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Flute or tuba: women and publishing success in top gastroenterology journals

      The proportion of women entering academia, business, and medicine has been steadily increasing over the last few decades. More women are choosing to train in previously male-dominated, procedure-oriented medical specialties, such as gastroenterology. Women now account for over one third of gastroenterology trainees in Accreditation Council for Graduate Medical Education accredited programs.
      • Brotherton S.E.
      • Etzel S.I.
      Graduate medical education 2013-2014.
      Although the pipeline into our specialty appears robust, like other areas of academia, business, and medicine, there has not been a commensurate increase in the proportion of women into positions of seniority, such as advancement into associate or full professor, or into positions of leadership, such as department chair or dean. Complex issues transform what would otherwise be a deep and robust bench of highly trained individuals into an academic sieve, resulting in the career exodus of many talented women along the continuum of postdoctoral training and work. This nearly universal phenomenon of exodus is observed in the promotional chain across all manner of industry.
      Although we can marvel at what must include a chicken-and-egg component for reasons why women do not achieve promotion or do not pursue more senior levels of career advancement, it is still imperative that we understand the factors that may contribute. In this issue of Gastrointestinal Endoscopy, Long et al
      • Long M.T.
      • Leszczynski A.
      • Thompson K.D.
      • et al.
      Female authorship in major academic gastroenterology journals: a look over 20 years.
      explore one reason why women gastroenterologists may lag behind their male colleagues’ promotions by evaluating the trend in publications by women over the last 20 years.
      Publishing scholarly material in peer-reviewed journals is one of the pillars that supports academic promotion and is a determining component for allocation of institutional resources. It is a metric by which faculty, departments, and entire institutions are judged. Dissemination of scientific knowledge is an essential element of sharing expertise, building a research portfolio, and obtaining external funding. Publication productivity can be a measure of success for mentoring programs and can even be loaded into a plug-in program to predict whether one has principle investigator moxie.
      • Beech B.M.
      • Calles-Escandon J.
      • Hairston K.G.
      • et al.
      Mentoring programs for underrepresented minority faculty in academic medical centers: a systematic review of the literature.
      • vanDijk D.
      • Manor O.
      • Carey L.B.
      Publication metrics and success on the academic job market.
      Long et al reported improving trends in the rates of women publishing original research in 5 high-impact gastroenterology journals. There are several interesting observations in their study. First, the overall proportion of women who are publishing as first and as senior authors in these journals has tripled over the last 2 decades. Second, they demonstrated that the arc of senior status in publication is flatter for women than expected. Third, the authors found that gender was linked with research topic and, fourth, that women are less likely to author editorials. Although this study was not designed to answer why these findings might occur, several possible causes and consequences of these observations deserve scrutiny.
      In this article, we can see an encouraging rise in the proportion of women authors that parallels the increase of women in academic gastroenterology; however, the productivity remains somewhat lower than what we might expect based on the current proportion of women academic gastroenterologists. Given the status imbued and the benefits gained by authorship in building an academic career, the fitting conclusion is that these differences in productivity could be a contributing factor to a persistent gender gap in promotion. The numerous reasons for lower productivity among women might leave social scientists in despair of explanation.
      • Xie Y.
      Social influences on science and engineering career decisions. From Biological, social, and organizational components of success for women in academic science and engineering.
      Offering simplistic explanations do injustice to what is a complex issue. The peak of impactful publication productivity occurs early in the life cycle of research, and (although controversial) this productivity predictably helps determine academic destiny, at least using some publication metrics of success.
      • Lopez S.A.
      • Svider P.F.
      • Misra P.
      • et al.
      Gender differences in promotion and scholarly impact: an analysis of 1460 academic ophthalmologists.
      Women are more likely to step away from a unidirectional academic ladder just when such impactful, early research to establish a scientific career foundation—publishing meaningful research, publishing frequently, publishing as first author, and publishing in top tier journals—could be happening.
      Conversely, the decision to stay the course or to drop out of a career in the health sciences may partly depend on early successes. Structural and cultural factors both play a role in how this story unfolds. These factors include gender stereotyping, which may inform choice of career focus (such as basic science or advanced endoscopy), important networking opportunities (such as participating as faculty at high profile courses), differences in performance expectations and leadership skills (such as appointment to a committee and chairing a committee), amounts and types of support (such as transitioning from K awards to R01 awards), and the lack of female role models in positions of consequence (such as senior author positions or leadership positions within specialty societies)—all important contributors to the prospect of successful career-building. Otherwise, the implicit message to many of our young women is that they should not or cannot pursue these kinds of roles.
      At the very least, we need to understand whether the publication success for women is linked to lower rates of manuscript submission (and if so, then what accounts for this difference) or whether publication success is related to other reasons such as less resilience for resubmission or lower rates of acceptance of manuscripts for women. Although these reasons seem equally unlikely, there is no affirmative action for scientific journals.
      • Budden A.E.
      • Tregenza T.
      • Aarssen L.W.
      • et al.
      Double-blind review favors increased representation of female authors.
      Gender is highly associated with likelihood of academic success, even when one controls for numerous external influences.
      • Jagsi R.
      • DeCastro R.
      • Griffith K.A.
      • et al.
      Similarities and differences in the career trajectories of male and female career development award recipients.
      Thus, once these reasons are parsed out, then we have a responsibility to help with corrective action.
      This work also serves to highlight the responsibility we have to younger generations of women gastroenterologists who look to more senior members of our specialty for inspiration, for example, path finding, exploration, and tacit permission to pursue careers traditionally dominated by the capable men in our field. Effective mentorship is fundamental for growth and advancement into positions of leadership in private practice and helps encourage real staying power in the life cycle of academia.
      • Levitt D.G.
      Careers of an elite cohort of U.S. basic life science postdoctoral fellows and the influence of their mentor’ citation record.
      In their study, Long et al
      • Long M.T.
      • Leszczynski A.
      • Thompson K.D.
      • et al.
      Female authorship in major academic gastroenterology journals: a look over 20 years.
      demonstrated that women were more likely to hold the first author position if the senior author was a woman but noted a disturbing trend in the curve of women moving into a senior author position. This curve appears to be flatter with fewer women maturing into this position than we might expect. The authors hypothesized that women in gastroenterology might be younger in the overall career arc and thus less likely to have reached senior author status. Yet their study encompassed a 20-year period, a time frame in which we could see adequate numbers of women move into this influential position.
      There could be a number of possible reasons for the lag of women representation in the senior author position. Women physicians, for example, may take on more administrative and service roles for their institutions and may be more likely to engage in direct patient care than their male colleagues. These efforts may result in longer hours in the work week, but, unfortunately, the time spent in these activities competes for the time required to develop funding and publication opportunities, the measurable energy sources widely recognized as necessary to fuel the combustion engine of academic success. Further, these activities may not be viewed as prestigious, without providing meaningful leadership or promotion opportunities.
      • Mitchell S.M.
      • Hesli V.L.
      Women don’t ask? Women don’t say no? Bargaining and service in the political science profession.
      The findings may thus reflect a diminishing pool of capable, experienced mentors not only for the young women of our profession but for all our trainees and junior faculty.
      In this study, women were less likely to author editorials for these prestigious journals, an animal of a slightly different stripe. Editorials are written from an opinion perspective, and invitations might connote influence because of reputation, exposure, seniority, and connectedness. Although there is not much comment on this finding, the implication remains that either fewer women are viewed in such light or, again, the pool of talent diminishes at the top.
      Finally, although our specialty is reaching gender parity, it is still telling that choice of research topic was associated with gender. Women were more likely to publish in topics related to the basic sciences and less likely to publish in Gastrointestinal Endoscopy, a journal that focuses on issues germane to endoscopy and advanced endoscopy. This is a fascinating observation and one that raises questions about opportunity, perceptions, and obstacles either perceived or real that may inform this kind of career decision-making. Is advanced endoscopy, like playing the tuba instead of the flute, not considered a traditional choice for women?
      • Hallam S.
      • Rogers L.
      • Creech A.
      Gender differences in musical instrument choice.
      Much of this specialty and subspecialty selection is implied or even taught and then wrapped up in the intricacies, commitments, and requirements for extra training and expectations for success. However, there are no studies of strength, cognitive development, brain function, endocrine modulation, or particular evolution that would support concerns for performance on tuba or in this subspecialty—we are not punching above our weight.
      Failure to address implicit or explicit cues that result in a systematic difference in this metric of publication for academic success could have negative influence on the pipeline of talented women—women who have the skills and style to make excellent leaders, future leaders. Success in academia wears a face that is predictable: publications and funding that contribute to opportunities for promotion. Although the good news is that most women who demonstrate early success remain in academia, the odds of women “succeeding” based on these metrics is lower than that for men.
      • Jagsi R.
      • DeCastro R.
      • Griffith K.A.
      • et al.
      Similarities and differences in the career trajectories of male and female career development award recipients.
      As we work through these issues to continue to promote gender parity in our specialties and subspecialties, it is important that we strive to encourage and develop the necessary skills for women to succeed within the current structure and to foster change where change needs to occur.
      • Valantine H.
      • Sandborg C.I.
      Changing the culture of academic medicine to eliminate the gender leadership gap: 50/50 by 2020.
      Working within the current structure will require that we provide women with strong mentors, perhaps the most important differentiator to help with career management of publications and funding ideas, requests, and reiterations.
      The American Society for Gastrointestinal Endoscopy has stepped out to invest in this idea in a real way, by supporting a cohort of young women and minority faculty with a substantial skills-training program called Leadership Education and Development, or LEAD. By incorporating instructional programs by experts on topics such as communication, peer support, networking, negotiation, leadership personality strengths and weaknesses, and program and project management, we will help strengthen our young faculty and future leaders. But this is just the beginning. Achieving parity requires not only a level playing field but umpires on that field who are blind to factors other than quality and skill of an applicant or author, much like symphony auditions on a musical instrument. The simple, do-it-yourself online site, which predicts whether you are principle investigator material, incorporates PubMed identification numbers, last name, and career duration. Even this simple tool recognizes the contribution of gender where it should contribute nothing: Results vary by up to 10% using identical inputs, depending on whether one lists oneself as male or female.
      • vanDijk D.
      • Manor O.
      • Carey L.B.
      Publication metrics and success on the academic job market.
      We need to address the structural issues for both training and promotion, which will require shifts within schedules already burdened by hefty competition of other requirements and activities. We can reconsider the challenge of the current calendar of academic training, where time-out for family-related activities may mean missing an opportunity for advanced endoscopic training. We can reexamine the expectations for academic promotion, where taking a similar time-out likely means missing opportunities to build the academic repertoire and thus any chance to be promoted. The “lattice framework” already adopted by many in business and found successful in some academic programs might work well for our trainees and faculty.
      • Valantine H.
      • Sandborg C.I.
      Changing the culture of academic medicine to eliminate the gender leadership gap: 50/50 by 2020.
      Women in our specialty are among the most highly ranked individuals to pursue academic medical careers and are invaluable assets for our future. It is critical that our trainees and young faculty, both women and men, believe the highest achievements are possible for them. No instrument of success, including publication in our highest-rated journals, is beyond their dreams in first or senior author positions or eventually as invited editorialists. Play the tuba. Play the drums. Play the endoscope.

      Disclosure

      The author disclosed no financial relationships relevant to this publication.

      References

        • Brotherton S.E.
        • Etzel S.I.
        Graduate medical education 2013-2014.
        JAMA. 2014; 312: 2427-2445
        • Long M.T.
        • Leszczynski A.
        • Thompson K.D.
        • et al.
        Female authorship in major academic gastroenterology journals: a look over 20 years.
        Gastrointest Endosc. 2015; 81: 1440-1447
        • Beech B.M.
        • Calles-Escandon J.
        • Hairston K.G.
        • et al.
        Mentoring programs for underrepresented minority faculty in academic medical centers: a systematic review of the literature.
        Acad Med. 2013; 88: 541-549
        • vanDijk D.
        • Manor O.
        • Carey L.B.
        Publication metrics and success on the academic job market.
        Curr Biol. 2014; 24: R516-R517
        • Xie Y.
        Social influences on science and engineering career decisions. From Biological, social, and organizational components of success for women in academic science and engineering.
        National Academies Press, Washington, DC2006
        • Lopez S.A.
        • Svider P.F.
        • Misra P.
        • et al.
        Gender differences in promotion and scholarly impact: an analysis of 1460 academic ophthalmologists.
        J Surg Educ. 2014; 71: 851-859
        • Budden A.E.
        • Tregenza T.
        • Aarssen L.W.
        • et al.
        Double-blind review favors increased representation of female authors.
        Trends Ecol Evol. 2008; 23: 4-6
        • Jagsi R.
        • DeCastro R.
        • Griffith K.A.
        • et al.
        Similarities and differences in the career trajectories of male and female career development award recipients.
        Acad Med. 2011; 86: 1415-1421
        • Levitt D.G.
        Careers of an elite cohort of U.S. basic life science postdoctoral fellows and the influence of their mentor’ citation record.
        BMC Med Educ. 2010; 10: 80
        • Mitchell S.M.
        • Hesli V.L.
        Women don’t ask? Women don’t say no? Bargaining and service in the political science profession.
        PS Polit Sci Polit. 2013; 46: 355-369
        • Hallam S.
        • Rogers L.
        • Creech A.
        Gender differences in musical instrument choice.
        Int J Music Educ. 2008; 26: 7-19
        • Valantine H.
        • Sandborg C.I.
        Changing the culture of academic medicine to eliminate the gender leadership gap: 50/50 by 2020.
        Acad Med. 2013; 88: 1411-1413

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