Organisational best practices towards gender equality in science and medicine

Systemic and organizational barriers and facilitators to the advancement of ethnic minority women nurses in healthcare leadership: A meta-synthesis

OBJECTIVE

This meta-synthesis explored system and organizational-level barriers and facilitators for women in nursing from ethnically minoritized backgrounds that impact their advancement in healthcare leadership. This topic is important because nursing accounts for a significant proportion of the global health workforce, and women represent the majority of the nursing profession, yet, women nurses are underrepresented in healthcare leadership. This disparity is further compounded for women nurses from ethnically minoritized backgrounds, including migrants.

DESIGN

Systematic review methods incorporating meta-synthesis.

DATA SOURCES

Six databases (MEDLINE, EMCARE, EMBASE, PsycINFO, PubMed, and CINAHL) were searched from January 2000 to November 2024 for terms including: "women", "nurses OR midwives", and "leadership". The search was limited to the English language.

REVIEW METHODS

Template analysis was performed to identify system and organizational-level barriers and facilitators that impact on ethnically minoritized women nurses' career progression. Methodological quality of included studies was assessed using the Joanna Briggs Institute Cross-sectional and Prevalence Studies criteria and Critical Appraisal Skills Programme-Qualitative Studies Checklist.

RESULTS

Twenty-one papers were included in this review. Under four main categories, seventeen sub-themes were identified: 1. Systemic/outer setting barriers (skills, education and qualification recognition for migrants; societal racial bias), 2. Systemic/outer setting facilitators (policies; supportive nursing organizations specific to ethnically minoritized women; research, evidence and awareness on racism; representation across all stakeholders in nursing), 3. Organizational/inner setting barriers (lack of support for organizational processes and policies; institutional racism; discriminatory organizational culture; limited access to effective mentoring and networking; ineffective support tools; impact of persistent barriers), and 4. Organizational/inner setting facilitators (organizational processes and policies; organizational culture; mentoring and networking; support tools; training and development).

CONCLUSION

Women nurses from ethnically minoritized backgrounds encounter systemic and organizational-level barriers to healthcare leadership, contributing to their underrepresentation in leadership. Recruitment, promotion, and retention processes for leadership positions are adversely affected, primarily due to bias, inadequate support mechanisms, and discrimination. Addressing these issues and removing structural barriers for women nurses from ethnically minoritized backgrounds requires a systemic and organizational-level approach. By identifying these disparities, healthcare systems can work towards creating equal opportunities for all nurses to advance, resulting in more comprehensive and equitable care delivery.

Shifting landscapes of gender equity in oncology journals: a decade of authorship trends

BACKGROUND

Gender disparities persist in academic oncology, particularly in authorship and senior academic roles. This study evaluates trends in authorship gender representation over the past decade across top oncology journals, focusing on regional, journal-specific, and citation-based disparities.

METHODS

A cross-sectional analysis was conducted on 29,005 articles published between 2014 and 2023 in the top 20 oncology journals, identified through the Web of Science database. Author gender was determined using the NamSor tool. Temporal trends were analyzed using linear regression, and multivariate logistic regression identified factors contributing to gender disparities. Regional and citation analyses explored geographic variations and citation count differences.

RESULTS

Among analyzed articles, 41.81% of first authors and 29.93% of last authors were female. Female first authorship showed a significant upward trend (P < 0.01), with gender parity projected by 2034, while parity for last authors is expected by 2055. Regional differences were notable, with North America and Europe leading in female representation. Certain journals, such as CA: A Cancer Journal for Clinicians and Molecular Cancer, exhibited higher female authorship proportions, while Journal of Clinical Oncology had the lowest. Citation analysis revealed female-authored articles received significantly fewer citations than male-authored ones (P < 0.01).

CONCLUSIONS

Although female authorship in oncology journals has increased over the past decade, disparities remain, particularly in senior roles and citation impact. Addressing these issues requires targeted strategies, including mentorship programs, greater female representation in editorial boards, and institutional policies promoting gender equity.

Representation of women in scientific subjects: overview of systematic reviews investigating career progress in academic publishing with a focus on mental health

BACKGROUND

Women's authorship position in science, technology, engineering, mathematics and medicine research reflects career progression, especially the transition from first to last (usually senior) author. Employment of women in mental health sciences has increased, and so should have had an impact on the change to senior author position.

AIMS

To identify if first or last women's authorship has changed, and mental health has better representation.

METHOD

We investigated women's authorship position in a systematic review and meta-analyses, following PRISMA guidelines and using random-effects regression analyses.

RESULTS

We identified 149 studies with sampling periods from 1975 to 2020 (excluding potential COVID-19 pandemic effects) that showed a large variation of women authors, and found an average proportion for first (26.2%) and last (16.1%) author position. In mental health (psychology and psychiatry), there was a higher representation, with 40% first author and 36.7% last author position, whereas medicine was 25.9% and 19.5%, respectively. The rate of change for psychology and psychiatry women authors was also higher every 10 years: 8.56% (95% CI 6.44-10.69%) for first and 6.86% (95% CI 4.57-9.15%) for last author, and rate was 2.35% higher for first author and 2.65% higher for last author than in medicine. Different methods of classifying gender and identification method did not affect our results.

CONCLUSIONS

Although mental health topics seem to fare better, our comprehensive review highlighted that the proportions of women first compared with last authors shows the same leaky pipeline as in other analyses, so we cannot be complacent about gender equality and career progression.

Inclusion, belonging, and institutional climate - overlooked factors driving diverse STEM faculty turnover?

Faculty turnover at institutes of higher learning disrupts educational continuity, compromises scholarly activity, has negative impacts on learner experiences, and is costly. As such, understanding the reasons why faculty leave-especially in cases where they plan to stay in academia-is critically important with respect to designing and implementing informed retention initiatives. We conducted a survey of STEM faculty who recently switched institutions to gain insights into factors driving their decision to leave. Across all respondents, we found that factors relating to culture/climate were more important than factors relating to pay/compensation or position title. This relative prioritization was even more apparent among women faculty and faculty from disadvantaged backgrounds. We contextualize and discuss the implications of our findings and provide strategies for cultivating inclusive climates to promote faculty retention.

Global perspectives to enhance strategies for advancing women in healthcare and STEMM leadership

The discourse surrounding gender equity has intensified recently, amplified by the impacts of the COVID-19 pandemic, highlighting the critical underrepresentation of women in leadership roles across various sectors including the media and healthcare. In medical research, this disparity is particularly pronounced, with women often excluded from senior positions despite their substantial presence in the workforce. This review seeks to explore the multifaceted issue of gender inequity in medical research leadership, examining the systemic barriers that women face, the socioeconomic factors that compound these challenges and the global variations in leadership representation of women. Diverse leadership teams are essential for fostering medical innovation, improving patient outcomes and ensuring that clinical trials and medical research are effective, inclusive and representative. The underrepresentation of women in leadership roles is not merely a matter of gender bias; it is intricately linked to socioeconomic factors that hinder their advancement. Women from lower socioeconomic backgrounds face additional obstacles, such as limited access to education and professional networks, which further exacerbate their underrepresentation in leadership positions. Moreover, cultural and societal norms play a significant role in shaping the career trajectories of women. As a group of immunologists, including representatives of the International Union of Immunological Sciences (IUIS) Gender Equity Committee, we review the causes of these inequities. We examine the impact of gender-diverse leadership on pre-clinical and medical research, emphasizing the need for inclusive leadership to drive progress in medical research and resulting healthcare. Finally, the review proposes strategies for improving gender equity in medical research leadership, including policy changes, organizational initiatives and societal shifts. By addressing these critical issues, this review contributes to the ongoing efforts to promote gender equity in medical research, ultimately enhancing the quality and inclusiveness of scientific inquiry and its impact on healthcare delivery.

Gender Differences in Authorship and Quality of Anesthesia Clinical Practice Guidelines From 2016 to 2020 Using the Appraisal of Guidelines for Research and Evaluation II Instrument

INTRODUCTION

Women continue to be underrepresented in academic anesthesiology. This study assessed guidelines in anesthesia journals over the past 5 years, evaluating differences in woman-led versus man-led guidelines in terms of author gender, quality, and changes over time. We hypothesized that anesthesia guidelines would be predominately man-led, and that there would be differences in quality between woman-led versus man-led guidelines.

METHODS

All clinical practice guidelines published in the top 10 anesthesia journals were identified as per Clarivate Analytics Impact Factor between 2016 and 2020. Fifty-one guidelines were included for author, gender, and quality analysis using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. Each guideline was assessed across 6 domains and 23 items and given an overall score, overall quality score, and overall rating/recommendation. Stratified and trend analyses were performed for woman-led versus man-led guidelines.

RESULTS

Fifty out of 51 guidelines were included: 1 was excluded due to unidentifiable first-author gender. In total, 255 of 1052 (24%) authors were women, and woman-led guidelines (woman-first author) represented 12 of 50 (24%) overall guidelines. Eighteen percent (9 of 50) of guidelines had all-male authors, and a majority (26 of 50, 52%) had less than one-third of female authors. The overall number and percentage of woman-led guidelines did not change over time. There was a significantly higher percentage of female authors in woman-led versus man-led guidelines, median 39% vs 20% ( P = .012), as well as a significantly higher number of female coauthors in guidelines that were woman-led median 3.5 vs 1.0, P = .049. For quality, there was no significant difference in the overall rating or objective quality of woman- versus man-led guidelines. However, there was a significant increase in the overall rating of all the guidelines over time ( P = .010), driven by the increase in overall rating among man-led guidelines, P = .002. The overall score of guidelines did not increase over time; however, they increased in man-led but not woman-led guidelines. There was no significant correlation between the percentage of female authors per guideline and either overall score or overall rating.

CONCLUSIONS

There is a substantial disparity in the number of women leading and contributing to guidelines which has not improved over time. Woman-led guidelines included more women and a higher percentage of women. There was no difference in quality of guidelines by first-author gender or percentage of female authors. Further systematic and quota-driven sponsorship is needed to promote gender equity, diversity, and inclusion in anesthesia guidelines.

Gender Distribution of Editorial Board Members in Palliative Care Journals: Assessment of Gender Parity

Objective: Although the representation of women in palliative care has improved in recent years, gender inequality still exists in editorial leadership. This study aimed to characterize gender distribution in leadership positions on the editorial boards of palliative care journals. Methods: This cross-sectional study analyzed the gender composition of editorial boards for palliative care journals indexed in the Web of Science (WoS) and the factors that affect this composition. Information on the gender of editorial board members was obtained from each journal's website. Results: A total of 1388 editorial board members from 28 palliative care journals were included in the analysis. The data analysis showed that 540 (38.9%) of the editorial board members were women, while 848 (61.1%) were men. Of the 31 editors-in-chief, only 11 (35.5%) were women. Editorial boards of journals classified as social work (OR, 5.92, 95% CI, 2.29-15.30, p < 0.001) and nursing (OR, 4.20, 95% CI, 1.73-10.17, p = 0.001) in WoS coverage were independently associated with gender diversity. There were differences in gender representation between the editorial boards of palliative care journals published in New Zealand (OR, 0.49, 95% CI, 0.29-0.80, p = 0.005), Japan (OR, 0.17, 95% CI, 0.08-0.32, p < 0.001), and those categorized under oncology in WoS coverage (OR, 0.64, 95% CI, 0.05-0.89, p = 0.009). Conclusions: Our findings demonstrated that women are underrepresented among editorial board members of palliative care journals. Additional efforts are required to broaden diversity policies in palliative care.

[Representation of women in senior positions in emergency medicine]

BACKGROUND

Gender equality and the empowerment of women is one of the 17 Sustainable Development Goals formulated by the United Nations. Gender-specific inequalities still exist, especially in medicine. Women are particularly lacking in leadership positions and in visible roles outside of patient care, such as at conferences and in scientific journals.

AIM

The aim of the study was to analyse the proportion of women in leadership positions in emergency medicine and the visible roles at emergency medicine conferences and scientific journals.

MATERIALS AND METHODS

A selective literature search in PubMed and an evaluation of the conference programmes from 2020-2021 as well as the editorial boards of journals were conducted with regard to the proportion of women.

RESULTS

Women continue to be significantly underrepresented on the editorial boards of emergency medicine journals and on the boards of leading emergency medicine organisations. Internationally, there are already programmes to increase the proportion of women in field of publications and scientific conferences; to date, there are only a few such programmes for women in emergency medicine in Germany.

CONCLUSION

Women in healthcare in general and in emergency medicine in particular are not equally represented outside of patient care. To date, there are hardly any programmes to promote women in emergency medicine in Germany. Mentoring, collegial support and organisational change are key to increasing the proportion of women in nonpatient care roles in emergency medicine.

Exploring the stability of the gender gap in faculty perceptions of gender climate at a rural regional university

Increasing awareness of gender barriers and biases in academic institutions is an essential component of institutional change strategies to promote equity and inclusion. There is an established perception gap in recognizing gender inequities in the workplace, whereby men faculty under acknowledge the stressors, barriers, and biases faced by their women faculty colleagues. This study explored the gender gap in faculty perceptions of institutional diversity climate at a rural comprehensive regional university in the United States. In addition to gender, differences across academic discipline and time were explored using 2 (men and women) x 2 (STEM and other) x 2 (2017 and 2022) between-groups ANOVAs. Results revealed a gender gap that persisted across time and perceptions of stressors, diversity climate, student behavior, leadership, and fairness in promotion/tenure procedures, with marginalized (women) faculty consistently reporting greater barriers/concern for women faculty relative to the perceptions of their men faculty colleagues. These findings are largely consistent with the extant literature and are discussed both with regard to future research directions and recommendations for reducing the perception gap and addressing institutional barriers to gender equity.

Perceptions of gender equity among critical care and other health professionals: A cross-sectional survey

OBJECTIVE

The objective of this study was to determine the association between gender and perceived gender equity in the critical care workforce and other health specialties.

DESIGN AND SETTING

We conducted an online cross-sectional survey between September and November 2020. Data on demographics and perceptions of equity including the representation of women across departments and in leadership roles, knowledge of and access to flexible work practices and carers leave, and opportunities for promotion were collected.

PARTICIPANTS

The study population included health professionals from critical care (defined as intensive care and emergency) and other specialties. We conducted a descriptive gender-disaggregated analysis.

RESULTS

A total of 478 respondents (70% women) completed the survey. The mean age of respondents was 43.9 ± 11.2 years. Approximately half of respondents were medical practitioners (n = 235, 54%), followed by nurses (n = 135, 36%)-the remainder were from other professions. The critical care workforce accounted for 280 (64%) of responder practice settings. Statistically significant differences were reported between genders on issues such as having confidence that their department would resolve equity issues (87 [70.7%] men vs. 146 [48.2%] women; p = 0.007), access to flexible work practices (5/124 [4.0%] men vs. 20/305 [6.6%] women p = 0.001), and taking unpaid leave for carer responsibilities (91 [30.3%] women vs 9 [7.4%] men, p < 0.001).

CONCLUSIONS

This work highlights differences in how men and women perceive gender equity, particularly in the critical care workforce. These findings are important to understand health care practitioners' perceptions of gender equity, as these perceptions inform behaviour.

Transforming higher education institutions through EDI leadership: A bibliometric exploration

This comprehensive bibliometric study analyzes 1820 journal articles from the Web of Science database to explore Equity, Diversity, and Inclusion (EDI) leadership in higher education institutions (HEIs). Utilizing co-citation and co-word analysis, the study identifies distinct thematic clusters. The co-citation analysis reveals five key themes: Race, Diversity, and Inclusion (RDI), Diversity, Leadership, and Self-Efficacy (DLSE), Gender Dynamics and Leadership Challenges, Women's Representation in Academic Medicine Leadership, and Transformational Leadership in HEIs. Meanwhile, the co-word analysis highlights three critical areas: Transformative Collaborative Resilience in HEIs, Advancing Gender Equality in Academic Medicine and STEM, and Inclusive Educational Leadership in HEIs. These themes collectively provide a deep understanding of the EDI leadership field's intellectual structure, suggesting significant areas for future research and practical application. The study emphasizes the necessity for HEIs to engage comprehensively in EDI leadership research, shedding light on the importance of transformative collaborative resilience, gender equality in STEM, and inclusive leadership. This research offers valuable insights for developing effective EDI leadership policies and practices, highlighting the interconnectedness of these themes in fostering a more equitable, diverse, and inclusive environment in higher education and beyond.

Discrimination and dental students: What is the reality in Brazilian institutions?

INTRODUCTION

This study aimed to evaluate whether there is discrimination in the dental educational environment, assess the main reasons for the discriminatory events, and if there is an association between discriminatory episodes and sociodemographic characteristics of undergraduate dental students.

MATERIALS AND METHODS

This observational cross-sectional study was conducted with a self-administered questionnaire to students enrolled in three Brazilian dental schools. Questions included sociodemographic characteristics and the occurrence of discriminatory episodes in the dental academic environment. Descriptive analysis was performed in RStudio 1.3 (R Core Team, RStudio, Inc., Boston, USA) software and the associations were tested using Pearson's chi-square test, considering 95% confidence intervals.

RESULTS

A total of 732 dental students were included, with a response rate of 70.2%. The vast majority of students were female (66.9%), with white/yellow skin colour (67.9%), and with a mean age of 22.6 (SD 4.1) years. Sixth-eight percent of students reported having experienced some discrimination in the academic environment and most reported feeling uncomfortable with the episode. The main reasons to have been discriminated against raised by students were specific behaviour/habit, have specific moral, ethical, and aesthetic values, gender, and socioeconomic status or social class. The occurrence of discriminatory episodes was associated with female gender (p = .05), non-heterosexual sexual orientation (p < .001), studying in public institutions (p < .001), receiving an institutional scholarship (p = .018), and being in the final undergraduate cycle (p < .001).

CONCLUSION

The occurrence of discriminatory episodes was common in Brazilian dental higher education. Discriminatory situations generate traumas and psychological marks, causing a loss of diversity within the academic environment that leads to loss of productivity, creativity, and innovation. Thus, strong institutional policies against discrimination are crucial to create a healthy dental academic environment.

Barriers to advancing women nurses in healthcare leadership: a systematic review and meta-synthesis

Background

Women comprise the majority of the nursing profession, yet nurses are underrepresented in healthcare leadership. We aimed to explore barriers for women nurses to advance in healthcare leadership to inform organisational interventions for career advancement.

Methods

In this systematic review and meta-synthesis, studies examining advancing women nurses and midwives in leadership within healthcare and academia in the international literature were included. Six databases (MEDLINE, EMCARE, EMBASE, PsycINFO, PubMed, and CINAHL PLUS) were searched for studies published in English between January 1 2000 and October 17 2023. The Grading of Recommendations Assessment, Development, and Evaluation tools (GRADE) was followed to assess confidence in the findings. Retrieved full texts were assessed for methodological rigour using the Critical Appraisal Skill Programme Qualitative Studies checklist and the Joanna Briggs Institute Cross-sectional and Prevalence Studies checklists. Reported barriers for women nurses' leadership attainment were identified and generated themes were mapped to the Abilities, Motivation, and Opportunities (AMO) framework.

Findings

There were 32 eligible studies; 18 qualitative, 11 quantitative, and 3 mixed-methods. Studies included high-income countries (n = 20), middle-income countries (n = 7) and across countries (n = 3) with two unspecified. Samples included registered nurses, nurse academics, executives, and leaders. The key barriers highlighted were related to: role modelling and leadership development (ability); multiple complex and interacting factors, including gender stereotyping, perception of professionalism, human relations policies, and gender bias (motivation); and systemic issues, such as organisational setting, structure, and support (opportunity).

Interpretation

The prevailing belief in the literature is that caregiving is a feminine occupation and along with societal expectations of women's subordinate position, these present substantial obstacles that limit women nurses from advancing into healthcare leadership. Ultimately, these factors restrict women nurses in career advancement and need to be addressed at a systems and organisational level.

Funding

The National Health and Medical Research Council (NHMRC), Australia.

Organisational Strategies for Women Nurses to Advance in Healthcare Leadership: A Systematic Review

Aim

We aimed to undertake a systematic review focusing on organisational strategies that specifically advance women nurses in healthcare leadership.

Background

Despite nursing being the largest health workforce and being dominated by women, they face significant barriers in career progression and have limited leadership opportunities, with a need to move from a focus on individuals to organisational level change.

Methods

Methods for our overarching systematic review are published and follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Databases searched include MEDLINE via OVID; MEDLINE in-process and other nonindexed citations via OVID; PsycINFO; and Scopus. Any study describing a strategy that was not implemented for nurses and all non-peer-reviewed studies were excluded. Included studies were appraised using CASP checklists. A thematic analysis approach was employed to facilitate the systematic generation of themes.

Results

Findings were reported under two main themes: leadership barriers and enablers and organisational strategies for advancing women nurses to leadership. The latter included: mentorship, leadership training, career planning and coaching, opportunities for networking, sponsorship, and targeted recruitment processes for increasing gender diversity in leadership roles.

Conclusion

This review synthesises organisational-level strategies that advance women nurses in healthcare leadership. Barriers and individual-level strategies for advancing women nurses in healthcare leadership have been extensively studied in the current literature. Systems and organisational strategies are less studied yet show that they can advance women in nursing into healthcare leadership. Implications for Nursing Management. This paper suggests that optimising women nurses' leadership attainment needs to shift focus from individual strategies to systemic level and organisational strategies and use tailored evidenced-based approaches.

Leadership through a gender lens: Disparities in Dental Research

This study aimed to analyze the 100 most-cited papers in Dentistry, with a focus on female leadership in dental research. Papers were retrieved from the Web of Science Core Collection (WoS- CC) in the category 'Dentistry, Oral Surgery & Medicine'. Gender was assessed through WoS-CC, Scopus, ResearchGate, social media, institutional websites, and software that assigns gender according to first names (https://genderapi.io). Characteristics of authors in leadership roles were retrieved, such as affiliation, publication history, citations, H factor, and i500. The 100 most-cited papers in Dentistry were authored by 394 researchers, 326 (82.7%) men, and 68 (17.3%) women - there were 4.8 male authors for each female. Among the lead authors, there were 11.3 males for each female. Among female senior authors, there were 7 males for each female. Among lead/senior authors of the 100 most-cited papers (first and last authors, respectively), 18 were women. There was an increase in the participation of women in the top cited papers regardless of authorship role across the six decades, with a peak of two female authors in the first decade of the 21st century. For female authors in leadership roles, their publication history shows the time between their first and last papers in WoS-CC ranged from 4 to 42 years for lead authors and 1 to 39 years for senior authors. Women were found to be largely underrepresented as leaders of the 100 most-cited papers, highlighting pervasive gender inequalities in dental research publications.

Ranking versus rating in peer review of research grant applications

The allocation of public funds for research has been predominantly based on peer review where reviewers are asked to rate an application on some form of ordinal scale from poor to excellent. Poor reliability and bias of peer review rating has led funding agencies to experiment with different approaches to assess applications. In this study, we compared the reliability and potential sources of bias associated with application rating with those of application ranking in 3,156 applications to the Canadian Institutes of Health Research. Ranking was more reliable than rating and less susceptible to the characteristics of the review panel, such as level of expertise and experience, for both reliability and potential sources of bias. However, both rating and ranking penalized early career investigators and favoured older applicants. Sex bias was only evident for rating and only when the applicant's H-index was at the lower end of the H-index distribution. We conclude that when compared to rating, ranking provides a more reliable assessment of the quality of research applications, is not as influenced by reviewer expertise or experience, and is associated with fewer sources of bias. Research funding agencies should consider adopting ranking methods to improve the quality of funding decisions in health research.

Gender inequities in dental research publications: Findings from 20 years

BACKGROUND

The first steps towards gender equity in science are measuring the magnitude of inequity and increasing awareness of the problem.

OBJECTIVES

To describe trends in gender disparities in first and last authorship in the most cited dental publications and general dental literature over a 20-year period.

METHODS

Articles and bibliometric data were retrieved from the Scopus database for the period 1996 to 2015. Two groups of 1000 articles each were retrieved: a random sample and another sample of top-cited articles for each year. The gender of the first and last author of each publication was manually identified. When this was not possible, we used an online software platform (https://genderize.io/). Descriptive analyses identified the proportion of women first and last authors in both samples, stratifying by dental discipline and geographic region. Trends were ascertained by frequency metrics across years. Gender disparity was observed in both first and last authorship, with a larger gap being observed in the top-cited sample.

RESULTS

Women led 28.4% and 20.3% of articles in the random and top-cited samples, respectively. A similar pattern was observed for the last authorship group (22.1% and 16.1%, respectively). An increasing trend in the proportion of articles led by women over time was observed in both samples. This increase was larger in the top-cited sample (from 15.0% in 1996-2000 to 25.1% in 2015) than in the random sample (from 26.3% in 1996-2000 to 33.2% in 2011).

CONCLUSIONS

Clear gender disparities in dental research publications in the last 20 years were identified in both general and top-cited manuscripts, across dental disciplines, across countries, across first and last authorship, and over time. It is paramount that actions are taken to attract, retain and promote women in science, as well as to monitor and ensure progress towards gender equity.

Saudi women's leadership experiences in the healthcare sector: A qualitative study

BACKGROUND

Gender equality in the workforce and the promotion of woman leadership is critical to economic growth and the sustainable development of society and the global community. However, gender diversity in leadership positions is a concern as women continue to be underrepresented. Ensuring equal opportunities in leadership positions in the health sector can help advance the achievement of the sustainable development goals (SDGs).

PURPOSE

The aim of this study was to explore Saudi women's perspectives and leadership experiences at senior-level positions in the healthcare sector.

METHODS

A descriptive qualitative approach was adopted to address the study aim. This included nine semi-structured interviews with Saudi women who have held leadership positions in the health sector over the past ten years. Reflexive thematic analysis was conducted by adopting the six phases.

RESULTS

The results showed that internal factors, such as qualifications, experience, and the innate qualities of a winner, are the most important factors that contribute to women's leadership. Women's role expectations, gender norms, and the patriarchal nature of the community have a negative impact on women's leadership. One of the new findings of this study was negative attitudes and lack of support from female colleagues.

CONCLUSION

Women leaders in health care in Saudi Arabia share similarities and differences with women leaders around the world. However, the Saudi community has its own social norms and gender roles that cannot be denied. While Vision 2030 brought a number of positive changes in women's empowerment that participants spoke of, more research is needed to explore men's perceptions, which can complete the picture and lead to organizational improvement and changes.

Equity, Diversity and Inclusion (EDI) in Organ Transplantation: An ESOT Survey About EDI Within ESOT as an Organization and its Educational Activities, and Transplantation Research and Science

The European Society of Organ Transplantation (ESOT) strives to promote equity, diversity, and inclusion (EDI) across all its activities. We surveyed the transplant community's experiences and perspectives regarding EDI within ESOT as an organization and its educational activities, and research in general. A total of 299 respondents completed the questionnaire. About half agreed that ESOT's Executive Committee, Council, and Sections/Committees are diverse and inclusive (51%) and that ESOT promotes EDI in its live and digital educational activities (54%). Forty percent of respondents agreed that scientific and clinical trials in the field of transplantation are diverse and inclusive. Despite the wide distribution of the survey, most of the respondents self-identified as White and were either physician or surgeon. However, the results contribute a unique insight into the experiences and perspectives of the transplantation community regarding EDI. Whilst ESOT is committed to the principles of EDI, perceptions and the high number of proposals show the apparent need to prioritize efforts to embed EDI across ESOT and transplantation science. These data should constitute a starting point for change and provide guidance for future efforts to promote EDI within the transplantation community.

Accomplished women leaders in informatics: insights about successful careers

We sought to learn from the experiences of women leaders in informatics by interviewing women in Informatics leadership roles. Participants reported career challenges, how they built confidence, advice to their younger selves, and suggestions for attracting and retaining additional women. Respondents were 16 women in leadership roles in academia (n = 9) and industry (n = 7). We conducted a thematic analysis revealing: (1) careers in informatics are serendipitous and nurtured by supportive communities, (2) challenges in leadership were profoundly related to gender issues, (3) "Big wins" in informatics careers were about making a difference, and (4) women leaders highlighted resilience, excellence, and personal authenticity as important for future women leaders. Sexism is undeniably present, although not all participants reported overt gender barriers. Confidence and authenticity in leadership point to the value offered by individual leaders. The next step is to continue to foster an informatics culture that encourages authenticity across the gender spectrum.

Impact of gender inequality on the educational and career development of young epileptologists in Italy: A survey of the Young Epilepsy Section - Italian chapter

OBJECTIVE

The Young Epilepsy Section-Italian chapter (YES-I) is the Italian section of the International League Against Epilepsy (ILAE)-YES. It was founded in 2019 with the aim of increasing the involvement of young epileptologists within scientific associations and facilitating their educational training. The Education and Career Task Force designed a survey on the impact of gender inequality on the educational and professional growth of young epileptologists.

METHODS

The survey was proposed via QR code during the 43rd National Congress of the Italian League Against Epilepsy (Padua, 8-10 June 2022), and subsequently distributed via email until 7th September 2022.

RESULTS

Of the respondents, 73.6% were female. Of note, 51% of the entire sample answered that they found "no impact" of gender on educational activities (64.3% male against 46.1% female). Only 10% of women stated they have seen very much gender-related inequality in their education or career. However, the majority of our cohort (66%) thought that gender had a negative impact on progression within a scientific society, as well as in female leadership roles in clinical practice (67.9%). Furthermore female medical staff received little work recognition (56.6%). Lastly, 83% of responders did not have children, and only 37.7% declared their colleagues to be empathic in relation to absences for family emergencies.

CONCLUSIONS

Lack of awareness of the gender inequality issue might explain inconsistencies in the findings of our survey. Despite the remarkable progress of women rights over the last century, our survey suggests that disparities in academic and decision-making roles exist also in the epileptology field.

Relationship Between Gender and Academic and Military Achievement Among USU Medical School Graduates

INTRODUCTION

Despite increases in the number of female matriculants in medical school, civilian data demonstrate that women still struggle to reach parity in attainment of leadership positions. In military medicine, we have seen a major increase in the number of women graduating from the USU. Yet, we still know little about the representation of female military physicians in leadership positions. The aim of this study is to examine the relationship between gender and academic and military achievement among USU School of Medicine graduates.

METHODS

Utilizing the USU alumni survey sent to graduates from the classes of 1980 to 2017, items of interest, such as highest military rank, leadership positions held, academic rank, and time in service, were used to evaluate the relationship between gender and academic and military achievement. Contingency table statistical analysis was conducted to compare the gender distribution on the survey items of interest.

RESULTS

Pairwise comparison demonstrated significant differences between gender in the O-4 (P = .003) and O-6 (P = .0002) groups, with females having a higher-than-expected number of O-4 officers and males having a higher-than-expected number of O-6 officers. These differences persisted in a subsample analysis that excluded those who separated from active duty prior to 20 years of service. There was a significant association between gender and holding the position of commanding officer (χ2(1) = 6.61, P < .05) with fewer females than expected. In addition, there was a significant association between gender and the highest academic rank achieved (χ2(3) = 9.48, P < 0.05) with lower-than-expected number of females reaching the level of full professor, in contrast to males who exceed the expected number.

CONCLUSIONS

This study suggests that female graduates of USU School of Medicine have not achieved promotion to the highest levels of rank, military, or academic leadership at the projected rate. Efforts to explore what barriers may impact military medicine's desire to have more equal representation of women in higher ranks and positions should be undertaken with specific attention to what drives retention versus separation of medical officers and if systematic changes are needed to help promote equity for women in military medicine.

Academic benchmark of highly influential ophthalmologists listed in the ophthalmology power list

OBJECTIVE

To review the academic benchmark of highly influential ophthalmologists listed in the ophthalmology '2020 Power List'.

METHODS

In this cross-sectional study, the academic profiles, achievements, and bibliometric profiles of all ophthalmologists listed in the 'Power List of 2020', regarded as the most influential figures in ophthalmology today, were analysed.

RESULTS

Ninety-five ophthalmologists were studied, after excluding 10 non-ophthalmologist figures that are also listed. Their mean age is 63 ± 11.7 years, with a strong male predominance (84.2%, n = 80 males, P < 0.001). All have a medical doctorate degree, and 31% (n = 29) have a Philosophy Doctor (PhD) degree. Fifty-three percent (n = 51) are graduates of medical schools in the United States (US). However, non-US ophthalmologists have a higher percentage of PhD degrees (41%, 18/44) vs. US ophthalmologists (22%, 11/51, P = 0.069), and also a longer duration of post-residency training (5.8 ± 3.1 vs. 1.8 ± 0.9 years, P < 0.001). The most common subspecialty was cataract and anterior segment surgery (42%, n = 40). The mean and standard deviation of the total number of papers published by ophthalmologists were 307.4 ± 226.3, with a mean citation record of 11,835.7 ± 13,330.5, and a mean h-index of 46.9 ± 27.9.

CONCLUSIONS

The ophthalmologists listed on the 'Power List of 2020' are leaders with high accomplishments and an established interest in research evidenced by a high record of publications and an exceptional bibliometric profile. The list contains more US figures with a gender disparity, demonstrating a greater difficulty for international ophthalmologists, especially women, in achieving this high level of recognition.

Gender distribution and women leadership in German Otolaryngology, Head and Neck Surgery

Objective

To determine the distribution of female physicians throughout the rank from resident to leadership positions in German Otolaryngology-Head and Neck Surgery (OHNS) departments.

Methods

This cross-sectional study collected data about the physician workforce in the German OHNS.The primary outcome was the proportion of female physicians. Data were collected from 165 departments from January 2022 to February 2022. The physician workforce was stratified based on gender and leadership.

Results

We included 2089 physicians from 165 departments of OHNS in German hospitals. Female residents and specialists outnumbered male peers (484/872 [55.5%] vs. 388/872 [44.5%] and 224/363 [61.71%] vs. 139/363 [38.29%], respectively). However, the women proportion decreased gradually with elevated hierarchical rank starting at the attending physician level to reaching its lowest extreme (14/165 [7.23%]) at the head of the department level. Holding a leadership position was associated with being male (n = 282 [85.2%] vs. n = 49 [14.8%], p < .0001). This persisted even after controlling the academic rank in a multivariable regression model (OR: 5.027, 95% CI: 3.536-7.146). The gap between the two genders in favor of men regarding leadership persisted in all kinds of hospitals. However, this disparity was lowest in university hospitals, (male: n = 83 [78.3%] vs. female: n = 23, [21.7%], p < .0001).

Conclusions

Even though women outnumbered men in resident and specialist positions, they are still underrepresented in leadership positions in OHNS. Continuous surveillance is needed to watch the dynamic changes in the gap between the two genders and address it with more sex equality-supporting policies.

Level of Evidence

IV.

A vision to advance gender equality within pharmacy leadership: Next steps to take the profession forward

The United Nations Sustainable Development Goal 5 to 'achieve gender equality and empower all women and girls' aims to eliminate all forms of discrimination against women and girls and ensure their full and effective participation in all spheres of life. In alignment with this, several key international initiatives are making progress towards gender equality in the pharmacy profession. The pharmacy profession must support women and accelerate the progress of women in leadership positions in pharmacy. International and national pharmacy professional bodies can play a critical role in fostering the change required to improve gender equality in all regions and countries. The ongoing development, evaluation and implementation of policies and initiatives are critical to a profession that is increasingly becoming feminised. Furthermore, there is an imperative to deeply understand the gender-based barriers and develop evidence-based strategies and solutions to support women in pharmacy leadership. There is extensive literature and research on gender inequality and its impact on leadership outside pharmacy which could be used strategically for the profession to develop its own evidence based strategic position. Robust initiatives are needed to ensure that women at all levels including women in pharmacy leadership are empowered and encouraged to participate in their profession. This commentary seeks to generate and contribute to the debate to ensure the profession is proactive and deliberate in tackling the challenges that have traditionally impeded women reaching leadership positions and several critical actions as next steps are proposed. Action is needed to improve gender equality in pharmacy leadership and a profession-wide discussion on ways to progress the above proposed actions is critically needed.

Experiences of Organizational Practices That Advance Women in Health Care Leadership

Importance

Women are underrepresented in health care leadership positions. Organizational practices and culture play a key role in mitigating this disparity.

Objective

To explore the experiences of women in leadership roles and inform how health care organizations can support the advancement of women into leadership.

Design, Setting, and Participants

This qualitative study used a constructivist grounded theory approach applied over a 1-year period (May 1, 2021, to May 31, 2022) in a large private health care network in Australia. Women were eligible if they had been in leadership positions for more than 5 years. Purposive and theoretical sampling guided recruitment of 28 women, representing medical, nursing, and allied health specialties. Interviews lasted 1 hour, producing 500 pages of transcripts for analysis.

Main Outcomes and Measures

The primary outcome was a model of organizational practices and conditions that advance women in health care leadership, extrapolated from the collective experiences of women in leadership. Key elements pertained to organizational patterns of interaction and group norms and behaviors that contributed toward women's experiences of career advancement.

Results

Overall, 28 women (23 [82%] White; 3 [11%] Southeast Asian) participated in the study, 10 (36%) of whom were in nursing, 9 (32%) of whom were in allied health, and 9 (32%) of whom were in medical disciplines. Organizational practices that advance women in health care leadership were highly dependent on conducive organizational culture enhancing women's credibility and capability as leaders. Four interrelated elements were identified that create the necessary conditions for an organizational culture to advance women in health care leadership, including (1) identifying and actively addressing systemic barriers, (2) challenging gendered assumptions and expectations of leadership behaviors, (3) providing mentorship to shape career opportunities, and (4) determining how these conditions all contribute toward raising women's credibility to enable internalizing a leadership identity. For women, advancing to leadership involved organizations moving away from ad hoc, inconsistent applications of gender equity practices and generating supportive practices that reinforced a workforce culture of credibility, collaboration, and continuous improvement to support women.

Conclusions and Relevance

In light of persisting inequity in health care leadership, women's experiences were captured in this qualitative study to identify organizational practices that support their advancement. Insights into factors that influence efficacy of these practices, including building a supportive culture and mentoring, are discussed. This research informs a National Health and Medical Research Council initiative with international collaborators to support organizations in advancing women in health care leadership.

Moving toward gender equity in the cardiology and cardiovascular research workforce in Germany: a report from the German Cardiac Society

Aims

Although the share of women in cardiology in Germany is growing steadily, this does not translate into leadership positions. Medical societies play a crucial role in shaping the national and international medical and scientific environment. The German Cardiac Society (DGK) aims to serve the public discourse on gender-equity by systematic analysis of data on gender representation within the society and in Germany.

Methods and results

We present gender disaggregated data collection of members, official organs, working groups, scientific meetings, as well as awards of the DGK based on anonymized exports from the DGK office as well as on data gathered from the DGK web page. From 2000 to 2020, the overall number of DGK members as well as the share of women increased (12.5% to 25.3%). In 2021, the share of women ranged from 40% to 50% in earlier career stages but was substantially lower at senior levels (23.9% of consulting/attending physicians, 7.1% of physicians-in-chief, 3.4% of directors). The share of women serving in DGK working groups had gained overall proportionality, but nuclei and speaker positions were largely held by men. Boards and project groups were predominantly represented by men as well. At the DGK-led scientific meetings, women contributed more often in junior relative to (invited) senior roles.

Conclusion

Increasing numbers of women in cardiology and in the DGK over the past 20 years did not translate into the respective increase in representation of women in leadership positions. There is an urgent need to identify and, more importantly, to overcome barriers towards gender equity. Transparent presentation of society-related data is the first step for future targeted actions in this regard.

Macro-level gender equality and women's depressive symptoms in South Korea: a longitudinal study

PURPOSE

In 2014, the Korean Government passed the Gender Equality Act, which was accompanied by policies to increase women's participation in the labour force and representation in positions of power in the public and private sectors. While Korea has witnessed modest progress in macro-level gender equality, little is known about the effects of these changes on mental health outcomes. Our study investigated the relationship between regional-level gender equality (as measured by women's economic and political power) and women's depressive symptoms from 2013-18, and whether the effects differed across women from different socioeconomic positions.

METHODS

To examine how change over time in political and economic power influences the severity of depressive symptoms, we applied a fixed-effect regression, using a nationally representative sample for women aged 19-64 (n = 9,589) from the Korean Longitudinal Survey of Women and Families (2013-2018, wave 4 to 6) residing across the 16 regions of South Korea.

RESULTS

Our study found that increases in women's political and economic power led to moderate reductions in depressive symptoms (-0.25 and -0.23 points in CESD respectively). Sensitivity analyses indicate that economic power is more consistently associated with subsequent reductions in CESD. The effect of economic and political power on depressive symptoms did not differ by women's socioeconomic positions.

CONCLUSIONS

Our findings suggest that even modest improvements in gender equality were associated with increases in women's mental health. Further progress to ensure gender equality, such as the anti-discrimination legislation, may lead to greater improvements in public mental health.

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.

The evolution of leadership: analyzing the presidents of American Dermatology Societies overtime

Within organized dermatology, it is imperative that leaders embody a diverse group of individuals, reflective of the dermatologists they represent and the greater U.S. population. Despite women constituting more than half of the dermatologic workforce, they represent a leadership minority in dermatology society higher level positions. This gap is evident by fewer women holding presidency positions within prominent dermatological societies; however, a comprehensive comparison across multiple societies has yet to be made. Our study analyzes and compares demographic as well as academic metrics of presidents from 16 prominent dermatology societies spanning 22 years, 2000-2021. Data were collected using organization websites, which demonstrated 247 unique presidents over 22 years. Of these presidents, 175 (70.9%) were male and 72 (29.1%) were female. Surgically focused societies had 63 (87.5%) male presidents and nine (12.5%) female presidents, while clinically focused societies had 112 (64.0%) male presidents and 63 (36.0%) female presidents (P < 0.0002). The publication h-index, academic rank, chairmanship, and number of advanced degrees, and total number of years in practice prior to election did not significantly differ between male and female leaders. There was no statistically significant difference in the proportion of female presidents across all societies between 2000 and 2021 by Cochran Armitage Trend Test. However, between 2016 and 2021, 35% of presidents were female and a general trend toward more gender balance may be noticed. This equality goal should continue to be emphasized in organized medicine.

Barriers to gender equality in STEMM: do leaders have the gender competence for change?

Purpose

Science, technology, engineering, mathematics and medicine (STEMM) workplaces worldwide remain stubbornly resistant to gender equality initiatives. Leaders are vital to driving change, but the extent to which their capabilities lead to change remains unknown. This article examines STEMM leaders' gender competence to achieving transformative changes in gender inequality.

Design/methodology/approach

This article examines the capability of STEMM leaders to act as change agents through an in-depth, qualitative analysis of perceptions of gender inequality, sexual harassment, sex discrimination and gender bias within their organisations. Findings are analysed using a customised tripartite gender competence schema, comprising commitment, knowledge and method (or know-how).

Findings

The findings suggest that while STEMM leaders may express a commitment to addressing gender inequality, misapprehensions about the nature and scope of the problem are likely to hamper efforts. Two key misapprehensions standout: a tendency to frame gender inequality in primarily numerical terms; and recourse to blaming external factors beyond STEMM for gender inequality in STEMM.

Originality/value

This article makes an original contribution by examining the gender competence of leaders in STEMM organisations, which has not been previously researched. The findings extend understanding of the salience of leaders' capabilities to lead change by identifying key gaps and misapprehensions in STEMM leaders' understanding of the nature and scope of the problem.

Physician Men Leaders in Emergency Medicine Bearing Witness to Gender-Based Discrimination

IMPORTANCE

Approximately 60% of women physicians in emergency medicine (EM) experience gender-based discrimination (GBD). Women physicians are also more likely to experience GBD than men physicians, particularly from patients, other physicians, or nursing staff.

OBJECTIVE

To describe the responses of men who are academic department chairs in EM to GBD directed toward a woman colleague.

DESIGN, SETTING, AND PARTICIPANTS

This qualitative study was a secondary data analysis drawn from interviews of men EM academic department chairs at 18 sites who participated in a qualitative descriptive study between April 2020 and February 2021 on their perceptions of the influence of gender and leadership in academic medicine. Narrative data related to GBD were extracted and coded using conventional content analysis. Codes were clustered into themes and subthemes and summarized. Data were analyzed from November to December 2021.

EXPOSURE

Semistructured interviews conducted via teleconferencing.

MAIN OUTCOMES AND MEASURES

Qualitative findings identifying experiences witnessing or learning about incidents of GBD against women colleagues, the impact of these observations, and personal or leadership actions taken in response to their observations.

RESULTS

All 18 men participants (mean [SD] age, 52.2 [7.5] years; mean [SD] time as a department chair, 7.2 [5.1] years) discussed witnessing or learning about incidents of GBD against women colleagues. The participant narratives revealed 3 themes: emotional responses to GBD, actions they took to address GBD, and reasons for not taking action to address GBD. When witnessing GBD, participants felt anger, disbelief, guilt, and shame. To take action, they served as upstanders, confronted and reported discrimination, provided faculty development on GBD, or enforced "zero-tolerance" policies. At times they did not take action because they did not believe the GBD warranted a response, perceived a power differential or an unsupportive institutional culture, or sought self-preservation.

CONCLUSIONS AND RELEVANCE

In this qualitative study of men physician leaders, we found all participants reported feeling troubled by GBD against women colleagues and, if possible, took action to address the discrimination. At times they did not take action because of unsupportive workplace cultures. These findings suggest that institutional culture change that supports the interventions of upstanders and does not tolerate GBD is needed.

Social Media and Cardiovascular Health: Implications for Women

PURPOSE OF REVIEW

Cardiovascular disease (CVD) is the leading cause of mortality in adult women in the USA, yet CVD is underrecognized in women. Disparities in care are further pronounced in women of racial/ethnic minority backgrounds. In this review, we discuss the role of social media (SoMe) as a tool to (i) promote women's cardiovascular (CV) health and (ii) address and potentially reduce gaps in care, particularly in general cardiology (targeting atherosclerotic cardiovascular disease), cardio-oncology, and cardio-obstetrics. We also briefly discuss women's CV health as a common, although not unique, focus of women in cardiology on SoMe.

RECENT FINDINGS

Studies have suggested the utility of social media to help advance subspecialties of cardiology. Leaders within general cardiology, cardio-oncology, and cardio-obstetrics have curated social media strategies to advance their respective fields and call attention to cardiovascular health disparities in female populations and racial/ethnic minorities. In addition to these types of uses, women in cardiology also frequently use SoMe to encourage a career in cardiology and to share experiences, challenges, and resources for support and career advancement as healthcare professionals; men in cardiology and especially those who are allies for sex and racial/ethnic minorities also use SoMe for these means. Herein, we highlight the role and myriad applications of social media in the promotion of women's cardiovascular health. We discuss five primary roles of social media: increasing public awareness, disseminating medical literature in a rapid and accessible fashion, facilitating professional networking, serving as a platform for medical conferences, and empowering patients. These core strategies are discussed through the lens of general cardiology, cardio-oncology, and cardio-obstetrics. We also demonstrate how these applications can be leveraged to increase representation of women in cardiology, also supporting an increased focus on women's cardiovascular health.

Using a Modified Delphi Approach and Nominal Group Technique for Organisational Priority Setting of Evidence-Based Interventions That Advance Women in Healthcare Leadership

BACKGROUND

Few studies address how to prioritise organisational interventions that advance women in leadership. We report on the relevance, feasibility and importance of evidence-based interventions for a large healthcare organisation. This study supports the first stage of implementation in a large National Health and Medical Research Council funded initiative seeking to advance women in healthcare leadership.

METHODS

An expert multi-disciplinary panel comprised of health professionals and leaders from a large healthcare network in Australia participated. The initial Delphi survey was administered online and results were presented in a Nominal Group Technique workshop. Here, the group made sense of the survey results, then evaluated findings against a framework on implementation criteria. Two further consensus surveys were conducted during the workshop.

RESULTS

Five priority areas were identified. These included: 1. A committed and supportive leadership team; 2. Improved governance structures; 3. Mentoring opportunities; 4. Leadership training and development; and 5. Flexibility in working. We describe the overall priority setting process in the context of our findings.

CONCLUSIONS

With evidence and expert input, we established priorities for advancing women in healthcare leadership with a partnering healthcare organisation. This approach can be adapted in other settings, seeking to advance women in leadership.

Prioritizing gender equity and intersectionality in Canadian global health institutions and partnerships

Despite governmental efforts to close the gender gap and global calls including Sustainable Development Goal 5 to promote gender equality, the sobering reality is that gender inequities continue to persist in Canadian global health institutions. Moreover, from health to the economy, security to social protection, COVID-19 has exposed and heightened pre-existing inequities, with women, especially marginalized women, being disproportionately impacted. Women, particularly women who face bias along multiple identity dimensions, continue to be at risk of being excluded or delegitimized as participants in the global health workforce and continue to face barriers in career advancement to leadership, management and governance positions in Canada. These inequities have downstream effects on the policies and programmes, including global health efforts intended to support equitable partnerships with colleagues in low- and middle- income countries. We review current institutional gender inequities in Canadian global health research, policy and practice and by extension, our global partnerships. Informed by this review, we offer four priority actions for institutional leaders and managers to gender-transform Canadian global health institutions to accompany both the immediate response and longer-term recovery efforts of COVID-19. In particular, we call for the need for tracking indicators of gender parity within and across our institutions and in global health research (e.g., representation and participation, pay, promotions, training opportunities, unpaid care work), accountability and progressive action.

Gender representation on editorial boards of leading oncology journals

Background

There has historically been women underrepresentation on editorial boards of peer-reviewed medical journals. High-ranked oncology journals showcase cancer-related scientific work at the forefront of the discipline. There is urgent need to investigate gender representation on editorial boards at leading oncology journals.

Materials and methods

Sixty high-ranked oncology journals based on impact factor calculated by the Journal Citation Reports (JCR) 2021 from Web of Science/Clarivate Analytics were identified. Gender-related information of editorial boards was obtained from each journal’s website. The gender of each member of the editorial team was confirmed by an internet search for picture and/or gender-specific pronoun from journal or personal profile. Fisher’s exact tests and analysis of variance were used to analyze categorical and continuous variables, respectively. Significance was set at P < 0.05.

Results

Among 4898 members on editorial boards of top oncology journals with the highest impact factor, 1177 were women. Women made up 24% (1177 of 4898) of members on editorial boards in top oncology journals, and there was significantly less women board members than men (P < 0.0001). The mean female composition of editorial boards of oncology journals was 27% (range from 4% to 100%). Among 71 editors-in-chief of the top oncology journals, 14 (20%) were women. There was a positive correlation between the presence of women in journal editorial leadership and the percentage of women on editorial boards (r_s = 0.340, P = 0.008). The underrepresentation of women on oncology journal editorial boards was significantly different among quartiles of journal impact factor. There was no significant correlation between women’s representation on journal editorial boards (%) and journal impact factors (r_s = 0.226, P = 0.086).

Conclusions

The results demonstrated that there are gender disparities among editorial leadership at high-impact oncology journals. There are cultural and structural barriers and prejudices to gender parity and diversity on editorial boards of oncology journals.

•

The representation of women on editorial boards of oncology journals has not been verified.

•

This large-scale study found that women comprised only 24% of editorial boards of top-ranked oncology journals.

•

The results demonstrated that there are gender disparities among editorial leadership at leading oncology journals.

'I felt forced to find an alternative': a qualitative analysis of women medical educators' narratives of career transitions

OBJECTIVES

While institutional and systemic attempts to increase women's participation in medical education have enabled increasing numbers to enter the field and achieve more senior positions, little is known about lived experiences of female clinical educators. Women clinicians are more likely to change careers and work less than full time. This study focuses on women medical educators' narratives of career change, with the aim of exploring the interplay between factors affecting career decision-making, career trajectory and professional development.  METHODS: We employed narrative enquiry approaches to two data sources (55 written accounts of turning points; 9 semistructured interviews reflecting on periods of career transition). Through analysing themes within each dataset before comparing and contrasting datasets simultaneously, we identified three areas of inconsistency and tension.

RESULTS

Participants reported feeling both drawn and pushed into medical education. Some respondents reported that they were compelled by circumstances to enter medical education. Participants' narratives were ambiguous regarding personal and professional identities. Additionally, participants asserted their position as autonomous agents while acknowledging their powerlessness when encountering organisational, social and cultural expectations limiting the ability to make independent choices. Even where primary decisions to pursue medical education were positive and motivated by interest, subsequent disappointments and challenges led some participants to doubt their choices.

CONCLUSIONS

Career advancement in medical education may involve women taking significant personal or career sacrifices, partly due to the continued existence of a medical culture allowing men to dominate senior ranks. Women medical educators achieving satisfying senior roles in the field may harbour lingering regret and resentment at the personal and career costs.

Perceived barriers to career progression in the headache field: A global web-based cross-sectional survey

BACKGROUND

It is well recognized that underrepresented and minoritized groups do not have the same career opportunities. However, there are limited data on the range and specifics of potential barriers that withhold people in headache medicine and science from reaching their full potential. Moreover, people from different geographical regions often perceive different challenges. We aimed to identify world-wide perceived career barriers and possibilities for promoting equality amongst professionals in the headache fields.

METHODS

A cross-sectional online survey was conducted among professionals in the field of headache globally. The questions of the survey were aimed at assessing perceived career barriers in four domains: professional recognition, opportunities in scientific societies, clinical practice, and salary and compensation. Perceived mentorship was also assessed.

RESULTS

In total 580 responders completed the survey (55.3% women). Gender was the most important perceived barrier in almost all domains. Additionally, country of birth emerged as an important barrier to participation in international scientific societies. Career barriers varied across world regions.

CONCLUSION

It is essential that longstanding and ongoing disparities by gender and country of origin for professionals in the headache field are globally acknowledged and addressed in areas of recruitment, retention, opportunities, mentor- and sponsorships, and advancement.

Factors that influence the implementation of organisational interventions for advancing women in healthcare leadership: A meta-ethnographic study

BACKGROUND

Gender inequity in healthcare leadership persists and progress is slow, with the focus firmly on problems, barriers and on requiring women themselves to adapt and compete in a system not designed for them. Women are individually burdened to advance their careers, with little effort given to addressing systemic barriers in the health sector. A recent systematic review prioritised organisational-level approaches and demonstrated effective interventions. In this meta-ethnographic study, we further this work by examining factors in implementation of organisational interventions for advancing women in leadership.

METHODS

The meta-ethnographic framework applied here follows the Noblit and Hare approach for synthesising findings and applying interpretive analysis to original research. We generated a new line-of-argument with insights for the healthcare sector. The protocol is registered (CRD42020162115) on the International Prospective Register of Systematic Reviews. Three academic databases (MEDLINE, PsycINFO, SCOPUS) were searched systematically between 2000 and 2021. Studies were analysed if they included organisational-level interventions that sought to measurably advance women in leadership. Study characteristics were extracted using a standard template for intervention details. Quality appraisal was conducted using the Critical Appraisal Skills Program tool. Data synthesis was conducted across 19 criteria of the Meta-Ethnography Reporting Guide (eMERGe).

FINDINGS

Fifteen qualitative studies were included. Analysis revealed three meta-themes that are central to successful implementation of organisational interventions that advance women in healthcare leadership: (1) leadership commitment and accountability, influenced by internal and external organisational settings, salient for long term outcomes and for developing an inclusive leadership culture; (2) intervention fit with individuals with consideration given to personal beliefs, preferences, experiences, capabilities or life circumstances, including capacity for leadership roles in their broader life context; balanced against maintaining interventional fidelity, and (3) cultural climate and organisational readiness for change, addressing traditional, conservative and constrictive perspectives on gender and leadership in health, highlighting the facilitating role of male colleagues.

INTERPRETATION

This meta-ethnographic research extends past work by integrating empirical evidence from a systematic literature review of effective organisational level interventions, with the identification of pragmatic themes to generate, implement, evaluate and embed evidence-based organisational interventions to advance women in healthcare leadership. This work can inform initiatives and policymakers to generate and implement new knowledge to advance women in healthcare leadership.

FUNDING

Epworth Health and Monash University provided scholarships for MM. HT is funded by an NHMRC / MRFF Practitioner Fellowship, JB by an NHMRC fellowship and HS by a Monash Warwick University Professorship.

Ten actions to achieve gender equity among intensivists: the French Society of Intensive Care (FICS) model

In our recent survey, we aimed to collect information on perceived inequity as well as professional and personal fulfillment among women intensivists in France. For the 371 respondents out of the 732 persons who received the survey, the findings were unequivocal: for one-third of the respondents, being a woman was considered as an obstacle to careers or academic advancement, and for two thirds, pregnancy was viewed as a barrier to their career advancement. Gender discrimination had been experienced by 55% of the respondents. In 2019, to promote and achieve gender equity in the French Intensive Care Society (FICS), ten actions were initiated and are detailed in the present manuscript together with supporting data: (1) creation of a working group: the FEMMIR group; (2) promotion of mentorship; (3) implementation of concrete sponsorship; (4) transparency and public reporting of gender ratios in editorial boards; (5) workshops dedicated to unconscious gender bias; (6) workshops dedicated to improved women assertiveness; (7) role models; (8) creation of educational/information programs for young intensivists; (9) development of research on gender inequity and, as a perspective; and (10) development of a wide-ranging program. This review is aimed at providing a toolbox of organizational best practices designed to achieve gender equity. It is particularly important to share promising practical action engaged in our FEMMIR group with other concerned professionals around the world.

The precarity of women’s academic work and careers during the COVID-19 pandemic

The novel coronavirus set off a global pandemic of the COVID-19 disease that affected higher education institutions in profound ways. Drawing on the experiences of more than 2029 academic women, this article shows the precarity of academic women’s work under pandemic conditions. We analysed seven persistent themes that emerged from the qualitative analysis of the open-ended responses to an online survey across South Africa’s 26 higher education institutions. In short, these seven factors have rendered women’s work precarious with serious implications for an already elusive gender inequality in the academy. Finally, we aim to provide insight for academic leaders and policymakers to accommodate support for women academics and families in higher education during this time and in the future.

Women's Footprint in Anti-Doping Sciences: A Bibliometric Approach to Research Impact

Bibliometrics, via the exploitation of large-scale publication data, is a facile approach to explore gender-related trends, especially gender equality in academic publishing and authorship. For the first time, this study aims to investigate the gender-related trends in anti-doping sciences to (1) explore the relational structure of gender aspects of authorial, topical, and methodological features, (2) give recognition to women's contribution to anti-doping research, and (3) identify unique “gendered” potentials for advancing anti-doping research. To deliver on these aims, we employed bibliometric tools to publication records in anti-doping. After constructing a database containing academic publications on any aspect of anti-doping with at least one woman among the authors, we applied state-of-the-art methods from bibliometric science mapping and network analysis. The Lotka distribution model showed that the anti-doping research is a closed community with only 70 authors appearing more than once. Male authors being the majority (66.2%), women are under-represented in this field. The most important authorship position in the academic articles is mainly occupied by men, publications with male corresponding authors were in 774 out of 991 anti-doping related papers. The close connection of the top twenty most influential authors, men and women, to the World Anti-Doping Agency in some professional capacity suggest that the Agency have an influence on the anti-doping research beyond directly providing funding. In terms of geographical regions, publications with female authors were dominated anti-doping research in Italy, Romania, and Spain. In research networks to date, women have outperformed male authors in information centrality, which means that women in anti-doping research have had higher level of control over the information flow in the field than their male counterparts. The results of this study confirm the potential of bibliometric approach in the identification of emerging research topics and quantifying gender differentiation in the field of anti-doping. Due to their higher information centrality, women are better positioned for problem-focused multidisciplinary research both within anti-doping community, and with researchers in cognate fields. Bibliometric analyses have proved to be a powerful tool for monitoring and advancing anti-doping research impact via identifying new avenues for multidisciplinary work, better gender representation, and diversity.

Revealing hidden experiences: Gendered microaggressions and surgical faculty burnout

BACKGROUND

Studies report higher burnout in women faculty surgeons compared to men. However, few studies have examined underlying mechanisms for these gendered differences. Gendered differences in microaggression experiences may explain part of the relationship between gender and burnout. We aimed to investigate the relationship between gender, gendered microaggressions, and burnout and test the hypothesis that microaggressions contribute to the relationship between gender and burnout.

METHODS

In this 2021 study, a survey was distributed to surgical faculty at 7 institutions. Variables included gender identity, race, average hours worked recently, the Oldenburg Burnout Inventory, and a modified Racial and Ethnic Microaggressions Scale to assess gendered microaggressions. To assess the relationship between surgical faculty gender and burnout, and if this relationship could be explained by microaggressions, a mediation model was tested.

RESULTS

A total of 109 participants (40% female) completed the survey and were included in analysis. The hypothesized indirect effect of gender on burnout (M = 2.70/5, SD = 0.81), through gender-based microaggressions (M = 1.7/5, SD = 1.9), was significant, B = -0.25, SE B = 0.09, confidence interval (-0.44 to -0.09): women surgeons reported higher levels of gendered microaggressions, which predicted higher levels of burnout. The overall model was significant (R² = .16, F[6,102] = 3.33, P < .01). Race, specialty, hours worked, and years of experience were all not significant in the model.

CONCLUSION

Gendered microaggressions mediate the relationship between gender and burnout, providing a potential mechanism for the higher rates of burnout in women surgeons evident in prior research. These multi-institutional data provide a focus for targeted initiatives that could decrease both burnout rates and the impact of gender bias on surgical faculty.

Embracing Diversity, Equity, and Inclusion in the Scientific Community—Viewpoints of the Diversity, Equity, and Inclusion Committee of the North American Vascular Biology Organization

Recent increased visibility on racial issues in the United States elicited public outcry and a collective call for action. The social justice movement has facilitated energetic discussions about race, sexual orientation, and various issues of diversity, equity, and inclusion. This article discusses issues faced by people of color that we as scientists can address, as well as challenges faced by women and internationally trained scientists in the scientific community that need immediate attention. Moreover, we highlight various ways to resolve such issues at both institutional and individual levels. Silence and incremental solutions are no longer acceptable to achieving lasting social justice and ensure prosperous societies that work for all.

An Eye on Gender Equality: A Review of the Evolving Role and Representation of Women in Ophthalmology

PURPOSE

In recent decades, women have achieved greater representation in ophthalmology. Globally, women now constitute approximately 25%-30% of ophthalmologists and 35%-45% of trainees. Nevertheless, women remain under-represented in key areas, including positions of professional and academic leadership and ophthalmic surgical subspecialization. Furthermore, there is evidence that women in ophthalmology encounter more bias and discrimination across multiple domains than men, including a gender-pay gap that is wider than in many other surgical subspecialties. Women ophthalmologists and trainees report sharply differing training experiences from male peers, including fewer opportunities to operate, more bullying and harassment, less access to mentorship, and contrasting expectations around contributions to family life.

DESIGN

Perspective.

METHODS

An extensive literature search was undertaken to compile and review papers published with a focus on gender equity across ophthalmology, surgery, and medicine.

RESULTS

We identified 8 broad domains that were widely discussed: leadership, research and academics, income, surgical exposure and subspecialization, harassment, career satisfaction, mentorship, and family and marital differences. We have summarized the current research across each of these areas, and discussed possible solutions to reduce the inequities reported.

CONCLUSIONS

This review draws on current research published around representation and experiences of women in ophthalmology and suggests that there are opportunities to improve gender inequity.