ISCCM Position Statement for Improving Gender Balance in Critical Care Medicine.

Gender disparity in Critical Care Medicine (CCM) persists globally, with women being underrepresented. Female Intensivists remain a minority, facing challenges in academic and leadership positions at the workplace and within academic societies. The Indian Society of Critical Care Medicine (ISCCM) recognized the need for addressing issues related to gender parity and constituted its first Diversity Equity and Inclusion (DEI) Committee in 2023. Through a Delphi process involving 38 Panelists including 53% women, consensus and stability were achieved for 18 statements (95%). From these 18 consensus statements, 15 position statements were drafted to address gender balance issues in CCM. These statements advocate for equal opportunities in recruitment, workplace inclusivity, prevention of harassment, and improved female representation in leadership roles, nominated positions, and conferences. While the consensus reflects a significant step toward gender equity, further efforts are required to implement, advocate, and evaluate the impact of these measures. The ISCCM position statements offer valuable guidance for promoting gender balance within society and the CCM community. How to cite this article: Sathe P, Shukla U, Kapadia FN, Ray S, Chanchalani G, Nasa P, et al. ISCCM Position Statement for Improving Gender Balance in Critical Care Medicine. Indian J Crit Care Med 2024;28(S2):S288-S296.

COVID-19 and stroke in women: impact on clinical, psychosocial and research aspects.

Despite the growing interest in gender medicine, the influence of sex and gender on human diseases, including stroke, continues to be underestimated and understudied. The COVID-19 pandemic has overall impacted not only the occurrence and management of stroke but has also exacerbated sex and gender disparities among both patients and healthcare providers. This paper aims to provide an updated overview on the influence of sex and gender in stroke pathophysiology and care during COVID-19 pandemic, through biological, clinical, psychosocial and research perspectives. Gender equity and awareness of the importance of sexual differences are sorely needed, especially in times of health crisis but have not yet been achieved to date. To this purpose, the sudden yet worldwide diffusion of COVID-19 represents a unique learning experience that highlights critical unmet needs also in gender medicine. The failures of this recent past should be kept as food for thought to inspire proper strategies reducing inequalities and to address women's health and wellbeing issues, particularly in case of future pandemics.

Female interns are not choosing radiology as a career-national survey providing insights into gender imbalance.

OBJECTIVES: Women are under-represented in Radiology, both globally and in Ireland. An annual review of the medical workforce in Ireland for the year 2021-2022 revealed that although the overall gender breakdown of trainees is similar, with 56% female and 44% male trainees, certain specialities have disproportionate numbers of a given gender. Females only account for 38% of Irish Radiology trainees, one of the lowest of all the specialties. The cause for this disparity is likely multifactorial, but a lack of interest in applying for Radiology training by female doctors is a possible cause. The objectives of this study were to identify specific factors that attract or deter intern doctors from considering a career in Radiology and to identify underlying gender-specific differences. MATERIALS AND METHODS: Anonymous online surveys were distributed to 50% of the intern population in Ireland between May and June 2022. The survey included questions on demographics, prior radiology exposure, and dedicated multiple-choice questions for those either considering or not considering radiology, which were subdivided into potentially influencing factors. RESULTS: Two-hundred-seven interns responded giving a response rate of 48.3%, which totalled almost 25% of the interns in Ireland. For those interns considering radiology, significantly more male interns (n = 24/67, 35.8%) are considering radiology compared with females (n = 26/139, 18.71%), (p < 0.009). Significantly more females were deterred by the perception of radiology as a male-based speciality (p < 0.004). CONCLUSION: Significantly fewer females are considering radiology, deterred by physics knowledge, use of technology, and, significantly, by the perception of radiology as a male-dominated speciality. CLINICAL RELEVANCE STATEMENT: This survey highlights important reasons that female interns are deterred from radiology. It will help direct future medical training and doctor recruitment policies, with a view to addressing the ongoing gender disparity in the Irish radiology workforce. KEY POINTS: Women are under-represented in the Irish and global Radiology workforce. Female interns are dissuaded from Radiology as a career by their perception of Radiology as male-dominated. This survey will shape medical training and doctor recruitment policies to improve gender diversity in radiology.

Barriers to female leadership in intensive care medicine: insights from an ESICM NEXT & Diversity Monitoring Group Survey.

BACKGROUND: The underrepresentation of women in leadership remains a pervasive issue, prompting a critical examination of support mechanisms within professional settings. Previous studies have identified challenges women face, ranging from limited visibility to barriers to career advancement. This survey aims to investigate perceptions regarding the effectiveness of women's leadership programs, mentoring initiatives, and a specialized communication course. Particularly it specifically targets addressing the challenges encountered by professional women. METHODS: This multi-center, observational, international online survey was developed in partnership between ESICM NEXT and the ESICM Diversity and Inclusiveness Monitoring Group for Healthcare. Invitations to participate were distributed to both females and men through emails and social networks. Data were collected from April 1, 2023, through October 1, 2023. RESULTS: Out of 354 respondents, 90 were men (25.42%) and 264 were women (74.58%). Among them, 251 completed the survey, shedding light on the persistent challenges faced by women in leadership roles, with 10%-50% of respondents holding such positions. Women's assertiveness is viewed differently, with 65% recognizing barriers such as harassment. Nearly half of the respondent's experience interruptions in meetings. Only 47.4% receiving conference invitations, with just over half accepting them. A mere 12% spoke at ESICM conferences in the last three years, receiving limited support from directors and colleagues, indicating varied obstacles for female professionals. Encouraging family participation, reducing fees, providing childcare, and offering economic support can enhance conference involvement. Despite 55% applying for ESICM positions, barriers like mobbing, harassment, lack of financial support, childcare, and language barriers were reported. Only 14% had access to paid family leave, while 32% benefited from subsidized childcare. Participation in the Effective Communication Course on Career Advancement Goals and engagement in women's leadership and mentoring programs could offer valuable insights and growth opportunities. Collaborating with Human Resources and leadership allies is crucial for overcoming barriers and promoting women's career growth. CONCLUSIONS: The urgency of addressing identified barriers to female leadership in intensive care medicine is underscored by the survey's comprehensive insights. A multifaceted and intersectional approach, considering sexism, structural barriers, and targeted strategies, is essential.

Mind the gap: Gender disparities in authorship in the Journal of Medical Imaging and Radiation Sciences.

INTRODUCTION: Research studies tracking gender and academic publication productivity in healthcare find gender disparities in research activity, publication, and authorship. Article authorship is one of the important metrics to track when seeking to understand gender inequality in academic career advancement. Research on gender disparities in publication productivity in the field of Medical Radiation Science (MRS) is very limited thus this study analyses and explains potential gender differences in article authorship and acceptance for publication in the Journal of Medical Imaging and Radiation Sciences (JMIRS) for a 5-year period (2017-2021). METHODS: Gender was inferred based on the author's first name or title (e.g., Mr, Mrs or Ms). For those who left the title blank or reported as 'Dr' or 'Prof,' a series of steps were taken to identify their gender. Where gender was impossible to ascribe, these authors were excluded. Descriptive and inferential statistics are reported for the study population. Descriptive and inferential statistics are used. Percentages of females are reported, and males constitute the other portion. Chi-square, slope analysis and z-tests were used to test hypotheses. RESULTS: Results show that female authorship overall and in all categories of authorship placement (i.e., first, last and corresponding) increased over the timeframe reviewed. The percentage gain in the increase was higher than that for male authorship. However, male authorship started from a higher baseline in 2017 and has also increased year on year and overall, as well as in each placement category examined. More female authors were in the MRS sub-specialism Radiation Therapy (RT) than in the other MRS sub-specialisms. Analysis of the acceptance rate of articles with female authors shows a weak downward trend, and this may be related to higher submission and acceptance rates of articles by male authors during the same period. CONCLUSION: Male authors are overrepresented in all categories, which raises questions about the persistence of gender disparities in JMIRS authorship and article acceptance. Positive trends in female authorship indicate progress, yet there is the persistence of the significant under-representation of women in the Medical Radiation Sciences workforce in academic publishing. Recruiting more males to address the gender imbalance in the profession should not be at the expense of females' career progression.

Patched but Still Leaky: An Update on the Pipeline for Women in Gastroenterology.

BACKGROUND: Women remain underrepresented in gastroenterology (GI). Studies have identified that a lack of formal mentorship for women contributes to this underrepresentation. While many GI divisions have adopted models for supporting GI fellows and faculty, there is a gap in our knowledge regarding mentorship options for internal medicine (IM) residents interested in GI. AIMS: To evaluate representation of women at each level of their career (resident, fellow, and attending) and examine trends in representation of women in GI compared to other IM subspecialties. METHODS: We analyzed AAMC Physician Specialty Data Reports to compare gender representation and growth of women representation across all IM subspecialties and residencies from 2007 to 2021. RESULTS: In 2021, 44.3% of IM residents, 37.8% of GI fellows, and 19.7% of actively practicing attending gastroenterologists were women. Since 2007, GI comprised significantly lower proportions of women attendings except for cardiology, and lower representation in fellows, except for cardiology and nephrology, than other IM subspecialties (p < 0.001). There was a consistently higher proportion of women GI fellows than attendings over the past 14 years (p < 0.01). CONCLUSIONS: GI has among the lowest representation of women at each career level compared to other IM subspecialties. Given the previously reported preference of gender congruent mentoring, the underrepresentation of senior academic gastroenterologists who are women may be a contributing factor to lower proportions of women trainees choosing to pursue GI.

41Bridging the gender gap in Cardiac Rehabilitation. The first step: The equal opportunities project.

Women receive similar or greater benefits than men from Cardiac Rehabilitation (CR). However, they are less likely to participate. An integrated and gender-sensitive approach to cardiovascular disease is required to enhance the quality and experience of care for women with different cardiovascular issues throughout their lives. The Italian Alliance for Cardiovascular Rehabilitation and Prevention (ITACARE-P) is committed to developing a gender-specific approach to CR that will more effectively meet the needs of both women and men.

Do male and female heads of households have different beliefs about gender equity among young people in Nigeria?

Introduction: Gender-transformative approaches (GTAs) have been successfully carried out to address harmful gender norms and power imbalances to promote more gender equitability. However, to improve the health and wellbeing of young people, it is necessary to involve household heads by positively transforming their beliefs on gender equity and norms. Methods: This study was cross-sectional quantitative research undertaken in six local government areas in Ebonyi State, Nigeria. The study population consisted of household heads in households with young people aged 15-24 years. Data were collected for 15 days using paper and electronic copies of the questionnaire. Descriptive, bivariate, and logistic regression analyses were performed using Stata. Results: The results showed that 46.32% of male and 62.81% of female heads of households disagreed with the statement "a good woman never questions her husband's opinions, even if she is not sure she agrees with them." Female heads of households aged 50 years and below with an odds ratio of 0.47 (p-value = 0.02) suggest they were 0.47 times more likely to have a positive attitude toward the rights and privileges of young girls. Male heads of households aged 50 years and below with an odds ratio of 1.05 (p-value = 0.84) suggest that they were 1.05 times more likely to have a positive attitude toward the rights and privileges of young girls. Conclusion: This paper provides new knowledge on the gender norm attitude of male and female heads of households on the rights, privileges, and equity promotion of young boys and young girls, as well as its associated factors.

Gender and Age Trends in HIV Incidence in Turkey between 1990 and 2021: Joinpoint and Age-Period-Cohort Analyses.

Background and Objectives: Despite a global decrease in HIV incidence, recent trends in Türkiye indicate a concerning rise, particularly among younger populations and women. This study investigates the local and regional dynamics influencing these trends using advanced epidemiological methodologies. Material and Methods: Utilizing Age-period-cohort analysis and joinpoint regression, we analysed HIV incidence and prevalence data from the Global Burden of Disease study for Türkiye. These methods allowed for a detailed examination of changes over time, identifying specific age groups and periods with significant shifts in incidence rates. Results: Key findings include a 13.03% increase in annual percentage change among males aged 15-19 and an 11.37% increase among females in the same age group. Additionally, the incidence rates among females have shown a significant rise after 2008. Conclusions: The rising HIV incidence in Türkiye reflects complex socio-economic, cultural, and biological factors, with significant increases among young people and women. Addressing these challenges requires targeted interventions, comprehensive educational programs, and inclusive healthcare services to align with global efforts and commitments. The study underscores the importance of incorporating young people in decision-making processes to effectively combat HIV in Türkiye.

Is there an editorial glass ceiling? Editorial leadership in nephrology and transplantation journals: A gender-based cross-sectional analysis.

AIM: Editors-in-Chief (EiC) play a key role as gatekeepers in academic medicine, often shaping research agendas. Women have historically been underrepresented in editorial leadership roles in academic medicine. The purpose of this study was to examine gender representation among EiC of contemporary transplantation and nephrology journals. METHODS: This cross-sectional study evaluated gender disparities among EiC of transplantation and nephrology medical journals. The study population was drawn from journals in two subject categories (1) 'Transplantation' and (2) 'Urology and Nephrology' in the 2023 Journal Citation Reports. Binary gender classification (woman/man) was determined by the names/pronouns used to describe the EiC on the journal or institutional webpage. The primary outcome was the proportion of women EiC. Secondary outcome was the proportion of women EiC based on journal topic, location and metrics. Descriptive statistics were used. Gender differences were compared using students t-test or Fisher's exact test. RESULTS: A total of 79 EiC were identified of which 16 (20%) were women and 63 (80%) were men (p < .001). Transplantation and nephrology journals had 21% and 20% women EiC, respectively. The proportion of women to men EiC was not impacted by journal category (p = .93), journal location (p = .61), journal impact factor (p = .71) or quartile (p = .59). CONCLUSION: There was a disparity in gender representation in EiC in nephrology and transplantation journals, with men holding 80% of all positions. These findings, among growing evidence of gender disparity, highlight a need for targeted efforts to promote gender equity in academic medicine.

Promoting gender equity in a home visits programme: a qualitative study in Northern Nigeria.

BACKGROUND: Gender inequities remain critical determinants influencing maternal health. Harmful gender norms and gender-based violence adversely affect maternal health. Gendered division of labour, lack of access to and control of resources, and limited women's decision-making autonomy impede women's access to maternal healthcare services. We undertook a cluster randomized controlled trial of universal home visits to pregnant women and their spouses in one local government area in Bauchi State, North-Eastern Nigeria. The trial demonstrated a significant improvement in maternal and child health outcomes and male knowledge, attitudes and behaviours. This paper qualitatively evaluates gender equity in the home visits programme. METHODS: The research team explored participants' views about gender equity in the home visits programme. We conducted nine key informant interviews with policymakers and 14 gender and age-stratified focus group discussions with men and women from visited households, with women and men home visitors and supervisors, and with men and women community leaders. Analysis used an adapted conceptual framework exploring gender equity in mainstream health. A deductive thematic analysis of interviews and focus group reports looked for patterns and meanings. RESULTS: All respondents considered the home visits programme to have a positive impact on gender equity, as they perceived gender equity. Visited women and men and home visitors reported increased male support for household chores, with men doing heavy work traditionally pre-assigned to women. Men increased their support for women's maternal health by paying for healthcare and providing nutritious food. Households and community members confirmed that women no longer needed their spouses' permission to use health services for their own healthcare. Households and home visitors reported an improvement in spousal communication. They perceived a significant reduction in domestic violence, which they attributed to the changing attitudes of both women and men due to the home visits. All stakeholder groups stressed the importance of engaging male spouses in the home visits programme. CONCLUSION: The home visits programme, as implemented, contributed to gender equity.

Nursing intervention with a gender approach in patients with arterial hypertension: a scoping review.

This scoping review aims to identify and synthesize the available literature describing the use of the gender approach in research and nursing clinical practice related to hypertension. The review was conducted following the scoping review framework recommended by Arksey and O'Malley. Elements related to content were chosen following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Data were extracted using a predesigned table and were presented narratively after the content analysis. The PubMed, CINAHL, Web of Science, PsycINFO, Cochrane, Scopus, ScienceDirect and ERIC databases were consulted between March 2022 and June 2024. Reference lists from all sources and gray literature were also reviewed to identify additional publications. A total of 18 studies were finally included in this scoping review. Most of the studies (83 percent) represent gender as a biological variable (sex), and only a few of them (22 percent) analyzed psychological or social differences. In addition, several studies include unequal representations of each sex, most of them use the terms "sex" and "gender" as incorrect or interchangeable, which makes it difficult to evaluate the results from a gender perspective. There is still a substantial gap in the literature related to nurses' intervention with a gender approach in patients with hypertension. Future studies should focus on improving health interventions by considering gender to improve equality and efficiency in health outcomes associated with hypertension and other cardiovascular risk factors.

Gender-responsive monitoring and evaluation for health systems.

Gender-responsive monitoring and evaluation (M&E) for health and health systems interventions and programs is vital to improve health, health systems, and gender equality outcomes. It can be used to identify and address gender disparities in program participation, outcomes, and benefits, as well as ensure that programs are designed and implemented in a way that is inclusive and accessible for all. While gender-responsive M&E is most effective when interventions and programs intentionally integrate a gender lens, it is relevant for all health systems programs and interventions. Within the literature, gender-responsive M&E is defined in different and diverse ways, making it difficult to operationalize. This is compounded by the complexity and multi-faceted nature of gender. Within this methodological musing, we present our evolving approach to gender-responsive M&E which we are operationalizing within the Monitoring for Gender and Equity (MAGE) project. We define gender-responsive M&E as intentionally integrating the needs, rights, preferences, and power relations among women and girls, men and boys, and gender minority individuals, as well as across social, political, economic, and health systems, in M&E processes. This is done through the integration of different types of gender data and indicators, including: sex or gender specific, sex or gender disaggregated, sex or gender specific/disaggregated which incorporate needs, rights and preferences, and gender power relations and systems indicators. Examples of each of these are included within the paper. Active approaches can also enhance the gender-responsiveness of any M&E activities, including incorporating an intersectional lens and tailoring the types of data and indicators included and processes used to the specific context. Incorporating gender into the programmatic cycle, including M&E, can lead to more fit-for-purpose, effective, and equitable programs and interventions. The framework presented in this paper provides an outline of how to do this, enabling the uptake of gender-responsive M&E.

A needs-based approach to promoting gender equity and inclusivity: insights from participatory research with farmer-producer organisations (FPOs).

The farmer-producer organisation (FPO) is an umbrella term used to describe modes of farmer collectivisation in India, i.e. co-operatives and companies. While women cultivators play a central role in agriculture, their continued marginalisation is reflected in a lack of engagement in FPO activities and governance structures, with only 3% of existing FPOs being female-led ventures. This paper examines the nature of tensions around social inequities-and how such tensions might be addressed in the collective spaces offered by FPOs-using a gender lens, specifically in balancing conflicting pressures of economic performance versus inclusion and meeting specific members' needs. Using a participatory research approach, a conceptual framework is developed and applied in three FPOs operating at various stages of development. With a specific focus on gender equity and social inclusion, selected cases involved FPOs with > 75% female membership and scheduled caste/tribe participation. Qualitative data on societal needs, based on the expectations and experiences of FPO participants, are then analysed to better understand (1) what might promote FPO participation and (2) how equity and inclusion may be enabled from the 'bottom-up'. This exploratory study informs the collective action debate with its new and intersectional approach to gender equity and inclusivity. Empirical observations and within-case analyses involving FPOs provide new insights into the functioning of these institutions and nuanced interactions involving their members. Findings suggest that informal micro-producer arrangements or vyavastha, in the FPO pre-registration phase, are well positioned to act as spatial agents for establishing ethical norms as FPOs collectivise and grow. In terms of promoting social objectives and evaluating FPOs operating in different stages, a set of guiding principles are proposed with follow-on implications for policy.

Gender inequalities in oral medicine and pathology research: Temporal trends of two decades.

OBJECTIVES: To analyze gender inequities and trends in the authorship of articles published in high-impact factor journals of the field of Oral Medicine and Pathology. METHODS: The gender and country of first and last authors were retrieved from original articles published between 2000 and 2022. Poisson regression models and classification and regression tree (CART) analysis were performed. RESULTS: A total of 6595 studies were analyzed for first authorship, and 6627 for last authorship. Only 39.2% (CI 95% 38.0-40.3) of the first authors and 24.1% (CI 95% 23.1-25.1) of the last authors were females. Females consistently faced underrepresentation throughout the 23-year evaluation. The only region where female first authors are not a minority is Latin America. Having a female as the last author increased the prevalence of females in the first author position by 42% (PR = 1.42, CI 95% [1.30-1.54]). The most important discriminant variable by CART was the first author region. CONCLUSION: Although a slight decrease in underrepresentation was noted over the period, after 2020, the gender gap tended to widen for both first and last authors. It is crucial to implement measures aimed at attracting, retaining, and advancing women in the field of science, while also actively monitoring advancements toward achieving gender equity.

Assessment of the gender gap in urology industry payments: An Open Payments Program data analysis.

PURPOSE: The Open Payments Program (OPP), established in 2013 under the Sunshine Act, mandated medical device and pharmaceutical manufacturers to submit records of financial incentives given to physicians for public availability. The study aims to characterize the gap in real general and real research payments between man and woman urologists. MATERIALS AND METHODS: The study sample included all urologists in the United States who received at least one general or research payment in the OPP database from 2015 to 2021. Recipients were identified using the National Provider Identifier and National Downloadable File datasets. Payments were analyzed by geography, year, payment type, and years since graduation. Multivariable analysis on odds of being in above the median in terms of money received was done with gender as a covariate. This analysis was also completed for all academic urologists. RESULTS: There was a total of 15,980 urologists; 13.6% were woman, and 86.4% were man. Compared to man urologists, woman urologists were less likely to be in the top half of total payments received (odds ratio [OR] 0.62) when adjusted for other variables. When looking at academic urologists, 18.1% were woman and 81.9% were man. However, woman academic urologists were even less likely to be in the top 50% of payments received (OR 0.55). CONCLUSIONS: This study is the first to characterize the difference in industry payments between man and woman urologists. The results should be utilized to educate physicians and industry, in order to achieve equitable engagement and funding for woman urologists.

Comment on "Sexism in Academia is Bad for Science and a Waste of Public Funding".

A recent comment by Boivin et al. urges academia and governments to address sexism and fight bias at higher education and research institutions as losing female academics is costing science and society too much. Herein, I discuss further underlying reasons of sexism in academia and the importance of a deep dive into the causes of inequity at individual faculty and school levels to develop bespoke and enforceable gender equity plans, the importance of not using basic statistic as the only tool to measure equity/inequity as well as how key performance indicators could be better used to advance gender equity and end sexism in academia.

Gender Inequalities of Health and Quality of Life in Informal Caregivers in Spain: Protocol for the Longitudinal and Multicenter CUIDAR-SE Study.

BACKGROUND: The aging population and increased disability prevalence in Spain have heightened the demand for long-term care. Informal caregiving, primarily performed by women, plays a crucial role in this scenario. This protocol outlines the CUIDAR-SE study, focusing on the gender-specific impact of informal caregiving on health and quality of life among caregivers in Andalusia and the Basque Country from 2013 to 2024. OBJECTIVE: This study aims to analyze the gender differences in health and quality of life indicators of informal caregivers residing in 2 Spanish autonomous communities (Granada, Andalusia, and Gipuzkoa; Basque Country) and their evolution over time, in relation to the characteristics of caregivers, the caregiving situation, and support received. METHODS: The CUIDAR-SE study uses a longitudinal, multicenter design across 3 phases, tracking health and quality of life indicators among informal caregivers. Using a questionnaire adapted to the Spanish context that uses validated scales and multilevel analysis, the research captures changes in caregivers' experiences amid societal crises, notably the 2008 economic crisis and the COVID-19 pandemic. A multistage randomized cluster sampling technique is used to minimize study design effects. RESULTS: Funding for the CUIDAR-SE study was in 3 phases starting in January 2013, 2017, and 2021, spanning a 10-year period. Data collection commenced in 2013 and continued annually, except for 2016 and 2020 due to financial and pandemic-related challenges. As of March 2024, a total of 1294 participants have been enrolled, with data collection ongoing for 2023. Initial data analysis focused on gender disparities in caregiver health, quality of life, burden, perceived needs, and received support, with results from phase I published. Currently, analysis is ongoing for phases II and III, as well as longitudinal analysis across all phases. CONCLUSIONS: This protocol aims to provide comprehensive insights into caregiving dynamics and caregivers' experiences over time, as well as understand the role of caregiving on gender inequality in health, considering regional variations. Despite limitations in participant recruitment, focusing on registered caregivers, the study offers a detailed exploration of the health impacts of caregiving in Spain. The incorporation of a gender perspective and the examination of diverse contextual factors enrich the study's depth, contributing significantly to the discourse on caregiving health complexities in Spain. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/58440.

Gender Disparities in the Academic Performance of Neurology Residents in Portugal.

Implicit bias has been linked to gender disparities in medical careers, impacting not only access to leadership positions but also early career opportunities. We aimed to evaluate if there were differences in the assessment of Neurology residents according to gender. We collected publicly available grades and rankings of two major evaluations that residents are submitted to, one at the beginning and another at the end of the neurology residency program, the National Board Exam and neurology examination, respectively. The National Board Examination is a multiple-choice gender-blinded evaluation, while the neurology examination is an oral gender-unblinded evaluation. We found that 36.5% of women and 21.6% of men were in the first quartile of the National Board Examination ranking, which reflects a similar representation among top classifications when assessed through a gender-blinded examination. On the other hand, the percentage of men who were in the top classification of NE, a gender-unblinded evaluation, was more than twice as high compared to women (37.8% vs 18.3%, p < 0.05). The findings of the present study may imply that there could be a disparity in women's career progression among neurology residents in Portugal, although the recruitment seems balanced between genders.