Women in Academic Psychiatry: Inequities, Barriers, and Promising Solutions

A Scoping Review of the Experiences of Internationally Educated Nurses Working With Older Adults in High-Income Countries

AIM

To comprehensively review the experiences and support needs of internationally educated nurses in healthcare settings for older people, identify current supportive interventions for internationally educated nurses in gerontological nursing practice and determine research gaps in the existing literature on their experiences and support needs. The review includes all types of nurses, except those focusing solely on undergraduate nurses who have yet to practise and nursing assistants.

METHODS

A scoping review by a Canadian review group followed the methodological framework outlined by Arksey and O'Malley (2005) and later refined by Levac, Colquhoun, and O'Brien (2010). Articles of any publication date were included. A two-stage screening process was conducted independently to determine eligibility. Data extraction was performed using a piloted charting form. We also conducted a consultative exercise with Canadian nurses. Thematic and descriptive analyses were employed to analyse the extracted data.

DATA SOURCES

Seven databases (PubMed, PsycINFO, PsychArticles, CINAHL, Scopus, Web of Science and EThOS) were systematically searched on April 27, 2024. Grey literature was searched using Google search engines, OpenGrey, ProQuest Sociological Abstracts and ProQuest ERIC, Healthcare Management Information Consortium, Open Grey repository, Proceedings First, Canada Health and Council for Allied Health Professions Research, and through expert consultation.

RESULTS

The scoping review identified 11 articles from Canada, Germany, Ireland, the Netherlands, New Zealand, Norway and the United Kingdom, highlighting positive experiences and challenges internationally educated nurses face in healthcare settings for older people. Nurses were primarily registered nurses. Challenges included workplace interpersonal issues, language barriers and organisational constraints, while positive experiences included being valued by older adults and colleagues.

CONCLUSION

The findings highlight the need for supportive interventions like mentorship, cultural competency training and organisation-led initiatives to improve internationally educated nurses' integration and retention in geriatric care, enhancing care quality for older persons.

IMPLICATIONS FOR PRACTICE

Enhancing mentorship programs, cultural competency training, and organization-led support initiatives can improve the integration, retention, and overall well-being of internationally educated nurses in geriatric care, ultimately enhancing the quality of care for older adults.

TRIAL REGISTRATION

osf.io/cwjem.

Research culture influences in health and biomedical research: rapid scoping review and content analysis

BACKGROUND

Research culture is strongly influenced by academic incentives and pressures such as the imperative to publish in academic journals, and can influence the nature and quality of the evidence we produce.

OBJECTIVE

The purpose of this rapid scoping review is to capture the breadth of differential pressures and contributors to current research culture, drawing together content from empirical research specific to the health and biomedical sciences.

STUDY DESIGN AND SETTING

PubMed and Web of Science were searched for empirical studies of influences and impacts on health and biomedical research culture, published between January 2012 and April 2024. Data charting extracted the key findings and relationships in research culture from included papers such as workforce composition; equitable access to research; academic journal trends, incentives, and reproducibility; erroneous research; questionable research practices; biases vested interests; and misconduct. A diverse author network was consulted to ensure content validity of the proposed framework of i) inclusivity, ii) transparency, iii) rigor, and iv) objectivity.

RESULTS

A growing field of studies examining research culture exists ranging from the inclusivity of the scientific workforce, the transparency of the data generated, the rigor of the methods used and the objectivity of the researchers involved. Figurative diagrams are presented to storyboard the links between research culture content and findings.

CONCLUSION

The wide range of research culture influences in the recent literature indicates the need for coordinated and sustained research culture conversations. Core principles in effective research environments should include inclusive collaboration and diverse research workforces, rigorous methodological approaches, transparency, data sharing, and reflection on scientific objectivity.

Development and Implementation of a Structured and Innovative Faculty-Wide Mentorship Program for a Large Department of Psychiatry

OBJECTIVES

Mentorship supports faculty to succeed in their careers with confidence, resilience, and satisfaction. To address inequities evident with an informal approach, a formal mentorship program was designed and implemented.

METHODS

The Quality Implementation Framework (QIF) was applied. Engagement with key stakeholders and users was emphasized. The goals of the program are to address inequities and create greater satisfaction with academic careers among diverse faculty working in various roles/sites. A central component is a primary 1:1 mentor/mentee model, supported with an online matching tool. 1:1 mentorship is augmented with several group mentorships, to support specific academic roles (e.g., clinician scientists; clinician teachers) or social identity. Mentorship training workshops and resources support mentors/mentees; topics include best practices, DEI, and mentorship and mentorship tools. Descriptive statistics (means, SDs, percentages) summarized findings on mentees/mentors at enrollment.

RESULTS

Sixty-six mentors registered. Recently hired faculty (n = 136) were invited to participate, resulting in 105 mentees (77%). There is a significant improvement in mentor perception of the department's culture of mentorship (t(198) = 4.188, p < 0.001). Key mentee goals were to gain career guidance and support, information on academic promotion, skills in professional relationships, and networking. Identified challenges among mentors/mentees include having differing goals, time commitment, and managing difficult conversations. Mentorship groups were well-received with high satisfaction.

CONCLUSIONS

Uptake and participation is encouraging. QIF will help identify contextual factors related to uptake and use of the program and additional implementation strategies needed. The project will contribute to literature on implementation and sustainability of mentorship programs.

Identifying the mentorship needs among faculty in a large department of psychiatry- support for the creation of a formal mentorship program

BACKGROUND

Study aims were to assess the current state and needs of faculty to inform the design of a formal mentorship program in a large academic Department of Psychiatry.

METHODS

A 57- item self-administered online survey questionnaire was distributed to all faculty members.

RESULTS

225 faculty members completed the survey (24%). 68% of respondents had a mentor and reported high satisfaction (mean = 4.3, SD = 1.05) (range 1 to 5). Among those respondents lacking access to mentorship, 65% expressed interest. Open-ended questions indicated that international medical graduates, faculty identifying as minority, women and clinician teachers may lack access to mentorship. PhD faculty felt disadvantaged compared to MD faculty in gaining first authorship (MNon-MD=1.64 ± 0.79 vs. MMD=1.36 ± 0.67; t = 2.51, p = .013); reported more authorship disputes (MNon-MD =1.99 ± 0.91 vs. MMD =1.66 ± 0.76; t = 2.63 p = .009) and experienced questionable scientific integrity concerning colleagues (MNon-MD =2.01 ± 0.92 vs. MMD =1.70 ± 0.81; t = 2.42 p = .017). For both MD and PhD faculty, women were significantly more likely to experience authorship disputes (χ2(2) = 8.67, p = .013). The department was perceived as treating faculty with respect (72% agreed) with 54% agreeing that it embraces diversity (54%). Identified benefits to mentorship included receiving advice about academic promotion, opportunities for career advancement, advocacy, and advice as a researcher, teacher or clinician. Only 26% of mentors received formal training to support their role; 59% expressed interest in education. Respondents supported a more formal, accessible, inclusive program, with training, tools, and a matching strategy based on mentee preferences.

CONCLUSIONS

Challenges and inequities were identified with the department's current ad hoc approach to mentorship. A limitation of the study was the response rate, while similar to response rates of other physician surveys, raises the potential for response bias. In comparing study participants to the department, the sample appeared to provide a fair representation. The study has implications for identifying the need and design of more formal mentorship programs in academic medicine.

Breaking barriers in the career development of women in academic psychiatry

Academic psychiatry is essential for advancing mental health understanding and treatments. However, women encounter more obstacles hindering their progress in academia than men. This Editorial aims to highlight these obstacles and propose strategies to address them, advocating for a more supportive environment for women psychiatrists' ongoing growth and development. The importance of supportive environments, fair access to opportunities and structural changes, including initiatives for mentorship, funding and flexible work arrangements, are crucial. Collaboration among governments, institutions and organisations is needed to enhance research infrastructure and promote gender equality. Encouraging and recognising women's contributions in research fosters inclusivity and innovation. Prioritising these efforts is vital for the existence, well-being and success of women in academic psychiatry.

Will they always be living the Sisyphus punishment? The triple whammy for racialized women: a qualitative investigation of primary care researchers in Canada

Background

Existing literature overlooks the role of gender and race on research productivity, particularly in the context of primary care research. This study examines how gender and race influence the research productivity of primary care researchers in Canada, addressing a gap in existing literature.

Methods

Qualitative, descriptive methods were used, involving 60-min interviews with 23 Canadian primary care researchers. 13 participants were female (57%) and 10 participants (43%) were male. Fourteen participants were White (non-racialized; 61%), 8 were racialized (35%) and 1 did not comment on race (4%). Reflexive thematic analysis captured participant perceptions of factors influencing research productivity, including individual, professional, institutional, and systemic aspects.

Findings

Systemic bias and institutional culture, including racism, sexism, and unconscious biases against racialized women, emerge as key barriers to research productivity. The parenting life stage further compounds these biases. Barriers include lack of representation in faculty roles, toxic work environments, research productivity metrics, and exclusion by colleagues. Participants indicated that institutional reforms and systemic interventions are needed to foster a diverse, equitable, and inclusive environment. Strategies include recruiting equity-focused leaders, increasing representation of racialized female faculty, diversity training, mentorship programs, providing meaningful support, flexible work arrangements, and protected research time. Sponsors can offer more targeted grants for female and racialized researchers. Adjusting metrics for gender, race, parenthood, and collaborative metrics is proposed to enhance diversity and inclusion among researchers.

Interpretation

This study underscores the importance of addressing systemic bias at institutional and systemic levels to create a fair and supportive environment for primary care researchers. A multitude of strategies are needed including increasing representation of racialized female faculty, creating supportive and psychologically safe work environments, and public reporting of data on faculty composition for accreditation and funding decisions. Together, these strategies can alleviate the triple whammy and free these researchers from the Sisyphus Punishment - the absurdity of being asked to climb a hill while pushing a boulder with no hope of reaching the top.

Funding

College of Family Physicians of Canada.

Gender Diversity in the Psychiatric Workforce: It's Still a (White) Man's World in Psychiatry

Academic psychiatry has slightly higher rates of women in the upper ranks and leadership positions than academic medicine as a whole but women continue to be seriously underrepresented. Psychiatry departments should take specific steps to address barriers for women in psychiatry including harassment and discrimination, Imposter Syndrome, lack of mentorship and sponsorship, work-life integration issues, and overinvolvement in nonpromotion generating activities. Addressing these barriers within academic psychiatry will improve the environment for all minorities.

Is there a gender gap in clinical neurosciences? A cross-sectional analysis of female participation in academic neurology, neurosurgery, and psychiatry

Gender equality or the lack thereof is a constantly recurring theme. Here, we sought to provide an overview of the status with respect to the participation and leadership of female doctors in clinical neuroscience analyzing different disciplines (neurosurgery, neurology and psychiatry). A total of 1910 articles published in six representative journals (07-12/2020) were reviewed. Of these, 1327 were original research papers, 145 invited publications and 303 letters/comments. Out of a total of 15,080 authors, 4365 (29%) were women. The percentage of female authors was found to differ significantly between the different specialties (19% in neurosurgery, 39% in neurology and 45% in psychiatry). Women were last authors in 9.5% of the papers in neurosurgery, 29% in neurology and 39% in psychiatry Based on these findings, it can be concluded that gender disparity in academic neuroscience is quite conspicuous. Our review seeks to address the reasons behind this phenomenon in the context of new publications as well as various cultural and historical underpinnings.

The role of gender as a barrier to the professional development of psychiatrists

BACKGROUND

Despite efforts toward greater gender equality in clinical and academic psychiatry in recent years, more information is needed about the challenges in professional development within psychiatry, and how these may vary with gender.

METHODS

A cross-sectional 27-item online survey was conducted with psychiatrists and psychiatric trainee members of the European Psychiatric Association.

RESULTS

A total of 561 psychiatrists and psychiatric trainees from 35 European countries participated representing a response rate of 52.8% for women and 17.7% for men from a total sample of 1,580. The specific challenges that women face in their professional development fall into two categories. One comprised women's negative attitudes concerning their abilities in self-promotion and networking. The other identified environmental barriers related to lack of opportunity and support and gender discrimination. Compared to men, women reported higher rates of gender discrimination in terms of professional advancement. Women were less likely to agree that their institutions had regular activities promoting inclusion, diversity, and training to address implicit gender bias. Working in high-income countries compared to middle-income countries relates to reporting institutional support for career progression.

CONCLUSIONS

These findings are an open call to hospital leaders, deans of medical schools, and department chairs to increase efforts to eradicate bias against women and create safer, inclusive, and respectful environments for all psychiatrists, a special call to women psychiatrists to be aware of inner tendencies to avoid self-promotion and networking and to think positively and confidently about themselves and their abilities.

Diversity, Equity, and Inclusion Efforts at a Departmental Level: Building a Committee as a Vehicle for Advancing Progress

Academic Health Centers (AHCs) across the nation are experiencing a reawakening to the importance of Diversity, Equity, and Inclusion (DEI). Such work impacts both employees and patients served by healthcare institutions. Yet, for departments without previously existing formal channels for this work, it is not always apparent where to begin. The current manuscript details a process for creating a committee as a vehicle for championing DEI efforts at the department level within an AHC. The authors present a six-step model for forming a DEI Committee and progress monitoring measures to remain accountable to identified objectives. In each step, the authors provide examples of their work with the goal for readers to tailor and apply each step to their own departments' DEI efforts. The current paper also identifies lessons learned with regard to barriers and facilitators of department-level DEI work. Reflections and next steps for DEI work beyond the proposed model are also discussed.

Renewal of academic psychiatry without addressing gender equity will render it Jurassic rather than endangered

While two editorials have raised concerns about the decline in Australian academic psychiatry, for a genuine rejuvenation to ever occur, we will need to re-examine how women can be better included in this important endeavour. While attainment of fellowship has reached gender parity, academic psychiatry has disappointingly lagged, with 80% of its senior leadership roles across Australia and New Zealand still held by men, with a similar situation in the United Kingdom and the United States as well as many other countries. Encouraging women into academic psychiatry is not only critical to progress as a profession but also will help address the current blindness to sex differences in biological psychiatry, as well the social impact of restrictive gender norms and the effects of gender-based violence on mental health. This potentially creates opportunities for significant gains and insights into mental disorders. However, addressing the barriers for women in academia requires tackling the entrenched disparities across salaries, grant funding, publications, teaching responsibilities, keynote invitations and academic promotions alongside the gender-based microaggressions, harassment and tokenism reported by many of our female academics. Many women must grapple with not just a 'second shift' but a 'third shift', making the burden of an academic career unreasonable and burnout more likely. Addressing this is no easy task. The varied research in academic medicine reveals no quick fixes, although promoting gender equity brings significant potential benefits. Areas such as academic psychiatry need to recognise our community's growing discomfort with workplaces that choose to maintain status quo. Gender equity must be a critical part of any quest to revive this important area of practice for our profession.

Female researchers in high-impact psychiatric journals: What do they focus on?

The regular analysis of publication trends, including gender aspects, is an important contribution to the identification of gender-specific differences in academic psychiatry. The present study aimed to characterise publication topics in three high-impact psychiatric journals across three time points within 15 years (2004, 2014 and 2019). Publication patterns of female authors compared to their male colleagues were examined. All articles published in 2019 in the three high-impact psychiatry journals JAMA Psychiatry, British Journal of Psychiatry and American Journal of Psychiatry were included and compared with data from the 2004 and 2014 assessments. Descriptive statistics were calculated and Chi-square tests were performed. In 2019, a total of 473 articles were published, 49.5% were original research articles, of which 50.4% were published by female first authors. The results of this study showed a stable trend in the publication of research on mood disorders as well as schizophrenia and psychotic disorders in high-ranking psychiatric journals. Although the percentage of female first authors in the three most common target populations under study (mood disorders, schizophrenia and general mental health) increased from 2004 to 2019, gender equality has not yet been achieved in these fields. However, in the two most frequent subject matters, basic biological research and psychosocial epidemiology, the percentage of female first authors was more than 50%. Consistent monitoring of publication trends and gender distribution by researchers and journals in psychiatric research should be continued to identify and counteract the possibility of the underrepresentation of women in certain fields.

Diversity Drives Innovation: The Impact of Female-Driven Publications

BACKGROUND

Gender disparities are pervasive in academic plastic surgery. Previous research demonstrates articles authored by women receive fewer citations than those written by men, suggesting the presence of implicit gender bias.

OBJECTIVES

The aim of this study was to describe current citation trends in plastic surgery literature and assess gender bias. The expectation was that women would be cited less frequently than their male peers.

METHODS

Articles published between 2017 and 2019 were collected from 8 representative plastic surgery journals stratified by impact factor. Names of primary and senior authors of the 50 most cited articles per year per journal were collected and author gender was determined via online database and internet search. The median numbers of citations by primary and senior author gender were compared by Kruskal-Wallis test.

RESULTS

Among 1167 articles, women wrote 27.3% as primary author and 18% as senior author. Women-authored articles were cited as often as those authored by men (P > 0.05) across all journal tiers. Articles with a female primary and male senior author had significantly more citations than articles with a male primary author (P = 0.038).

CONCLUSIONS

No implicit gender bias was identified in citation trends, a finding unique to plastic surgery. Women primary authors are cited more often than male primary authors despite women comprising a small fraction of authorship overall. Additionally, variegated authorship pairings outperformed homogeneous ones. Therefore, increasing gender diversity within plastic surgery academia remains critical.

Gender differences in endowed chairs in Departments of Psychiatry and Behavioral Sciences from the top-10 NIH-funded medical schools in the US

The current study examined gender differences in endowed chairs within Departments of Psychiatry and Behavioral Sciences across the top 10 NIH-funded Schools of Medicine. The names of full professors with and without endowed chairs were collected and a multivariable logistic regression model was constructed to predict having an endowed chair considering gender, primary degree, NIH funding, and citation number. Secondary analyses repeated the models separately for individuals holding an MD or MD/PhD versus those with a non-MD doctoral degree (i.e., PhD). There were 715 full professors (36% women) and 115 endowed chairs (35% women). When adjusting for primary degree type, funding, and citations, women were significantly more likely to hold an endowed chair than men. Secondary models indicated that findings differed based on primary degree type. Among those with an MD or MD/PhD, gender was not associated with holding an endowed chair while among faculty with a PhD, women full professors were significantly more likely to hold an endowed chair than men. These results diverge from a prior study of Departments of Medicine in which endowed chairs were found to favor men.

For us by us: Instituting mentorship models that credit minoritized medical faculty expertise and lived experience

The woefully low proportion of scientists and clinicians underrepresented in medicine (UIM), including members of African-American/Black, Hispanic/Latinx, American Indian/Alaska Native or Native Hawaiian/Pacific Islander communities, is well characterized and documented. Diversity in medicine is not only just, but it improves quality and outcomes. Yet, diversity in academic medicine remains stagnant, despite national recognition and urgent calls to improve diversity, equity, and inclusion across health sciences. One strategy that has shown to improve diversity in many sectors is high quality mentoring. While many institutions have adopted mentoring programs, there remains a lack of mentorship that is equitable, individualized, and sets a clear timeline for academic milestones that will position UIM mentees at the optimal trajectory for promotion and retention. A barrier to assembling these programs is the small number of UIM among the senior faculty ranks who are able to serve in this role, given the disproportionate burden to serve on a multitude of academic committees, task forces, and workgroups to fulfill institutional mandates to diversify representation. These time-consuming services, documented in the literature as the "minority tax," are generally uncompensated and unaccounted for in terms of consideration for promotion, leadership positions, and other measures of career advancement. The Justice, Equity, Diversity, and Inclusion Academic Mentors (JAM) Council represents a novel, culturally responsive, and anti-racist approach to achieve a more equitable and inclusive institutional environment. This approach strategically leverages the intergenerational wisdom and experience of senior UIM faculty via time-protected effort with the overall goals of improving rates of promotion, retention, and career satisfaction of early career UIM colleagues. This community case study describes the rationale, resources needed, processes, and proposed workflow required to launch the JAM Council, as well as the major roles and responsibilities for JAM mentors and mentees, which may be considered by academic medical centers focused on improving diversity among the faculty ranks.

Gender Diversity in the Psychiatric Workforce: It's Still a (White) Man's World in Psychiatry

Academic psychiatry has slightly higher rates of women in the upper ranks and leadership positions than academic medicine as a whole but women continue to be seriously underrepresented. Psychiatry departments should take specific steps to address barriers for women in psychiatry including harassment and discrimination, Imposter Syndrome, lack of mentorship and sponsorship, work-life integration issues, and overinvolvement in nonpromotion generating activities. Addressing these barriers within academic psychiatry will improve the environment for all minorities.

From struggle to opportunity: Reimagining medical education in a pandemic era

The COVID-19 pandemic has disrupted the international medical education community in unprecedented ways. The restrictions imposed to control the spread of the virus have upended our routines and forced us to reimagine our work structures, educational programming and delivery of patient care in ways that will likely continue to change how we live and work for the foreseeable future. Yet, despite these interruptions, the pandemic has additionally sparked a transformative impulse in some to actively engage in critical introspection around the future of their work, compelling us to consider what changes could (and perhaps should) occur after the pandemic is over. Drawing on key concepts associated with scholar Paulo Freire's critical pedagogy, this paper serves as a call to action, illuminating the critical imaginings that have come out of this collective moment of struggle and instability, suggesting that we can perhaps create a more just, compassionate world even in the wake of extraordinary hardship.