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Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA
Albany Medical College, 49 New Scotland Ave, Albany, NY 12208, USADivision of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA
Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA
Corresponding author. , Division of Pediatric General Thoracic and Fetal Surgery, University of California, Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA. Tel.: +1916 734-2724; fax: +1916 734-5633.
Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA
Leadership in academic conferences is an important factor for academic advancement. Underrepresentation of women in academic surgical conferences has been demonstrated in other subspecialties, but it has not been well-studied in pediatric surgery.
Methods
This retrospective descriptive study analyzes conference participation at 2 national pediatric surgery annual conference programs from 2003 to 2022. Moderator, speakers, and research presenter sex was collected. The primary outcome was the proportion of female participants in each of these roles. Mann-Kendall trend test was conducted to assess for significance.
Results
Across 29 meetings, a total of 523 sessions were examined. Overall, female participation in all roles increased from 2003 to 2022. There were statistically positive trends of female participation in leadership roles as moderator (p=0.003) and speaker (p=0.01), with moderator role demonstrating the largest proportional female increase over time – with a 7-fold increase from 7.1% in 2003 to 50.0% in 2022. There was also a significant increasing trend in female participation as research presenters (p<0.01) from 25.4% to 46.4%.
Conclusion
Gender representation in pediatric surgery conferences has improved over the last two decades. Women now represent approximately half of all participatory roles, and efforts to continue providing equal opportunities for women at pediatric surgery academic conferences should continue.
The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant number UL1 TR001860 for author AH and supported in part by the UC Davis Paul Calabresi Career Development Award for Clinical Oncology as funded by the National Cancer Institute/National Institutes of Health through grant #2K12CA138464-11 for author EB. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Conflict of Interest
Authors have no conflict of interest to disclose.
1. Introduction
The proportion of women entering surgical fields has increased over the past two decades. In 2017, 40% of United States general surgery residents were women compared to only 14% in 2001.[
Conference proceeding from the 50th Annual Meeting of the Canadian Association of Paediatric Surgeons: “CAPS Serving Canada – Gender, Diversity, and CAPS.
] Additionally, only 27% of pediatric surgery fellowship program directors are female and only 5 out of 51 (9.8%) division chiefs at United States pediatric training programs are women in 2022.
Establishing a national reputation is a key factor considered in academic advancement and relies on successful publications and presence at academic conferences, which are a key platform for dissemination of new information and the creation of fruitful collaborations. While the underrepresentation of women in academic conferences has been well described in multiple surgical specialties including otolaryngology, plastic, cardiothoracic and orthopedic surgery, it has not been studied in pediatric surgery [
]. Given the high and increasing proportions of women in the field of pediatric surgery, assessing the representation of women at academic conferences is an important step in understanding potential barriers for women in the field and opportunities for improvement. The aim of this study was to describe the trend in proportions of gender distributions in different roles at pediatric surgery conferences over the last two decades. We hypothesize that female representation at pediatric conferences has overall increased over the last 18 years.
2. Methods
2.1 Study Population
Attendees whose names were printed in the publicly available conference programs of the American Pediatric Surgical Association (APSA) annual meetings from 2003 to 2021 and American Association of Pediatrics (AAP) annual meeting surgery sections from 2010 to 2021 were included. Aggregate gender information of membership of APSA from 2003 and 2021 were also included. These meetings were chosen to represent major pediatric surgery conferences in United States with publicly available conference programs.
2.2 Study Design
Approval for Institutional Review Board (IRB) approval was submitted and determined to not require formal IRB approval. This is a retrospective descriptive study examining trends in the proportion of female participants at academic pediatric surgery conferences. The primary outcome of interest is the proportions of each gender in the following roles: moderator, speaker, and research presenter. The participants were categorized into these roles based on the description of the session on the conference program. Gender was categorized as male, female, or unknown. Speakers included any presenters who had a speaking role and who were not presenting scientific abstracts including panelists and invited lecturers. Moderators were from any session type, including but not limited to research presentations and panels. Trends in the proportion of female APSA members were also studied from 2003 to 2022.
2.3 Data Collection
Attendees were identified from publicly available annual meeting programs of APSA and AAP surgery subsections. Conference programs did not specifically mention the gender of the participants. The names of participants in each of the identified roles were manually collected from the conference programs. The participants were categorized by traditional definition of gender, with gender confirmed by online search including hospital directories and/or other institutional websites that included the participant’s photo and biographical description including pronouns. If the gender was unclear, the participants were placed in the “unknown” category and excluded. If a participant both moderated and delivered a lecture or was on the panel in the same session, they were included as both moderator and as a speaker. All-male moderated sessions and all-male panel sessions were also identified. The 2020 APSA and AAP annual conferences were virtual due to the COVID-19 pandemic. The 2008 APSA annual program and 2015 to 2016 AAP annual programs were not available online.
We also solicited the APSA organization membership data. Aggregate data of gender composition and membership categories was obtained for 2003 to 2022. The membership was categorized based on the membership categories that were present at the time of the membership registration. These were further grouped into senior level members (senior members, regular members, and associate members), and junior level members (candidate member, resident members, and medical student members).
2.4 Statistical Analysis
Non-cyclical chronicity data was presented using year and percentages. Mann-Kendall trend test was used to determine if there were significant trends in proportion of women in different roles over time. Alpha was set to p <0.05. Statistical analysis was performed using SAS Studio software, version 9.45 (SAS institute INC., Cary, NC, USA).
3. Results
3.1 Female participation in conferences
A total of 523 sessions were examined across 29 annual meetings of APSA and AAP section on surgery. The research presenter role is largely compromised by trainees, and in the 2022 APSA meeting, 46.4% of research presenters were female. Leadership role as moderator were evenly split between female and male moderators at 50.0% each. The other leadership role as speakers, however, remains mainly male-dominated with 58.6% of speaking roles being male. In 2003 APSA meeting, there was a large gender imbalance in moderator role with only 7.14% moderators being female. This is disparity is also seen in the research presenter role with just 25.38% of research presenters being female. However, women in leadership roles as speakers comprised of 50% all speakers in 2003, which was an outlier and the highest proportion during the years studied. Female participation as moderators demonstrated the largest proportional statistically significant positive trend (z=2.47, p=0.003) over 20 years with a 7-fold increase (7.1% to 50.0%) (Fig. 1.). There was also a significant trend in the increased proportion of female speakers (z=2.80, p=0.01) and female research presenters (z=2.26, p<0.01).
Figure 1Trends in the proportion of female participants in various roles at national pediatric surgery conferences from 2003 to 2022. Proportion of female participants in (A) moderator, (B) speaker, and (C) research presenter roles. Significance in the trend assessed with Mann-Kendall trend test.
Regarding the proportion of sessions moderated by only men, there was a significant downward trend in sessions moderated by all men with zero female moderators (z=-3.32, p=0.0002) from 85.7% in 2003 to 16.7% in 2022 (Fig. 2.). While there was a similar down-trend in male only panels, also known as “manels”, from a single all male panel in 2005 to no male only panels out of 8 panels in 2022, this did not reach statistical significance (z=-0.07, p=0.0626). Of note, all of the session examined in this study, only 2 all-female panels were recorded - one in the 2019 APSA meeting, and one in the 2020 AAP meeting.
Figure 2Trends in the proportion of male only leadership representation at national pediatric surgery conferences from 2003 to 2022. Trends in proportion of (A) all male moderator sessions and (B) all male panels. Significance in the trend assessed with Mann-Kendall trend test.
The current 2022 APSA membership breakdown by gender is presented in Table 1. Women comprise 42.1%, 63.9% and 47.7% of medical student, resident, and candidate membership, respectively, in the junior level membership. In the senior level membership, women comprise 26% of associate members, 30% of regular members and 11.2% of senior members. In different membership categories in 2004, women comprised 20% of candidate membership, which was the only junior level membership available at the time. In the senior level membership, women comprised 12.6% and 4.3% of the available regular and senior membership respectively.
Table 1Gender breakdown of 2022 American Pediatric Surgery Association membership.
Total membership increased from 674 members in 2003 to 1615 members in 2022. Of those members, total female membership increased from 12.2% (n=82) in 2003 to 30.0% (n=484) in 2022, demonstrating a statistically significant trend (p<0.001) (Fig. 3.). Both junior and senior level membership had significant increasing trends in female members (p<0.001) with 2.8-fold and 2.5-fold increase in junior level and senior level respectively from 2003 to 2022.
Figure 3Proportion of female APSA members from 2003 to 2022. Proportion of female APSA members at (A) all levels, (B) junior level and (C) senior level membership. APSA = American Pediatric Surgical Association. Significance in the trend assessed with Mann-Kendall trend test.
Gender representation in leadership and speaking roles at national conferences has been studied across surgery, all of which demonstrate a glaring gender disparity.[
] Some of these disparities are most apparent in specialties where women remain the minority in the field, but also persist in fields with higher proportions of women surgeons. . In plastic surgery, a study looking at abstracts submitted to three national meetings concluded that females were 29% of the presenters and only 16% of abstract senior authors.[
] Moreover, a study assessing dermatologic surgery conferences between 2009 and 2017 reported significantly fewer speaking opportunities and speaking minutes for women.[
] In national neurosurgery conferences, women made less than 15% of the presenters and the percentage of all-male panels was anywhere between 20.7% and 61% depending on the conference.[
] Another study assessing 15 major surgical societies saw increased representation of women in eight societies, stable representation in four societies and consistent underrepresentation of women in three societies.[
] Although our results demonstrate greater female involvement in presenter and moderator roles, a future step could include examining the proportion of female first and senior authors over time. A recent paper examined this effect in pediatric neurosurgery and found that a greater proportion of first authors were female, while males made up the majority of senior authors.[
] In addition, they found that among all neurosurgery sub-specialties, pediatric neurosurgery had the highest proportion of female first and senior authors.[
] Generating this data for general pediatric surgery and comparing it to subspecialty pediatric surgery will be an important next step in diversity, equity and inclusion efforts to increase female representation in our field.
As women in surgery increase across all levels of training and specialties, there have been concerted efforts to improve female representation, particularly in leadership roles.[
] In 2022, women in the moderator role at pediatric surgery conferences reached 50% and women speakers comprised 41.4% of speakers in 2022 conferences. Given that the current membership of regular and senior level APSA members in 2022 is 30.0% and 11.2% respectively, this indicates conscious efforts to include more women in visible speaking roles at these conferences. This is also reflected in the historical trends of women in moderator and speaker roles, which both have demonstrated a significant upward trend. 50% of speakers being women in 2003 is likely an outlier, with proportions of women speaker consistently less than 25% until 2013, and never reaching the same level even in 2022. One of the most effective ways to increase the number of women on panels and in leadership is to increase the number of women in the field. This study shows a significant rise in the proportion of women members in APSA, likely a surrogate for women in the pediatric surgery field in United States, with almost 3-fold increase over the last two decades. This is the slow but steady progress towards lasting change.
More women trainees are pursuing and matching into pediatric surgery. Women now comprise more than half of APSA resident members and are nearing 50% of candidate members, a category comprised of current pediatric surgery fellows. Combined, women encompass 56.3% of junior level membership of APSA. This interest is also reflected in conference participation as research presenters, where many research presenters are female medical students, residents, and fellows. We demonstrated a significant increasing trend over the last 2 decades in the percentage of female presenters which coincides with the increase in female junior membership of APSA. Looking at these trends, there appears to be an increase in the number of women entering pediatric surgery. In addition, given the current number of women fellows and fellowship applicants, there may continue to be a natural increase in female, senior pediatric surgeons.
There have also been significant increases in the proportion of women in leadership roles at academic conferences over time. There have been more female panelists at American College of Surgeons Clinical Congress, and of moderators at Academic Surgical Congress over time.[
] Furthermore, the pediatric surgery specialty track at the American College of Surgeons (ACS) meeting has had higher than overall proportion of women panelists, and lower than overall proportion of panels comprised entirely of men compared to other subspecialties at that conference.[
] This study also demonstrates an increases in the proportion of women moderators and speakers over 20 years. However, it is important to note the discrepancy between total female pediatric surgeon numbers and female pediatric surgery faculty. Only 38% of pediatric surgery faculty potentially highlighting a discrepancy between women taking academic pediatric surgery positions compared to male colleagues.[
Conference proceeding from the 50th Annual Meeting of the Canadian Association of Paediatric Surgeons: “CAPS Serving Canada – Gender, Diversity, and CAPS.
] Continued support for women at national conferences and in academic medicine may help bridge this imbalance.
Our data also demonstrates that while there has been a high proportion of all male panels at these select pediatric surgery conferences, there have been none in the last 4 years. While the overall decrease was not significant, this implies some progress but also highlights an area for ongoing efforts. In a similar fashion, all-male moderated sessions have significantly trended downwards over the last 2 decades. This is particularly important as it can impact female participation in the conferences. Conferences are important platforms for clinicians and academics to increase their professional visibility. Additionally, female representation and visibility in academic surgery is an important factor for medical students and trainees seeking careers in pediatric surgery. Having a female academic surgeon role model or mentor may encourage and support the learners’ path toward pediatric surgery. In a study of female participation at UK Society for Endocrinology’s annual national conference, there was a higher proportion of subsequent questions in the session from women, if the opening question was posed by a woman. [
] In the subsequent year, they increased the number of sessions with woman chairs and saw that the number of questions in the year with increased woman chairs was significantly greater than the previous year. Additionally, science, technology, engineer and mathematics fields continue to demonstrate the previous observation seen in medicine in which if the first question is asked by a male audience member, subsequent questions by female members is decreased.[
There are several limitations to this study. First, we examined only two national conferences in the United States as these programs were readily available and represented two of the largest national pediatric surgery conference in the United States. However, there are multiple regional conferences that were not included that may have provide a more granular picture of the topic. Additionally, this is an evaluation of conferences in the United States with the majority of attendees from North America and therefore cannot be generalized to female representation in the arena of global pediatric surgery. The changes to conference format between the years, with increased research presentation sessions and lack of panels in some years, introduces variation in available opportunities at each conference. Furthermore, this data may not accurately estimate the number of individual men and women speaking at each meeting, as we did not account for double counting of the presenters, moderators, and speakers. Lastly, we acknowledge reporting gender in the conventional binary definition, and does not account for participants who may identify otherwise.
5. Conclusion
In conclusion, gender representation in pediatric surgery conferences has become more balanced over the last two decades. Women now represent about half of all participatory roles, including more visible roles, such as moderators and speakers, consistent with their relative overall increased representation in the field. However, continued efforts are still needed to provide opportunities for women at pediatric surgery academic conferences, with a final goal of fostering female collaboration, boosting female participation, and increasing the proportion of female surgeons in faculty positions. In future studies, there is additional opportunity to examine disparity issues in representation among pediatric surgeons from minority and marginalized groups, such as the LGBTQIA+ community or racial/ethnic minorities.
Acknowledgements
Authors would like to thank Ms. Marina Petrulla for her help with obtaining membership information for APSA.
References
2018 ACS Governors Survey
Gender inequality and harassment remain a challenge in surgery.
Conference proceeding from the 50th Annual Meeting of the Canadian Association of Paediatric Surgeons: “CAPS Serving Canada – Gender, Diversity, and CAPS.
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