A recent study has highlighted a significant gender disparity in grand round lectures across U.S. internal medicine residency programs. Conducted by Ersilia M. DeFilippis, MD, from the Center for Advanced Cardiac Care at Columbia University Irving Medical Center, this research analyzed 3,806 grand round lectures from September 1997 to December 2022. The findings reveal that only 21% of these lectures were delivered by women, while men gave the remaining 79%.
The study's data was drawn from just 42 of the 626 internal medicine residency programs in the United States, suggesting that the issue of underrepresentation might be even more widespread. Senior author Nosheen Reza, MD, director of the Penn Women in Cardiology Program at the University of Pennsylvania, emphasized that while there has been an increase in female speakers, the growth is modest.
"We were heartened to see growth, albeit very small growth, but positive signals toward more women speakers over time." – Nosheen Reza, MD
The analysis excluded grand rounds with multiple speakers and trainee-led case conferences to maintain focus on individual contributions. Over the 25-year period, the number of female grand round speakers increased by an average of 1% per year. However, despite this gradual rise, disparities persist across various medical subspecialties.
A closer examination reveals that women were predominantly invited to speak on women's cardiovascular health, accounting for 80 lectures compared to 17 by their male counterparts. Nevertheless, this topic constituted only 10% of all grand round lectures, indicating an area of potential growth for female representation.
"And those are specific areas where we should try to elevate women's voices," – Nosheen Reza, MD
Conversely, men dominated discussions on other medical topics, with a mere 0.6% of their lectures focusing on women's cardiovascular health. Notably, women were underrepresented in subspecialties such as electrophysiology and basic translational science — areas where their presence remained stagnant throughout the study.
According to data from the Association of American Medical Colleges for 2018-2019, women made up just 21% of cardiology faculty at U.S. medical schools. The percentage of practicing female cardiologists is even lower, estimated between 12.6% and 14%. These figures underscore the broader challenge of achieving gender equity within the field.
Mary N. Walsh, MD, addressed the challenges institutions face in rectifying this imbalance.
"You can't assign responsibility to these institutions for how many women they have giving their grand rounds unless you know how many they invited. It's very hard data to get." – Mary N. Walsh, MD
Walsh suggests that utilizing a directory could help institutions increase female participation in grand rounds. This strategy was effectively implemented by Nosheen Reza at her institution.
"Internally, we were only inviting about 10%-11% of (women speakers). I thought, obviously we could do much better than this," – Nosheen Reza, MD
"We saw very quickly — within 2-3 years — that actually we completely flipped the representation and there were a couple of years when we had 50%-55% of women speakers," – Nosheen Reza, MD
The invitation to deliver a grand round lecture is often a recognition of expertise and accomplishment within a specific medical field. Therefore, ensuring equitable opportunities for women is essential for acknowledging their contributions and expertise.
"It's an invitation one gets generally when becoming accomplished in a field and if there's a differential in inviting men vs women, then women aren't being recognized for their expertise." – Mary N. Walsh, MD
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