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Diversity Drives Representation: An Internal Audit of Gender Representation in Citation Practices of a Single Surgical Laboratory Open PDF
(Ovid Technologies (Wolters Kluwer Health), 2024-06)
Fioranelli, Gabriela A.
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Lo, Yunee
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Jesch, Anna K.
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Laluzerne, Matthew J.
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Donnelly, D’Andrea
BACKGROUND: Large-scale retrospective studies have identified implicit gender bias in citation behaviors across multiple medical fields. There are minimal resources to directly assess one's own citation behavior before publication at a laboratory level. In this study, we performed an internal audit of our own citation practices and behavior, looking at the representation of authors by gender in our own bibliographies. METHODS: Bibliographies were collated from our laboratory's publications between 2015 and 2022 with a single senior author, who was excluded from participating in this study. Bibliographies were run through a simulation originally constructed and used by authors from the University of Pennsylvania that categorized authors of each article by gender: man or woman, according to external database records. RESULTS: Of the 1697 citations, the first and last authorship sequences displayed to be 60.8% male/male, 10.1% male/female, 16.3% female/male and 12.8% female/female. Men-led articles within our laboratory cited 67.4% male/male articles in their bibliographies compared with women-led articles citing 53.9%. All laboratory bibliographies consisted of 77.1% male senior authors compared with 22.9% female senior authors. CONCLUSIONS: Our data confirm that a gender bias in citation practices exists at the laboratory level. Promisingly, these data also indicate that diversity within an individual laboratory group leads to diversity in representation; therefore, diversifying a team of researchers is prone to improve the overall work and success of the laboratory. We encourage laboratory groups to challenge their own biases by replicating their own results and discovering how these biases might be impacting their publications.
Trends and disparities in female authorship in surgical publications: A large-scale bibliometric study using natural language processing Open PDF
(Elsevier BV, 2026-06)
Renedo, Daniela
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Rivier, Cyprien A.
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Acosta, Julian N.
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Koo, Andrew
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Sujijantarat, Nanthiya
Background: Gender disparities in academic surgery persist, particularly in authorship positions that signal leadership, mentorship, and scholarly influence. Comprehensive global analyses across surgical specialties remain limited. This study examined gender representation among first and last (senior) authors across surgical subspecialties, countries, and continents using natural language processing applied to bibliometric data. Methods: In a cross-sectional bibliometric study of surgical publications indexed in MEDLINE (January 1, 2015, to December 31, 2024), articles were drawn from 30 high-impact journals across 15 subspecialties. Natural language processing tools inferred author gender and country of affiliation. After excluding entries with missing or unclassifiable data, 112,841 articles were analyzed. The main outcome was proportion of female first and last authors by specialty, region, article type, and journal. Secondary measures included temporal trends, Gender Parity Index (GPI), and results of χ2 and trend analyses. Results: Of 112,727 articles, 32,909 (29.2%) had female first authors, and 22,505 (19.9%) had female last authors. Female first authorship increased from 26.1% in 2015 to 34.1% in 2024, and female last authorship increased from 17.8% to 22.8% (both P < .001). Obstetrics/gynecology (59.8%), pediatric surgery (42.5%), and transplant surgery (39.4%) had the highest female first authorship, whereas cardiothoracic surgery (17.6%) and neurosurgery (18.9%) had the lowest. Representation also varied by country (Australia 32.1% vs Japan 10.1%) and article type (editorials 34.6% vs technical reports 14.3%). Differences by specialty, region, and article type were significant (P < .001). Conclusion: Despite modest progress, substantial gender disparities remain, especially in senior roles, technical specialties, and high-prestige article types. Targeted initiatives are needed to promote equity in surgical research and leadership worldwide.
Bias in Student Evaluations of Surgical Attendings: Role of Gender, Race, Age and Experience Open PDF
(Elsevier BV, 2026-06)
Theis, Claudia
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Jacob, Anusha S.
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Kapadia, Muneera Rehana
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Pascarella, Luigi
Introduction Student evaluations influence faculty promotion but may reflect implicit bias. We assessed whether surgeon gender, race, age, and experience were associated with differences in student evaluations at a large academic medical center. Materials and methods This retrospective cohort study included 149 surgical attendings evaluated by medical students at the University of North Carolina between 2016 and 2020. Quantitative evaluation items were rated on 5-point Likert scales and analyzed using surgeon-level summary comparisons (Wilcoxon rank-sum and Kruskal–Wallis tests), evaluation-level multivariable logistic regression, and generalized estimating equations (GEEs) to account for clustering of multiple evaluations per attending. Qualitative free-text comments were analyzed using a validated natural language processing framework and summarized on a 5-point sentiment scale. Results A total of 149 surgical attendings were evaluated, including 39 women (26.2%) and 110 men (73.8%). The racial and ethnic distribution was 102 White (68.5%), 28 Asian (18.8%), 13 Black (8.7%), and 6 Latino (4.0%). In total, 2475 quantitative evaluations were analyzed, of which 1542 (62.3%) included narrative comments. The median time in practice was 14 y (Q1-Q3: 9-22), and the median time at the University of North Carolina was 11 y (Q1-Q3: 7-19.5). Median composite quantitative evaluation scores were lower for women than for men (4.42 [4.32-4.61] versus 4.61 [4.40-4.82] on a 5-point scale; P = 0.002). In GEE models accounting for clustering of evaluations within attendings and adjusting for age, race/ethnicity, and years in practice, women remained independently associated with lower evaluation scores (β = −0.206; 95% confidence interval: −0.294 to −0.118; P < 0.001). Composite evaluation scores did not differ significantly across racial or ethnic groups (Kruskal–Wallis P = 0.40), and race was not a significant predictor in adjusted models (GEE P = 0.13). Attendings aged ≥50 y had lower unadjusted evaluation scores than younger colleagues (P = 0.03); however, age was not independently associated with evaluation scores after clustering adjustment (GEE P = 0.14). Qualitative sentiment scores were uniformly high (median 4.0 [Q1-Q3: 4.0-4.5]) and did not differ by gender, race, or age. Conclusions Women surgeons received lower quantitative scores than their male colleagues, despite similarly positive qualitative feedback. Age differences were observed in unadjusted analyses but were attenuated after accounting for clustering, whereas no significant differences were observed by race or years in practice. Although absolute score differences were modest, these findings suggest that commonly used student evaluation metrics may reflect gender-related bias and should be interpreted cautiously in academic surgical assessment.
Gender representation trends in cardiothoracic surgery journal editorial boards Open PDF
(Elsevier BV, 2024-12)
Higaki, Adrian Acuna
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Papageorge, Marianna V.
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Waldron, Christina
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Huggins, Lenique
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Brinker, Morgan
Objective We aimed to characterize chronologic trends of gender composition of the editorial boards of major cardiothoracic surgery journals in the current era. Methods A cross-sectional analysis was performed of gender representation in editorial board members of 2 North American cardiothoracic surgery journals from 2008 to 2023. Member names and roles were collected from available monthly issues. Validated software programming was used to classify gender. The annual proportion of women representation was compared to the thoracic surgery workforce. Results During the study period, 558 individuals (3641 names) were identified, 14.3% of whom were women. The total number of editorial board women increased for both journals. The proportion of women also increased from 2.5% (3 out of 118) in 2008 to 17.8% (71 out of 399) in 2023 (P < .001), exceeding the percentage of women in the thoracic surgery workforce, which increased from 3.8% in 2007 to 8.3% in 2021 (P < .001). The average duration of participation was longer for men than for women (53.8 vs 44.5 months; P = .01). Women in editorial board senior roles also increased from 3.3% (1 out of 30) in 2008 to 28.6% (42 out of 147) in 2023 (P < .001), almost triple the increase in nondesignated roles from 2.3% (2 out of 88) in 2008 to 11.5% (29 out of 252) in 2023 (P < .001). Conclusions In recent years, the appointment of women to the editorial boards of high-impact cardiothoracic surgery journals and senior roles have proportionally exceeded the overall representation of women in cardiothoracic surgery. These findings indicate progress in inclusive efforts and offer insight toward reducing academic gender disparities.
Sex Disparities in Spine Surgeon Leadership of Clinical Trials for Degenerative Spine Disease Research Open PDF
(Ovid Technologies (Wolters Kluwer Health), 2025-08-28)
Silvestre, Jason
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Walker, Jasmine J.
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Kang, James D.
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Ravinsky, Robert A.
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Lawrence, James P.
Introduction: Despite increasing awareness, women remain underrepresented in academic spine surgery. This study assessed whether women were equitably represented among spine surgeon PIs of clinical trials for degenerative spine disease research. Methods: This was a retrospective cohort study of spine surgeon principal investigators (PIs) in the United States (2015 to 2022). ClinicalTrials.gov was queried for the most common diagnoses and surgeries for degenerative spine diseases. Characteristics of spine surgeon PIs were collected from academic profiles. Participation-to-prevalence ratios (PPRs) were calculated for men and women PIs relative to their prevalence among spine surgery faculty at accredited training programs. A PPR of 0.8 to 1.2 indicated equitable sex representation. A PPR <0.8 was defined as underrepresentation and >1.2 as overrepresentation. Results: In total, 129 spine surgeon PIs of 91 clinical trials were included in this study. Overall, there were 125 male (97%) and four female (3%) spine surgeon PIs. Overall, women were underrepresented among spine surgeon PIs (PPR = 0.64), whereas men had equitable representation (PPR = 1.02). From 2015 to 2018, female spine surgeons were underrepresented (PPR = 0.33), but achieved equitable representation from 2019 to 2022 (PPR = 0.95). Male spine surgeons had consistently equitable representation across the study period (PPR range 1.00 to 1.03). Women had equitable representation at assistant (PPR = 1.08) and associate (PPR = 0.31) professor ranks, but were underrepresented at the full professor rank (PPR = 0). PIs were funded by industry (54%), academic institution (44%), and US Federal (2%) sources. No differences were observed in funding sources by sex ( P = 0.36). Discussion: There are a limited number of female spine surgeon PIs for degenerative spine disease clinical trials, which may have negative implications on the vitality of the specialty moving forward. Future investigations are needed to understand the barriers women face in obtaining clinical trial leadership positions.
Exploring gender disparities in academic orthopaedic surgery faculty: analyzing subspecialty and leadership diversity to foster inclusivity Open PDF
(Springer Science and Business Media LLC, 2025-07-11)
Anand, Malini
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Julian, Kaitlyn R.
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Mulcahey, Mary K.
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Wong, Stephanie E.
Background The historic gap in gender diversity within orthopaedic surgery is widely acknowledged and continues to persist. The lack of female representation in orthopaedic surgery has been attributed to a variety of factors, including the absence of female mentors and leaders within the field. As such, we sought to examine the gender diversity among orthopaedic surgery faculty in various subspecialties at academic institutions and the distribution of female faculty in positions of leadership. Methods The American Medical Association Fellowship and Residency Electronic Interactive Database (FREIDA) was used to identify all allopathic orthopaedic surgery residency programs during the 2022 to 2023 academic year. The total number of faculty, and distribution of female faculty by subspecialty were collected from January to March 2023. The mean and percentage of female faculty in each subspecialty per program was calculated. Results The total number of orthopaedic surgery female faculty identified was 524. The subspecialty with the highest percentage of female faculty per program was pediatrics at 26.1% (148/511). Hand (18.6%; 113/511), oncology (19.2%; 38/511), foot and ankle (13.6%; 49/511), spine (3.9%; 21/511), shoulder and elbow (7.4%; 7/511) and adult reconstruction (3.7%; 24/511) had lower percentages of female faculty per program. A total of 52 (10.2%) female section chiefs were identified across all programs. Oncology had the highest percentage of female faculty represented in section leadership at 18.4% (7) and sports medicine had the lowest at 4.8% (4). Conclusion Gender diversity of faculty in orthopaedic surgery is low with adult reconstruction (3.7%), spine (3.9%), and shoulder and elbow (7.4%) having the lowest percentages of female faculty. The percentage of female faculty represented in section leadership is also lacking with a total of 52 (10.2%) female section chiefs identified across all programs. Increasing the number of females in leadership positions across all orthopaedic subspecialties may be one step in helping improve gender diversity in the field.
Gender-Based Disparities in Academic Orthopaedic Surgery Physician Compensation in 2023 Open PDF
(Ovid Technologies (Wolters Kluwer Health), 2025-03-11)
Chauhan, Dhun
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DeYoung, Joshua K.
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Goodrich, Ezra
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Templeton, Kimberly
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Day, Charles S.
Background: Orthopaedic surgery remains one of the least diverse specialties in medicine. Parity in opportunity and recognition are key factors in attracting and retaining a diverse group of individuals in the field. The primary purpose of this study was to assess gender-based discrepancies in total salary compensation by rank for academic orthopaedic surgery faculty. Methods: Aggregate data were obtained from the Association of American Medical Colleges for fiscal year 2023. Mean compensation was compared for orthopaedic surgery faculty and total surgery faculty at all academic ranks based on gender and race. Results: Men received markedly higher total compensation for all ranks except chair within orthopaedic surgery. At the instructor level, men earned an average annual income of $554,245 while women received $229,204, demonstrating a significant pay gap (P = 0.0019). At the assistant professor (men: $628,346; women: $475,857), associate professor (men: $732,381; women: $575,877), and professor (men: $743,822; women: $472,140) levels, there existed significant pay disparities (P < 0.0001 for all three academic levels, respectively). At the chief position, men earned an average of $1,185,873 annually while women received $596,270 (P = 0.0006). Aggregate data for other surgical specialties demonstrated similar results, with women receiving lower total compensation at all ranks compared with men. Conclusion: This analysis of the 2023 American Medical Colleges Faculty Salary Report demonstrates a notable pay differential between men and women in orthopaedic surgery and surgical specialties, in general, across multiple academic levels including instructor, assistant professor, associate professor, professor, and chief of division. Although there has been increasing awareness of gender-based compensation disparities within surgical specialties, particularly in orthopaedic surgery, these disparities are still clearly present.
Representation of Women Authors in the 100 Most‐Cited Facial Plastic and Reconstructive Surgery Articles Open PDF
(Wiley, 2025-02-25)
Fleischer, Lindsay
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Ahn, Yoo Jin
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Urban, Matthew J.
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Revenaugh, Peter C.
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Smith, Ryan M.
Objective This study aims to determine the representation of women among most‐cited facial plastic and reconstructive surgery articles. Study Design A bibliometric analysis of the most‐cited articles from 9 high‐impact facial plastic surgery journals. Setting Online database. Methods A retrospective analysis of the 100 most‐cited articles in facial plastic surgery was conducted using the Elsevier Scopus database. The representation of women among first, senior, and corresponding authors was assessed using the US Social Security Baby Names Database. Accredited websites were utilized for further clarification of gender, professional background, and title. A 2‐tailed t‐test was performed to compare the average number of citations by gender, while chi‐square analysis was used to compare the relative number of women authors between 5‐year intervals, citation rank, and nationalities. A significance level of 0.05 was used. Results The top 100 most‐cited articles had the highest total number of citations between 2000 and 2004. US institutions published 71% of these articles. The gender of 99% of first authors, 94% of senior authors, and 94% of corresponding authors was identified. Among these, 11% of first authors, 14% of senior authors, and 10% of corresponding authors were women. Of the 19 women authors, 11 were physicians. No statistically significant difference in the relative number of first, senior, and corresponding women authors was observed between years of publication, citation quartile, and article nationality. Conclusion Despite increasing women facial plastic surgery trainees, women's academic contributions continue to trail. Additional efforts are needed to support and highlight academic achievements of women facial plastic surgeons.
Representation of women among cardiothoracic surgery editorial boards: Trends over the past 2 decades Open PDF
(Elsevier BV, 2025-03)
Stuart, Christina M.
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Mott, Nicole M.
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Mungo, Alison H.
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Meguid, Robert A.
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Mitchell, John D.
Abstract Objective The objective of this study was to examine representation of women on the editorial boards of cardiothoracic surgery-focused journals over the past 2 decades to identify changes over time compared with women cardiothoracic surgeon and trainee representation, and to highlight additional opportunities for improvement. Methods The editorial boards of 2 high-impact cardiothoracic surgery journals were reviewed from 2000 to 2023. Data on editorial board positions, including editors-in-chief, associate/deputy editors, feature editors, and general members of the editorial board were abstracted. The proportion of women editors was assessed. Data were compared with publicly available information from the Association of American Medical Colleges on physician specialty by sex. Results Of 3460 editorial positions, 332 (9.6%) were held by women. Women occupied 2.2% (1 out of 45) of editor-in-chief positions, 13.2% (78 out of 592) of senior editor positions, 11.5% (33 out of 287) of feature editor positions, and 8.3% (221 out of 2663) of general editorial board positions. The proportion of women holding any editorial board position significantly increased from 2.4% in 2000 to 18.2% in 2023 (P = .01). Overall, editorial board representation increased at a rate of 0.7% ± 1.3% per year, not significantly different from the growth of practicing women cardiothoracic surgeons at 0.3% ± 0.5% per year (P = .584). Discussion Representation of women on the editorial boards of cardiothoracic surgery-focused journals has increased commensurate with the increasing proportion of practicing women cardiothoracic surgeons, although remains at 16%. Work remains to continue the recruitment of women to cardiothoracic surgery as well as to identify the key elements that can support them in positions of leadership.
Shattering the Glass Scalpel: Analyzing Female Representation in Orthopedic Surgery Across the United States Open PDF
(Springer Science and Business Media LLC, 2025-03-05)
Loyst, Rachel A
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Hidalgo Perea, Sofia
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Vanhelmond, Taylor
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Patterson, Diana
Background Orthopedic surgery has historically been a male-dominated field, with slower growth in female participation compared to other surgical specialties. The present study aims to assess the extent of this influence, examine whether the dynamic is changing, and further analyze female participation trends, focusing on various regions of the United States and including analyses of female residents. Methodology Orthopedic surgery residency programs were surveyed online. A list of 200 programs was sourced from the Association of American Medical Colleges, which provided details including the program names, cities, states, regions, and website links. The homepages of the residency program as well as the department of orthopedic surgery were surveyed for any mention of women or female in orthopedics, number of female residents, total number of residents (class of 2025-2029), number of female faculty operative orthopedic faculty, total number of operative orthopedic faculty physicians, specialty of the female orthopedic faculty, program director gender, assistant program director gender, and chair of the program gender. Data analyses were performed using SPSS Software version 28.0 (IBM Corp., Armonk, NY, USA) and Rstudio version 1.4.1106 (Boston, MA, USA). Results In total, 55 Midwest (28%), 53 Northeast (27%), 63 South (32%), and 27 West (14%) orthopedic surgery residency programs were included. Female orthopedic surgery residents comprised 23.7% of all orthopedic residents across the United States. When analyzed by geographic region, female residents comprised 22.7% of all residents in the Midwest, 24.3% in the Northeast, 22.5% in the South, and 27.0% in the West. In the Northeast region, there was a notable upward trend in the percentage of female residents across PGY5 to PGY1 years (τ = 1, p = 0.027). A total of 25 (12.6%) programs had a section in their residency program or orthopedic department website homepage that mentioned and/or was dedicated to women or females. There was a significant association between region and homepage mention of women (χ² (8, N = 198) = 105.7; p < 0.001). A total of 12.9% of all orthopedic residency program directors were female, while 21.2% of all associate program directors were female. Conclusions These findings underscore the importance of monitoring and addressing regional disparities in gender representation within orthopedic surgery residency programs. By identifying trends and disparities, healthcare institutions and policymakers can implement targeted interventions to promote gender equity and cultivate a diverse and inclusive workforce.

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