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Gender parity in editorial boards and senior authorship: a long but hopeful road ahead

Published:August 12, 2021DOI:https://doi.org/10.1016/j.gie.2021.06.015

      Abbreviation:

      AAMC (Association of American Medical Colleges)
      The focus on equity, diversity, and inclusion has been increasingly prominent over the past year. Medical societies and institutions are charged with assessing and improving practices to achieve gender equity and are publicly committing to prioritizing this goal. As a profession we are deepening our acknowledgment around the challenges gender inequity presents for gender minorities in academic medicine as it relates to academic advancement. An appreciation for the larger context involves understanding that although women are more likely to pursue academic medicine, a lack of gender parity in top leadership roles persists. This is evidenced by statistics presented by the Association of American Medical Colleges citing that only 18% of academic department chairs and medical school deans in the United States are women, and in the field of gastroenterology, <10% of division chiefs are women.
      Association of American Medical Colleges
      The state of women in academic medicine: exploring pathways to equity.
      ,
      • Subramaniam M.
      • Azad N.
      • Wasan S.K.
      • et al.
      Equal opportunity: women representation on editorial boards and authorship of editorials in gastroenterology and hepatology journals.
      Publishing is a highly valued metric for academic promotion. In the medical literature, women are inadequately represented as authors and editorial board members in academia. Male faculty have significantly more publications and achieve a higher academic rank when compared with female faculty.
      • Polanco N.A.P.
      • McNally B.B.
      • Levy C.
      • et al.
      Gender differences in hepatology medical literature.
      An analysis of >1.5 million peer-reviewed medical research articles globally found that women constituted 35% of authors overall, 40% of first authors, and 27% of senior authors from 2007 to 2015.
      • Nielsen M.W.
      • Andersen J.P.
      • Schiebinger L.
      • et al.
      One and a half million medical papers reveal a link between author gender and attention to gender and sex analysis.
      Looking specifically at editorials, which are mainly commissioned by invitation, a recent study found that the average male-to-female first author ratio across 59 top international medical and public health journals was 2.08 between 2008 and 2018.
      • Chang A.Y.
      • Cesare N.
      Handing the microphone to women: changes in gender representation in editorial contributions across medical and health journals 2008-2018.
      On subanalysis, the authors found that the average male-to-female gender ratio in journals in the United States was 1.70.
      • Chang A.Y.
      • Cesare N.
      Handing the microphone to women: changes in gender representation in editorial contributions across medical and health journals 2008-2018.
      In this study by Leung et al,
      • Leung K.
      • Jawaid N.
      • Bollegala N.
      Gender differences in gastroenterology and hepatology authorship and editorial boards.
      the authors characterize the current gender representation of editors-in-chief, editorial board members, and first and senior authors of published articles in 2019 of the top-ranked gastroenterology and hepatology academic journals. In looking at the gender distribution of these positions from 29 journals with a mean impact factor of 5.55, 357 journal issues, and 8036 articles, the results were sobering. Only 7.7% were female chief editors, 17.4% (601/3455) female editorial board members, and 19% (1390/7445) senior authors. Importantly, the gender distribution of female first authorship (31.7%, 2547/8036) was generally aligned with the current percentage of women in the field of gastroenterology and hepatology. Furthermore, no statistically significant correlations between a journal’s impact factor or gender of the chief editor with gender representation on editorial boards or first or senior author were found. The authors concluded that despite female first authorship mirroring that of the current landscape of female GI and hepatology representation, the representation of women in leadership and membership positions on editorial boards and senior authorship remain as spaces overwhelmingly dominated by men.
      Gender bias in authorship of papers has been observed in a variety of medical specialties, inclusive of, but not limited to, pediatrics, dermatology, radiology, and psychiatry.
      • Madden C.
      • O’Malley R.
      • O’Connor P.
      • et al.
      Gender in authorship and editorship in medical education journals: a bibliometric review.
      Within gastroenterology, the same disconcerting trend has been noted in our own literature. Although the gap has narrowed with regard to first and senior authorship, closure of the gender gap in editorial boards has been less progressive. This trend is most pronounced in hepatology—a 2020 review of gender differences in high-impact hepatology literature found that approximately 71% to 72% of original articles and reviews/editorials had a male first or senior author and approximately 28% to 29% had a female first or senior author.
      • Polanco N.A.P.
      • McNally B.B.
      • Levy C.
      • et al.
      Gender differences in hepatology medical literature.
      Taking into consideration that 45% to 53% of transplant hepatology fellows are female, this finding is incredibly disheartening.
      • Garcia-Tsao G.
      Empowering women: perspective from a hepatologist.
      Similar to the current study, the authors found a positive correlation between gender concordance and authorship—a statistic that has been established in prior studies within and outside of the field of gastroenterology.
      • Polanco N.A.P.
      • McNally B.B.
      • Levy C.
      • et al.
      Gender differences in hepatology medical literature.
      ,
      • Nielsen M.W.
      • Andersen J.P.
      • Schiebinger L.
      • et al.
      One and a half million medical papers reveal a link between author gender and attention to gender and sex analysis.
      However, there has been some noteworthy improvement. The proportion of women editorial board members in gastroenterology has increased to 19.8% in 2020 from 2.9% in 1985, whereas editorials with female authors have also increased to 22.2% in 2020 from no representation in 1985.
      • Subramaniam M.
      • Azad N.
      • Wasan S.K.
      • et al.
      Equal opportunity: women representation on editorial boards and authorship of editorials in gastroenterology and hepatology journals.
      We see these gains as gleams of hope while also recognizing that there is a long road ahead in achieving gender parity. By contrast, within the high-impact medical education journals, there has been a significant increase in female authorship over time. A review of >5700 articles across a 49-year time period found that woman first authors increased from 6.6% in 1970 to 53.7% in 2019 and senior authors from 9.5% in 1970 to 46% in 2019.
      • Madden C.
      • O’Malley R.
      • O’Connor P.
      • et al.
      Gender in authorship and editorship in medical education journals: a bibliometric review.
      These findings are not surprising, given the gender distribution (57.9% men, 42.1% women) within their editorial boards.
      • Madden C.
      • O’Malley R.
      • O’Connor P.
      • et al.
      Gender in authorship and editorship in medical education journals: a bibliometric review.
      Is the impressive improvement in the gender distribution gap due to targeted efforts or is it simply that women form the majority of clinician-educators?
      • Madden C.
      • O’Malley R.
      • O’Connor P.
      • et al.
      Gender in authorship and editorship in medical education journals: a bibliometric review.
      The well-known mantra to which academicians are told to take heed, “publish or perish,” has been propagated for good reason. Conventionally, one measure of professional success in academia, an individual’s scholarship, obliges those who seek to advance in their careers to not only publish often but also hold key positions of first and senior authorship. Additionally, occupying a position on an editorial board assumes great responsibility and is a considerable contribution to the field in which one practices. The notable exclusion of women from the editorial boards of gastroenterology journals and as senior authors in gastroenterology publications does a disservice to the field at large. The absence of a diverse set of female gastroenterologists on editorial boards in numbers representative of the field is a detriment because it fails to enrich the diversity of thought, experience, and perspective that the voices of gender minorities unequivocally provide. The dearth of female senior authorship evokes a similar sentiment that begs for change as we digest the findings from the study by Leung et al
      • Leung K.
      • Jawaid N.
      • Bollegala N.
      Gender differences in gastroenterology and hepatology authorship and editorial boards.
      and its implications.
      Diversity drives excellence. It breeds innovation. Equity in all spaces of our profession is long overdue and is a necessity to advance the field. Gender-based compensation inequality, unequal gender representation in procedural fields like gastroenterology, lack of uniformity of maternity leave policies for trainees, and a disparity in editor-in-chief, editorial board, and senior author positions on publications each serves as an example of the consequences of our society’s history of how women are (de)valued.
      • Leung K.
      • Jawaid N.
      • Bollegala N.
      Gender differences in gastroenterology and hepatology authorship and editorial boards.
      ,
      • Feld L.D.
      Baby steps in the right direction: toward a parental leave policy for gastroenterology fellows.
      The field of medicine is no different. As an institution we must remember that it is impact, not intent, that should be the driver of how we look at our current systems and policies critically for quality improvement. The current framework that produces the observations we see in the findings by Leung et al
      • Leung K.
      • Jawaid N.
      • Bollegala N.
      Gender differences in gastroenterology and hepatology authorship and editorial boards.
      tells us that women’s voices, women’s power, and women’s talent must be heard and seen with more clarity and purpose within our profession.
      It is crucial that gastroenterology journals be intentional in their efforts to achieve gender parity within their authorship and editorial boards. Gender parity does not imply equal gender distribution within the field, given the low number of practicing female gastroenterologists at present. However, a deliberate effort should be made to increase the pool of female peer reviewers and authors for invited commentaries. Strategies to use include offering more women editorial opportunities, thereby strengthening their academic profiles. Such strategies may subsequently lead to speaker invitations to top medical conferences that in turn would generate further academic opportunities. Ensuring gender equity in publishing may promote gender equality in the sciences overall.
      • Chang A.Y.
      • Cesare N.
      Handing the microphone to women: changes in gender representation in editorial contributions across medical and health journals 2008-2018.
      In this study, male-dominated editorial boards had a significant positive correlation to male authorship and a negative correlation with female first and senior authorship. Given this concerning trend, another stratagem includes a double-blind review policy, which should be adopted across all gastroenterology journals. A significant increase in female first-author articles has been observed with the introduction of a double-blind review policy.
      • Chang A.Y.
      • Cesare N.
      Handing the microphone to women: changes in gender representation in editorial contributions across medical and health journals 2008-2018.
      For quality assurance purposes, journals should assess whether they are rejecting a larger proportion of female authors in comparison with their male colleagues by analyzing their pool of rejected papers.
      • Madden C.
      • O’Malley R.
      • O’Connor P.
      • et al.
      Gender in authorship and editorship in medical education journals: a bibliometric review.
      Gender inequities are in the spotlight with marked attention from our professional organizations. The board of directors at the AAMC has highlighted this as an important issue by endorsing a statement and call to action for leaders in academic medicine to address gender inequities within their respective institutions.
      Association of American Medical Colleges
      Gender equity in academic medicine.
      The focus areas as defined by the AAMC include workforce leadership, compensation, research, and recognition.
      Association of American Medical Colleges
      Gender equity in academic medicine.
      Improving gender equity within our editorial boards promotes both workforce leadership and recognition.
      In conclusion, the findings from the study by Leung et al
      • Leung K.
      • Jawaid N.
      • Bollegala N.
      Gender differences in gastroenterology and hepatology authorship and editorial boards.
      are consistent with the trends noted across the medical literature in multiple specialties.
      • Leung K.
      • Jawaid N.
      • Bollegala N.
      Gender differences in gastroenterology and hepatology authorship and editorial boards.
      Although female first and senior authorship is approaching representation within the field, editorial boards lag behind. Gastroenterology journals need to be thoughtful in promoting and supporting women in academic medicine, with an important step being their commitment to increase representation in publishing.

      Disclosure

      All authors disclosed no financial relationships.

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