Gender difference in authorship of clinical practice guidelines and position statements in endocrinology

Analysis of Pediatric Clinical Practice Guideline Authors by Gender, Race, and Ethnicity

Background and Objectives: Clinical practice guidelines (CPGs) have significantly influenced medical practice worldwide. Nevertheless, the authorship of CPGs produced by several medical societies has not been representative of the field and population they address, as women and individuals from racial and ethnic minority groups have been underrepresented as authors. We hypothesized that women and individuals from minoritized racial and ethnic groups would also be underrepresented as authors of CPGs produced by the American Academy of Pediatrics (AAP). Methods: In this cross-sectional study, the gender, race, and ethnic composition of authors and subcommittee participants of AAP-produced CPGs published from January 2010 through May 2023 were analyzed and compared to the 2010 and 2021 U.S. population and 2010 and 2022 U.S. medical school pediatric faculty. Results: Women (39.7%, 127/320 of all positions, and 42.5%, 85/200 of named author positions) and women physicians (35.2%, 101/287 of all positions, and 36.4%, 64/176 of named author positions) were significantly underrepresented-while men and men physicians were significantly overrepresented-from their respective composition in the U.S. Census and pediatric faculty. Women and women physicians from all racial and ethnic groups and men and men physicians from minority racial and ethnic groups were significantly underrepresented-from their respective composition in the U.S. Census and pediatric faculty. No Black man was identified as an author. Conclusions: Medical societies that produce CPGs should be cognizant of these inequities and ensure appropriate authorship diversity.

Representation of Authors by Gender, Race, and Ethnicity in Pathology Clinical Practice Guidelines

CONTEXT.—

United States' clinical practice guidelines (CPGs) are often produced by professional societies and used worldwide in daily medical practice. However, studies in various medical specialties demonstrate underrepresentation of women and racial and ethnic minority groups in CPGs. The representation of authors by gender, race, and ethnicity of US pathology CPGs has not been previously evaluated.

OBJECTIVE.—

To assess if women and individuals from racial and ethnic minority groups are underrepresented as authors of pathology CPGs.

DESIGN.—

The gender, race, ethnicity, and terminal degrees of authors of 18 CPGs from the College of American Pathologists were coded by using photographs and other available information online and compared to their representation in academic pathology per Association of American Medical Colleges benchmark data.

RESULTS.—

Two hundred seventy-five author positions (202 physician author positions) were analyzed. Women overall (119 of 275; 43.3%) and women physicians (65 of 202; 32.2%) held fewer positions than all men and men physicians. Women physicians were significantly underrepresented in physician author positions, while White men physicians were significantly overrepresented in all, first, senior, and corresponding authorship roles when compared to the proportion of women and White men physicians among pathology faculty, respectively. Asian men and women physicians were underrepresented as compared to their representation among pathology faculty.

CONCLUSIONS.—

Men, particularly White men physicians, are overrepresented among pathology CPG author positions, while women physicians and some physicians from racial and ethnic minority groups are underrepresented. Further research is needed to understand the impact of these findings on the careers of underrepresented physicians and the content of guidelines.

A Systematic Review of Gender Disparity in the Authorship of Clinical Trials and Clinical Practice Guidelines in Various Medicine Subspecialties

Authorship in clinical trials and clinical practice guidelines is considered prestigious and is associated with broader peer recognition. This systematic review investigated female representation among studies reporting authorship trends in clinical trials or clinical practice guidelines in different medicine subspecialties. Our search strategy yielded 836 articles, of which 30 met the inclusion criteria. Our findings indicate that females are severely underrepresented in authorship of clinical trials and clinical practice guidelines. Although the proportions of females may have improved in the past decade, the gains are marginal. Notably, studies in this domain predominantly focus on first/last authorship positions, and whether females are underrepresented in other positions as collaborative partners is currently unknown. Also, authorship trends in clinical trials or clinical practice guidelines of most medicine subspecialties besides cardiovascular medicine remain under-researched. Hence, standardizing the methodology for studying gender disparity in research output for comparative analysis between different subspecialties is as urgent as addressing the gender disparity in authorship.

The representation of women on Australian clinical practice guideline panels, 2010-2020

OBJECTIVES

To assess the composition by gender of Australian clinical practice guideline development panels; to explore guideline development-related factors that influence the composition of panels.

DESIGN, SETTING, PARTICIPANTS

Survey of clinical guidelines published in Australia during 2010-2020 that observed the 2016 NHMRC Standards for Guidelines, identified (June 2021) in the NHMRC Clinical Practice Guideline Portal or by searching the Guideline International Network guidelines library, the Trip medical database, and PubMed. The gender of contributors to guideline development was inferred from gendered titles (guideline documents) or pronouns (online biographies).

MAIN OUTCOME MEASURES

The overall proportion of guideline panel members - the guideline contributors who formally considered evidence and formulated recommendations (ie, guideline panel chairs and members) - who were women.

RESULTS

Of 406 eligible guidelines, 335 listed the names of people who contributed to their development (82%). Of 7472 named contributors (including 511 guideline panel chairs [6.8%] and 5039 guideline panel members [67.4%]), 3514 were men (47.0%), 3345 were women (44.8%), and gender could not be determined for 612 (8.2%). A total of 215 guideline panel chairs were women (42.1%), 280 were men (54.8%); 2566 guideline panel members were men (50.9%), 2071 were women (41.1%). The proportion of female guideline panel members was smaller than 40% for 179 guidelines (53%) and larger than 60% for 71 guidelines (21%). The median guideline proportion of female panel members was smaller than 50% for all but two years (2017, 2018).

CONCLUSIONS

The representation of women in health leadership roles in Australia does not reflect their level of participation in the health care workforce. In particular, clinical guideline development bodies should develop transparent policies for increasing the participation of women in guideline development panels.

Gender Representation Among Physician Authors of Practice Guidelines Developed, Endorsed, or Affirmed by the American Academy of Neurology

BACKGROUND AND OBJECTIVES

To assess American Academy of Neurology (AAN)-recommended Practice Guidelines (PGs) for equity in gender representation among physician authors.

METHODS

This cross-sectional study included AAN-recommended PG publications from January 1, 2015, to December 31, 2020. Author degrees and gender were identified by 2 reviewers using the publication and/or online searches. Gender was determined from pronouns or photographs. Gender representation was compared with Association of American Medical Colleges (AAMC) data on academic neurologists. Data were analyzed using Z tests of 2 proportions and descriptive statistics.

RESULTS

AAMC benchmarks report academic women neurologists represented 35% of the specialty in 2015, 38% in 2018, and 39% in 2020. We identified 68 unique PG publications with 709 physician authors, 31% (223) women, 68% (484) men, and 0.3% (2) gender could not be identified. Representation of women physicians was low among PG authors across all benchmarks, significantly so for 2018 and 2020 (p < 0.01). Among physician first authors, women were significantly underrepresented across all benchmarks (18% [12/65], p < 0.01). Representation of women physicians was lower when men physicians were first authors vs women physicians (31% [161/524] vs 43% [50/118], p = 0.02). Among subspecialties with 10+ PGs, women physician authorship was highest in child neurology (48% [57/120]) and lowest in stroke and vascular neurology (16% [18/113]).

DISCUSSION

We found that women physicians were underrepresented as authors of AAN-recommended PGs. This suggests a missed opportunity for neurology because PGs that include expertise from women physicians may improve care and translation into practice. In addition, women physicians lose out on professional development from authorship. Further research is needed to understand causality and address gaps.

Author Diversity on Clinical Practice Guideline Committees

ABSTRACT

Reports have demonstrated that women overall and women physicians, in particular, are underrepresented as authors of clinical practice guidelines. This analysis used publicly available information to explore the diversity of rehabilitation-related clinical practice guideline authors by gender, race, and ethnicity. Primary analysis identified authors' gender, race, ethnicity, and visible minority status. Two sets were analyzed: (1) clinical practice guidelines by Department of Veterans Affairs (VA) categorized as "Rehabilitation" or "Pain" (n = 7; VA clinical practice guidelines) and (2) a set (n = 10) published in the United States (US) from 2019 to 2021 that were selected because of low numbers of inclusion at less than 20% women authors. Key findings include that among physician authors, both the VA and US clinical practice guidelines underrepresented women (15 [24.2%] and 27 [16.7%], respectively) and those coded as a racial or ethnic minority were particularly underrepresented. Notably, women authors overall were equally represented (92 [50.0%]) in the VA clinical practice guidelines. The US clinical practice guidelines had women authors who were underrepresented (36 [19.0%]). Secondary analysis of the entire set of VA clinical practice guidelines (n = 21) found gaps in diversity-related content. Clinical practice guidelines have far-reaching health and economic impacts, and addressing disparities in the diversity of author teams and/or gaps in diversity-related content is of paramount importance.

Female Representation: Australian Diabetes and Endocrinology Societies

BACKGROUND

Endocrinology has one of the highest proportions of female specialists and trainees, however females have traditionally been underrepresented in leadership positions and as speakers at scientific meetings.

HYPOTHESIS

Females would represent less than half of invited speakers (plenary, symposium sessions) at endocrinology conferences and in leadership positions of endocrinology societies.

METHOD

An audit of Australian diabetes and endocrinology societies and their respective annual scientific meetings between 2016 - 2020. Analysis of the gender of conference speakers across oral, symposium and plenary sessions, session chairs, program organising committees and society committees.

RESULTS

A total of 1638 speakers (females 856, 52.3%) across 550.4 hours (females 273.6, 49.7%) of presentations at the conferences were identified. Among plenary sessions of all 3 societies there were more male (61%) than female speakers. A total of 608 session chairs were identified, with 313 (51.5%) females. The majority of organising committee members (n=116) were female (56%), however the representation across each organising committee varied. There was a low proportion of society female council members (39% female).

CONCLUSION

There was an equal representation of females and males as conference speakers and session chairs. However, there was an underrepresentation of women in more prestigious roles of plenary speakers and society council members. We implore conscious efforts to address this disparity.