Women's Experiences of Promotion and Tenure in Academic Medicine and Potential Implications for Gender Disparities in Career Advancement: A Qualitative Analysis

Gender and Pathways to Leadership in Academic Anesthesiology: A Qualitative Content Analysis of US Chairpersons' Curricula Vitae

BACKGROUND

Women are underrepresented in medicine and academic anesthesiology, and especially in leadership positions. We sought to characterize career achievement milestones of female versus male academic anesthesiology chairs to understand possible gender-related differences in pathways to leadership.

METHODS

We conducted a retrospective observational cross-sectional analysis. In November 2019, curricula vitae (CVs) were requested from then-current members of the US Association of Academic Anesthesiology Chairs. Data reflecting accomplishments up to the time of chair appointment were systematically extracted from CVs and analyzed using a mixed methods approach with qualitative content analysis supplemented by descriptive statistics and bivariate statistical testing. Missing data were not imputed.

RESULTS

Seventy-two CVs were received from eligible individuals (response rate 67.3%). The respondent sample was 12.5% women (n = 9), 87.5% men (n = 63), and no transgender or nonbinary people; this is similar to the known gender balance in anesthesiology chairs in the United States. No statistically significant differences in objective markers of academic achievement at the time of chair appointment were evident for female versus male chairs, including time elapsed between the first faculty appointment and assumption of the chair role (median 25 vs 18 years, P = .06), number of publications at the time the chair was assumed (101 vs 69, P = .28), or proportion who had ever held a National Institutes of Health (NIH) grant as principal investigator (44.4% vs 25.4%, 0.25). Four phenotypes of career paths were discernible in the data: the clinician-administrator, the educator, the investigator, and the well-rounded scholar; these did not differ by gender.

CONCLUSIONS

Female chairpersons who were members of the Association of Academic Anesthesiology Chairs in the United States demonstrated similar patterns of academic achievement as compared to male chairpersons at the time the position of chair was assumed, suggesting that they were equally qualified for the role as compared to men. Four patterns of career achievements were evident in the chairperson group, suggesting multiple viable pathways to this leadership position.

Faculty Tenure in US Academic Medical Institutions: A Critical Review of Controversy and Debate

For over a century, tenure has been a foundational tenet in American academic institutions, being synonymous with the concept of academic freedom. This concept has been extrapolated to US Academic Medical Institutions (AMIs) in multiple domains including teaching and research, sharing opinions as private citizens and on matters of institutional governance as well as providing clinicians, educators, scientists, and scholars opportunities for secure employment. In recent decades, however, there has been a steady erosion of the tenure system in US AMIs, and constituents suggest that this archaic construct would benefit from reform or even its complete abolition. The present treatise offers a historical perspective on the tenure system in AMIs, reviews the enthusiastic debate and controversies including the concomitant advantages, disadvantages, challenges, and the underlying reasons for its decline over the last few decades, and expounds on the ramifications of such trends. This exposition also discusses alternatives and reform to the tenure system which, if implemented, would still guarantee freedom in academic medicine.

The impostor phenomenon among surgeons and surgeons in training: a scoping review

BACKGROUND

The impostor phenomenon (IP), is a condition in which people think they are incapable of success and tend to attribute their success to external causes such as luck, error, or knowing the appropriate individuals. It has been confirmed as a contributor to burnout for practicing physicians, residents, and medical students. The purpose of this scoping review is to describe the prevalence and scope of IP among surgeons and surgeons in training, in order to determine gaps that can be addressed in future research.

METHODS

Searches were conducted in the following databases: Embase, PubMed, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, Web of Science, PsycINFO, Google Scholar, and ProQuest from inception to 30 June 2024. Two investigators independently assessed the articles based on the inclusion and exclusion criteria. All titles and abstracts meeting the inclusion criteria were carefully reviewed for the full text. The individual screening results were compared, and any discrepancies were discussed with a third investigator and a final consensus for further analysis.

RESULTS

The Clance Impostor Phenomenon Scale (CIPS) was used to assess the prevalence in the included studies. The prevalence of IP among surgeons and surgeons in training ranged from 27.5 to 100%. Women were more prone to suffer from IP when compared to their male counterparts. Most literature also showed that female surgeons reported statistically higher in IP scores than males. Level of education and academic achievements were also associated with IP.

CONCLUSIONS

This scoping review identified the published literature on IP among surgeons and surgeons in training and focused on the existing research objects to discover the gaps in the current research. Future directions may focus on early interventions aimed at identifying and managing IP.

The Only Constant is Change: A Longitudinal Analysis of Women's Representation Across American Pediatric Surgical Association (APSA) Committee Leadership

BACKGROUND

Women have historically been underrepresented in surgical leadership and in specialty organizations. This study longitudinally examines representation of women across committee leadership within the American Pediatric Surgical Association (APSA).

METHODS

Annual APSA committee chair and vice-chair rosters (2003-2023) were obtained. If not self-reported in the membership roster, gender was classified based upon review of publicly available data. Proportions of women who served as chairs and vice-chairs were quantified by committee and by year.

RESULTS

Overall, the proportion of women serving as APSA committee chairs and vice-chairs increased from 11% to 48% during the study period (p = 0.001). In examining each position, the proportion of women chairs increased from 12% to 40% (p = 0.042), while women vice-chairs increased from 10% to 58% (p = 0.009). The committees with the highest cumulative proportion of women chairs were Benjy Brooks (100%), Diversity Equity & Inclusion (100%), Finance (100%), Global Pediatric Surgery (67%), and Wellness (67%). Four committees- Trauma, Access to Surgery for Kids, Practice, and Professional Development - were not led by a woman chair in the entire study period. Additionally, five committees that traditionally have had significant impact on organizational workflow and agendas all had cumulative proportions of women chairs of less than 50% - Education (33%), Publications (28.6%), Outcomes (19%), Surgical Quality & Safety (18.8%) and Program (9.5%).

CONCLUSION

These results demonstrate encouraging trends in the gender diversity of APSA leadership. However, this progress does not appear to be evenly distributed; leadership of key committees continues to lack substantial women's representation.

LEVEL OF EVIDENCE

III.

"Equal pay for equal work": Exploring the gender pay gap in radiology

Among the enduring disparities confronting the United States is the gender pay gap. Women experience lower wages than their male peers in nearly every major occupation, including medicine, and this further underscores how gender-based inequities within the practice of radiology are wide regarding pay, promotion opportunities, and leadership representation in diagnostic and interventional radiology. This review article analyzes the historical and current data for the gender pay gap in radiology relative to other medical specialties, as well as the influence of other intersecting factors, such as race or ethnicity. The manuscript identifies key root causes of the pay discrepancies, including underrepresentation of women in leadership positions, deeply held biases, stereotypes, and inequities in promotion practices. Several strategies have been explored to tackle these challenges, encompassing enhancing pay transparency, reinforcing the commitments of institutions to pay equity, and advocating for systemic changes.

Examining Gender Representation in US News and World Report Top 25 Urology Departments: Female Faculty Hold Lower Professorial Levels and Publication Rates Than Male Counterparts

OBJECTIVES

To examine female representation in US News and World Report (USNWR) top 25 US Urology departments and identify trends of female representation in institutional roles.

METHODS

Using the 2022 USNWR, we collected data from each institution's websites along with a compared geographically local cohort to evaluate the presence of female residents, female attendings, and professorial levels. First or last author faculty publications numbers were found using PubMed and Scopus in fiscal year 2022.

RESULTS

The top 25 institutions averaged ~32.3% female residents and 18.7% female attendings, which was not significantly different from the comparison cohort. Of the total publications of fiscal year 2022, female attendings contributed ~14% (p < 0.001), also not significantly different from the comparison cohort. Only 20.4% of listed female attendings in top 25 programs are full Professors, compared to 41.1% of the listed men (p < 0.05). The most common level of female professorship is Assistant Professor (53.4%). Level of female professorship between cohort was significantly different, with female urologists more likely to hold a title of full Professor in the top 25 cohort compared to the nontop 25 cohort regardless of similar publication output (p < 0.05).

CONCLUSIONS

Female faculty in Urology continue to be underrepresented in the top Urology departments, with significant difference in equitable female professorship appointments between top 25 and nontop 25 departments. Future directions include examining the impact of early mentorship and sponsorship on representation over time.

Utilizing Relative Citation Ratio to Compare Academic Productivity by Gender in Plastic Surgery

INTRODUCTION

The relative citation ratio (RCR) is a bibliometric index utilized to assess research productivity. Mean relative citation ratio (m-RCR) and weighted relative citation ratio (w-RCR) can be utilized to assess individual research quality as well as career-long productivity, respectively. We sought to determine differences in academic productivity between genders and identify demographic variables associated with increased academic productivity.

METHODS

A list of Plastic and Reconstructive Surgery residency programs was compiled utilizing the American Council of Academic Plastic Surgeons website. Each program department's website was utilized to generate a list of practicing surgeons and respective demographic information. Both mean and weighted RCR were obtained using the iCite, a National Institutes of Health bibliometric tool. Surgeons were excluded if any demographic or RCR data was not accessible. Chi-squared test, Mann-Whitney U test, Kruskal-Wallis test, and multivariable linear regressions were performed.

RESULTS

A total of 785 academic plastic surgeons met the criteria and were included in the analysis, 186 of whom were women and 599 men. Both academic rank and model of residency training were significantly associated with gender in chi-squared analysis (P < 0.05). Mean relative citation ratio was higher among men in departments. Mean w-RCR was higher among men of assistant professor status, chief/chairperson status, integrated model of residency training, faculty size ≥six and in departments and divisions. Academic rank and faculty size were associated with higher w-RCR upon multivariable linear regression.

CONCLUSIONS

Although differences exist in mean w-RCR between men and women in plastic surgery, gender is not a predictor of increased academic productivity. RCR is an accurate means of assessing gender differences in academic productivity as it comprehensively considers both quality and quantity of research and may be superior to other, older bibliometric indices.

Inferring gender from first names: Comparing the accuracy of Genderize, Gender API, and the gender R package on authors of diverse nationality

Meta-researchers commonly leverage tools that infer gender from first names, especially when studying gender disparities. However, tools vary in their accuracy, ease of use, and cost. The objective of this study was to compare the accuracy and cost of the commercial software Genderize and Gender API, and the open-source gender R package. Differences in binary gender prediction accuracy between the three services were evaluated. Gender prediction accuracy was tested on a multi-national dataset of 32,968 gender-labeled clinical trial authors. Additionally, two datasets from previous studies with 5779 and 6131 names, respectively, were re-evaluated with modern implementations of Genderize and Gender API. The gender inference accuracy of Genderize and Gender API were compared, both with and without supplying trialists' country of origin in the API call. The accuracy of the gender R package was only evaluated without supplying countries of origin. The accuracy of Genderize, Gender API, and the gender R package were defined as the percentage of correct gender predictions. Accuracy differences between methods were evaluated using McNemar's test. Genderize and Gender API demonstrated 96.6% and 96.1% accuracy, respectively, when countries of origin were not supplied in the API calls. Genderize and Gender API achieved the highest accuracy when predicting the gender of German authors with accuracies greater than 98%. Genderize and Gender API were least accurate with South Korean, Chinese, Singaporean, and Taiwanese authors, demonstrating below 82% accuracy. Genderize can provide similar accuracy to Gender API while being 4.85x less expensive. The gender R package achieved below 86% accuracy on the full dataset. In the replication studies, Genderize and gender API demonstrated better performance than in the original publications. Our results indicate that Genderize and Gender API achieve similar accuracy on a multinational dataset. The gender R package is uniformly less accurate than Genderize and Gender API.

You Can't Be What You Can't See: The Progression of Women in Otolaryngology-Head and Neck Surgery

Objective: To examine trends in the gender composition of residents and faculty in Otolaryngology-Head and Neck Surgery residency programs in the United States and to investigate the correlation between women's representation in leadership positions and the proportion of women faculty and residents. Methods: A literature review was first performed to analyze trends in the gender composition of residents and faculty in Otolaryngology-Head and Neck Surgery (OHNS) residency programs. Current residency programs were then identified using the Electronic Residency Application Service 2023 Participating Specialties and Programs website. The following data was collected from each program website: gender of associated medical school dean, gender of department chair, gender of residency program director, and total number and gender of fellowship directors, faculty, and residents. Wilcoxon rank sum test and Fischer's exact test were used to analyze relationships between the number of women in leadership positions and the proportion of women faculty and residents. Results: An increase in the number of women chairs, residency program directors, residents, and faculty over the past decade is documented across published literature. One hundred twenty-three current academic residency programs were identified. Women accounted for 42%, 30%, 27%, and 8% of current residents, residency program directors, faculty, and department chairs, respectively. Department chair gender was significantly correlated with number of women faculty (P = .01). Any women in a leadership position were correlated with a statistically significant increase in median percent of women faculty (P = .006). Conclusion: Further understanding of how the mentorship of women promotes gender equity is necessary to promote gender diversity in OHNS.

Where are the women in spine surgery? A demographic study of the range of gender disparity in academic spine hospitals in the United States

BACKGROUND CONTEXT

There is a paucity of women in the field of academic spine surgery. In 2022, 20% of orthopedic surgery residents and 24% of neurosurgery residents were women, the lowest and third lowest of all medical specialties respectively. There exists a significant discrepancy in the number of women employed as adult spine surgeons at academic hospitals.

PURPOSE

To quantify the number of female attending spine surgeons at academic hospitals and identify institutions that based on faculty diversity are demonstrating inequity.

STUDY DESIGN

Descriptive.

METHODS

Demographic data was collected utilizing the 2023 to 2024 NASS Fellowship Directory in combination with publicly available information on faculty profiles from January 1, 2024 to January 30, 2024. Data collected included gender and training institutions (medical school, residency, and fellowship). Adult spine fellowship-trained orthopedic surgeons and neurosurgeons who perform adult spine surgery were included.

RESULTS

There are 943 neurosurgical and orthopedic adult spine surgeons employed at 73 academic hospitals. The breakdown of orthopedic spine surgeons versus neurosurgeons is roughly equivalent, at 453 and 490, respectively. Among orthopedic spine surgeons, 19 out of 453 (4%) are female. Among neurosurgeons, 44 out of 490 (9%) are female. The number of female academic spine surgeons who are neurosurgeons is more than double that of orthopedic surgeons. Twelve out of the 19 (63%) female orthopedic spine surgeons, and 16 out of the 44 (36%) female neurosurgeons are employed at the program where they trained. Out of 45 larger academic spine hospitals with >10 faculty members, there were 15 without any female faculty. There is 1 academic hospital with ≥ 20 spine faculty, and zero women.

CONCLUSION

The number of women pursuing academic spine careers continues to lag behind present day demographics of training programs. These continued trends should prompt both individuals and institutions to support progress in gender disparity research.

Gender diversity in pediatric surgery: academic ranks and scholarly productivity amongst pediatric surgeons

Purpose

Despite a growing number of women entering medical school, a small proportion of women pursue surgical specialties, including pediatric surgery. This multi-center study assesses gender-based differences in measures of scholarly productivity and distribution of faculty positions.

Methods

This is a retrospective web-based study of all pediatric surgeons at twelve large institutions across the United States. Data published by the American Association of Medical Colleges was compiled and analyzed to understand the gender distributions of medical students, general surgery residents, and pediatric surgery fellows. P-values were calculated using two-sided Student's independent t-tests and chi-squared tests.

Results

There have been a growing number of women applying into pediatric surgery, but the proportion of women matriculating into these fellowships is not concordant. Women are still underrepresented (28%) amongst the pediatric surgeon workforce. A total of 111 pediatric surgeons were identified for this study, which included 31 women (28%) and 80 males (72%). There was a significant difference in the distribution across academic ranks between genders (p < 0.001). Women had significantly fewer publications per year after residency, fewer total publications, and a lower h-index in comparison to men (p < .001, p = .005, p = .002, respectively).

Conclusions

Women are not only underrepresented in pediatric surgery, but there are also significant differences in the distribution of faculty positions and scholarly productivity when comparing men and women. There is a pressing need to improve gender diversity and identify barriers that may prevent women from advancing to leadership positions and achieving professional success.

Put Yourself out There! A Strategy for Effective Self-Promotion in Academic Medicine

Introduction

Trainees and faculty in academic medicine often struggle with self-promotion. Barriers may be more formidable for women and other groups underrepresented in medicine. Experience-based stories illustrating personal strengths are preferable when engaging in self-promotion activities.

Methods

We developed a 90- to 120-minute workshop utilizing approaches such as iterative journaling and peer discussion to teach the development of problem-action-result (PAR) stories for self-promotion efforts in interviews and written applications to new positions. Participants provided Likert-scale (1 = strongly disagree, 5 = strongly agree) and free-response evaluations, which we analyzed for workshop strengths and areas for improvement.

Results

We presented the workshop in person to 28 pediatric residents and subsequently to 22 residents, fellows, and faculty at an in-person national meeting. Sixty-one percent of the resident group and 100% of the national workshop group completed the evaluation. Both groups reported high satisfaction with the workshop's format (M = 4.7) and content (M = 4.7) and indicated intention to use the skills learned (M = 4.7). Strengths included the PAR format, interactivity, journaling, opportunity for reflection, and tips for interviewing and writing. Areas to improve included offering the workshop earlier in the academic year and providing more written examples of PAR stories.

Discussion

This workshop used strategies of personal reflection, journaling, and peer feedback to help participants understand behavior-based recruiting practices and the PAR framework as a strategy for successful self-promotion. Learners can use these strategies to develop greater confidence and efficacy and to address barriers to effective self-promotion they encounter.

Changes in self-confidence in professional, personal, and scientific skills by gender during physician-scientist training at the University of Pittsburgh

Introduction

Persistence in physician-scientist careers has been suboptimal, particularly among women. There is a gender gap in self-confidence in medicine. We measured the impact of our physician-scientist training programs on trainee's confidence in professional, personal, and scientific competencies, using a survey measuring self-rated confidence in 36 competencies across two timepoints.

Methods

Results were analyzed for the full survey and for thematic subscales identified through exploratory factor analysis (EFA). A mixed effects linear model and a difference in differences (DID) design were used to assess the differential impact of the programing by gender and career level.

Results

Analysis included 100 MD-PhD or MD-only medical student or resident/fellow trainees enrolled between 2020 and 2023. Five subscales were identified through EFA; career sustainability, science productivity, grant management, goal setting, and goal alignment (Cronbach's alpha 0.85-0.94). Overall, mean scores increased significantly for all five subscales. Women significantly increased their confidence levels in all five areas, whereas men increased only in science productivity and grant management. Mixed effects models showed significant increases over time for women compared to men in career sustainability and goal alignment. Residents and fellows had greater increases than medical students across all subscales.

Conclusion

Physician-scientist trainees fellows increased their confidence in personal, professional, and scientific skills during training. Training had a greater impact on women than men in building confidence in sustaining careers and aligning their goals with professional and institutional priorities. The magnitude of increased confidence among residents and fellows exceeded that in medical students.

Unconscious bias in speaker introductions at a national vascular surgery meeting: The impact of rank, race and gender

OBJECTIVES

Unconscious bias can impact manner of speaker introductions in formal academic settings. We examined speaker introductions at the Society of Vascular Surgeons Annual Meeting to determine factors associated with non-professional address.

METHODS

We examined speaker introductions from the 2019 SVS Vascular Annual Meeting. Professional title with either full name or last name was considered professional address. Speaker and moderator demographics were collected. Univariate and multivariate logistic regression analyses were performed to identify associations between introduction and speaker and moderator characteristics.

RESULTS

336 talks met inclusion criteria. Both speakers and moderators were more likely to be white (63.4 ​% and 65.8 ​%,p ​= ​0.92), man (75.6 ​% and 74.4 ​%,p ​= ​0.82) and full professor rank (34.5 ​% and 42.3 ​%, p ​< ​0.001). On multivariable regression, non-professional address was associated with speaker rank of trainee (OR 3.13, p ​= ​0.05) and when moderator was white (OR 2.42, p ​= ​0.03).

CONCLUSIONS

This study emphasizes the potential negative impact of unconscious bias at a national meeting for vascular surgeons and the need to mitigate this effect at the organization level.

The Female Global Scholars Program: A mixed-methods evaluation of a novel intervention to promote the retention and advancement of women in global health research

Fewer than 25% of global health leadership positions worldwide are held by women, adversely impacting women's health and widening gendered health disparities. The Female Global Scholars (FGS) Program, established in 2018 at Weill Cornell Medicine, is a two-year hybrid training and peer-mentorship program that promotes the retention and advancement of early-career female investigators conducting health research in low- and middle-income countries (LMICs). The purpose of this study is to determine the impact of the FGS Program on individual career advancement, academic productivity, and research self-efficacy. This mixed-methods study followed an explanatory sequential design. Participants completed an electronic survey collecting information on demographics, academic milestones, and research skill competency. Survey data were descriptively analyzed using R (Version 1.4.1106). In-depth interviews explored perceptions of the impact of the FGS Program on career development. The authors independently reviewed and thematically analyzed de-identified transcripts using NVivo (Version 13). In June 2022, twelve participants completed the survey. The median age was 40 years; 90% carried an MD, PhD, or other post-graduate degree. Since joining the FGS Program, respondents achieved a combined total of eight awarded grants, five academic promotions, 12 oral scientific presentations and 35 first-author peer-reviewed publications. Thematic analysis identified four overarching themes: gaining confidence through mimicry; improved self-efficacy to address gendered challenges; real-world application of scientific and career development skills; and building multi-disciplinary communities in a protected female-only space. We demonstrate that this low-cost training and mentorship program successfully addresses critical barriers that impede women's advancement in global health research. Our data may inform the adaptation of this initiative across other academic institutions.

Career trajectories of MD-PhD physician scientists: The loss of women investigators

Advances in biomedical research require a robust physician scientist workforce. Despite being equally successful at securing early career awards from the NIH as men, women MD-PhD physician scientists are less likely to serve as principal investigators on mid- and later careers awards. Here, we discuss the causes of gender disparities in academic medicine, the implications of losing highly trained women physician scientists, and the institutional and systemic changes needed to sustain this pool of talented investigators.

Promotion Criteria for Medical Educators: Are We Climbing a Ladder with Invisible Rungs?

OBJECTIVE

In 2006 the Association of American Medical Colleges recommended standardization of documentation of the contributions of medical educators and guidelines for their academic promotion. The authors characterized current United States (US) medical school promotion guidelines for medical educators.

METHODS

Authors collected publicly available data from medical school promotion websites from March through July 2022 after determining categories by traditional-set domains as well as peer-reviewed standards. Extracted data were analyzed using descriptive and inferential statistics, and frequencies were calculated for nominal and categorical data.

RESULTS

Of 155 medical schools identified, promotion criteria were publicly available for 143 (92%) schools. Ninety-one (64%) schools identified a distinct educator track. Of those with a defined educator track, 44 (48%) schools consider workshops or other media when evaluating candidates for promotion, and only 52 (57%) of schools with a specified educational track require additional documentation of teaching or education as part of their promotion process. Notably, 34 (37%) of the 91 schools with an educator track specifically require an Educational Portfolio, compared to 27 (52%) of the 52 schools that do not have a specific educator track for promotion.

CONCLUSION

This study describes the current lack of clarity and consistency of the promotion criteria for medical educators and indicates that the guidelines proposed by the Association of American Medical Colleges over 15 years ago have not been widely adopted. These data amplify previous calls for a more objective set of criteria for evaluating and recognizing the contributions of medical educators.

Gender differences in scholarly productivity of early-career transfusion medicine physicians

BACKGROUND AND OBJECTIVES

Promotion in academic medicine requires evidence of the creation and dissemination of scholarly output, primarily through peer-reviewed publications. Studies demonstrate that scholarly activity and impact are lower for women physicians than for men physicians, especially during the early stages of their academic careers. This report reviewed physicians' academic productivity after passing their Blood Banking/Transfusion Medicine (BBTM) subspecialty exam to determine if gender discrepancies exist.

METHODS

A cross-sectional analysis was designed to determine trends in scholarly activity for women physicians versus men physicians in BBTM. Indexed publications were reviewed using iCite, the National Institutes of Health (NIH) Office of Portfolio Analysis tool, from 1 January 2017 to 1 December 2021, for BBTM examinees who passed the sub-speciality fellowship exam in the years 2016 through 2018.

RESULTS

Overall, women physicians had statistically significant fewer total career publications (median 6 vs. 9 cumulative papers, p = 0.03). Women published at a lower rate after passing BBTM boards, which was not statistically significant (0.7 vs. 1.3 publications per year). Other statistically significant findings include fewer early-career BBTM women physicians were first authors compared with men physicians (p = 0.03) and impact as assessed by relative citation ratio was higher for men (p = 0.01).

CONCLUSIONS

This study demonstrates that there are gender differences in scholarly productivity and impact on early-career BBTM physicians. Given that this cohort of BBTM physicians are early-career professionals, the significant difference in first authorship publications between women and men physicians is especially concerning. Publication metrics should be followed to ensure equitable research environments for early-career BBTM physicians.

Professional Experiences and Career Trajectories of Mid- to Senior-Career Women Clinician-Scientists: A Qualitative Study

Importance

Despite increasing evidence and recognition of persistent gender disparities in academic medicine, qualitative data detailing the association of gender-based experiences with career progression remain sparse, particularly at the mid- to senior-career stage.

Objective

To investigate the role gender has played in everyday professional experiences of mid- to senior-career women clinician-scientists and their perceptions of gender-related barriers experienced across their careers.

Design, Setting, and Participants

In this qualitative study, a total of 60 of 159 invited clinician-scientists who received National Institutes of Health K08 or K23 awards between 2006 and 2009 and responded to a survey in 2021 agreed to participate. Invitees were selected using random, purposive sampling to support sample heterogeneity. Semistructured in-depth interviews were conducted January to May 2022. For this study, interviews from 31 women were analyzed using the framework approach to thematic analysis. Data analyses were performed between August and October 2023.

Main Outcomes and Measures

Descriptive themes of participant experiences of gender and gender-based barriers in academic medicine.

Results

A total of 31 women clinician-scientists (8 identifying as Asian [25.8%], 14 identifying as White [45.2%], and 9 identifying as members of a minority group underrepresented in medicine [29.0%]; 14 aged 40-49 years [45.2%] and 14 aged 50-59 years [45.2%]) were included. Among them, 17 participants (54.8%) had children who required adult supervision or care, 7 participants (22.6%) had children who did not require supervision or care, and 6 participants (19.4%) did not have children. There were 4 dominant themes identified within participant experiences in academic medicine: the mental burden of gendered expectations at work and home, inequitable treatment of women in bureaucratic processes, subtle and less subtle professional exclusion of women, and value of communities built on shared identities, experiences, and solidarity.

Conclusions and Relevance

This study found that women perceived the institution of academic medicine as a male-centric system misaligned with the needs of women, with associated feelings of exclusion, disillusionment, and loss of trust in their institutions. Findings suggest that the confluence of domestic obligations and unaccommodating institutional environments may make it difficult for women clinician-scientists to achieve established timelines of career progression and productivity; these findings may have long-term implications for the well-being and retention of women in academic medicine.

Reflect, Inspire, Strengthen, and Empower 2.0 Program: Advancing Careers and Leadership for Women Physician Staff in an Academic Institution

Background

To study the effects of the Reflect, Inspire, Strengthen, and Empower (RISE) 2.0 Program designed for professional development of women staff. Topics included emotional intelligence, appreciative coaching, resilience, and strategic career development.

Methods

The RISE 2.0 program was held between September 2020 and February 2021. After each session, program satisfaction surveys were sent to evaluate whether session objectives were met. Professional network, professional mentor, and professional goals were surveyed at the introductory session and at 1 month after the program ended. Survey data about leadership self-efficacy, motivation to lead, and well-being were collected at the introductory session (baseline) and at months 1 and 3 to evaluate the sustainability of program outcomes.

Results

Of the 71 notified, 41 (58%) committed to the program. Results increased for having a robust professional network from baseline to month 1 for very good (7.3% to 13.3%) and excellent (19.5% to 40%). Those who responded favorably to setting and attaining ambitious goals increased from 78.1% to 93.3%. For leadership self-efficacy, all except 2 respondents reported an increase in ratings from baseline to month 3. Motivation to lead changed only slightly. Well-being scores fluctuated as affected by daily needs and fulfillment. For 10 of 15 respondents, well-being increased overall from baseline to month 1 or 3, from month 1 to 3.

Conclusions

Based on participant evaluations and feedback, the RISE 2.0 program received positive responses overall in achieving its learning goals. The program exhibited promise in fostering career advancement and leadership development, particularly when assessed using indicators predictive of successful leadership, such as self-efficacy, motivation to lead, and overall wellbeing.

Gender trends in dentistry: Dental faculty and academic leadership

OBJECTIVES

Gender equality in the healthcare workforce has been a topic of discourse for many decades. In dental academia, women's representation of enrolled students and faculty has risen consistently since the 1980s. However, women in faculty leadership positions may still be lagging when compared to men. The purpose of this study was to evaluate the number of women who occupy the upper echelons of academic rank and title by analyzing cross-referenced data from the American Dental Association and the American Dental Education Association on women dental school graduates in relation to academic appointments.

METHODS

Gender distribution in rank, title, and appointments in the decade from 2011 to 2019, as well as percentage of women graduates over the same period, were collected for descriptive statistics. Multiple linear regression analysis, Cochran Armitage, and chi-square tests were conducted to examine trends over the years and to determine significant differences in overall percentages (p < 0.05).

RESULTS

The total women faculty percentages ranged from 36% to 40%. While the lower-level rank of instructor retained a higher representation of women (56%-65%), the higher rank of professor had disproportionately lower women percentages (18%-26%). Graduates, full-time faculty, lower-level academic ranks, and higher-level academic ranks for women followed similar upward trends that were statistically significant (p < 0.05). When comparing the different groups against each other, the annual increase in women DMD/DDS graduate percentage was higher than women full-time faculty (0.28%), instructor rank (0.92%), professor rank (0.50%), and department chair appointments (0.49%).

CONCLUSIONS

Our data show that women are still underrepresented at higher academic ranks. However, the upward trends for professors, assistant deans, and program chairs suggest that in recent years, more women faculty may have been encouraged, mentored, or offered higher administrative positions in academic institutions.

Authorship Trends and Disparities in Cardiothoracic Surgery

BACKGROUND

Previous investigations have revealed significant gender disparities in the academic arenas of cardiothoracic surgery. However, the status of gender representation in cardiothoracic publications has not been well described. This study aimed to evaluate authorship trends by gender in two high-impact cardiothoracic surgical journals.

METHODS

In this bibliometric analysis, PubMed was searched for articles published in The Annals of Thoracic Surgery and the Journal of Thoracic and Cardiovascular Surgery from 2010 to 2021. The web-based application Genderize.io was used to classify names of first and last authors as men vs women. The Cochran-Armitage trend test and multivariable logistic regression were used to evaluate authorship per year and the association of first and last author gender, respectively.

RESULTS

Among 14,443 articles, 16.7% had women first authors and 8.1% had women last authors. The proportion of articles written by women authors increased, rising from 12.6% to 21.1% (P < .0001) for first and 5.4% to 11.5% (P < .0001) for last authors. Papers written with women as first author were associated with 2.0 higher odds of having a woman as last author (95% CI, 1.7-2.3; P < .0001). The mean number of last author publications was higher for men than for women (2.4 vs 1.7, P < .0001).

CONCLUSIONS

Over the past decade, despite a welcomed increase in women authorship in high-impact journals in cardiothoracic surgery, women represent a small proportion of published authors. Women first authors are more likely to publish with women last authors, demonstrating the impact of same-gender collaborations while emphasizing a need for cross-gender mentorship.

Gender Disparity in Teaching Evaluations of Pediatric Faculty by Residents

OBJECTIVES

Despite their overrepresentation, female physicians continue to have lower rates of promotion compared with male physicians. Teaching evaluations play a role in physician advancement. Few studies have investigated gender disparity in resident evaluations of pediatric faculty. We hypothesized that gender disparities in resident evaluations of faculty exist and vary across subspecialties and primary work environments.

METHODS

Pediatric faculty institution-specific evaluations completed by residents from January 1, 2015, to March 9, 2020, were obtained from a single academic center. Mean ratings of faculty performance were compared by gender using a Wilcoxon 2-sample test.

RESULTS

Fifteen-thousand one-hundred and forty-two evaluations (5091 of male faculty and 10 051 of female faculty) were included. Female faculty were rated higher in overall teaching ability (female = 4.67 versus male = 4.65; P = .004). There was no statistical difference in the mean ratings of male and female faculty in the inpatient setting, whereas outpatient female faculty were rated higher in overall teaching ability (female = 4.79 versus male = 4.73; P = .005). For general pediatric faculty, females received higher ratings for overall teaching ability (female = 4.75 versus male = 4.70; P < .001). By contrast, there was no difference in ratings of subspecialty pediatric faculty.

CONCLUSIONS

Pediatric female faculty were statistically rated higher than male faculty in overall teaching ability, although these findings may not be educationally significant. The difference was driven by evaluations in the outpatient setting and for general pediatricians. This study is one of the first in pediatrics adding to the continued investigation of gender disparities in academic medicine.

Are committee experiences of minoritized family medicine faculty part of the minority tax? a qualitative study

BACKGROUND AND OBJECTIVES

Because much of the work in academic medicine is done by committee, early career URiM faculty, are often asked to serve on multiple committees, including diversity work that may not be recognized as important. They may also be asked to serve on committees to satisfy a diversity "check box," and may be asked more often than their non-URiM peers to serve in this capacity. We sought to describe the committee experiences of early career URiM faculty, hypothesizing that they may see committee service as a minority tax.

METHODS

Participants in the Leadership through Scholarship Fellowship (LTSF) were asked to share their experiences with committee service in their careers after participating in a faculty development discussion. Their responses were analyzed and reported using qualitative, open, axial, and abductive reasoning methods.

RESULTS

Four themes, with eight sub-themes (in parenthesis), emerged from the content analysis of the LTSF fellows responses to the prompt: Time commitment (Timing of committee work and lack of protected time for research and scholarship), URiM Committee service (Expectation that URiM person will serve on committees and consequences for not serving), Mentoring issues (no mentoring regarding committee service, faculty involvement is lacking and the conflicting nature of committee work) and Voice (Lack of voice or acknowledgement).

CONCLUSIONS

Early career URiM faculty reported an expectation of serving on committees and consequences for not serving related to their identity, but other areas of committee service they shared were not connected to their URiM identity. Because most of the experiences were not connected to the LTSF fellows' URiM identity, this group has identified areas of committee service that may affect all early career faculty. More research is necessary to determine how committee service affects URiM and non-URiM faculty in academic family medicine.

"I Came up Short on the Academic Ladder": A Grounded Theory Study of Careerism in Academic Surgery

OBJECTIVE

This study aims to explore the definition of career success in academic surgery.

BACKGROUND

Career success in academic surgery is frequently defined as the achievement of a specific title, from full professor to department chair. This type of definition is convenient and established but potentially incomplete. The business literature has a more nuanced view of the relationship between titles and success, but this relationship has not been studied in medicine.

METHODS

Semi-structured interviews were conducted from May to November 2020. Data were analyzed in an iterative fashion using grounded theory methodology to develop a conceptual model.

RESULTS

We conducted 26 semi-structured interviews with practicing surgeons differing in years of experience; 12 (46%) participants were female, mean age of 48. Participants included 5 chairs of surgery, 6 division chiefs, and 7 past or current presidents of national societies. Four themes emerged on the importance of titles: Some study participants reported that (1) titles are a barometer of success; others argued that (2) titles are not a sufficient metric to define success; (3) titles are a means to an end; and (4) there is a desire to achieve the title of a respected mentor.

CONCLUSIONS

As the definition of career success in academic surgery changes to encompass a broader range of interests and ambitions, the traditional markers of success must come into review. Academic surgeons see the value of titles as a marker of success and as a means to achieving other goals, but overwhelmingly our interviewees felt that titles were a double-edged sword and that a more inclusive definition of academic success was needed.

The Gender Gap in Promotions: Inhibitors and Catalysts, Strategies to Close the Gap

The gender gap is an amalgam of gender disparity issues in the workplace ranging from fewer opportunities to network, decreased funding for research, microaggressions, nebulous promotional criteria and difficulty achieving the perception of professionalism because of inherent gender bias. Contributing home factors include more substantial household duties for women typically, spouses who also have a career, and the inherent delay associated with maternity leave for those who choose to have children. This article subdivides gender disparity that impedes promotion into experiences inside and outside the workplace. Disparities within the workplace are divided into directly quantified versus qualitative differences.

Academic anaesthesiology: a global perspective on training, support, and future development of early career researchers

As anaesthesiologists face increasing clinical demands and a limited and competitive funding environment for academic work, the sustainability of academic anaesthesiologists has never been more tenuous. Yet, the speciality needs academic anaesthesiologists in many roles, extending beyond routine clinical duties. Anaesthesiologist educators, researchers, and administrators are required not only to train future generations but also to lead innovation and expansion of anaesthesiology and related specialities, all to improve patient care. This group of early career researchers with geographically distinct training and practice backgrounds aim to highlight the diversity in clinical and academic training and career development pathways for anaesthesiologists globally. Although multiple routes to success exist, one common thread is the need for consistent support of strong mentors and sponsors. Moreover, to address inequitable opportunities, we emphasise the need for diversity and inclusivity through global collaboration and exchange that aims to improve access to research training and participation. We are optimistic that by focusing on these fundamental principles, we can help build a more resilient and sustainable future for academic anaesthesiologists around the world.

Leadership and Impostor Syndrome in Surgery

BACKGROUND

Impostor syndrome is an internalized sense of incompetence and not belonging. We examined associations between impostor syndrome and holding leadership positions in medicine.

STUDY DESIGN

A cross-sectional survey was distributed to US physicians from June 2021 to December 2021 through medical schools and professional organizations. Differences were tested with the chi-square test and t -test for categorical and continuous variables, respectively. Logistic regression was used to identify factors associated with holding leadership positions and experiencing impostor syndrome.

RESULTS

A total of 2,183 attending and retired physicians were included in the analytic cohort; 1,471 (67.4%) were in leadership roles and 712 (32.6%) were not. After adjustment, male physicians were more likely than women to hold leadership positions (odds ratio 1.4; 95% CI 1.16 to 1.69; p < 0.001). Non-US citizens (permanent resident or visa holder) were less likely to hold leadership positions than US citizens (odds ratio 0.3; 95% CI 0.16 to 0.55; p < 0.001). Having a leadership position was associated with lower odds of impostor syndrome (odds ratio 0.54; 95% CI 0.43 to 0.68; p < 0.001). Female surgeons were more likely to report impostor syndrome compared to male surgeons (90.0% vs 67.7%; p < 0.001), an association that persisted even when female surgeons held leadership roles. Similar trends were appreciated for female and male nonsurgeons. Impostor syndrome rates did not differ by race and ethnicity, including among those underrepresented in medicine, even after adjustment for gender and leadership role.

CONCLUSIONS

Female physicians were more likely to experience impostor syndrome than men, regardless of specialty or leadership role. Although several identity-based gaps persist in leadership, impostor syndrome among racially minoritized groups may not be a significant contributor.

How Do Academic Medicine Pathways Differ for Underrepresented Trainees and Physicians? A Critical Scoping Review

PURPOSE

Academic medicine faces difficulty recruiting and retaining a diverse workforce. The proportion of medical students who are underrepresented in medicine (URiM) is smaller than the proportion of URiM's in the general population, and these numbers worsen with each step up the academic medicine ladder. Previously known as the "leaky pipeline," this phenomenon may be better understood as disparate "pathways with potholes," which acknowledges the different structural barriers that URiM trainees and faculty face in academic medicine. This critical scoping review analyzed current literature to determine what variables contribute to the inequitable "pathways and potholes" URiM physicians experience in academic medicine.

METHOD

The authors combined scoping review methodology with a critical lens. The comprehensive search strategy used terms about academic medicine, underrepresented groups, and leaving academic medical careers. One reviewer conducted screening, full text review, and data extraction while in consultation with members of the research team. Data extraction focused on themes related to pathways and potholes, such as attrition, recruitment, and retention in academic medicine. Themes were iteratively merged, and quality of contribution to the field and literature gaps were noted.

RESULTS

Included papers clustered into attrition, recruitment, and retention. Those pertaining to attrition noted that URiM faculty are less likely to get promoted even when controlling for scholarly output, and a hostile work environment may exacerbate attrition. Recruitment and retention strategies were most effective when multi-pronged approaches changed every step of the recruitment and promotion processes.

CONCLUSIONS

These studies provide examples of various "potholes" that can affect representation in academic medicine of URiM trainees and faculty. However, only a few studies examined the link between isolating and hostile work environments, the so-called "chilly climate," and attrition from academic medicine. Understanding these concepts is key to producing the most effective interventions to improve diversity in medicine.

Workforce Attrition Among Male and Female Physicians Working in US Academic Hospitals, 2014-2019

Importance

Retaining female physicians in the academic health care workforce is necessary to serve the needs of sociodemographically diverse patient populations.

Objective

To investigate differences in rates of leaving academia between male and female physicians.

Design, Setting, and Participants

This cohort study used Care Compare data from the Centers for Medicare & Medicaid Services for all physicians who billed Medicare from teaching hospitals from March 2014 to December 2019, excluding physicians who retired during the study period. Data were analyzed from November 11, 2021, to May 24, 2022.

Exposure

Physician gender.

Main Outcome and Measures

The primary outcome was leaving academia, which was defined as not billing Medicare from a teaching hospital for more than 1 year. Multivariable logistic regression was conducted adjusting for physician characteristics and region of the country.

Results

There were 294 963 physicians analyzed (69.5% male). The overall attrition rate from academia was 34.2% after 5 years (38.3% for female physicians and 32.4% for male physicians). Female physicians had higher attrition rates than their male counterparts across every career stage (time since medical school graduation: <15 years, 40.5% vs 34.8%; 15-29 years, 36.4% vs 30.3%; ≥30 years, 38.5% vs 33.3%). On adjusted analysis, female physicians were more likely to leave academia than were their male counterparts (odds ratio, 1.25; 95% CI, 1.23-1.28).

Conclusions and Relevance

In this cohort study, female physicians were more likely to leave academia than were male physicians at all career stages. The findings suggest that diversity, equity, and inclusion efforts should address attrition issues in addition to recruiting more female physicians into academic medicine.

The gender citation gap: Why and how it matters

The weight of evidence suggests that articles written by men and women receive citations at comparable rates. This suggests that research quality or gender-based bias in research evaluation and citing behaviors may not be the reason why academic women accumulate fewer citations than men at the career level. In this article, I outline a career perspective that highlights women's disadvantages in career progression as the root causes for the gender citation gap. I also consider how the gender citation gap may perpetuate the unequal pay between genders in science. My analysis of two different datasets, one including paper and citation information for over 130,000 highly cited scholars during the 1996-2020 period and another including citation and salary information for nearly 2,000 Canadian scholars over the 2014-2019 period, shows several important findings. First, papers written by women on average receive more citations than those written by men. Second, the gender citation gap grows larger with time as men and women progress in their careers, but the opposite pattern holds when research productivity and collaborative networks are considered. Third, higher citations lead to higher pay, and gender differences in citations explain a significant share of the gender wage gap. Findings demonstrate the critical need for more attention toward gender differences in career progression when investigating the causes and solutions for gender disparities in science.

Women in Hand Surgery: Considerations and Support

Hand surgeons and trainees face many challenges in pursuit of their professional and familial goals. The culture of the training programs must change to aknowledge and address the needs of women as they naviagate career and their childbearing years. Challenges to maternity and family planning dissuade and perhaps prohibit female trainees from choosing surgical specialties and of those who do, from reaching their full professional potential. In the following chapter we will review current data on infertility, obstetrical complications, breastfeeding, maternity leave, career advancement and childcare in an effort to increase support for female trainees and practicing female hand surgeons.

Gender disparity in academic advancement: exploring differences among adult and pediatric radiologists

BACKGROUND

Gender imbalance in research output and academic rank in academic radiology is well-documented and long-standing. Less is known regarding this imbalance among pediatric radiologists.

OBJECTIVE

To characterize gender differences for academic rank and scholarly productivity of pediatric radiologists relative to adult radiologists.

MATERIALS AND METHODS

During summer 2021, faculty data for the top 10 U.S. News & World Report ranked adult radiology programs and the top 12 largest pediatric hospital radiology departments were collected. Information regarding self-reported gender, age, years of practice and academic rank was accessed from institutional websites and public provider databases. The h-index and the number of publications were acquired via Scopus. Group comparisons were performed using Mann-Whitney and chi-square tests.

RESULTS

Three hundred and sixty-four (160 women) pediatric and 1,170 (468 women) adult radiologists were included. Compared to adult radiologists, there were significantly fewer pediatric radiologists in advanced ranks (associate or full professor) (P = 0.024), driven by differences between male (P = 0.033) but not female radiologists (P = 0.67). Among pediatric radiologists, there was no significant difference in years in practice (P = 0.29) between males and females. There also was no significant difference in academic rank by gender (P = 0.37), different from adult radiology where men outnumber women in advanced ranks (P < 0.001). Male pediatric radiologists displayed higher academic productivity (h-index: 9.0 vs. 7.0; P = 0.01 and number of publications: 31 vs. 18; P = 0.003) than their female colleagues.

CONCLUSION

Academic pediatric radiology seems to have more equitable academic advancement than academic adult radiology. Despite similar time in the workforce, academic output among female pediatric radiologists lags that of their male colleagues.

Analysis of gender representation on transfusion medicine journal editorial boards: Comparison between 2019 and 2022

BACKGROUND AND OBJECTIVES

A 2019 study highlighted significant gender inequities among blood banking and transfusion medicine (BBTM) journal editorial boards. We sought to assess if the representation of women has improved in the intervening 3 years.

MATERIALS AND METHODS

We analysed the gender composition of nine BBTM journal editorial boards as of 13 September 2022, including the seven journals studied in 2019. We compared this to the proportion of females (term used by authors) on seven BBTM journal editorial boards in 2019 to assess change in the editorial board composition. We also assessed gender composition by editorial position (editor-in-chief [EIC], associate/assistant/titled editors and editorial board members).

RESULTS

Nine BBTM journals have a total of 398 editorial positions and comprise significantly more men than women (68.8%, 274/398 vs. 31.2%, 124/398; p < 0.001). Among the seven journals analysed in 2019, the proportion of women on these seven editorial boards has remained unchanged (2019: 30.1%, 81/269 vs. 2022: 31.9%, 103/323; p = 0.66) despite the addition of 54 editorial positions.

CONCLUSION

Women remain inequitably represented on journal editorial boards among all journal editorial positions. Although advocacy efforts are increasing, there has been limited improvement in gender equity in 3 years, despite a 20% increase in editorial positions.

Redressing injustices: how women students enact agency in undergraduate medical education

This study presents descriptions of epistemic injustice in the experiences of women medical students and provides accounts about how these students worked to redress these injustices. Epistemic injustice is both the immediate discrediting of an individual's knowledge based on their social identity and the act of persistently ignoring possibilities for other ways of knowing. Using critical narrative interviews and personal reflections over an eight-month period, 22 women students during their first year of medical school described instances when their knowledge and experience was discredited and ignored, then the ways they enacted agency to redress these injustices. Participants described three distinct ways they worked to redress injustices: reclaiming why they belong in medicine, speaking up and calling out the curriculum, and uplifting one another. This study has implications for recognizing medical students as whole individuals with lived histories and experiences and advocates for recognizing medical students' perspectives as valuable sources of knowledge.

Gender Differences in Emergency Medicine Attending Physician Comments to Residents: A Qualitative Analysis

IMPORTANCE

Prior studies have revealed gender differences in the milestone and clinical competency committee assessment of emergency medicine (EM) residents.

OBJECTIVE

To explore gender disparities and the reasons for such disparities in the narrative comments from EM attending physicians to EM residents.

DESIGN, SETTING, AND PARTICIPANTS

This multicenter qualitative analysis examined 10 488 narrative comments among EM faculty and EM residents between 2015 to 2018 in 5 EM training programs in the US. Data were analyzed from 2019 to 2021.

MAIN OUTCOMES AND MEASURES

Differences in narrative comments by gender and study site. Qualitative analysis included deidentification and iterative coding of the data set using an axial coding approach, with double coding of 20% of the comments at random to assess intercoder reliability (κ, 0.84). The authors reviewed the unmasked coded data set to identify emerging themes. Summary statistics were calculated for the number of narrative comments and their coded themes by gender and study site. χ2 tests were used to determine differences in the proportion of narrative comments by gender of faculty and resident.

RESULTS

In this study of 283 EM residents, of whom 113 (40%) identified as women, and 277 EM attending physicians, of whom 95 (34%) identified as women, there were notable gender differences in the content of the narrative comments from faculty to residents. Men faculty, compared with women faculty, were more likely to provide either nonspecific comments (115 of 182 [63.2%] vs 40 of 95 [42.1%]), or no comments (3387 of 10 496 [32.3%] vs 1169 of 4548 [25.7%]; P < .001) to men and women residents. Compared with men residents, more women residents were told that they were performing below level by men and women faculty (36 of 113 [31.9%] vs 43 of 170 [25.3%]), with the most common theme including lack of confidence with procedural skills.

CONCLUSIONS AND RELEVANCE

In this qualitative study of narrative comments provided by EM attending physicians to residents, multiple modifiable contributors to gender disparities in assessment were identified, including the presence, content, and specificity of comments. Among women residents, procedural competency was associated with being conflated with procedural confidence. These findings can inform interventions to improve parity in assessment across graduate medical education.

Leadership Diversity and Development in the Nation's Cancer Centers

The capacity and diversity of the oncology leadership workforce has not kept pace with the emerging needs of our increasingly complex cancer centers and the spectrum of challenges our institutions face in reducing the cancer burden in diverse catchment areas. Recognizing the importance of a diverse workforce to reduce cancer inequities, the Association of American Cancer Institutes conducted a survey of its 103 cancer centers to examine diversity in leadership roles from research program leaders to cancer center directors. A total of 82 (80%) centers responded, including 64 National Cancer Institute-designated and 18 emerging centers. Among these 82 respondents, non-Hispanic White individuals comprised 79% of center directors, 82% of deputy directors, 72% of associate directors, and 72% of program leaders. Women are underrepresented in all leadership roles (ranging from 16% for center directors to 45% for associate directors). Although the limited gender, ethnic, and racial diversity of center directors and perhaps deputy directors is less surprising, the demographics of current research program leaders and associate directors exposes a substantial lack of diversity in the traditional cancer center senior leadership pipeline. Sole reliance on the cohort of current center leaders and leadership pipeline is unlikely to produce the diversity in cancer center leadership needed to facilitate the ability of those centers to address the needs of the diverse populations they serve. Informed by these data, this commentary describes some best practices to build a pipeline of emerging leaders who are representative of the diverse populations served by these institutions and who are well positioned to succeed.

Gender Equity in Science and Medicine: Breaking the Impasse

Women comprise half of the scientific and medical workforce, yet still hold a minority of leadership positions. Here I discuss the barriers to gender equity and offer a new approach to address the problem.

Networking practices and gender inequities in academic medicine: Women's and men's perspectives

BACKGROUND

Studies of gender inequities in academic medicine suggest the negative impact of men's networking practices, but little is known about how they shape faculty experiences.

METHODS

In this qualitative study, in-depth, semi-structured interviews were conducted with 52 women and 52 men academic medicine faculty members at 16 institutions across the US in 2019. Interviews explored participants' experiences and perceptions of gender inequities in academic medicine, including perceptions of men's networking practices. Interviews were recorded and transcribed verbatim, and transcripts were analyzed using a mixture of deductively and inductively generated codes.

FINDINGS

Qualitative analysis of interview transcripts identified different dominant themes: (1) Women were often excluded from networking activities dominated by men, (2) Both women and men referred to men's networking practices in academic medicine, and believed they conferred benefits to members and excluded non-members from such benefits, (3) Participation in such networking activities yielded professional advantages, (4) Women made efforts to counteract their exclusion yet identified limits of those efforts.

INTERPRETATION

The data suggests that gender inequities in academic medicine might be associated with professional interactions that occur outside of the scope of professional work practices and in formal work sites. Additional research is needed to better understand practices such as informal networking activities and their impact in order to promote gender equity.