PUBBLICAZIONE/PUBLICATION

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Declining racial and ethnic representation in clinical academic medicine: A longitudinal study of 16 US medical specialties Open PDF
(2018)
Lett, Elle
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Orji, Whitney U.
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Sebro, Ronnie
OBJECTIVE: To evaluate trends in racial, ethnic, and sex representation at US medical schools across 16 specialties: internal medicine, pediatrics, surgery, psychiatry, radiology, anesthesiology, obstetrics and gynecology, neurology, family practice, pathology, emergency medicine, orthopedic surgery, ophthalmology, otolaryngology, physical medicine and rehabilitation, and dermatology. Using a novel, Census-derived statistical measure of diversity, the S-score, we quantified the degree of underrepresentation for racial minority groups and female faculty by rank for assistant, associate, and full professors from 1990-2016. METHODS: This longitudinal study of faculty diversity uses data obtained from the American Association of Medical Colleges (AAMC) Faculty Roster from US allopathic medical schools. The proportion of professors of racial minority groups and female faculty by rank was compared to the US population based on data from the US Census Bureau. The Roster includes data on 52,939 clinical medical faculty in 1990, and 129,545 in 2016, at the assistant professor level or higher. The primary measure used in this study was the S-score, a measure of representation based on the probability of the observed frequency of faculty from a racial/ethnic group and sex, given the racial and ethnic distribution of the US. Pearson correlations and 95% confidence intervals for S-score with time were used to measure trends. RESULTS: Blacks and Hispanics showed statistically significant trends (p<0.05) towards increasing underrepresentation in most specialties and are more underrepresented in 2016 than in 1990 across all ranks and specialties analyzed, except for Black females in obstetrics & gynecology. White females were also underrepresented in many specialties and in a subset of specialties trended toward greater underrepresentation. CONCLUSIONS: Current efforts to improve faculty diversity are inadequate in generating an academic physician workforce that represents the diversity of the US. More aggressive measures for faculty recruitment, retention, and promotion are necessary to reach equity in academia and healthcare.
Gender Distribution of Scholarship and Measures of National Recognition in Hospital Medicine Open PDF
(2022)
Kim, Juliann L.
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Allan, Jessica M.
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Fromme, H. Barrett
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Forster, Catherine S.
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Shaughnessy, Erin
OBJECTIVE: Our specific aim was to assess the gender distribution of aspects of scholarly productivity and professional standing for pediatric hospital medicine over a 5-year period. We also evaluated for correlation between the makeup of editorial boards, conference planning committees, and chosen content. METHODS: We reviewed scholarly publications, presentations, editorial boards, planning committees, awardees, and society leadership in pediatric hospital medicine from 2015 to 2019 and determined gender using published methods to assess for differences between observed proportions of women authors and presenters and the proportion of women in the field. RESULTS: The field of pediatric hospital medicine at large is 69% women (95% confidence internal [CI] 68%-71%), and an estimated 57% of senior members are women (95% CI 54%-60%). We evaluated 570 original science manuscripts and found 67% (95% CI 63%-71%) women first authors and 49% (95% CI 44%-53%) women senior authors. We evaluated 1093 presentations at national conferences and found 69% (95% CI 65%-72%) women presenters of submitted content and 44% (95% CI 37%-51%) women presenters of invited content. Senior authorship and invited speaking engagements demonstrated disproportionately low representation of women when compared with senior members of the field (senior authorship, P = .002; invited presenters, P < .001). Strong positive correlation between gender composition of conference planning committees and selected content was also noted (r = 0.94). CONCLUSION: Our study demonstrated representative gender distribution for some aspects of scholarly productivity in pediatric hospital medicine; however, a lack of gender parity exists in senior roles.
Pre- and post-COVID-19 gender trends in authorship for paediatric radiology articles worldwide: a systematic review Open PDF
(2024)
Kamran, Rakhshan
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Jackman, Liam
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Chan, Cynthia
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Lee, Ann C.
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Kamran, Aleeza
BACKGROUND: Gender inequalities in academic medicine persist despite progress over the past decade. Evidence-based targeted interventions are needed to reduce gender inequalities. OBJECTIVE: This systematic review aimed to investigate the impact of COVID-19 on gender trends in authorship of paediatric radiology research worldwide. MATERIALS AND METHODS: This prospectively registered, PRISMA-compliant systematic review searched the following databases: PubMed, MEDLINE, Web of Science, and Scopus from January 1, 2018, to May 29, 2023, with no restrictions on country of origin. Screening and data extraction occurred independently and in duplicate. Gender of first, last, and corresponding authors were determined using an artificial intelligence-powered, validated, multinational database ( www.genderize.io ). Two time periods were categorised according to the Johns Hopkins Center for Systems Science and Engineering: pre-COVID (prior to March 2020) and peak and post-COVID (March 2020 onwards). One-sample binomial testing was used to analyse proportion of authorship based on gender. Categorical variables were described as frequencies and percentages, and compared using testing chi-square or Fisher exact testing, with a threshold of P<0.05 representing statistical significance. RESULTS: In total, 922 articles were included with 39 countries represented. A statistically significant difference in authorship based on gender persisted during the peak and post-COVID time period (March 2020 onwards) where women represented a statistically significant lower proportion of last (35.5%) and corresponding (42.7%) authors (P<0.001, P=0.001, respectively). Statistically significant differences for first authors were not found in either period (P=0.08 and P=0.48). CONCLUSION: This study identifies differences in gender trends for authorship in paediatric radiology research worldwide. Future efforts to increase authorship by women are needed.
The "gender gap" in authorship of academic medical literature--a 35-year perspective Open PDF
(2006)
Jagsi, Reshma
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Guancial, Elizabeth A.
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Worobey, Cynthia Cooper
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Henault, Lori E.
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Chang, Yuchiao
BACKGROUND: Participation of women in the medical profession has increased during the past four decades, but issues of concern persist regarding disparities between the sexes in academic medicine. Advancement is largely driven by peer-reviewed original research, so we sought to determine the representation of female physician-investigators among the authors of selected publications during the past 35 years. METHODS: Original articles from six prominent medical journals--the New England Journal of Medicine (NEJM), the Journal of the American Medical Association (JAMA), the Annals of Internal Medicine (Ann Intern Med), the Annals of Surgery (Ann Surg), Obstetrics & Gynecology (Obstet Gynecol), and the Journal of Pediatrics (J Pediatr)--were categorized according to the sex of both the first and the senior (last listed) author. Sex was also determined for the authors of guest editorials in NEJM and JAMA. Data were collected for the years 1970, 1980, 1990, 2000, and 2004. The analysis was restricted to authors from U.S. institutions holding M.D. degrees. RESULTS: The sex was determined for 98.5 percent of the 7249 U.S. authors of original research with M.D. degrees. The proportion of first authors who were women increased from 5.9 percent in 1970 to 29.3 percent in 2004 (P<0.001), and the proportion of senior authors who were women increased from 3.7 percent to 19.3 percent (P<0.001) during the same period. The proportion of authors who were women increased most sharply in Obstet Gynecol (from 6.7 percent of first authors and 6.8 percent of senior authors in 1970 to 40.7 percent of first authors and 28.0 percent of senior authors in 2004) and J Pediatr (from 15.0 percent of first authors and 4.3 percent of senior authors in 1970 to 38.9 percent of first authors and 38.0 percent of senior authors in 2004) and remained low in Ann Surg (from 2.3 percent of first authors and 0.7 percent of senior authors in 1970 to 16.7 percent of first authors and 6.7 percent of senior authors in 2004). In 2004, 11.4 percent of the authors of guest editorials in NEJM and 18.8 percent of the authors of guest editorials in JAMA were women. CONCLUSIONS: Over the past four decades, the proportion of women among both first and senior physician-authors of original research in the United States has significantly increased. Nevertheless, women still compose a minority of the authors of original research and guest editorials in the journals studied.
Sex Differences in Academic Productivity Across Academic Ranks and Specialties in Academic Medicine: A Systematic Review and Meta-analysis Open PDF
(2021)
Ha, Giang L.
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Lehrer, Eric J.
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Wang, Ming
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Holliday, Emma
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Jagsi, Reshma
Importance: Despite equal numbers of men and women entering medical school, women are underrepresented in the upper echelons of academic medicine and receive less compensation and research funding. Citation-related publication productivity metrics, such as the h-index, are increasingly used for hiring, salary, grants, retention, promotion, and tenure decisions. Exploring sex differences in these metrics across academic medicine provides deeper insight into why differences are observed in career outcomes. Objective: To systematically examine the available literature on sex differences in h-index of academic faculty physicians across all medical specialties and all levels of academic rank. Data Sources: Medical literature with the term h-index found in PubMed and published between January 1, 2009, and December 31, 2018, was used. Study Selection: A PICOS (Population, Intervention, Comparison, and Outcomes), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses), and MOOSE (Meta-analysis of Observational Studies in Epidemiology) selection protocol was used to find observational studies that published h-indexes for faculty physicians that were stratified by sex. Studies were excluded if they were review articles, retracted, or unavailable online. Ultimately, 14 of 786 studies (1.78%) met the inclusion criteria. Data Extraction and Synthesis: Data from 9 studies across 16 specialties were examined using weighted random-effects meta-analyses. Five studies were excluded because of overlapping specialties with another study or because they were missing appropriate statistics for the meta-analysis. Four of these studies were included in qualitative synthesis to bring the total to 13 studies. Main Outcomes and Measures: The primary study outcome was the h-index. Results: The meta-analysis included 10 665 North American unique academic physicians across 9 different studies from the years 2009 to 2018. Of the 10 665 physicians, 2655 (24.89%) were women. Summary effect sizes for mean h-indexes of men and women and mean h-index difference between men and women were determined for all faculty physicians and at each academic rank. Overall, female faculty had lower h-indexes than male faculty (mean difference, -4.09; 95% CI, -5.44 to -2.73; P < .001). When adjusting for academic rank, female faculty still had lower h-indexes than male faculty at the ranks of assistant professor (mean difference, -1.3; 95% CI, -1.90 to -0.72; P < .001), associate professor (mean difference, -2.09; 95% CI, -3.40 to -0.78; P = .002), and professor (mean difference, -3.41; 95% CI, -6.24 to -0.58; P = .02). Conclusions and Relevance: In this systematic review and meta-analysis, women had lower h-indexes than men across most specialties and at all academic ranks, but it is unclear why these differences exist. These findings suggest that future investigation should be conducted regarding the causes of lower h-indexes in women and that interventions should be developed to provide a more equitable environment for all physicians regardless of sex.
The Role of Gender in Publication in The Journal of Pediatrics 2015-2016: Equal Reviews, Unequal Opportunities Open PDF
(2018)
Williams, Wadsworth A.
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Garvey, Katherine L.
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Goodman, Denise M.
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Lauderdale, Diane S.
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Ross, Lainie Friedman
OBJECTIVES: To examine whether the gender of corresponding authors, reviewers, and editors led to differential publication recommendations and outcomes for original research articles and invited editorials submitted to The Journal of Pediatrics in 2015 and 2016. STUDY DESIGN: Names of corresponding authors, reviewers, editors, and editorial writers in The Journal of Pediatrics databases for 2015-2016 were analyzed to determine gender using computer algorithms and Internet searches. Reviewer recommendations and final editor dispositions were stratified by their gender and the gender of the corresponding authors. RESULTS: Of 3729 original manuscripts, 54.3% had female corresponding authors. Women were the associate editor (40.2% of submissions), guest editor (34.8%), or primary reviewer (37.4%), with no gender difference in editor or reviewer assignments for submissions by female vs male corresponding authors. There were no outcome differences by author gender for manuscripts overseen by female (P = .71) or male (P = .62) editors nor recommendation differences by female (P = .18) or male (P = .71) reviewers. Female editors had a lower acceptance rate overall than male editors (20.1% vs 25.6%; P < .001). Women were statistically less likely to accept and complete the invitation to peer review original articles (34.0%; 2295 of 6743) compared with men (40.0%; 3930 of 9823; P < .001). Women wrote 33 of 107 editorials (30.8%). CONCLUSIONS: There were no differences in reviewer recommendations or editor decisions for original research articles based on corresponding author gender. However, women had fewer opportunities to serve as peer reviewers and editorial writers than would be expected given their representation as academic pediatric faculty.
Gender Difference in Teaching Evaluation Scores of Pediatric Faculty Open PDF
(2023)
Tiedt, Kristin
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Webber, Sarah
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Babal, Jessica
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Nackers, Kirstin A. M.
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Allen, Ann
OBJECTIVE: To evaluate associations between faculty gender and milestone-based teaching assessment scores assigned by residents. METHODS: We performed a retrospective cohort study of milestone-based clinical teaching assessments of pediatric faculty completed by pediatric residents at a mid-sized residency program from July 2016 to June 2019. Assessments included 3 domains (Clinical Interactions, Teaching Skills, Role Modeling/Professionalism) comprised of a total of 11 sub-competency items. We used multilevel logistic regression accounting for repeat measures and clustering to evaluate associations between faculty gender and assessment scores in the 1) top quartile, 2) bottom quartile, or 3) top-box (highest score). Findings were adjusted for faculty rank and academic track, and resident year and gender. RESULTS: Over 3 years, 2889 assessments of 104 faculty were performed by 91 residents. Between assessments of women and men faculty, there were no significant differences in the odds of receiving a score in the top quartile for the 3 domains (Clinical aOR 0.99, P = .86; Teaching aOR 0.99, P = .93; Role Modeling aOR 0.87, P = .089). However, assessments of women were more likely to receive a score in the bottom quartile in both Teaching (aOR 1.23, P = .019) and Role Modeling (aOR 1.26, P = .008). Assessments of women also had lower odds of receiving the highest score in 6 of 11 sub-competencies. CONCLUSION: Results suggest that gender bias may play a role in resident assessments of pediatric faculty. Future studies are needed to determine if findings are replicated in other settings and to identify opportunities to reduce the gender gap in pediatric academic medicine.
Women in Pediatrics: Progress, Barriers, and Opportunities for Equity, Diversity, and Inclusion. Open PDF
(2019)
Spector, Nancy D.
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Asante, Philomena A.
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Marcelin, Jasmine R.
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Poorman, Julie A.
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Larson, Allison R.
Gender bias and discrimination have profound and far-reaching effects on the health care workforce, delivery of patient care, and advancement of science and are antithetical to the principles of professionalism. In the quest for gender equity, medicine, with its abundance of highly educated and qualified women, should be leading the way. The sheer number of women who comprise the majority of pediatricians in the United States suggests this specialty has a unique opportunity to stand out as progressively equitable. Indeed, there has been much progress to celebrate for women in medicine and pediatrics. However, many challenges remain, and there are areas in which progress is too slow, stalled, or even regressing. The fair treatment of women pediatricians will require enhanced and simultaneous commitment from leaders in 4 key gatekeeper groups: academic medical centers, hospitals, health care organizations, and practices; medical societies; journals; and funding agencies. In this report, we describe the 6-step equity, diversity, and inclusion cycle, which provides a strategic methodology to (1) examine equity, diversity, and inclusion data; (2) share results with stakeholders; (3) investigate causality; (4) implement strategic interventions; (5) track outcomes and adjust strategies; and (6) disseminate results. Next steps include the enforcement of a climate of transparency and accountability, with leaders prioritizing and financially supporting workforce gender equity. This scientific and data-driven approach will accelerate progress and help pave a pathway to better health care and science.
Female Authorship Publishing Trends and Forecasting in Pediatric Urology: Are We Closer to Gender Equality? Open PDF
(2020)
Rickard, Mandy
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Hannick, Jessica H.
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Blais, Anne-Sophie
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Wang, Jishen
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Santos, Joana Dos
OBJECTIVE: To review the literature of 5 pediatric urology topics and conduct gender based and forecasting analyses of first and corresponding authors. METHODS: A PubMed search was performed for hypospadias, hydronephrosis, vesicoureteral reflux, bladder and bowel dysfunction, and cryptorchidism over 3 decades from 1990 to 2019. The 50 most relevant "best match" papers from each decade were extracted by topic. Author gender, specialty, and advanced degrees, along with journal and publication variables were collected. Forecasting analyses were conducted through the Holt-Winters method. RESULTS: Among 750 papers analyzed, 78% of corresponding and 70% of first authors were male. A significant upward trend was observed for female-authored publications in both first and corresponding positions over time (P <.01). Forecasting analyses predicted a continuing upward trend for female corresponding (55%) and first authors (83%) by 2049. Most studies originated from pediatric urology (59%), followed by pediatric surgery (9%) and endocrinology/genetics (5%). Papers focused in The Journal of Urology (30%) with the majority originating from the United States (38%). Most were retrospective (44%) and discussed medical (54%) versus surgical management (20%). CONCLUSION: The majority of pediatric urology literature has been generated by male authors. A persistent, rising trend in female authorship across all examined pediatric urology topics was noted. These encouraging findings are projected to continue to increase in the future, suggesting a movement toward equal and fair gender representation in authorship in pediatric urology.
Gender Differences Among Academic Pediatric Radiology Faculty in the United States and Canada Open PDF
(2020)
Counter, William B.
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Khurshid, Kiran
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Jalal, Sabeena
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Castillo, Mauricio
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White, Ammie M.
OBJECTIVE: It is currently unknown whether efforts in recent years to create equal opportunities for female faculty in academic medicine have succeeded. We looked at faculty members in academic pediatric radiology departments across the United States and Canada to assess for evidence of gender disparities and differences in academic performance between males and females. METHODS: The analysis included diagnostic radiology programs across the United States and Canada, as specified by the American Medical Association's Fellowship and Residency Electronic Interactive Database (FREIDA Online) and the Canadian Resident Matching Service website. The Scopus database was used to retrieve the H-index, number of publications, and number of citations for each faculty member. We examined the distribution of male and female faculty members across geographical regions, academic ranks, and leadership roles. Academic performance was also compared. RESULTS: Across all regions and academic ranks, disparities exist between the number of male and female faculty members. The greatest disparity was found amongst the professor rank, where more than 70% of positions were occupied by males. Female professors were found to demonstrate similar levels of academic performance compared to their male counterparts, although this parity was not observed amongst assistant and associate professors. CONCLUSION: Women occupied almost half (46.6%) of the total academic pediatric radiology workforce, despite having been previously shown to make up only 21% of radiologists. However, gender disparities currently exist among academic pediatric radiology faculty, with a significantly higher percentage of men in pediatric radiology faculty positions. Women, however, currently occupy a greater percentage of leadership positions compared to men, even though the majority of senior academic ranks are held by men.

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