Authorship Trends and Disparities in Cardiothoracic Surgery

Resident-led Research Initiative Drives Collaboration and Productivity: A Bibliometric Network-Based Analysis

OBJECTIVE

Collaborative clinical research among trainees can accelerate new discoveries, improve nontechnical skills, and foster career growth. However, various obstacles exist which make research efforts during surgical training challenging. The purpose of this study was to evaluate whether a resident-led digital research infrastructure was associated with increased academic productivity among individuals and collaboration in scholarship during surgical training.

DESIGN

A multimodal resident-led initiative, Surgery Residents' Research Forum (SuRRF) was implemented in 2019. Databases were queried for publications for surgical residents and fellows from 2015 to 2023. Bibliometric network maps were created to evaluate scholarly activity and collaboration before and after SuRRF implementation. Networks consisted of clusters (representing set of related research items), linkages (representing co-authored items), and link strength (representing increased frequency of co-authorship).

SETTING

Residency and fellowship programs from teaching hospitals of an integrated health system in New York.

PARTICIPANTS

General surgery and surgical subspecialty residents and fellows.

RESULTS

A mean of 77 trainees were included each AY. Trainee participation in research increased from 26.1% in 2015 to 2016 to 62.5% in 2022 to 2023. The number of research items increased from 30 in 2015 to 2016 to 135 in 2022 to 2023. Bibliometric network analysis revealed an increase in research clusters, number of linkages, and link strength from 2015 to 2016 (10, 11, and 13 respectively) to 2022 to 2023 (25, 80, and 126, respectively). Pre-SuRRF to post-SuRRF analysis revealed a significant increase in the number of research items (40.25-109.5, p = 0.002), number of research clusters (11.75-23.25, p < 0.001), number of links (9.5-50.5, p = 0.027), and link strength (13.0-75.5, p = 0.029).

CONCLUSION

The resident research initiative, SuRRF, was associated with increased collaboration and academic productivity. Expanding similar programs nationally could enhance clinical research feasibility and foster a culture of collaboration and academic growth for surgical residents and fellows.

Diversity presentations at cardiothoracic surgery meetings: Opportunity to align our actions with our values

OBJECTIVE

Substantial efforts have been directed toward identifying and addressing cardiothoracic surgical disparities in both patient care and our workforce. We aimed to characterize the presence over time of diversity and disparities-related content at cardiothoracic surgical society meetings.

METHODS

Annual meeting program books from the American Association for Thoracic Surgery and the Society of Thoracic Surgeons from 2013 to 2023 were manually reviewed to identify abstract presentations, invited talks, and dedicated sessions related to diversity, equity, or social determinants of health. Relevant presentations were further categorized as issues in the surgical workforce versus patient care. Applicable presentations and sessions were quantified in each domain and proportions compared with the χ2 test.

RESULTS

Of 7812 presentations over 11 years, 167 (2.1%) were related to issues of diversity. These included 118 abstracts, among which 19 (16.1%) covered workforce diversity issues whereas 99 (83.9%) addressed patient care inequities. Among 48 invited disparities talks, 28 (58.3%) related to workforce challenges and 20 (41.7%) explored variabilities in patient care. Seventeen complete sessions were dedicated to diversity and disparities, with 9 (52.9%) addressing those in the workforce and 8 (47.1%) related to patient care. Comparing the first 5 years with the final 5 years of study, the proportion of talks (abstracts and invited) related to diversity and inclusion increased 3-fold.

CONCLUSIONS

Recent years have shown an explosion in cardiothoracic surgery meeting content focused on diversity but still account for a diminutive proportion of overall content. These data highlight an opportunity to further align scholarly activity with our values.

Representation of women among cardiothoracic surgery editorial boards: Trends over the past 2 decades

OBJECTIVE

The objective of this study was to examine representation of women on the editorial boards of cardiothoracic surgery-focused journals over the past 2 decades to identify changes over time compared with women cardiothoracic surgeon and trainee representation, and to highlight additional opportunities for improvement.

METHODS

The editorial boards of 2 high-impact cardiothoracic surgery journals were reviewed from 2000 to 2023. Data on editorial board positions, including editors-in-chief, associate/deputy editors, feature editors, and general members of the editorial board were abstracted. The proportion of women editors was assessed. Data were compared with publicly available information from the Association of American Medical Colleges on physician specialty by sex.

RESULTS

Of 3460 editorial positions, 332 (9.6%) were held by women. Women occupied 2.2% (1 out of 45) of editor-in-chief positions, 13.2% (78 out of 592) of senior editor positions, 11.5% (33 out of 287) of feature editor positions, and 8.3% (221 out of 2663) of general editorial board positions. The proportion of women holding any editorial board position significantly increased from 2.4% in 2000 to 18.2% in 2023 (P = .01). Overall, editorial board representation increased at a rate of 0.7% ± 1.3% per year, not significantly different from the growth of practicing women cardiothoracic surgeons at 0.3% ± 0.5% per year (P = .584).

DISCUSSION

Representation of women on the editorial boards of cardiothoracic surgery-focused journals has increased commensurate with the increasing proportion of practicing women cardiothoracic surgeons, although remains at 16%. Work remains to continue the recruitment of women to cardiothoracic surgery as well as to identify the key elements that can support them in positions of leadership.

The Representation of Women Moderators at The Society of Thoracic Surgeons Annual Meeting

BACKGROUND

Recently, there has been an increase in the representation of women within the cardiothoracic surgery workforce, with discussions about gender equity garnering interest. We sought to identify whether this increase is accompanied by commensurate selection for representation at national meetings.

METHODS

Online archives of The Society of Thoracic Surgeons (STS) Annual Meetings were reviewed from 2015 to 2024. Data regarding the moderator's gender were abstracted. The gender distribution of moderators across the various session categories was surveyed, and subgroup analyses were performed.

RESULTS

During the years of study, the STS Annual Meeting Taskforce selected 983 moderators to participate in the conference, including 218 women. The representation of women moderators demonstrated a favorable, upward trend. In 2015, 12.1% of moderators were women, with a consistent rate from 2015 to 2018. There was a noticeable rise in invited women moderators in 2019, with 25.4% of moderators being women. This proportion increased to 36.9% women in 2024. General Thoracic sessions have consistently included a greater percentage of women moderators compared with other sessions. Other topic areas, such as Education and Quality Improvement and Critical Care, transitioned to greater representation of women in recent years.

CONCLUSIONS

There has been an increase over time in women moderators selected for participation in the STS Annual Meeting, with progress in gender diversity seen in most session types. Although the overall proportion of women within cardiothoracic surgery remains low, the STS has increasingly worked toward encouraging inclusivity. Efforts to further support well-rounded representation are of important benefit.

A Cross-Sectional Public Data Study of Female Leaders in Surgical Critical Care Fellowships

INTRODUCTION

Female leadership in surgery has been associated with improved gender parity in staffing and stronger focus on wellness. The aim of this study was to examine the gender distribution of leaders in Surgical Critical Care (SCC) training programs. We hypothesize that male and female leaders would have different levels of scholarly achievements, and that programs led by women would be more likely to emphasize wellness initiatives in public-facing websites.

METHODS

We analyzed SCC programs from 2018 to 2022, and identified leaders in the roles of Fellowship Program Director (PD), Division Chief, and Department Chair were from department websites. Program information, characteristics of leaders such as additional degrees and academic productivity, and wellness initiatives were collected. Academic productivity was approximated using the H-index.

RESULTS

Data from 126 SCC program showed that women were underrepresented (female faculty = 33%, female leaders = 27%). Most female leaders were PDs (61.3%) rather than division chief or chair. Male and female leaders had similar H-index and additional degrees (all P > 0.05). Female leadership correlated with higher female faculty representation (P < 0.001). Programs with female PDs were more likely to emphasize wellness in public-facing platforms (odds ratio 3.34, P = 0.03).

CONCLUSIONS

Female leadership in SCC is associated with greater female representation and a stronger emphasis on wellness initiatives. This study reinforces importance of inclusive leadership in Acute Care Surgery.

Gender Gap in Academic Surgery: Disparities in Early-Career Scholarly Productivity Sets the Stage for Unequal Academic Advancement

INTRODUCTION

Gender disparities exist in academic surgery despite advances in the field. This study aimed to examine the extent of gender disparities in career advancement and promotion among academic faculty in surgery and understand the influence of academic productivity.

METHODS

Cross-sectional study using publicly available information from online faculty profiles of 18 large academic US general surgery residency programs. Gender equality was examined overall and as subgroups by career stage (late-, mid-, and early-career) to account for differences over time. Logistic regression identified factors associated with gender disparities. Mediation analysis examined if the gender difference in academic advancement was mediated by academic productivity.

RESULTS

Of the 1467 faculty members, 388 (26.4%) were women. Gender disparity in academic advancement was observed in the early-career cohort (33.4% versus 23.8%, P = 0.006). Women in the early-career cohort were nearly 40% less likely to achieve academic advancement (odds ratio 0.62 [95% confidence interval 0.44-0.88]) and more than 50% less likely to have >30 publications (odds ratio 0.45 [95% confidence interval 0.32-0.63]) than men. The effect of gender was no longer significant once publication volume and fellowship training was incorporated into the model on multivariable regression. Mediation analysis showed that >30 publications mediated nearly 67% of the effect of gender on academic advancement in the early-career cohort.

CONCLUSIONS

The gender gap in academic advancement for early-career faculty can partially be explained by the lower number of publications produced by women faculty. Institutions need to ensure that resources and support are designed to ensure equal opportunities regardless of gender.

Gender representation trends in cardiothoracic surgery journal editorial boards

OBJECTIVE

We aimed to characterize chronologic trends of gender composition of the editorial boards of major cardiothoracic surgery journals in the current era.

METHODS

A cross-sectional analysis was performed of gender representation in editorial board members of 2 North American cardiothoracic surgery journals from 2008 to 2023. Member names and roles were collected from available monthly issues. Validated software programming was used to classify gender. The annual proportion of women representation was compared to the thoracic surgery workforce.

RESULTS

During the study period, 558 individuals (3641 names) were identified, 14.3% of whom were women. The total number of editorial board women increased for both journals. The proportion of women also increased from 2.5% (3 out of 118) in 2008 to 17.8% (71 out of 399) in 2023 (P < .001), exceeding the percentage of women in the thoracic surgery workforce, which increased from 3.8% in 2007 to 8.3% in 2021 (P < .001). The average duration of participation was longer for men than for women (53.8 vs 44.5 months; P = .01). Women in editorial board senior roles also increased from 3.3% (1 out of 30) in 2008 to 28.6% (42 out of 147) in 2023 (P < .001), almost triple the increase in nondesignated roles from 2.3% (2 out of 88) in 2008 to 11.5% (29 out of 252) in 2023 (P < .001).

CONCLUSIONS

In recent years, the appointment of women to the editorial boards of high-impact cardiothoracic surgery journals and senior roles have proportionally exceeded the overall representation of women in cardiothoracic surgery. These findings indicate progress in inclusive efforts and offer insight toward reducing academic gender disparities.

Gender representation in cardiothoracic surgical academia: a call to support women across the globe

CENTRAL MESSAGE

Underrepresentation of women in surgical specialties persists, especially in academic leadership roles. Efforts to better understand disparities and support women cardiothoracic surgeons are ongoing.

Trends in Scientific Collaboration Between Men and Women Following the #MeToo Movement

BACKGROUND

The #MeToo movement raised global awareness about harassment in the workplace. Concerns were raised, however, that the movement may have unintendedly harmed women in academia by decreasing collaboration invitations from men in senior positions, who might be more reluctant to collaborate.

OBJECTIVE

To analyze whether collaborations between first author women and last author men decreased after the #MeToo movement.

DESIGN

Retrospective observational study.

PARTICIPANTS

Names of first and last authors of 122,450 US review articles from the PubMed database published between 2014 and 2020.

MAIN MEASURES

Change in the proportion of review articles with a first author woman and a last author man following the peak of the #MeToo movement in October 2017. Additionally, among review articles with a last author man, trends of women first authorship in the USA and Europe (control group) were compared.

KEY RESULTS

We analyzed 122,450 review articles with first and last authors from US institutions. Of 85,015 articles by a man last author, 37.5% (31,902) had a woman first author. In contrast, when the last author was a woman, the first author was also a woman in 53.6% of articles (20,078) (p<0.001 for difference). Among review articles with a last author man, there was no change in the proportion of articles with a woman first author before versus after the peak of the #MeToo movement (e.g., p=0.13 for difference between the 12 months following October 2017 compared to the pre-#Me-too period). Among European institutions, of 72,036 articles by a man last author, 43.4% (31,294) had a woman first author, higher than the proportion observed in the USA. Trends in collaboration between first author women and last author men were similar in the USA and Europe after the peak of the #MeToo movement (p=0.65).

CONCLUSIONS

The #MeToo movement was not associated with a reduction in the rate of scientific review article authorship collaborations between first author women and last author men in the life sciences. These findings, if generalizable, suggest it is possible to promote accountability for harassment in the workplace without limiting decreases in collaboration.

Gender trends in cardiothoracic surgery authorship

OBJECTIVE

In recent years, the historically low proportion of women cardiothoracic surgeons and trainees has been a subject of intense focus. Publications remain a key metric of academic success and career advancement. We sought to identify trends in the gender of first and last author publications in cardiothoracic surgery.

METHODS

We searched for publications between 2011 and 2020 in 2 US cardiothoracic surgery journals, identifying those with Medical Subject Heading publication types of clinical trials, observational studies, meta-analyses, commentary, reviews, and case reports. A commercially available, validated software (Gender-API) was used to associate gender with author names. Association of American Medical Colleges Physician Specialty Data Reports were used to identify concurrent changes in the proportion of active women in cardiothoracic surgery.

RESULTS

We identified 6934 (57.1%) pieces of commentary; 3694 (30.4%) case reports; 1030 (8.5%) reviews, systematic analyses, meta-analyses, or observational studies; and 484 (4%) clinical trials. In total, 15,189 total names were included in analysis. Over the 10-year study period, first authorship by women rose from 8.5% to 16% (0.42% per year, on average), whereas the percentage of active US women cardiothoracic physicians rose from 4.6% to 8% (0.42% per year). Last authorship was generally flat over the decade, going from 8.9% in 2011% to 7.8% in 2020 and on average, increased at just 0.06% per year (P = .79).

CONCLUSIONS

Over the past decade, authorship by women has steadily increased, more so at the first author position. Author-volunteered gender identification at the time of manuscript acceptance may be useful to more accurately follow trends in publication.