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  • Item type:Publication,
    Bias in Student Evaluations of Surgical Attendings: Role of Gender, Race, Age and Experience Open PDF 
    (Elsevier BV, 2026-06)
    Theis, Claudia
    ;
    Jacob, Anusha S.
    ;
    Kapadia, Muneera Rehana
    ;
    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.
  • Item type:Publication,
    Engaging and Empowering Future Female Surgeons: Development of the Medical Student Section of the Society of Women in Urology Open PDF 
    (Elsevier BV, 2025-10)
    Booher, Allison G.
    ;
    Vereecken, Sasha J.
    ;
    Kim, Erin
    ;
    Penmatcha, Neharika
    ;
    Aponte, Alexandra
    OBJECTIVE: To describe a replicable model for a large-scale, cross-institutional, and student-driven initiative to promote gender equity within surgical fields. METHODS: To address the lack of a national infrastructure to support female medical students pursuing careers in Urology, a historically male-dominated specialty, the society of women in urology (SWIU) established its medical student section, called SWIUdents, as a student-led initiative to offer mentorship, education, and networking resources for future female urologists. In 2022, SWIUdents convened its first medical student leadership board, comprised of two co-chairs and four subcommittees focused on membership, program implementation, mentorship, and community relations. SWIUdents membership was open to medical students of all gender identities, and recruitment for the organization took place via official SWIU communications, social media, and word of mouth. RESULTS: As of April 2025, there are 319 SWIUdents members, 195 of which are current medical students, representing all regional sections of the American Urological Association (AUA), as well as international medical students. In the 2024 to 2025 academic year, SWIUdents paired 87 medical students with resident or faculty members in Urology. SWIUdents also maintains an active social media presence and offers a broad array of programming, with robust attendance at monthly webinars and journal clubs. CONCLUSIONS: This paper outlines the development and infrastructure of SWIUdents, a national, student-driven model which may be replicated by other specialty organizations aiming to engage and empower women and other groups underrepresented within their respective field.
  • Item type:Publication,
    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.
    ;
    Lehrer, Eric J.
    ;
    Wang, Ming
    ;
    Holliday, Emma
    ;
    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.