop aims to provide participants with knowledge about linguistic bias (focused on gender), how to recognize it, and strategies to apply to mitigate it when writing LORs. We developed an interactive 60-minute workshop for faculty and graduate medical education program directors consisting of didactics, reflection exercises, and group activities. We used a postworkshop survey to evaluate the effectiveness of the workshop. Descriptive statistics were used to analyze Likert-scale questions and a thematic content analysis for open-ended prompts. We presented the workshop four times (two local and two national conferences) with one in-person and one virtual format for each. There were 50 participants who completed a postworkshop survey out of 74 total participants (68% response rate). Ninety-nine percent of participants felt the workshop met its educational objectives, and 100% felt it was a valuable use of their time. Major themes described for intended behavior change included utilization of the gender bias calculator, mindful use and balance of agentic versus communal traits, closer attention to letter length, and dissemination of this knowledge to colleagues. This workshop was an effective method for helping participants recognize gender bias when writing LORs and learn strategies to mitigate it.

Pregnancy and Residency: Overdue for Equity

(N Engl J Med. 2023;16;388:966–967) Three female physicians discuss the difficulty of combining pregnancy with medical training. Some obstacles include how to balance the physical demands of growing a baby with an inflexible schedule, a lack of maternity leave options, social pressure to not burden fellow staff during the prenatal and postnatal period, the adverse effects of stress on the mother and infant’s health, deferring childbearing until after training, slow uptake of policy changes, and career disruptions to have a child. Despite the unique experiences of these physicians, there was a shared theme: a healthy pregnancy and simultaneously successfully complete residency with their peers was unattainable. A lack of gender equity in medicine is at the root of the problem.

Beyond the Operating Room: Exploring Gender Bias in Leadership Positions in German Plastic Surgery

Background: Despite efforts to promote gender equity in medicine, gender disparities persist in various medical specialties, including plastic surgery. This study aimed to investigate the representation of female physicians in leadership positions in German plastic surgery departments. Methods: This cross-sectional study collected data about the physician workforce in the German plastic surgery field. The primary outcome was the proportion of female physicians in plastic surgery departments. Data were collected from 94 departments. The physician workforce was stratified based on gender and leadership. Results: We included 812 physicians working in different German plastic surgery departments. Of those, 76.8% were in leadership positions, and 35.1% were women. There was a significant association between being male sex and holding a leadership position (n = 158/188, 84% versus n = 30/188, 16%, P < 0.0001). This association persisted even after accounting for the academic grade of each physician in a multivariable regression model (OR 2.565; 95% confidence interval, 1.628–4.041) Conclusions: Women are significantly underrepresented in leadership positions in German plastic surgery, with only 16% of female physicians holding such positions. Furthermore, being male sex was significantly associated with holding a leadership position, even after adjusting for the academic grade. These findings emphasize the existence of gender bias in the selection process for leadership positions in plastic surgery.

A Journey Toward Gender Equity in Medicine

A Journey Toward Gender Equity in Medicine

Evaluating implicit gender bias at Canadian otolaryngology meetings through use of professional title.

Increasing numbers of women enter medical school annually. The number of female physicians in leadership positions has been much slower to equalize. There are also well-documented differences in the treatment of women as compared to men in professional settings. Female presenters are less likely to be introduced by their professional title ("Doctor") for grand rounds and conferences, especially with a man performing the introduction. This study reviewed the Canadian Society of Otolaryngology-Head and Neck Surgery (CSOHNS) meetings from 2017 to 2020 to determine the proportion of presenters introduced by their professional title and whether this varied by gender. Recordings from CSOHNS meetings were reviewed and coded for introducer and presenter demographics, including leadership positions and gender. Chi-squared tests of proportion and multivariate logistic regression was used to compare genders and identify factors associated with professional versus unprofessional forms of address. No significant association was found between professional title use and introducer or presenter gender. Female presenters were introduced with professional title 69.6% of the time, while male presenters were introduced with professional title 67.6% of the time (P = 0.69). Residents were introduced with a professional title with the most frequency (75.8%), while attending staff were introduced with a professional title with the least frequency (63.0%) (P = 0.02). The lack of gender bias in speaker introductions at recent CSOHNS meetings demonstrates progress in achieving gender equity in medicine. Research efforts should continue to define additional forms of unconscious bias that may be contributing to gender inequity in leadership positions.

403P Gender trend over time of principal investigators within large Australian cancer clinical trials groups

Despite increased global effort in promoting gender equity in medicine, progress remains slow, particularly with respect to clinical research and leadership roles. Our study assesses trends in female Principal Investigators (PI) amongst academic Cancer Clinical Trials Groups in Australia.

Gender, Parenting Status, and the Academic Productivity of Pediatricians During the COVID-19 Pandemic.

During the coronavirus disease 2019 pandemic, many women physicians experienced increased caregiver responsibilities, potentially leading to worsened gender inequities. We surveyed faculty and trainees at a quaternary-care children's hospital regarding work environment, household obligations, and academic productivity to examine differential effects on productivity by gender and parenting status. We used descriptive statistics for demographics and analyzed Likert-scale responses with χ2 or Fisher's exact tests. We performed multivariable logistic regression to determine factors associated with self-reported academic productivity. We analyzed free-response comments using thematic analysis. The August 2021 survey was completed by 366 respondents (65% women; 46% response rate). Women were significantly more likely to report decreased academic productivity than men (66% [146/222] vs 30% [38/129], P <.001). Nearly one-half (49%) were parents with 80% utilizing childcare. Of these, 61% experienced unreliable childcare during the pandemic. Parents with unreliable childcare reported significantly decreased academic productivity compared with those with reliable childcare (76% [64/84] vs 36% [19/53], P <.001), and, among those with unreliable childcare, women disproportionally reported decreased academic productivity compared with men (88.5% [54/61] vs 43.5% [10/23], P <.001). After multivariable adjustment, women physicians with children were significantly more likely to report decreased academic productivity than men with children (adjusted odds ratio: 10.19, 95% confidence interval: 4.68-22.23). The coronavirus disease 2019 pandemic has differentially impacted men and women physicians, with women physician parents more likely to report decreased academic productivity than men with children. Unreliable childcare was a significant contributor to this disparity. Institutions must prioritize initiatives to improve gender equity in medicine.

Developing Priorities to Alleviate the Long-Term Impact of the COVID-19 Pandemic on Women Engaged in Diabetes Research, Education, and Care: A Concept Mapping Study.

The aim of this study was to develop priorities through stakeholder engagement to alleviate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the professional careers of women engaged in diabetes research, education, and care. This study used concept mapping, a mixed-methods, multistep process, to generate a conceptual map of recommendations through the following steps: 1) identify stakeholders and develop the focus prompt, 2) generate ideas through brainstorming, 3) structure ideas through sorting and rating on priority and likelihood, 4) analyze the data and create a cluster map, and 5) interpret and use results. Fifty-two participants completed the brainstorming phase, and 24 participated in sorting and rating. The final concept map included seven clusters. Those rated as highest priority were to ensure supportive workplace culture (μ = 4.43); promote practices to achieve gender parity in hiring, workload, and promotion (μ = 4.37); and increase funding opportunities and allow extensions (μ = 4.36). This study identified recommendations for institutions to better support women engaged in diabetes-related work to alleviate the long-term impact of the COVID-19 pandemic on their careers. Some areas were rated as high in priority and high in likelihood, such as ensuring a supportive workplace culture. In contrast, family-friendly benefits and policies were rated as high in priority but low in likelihood of being implemented; these may take more effort to address, including coordinated efforts within institutions (e.g., women's academic networks) and professional societies to promote standards and programs that advance gender equity in medicine.

Medical Student Research Journals: The International Journal of Medical Students (IJMS) Legacy.

The International Journal of Medical Students (IJMS) has emerged over the past decade as a critical platform for showcasing medical student innovation and experiences. Though the work of trainees has historically been undervalued and over scrutinized, the IJMS is committed to highlighting the immense capacity for novel and robust research in this cohort. Thus, supporting an upcoming generation of leaders in medicine and academia to gain confidence in their work and contribute positively to the scientific community. In this issue of the IJMS, we are proud to present 16 articles from the Americas, Europe, Asia, and Africa. Original research articles cover a breadth of topics, including medical training, impacts of the COVID-19 pandemic on teaching and communication, pediatric respiratory illness, gender equity in medicine, understudied illnesses, and cardiovascular disease. The IJMS is proud to feature first-hand experiences of medical trainees in each issue. Accordingly, in the present issue perspectives of six medical students are outlined following unique and career-altering experiences. From working in palliative care to international outreach program, local vaccination initiatives, and the creation of a student-oriented research and innovation council in India. The IJMs extends our gratitude to our contributors, team, and readers for another remarkable issue.

Double Discrimination, the Pay Gap in Gynecologic Surgery, and Its Association With Quality of Care.

In this commentary, we describe historical and other influences that drive "double discrimination" in gynecologic surgery-lower pay in the area of surgery that boasts the largest proportion of female surgeons and is focused on female patients and explore how it results in potentially lower quality care. Insurers reimburse procedures for women at a lower rate than similar procedures for men, although there is no medically justifiable reason for this disparity. The wage gap created by lower reimbursement rates disproportionately affects female surgeons, who are disproportionately represented among gynecologic surgeons. This contributes to a large wage gap in surgery for women. Finally, poor reimbursement for gynecologic surgery pushes many obstetrics and gynecology surgeons to preferentially perform obstetric services, resulting in a high prevalence of low-volume gynecologic surgeons, a metric that is closely tied to higher complication rates. Creating equity in reimbursement for gynecologic surgery is one important and ethically required step forward to gender equity in medicine for patients and surgeons.

Advancing gender equity in medicine.

KEY POINTS The medical profession has an equity problem, particularly in leadership. Several Canadian studies have highlighted the extent of gender inequity in leadership in medicine, and the extent to which opportunities in academic medicine are inequitable by gender. Gender (as defined in [Box 1][

The current status of gender equity in medicine in Korea: an online survey about perceived gender discrimination

BackgroundAlthough the number of women doctors has increased in South Korea, and efforts to improve gender awareness have gained importance in recent years, the issue of gender equity in the medical field has not been fully evaluated. The aim of this study was to determine the current status of gender equity in the medical profession in Korea.MethodsAn online survey on perceived gender discrimination was conducted for 2 months, with both men and women doctors participating. The results were analyzed using descriptive statistics.ResultsA total of 1170 doctors responded to the survey (9.2% response rate). The survey found that 47.3% of the women respondents and 18.2% of the men had experienced gender discrimination in the resident selection process (P < 0.05), 17.2% of the women and 8.7% of the men had experienced discrimination during the fellowship application process (P < 0.05), and 36.2% of the women and 8.0% of the men had experienced discrimination during the professorship application process (P < 0.05). Both men and women cited the issue of childbirth and parenting as the number one cause of gender discrimination against women doctors.ConclusionsThis study revealed the presence of perceived gender discrimination in the Korean medical society. To address discrimination, a basic approach is necessary to change the working environment so that it is flexible for women doctors, and to change the current culture where the burden of family care, including pregnancy, childbirth, and childcare, is the primary responsibility of women.

Women in Medicine: Dr. May Cohen, aka “The Gender Lady”

Some of the greatest strides seen in Canadian women’s health and in gender equity in medicine can be attributed to Dr. May Cohen: an unyielding activist who dedicated her life’s work to advocacy. From spearheading the development of the first Women’s Health Office at McMaster University to serving as President of the Federation of Medical Women in Canada, her career is a testament to what can be achieved with a strong social conscience and unwavering determination.

Improving gender equity in critical care medicine: a protocol to establish priorities and strategies for implementation

IntroductionWhile the number of women entering medical school now equals or surpasses the number of men, gender equity in medicine has not been achieved. Women continue to be under-represented in...

Does academic authorship reflect gender bias in pediatric surgery? An analysis of the Journal of Pediatric Surgery, 2007–2017

BackgroundGender representation in academic publications has been considered a surrogate for gender equity in medicine, although this concept has not been evaluated in pediatric surgery. MethodsFirst and last author genders for Journal of Pediatric Surgery articles from United States and/or Canadian institutions (2007, 2012, 2017) were identified. These data were compared to gender proportions for applicants to and matriculants in pediatric surgery fellowships as well as among American Pediatric Surgical Association (APSA) members. ResultsAuthorship gender was identified for 632/640 primary articles (98.8%). From 2007 to 2017, the proportion of women as first authors increased from 33.0% to 53.9% (p < 0.001) and as last authors from 16.2% to 26.4% (p = 0.01). The proportion of women fellowship applicants rose from 35.9% to 57.6% (p < 0.001); among those who successfully matched the rise was nonlinear (20.5%–34.0%, p = 0.16). APSA junior and senior women membership proportions rose during the study period [from 28.1% to 43.4% (p = 0.06 for linear trend) and 17.9% to 24.4% (p = 0.005 for linear trend), respectively]. ConclusionsOver the past decade, the overall proportion of women authors in a leading academic pediatric surgery journal has increased significantly, although representation among last authors remains disproportionately low. The numbers of women applicants to pediatric surgery fellowship increased but there was not a concordant rise in the number of women accepted into training positions. Type of studyBibliometric analysis. Level of evidencen/a

Association of Physician Characteristics With Perceptions and Experiences of Gender Equity in an Academic Internal Medicine Department

The persistence of inequities that disadvantage women physicians remains empirically underexplained. Understanding the cultural factors that are associated with disparities in harassment, discrimination, remuneration, and career trajectory are critical to addressing inequities. To explore how physicians perceive the climate for women physicians and compare perceptions and experiences of gender inequity among physicians based on characteristics including gender, faculty status, parental status, and years in practice. This sequential, explanatory, mixed-methods qualitative study used the Culture Conducive to Women's Academic Success (CCWAS; range 45-225, with higher scores indicating better perceived culture toward women), followed by individual semistructured interviews with physicians at the Department of Medicine of the University of Calgary. All 389 physician members of the Department of Medicine, including academic and clinical physicians and those of any gender, were invited to participate in the survey and interview phases. The culture within the department for women physicians was assessed using the CCWAS score. Scores were compared between respondents' gender and years in practice. Interviews with physicians were used to further explore findings from the CCWAS and to understand experiences and perceptions of gender disparities. A total of 169 of 389 physicians completed the survey (response rate, 43.4%; 102 [59.9%] women; 65 [38.9%] men; and 2 [1.2%] who did not disclose gender); 28 participants (7.2%) elected to participate in an interview (22 [78.6%] women; 6 [21.4%] men). Women physicians perceived the culture of the department toward women as significantly worse than men physicians (median [interquartile range] CCWAS score, 137.0 [118.0-155.0] vs 164.5 [154.0-183.4]; P < .001). Physicians with more than 15 years in practice perceived the culture toward women as significantly more favorable than physicians with 15 years or less in practice (median [interquartile range] CCWAS score, 157.0 [138.8-181.3] vs 147.0 [127.5-164.3]; P = .02). Qualitative data demonstrated that experiences of junior women (ie, physicians who graduated medical school after 1996, when an equal number of men and women in medical school was achieved in Canada) and perceptions of senior men (ie, those who graduated before 1996) were most different; junior women reported high rates of discrimination and harassment, while senior men perceived that the Department of Medicine had achieved gender equity. In this study, senior men physicians' perceptions of gender equity were different from lived experiences of gender inequity reported by junior women physicians. This demographic mismatch between perceptions and experiences of gender equity in medicine may explain the lack of action by leaders and decision-makers in medicine to mitigate disparities.

How to Fix the Gender Disparity in Pediatrics.

Since Elizabeth Blackwell became the first woman to graduate from an American medical school in 1849, women have made many gains in the health care field. However, as Spector et al1 point out in this issue of Pediatrics , the battle for gender equity in medicine in general, and in pediatrics in particular, is far from over. The real questions for those of us who, like myself, have been in positions to make change are why have we not achieved more progress, and what exactly are we going to do about it? Medicine is doing better than business, in which only 5% of companies had women chief executive officers in 2016,2 and nonmedical higher education, in which only 30% of colleges and universities had women at the highest level of leadership.3 Some progress is being made, as reflected in improvements in the trends toward pay equity, representation among the leadership of academic medical centers and other health care organizations, participation on journal editorial boards, research funding, and recognition by medical societies … Address correspondence to Alice D. Ackerman, MD, MBA, 4069 Postal Dr, #20834, Roanoke, VA 24018. E-mail: adackerman{at}vt.edu