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Beyond the Scores: Gendered Interpretations of Emergency Medicine Resident Assessments of Interdependent Performances Open PDF
(Ubiquity Press, Ltd., 2025-08-21)
El Galad, Asil
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Sebok-Syer, Stefanie S.
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Panza, Michael
;
Ng, Kristen
;
Lingard, Lorelei
PURPOSE: In medicine, gender bias and gendered language within assessments of individual performance are well established. Recent shifts toward assessing interdependence (the ability to work supportively and collaboratively within teams) demand we understand how gender bias and gendered language influence assessments. In exploring how faculty assess residents' interdependent performances, this study evaluated how gender-presentation influences faculty raters' assessments of residents' interdependence in Emergency Medicine (EM). METHODS: Using a multiple-methods (an experimental within-subjects study with follow-up interviews), 18 EM faculty from Canada and the United States assessed scripted videos of identical clinical encounters acted by male- and female-presenting residents. Faculty assessed female residents via anonymous online surveys and, six months later, assessed male residents via follow-up interviews using the same clinical scenarios. After every clip, faculty completed entrustable professional activity (EPA) and Milestone ratings and provided narrative justifications. Statistical analyses were conducted using Wilcoxon signed-rank tests to assess gender differences in EPA and Milestone scores. Qualitative data were analyzed using thematic analysis to identify recurring, gendered patterns in narrative justifications. RESULTS: Quantitative results revealed no gender differences in Milestone and EPA scores, except for the resuscitation entrustment rating, where male residents were rated less favorably (z = -3.09, p = 0.002). Qualitative findings uncovered subtle gender differences. For the same clinical performances, male residents were frequently described as leaders, while female residents as collaborative. Furthermore, male residents' help-seeking was framed as proactive, whereas female residents' help-seeking was indicative of lacking knowledge. Finally, bias was not consistent across genders: male leadership expectations could negatively flavor assessments of male collaborative performances. CONCLUSION: EPA and Milestone scores showed marginal gender-based differences, while narrative justifications reflected clear gendered expectations about residents' interdependence. These findings highlight the need for equity-oriented assessment practices that interrogate both the numbers and the narratives. As team-based competencies like interdependence become central to clinical training, ensuring that assessments reflect fair, unbiased interpretations are essential to supporting all learners equitably.
Gender differences in how scientists present the importance of their research: observational study Open PDF
(2019)
Lerchenmueller, Marc J.
;
Sorenson, Olav
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Jena, Anupam B.
OBJECTIVES: Women remain underrepresented on faculties of medicine and the life sciences more broadly. Whether gender differences in self presentation of clinical research exist and may contribute to this gender gap has been challenging to explore empirically. The objective of this study was to analyze whether men and women differ in how positively they frame their research findings and to analyze whether the positive framing of research is associated with higher downstream citations. DESIGN: Retrospective observational study. DATA SOURCES: Titles and abstracts from 101 720 clinical research articles and approximately 6.2 million general life science articles indexed in PubMed and published between 2002 and 2017. MAIN OUTCOME MEASURES: Analysis of article titles and abstracts to determine whether men and women differ in how positively they present their research through use of terms such as "novel" or "excellent." For a set of 25 positive terms, we estimated the relative probability of positive framing as a function of the gender composition of the first and last authors, adjusting for scientific journal, year of publication, journal impact, and scientific field. RESULTS: Articles in which both the first and last author were women used at least one of the 25 positive terms in 10.9% of titles or abstracts versus 12.2% for articles involving a male first or last author, corresponding to a 12.3% relative difference (95% CI 5.7% to 18.9%). Gender differences in positive presentation were greatest in high impact clinical journals (impact factor >10), in which women were 21.4% less likely to present research positively. Across all clinical journals, positive presentation was associated with 9.4% (6.6% to 12.2%) higher subsequent citations, and in high impact clinical journals 13.0% (9.5% to 16.5%) higher citations. Results were similar when broadened to general life science articles published in journals indexed by PubMed, suggesting that gender differences in positive word use generalize to broader samples. CONCLUSIONS: Clinical articles involving a male first or last author were more likely to present research findings positively in titles and abstracts compared with articles in which both the first and last author were women, particularly in the highest impact journals. Positive presentation of research findings was associated with higher downstream citations.
Trends in gender of authors of original research in oncology among major medical journals: A retrospective bibliometric study Open PDF
(2021)
Lee, S.F.
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Redondo Sánchez, D.
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Sánchez, M.
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Gelaye, B.
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Chiang, C.L.
Objective We evaluated the temporal trend in gender ratios of first and last authors in the field of oncological research published in major general medical and oncology journals and examined the gender pattern in coauthorship. Design We conducted a retrospective study in PubMed using the R package RISmed. We retrieved original research articles published in four general medical journals and six oncology specialty journals. These journals were selected based on their impact factors and popularity among oncologists. We identified the names of first and last authors from 1 January 2002 to 31 December 2019. The gender of the authors was identified and validated using the Gender API database (https://gender-api.com/). Primary and secondary outcome measures The percentages of first and last authors by gender and the gender ratios (male to female) and temporal trends in gender ratios of first and last authors were determined. Results We identified 34 624 research articles, in which 32 452 had the gender of both first and last authors identified. Among these 11 650 (33.6%) had women as the first author and 7908 (22.8%) as the last author, respectively. The proportion of female first and last authors increased from 26.6% and 16.2% in 2002, to 32.9% and 27.5% in 2019, respectively. However, the gender ratio (male to female) of first and last authors decreased by 1.5% and 2.6% per year, respectively, which were statistically significant (first author: Incidence rate ratio (IRR) 0.98, 95% CI 0.97 to 1.00; last author: IRR 0.97, 95% CI 0.96 to 0.99). Male first and last authorship was the most common combination. Male-female and female-female pairs increased by 2.0% and 5.0%, respectively (IRR 1.02, 95% CI 1.01 to 1.03 and IRR 1.05, 95% CI 1.04 to 1.06, respectively). Conclusions The continued under-representation of women means that more efforts to address parity for advancement of women in academic oncology are needed. © 2021 Author(s). Published by BMJ.
Gender disparities in industry compensation and research payments among neurointerventional surgeons in the USA Open PDF
(BMJ Publishing Group, 2023)
Kyarunts, M.
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Michaelcheck, C.E.
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Kobeissi, H.
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Kallmes, D.F.
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Agid, R.
Background: The purpose of this study is to examine the presence of gender disparity represented by industry payments and research funding within the field of interventional neuroradiology. Methods: Payment information was collected using the Centers for Medicare and Medicaid Services Open Payment database for the year 2019. Kruskal-Wallis tests were used to analyze differences in annual compensation based on sex in $US, while controlling for geographic factors, academic rank, and h-index. A sample t-test was performed to look at gender differences in h-indexes. Results: The study cohort was comprised of 893 interventional neuroradiologists, 73 (8.2%) of which were female. Of the $48889.20 in mean annual payments reported in the database, $5847.13 (11.2%) went to female interventional neuroradiologists (P<0.05). The significant difference in compensation between male and female neuroradiologists was evident after controlling for state-level variance and academic position. There was a statistically significant difference in total reimbursement (P<0.001), research (P<0.001), consulting (P<0.04), food and beverage (P<0.02), and compensation for services other than consulting between males and females (P<0.02). A statistically significant difference was found for h-index based on gender (males=16.7, females=10.1; P<0.001). Conclusions: Our findings indicate that in the field of interventional neuroradiology, females receive less research funding and private industry compensation, have lower h-indexes, and are less likely to occupy the highest academic positions. The difference in funding did not differ when accounting for geographic state of practice and academic rank. Future studies should work to identify potential contributory factors of these trends. © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
Academic Productivity Differences by Gender and Child Age in Science, Technology, Engineering, Mathematics, and Medicine Faculty During the COVID-19 Pandemic Open PDF
(2021)
Krukowski, Rebecca A.
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Jagsi, Reshma
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Cardel, Michelle I.
Background: Due to the COVID-19 pandemic, most faculty in science, technology, engineering, mathematics, and medicine (STEMM) began working from home, including many who were simultaneously caring for children. The objective was to assess associations of gender and parental status with self-reported academic productivity before (i.e., mid-January to mid-March 2020) and during the pandemic (i.e., mid-March to mid-May 2020). Materials and Methods: STEMM faculty in the United States (N = 284, 67.6% women, 57.0% with children younger than the age of 18 years living at home) completed a survey about the number of hours worked and the frequency of academic productivity activities. Results: There was no significant difference in the hours worked per week by gender (men, M [standard deviation, SD] = 45.8 [16.7], women = 43.1 [16.3]). Faculty with 0-5-year-old children reported significantly fewer work hours (33.7 [13.9]) compared to all other groups (No children = 49.2 [14.9], 6-11 years old = 48.3 [13.9], and 12-17 years old = 49.5 [13.9], p < 0.0001). Women's self-reported first/corresponding author's and coauthor's article submissions decreased significantly between the two time periods; men's productivity metrics did not change. Faculty with 0-5-year-old children completed significantly fewer peer review assignments, attended fewer funding panel meetings, and submitted fewer first authors' articles during the pandemic compared to the previous period. Those with children aged 6 years or older at home or without children at home reported significant increases or stable productivity. Conclusions: Overall, significant disparities were observed in academic productivity by gender and child age during the pandemic and if confirmed by further research, should be considered by academic institutions and funding agencies when making decisions regarding funding and hiring as well as promotion and tenure.
An International Survey of Female Dental Students' Perceptions About Gender Bias and Sexual Misconduct at Four Dental Schools. Open PDF
(2018)
Ivanoff, Chris S.
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Luan, Diana M.
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Hottel, Timothy L.
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Andonov, Bogomil
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Ricci Volpato, Luiz Evaristo
As women enter the dental profession in increasing numbers in North America and around the world, the questions of how they perceive their environment and what kind of barriers they face are important subjects to be addressed. The aim of this study was to assess and compare women dental students' perceptions of bias in their environment and experiences of sexual misconduct at one dental school in each of four countries. In spring 2017, 1,293 female students at four dental schools in the U.S., Bulgaria, Brazil, and India were invited to participate in a 24-item survey developed by researchers from the four countries; 990 students responded (response rate 76.6%). The overall majority of the respondents reported thinking the admissions process at their school was fair (79.7%); but a fifth of U.S. and Brazilian students perceived their school was not fully embracing of females, with most Bulgarian students agreeing (87.2%) and all Indian students disagreeing. Most respondents overall perceived that male faculty members did not favor male students (79.5%) and did not think there was discrimination against female students by faculty (87.1%), but half of the U.S. respondents reported feeling discriminated against by both male faculty and male students. When the responses "I've been verbally harassed" and "I've been somewhat verbally harassed" were combined, 10.1% of the U.S. respondents reported verbal harassment, compared to 20% of Brazilian, 15% of Bulgarian, and 2% of Indian respondents. When the responses "I've been sexually assaulted" and "I've been somewhat sexually assaulted" were combined, 6% of U.S. respondents reported being sexually assaulted, compared to 6.2% of Brazilian, 2.5% of Bulgarian, and none of the Indian respondents. Almost half (46.9%) of these students overall perceived their school was not or only somewhat vigilant about issues of sexual misconduct, and only 54% said they would feel comfortable or very comfortable reporting misconduct. These results suggest that academic dental institutions in all four countries need improvements to make their environments more equitable and free of bias and sexual misconduct.
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.
Trial characteristics associated with under-enrolment of females in randomized controlled trials of heart failure with reduced ejection fraction: a systematic review Open PDF
(2021)
Whitelaw, Sera
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Sullivan, Kristen
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Eliya, Yousif
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Alruwayeh, Mohammad
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Thabane, Lehana
AIMS: To evaluate temporal trends in the enrolment of females in randomized controlled trials (RCTs) of heart failure with reduced ejection fraction (HFrEF) published in high-impact journals, and assess RCT characteristics associated with under-enrolment. METHODS AND RESULTS: We searched MEDLINE, EMBASE and CINAHL for studies published from January 2000 to May 2019 in journals with impact factor ≥10. We included RCTs that recruited adults with HFrEF. We used a 20% threshold below the sex distribution of HFrEF to define under-enrolment. We used multivariable logistic regression to assess trial characteristics independently associated with under-enrolment. We included 317 RCTs. Among the 183 097 participants, mean (standard deviation) age was 63.0 (7.0) years and 25.5% were female. Females were under-enrolled in 71.6% [95% confidence interval (CI) 66.6-76.6%] of the RCTs; enrolment did not increase significantly between 2000-2019. Sex-related eligibility criteria [odds ratio (OR) 2.05, 95% CI 1.01-4.16; P = 0.046]; recruitment in ambulatory settings (OR 2.56, 95% CI 1.37-4.81; P = 0.003); trial coordination in North America (OR 4.44, 95% CI 1.09-18.07; P = 0.037), Europe (OR 6.79, 95% CI 1.63-27.39; P = 0.018) and Asia (OR 9.33, 95% CI 1.40-12.40; P = 0.033); drug (OR 1.76, 95% CI 1.96-7.36; P < 0.001) and device/surgical interventions (OR 1.69, 95% CI 1.16-9.43; P = 0.002); and men in first and last authorship position (OR 1.32, 95% CI 1.12-3.54; P = 0.047) were associated with under-enrolment of females. CONCLUSIONS: Females were under-enrolled relative to disease distribution in a majority of high-impact HFrEF RCTs, with no change in temporal trends between 2000 and 2019. Trial characteristics and gender of trial leaders were associated with under-enrolment.
Sex Differences in Faculty Rank Among Academic Surgeons in the United States in 2014. Open PDF
(2018)
Blumenthal, Daniel M.
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Bergmark, Regan W.
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Raol, Nikhila
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Bohnen, Jordan D.
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Eloy, Jean Anderson
OBJECTIVE: The aim of this study was to evaluate sex differences in full professorship among a comprehensive, contemporary cohort of US academic surgeons. SUMMARY OF BACKGROUND DATA: Previous work demonstrates that women are less likely than men to be full professors in academic medicine, and in certain surgical subspecialties. Whether sex differences in academic rank exist across all surgical fields, and after adjustment for confounders, is not known. METHODS: A comprehensive list of surgeons with faculty appointments at US medical schools in 2014 was obtained from Association of American Medical Colleges (AAMC) faculty roster and linked to a comprehensive physician database from Doximity, an online physician networking website, which contained the following data for all physicians: sex, age, years since residency, publication number (total and first/last author), clinical trials participation, National Institutes of Health grants, and surgical subspecialty. A 20% sample of 2013 Medicare payments for care was added to this dataset. Multivariable regression models were used to estimate sex differences in full professorship, adjusting for these variables and medical school-specific fixed effects. RESULTS: Among 11,549 surgeon faculty at US medical schools in 2014, 1692 (14.7%) were women. Women comprised 19.4% of assistant professors (1072/5538), 13.8% of associate professors (404/2931), and 7.0% of full professors (216/3080). After multivariable analysis, women were less likely to be full professors than men (adjusted odds ratio: 0.76, 95% confidence interval: 0.6-0.9). CONCLUSION: Among surgical faculty at US medical schools in 2014, women were less likely than men to be full professors after adjustment for multiple factors known to impact faculty rank.

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