A, Percentages of GR sessions presented by nontrainee women by intramural (holding any faculty or staff title at a GR-sponsoring university) vs extramural (holding no faculty or staff title at a GR-sponsoring university) speaker affiliation. Median values indicated by horizontal bars. B, Percentages of GR sessions presented by nontrainee women normalized to percentages of 2013-2014 demographic who are women among enrolled medical students (46.7%) and specialties’ residents and MD- and equivalent degree-holding faculty. Median values indicated by horizontal bars. Values less than 1 indicate that the rate of female-presented GR sessions fell below representation of women in the specialties’ trainee or faculty demographic. OB/GYN indicates obstetrics/gynecology.
aP < .01 compared with the intramural speaker affiliation.
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Boiko JR, Anderson AJM, Gordon RA. Representation of Women Among Academic Grand Rounds Speakers. JAMA Intern Med. 2017;177(5):722–724. doi:10.1001/jamainternmed.2016.9646
Grand rounds (GR), a time-honored method of disseminating clinical and research knowledge to medical audiences, showcases speakers as successful academic role models. Exposure to successful female role models, such as GR speakers, may positively affect the retention of women in academic medicine.1,2 In the present study, we sought to determine whether women’s representation as GR speakers reflects their representation in academic medical workforces.
We surveyed GR speaker series in clinical specialties, each encompassing more than 2% of US academic physicians per the Association of American Medical Colleges.3 Specialties for which 15 or more National Institutes of Health–funded departments4 made from January 1 to December 31, 2014, GR calendars available via websites or email were analyzed. We categorized speakers by trainee status, institutional affiliation, and gender (inferred by first name and confirmed by speaker photographs in cases of ambiguity). Meetings, annual reports, and ceremonies were excluded. Female speaker percentages were compared with workforce demographics3 using 1-sample t tests, and intramural and extramural percentages were compared via a paired t test (2-sided; P < .05 was considered significant). The University of Pittsburgh Institutional Review Board exempted this study.
Nine specialties met the inclusion criteria (Table). Emergency medicine and family medicine were the only eligible specialties without 15 or more locatable calendars. Overall, women presented 20.0% to 60.3% of the total sessions (median, 28.3%). Trainee-delivered sessions displayed comparable female and male speaker representation, comprising 2.3% to 24.1% of the total sessions.
Among sessions delivered by faculty or other nontrainees, female representation ranged from 19.6% to 53.3% (median, 26.2%). Compared with national academic medical workforces, the percentages of nontrainee female speakers were uniformly significantly lower than the female composition of the resident workforces, and lower than the female composition of the faculty workforces in all specialties except obstetrics/gynecology and surgery.
Among nontrainee speakers, extramural speakers were less likely than intramural speakers to be women (median, 22.4% vs 29.0%; P = .01) (Figure). When total nontrainee female speaker percentages were normalized to workforce demographic female percentages, median ratios were 0.56 for medical students, 0.61 for residents, and 0.79 for faculty (instructor through full professor).
Women’s representation among academic GR speakers falls below the percentage of female medical students (46.7%) and residents (46% overall), and often falls lower than faculty (36% overall).3 This finding suggests that audiences are not typically exposed to presenter lineups resembling their demographic gender profiles. Such trends may reflect tendencies to invite senior speakers, since academic medicine’s “leaky pipeline” leaves few women among the full professor ranks. Despite longstanding female medical student enrollment near 50% and increasing numbers of women entering junior faculty positions, women still depart academic medicine more rapidly than men.3 Because women will not constitute half of the senior faculty at existing rates,3 it is unlikely that waiting for current trainees to ascend academic ladders will equalize gender representation at GR podiums.
Speaker selections convey messages of “this is what a leader looks like,” and women’s visibility in prestigious academic venues may subconsciously affect women’s desires to pursue academic medicine. The lower a field’s female visibility, the more likely women are to consider male stereotypes necessary for success.5 Thus, even inadvertently disproportionate showcasing of male speakers in GR may limit female trainees’ identification as future academic medical practitioners and stifle female faculty’s academic ambitions. With this knowledge, GR organizers may consider implementing transparent processes to highlight more female role models that are analogous to approaches championed at some conferences, such as appointing more women to speaker invitation committees.2,6
Representation of women at GR podiums reflects and potentially contributes to limited female retention in academic medicine. Associations between GR representation of women and retention of women in academic medicine require further exploration; future efforts can focus on showcasing successful women role models as GR speakers.
Corresponding Author: Julie R. Boiko, MD, MS, Department of Pediatrics, University of California, San Francisco, 550 16th St, 4th Flr, San Francisco, CA 94158 (firstname.lastname@example.org).
Published Online: March 6, 2017. doi:10.1001/jamainternmed.2016.9646
Author Contributions: Dr Boiko had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: All authors.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: All authors.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Boiko, Anderson.
Administrative, technical, or material support: All authors.
Study supervision: Boiko.
Conflict of Interest Disclosures: None reported.
Additional Contributions: The University of Pittsburgh Clinical and Translational Science Institute Research Facilitator Program advised on data analysis. Dena Hofkosh, MD, MEd (University of Pittsburgh School of Medicine), Joan Lakoski, PhD (American Association of Colleges of Pharmacy), Diana Lautenberger, MAT (Association of American Medical Colleges), and Richard Steinman, MD, PhD (University of Pittsburgh School of Medicine), provided critical reading of the manuscript. There was no financial compensation.