Mentorship of Underrepresented Physicians and Trainees in Academic Medicine: a Systematic Review

Reference letters play an important role for both postgraduate residency applications and medical faculty hiring processes. This study seeks to characterise the ways in which gender bias may manifest in the language of reference letters in academic medicine. In particular, we conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched Embase, MEDLINE and PsycINFO from database inception to July 2020 for original studies that assessed gendered language in medical reference letters for residency applications and medical faculty hiring. A total of 16 studies, involving 12 738 letters of recommendation written for 7074 applicants, were included. A total of 32% of applicants were women. There were significant differences in how women were described in reference letters. A total of 64% (7/11) studies found a significant difference in gendered adjectives between men and women. Among the 7 studies, a total of 86% (6/7) noted that women applicants were more likely to be described using communal adjectives, such as “delightful” or “compassionate”, while men applicants were more likely to be described using agentic adjectives, such as “leader” or “exceptional”. Several studies noted that reference letters for women applicants had more frequent use of doubt raisers and mentions of applicant personal life and/or physical appearance. Only one study assessed the outcome of gendered language on application success, noting a higher residency match rate for men applicants. Reference letters within medicine and medical education exhibit language discrepancies between men and women applicants, which may contribute to gender bias against women in medicine.

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Women’s leadership in academic medicine: a systematic review of extent, condition and interventions

BMJ Open ◽

10.1136/bmjopen-2019-032232 ◽

2020 ◽

Vol 10 (1) ◽

pp. e032232 ◽

Cited By ~ 2

Author(s):

Lulu Alwazzan ◽

Samiah S Al-Angari

Keyword(s):

Systematic Review ◽

Leadership Development ◽

Academic Medicine ◽

Medical Schools ◽

Women's Leadership ◽

Research Quality ◽

Cochrane Library ◽

Cross Sectional ◽

Quantitative Studies ◽

The Impact

ObjectivesBecause culture reflects leadership, the making of diverse and inclusive medical schools begins with diversity among leaders. The inclusion of women leaders remains elusive, warranting a systematic exploration of scholarship in this area. We ask: (1) What is the extent of women’s leadership in academic medicine? (2) What factors influence women’s leadership? (3) What is the impact of leadership development programmes?DesignSystematic review.Data sourcesA systematic search of six online databases (OvidMEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library and ERIC) from the earliest date available to April 2018 was conducted. Bridging searches were conducted from April 2018 until October 2019.Eligibility criteria(1) Peer-reviewed; (2) English; (3) Quantitative studies (prospective and retrospective cohort, cross-sectional and preintervention/postintervention); evaluating (4) The extent of women’s leadership at departmental, college and graduate programme levels; (5) Factors influencing women’s leadership; (6) Leadership development programmes. Quantitative studies that explored women’s leadership in journal editorial boards and professional societies and qualitative study designs were excluded.Data extraction and synthesisTwo reviewers screened retrieved data of abstracts and full-texts for eligibility, assessment and extracted study-level data independently. The included studies were objectively appraised using the Medical Education Research Quality Study Instrument with an inter-rater reliability of (κ=0.93).ResultsOf 4024 records retrieved, 40 studies met the inclusion criteria. The extent of women’s leadership was determined through gender distribution of leadership positions. Women’s leadership emergence was hindered by institutional requirements such as research productivity and educational credentials, while women’s enactment of leadership was hindered by lack of policy implementation. Leadership development programmes had a positive influence on women’s individual enactment of leadership and on medical schools’ cultures.ConclusionsScholarship on women’s leadership inadvertently produced institute-centric rather than women-centric research. More robust contextualised scholarship is needed to provide practical-recommendations; drawing on existing conceptual frameworks and using more rigorous research methods.

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Mentoring as an intervention to promote gender equality in academic medicine: a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-040355 ◽

2021 ◽

Vol 11 (1) ◽

pp. e040355

Author(s):

Allan House ◽

Naila Dracup ◽

Paula Burkinshaw ◽

Vicky Ward ◽

Louise D Bryant

Keyword(s):

Systematic Review ◽

Gender Equality ◽

Academic Medicine ◽

Academic Career ◽

Extended Period ◽

Well Being ◽

Healthcare Organisation ◽

Gender Inequalities ◽

Eligibility Criteria ◽

The Impact

BackgroundMentoring is frequently suggested as an intervention to address gender inequalities in the workplace.ObjectivesTo systematically review evidence published since a definitive review in 2006 on the effectiveness of mentoring interventions aimed at achieving gender equality in academic medicine.DesignSystematic Review, using the Template for Intervention Description and Replication as a template for data extraction and synthesis.SampleStudies were included if they described a specific mentoring intervention in a medical school or analogous academic healthcare organisation and included results from an evaluation of the intervention.Eligibility criteriaMentoring was defined as (1) a formally organised intervention entailing a supportive relationship between a mentor, defined as a more senior/experienced person and a mentee defined as a more junior/inexperienced person; (2) mentoring intervention involved academic career support (3) the mentoring relationship was outside line management or supervision of performance and was defined by contact over an extended period of time.OutcomesThe impact of mentoring was usually reported at the level of individual participants, for example, satisfaction and well-being or self-reported career progression. We sought evidence of impact on gender equality via reports of organisation-level effectiveness, of promotion or retention, pay and academic performance of female staff.ResultsWe identified 32 publications: 8 review articles, 20 primary observational studies and 4 randomised controlled trials. A further 19 discussed mentoring in relation to gender but did not meet our eligibility criteria. The terminology used, and the structures and processes reported as constituting mentoring, varied greatly. We identified that mentoring is popular with many who receive it; however, we found no robust evidence of effectiveness in reducing gender inequalities. Primary research used weak evaluation designs.ConclusionsMentoring is a complex intervention. Future evaluations should adopt standardised approaches used in applied health research to the design and evaluation of effectiveness and cost-effectiveness.

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Content and outcomes of narrative medicine programmes: a systematic review of the literature through 2019

BMJ Open ◽

10.1136/bmjopen-2019-031568 ◽

2020 ◽

Vol 10 (1) ◽

pp. e031568 ◽

Cited By ~ 3

Author(s):

Christy DiFrances Remein ◽

Ellen Childs ◽

John Carlo Pasco ◽

Ludovic Trinquart ◽

David B Flynn ◽

...

Keyword(s):

Systematic Review ◽

Academic Medicine ◽

Narrative Medicine ◽

Qualitative Evaluation ◽

Health Sciences ◽

Personal Accomplishment ◽

Relationship Building ◽

Positive Outcomes ◽

Participant Satisfaction ◽

As Relationship

ObjectivesNarrative medicine (NM) incorporates stories into health sciences paradigms as fundamental aspects of the human experience. The aim of this systematic review is to answer the research question: how effective is the implementation and evaluation of NM programmes in academic medicine and health sciences? We documented objectives, content and evaluation outcomes of NM programming to provide recommendations for future narrative-based education.MethodsWe conducted a systematic review of literature published through 2019 using five major databases: PubMed, Embase, PsycINFO, ERIC and MedEdPORTAL. Eligible NM programming included textual analysis/close reading of published literature and creative/reflective writing. Qualifying participants comprised individuals from academic medicine and health sciences disciplines. We reviewed and categorised programme goals, content and evaluation activities to assess participant satisfaction and programme efficacy. Two members of the research team assessed the risk of bias, independently screening records via a two-round, iterative process to reach consensus on eligibility.ResultsOf 1569 original citations identified, we selected 55 unique programmes (described in 61 records). In all, 41 (75%) programmes reported a form of evaluation; evaluation methods lacked consistency. Twenty-two programmes used quantitative evaluation (13 well described), and 33 programmes used qualitative evaluation (27 well described). Well-described quantitative evaluations relied on 32 different measures (7 validated) and showed evidence of high participant satisfaction and pre-post improvement in competencies such as relationship-building, empathy, confidence/personal accomplishment, pedagogical skills and clinical skills. An average of 88.3% of participants agreed or strongly agreed that the programme had positive outcomes. Qualitative evaluation identified high participant satisfaction and improvement in competencies such as relationship-building, empathy, perspective-taking/reflection, resilience and burnout detection/mitigation, confidence/personal accomplishment, narrative competence, and ethical inquiry.ConclusionEvaluation suggests that NM programming leads to high participant satisfaction and positive outcomes across various competencies. We suggest best practices and innovative future directions for programme implementation and evaluation.

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A Systematic Review of Qualitative Research on the Meaning and Characteristics of Mentoring in Academic Medicine

Journal of General Internal Medicine ◽

10.1007/s11606-009-1165-8 ◽

2009 ◽

Vol 25 (1) ◽

pp. 72-78 ◽

Cited By ~ 288

Author(s):

Dario Sambunjak ◽

Sharon E. Straus ◽

Ana Marusic

Keyword(s):

Systematic Review ◽

Qualitative Research ◽

Academic Medicine

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Gender differences in faculty rank among academic physicians: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2021-050322 ◽

2021 ◽

Vol 11 (11) ◽

pp. e050322

Author(s):

Ben Li ◽

Jean Jacob-Brassard ◽

Fahima Dossa ◽

Konrad Salata ◽

Teruko Kishibe ◽

...

Keyword(s):

Systematic Review ◽

Gender Gap ◽

Academic Medicine ◽

Data Extraction ◽

Meta Analysis ◽

Mean Difference ◽

Cochrane Central Register ◽

Faculty Rank ◽

Geographical Regions ◽

Over Time

ObjectiveMany studies have analysed gender bias in academic medicine; however, no comprehensive synthesis of the literature has been performed. We conducted a pooled analysis of the difference in the proportion of men versus women with full professorship among academic physicians.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, Embase, Cochrane Central Register of Controlled Trials, Education Resources Information Center and PsycINFO were searched from inception to 3 July 2020.Study selectionAll original studies reporting faculty rank stratified by gender worldwide were included.Data extraction and synthesisStudy screening, data extraction and quality assessment were performed by two independent reviewers, with a third author resolving discrepancies. Meta-analysis was conducted using random-effects models.ResultsOur search yielded 5897 articles. 218 studies were included with 991 207 academic physician data points. Men were 2.77 times more likely to be full professors (182 271/643 790 men vs 30 349/251 501 women, OR 2.77, 95% CI 2.57 to 2.98). Although men practised for longer (median 18 vs 12 years, p<0.00002), the gender gap remained after pooling seven studies that adjusted for factors including time in practice, specialty, publications, h-index, additional PhD and institution (adjusted OR 1.83, 95% CI 1.04 to 3.20). Meta-regression by data collection year demonstrated improvement over time (p=0.0011); however, subgroup analysis showed that gender disparities remain significant in the 2010–2020 decade (OR 2.63, 95% CI 2.48 to 2.80). The gender gap was present across all specialties and both within and outside of North America. Men published more papers (mean difference 17.2, 95% CI 14.7 to 19.7), earned higher salaries (mean difference $33 256, 95% CI $25 969 to $40 542) and were more likely to be departmental chairs (OR 2.61, 95% CI 2.19 to 3.12).ConclusionsGender inequity in academic medicine exists across all specialties, geographical regions and multiple measures of success, including academic rank, publications, salary and leadership. Men are more likely than women to be full professors after controlling for experience, academic productivity and specialty. Although there has been some improvement over time, the gender disparity in faculty rank persists.PROSPERO registration numberCRD42020197414.

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