Gender disparities in shoulder and elbow publications

Persistent Gender Disparity in Authorship of Arthroscopic Surgery Research

Purpose

To examine how the gender of the first and last authors of annual meeting abstracts and journal articles from a related source have changed between 2012 and 2022.

Methods

All abstracts and original research articles published from 2012 to 2022 were extracted from the websites of The Arthroscopy Association of North America and Arthroscopy: The Journal of Arthroscopic and Related Surgery, respectively. The full names of first and last authors were analyzed with the validated Genderize algorithm. Analyses were performed to evaluate authorship of abstracts and articles.

Results

Of 850 abstracts, 845 (99.4%) had an identifiable first-author gender and 843 (99.2%) had an identifiable last-author gender. The proportion of female first authors increased from 9.2% in 2012 to 15.2% in 2022, whereas the proportion of female last authors decreased from 13.5% in 2012 to 12.3% in 2022. Of 4,811 articles, 4,744 (98.6%) had an identifiable first author gender and 4,767 (99.1%) had an identifiable last author gender. The proportion of female first authors increased from 10.4% in 2012 to 16.8% in 2022, whereas the proportion of female last authors decreased from 19.0% in 2012 to 9.1% in 2022. For both abstracts and articles, the gender of the last author was not significantly associated with the presence of a female first author.

Conclusions

Between 2021 and 2022, there was a significant increase in the proportion of female first authors of both abstracts and articles examined in this study. However, a similar increase was not seen among last authors.

Clinical Relevance

It is important to examine gender representation among authors who publish arthroscopic research to understand how a greater balance may be achieved.

Gender influence on career trajectory as a shoulder and elbow surgeon

Background

Women continue to make up a minority of orthopedic surgeons, especially shoulder and elbow surgeons. There exists no study that investigates the effect of gender on one's academic career as a shoulder and elbow orthopedic surgeon, which was the purpose of this cross-sectional study.

Methods

The American Shoulder and Elbow Surgeons website was used to identify surgeons. Demographics, education, and current professional roles were obtained using the websites of institutions, hospital employers, physicians, LinkedIn, and Doximity. Research productivity metrics were obtained using SCOPUS and Google Scholar. Outcome measures included current academic/leadership roles, and research productivity. Statistical analysis was performed using the Chi-squared test and Mann-Whitney U test.

Results

Totally, 893 surgeons were identified, 60 being female (6.7%). Males had a significantly higher average h-index (P = 0.003), total number of publications (P = 0.019), citations (P = 0.03) and ASES membership ranks than female surgeons (P = 0.037; P = 0.004). There were no significant differences between genders in current professional or leadership roles.

Discussion

Female surgeons had a significantly lower number of citations, publications, and h-index but equal leadership positions such as fellowship director, residency director, chief of service, and department chair compared to their male counterparts.

Level of evidence

Level III, cross-sectional study.

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.

What Are the Trends in Women's Representation Among Lead Investigators of Orthopaedic Clinical Trials?

BACKGROUND

Serving as a principal investigator for a clinical trial can bring national visibility and recognition to physicians, and it can have a substantial impact on their promotion and tenure. In the field of orthopaedics, there is a well-known gender gap in terms of representation and leadership. Examining the representation of women in clinical trial leadership may help to inform and enable the design of targeted interventions and policies to foster a more inclusive and diverse environment in clinical trial leadership.

QUESTIONS/PURPOSES

(1) What is the proportion of women principal investigators in orthopaedic clinical trials, and has this changed over time? (2) Are there trial characteristics (trial phase, status, funding source, and intervention) associated with women principal investigators? (3) What is the geographic distribution globally and regionally within the United States of clinical trials led by women principal investigators?

METHODS

A cross-sectional survey of clinical trials using the ClinialTrials.gov registry and results database provided by the NIH was performed on August 22, 2022. Trial characteristics included principal investigator names and gender, trial phase, type, funding source, intervention, and location (defined by continent and US Census region). Our primary outcome was the overall proportion of women orthopaedic principal investigators over time. We assessed this by comparing the proportion of women principal investigators from 2007 to 2022. Our secondary outcomes were trial characteristics (trial phase, status, funding source, and intervention) and geographic distribution (globally and within the United States) associated with women principal investigators. Baseline characteristics of the clinical trials were calculated using frequencies and percentages for categorical variables. Fisher exact tests were conducted to evaluate differences in gender proportions based on the included clinical trial characteristics. Univariate linear regression was applied to analyze trends in the annual proportion of women principal investigators over time.

RESULTS

The overall proportion of women principal investigators was 18% (592 of 3246), and this proportion increased over the study period. Specifically, the proportion of women leading clinical trials was 13% (16 of 121) in 2007 and 22% (53 of 242) in 2022 (r 2 = 0.68; p < 0.001). This trend was also observed when evaluating only US women principal investigators (r 2 = 0.47; p = 0.003) and non-US women principal investigators over the study period (r 2 = 0.298; p = 0.03). There was no difference in the distribution of trial phases between men and women principal investigators. Most men and women were involved in "not applicable" or Phase IV trials. Similarly, there was no difference in trial status or funding source. However, women principal investigators had a higher proportion of studies involving behavioral interventions (11% [67 of 592]) compared with men principal investigators (3% [74 of 2654]; p = 0.03). The proportion of women principal investigators over the study period by world region revealed a higher proportion of women principal investigators in Asia (23% [88 of 391]), followed by South America (24% [12 of 49]), North America (18% [306 of 1746]), and Europe (16% [136 of 833]). Among all US trials over the study period, the proportion of women principal investigators across the US Census region was Northeast (19% [62 of 329]), South (18% [90 of 488]), West (20% [97 of 492]), and Midwest (13% [22 of 168]).

CONCLUSION

Although there has been a notable increase in the proportion of women principal investigators over time, the overall representation remains relatively low. The disparities observed in trial characteristics and geographic distribution of women principal investigators further emphasize the need for targeted interventions and policies to foster a more inclusive and diverse environment in clinical trial leadership.

CLINICAL RELEVANCE

These results underscore the importance of adopting practices and strategies that foster gender equity in the leadership of orthopaedic clinical trials. By establishing mentorship and sponsorship programs, early-career women surgeons can be connected with experienced leaders, cultivating a supportive network and offering valuable career guidance. Additionally, addressing geographic disparities in the representation of women principal investigators can involve the implementation of mentorship and sponsorship programs in regions with lower representation.