Women in Intensive Care study: a preliminary assessment of international data on female representation in the ICU physician workforce, leadership and academic positions

Gender differences in professional social networks use among critical care researchers

BACKGROUND

Recent studies highlight that female anaesthesiology researchers have lower visibility on professional social networks (PSNs) than male researchers.

OBJECTIVE

The objective of this work was to compare the use of PSNs between women and men in critical care research.

METHODS

We included the first/last authors (FAs/LAs) among the most frequently cited articles in 2018 and 2019 in three critical care journals (Intensive Care Medicine, Critical Care Medicine, and Critical Care). We compared the use of three PSNs-Twitter, ResearchGate, and LinkedIn-between women and men in the FA/LA positions.

RESULTS

We analysed 494 articles, which allowed us to include 426 FAs and 383 LAs. The use of a PSN was similar between women and men (Twitter: 35 vs. 31% FA p = 0.76, 38 vs. 31% LA p = 0.24; ResearchGate: 60 vs. 70% FA p = 0.06, 67 vs. 66% LA p = 0.95; LinkedIn: 54 vs. 56% FA p = 0.25, 68 vs. 64% LA p = 0.58; respectively). On ResearchGate, women had a lower reputation score (FA group 26.4 [19.5-31.5] vs. 34.8 [27.4-41.6], p < 0.01; LA group 38.5 [30.9-43.7] vs. 42.3 [37.6-46.4], p < 0.01) and fewer followers (FA group 28.5 [19-45] vs. 68.5 [72,5-657] p < 0.01; LA group 96.5 [43,8-258] vs. 178 [76.3-313.5] p = 0.02). Female researchers were FAs in 30% of the articles and LAs in 16%.

CONCLUSION

In the field of critical care, the visibility of female researchers on the social networks dedicated to scientific research is lower than that of male researchers.

An Update on Gender Disparity in Critical Care Conferences

This commentary's objective was to identify whether female representation at critical care conferences has improved since our previous publication in 2018. We audited the scientific programs from three international (International Symposium on Intensive Care and Emergency Medicine [ISICEM], European Society of Intensive Care Medicine [ESICM], and Society of Critical Care Medicine [SCCM]) and two national (State of the Art [SOA] and Critical Care Canada Forum) critical care conferences from the years 2017 to 2022. We collected data on the number of female faculty members and categorized them into physicians, nurses, allied health professions (AHPs), and other. Across all conferences, there was an increased representation of females as speakers and moderators over the 6 years. However, at each conference, male speakers outnumbered female speakers. Only two conferences achieved gender parity in speakers, SCCM in 2021 (48% female) and 2022 and SOA in 2022 (48% female). These conferences also had the highest representation of female nursing and AHP speakers (25% in SCCM, 2021; 19% in SOA, 2022). While there was a statistically significant increase in female speakers (p < 0.01) in 2022 compared with 2016, there was a persistent gender gap in the representation of men and female physicians. While the proportion of female moderators increased in each conference every year, the increase was statistically only significant for ISICEM, ESICM, and SCCM (p < 0.05). The proportion of female nurses and AHP speakers increased in 2022 compared with 2016 (p < 0.0001) but their overall representation was low with the highest proportion (25%) in the 2022 SCCM conference and the lowest (0.5%) in the 2017 ISICEM conference. This follow-up study demonstrates a narrowing but persisting gender gap in the studied critical care conferences. Thus, a commitment toward minimizing gender inequalities is warranted.

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.

Gender and authorship of publications from Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)

Introduction

Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) is a network fostering clinical research to optimize care for critically ill children. We aim to examine the efforts of the PALISI Network to increase gender parity in research, as evidenced by authorship.

Methods

The first and senior authors of all published PALISI articles from 2002 to 2021 were analyzed for gender of presentation. Funding sources, impact factors, professional roles, and location were extracted.

Results

We identified 303 articles, 61 published from 2002 to 2011, and 242 from 2012 to 2021. There were 302 first authors, representing 188 unique individuals, and 283 senior authors, representing 119 unique individuals. Over half (55.6%, n = 168) of the first authors were women. More women were first authors from 2012 to 2021 (n = 145, 60.2%) as compared to the years 2002-2011 [37.7%, n = 23, OR = 2.50 (95% CI: 1.40, 4.45, p = 0.002)]. Senior authors were 36.0% (n = 102) women, with no change over time. Women senior authors had a higher proportion of women first authors (67.7% vs. 32.4%, p = 0.017). No gender differences were noted based on article type or impact factor. The majority of authors came from institutions in the United States. Women had comparatively more NIH and CDC funding but received less funding from foundations and AHRQ.

Discussion

In PALISI publications, first authorship by women has increased over time, such that it now exceeds both the proportion of women pediatric intensivists and women first authors in critical care publications. Senior authorship by women has been stagnant. A multifactorial approach by individuals, institutions, networks, and journals is needed to bring senior women authors to parity.

Gender equity of authorship in pulmonary medicine over the past decade

BACKGROUND

Gender disparity in authorship broadly persists in medical literature, little is known about female authorship within pulmonary medicine.

METHODS

A bibliometric analysis of publications from 2012 to 2021 in 12 journals with the highest impact in pulmonary medicine was conducted. Only original research and review articles were included. Names of the first and last authors were extracted and their genders were identified using the Gender-API web. Female authorship was described by overall distribution and distribution by country/region/continent and journal. We compared the article citations by gender combinations, evaluated the trend in female authorship, and forecasted when parity for first and last authorship would be reached. We also conducted a systematic review of female authorship in clinical medicine.

RESULTS

14,875 articles were included, and the overall percentage of female first authors was higher than last authors (37.0% vs 22.2%, p<0.001). Asia had the lowest percentage of female first (27.6%) and last (15.2%) authors. The percentages of female first and last authors increased slightly over time, except for a rapid increase in the COVID-19 pandemic periods. Parity was predicted in 2046 for the first authors and 2059 for the last authors. Articles with male authors were cited more than articles with female authors. However, male-male collaborations significantly decreased, whereas female-female collaborations significantly increased.

CONCLUSIONS

Despite the slow improvement in female authorship over the past decade, there is still a substantial gender disparity in female first and last authorship in high-impact medical journals in pulmonary medicine.

Gender and racial differences in first and senior authorship of high-impact critical care randomized controlled trial studies from 2000 to 2022

BACKGROUND

Females and ethnic minorities are underrepresented in the first and senior authorships positions of academic publications. This stems from various structural and systemic inequalities and discrimination in the journal peer-review process, as well as educational, institutional, and organizational cultures.

METHODS

A retrospective bibliometric study design was used to investigate the representation of gender and racial/ethnic groups in the authorship of critical care randomized controlled trials in 12 high-impact journals from 2000 to 2022.

RESULTS

In the 1398 randomized controlled trials included in this study, only 24.61% of the first authors and 16.6% of the senior authors were female. Although female authorship increased during the study period, authorship was significantly higher for males throughout (Chi-square for trend, p < 0.0001). The educational attainment [χ²(4) = 99.2, p < 0.0001] and the country of the author's affiliated institution [χ²(42) = 70.3, p = 0.0029] were significantly associated with gender. Male authorship was significantly more prevalent in 10 out of 12 journals analyzed in this study [χ²(11) = 110.1, p < 0.0001]. The most common race/ethnic group in our study population was White (85.1% women, 85.4% males), followed by Asians (14.3% females, 14.3% males). Although there was a significant increase in the number of non-White authors between 2000 and 2022 [χ²(22) = 77.3, p < 0.0001], the trend was driven by an increase in non-White male and not non-White female authors. Race/ethnicity was significantly associated with the country of the author's affiliated institution [χ²(41) = 1107, p < 0.0001] but not with gender or educational attainment.

CONCLUSIONS

Persistent gender and racial disparities in high-impact medical and critical care journals underscore the need to revise policies and strategies to encourage greater diversity in critical care research.

Challenges in intensive medicine: Diversity, equity and inclusion. Gender statement of the Spanish Society of Intensive and Critical Medicine and Coronary Units (SEMICYUC)

Gender is a social determinant that impacts health and generates inequalities at all levels. It has impacts patients and critical conditions, health professionals and professional career development, and scientific societies from a perspective of social justice. All the International scientific societies of Intensive Care Medicine committed to contributing a gender perspective agree on the institutional need for achieving a formal positioning standpoint. The Spanish Society of Intensive and Critical Medicine and Coronary Units (SEMICYUC) is committed to ensuring the equality, inclusion and representativeness of its health professionals to fight the existing gender gap in the field of Intensive Medicine.

The Current State of Workforce Diversity and Inclusion in Pediatric Critical Care

Literature suggests the pediatric critical care (PCC) workforce includes limited providers from groups underrepresented in medicine (URiM; African American/Black, Hispanic/Latinx, American Indian/Alaska Native, Native Hawaiian/Pacific Islander). Additionally, women and providers URiM hold fewer leadership positions regardless of health-care discipline or specialty. Data on sexual and gender minority representation and persons with different physical abilities within the PCC workforce are incomplete or unknown. More data are needed to understand the true landscape of the PCC workforce across disciplines. Efforts to increase representation, promote mentorship/sponsorship, and cultivate inclusivity must be prioritized to foster diversity and inclusion in PCC.

Gender distribution of editorial board members in critical care journals: Assessment of gender parity

PURPOSE

To reveal factors related to gender parity on editorial boards of critical care journals indexing in SCI-E.

METHODS

The genders were defined according to data obtained from journals' websites between 01-30 September 2022. Publisher properties and journal metrics were analyzed by using Chi-square, Fisher exact, Mann-Whitney U tests, and Spearman's correlation coefficient. Logistic regression analysis was used to reveal independent factors.

RESULTS

Women's representation on editorial boards was 23.6%. The USA (OR, 0.04, 95% CI, 0.01-0.15, p < 0.001) and Netherlands (OR, 0.04, 95% CI, 0.01-0.16, p < 0.001) as publisher's countries, an IF >5 (OR, 0.25, 95% CI, 0.17-0.38, p < 0.001), publication duration <30 years (OR, 0.09, 95% CI, 0.06-0.12, p < 0.001), multidisciplinary perspective of editorial policy (OR, 0.46, 95% CI, 0.32-0.65, p < 0.001), journals categorized also in nursing (OR, 0.38, 95% CI, 0.22-0.66, p < 0.001), and being a section editor (OR, 0.49, 95% CI, 0.32-0.74, p = 0.001) were associated with gender parity. Europe as a journal continent (OR, 36.71, 95% CI, 8.39-160.53, p < 0.001) was related to gender disparity.

CONCLUSIONS

Further efforts are needed to expand diversity policies in critical care medicine.

Gender differences in pulmonology and critical care authorship and editorial boards

OBJECTIVE

This study aims to characterize the gender distribution of first authors, senior authors, and editorial board members across several high-impact factor journals in PCCM.

METHODS

In this cross-sectional study, we analysed gender disparities in critical care authorship and editorial boards, based on publications from 1 January 2019 to 31 December 2021 from the top 20 high impact journals based on the Journal of Citation Reports.

RESULTS

Among 20 journals (median impact factor of 6.66), 25% of editors-in-chief and 28.8% of editorial board members were female. From 2019 to 2021, a total of 23,994 articles were published. Female first authors and last authors made up 29.1% and 21.2% of the authorship, respectively (n = 6637 articles).

CONCLUSIONS

Our study demonstrates significant gender disparities in critical care authorship and editorial boards, with males predominantly filling the roles of editors in chief, editorial members, and first and senior authors. Despite this significant difference in gender distribution, there was no statistically significant correlation between authorship and editor gender.

Health and Well-Being of Intensive Care Unit Physicians: How to Ensure the Longevity of a Critical Specialty

A second epidemic of burnout, fatigue, anxiety, and moral distress has emerged concurrently with the coronavirus disease 2019 (COVID-19) pandemic, and critical care physicians are especially affected. This article reviews the history of burnout in health care workers, presents the signs and symptoms, discusses the specific impact of the COVID-19 pandemic on intensive care unit caregivers, and attempts to identify potential strategies to combat the Great Resignation disproportionately affecting health care workers. The article also focuses on how the specialty can amplify the voices and highlight the leadership potential of underrepresented minorities, physicians with disabilities, and the aging physician population.

Influence of the COVID-19 Pandemic on Author Sex and Manuscript Acceptance Rates among Pulmonary and Critical Care Journals

Rationale: The coronavirus disease (COVID-19) pandemic has negatively affected women more than men and may influence the publication of non-COVID-19 research. Objectives: To evaluate whether the COVID-19 pandemic is associated with changes in manuscript acceptance rates among pulmonary/critical care journals and sex-based disparities in these rates. Methods: We analyzed first, senior, and corresponding author sex (female vs. male, identified by matching first names in a validated Genderize database) of manuscripts submitted to four pulmonary/critical care journals between January 1, 2018 and December 31, 2020. We constructed interrupted time series regression models to evaluate whether the proportion of female first and senior authors of non-COVID-19 original research manuscripts changed with the pandemic. Next, we performed multivariable logistic regressions to evaluate the association of author sex with acceptance of original research manuscripts. Results: Among 8,332 original research submissions, women represented 39.9% and 28.3% of first and senior authors, respectively. We found no change in the proportion of female first or senior authors of non-COVID-19 or COVID-19 submitted research manuscripts during the COVID-19 era. Non-COVID-19 manuscripts submitted during the COVID-19 era had reduced odds of acceptance, regardless of author sex (first author adjusted OR [aOR], 0.46 [95% confidence interval (CI), 0.36-0.59]; senior author aOR, 0.46 [95% CI, 0.37-0.57]). Female senior authorship was associated with decreased acceptance of non-COVID-19 research manuscripts (crude rates, 14.4% [male] vs. 13.2% [female]; aOR, 0.84 [95% CI, 0.71-0.99]). Conclusions: Although female author submissions were not disproportionately influenced by COVID-19, we found evidence suggesting sex disparities in manuscript acceptance rates. Journals may need to consider strategies to reduce this disparity, and academic institutions may need to factor our findings, including lower acceptance rates for non-COVID-19 manuscripts, into promotion decisions.

Systematized and efficient: organization of critical care in the future

Since the advent of critical care in the twentieth century, the core elements that are the foundation for critical care systems, namely to care for critically ill and injured patients and to save lives, have evolved enormously. The past half-century has seen dramatic advancements in diagnostic, organ support, and treatment modalities in critical care, with further improvements now needed to achieve personalized critical care of the highest quality. For critical care to be even higher quality in the future, advancements in the following areas are key: the physical ICU space; the people that care for critically ill patients; the equipment and technologies; the information systems and data; and the research systems that impact critically ill patients and families. With acutely and critically ill patients and their families as the absolute focal point, advancements across these areas will hopefully transform care and outcomes over the coming years.

Assessment of Gender Parity: Leadership Representation in Pulmonary and Critical Care Medicine

Background: Academic centers' and professional societies' top leadership representation and professional societies' award recipients remain disparate by gender in many fields. Little is known regarding leadership representation and recognition within pulmonary, critical care, and sleep medicine (PCCM), which has ∼22% women physicians. We sought to understand the landscape of female PCCM leaders. Methods: We abstracted gender of fellowship program directors (PDs), Department of Medicine (DOM) Chairs and Division Chiefs from academic medical centers with PCCM fellowship programs from 2018 and for comparison 2008. We abstracted leadership and recognition award recipients within four PCCM professional societies from 2013 to 2018 (American Thoracic Society [ATS], American Academy of Sleep Medicine [AASM], American College of Chest Physicians [CHEST], and Society of Critical Care Medicine [SCCM]). Results: In 2018, 29% of PCCM PD, 15% of PCCM Division Chiefs, and 15% of DOM Chairs were women. There were significantly more female PDs in 2018 (29%) compared with 2008 (16%, p = 0.04). On average, 25% of society presidents were women, with 28% of PCCM societal awards going to women, with significant difference between societies (p = 0.04). Each society differed in average distribution of female board members over the 6-year period: ATS 38%, AASM 35%, CHEST 18%, and SCCM 44% (p < 0.001). Conclusion: PCCM leadership and societal recognition are disparate by gender with few women holding top leadership roles and receiving societal recognition. Fortunately, the distribution notably is starting to reflect the specialty's demographics. Understanding why these inequalities exist will be essential to achieving gender parity in PCCM.

Trends in the Extracorporeal Membrane Oxygenation Literature: A Bibliometric Analysis in the COVID-19 Era

Extracorporeal Membrane Oxygenation (ECMO) was first used in the 1970s. Its use is increasingly common in critical care and perioperative settings and has gained newfound prominence during COVID-19. To guide future research, we conducted a bibliometric analysis of ECMO literature. Thomson Reuters Web of Science was searched to March 7, 2021. Articles were ranked by total number of citations. Data was extracted from the 100 most cited papers relevant to ECMO for study design, topic, author, year, and institution. Journal impact factor for 2019 and Eigenfactor scores were also recorded. Our search retrieved a total of 18,802 articles. Median number of citations for the top 100 articles was 220 (range 157-1,819). These were published in 34 journals, with first authors originating from 15 countries. The Annals of Thoracic Surgery had the highest number of articles (n = 9) while Lancet publications had the most citations (n = 3,191). Use of ECMO was most commonly observed in cardiogenic shock or acute respiratory distress syndrome. United States had the greatest article output (n = 49). With 10 publications, 2013 was the most prolific year. Using linear regression, when controlled for time since publication, there was no statistically significant relationship between 2019 journal impact factor and number of article citations (p = .09). Top articles in the ECMO literature are of considerable impact and quality. As the United States produced the bulk of the prominent evidence base, and most data were regarding respiratory issues, outsized advances in ECMO may be possible within the United States during the COVID-19 era.

Female representation in intensive care medicine: Challenges and perspectives from China

The gender gap in the practice of intensive care medicine has increasingly been recognized as a problem in recent years. Despite limited information, the available data suggest that representation of women in the physician workforce, academic positions, and leadership roles in intensive care is inadequate globally. In this article, we describe the situation of female intensive care unit (ICU) physicians from the perspective of Chinese intensivists. The proportion of female ICU physicians in China has been increasing in recent years. The biggest challenges faced by female ICU physicians include balance of work and life, difficulties in career planning, and lack of academic influence. More attention and policy support should be provided to help them play a better role in intensive care medicine.

Gender distribution in boards of intensive care medicine societies

PURPOSE

The established gender gap in intensive care medicine is larger compared to other medical specialties. The aim of this study was to evaluate gender distribution in boards of intensive care medicine societies worldwide.

METHODS

In this cross-sectional analysis, board members and presidents of all intensive care medicine societies associated with the European Society of Intensive Care Medicine were eligible for study inclusion. Exclusion criteria were: A) society without focus on intensive care and B) online information unavailable.

RESULTS

In 2021, 65 presidents and 820 board members were analyzed. Ten presidents (15%) and 231 board members (28%) were women. The proportion of women presidents reached from 0% in Africa to 20% in Europe and South America. The proportion of women board members was highest in North and South America with 42% and 46% respectively and lowest in Africa (21%) and Asia (10%). In Europe, 31% of board members were women and 35% in Australia/New Zealand. Among presidents, women were underrepresented in all continents while gender distribution among board members varied significantly between countries (p < 0.0001).

CONCLUSION

Our analysis reveals an inequality in gender distribution in the boards of national intensive care medicine societies which varies but persists for all global regions.

Impact of Gender on Clinical Evaluation of Trainees in the Intensive Care Unit

Background: Gender disparities in medical education are increasingly demonstrated, including in trainee assessment.

Objective: This study aimed to evaluate whether gender differences exist in trainees’ evaluation during intensive care unit (ICU) rotations, which has not been previously studied.

Methods: We reviewed the in-training evaluation reports (ITERs) for trainees rotating through five academic ICUs at the University of Toronto over a 10-year period (2007–2017). We compared the mean global score for the rotation and the mean score for seven training subdomains between men and women trainees. All scores were reported on a scale of 1 (unsatisfactory) to 5 (outstanding).

Results: Over the 10-year period, there were 3,203 ITERS overall, representing 1,207 women and 1,996 men trainees. The mean overall score was lower for women than for men trainees: 4.26 (standard deviation [SD], 0.58) for women and 4.30 (SD, 0.60) for men (P = 0.04). This difference was driven by anesthesia trainees, in whom the mean overall score was 4.21 for women and 4.37 for men (P < 0.001), with men trainees scoring consistently higher across all seven training subdomains. Within surgical, internal medicine, and critical care residents, there were no differences between men and women in the overall score or the scores across any of the seven subdomains. Across all ITERS, women were less likely than men to receive an overall rating of 5 (outstanding) for the ICU rotation (33% women vs. 37% men; odds ratio, 0.83; 95% confidence interval, 0.71–0.96).

Conclusion: Overall, quantitative evaluation scores between women and men trainees in the ICU are relatively similar. Within anesthesia trainees, scores for men were consistently higher across all domains of evaluation, a finding that requires further investigation.

Women Representation as First and Corresponding Authors in Neuroanesthesiology and Neurocritical Care Journals: A Retrospective Analysis

INTRODUCTION

There is limited literature on the representation of women in leading roles in neuroanesthesiology and neurocritical care academia. We aimed to determine the representation of women as first and corresponding authors in articles published in 3 dedicated journals of neuroanesthesiology and neurocritical care during last 5 years.

METHODS

Articles published in the Journal of Neurosurgical Anesthesiology, Neurocritical Care, and Journal of Neuroanaesthesiology and Critical Care between July 1, 2015 and June 30, 2020 were included in this study. The primary outcome was the proportion of women first authors, and secondary outcomes were the percentage of women corresponding authors, and representation of women as first and corresponding author by article type and country of affiliation.

RESULTS

Of the 1164 articles included in the study, 403 (34.6%) had a woman first author. Women first authorship was highest for Special Articles (5/11; 45.5%), Clinical Reports (44/113; 38.9%) and Narrative Review Articles (58/151; 38.4%) and lowest for Original Research Articles (198/597; 33.2%). Women accounted for 29.6% (344/1164) of corresponding authors across all article types. Overall, the United States and India had the highest representation of women first authors (159/403; 39.0% and 107/344; 31.0%, respectively), and India also had highest proportion of women corresponding authors (107/272; 39.3%).

CONCLUSIONS

Women were underrepresented compared with men as first author of articles published in 3 dedicated neuroanesthesiology and neurocritical care journals over the last 5 years. Women had the lowest representation as authors of Original Research Articles.

Gender disparity in critical care publications: a novel Female First Author Index

Background

Bibliometric analyses show gender bias against women in scientific publications and citations. We hypothesized that a metric of an individual senior author’s inclusivity of women as first authors in critical care publications would predict gender inequality.

Methods

Using PubMed and Web of Science, we conducted a bibliometric analysis of original research publications in critical care from 2008 to 2018 in 11 specialty and general journals. Gender for first and senior authors was assigned by a gender determination application, and manually if needed. For all senior authors we defined the novel Female First Author Index (FFA-index) = #Female first authors in publications by an individual senior author/Total # publications by that senior author. We produced a novel interactive web-based application using the R package Shiny to increase potential utilization of the FFA-index.

Results

Of 7370 publications, 30.4% had female first authors and 15.5% had female senior authors. After adjustment for impact factor, journal, year of publication, number of authors, country, and gender determination accuracy, female senior authorship was associated with a 1.9-fold increase in female first authorship [OR = 1.85 (95% CI 1.62, 2.11); p < 0.001] compared with male senior authorship. The mean (SD) FFA-index for all individual senior authors was 30.5 (42.9); with a significant difference in FFA-index between male and female senior authors (27.6 versus 42.5, respectively; p < 0.001). The interactive web-based application (FFA-index App) produces the same FFA-index output as our study results.

Conclusions

Female representation at prominent authorship positions in critical care publications is still far from achieving gender parity. By creating an authorship index score, we propose a frame of reference for the advancement of female first authorship.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13613-021-00889-3.

Perceived inequity, professional and personal fulfillment by women intensivists in France

Background

The medical workforce has been feminized for the last two decades worldwide. Nonetheless, women remain under-represented among intensivists. We conducted a survey among French women intensivists to assess their professional and personal quality of life and their perception of potential gender discrimination at work.

Methods

We conducted an observational descriptive study by sending a survey, designed by the group FEMMIR (FEmmes Médecins en Médecine Intensive Réanimation), to women intensivists in France, using primarily the Société de Réanimation de Langue Française (SRLF) mailing list. The questionnaire was also available online between September 2019 and January 2020 and women intensivists were encouraged to answer through email reminders. It pertained to five main domains, including demographic characteristics, work position, workload and clinical/research activities, self-fulfillment scale, perceived discrimination at work and suggested measures to implement.

Results

Three hundred and seventy-one women responded to the questionnaire, among whom 16% had an academic position. Being a woman intensivist and pregnancy were both considered to increase difficulties in careers’ advancement by 31% and 73% of the respondents, respectively. Almost half of the respondents (46%) quoted their quality of life equal to or lower than 6 on a scale varying from 1 (very bad quality of life) to 10 (excellent quality of life). They were 52% to feel an imbalance between their personal and professional life at the cost of their personal life. Gender discrimination has been experienced by 55% of the respondents while 37% confided having already been subject of bullying or harassment. Opportunities to adjust their work timetable including part-time work, better considerations for pregnant women including increasing the number of intensivists and the systematic replacement during maternity leave, and the respect of the law regarding the paternity leave were suggested as key measures to enable better professional and personal accomplishment by women intensivists.

Conclusion

In this first large French survey in women intensivists, we pointed out issues felt by women intensivists that included an imbalance between professional and personal life, a perceived loss of opportunity due to the fact of being a woman, frequent reported bullying or harassment and a lack of consideration of the needs related to pregnancy and motherhood.

Addressing gender imbalance in intensive care

There is a large gender gap in critical care medicine with women underrepresented, particularly in positions of leadership. Yet gender diversity better reflects the current critical care community and has multiple beneficial effects at individual and societal levels. In this Viewpoint, we discuss some of the reasons for the persistent gender imbalance in critical care medicine, and suggest some possible strategies to help achieve greater equity and inclusion. An explicit and consistent focus on eliminating gender inequity is needed until gender diversity and inclusion become the norms in critical care medicine.

Challenges and Obstacles Faced by Trainee Female Physicians: An Integrative Research on Gender Discrimination, Stress, Depression and Harassment

This study's purpose is to assess the challenges and obstacles faced by female trainee physicians and suggest solutions that could resolve these issues and improve their performance. The study utilized an observational, analytical, cross-sectional design based on a self-administered open-ended and validated questionnaire which was distributed to 133 recruited female resident trainees of medical units in Jeddah, Saudi Arabia. The findings of the study revealed that 52% female trainees experienced gender discrimination, mostly (65%) by their superiors, while 40% were regularly harassed. About half (53%) of the interviewees were severely depressed, resulting in their reconsidering their career in medicine. A total of 14% thought of suicide, while four planned to end and five had attempted to end their life. However, only eight (6%) participants officially reported the cases of harassment to the accountable superiors. Half of them felt neglected by the healthcare administration, and one-fourth (24%) were underachieving in their studies and work. The study concluded that work dissatisfaction, limited clinical correspondence, high depression, burnout, stress and drop-out rates-all deriving from common gender discrimination-compose the alarming and complex challenges that female trainee residents in Jeddah of various levels and specialties have to face.

A Longitudinal Study of Gender Parity Trends of General Membership and Leadership in the Neurocritical Care Society between 2002 and 2019

BACKGROUND

Several studies in critical care and neurology demonstrate women under-representation in professional societies; representation trends within the Neurocritical Care Society (NCS) are unknown. We examined longitudinal gender parity trends in membership and leadership within NCS.

METHODS

A retrospective study of NCS membership and leadership rosters was conducted. To determine gender, self-reported binary gender was extracted. For individuals without recorded gender, a systematic Web-based search to identify usage of gender-specific pronouns in publicly available biographies was performed. According to previously published methods, available photographs were utilized to record presumed gender identification in the absence of available pronoun descriptors. We analyzed available data longitudinally from 2002 to 2019 and performed descriptive statistical and linear regression analyses.

RESULTS

In overall membership, the proportion of women members demonstrated an average 11% increase between 2005 and 2018 (95% confidence interval (CI) - 8.1 to 30.1, p = 0.08). The proportion of women Board of Directors (BOD) members increased significantly over time to 50% in 2019. There was an increase in women Officers from 0% in the first 3 years (2002-2004) to 40% in 2019, with two women Presidents out of 17 from 2002 to 2019. For available Executive Committee rosters, there was a statistically significant nearly 3% increase per year (95% CI 1.5-4; p = 0.0007) in the proportion of women members. Rosters for Committee members and chairpersons were also incomplete, but in an analysis of the available data, there was a statistically significant increase of 5% per year analyzed (95% CI 0.5-9.7; p = 0.04) in the proportion of women Committee members. We also found a statistically significant 4.3% increase per year analyzed (95% CI 2.4-6.1; p = 0.003) in the proportion of women Committee chairpersons.

CONCLUSIONS

This is the first study of longitudinal gender parity trends within neurocritical care. We report that from 2002 to 2019, the NCS has undergone a significant increase in women representation in general membership, committee membership, and leadership positions.

Role of Critical Care Medicine Training in the Cardiovascular Intensive Care Unit: Survey Responses From Dual Certified Critical Care Cardiologists

Background Cardiovascular intensive care units ( CICUs ) have evolved from coronary care wards into distinct units for critically ill patients with primary cardiac diseases, often suffering from illnesses that cross multiple disciplines. Mounting evidence has demonstrated improved survival with the incorporation of dedicated CICU providers with expertise in critical care medicine ( CCM ). This is the first study to systematically survey dual certified physicians in order to assess the relevance of CCM training to contemporary CICU care. Methods and Results Utilizing American Board of Internal Medicine data through 2014, 397 eligible physicians had obtained initial certification in both cardiovascular disease and CCM . A survey to delineate the role of critical care training in the CICU was provided to these physicians. Among those surveyed, 120 physicians (30%) responded. Dual certified physicians reported frequent use of their CCM skills in the CICU , highlighting ventilator management, multiorgan dysfunction management, end-of-life care, and airway management. The majority (85%) cited these skills as the reason CCM training should be prioritized by future CICU providers. Few (17%) agreed that general cardiology fellowship alone is currently sufficient to care for patients in the modern CICU . Furthermore, there was a consensus that there is an unmet need for cardiologists trained in CCM (70%) and that CICU s should adopt a level system similar to trauma centers (61%). Conclusions Citing specific skills acquired during CCM training, dual certified critical care cardiologists reported that their additional critical care experience was necessary in their practice to effectively deliver care in the modern CICU .

Gender Differences in Authorship of Critical Care Literature

Rationale: Gender gaps exist in academic leadership positions in critical care. Peer-reviewed publications are crucial to career advancement, and yet little is known regarding gender differences in authorship of critical care research.Objectives: To evaluate gender differences in authorship of critical care literature.Methods: We used a validated database of author gender to analyze authorship of critical care articles indexed in PubMed between 2008 and 2018 in 40 frequently cited journals. High-impact journals were defined as those in the top 5% of all journals. We used mixed-effects logistic regression to evaluate the association of senior author gender with first and middle author gender, as well as association of first author gender with journal impact factor.Measurements and Main Results: Among 18,483 studies, 30.8% had female first authors, and 19.5% had female senior authors. Female authorship rose slightly over the last decade (average annual increases of 0.44% [P < 0.01] and 0.51% [P < 0.01] for female first and senior authors, respectively). When the senior author was female, the odds of female coauthorship rose substantially (first author adjusted odds ratio [aOR], 1.93; 95% confidence interval [CI], 1.71-2.17; middle author aOR, 1.48; 95% CI, 1.29-1.69). Female first authors had higher odds than men of publishing in lower-impact journals (aOR, 1.30; 95% CI, 1.16-1.45).Conclusions: Women comprise less than one-third of first authors and one-fourth of senior authors of critical care research, with minimal increase over the past decade. When the senior author was female, the odds of female coauthorship rose substantially. However, female first authors tend to publish in lower-impact journals. These findings may help explain the underrepresentation of women in critical care academic leadership positions and identify targets for improvement.

Representation of women amongst speakers at the Canadian Anesthesiologists' Society annual meeting: a retrospective analysis from 2007 to 2019

PURPOSE

Despite an increase in the proportion of women entering the field of anesthesiology, women remain underrepresented in academic and leadership positions. Speaking at national and international conferences is an important component of academic visibility and promotion. To date, the gender representation of speakers at the Canadian Anesthesiologists' Society (CAS) annual meeting has not been examined.

METHODS

We conducted a retrospective analysis of the representation of women amongst speakers at the CAS annual meeting between 2007 and 2019, inclusively. We also examined the representation of women in different subspecialty subject area symposia at each CAS annual meeting, and the gender composition of meeting symposia panels (i.e., groups of two or more speakers in a session) at the meeting.

RESULTS

Overall, 28.5% (358/1,256) of speaker slots included women, similar to their representation in Canadian clinical anesthesiology over the study period (26.7%), and increasing significantly over the study period. Women were more highly represented as obstetric anesthesia speakers at the CAS annual meetings, with lower representation in cardiothoracic anesthesia, transplant anesthesia, and critical care symposia. Of the 311 meeting symposia, 146 (46%) were composed of all men speakers.

CONCLUSION

The representation of women speakers at the CAS annual meeting was similar to the representation of women in the anesthesiology workforce in Canada over the study period. Gender representation varied widely by subspecialty symposia, subject area, and women were absent from nearly half of all symposia at the CAS annual meetings, which are potential areas of future investigation and intervention.

Two Sides of the Same Coin: Addressing Racial and Gender Disparities Among Physicians and the Impact on the Community They Serve

The influence of historical cultural norms is evident when analyzing the physician demographics in the United States. To this day, there exists a paucity in diversity as it pertains to gender balance and ethnicity. This phenomenon is particularly concerning when studies support the notion that race and gender concordance are associated with improved outcomes. The literature presented in this article identifies potential targets for interventions on how to attract, train, and retain minority physicians.

Gender disparity and implicit gender bias amongst doctors in intensive care medicine: A 'disease' we need to recognise and treat

UK medical schools have trained equal numbers of male and female doctors for almost 20 years. However, within intensive care medicine only 22% of consultants are female. This article uses the classic descriptors of a disease to explain how unconscious gender bias leads to gender disparity. It provides an introduction and summary of the literature explaining how unconscious biases are formed. It then shows how through overvaluing classically male, or agentic traits, intensive care medicine is at high risk of perpetuating gender disparity to the detriment of the whole speciality. Finally, it covers practical options on how to improve bias awareness and gender disparity nationally and locally within intensive care medicine.

Gender disparity in ICU staffing in Argentina

PURPOSE

Gender disparities in healthcare are striking, notwithstanding an increase in female students and physicians. Underrepresentation of women in leadership positions is well-documented; however, information from low and middle-income countries (LMICs) is still sparse. The Argentinian Society of Intensive Care Medicine (SATI) aimed to characterize the gender composition in Argentine ICUs.

METHODS AND RESULTS

Between 8/1/2018 and 1/1/2019, 131 questionnaires were submitted to ICU Department Chairs of SATI research networks. Gender distribution of the different staffing levels, board certification and hospital characteristics were recorded. One-hundred and four were completed, including 2186 physicians; 44% were female. Female participation decreased with highest responsibility: only 23% of Department Chairs were female (P = .002 vs. the rest of the staffing categories, adjusted for multiple comparisons). Residents exhibited the highest proportion of female physicians (47%). Board certification was similar for both sexes (62.3% vs. 62.2%, P = .97). Female/male distribution in public and private hospitals was 47%/53% and 40/60% (P < .01), respectively.

CONCLUSION

Our data provide evidence of an important gender gap in ICU management in a LMIC. Women were poorly represented in the leadership positions, although qualifications were similar to men. Moreover, female physicians worked more frequently in the public health subsector, usually underfinanced in LMICs-a surrogate of a gender pay gap.

Trends in the Proportion of Female Speakers at Medical Conferences in the United States and in Canada, 2007 to 2017

IMPORTANCE

Gender equity is a prominent issue in the medical profession. Representation of female physicians at academic meetings has been identified as an important component of gender equity; however, this topic has not been systematically assessed.

OBJECTIVE

To determine the trend during the last decade in the proportion of speakers who were women at major academic medical conferences held in Canada and in the United States.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional analysis was conducted examining the gender of speakers listed in meeting programs of medical conferences held in Canada and in the United States in 2007 and from 2013 through 2017. Eligible conferences were identified using a sensitive search strategy, and a previously validated tool was used to analyze each meeting speaker list and to assign a proportion of female speakers. Conferences held in English language, hosted in Canada or the United States, and targeted to a physician audience with 100 or more attendees were included. The comparison group was active physicians in Canada and in the United States.

MAIN OUTCOMES AND MEASURES

The mean of the proportion of female speakers at each conference per year.

RESULTS

In total, 181 conferences with 701 individual meetings were analyzed, including 100 medical and 81 surgical specialty conferences. The proportion of women ranged from 0% to 82.6% of all speakers. The mean (SD) proportion of female conference speakers for all meetings analyzed significantly increased from 24.6% (14.6%) for 40 meetings in 2007 to 34.1% (15.1%) for 181 meetings in 2017 (P < .001). The mean proportion of female speakers at medical specialty conferences was 9.8% higher (SE, 1.9%; P < .001) than the mean proportion of female speakers at surgical specialty conferences for all years analyzed. The mean proportion of female speakers at conferences was similar to the mean proportion of active female physicians across all specialties in the United States and in Canada for all years analyzed.

CONCLUSIONS AND RELEVANCE

Although our findings indicate that the proportion of female speakers at medical conferences increased during the last decade, women continue to be underrepresented. Speaker invitation and selection at conferences represent important opportunities to influence gender equity within medicine.