Representation of Women and Minority Faculty and Fellows in Academic Pediatric Cardiology Training Programs

Characteristics and Perspectives of Female Pediatric Cardiology Division Chiefs

BACKGROUND

Representation of women at successive career stages decreases within academic pediatric cardiology. Despite equal gender representation among pediatric cardiology trainees and board-eligible pediatric cardiologists, only 13% of U.S. programs have female division chiefs. There is little insight into what drives success among women who, despite these odds, attain the highest levels of academic success and leadership.

OBJECTIVES

The aim of this study was to describe perspectives of women pediatric cardiology chiefs.

METHODS

This was a qualitative study using semistructured virtually conducted interviews. All current and former female chiefs of North American academic pediatric cardiology divisions were invited to participate. We completed inductive thematic analysis of transcribed interviews.

RESULTS

Among eligible individuals, 16 of 20 agreed to participate. While 9 (56%) had worked under female chairs of pediatrics, only 4 (25%) previously had a female division chief. All held formal leadership roles before being chief. All participated in leadership training. Most were married (94%) and had children (81%). Three major findings were identified: "I didn't set out to be chief," which included minor findings of the need for external validation, self-doubt, and late achievement of chief-level leadership; leveraging and discarding stereotypically feminine qualities; and solutions.

CONCLUSIONS

Women who rise to the highest leadership ranks in pediatric cardiology have shared perspectives. These perspectives are influenced by gender norms and inform ideas to address attrition of women in academic pediatric cardiology. Participants emphasized a need for increased awareness of this issue in pediatric cardiology, the importance of sponsorship, access to leadership training/coaching, and workplace and schedule flexibility as potential solutions.

Gender Distribution in Paediatric Cardiology Training Programs in Canada

Background

Despite female medical students being the majority, there are certain medical specialities that continue to have a prevalence of male trainees, such as adult cardiology. The purpose of this study is to examine gender distribution within Canadian paediatric cardiology training programs.

Methods

Both application and successful matches to core paediatric residency programs and paediatric cardiology programs were obtained through the Canadian Resident Matching Service. Analysis was performed to determine if the association between gender of paediatric residents and paediatric cardiology applicants/fellows was significant.

Results

Between 2016 and 2024, 12% (n = 3/26) of individuals who successfully matched into a Canadian paediatric cardiology training program identified as female and 88% (n = 23/26) identified as male. Between 2013 and 2023, 78% (n = 947/1220) of individuals who successfully matched into a Canadian paediatrics residency identified as female and 22% (n = 273/1220) identified as male. There was a statistically significant difference between the gender of paediatric residents and the gender of paediatric cardiology residents (P < 0.0001). There was no significant association between applicant gender and match outcome within paediatric cardiology training programs (P < 0.23).

Conclusions

There is a gender discrepancy within Canadian paediatric cardiology training programs with a predominance of male trainees in the recent era. It appears that female under-representation in the field is due to the low number of female applicants. Although limited by sample size, there was no clear association between applicant gender and success of admission to a paediatric cardiology training program.

JAHA at Scientific Sessions 2023: Moving Toward Social Justice in Cardiovascular Health in the United States

Attention to social justice is essential to improving cardiovascular health outcomes. In the absence of social justice, equitable cardiovascular health is impossible. This viewpoint provides a brief synopsis of the 2023 Journal of the American Heart Association (JAHA)-sponsored session titled "Moving Towards Social Justice in Cardiovascular Health." We define social justice and summarize the burden of cardiovascular disease inequity in the United States. We also highlight strategies for achieving social justice, including addressing workforce diversity, integrating social determinants into cardiovascular research, designing cardiovascular interventions to close the equity gap, and improving inclusivity in cardiovascular disease trials.

What Makes an Effective Chief of Pediatric Cardiology: Insights From Chiefs of North American Pediatric Programs

BACKGROUND

Although the position of a pediatric cardiology chief is often seen as the apex of one's academic career, its roles, responsibilities, and qualifications are not well defined in the literature. This study was done to gain further insight of the role and attributes of a pediatric cardiology chief by surveying those who are currently serving the position across North American centers.

METHODS AND RESULTS

This was a mixed-methods study with a survey given to North American pediatric cardiology chiefs at programs with fellowship training programs. The survey was a semistructured questionnaire that was independently reviewed by 3 cardiologists. Smaller private practice groups and nonacademic programs were excluded. Survey inventory included items rated on a 5-point Likert scale, open-ended prompts, and targeted questions. A total of 40 of 65 (62%) pediatric cardiology chiefs responded to the survey. Respondents identified key chief attributes included communication skills, honesty/transparency, and conflict-resolution skills. Likert scale data demonstrated participants were satisfied with their position, although many reported growing concerns of increased demands from administration, faculty, and pressures of program performance in the current era. There is also a noted paucity of diversity among those serving in leadership positions within pediatric cardiology, which was acknowledged by survey respondents.

CONCLUSIONS

We gathered information directly from current North American pediatric cardiology chiefs examining the current era of its role. There are resounding themes on the emphasis for communication, honesty, conflict resolution, and mentorship. Future studies should examine faculty perceptions and a global perspective of the role.

Mind the Gap! Working Toward Gender Equity in Pediatric and Congenital Heart Disease: Present and Future

Evidence from medicine and other fields has shown that gender diversity results in better decision making and outcomes. The incoming workforce of congenital heart specialists (especially in pediatric cardiology) appears to be more gender balanced, but past studies have shown many inequities. Gender-associated differences in leadership positions, opportunities presented for academic advancement, and recognition for academic contributions to the field persist. In addition, compensation packages remain disparate if evaluated based on gender with equivalent experience and expertise. This review explores these inequities and has suggested individual and institutional changes that could be made to recruit and retain women, monitor the climate of the institution, and identify and eliminate bias in areas like salary and promotions.

Child Health Needs and the Pediatric Cardiology Workforce: 2020-2040

This article evaluates the pediatric cardiology (PC) workforce and forecasts its future supply. Produced as part of a supplement in Pediatrics, this effort represents a collaboration among the American Board of Pediatrics Foundation, the University of North Carolina at Chapel Hill's Carolina Health Workforce Research Center, the Strategic Modeling and Analysis Ltd., and members of the pediatric subspecialty community. PC is a complex subspecialty including care from fetal life through adulthood and in practice settings that range from the outpatient clinic to procedural settings to the cardiac ICU. Complex subdisciplines include imaging, electrophysiology, heart failure, and interventional and critical care. Using American Board of Pediatrics data, US Census Bureau data, and data from the modeling project, projections were created to model the subspecialty workforce through 2040. Across all modeling scenarios considered, there is considerable projected growth in the supply of pediatric cardiologists by 2040. However, there is significant regional variation in the projected supply of trainees relative to demand in terms of local population growth, with evidence of a likely mismatch between areas surrounding training centers versus areas of greatest workforce need. In addition, this article highlights areas for future focus, including efforts to attract more residents to the subspecialty in general, particularly underrepresented minority members; increased support, more part-time career options, and improved academic career advancement for women in PC; and the development of better "real-time" workforce data to guide trainees and training programs in decisions regarding sub-subspecialty job availability.

Health Equity and Policy Considerations for Pediatric and Adult Congenital Heart Disease Care among Minoritized Populations in the United States

Achieving health equity in populations with congenital heart disease (CHD) requires recognizing existing disparities throughout the lifespan that negatively and disproportionately impact specific groups of individuals. These disparities occur at individual, institutional, or system levels and often result in increased morbidity and mortality for marginalized or racially minoritized populations (population subgroups (e.g., ethnic, racial, social, religious) with differential power compared to those deemed to hold the majority power in the population). Creating actionable strategies and solutions to address these health disparities in patients with CHD requires critically examining multilevel factors and health policies that continue to drive health inequities, including varying social determinants of health (SDOH), systemic inequities, and structural racism. In this comprehensive review article, we focus on health equity solutions and health policy considerations for minoritized and marginalized populations with CHD throughout their lifespan in the United States. We review unique challenges that these populations may face and strategies for mitigating disparities in lifelong CHD care. We assess ways to deliver culturally competent CHD care and to help lower-health-literacy populations navigate CHD care. Finally, we review system-level health policies that impact reimbursement and research funding, as well as institutional policies that impact leadership diversity and representation in the workforce.