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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,
    Gender Trends in Academic Radiology Publication in the United States Revisited Open PDF 
    (2018)
    O'Connor, Erin E.
    ;
    Chen, Pauline
    ;
    Weston, Brian
    ;
    Anderson, Redmond
    ;
    Zeffiro, Timothy
    RATIONALE AND OBJECTIVES: Although substantial increases in publications by female academic radiologists have appeared over the last several decades, it is possible that the rate of increase is decreasing. We examined temporal trends in gender composition for full-time radiology faculty, radiology residents, and medical students over a 46-year period. METHODS: We examined authorship gender trends to determine if the increases in female authorship seen since 1970 have been sustained in recent years and whether female radiologists continue to publish in proportion to their numbers in academic departments. Original articles for selected years in Radiology and in the American Journal of Roentgenology between 1970 and 2016 were examined to determine the gender of first, corresponding, and last authors. Generalized linear models evaluated (1) changes in proportions of female authorship over time and (2) associations between proportions of female authorship and female radiology faculty representation. RESULTS: While linear increases in first, corresponding, and senior authorships were observed for female radiologists from 1970 to 2000, the rate of increase in female first and corresponding authorships then changed, with the slope of the first author relationship decreasing from 0.81 to 0.34, corresponding to 47% fewer female first authors added per year. In contrast, the proportion of female last authorship continued to increase at the same rate. The proportion of female first authorship was linearly related to the proportion of female radiology faculty from 1970 to 2016. CONCLUSIONS: Annual increases in first author academic productivity of female radiologists have lessened in the past 16 years, possibly related to reductions in the growth of female radiology faculty and trainees. As mixed, compared to homogeneous gender, authorship teams are associated with more citations, efforts to encourage more women to pursue careers in academic radiology could benefit the radiology research community.
  • Item type:Publication,
    Revisiting the Gender Gap in Orthopaedic Surgery: Investigating the Relationship Between Orthopaedic Surgery Female Faculty and Female Residency Applicants. Open PDF 
    (2019)
    Munger, Alana M.
    ;
    Heckmann, Nathanael
    ;
    McKnight, Braden
    ;
    Dusch, Marie N.
    ;
    Hatch, George F. 3rd
    INTRODUCTION: Although women now constitute approximately half of all graduating medical students, orthopaedic surgery continues to lag behind in its ability to recruit female applicants. One hypothesis for this discrepancy is the lack of female faculty mentors at academic institutions. The three objectives of this study were the following: (1) to quantify the proportion of female orthopaedic surgery residency applicants, (2) to quantify the proportion of female orthopaedic surgery faculty, and (3) to investigate the relationship between female orthopaedic surgery faculty at an academic institution and the corresponding number of female orthopaedic surgery residency applicants. METHODS: Data from the Association of American Medical Colleges from 2005 to 2014 were used to calculate the number of medical school graduates, the number of orthopaedic surgery residency applicants, and the number of orthopaedic full-time faculty in the United States. Institutions were excluded if they had incomplete data. A Spearman rank correlation was used to assess for a correlation between the 9-year total number of female orthopaedic surgery applicants and the average number of female orthopaedic surgery faculty members. RESULTS: A total of 101 U.S. medical schools were included in the final analysis. During the period examined, women accounted for 48.7% of medical school graduates, 14.9% of orthopaedic surgery applicants, and 13.2% of full-time orthopaedic surgery faculty. The percentage of female residency applicants increased from 13.91% in 2005 to 2006 to 16.02% in 2013 to 2014 while the percentage of female faculty increased from 12.26% in 2005 to 2006 to 15.79% in 2013 to 2014. No correlation was found between the average number of female orthopaedic surgery faculty at an institution and the total number of female orthopaedic surgery applicants from that institution during the study period examined (Rho, 0.0176; P = 0.5957). CONCLUSIONS: The data presented in this study failed to demonstrate a relationship between the number of female faculty and the number of women who apply into orthopaedic surgery, which highlights the complex nature of this issue. More research is needed to examine factors influencing the recruitment of female medical students.
  • 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.
  • Item type:Publication,
    A gender gap in the next generation of physician-scientists: Medical student interest and participation in research Open PDF 
    (BMJ Publishing Group, 2002)
    Guelich, J.M.
    ;
    Singer, B.H.
    ;
    Castro, M.C.
    ;
    Rosenberg, L.E.
    Background: For 2 decades, the number of physician-scientists has not kept pace with the overall growth of the medical research community. Concomitantly, the number of women entering medical schools has increased markedly. We have explored the effect of the changing gender composition of medical schools on the present and future pipeline of young physician-scientists. Methods: We analyzed data obtained from the Association of American Medical Colleges, the National Institutes of Health, and the Howard Hughes Medical Institute pertaining to the expressed research intentions or research participation of male and female medical students in the United States. Results: A statistically significant decline in the percentage of matriculating and graduating medical students-both men and women-who expressed strong research career intentions occurred during the decade between 1987 and 1997. Moreover, matriculating and graduating women were significantly less likely than men to indicate strong research career intentions. Each of these trends has been observed for medical schools overall and for research-intensive ones. Cohort data obtained by tracking individuals from matriculation to graduation revealed that women who expressed strong research career intentions upon matriculation were more likely than men to decrease their research career intentions during medical school. Medical student participation in research supported the gender gap identified by assessing research intentions. Female medical student participation in the Medical Scientist Training Program and the Howard Hughes Medical Institute/National Institutes of Health-sponsored Cloisters Program has increased but lags far behind the growth in the female population in medical schools. Conclusion: Three worrisome trends in the research career intentions and participation of the nation's medical students (a decade-long decline for both men and women, a large and persistent gender gap, and a negative effect of the medical school experience for women) presage a further decline in the physician-scientist pipeline unless they are reversed promptly and decisively.