Gender Trends of Authors Presenting at a Regional Vascular Surgery Meeting - Are We Missing a Unique Opportunity to Mentor?
Diana Otoya, Kedar Lavingia, Michael Amendola
VA Medical Center/VCU, Richmond, VA
BACKGROUND: The last half century has seen significant changes in the demographics of American medical school applicants, including a steady increase in females. Data from the Association of American Medical Colleges (AAMC) indicates that women make up just over half of all medical students educated in the United States. As the gender diversity of medical students has changed, it has been reflected in most surgical fields with an increase in female post-graduate trainees. Vascular surgery has traditionally been an additional fellowship training pathway for general surgery residents but became its own distinct specialty recruiting graduating medical students in 2005. Since it’s separation from a distinct fellowship pathway, the specialty has seen a dramatic rise in female trainees. However, when surveyed, men are still more likely to pursue fellowships in Vascular Surgery compared to their female counterparts. A recent survey noted that medical students often cite lifestyle, family, and mentorship as factors influencing career decisions. This study also noted that a lack of mentors was an important issue for 29% of women. However, when asked about mentorship, 35.7% of medical students noted that their female role model was a negative influence citing that female surgeons often logged long work hours with inadequate time to see spouses and/or children. The influence of gender as it relates to mentorship is also demonstrated among residents and fellows. A 2017 survey of 900 members of The Society of Vascular Surgery and found 72.9% of women applied to academic positions after completing training compared to 58.8% of males. Women more frequently cited mentorship as a reason for choosing academic practice when compared to men. Women were also more likely than males to work in the same geographic region in which they trained. This would suggest that when women apply for a position in a male dominated field, they are more likely than males to rely on personal contacts rather than job postings, advertisements, employment agencies, and/or other less personal search criteria for potential employment opportunities. This data is potentially limited due to the traditional communication methods outside of the current modern online communication pathways. Regardless, interfacing with females who have chosen Vascular Surgery as their career path makes mentorship of this population even more crucial.The Southern Association of Vascular Surgery (SAVS) was established in 1976. It holds an annual symposium which includes selected abstracts submitted from member states (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Virginia, West Virginia, and Washington DC). Presentations occurring at this annual meeting include a discussant (designated by the program committee) to review the submitted potential manuscript and submit questions to the presenter. The presenter, who is usually a trainee of one of the southern member states, will address these questions publicly during their SAVS Annual Meeting presentation. This discussion is considered a public critique of the work and often appears as an appendix of the manuscripts if published. Regional gatherings such as the SAVS Annual Meeting foster a collaborative environment for communication of research, discovery of innovation, and a unique opportunity for networking, recruitment, and mentorship from members to trainees. We therefore sought to analyze gender as it pertains to participation in the SAVS Annual Meeting. Additionally, we examined gender trends within SAVS membership as well as Board Certification in Vascular Surgery as published by the American Board of Surgery. We set forth to analyze gender as it relates to authorship, membership, and assigned discussants at The Southern Association of Vascular Surgery (SAVS) Annual Meeting. Additionally, we examined yearly gender trends within SAVS membership as compared to SAVS member state Board Certification rates in Vascular Surgery.
METHODS: Based on the study design, the research was exempt from Institutional Review Board. Annual published program presentations and membership rolls from the 2012 to 2019 from the SAVS were obtained and reviewed by a single reviewer (DO). Each program year was analyzed for total membership numbers, sex of members, abstract presenter sex, discussant sex and presentation type (podium or poster). Each presentation was also categorized by topic: abdominal aortic aneurysm, thoracic aortic aneurysm, amputation, cerebrovascular, peripheral vascular disease, hemodialysis access and other. PUBMED (www.pubmed.com) was then searched for each title from the SAVS Annual Meeting program listing to evaluate for eventual journal publication. The time from presentation to subsequent publication was noted, if it occurred. The sex of the first author listed on the associated manuscript was documented as well as any change in sex at time of publication. In order to correctly identify the authors/presenter/member’s sex the SAVS membership rolls, which training program and practicing state, was crossed referenced with publicly available resources that list the sex of the physician being searched, websites such as Doximity, Usnews, Healthgrades, as well as their associated training program or university website were searched. The American Board of Surgery was petitioned for diplomat sex and year of board certification for the 15 southern member states (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Virginia, West Virginia, and Washington DC) of the SAVS during the same time period. All statistical analyses were performed using the Windows-based Excel Spreadsheet version 16.39 (Microsoft Corporation. 2018. Microsoft Excel. Retrieved from https://office.microsoft.com/excel). All continuous variables were analyzed with 2-tailed students t-test* with a 0.05 significance level. Discrete factors were compared using the Fisher’s Exact test† with a 0.05 significance level. Analysis of Covariance** with a 0.05 significance level was utilized to compare SAVS and ABS-VS diplomate membership trends over the years examined. Linear regression was applied to membership numbers with slope (m) and R2 analysis with a 0.05 significance level.
RESULTS: There were 260 presentations (178 podium; 68.5%) from the eight years examined. Out of the 260 presentations, 67 or 26% of the presentations were by a female author. Aortic disease, specifically abdominal aortic disease, was the most common presentation topic during the eight years examined. Overall, there was a gradual increase in thoracic aortic disease presentations, and a decrease in peripheral vascular disease presentations. Hemodialysis access presentations comprised a stable minority of presentations throughout the 8 years.The membership rolls from 2012 to 2019 indicate that SAVS had the fewest female members in the first year examined 2012 (9 females or 2.02% of all members). Female membership increased over the next two years but plateaued during 2015 and 2016 (a total of 18 female members). The highest total number of females was 24 in 2018 and highest percentage of females was 5.75% in 2019. During the same time period, the southern states saw a significant rise in the percentage of newly boarded Vascular Surgeons that were female. During the years examined, the overall gender distribution trend within SAVS membership (R2 = 0.92, m=0.43) and newly Board Certified Vascular Surgeons in southern states (R2 = 0.82, m=2.5) increased with the later more significantly acutely (p=0.0008**). In a similar fashion, the percentage of female first authors and discussants at the SAVS Annual Meeting also increased over the time period examined ((p=0.20**). 59.7% of presentations by females were podium presentations, compared to 75% for males (p=0.03†). Males were more likely than females to present on aortic aneurysm topics (p=0.05*) with no statistical difference in the gender of presenter for the remaining topics of cerebrovascular, amputation, peripheral vascular disease, hemodialysis access and other. Females presenters had a same gendered discussant 10.5% of the time compared to male presenters who had a same gendered discussant 95.1% of the time (p<0.0001†). The percentage female SAVS members and percentage female discussants increased over the time periods (Figure 1) with greater increase in female discussants compared to the female members based on Analysis of Covariance (p=0.02; t-statistic = 2.56).Male and female presenters had approximately the same number of authors per abstract (6.1 ± 2.2 vs. 6.4 ± 2.1 p=0.24*). Females were also less likely to be published when compared to their male counterparts (41.8% vs 59.7%, p=0.02†). There was no statistical difference in change of gender of the first author from conference presentation to eventual manuscript publication. There was no statistical difference in the number of days to publication between males and females (Table 1).
CONCLUSIONS: In examining eight years of the SAVS Annual Meeting Programs, we found that the proportion of female members, discussants, and authors steadily increased. Statistically, female members were underrepresented within the SAVS membership rolls when compared to known boarded female vascular surgeons among southern member states during the time period examined. Female presenters interfaced with female discussants only a minority of the time, whereas their male counterparts interfaced with male discussants the majority of the time. Females were less likely than male counterparts to have posters, publish manuscripts, or deliver podium presentations. This gender gap in membership, discussants interaction, and authorship highlights a unique opportunity to enhance and potentially increase mentorship opportunities for female trainees who are presenting and/or attending this regional vascular surgery meeting.
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