Gender equity: Articles

Abstract
Purpose: The number of women in high-level leadership in academic medicine remains disproportionately low. Early career programs may help increase women's representation in leadership. We evaluated the Early Career Women's Leadership Program (ECWLP). We hypothesized that participants would rate themselves as having increased confidence in their leadership potential, improved leadership skills, and greater alignment between their goals for well-being and leading after the program. We also explored the participants' aspirations and confidence around pursuing high-level leadership before and after the program.

Methods: We surveyed women physicians and scientists before and after they participated in the 2023 ECWLP, consisting of 11 seminars over six months. We analyzed pre- and post-program data using Wilcoxon signed-rank tests. We analyzed answers to open-ended questions with a content analysis approach.

Results: 47/51 (92%) participants responded, and 74% answered pre- and post-program questionnaires. Several metrics increased after the program, including women's confidence in their ability to lead (p<0.001), negotiate (p<0.001), articulate their career vision (p<0.001), reframe obstacles (p<0.001), challenge their assumptions (p<0.001), and align their personal and professional values (p=0.002). Perceptions of conflict between aspiring to lead and having family responsibilities (p=0.003) and achieving physical well-being (p=0.002) decreased. Perceived barriers to advancement included not being part of influential networks, a lack of transparency in leadership, and a competitive and individualistic culture. In the qualitative analysis, women described balancing internal factors such as self-doubt with external factors like competing professional demands when considering leadership. Many believed that becoming a leader would be detrimental to their well-being. Beneficial ECWLP components included support for self-reflection, tactical planning to pursue leadership, and creating a safe environment.

Conclusion: The ECWLP improved women's confidence and strategic plans to pursue leadership in a way that supported their work-life integration. Early career leadership programs may encourage and prepare women for high-level leadership.

Abstract
Background: Gender equity is essential for improving health outcomes globally. Despite comprising 75% of the global health workforce and dominating academic global health programs, women remain underrepresented in leadership positions in global health organizations. Our study aimed to identify potential gender differences in the beliefs and attitudes regarding barriers that women anesthesiologists encounter in pursuing careers and leadership roles in global health and to identify recommendations for improving gender equity in global health.

Methods: We conducted a cross-sectional online survey focusing on career leadership opportunities and challenges uniquely faced by women clinicians in global health. We obtained permission from the World Federation of Societies of Anaesthesiologists to distribute our questionnaire to their leadership committee members during 2 months (May-July 2022).

Results: The questionnaire was distributed to 164 study participants with 67 individuals (44.8% female) based in 38 different countries completing the survey (response rate 40.9%). Overall, 47.8% of the participants aspired to a leadership position in global health and 58.2% agreed women face unique barriers to global health leadership (70.0% of women compared to 48.6% of men; P = .081). Female gender (odds ratio [OR], 19.22, P = .004) and divorced marital status (OR, 746.26, P = .004) were positively associated and African ethnicity (OR, 0.002, P = .017) was negatively associated with the perception of gender bias in their career growth. The main challenges included balancing work and family responsibilities, lack of female mentors or role models, gender-based discrimination, and limited opportunities for career advancement. Men acknowledged these challenges but reported personally experiencing them to a lesser extent, particularly concerning lack of opportunities (P = .005), inadequate pay (P = .000), and lack of training (P = .000).

Conclusions: Gender disparities exist in the pursuit of global health careers. This study underscored that more women than men perceive barriers in pursuing leadership roles in global health and that men generally encounter these obstacles to a lesser extent. Female representation in leadership positions could be supported through evidence-informed policies that promote work-life balance, improve mentorship, offer equal opportunities for career advancement and adequate pay, and combat gender-based discrimination.

Abstract
Background: Gender imbalance and poor representation of women complicate the anesthesiology workforce crisis in sub-Saharan Africa (SSA). This study was performed to obtain a better understanding of gender disparity among medical graduates and anesthesiologists in SSA.

Methods: Using a quantitative, participatory, insider research study, led by female anesthesiologists as the national coordinators in SSA, we collected data from academic or national health authorities and agencies. National coordinators were nominees of anesthesiology societies that responded to our email invitations. Data gathered from 13 countries included information on medical graduates, anesthesiologists graduating between 1998 and 2021, and number of anesthesiologists licensed to practice in 2018. We compared data between Francophone and Anglophone countries, and between countries in East Africa and West Africa/Central Africa. We calculated anesthesiology workforce densities and compared representation of women among graduating anesthesiologists and medical graduates.Data analysis was performed using linear regression. We used F-tests on regression slopes to assess the trends in representation of women over the years and the differences between the slopes. A value of P < .050 was considered statistically significant.

Results: Over a 20-year period, the representation of female medical graduates in SSA increased from 29% (1998) to 41% (2017), whereas representation of female anesthesiologists was inconsistent, with an average of 25%, and lagged behind. Growth and gender disparity patterns were different between West Africa/Central Africa and East Africa. Representation of female anesthesiologists was higher in East Africa (39.4%) than West Africa/Central Africa (19.7%); and the representation of female medical graduates in East Africa (42.5%) was also higher that West Africa/Central Africa (33.1%).

Conclusions: On average, in SSA, female medical graduates (36.9%), female anesthesiologists (24.9%), and female anesthesiology residents projected to graduate between 2018 and 2022 (25.2%) were underrepresented when compared to their male counterparts. Women were underrepresented in SSA, despite evidence that their representation in medicine and anesthesiology in East African countries was rising.

Abstract
Returning to work after maternity leave poses significant challenges, with potential long-term implications including decreased engagement or attrition of clinicians. Many quantitative studies have identified challenges and supports for women during pregnancy, maternity leave and re-entry to clinical practice. This qualitative study explored the experiences of anaesthetists returning to clinical work after maternity leave, to identify influential factors with the aim of providing a framework to assist planning re-entry. We conducted semi-structured interviews with 15 anaesthetists. Attendees of a re-entry programme were invited to participate, with purposive sampling and snowball recruitment to provide diversity of location and training stage, until data saturation was reached at 13 interviews. Five themes were identified: leave duration; planning re-entry; workplace culture; career impact and emotional impact. Leave duration was influenced by concerns about deskilling, but shorter periods of leave had logistical challenges, including fatigue. Most participants started planning to return to work with few or no formal processes in the workplace. Workplace culture, including support for breastfeeding, was identified as valuable, but variable. Participants also experienced negative attitudes on re-entry, including difficulty accessing permanent work, with potential career impacts. Many participants identified changes to professional and personal identity influencing the experience with emotional sequelae. This research describes factors which may be considered to assist clinicians returning to work after maternity leave and identifies challenges, including negative attitudes, which may pose significant barriers to women practising in anaesthesia and may contribute to lack of female leadership in some workplaces.

Abstract
Disparities in pain care are well-documented such that women and people of color have their pain undertreated and underestimated compared to men and White people. One of the contributors of the undertreatment of pain for people of color and women may be the inaccurate assessment of pain. Understanding the pain assessment process is an important step in evaluating the magnitude of and intervening on pain disparities in care. In the current work, we focus on documenting intersectional race and gender biases in pain assessment and present results of a novel intervention for reducing these biases. Across three studies (N = 532) and a mini meta-analysis using real videotaped people in pain as stimuli, we demonstrate that observers disproportionately underestimated women of color's pain compared to all other groups (men of color, White women, and White men). In Study 3 (N = 232), we show that a novel intervention focused on behavioral skill building (i.e., practice and immediate feedback) significantly reduced observers' pain assessment biases towards marginalized groups compared to all other types of trainings (raising awareness of societal biases, raising awareness of self-biases, and a control condition). While it is an open question as to how long this type of intervention lasts, behavioral skills building around assessing marginalized people's pain more accurately is a promising training tool for healthcare professionals. PERSPECTIVE: This article demonstrates the underestimation of pain among people of color and women. We also found support that a novel intervention reduced observers' pain assessment biases towards marginalized groups. This could be used in medical education or clinical care to reduce intersectional pain care disparities.

Keywords: diversity; gender equity; inclusion; sexism; thwarted belongingness.

Abstract
Gender inequity remains an issue in anaesthesia despite increasing numbers of women training and achieving fellowship in the speciality. Women are under-represented in all areas of anaesthetic research, academia and leadership. The Gender Equity Subcommittee of the Australian and New Zealand College of Anaesthetists recently conducted a survey asking "Does gender still matter in the pursuit of a career in anaesthesia in 2022?". The survey was distributed to a randomly selected sample of 1225 anaesthetic consultants and completed by 470 respondents (38% response rate) with 793 free-text comments provided. Three overarching themes were identified: gender effects on the career and family interface; women do not fit the mould; and gender equity changes the status quo. Women respondents described a need to make a choice between career and family, which was not described by men, as well as stigmatisation of part-time work, a lack of access to challenging work and negative impacts of parental leave. Women respondents also described a sense of marginalisation within anaesthesia due to a 'boys' club' mentality, a lack of professional respect and insufficient structural supports for women in leadership. This was compounded for women from ethnically and culturally diverse backgrounds. A need for specific strategies to support anaesthetic careers for women was described as well as normalisation of flexibility in workplaces, combined with a broadening of our definition of success to allow people of all genders to experience fulfilment both at home and at work. This study is the first published qualitative data on factors affecting gender equity for anaesthetists in Australia and Aotearoa New Zealand. It highlights the need for further exploration, as well providing a foundation for changes in attitude and structural changes towards advancing gender equity.

Abstract
Objectives: Critical care medicine is a medical specialty where women remain underrepresented relative to men. The purpose of this study was to explore perceived drivers (i.e., influencing factors) and implications (i.e., associated consequences) of gender inequity in critical care medicine and determine strategies to attract and retain women.

Design: Qualitative interview-based study.

Setting: We recruited participants from the 13 Canadian Universities with adult critical care medicine training programs.

Participants: We invited all faculty members (clinical and academic) and trainees to participate in a semistructured telephone interview and purposely aimed to recruit two faculty members (one woman and one man) and one trainee from each site. Interviews were transcribed verbatim, and two investigators conducted thematic analysis.

Interventions: Not applicable.

Measurements and main results: Three-hundred seventy-one faculty members (20% women, 80% men) and 105 trainees (28% women, 72% men) were invited to participate, 48 participants were required to achieve saturation. Participants unanimously described critical care medicine as a specialty practiced predominantly by men. Most women described experiences of being personally or professionally impacted by gender inequity in their group. Postulated drivers of the gender gap included institutional and interpersonal factors. Mentorship programs that span institutions, targeted policies to support family planning, and opportunities for modified role descriptions were common strategies suggested to attract and retain women.

Conclusions: Participants identified a gender gap in critical care medicine and provided important insight into the impact for personal, professional, and group dynamics. Recommended improvement strategies are feasible, map broadly onto reported drivers and implications, and are applicable to critical care medicine and more broadly throughout medical specialties.

Abstract
A survey sent to fellows of the Australian and New Zealand College of Anaesthetists (ANZCA) aimed to document issues affecting gender equity in the anaesthesia workplace. A response rate of 38% was achieved, with women representing a greater proportion of respondents (64.2%). On average women worked fewer hours than men and spent a larger percentage of time in public practice; however, satisfaction rates were similar between genders. There was a gender pay gap which could not be explained by the number of hours worked or years since achieving fellowship. The rates of bullying and harassment were high among all genders and have not changed in 20 years since the first gender equity survey by Strange Khursandi in 1998. Women perceived that they were more likely to be discriminated against particularly in the presence of other sources of discrimination, and highlighted the importance of the need for diversity and inclusion in anaesthetic workplaces. Furthermore, women reported higher rates of caregiving and unpaid domestic responsibilities, confirming that anaesthetists are not immune to the factors affecting broader society despite our professional status. The overall effect was summarised by half of female respondents reporting that they felt their gender was a barrier to a career in anaesthesia. While unable to be included in statistics due to low numbers, non-binary gendered anaesthetists responded and must be included in all future work. The inequities documented here are evidence that ANZCA's gender equity subcommittee must continue promoting and implementing policies in workplaces across Australia and New Zealand.

Abstract
Despite progress made over the past decade, women are under-represented in positions of leadership in academic medicine. Women physicians face numerous challenges throughout their careers. Despite achieving leadership positions, women in leadership continue to experience the impact of those challenges. In this review, we describe four misconceptions about women in leadership, along with their impact and recommendations. First, we describe differences between mentorship and sponsorship, as well as their impact on attaining leadership positions. Second, the gender pay gap persists throughout women's careers, regardless of leadership positions. Third, we explore the role of self-efficacy in leadership in the context of stereotype threats. Fourth, gendered expectations of leadership characteristics place an undue burden on women, detracting from their leadership effectiveness. Organizations can address the challenges women face by creating robust mentorship and sponsorship networks, establishing transparent and equitable pay policies, promoting and normalizing a broader range of leadership styles, and improving work flexibility and support structure. Ultimately, such changes serve all members of the organization through increased retention and engagement.

Abstract
Background: Suggested anaesthetic dose ranges do not differ by sex, likely because of limited studies comparing sexes. Our objective was to systematically synthesise studies with outcomes of unintended anaesthesia awareness under anaesthesia, intraoperative connected consciousness, time to emergence from anaesthesia, and dosing to achieve adequate depth of anaesthesia, and to compare between females and males.

Methods: Studies were identified from MEDLINE, Embase, and the Cochrane library databases until August 2, 2022. Controlled clinical trials (randomised/non-randomised) and prospective cohort studies that reported outcomes by sex were included. Results were synthesised by random effects meta-analysis where possible, or narrative form.

Results: Of the 19 749 studies identified, 64 (98 243 participants; 53 143 females and 45 100 males) were eligible for inclusion, and 44 citations contributed to meta-analysis. Females had a higher incidence of awareness with postoperative recall (33 studies, odds ratio 1.38, 95% confidence interval [CI] 1.09-1.75) and connected consciousness during anaesthesia (three studies, OR 2.09, 95% CI 1.04-4.23) than males. Time to emergence was faster in females, including time to eye-opening (10 studies, mean difference -2.28 min, 95% CI -3.58 to -0.98), and time to response to command (six studies, mean difference -2.84 min, 95% CI -4.07 to -1.62). Data on depth of anaesthesia were heterogenous, limiting synthesis to a qualitative review which did not identify sex differences.

Conclusions: Female sex was associated with a greater incidence of awareness under general anaesthesia, and faster emergence from anaesthesia. These data suggest reappraisal of anaesthetic care, including whether similar drug dosing for females and males represents best care.

Anaesthesiology research has made a huge shift in sex distribution owing to the increasing number of women entering the field. This article discusses the effects of this shift on sex equality in anaesthesiology, based on scientific authorships.

This article examines the only 5 women to become presidents of the American Society of Anesthesiologists (ASA) so far. Through their personal histories, these physicians tell a collective history of women in this specialty from the 1950s to today.

Keywords: anesthesia; global health; medical education; rural health; underserved health.

This review outlines the biological factors that impact the perioperative care of TGD patients, such as the management of estrogen and testosterone HT, safe use of sugammadex, interpretation of laboratory values in the context of HT, pregnancy testing, drug dosing, breast binding, altered airway and urethral anatomy after prior GAS, pain management, and other GAS considerations.

The goals of this study are to examine the representation of women in leadership positions in anesthesiology societies compared to women society members and women anesthesiologists and to analyze the trend in women society presidents over time.

Keywords: COVID-19; Women physicians; burnout; gender equity.

Keywords: Mentorship; low and middle income countries (LMICs); research; research capacity strengthening; sexual and reproductive health and rights (SRHR); women.

Keywords: Myanmar; SRHR; gender; reproductive health; war.

Abstract
Background: The representation of women among leaders in the field of anesthesia continues to trail that of their male counterparts. This qualitative study was conducted to understand the pathway of leadership acquisition among women in the field of anesthesiology.

Methods: Using constructivist grounded theory, we sought to determine whether there were specific internal or external factors that were common to women in leadership in the specialty field of anesthesiology, and specifically, how they obtained leadership positions. Semistructured interviews were conducted for data collection. A total of 26 women in leadership positions in anesthesiology participated in this study.

Results: The analysis of these interviews resulted in the development of 4 common themes related to career pathways for these women in leadership. Each theme was examined in depth to determine the qualities necessary for individuals to advance in the field and the pathway to obtaining leadership positions. The findings of this study showed that early-career, high-value mentorship and sponsorship were important factors in leadership acquisition. Most participants (n = 20; 76%) had early mentors. Of those with early mentorship, 13 (65%) had high-value mentors, who we define as someone with power or authority. Sponsorship was the leading factor contributing to leadership acquisition.

Conclusions: The results of this qualitative study may serve as a guide for encouraging female anesthesiologists with leadership aspirations. We suggest that the specialty field of anesthesiology institute targeted measures to help increase the percentage of women leadership with formal sponsorship programs at the local and national levels.

Abstract
Purpose: Although it is important to recognize gender disparities in publishing to achieve gender diversity, women's authorship in Japan remains unclear. Therefore, this study aimed to investigate the percentage and analyze the trends of articles authored and published in anesthesiology journals by Japanese female authors.

Methods: The genders of the first and last authors affiliated with Japanese institutions were surveyed in the Journal of Anesthesia (JA) (1990, 1995, and 2000-2022) and 11 international anesthesiology journals (2010-2022).

Results: We included 845 and 819 original research articles from JA in the analyses of the first and last authors, respectively. The proportion of female first authors significantly increased from 41 (11.7%) out of 351 before 2009 to 119 (24.1%) out of 494 after 2010 (p < 0.001). The proportion of female last authors was 11 (3.3%) out of 335 before 2009 and 22 (4.5%) out of 484 after 2010, respectively, with no significant difference (p = 0.470). We included 624 and 572 original research articles from international anesthesiology journals in the analyses of first and last authors, respectively. Among these, there were 134 (21.5%) and 23 (4.0%) female first and last authors, respectively. These proportions in international anesthesiology journals did not significantly differ from those in JA (p = 0.334, p = 0.789, respectively).

Conclusion: The percentage of female first authors has increased, commensurate with the percentage of female anesthesiologists. However, the percentage of female last authors has not increased and remains low in Japan.

This article is being published concurrently in Journal of Pain, PAIN, European Journal of Pain, Pain Medicine, Canadian Journal of Pain, Journal of Pain Research, Clinical Journal of Pain, and PAIN Reports. The articles are identical except for minor stylistic and spelling differences in keeping with each journal’s style. Citation from any of the journals can be used when citing this article.

The Presidential Address of the outgoing President of the Australian Society of Anaesthetists (ASA) was renamed the Geoffrey Kaye Oration in 1986 after the first and longest serving Secretary of the Society.1 The development of the specialty of anaesthesia in Australia benefitted from his ‘unique talents in research, teaching and organisation’, which were accompanied by his ‘dedication and capacity for hard and unremitting work’.2
On 19 January 1934, Geoffrey Kaye (1903–1986) and six other men stepped away from the Fourth Australasian Medical Congress of the British Medical Association to Hadley’s Hotel in Hobart and founded the ASA. This was undoubtedly a challenging time for the specialty but very much a cherished moment. This event created the fourth medical organisation in Australia and a split from the British Medical Association. Anaesthesia had been overlooked and not included in the initial scientific program of the Congress. This step, of forming a separate anaesthesia organisation, marked in Australia that anaesthesia, ‘for so long merely the handmaiden of surgery, was now itself a science and an art and for its practice there must be training and teaching’ and it would be the newly formed ASA which would steer this course.2
Since that day in 1934, the Annual General Meeting of the ASA has almost always been held in conjunction with the National Scientific Congress (NSC). Annual General Meetings and Congresses mark time for organisations such as ours. Whilst reflecting on the Congresses that have marked my time as President, there are two moments that I would like to share with you today.
The first is the 2019 NSC in Sydney, convened by Dr Anne Jaumees. During the NSC a colleague asked me what number female President of the ASA I would be. As I had been in an Acting President role for a good part of the year, I was embarrassed that I didn’t know the answer, but I quickly looked it up. Five. I am the fifth woman to be President of the Australian Society of Anaesthetists and the 46th President.

Background: Historically in medicine, women and minorities have been underrepresented. This trend is especially significant in the anesthesiology workforce.

Objective: The goals of this study were to quantify the current state of diversity by race/ethnicity, gender, and sexual orientation among anesthesiology residents.

Methods: An institutionally reviewed and validated survey was delivered through Qualtrics to 130 anesthesiology program directors. Topics addressed included gender identity, sexual orientation, racial and ethnic background, rationale for pursuing anesthesiology, and medical training experiences. The study was administered from February to April 2021; 135 anesthesiology residents responded to the survey.

Results: The sample was 44.4% white (n = 60), 54.1% male (n = 73), and 83.7% (n = 113) of respondents self-reported as straight or heterosexual. Respondents indicated that role models/mentors were somewhat or very important in their desire to pursue anesthesiology (n = 85; 67.2%), 42% reported that having women/diverse faculty was somewhat or very important in their decision to pursue anesthesiology. Discrimination during the anesthesiology residency application process or as a resident ranged from 4.4% due to sexual orientation to 18.7% due to gender/gender identity and race/ethnicity.

Conclusions: Experiences of discrimination based on race/ethnicity, gender, and gender identity continues to be a concern among anesthesiology trainees. Creating an environment that is inclusive and supportive of all trainees regardless of race/ethnicity, gender/gender identity, and sexual orientation is needed. Interventions and strategies to create an inclusive environment may improve diversity within anesthesiology.

As the field of anesthesiology evolves and grows, so does the important role women play in its ongoing success and development. The ASA Monitor had the privilege of speaking with three women whose leadership and expertise have had – and continue to have – a positive impact on anaesthesiology and medicine as a whole.

Abstract
A survey carried out by the Australian Society of Anaesthetists explored gender issues in the personal and professional lives of anaesthetists. Issues highlighted include training and career paths, combining anaesthetic training with domestic responsibilities, personal relationships, pregnancy and childrearing, private practice, part-time work, parental leave, the single anaesthetist, doctor spouses, sexual harassment, and negative attitudes in colleagues. Particular problems were identified in the training years, in part-time work, in private practice, and in combining parental and domestic responsibilities with a career in anaesthesia. Strategies to address relevant issues are discussed, with reference to the increasing proportion of women in medicine and anaesthesia.

Background: Although there has been a considerable increase in the representation of women in medicine, a gender gap still exists with regard to leadership positions. This gender discrepancy has been identified in the field of anesthesiology, in terms of first and senior authorship, as well as in general composition of editorial boards in Anesthesiology and Anesthesia & Analgesia. The goal of this study is to examine the current representation of women in editorial boards of anesthesia journals with respect to the hierarchy of different editorial positions and to assess whether there has been improvement toward equity in recent years.

Methods: A comprehensive search was performed for anesthesiology journals indexed in the Scimago Journal and Country Rank in May 2020. The editorial boards of the top 20 journals by impact factor were analyzed. Editorial board members were categorized based on their title. Gender was assigned using images or pronouns on research databases or hospital-affiliated websites. The percentage of women within each category was calculated. When available, the year the editors obtained their medical degree was collected. A binomial proportion test was used to analyze the distribution of women overall and among editorial roles, compared to the proportion of women anesthesiologists (26%). A Wilcoxon rank-sum test was used to compare time since medical degree between genders. Additionally, women representation in anesthesiology editorial boards in 2020 was compared to 2010.

Results: A total of 19 journals were included in this study, as 1 journal did not disclose editorial board membership. Overall, women occupied 18% of all editorial board positions. All editors-in-chief and assistant/associate/deputy editors-in-chief were men. Women consisted of 17.1% of executive/section/senior editors, 17.9% of editors, and 20.6% of associate/assistant editors. There were significantly fewer women editorial board members than the percentage of women anesthesiologists (18% vs 26%; P < .001). Editorial boards from 2010 were available for 14 journals, and of these journals, women comprised 12% of editorial board members in 2010 compared to 19% in 2020 (P = .001).

Conclusions: These findings suggest that in anesthesiology journals, women are underrepresented at all editorial levels, especially at higher levels. As editorial boards have a significant impact on which articles are published by a journal and thereby significant influence on the specialty as a whole, the lack of gender equity in editorial boards should be addressed.

Editor—Previous analyses have described a gender gap in authorship in the anaesthesiology literature.1, 2, 3, 4, 5 However, there is a lack of recent data to determine if the gender gap is improving in the current era. We sought to update the literature on the topic; we also aimed at identifying factors associated with woman authorship as compared with man authorship.

For this purpose, we evaluated the prevalence of woman first author and last author in articles published from 2008 to 2018 in the five general anaesthesia journals with the highest 2018 impact factor (excluding subspecialty journals).

Despite increasing numbers of women entering anaesthesia, they remain persistently under-represented within academic anaesthesia and research. Gender discordance is seen across multiple aspects of research, including authorship, editorship, peer review, grant receipt, speaking and leading. Women are also under-represented at higher faculty ranks and in department chair positions. These inequities are further magnified for women with intersectional identities, such as those who identify as Black, indigenous and women of colour. Several barriers to participation in research have been identified to date, including a disproportionate amount of family responsibilities, a disproportionate burden of clinical service, gender bias, sexual harassment and the gender pay gap. Several strategies to improve gender equity have been proposed. Increasing access to formal mentorship of women in academic medicine is frequently cited and has been used by healthcare institutions and medical societies. Senior faculty and leaders must also be conscious of including women in sponsorship and networking opportunities. Institutions should provide support for parents of all genders, including supportive parental leave policies and flexible work models. Women should also be materially supported to attend formal educational conferences targeted for women, aimed at improving networking, peer support and professional development. Finally, leaders must display a clear intolerance for sexual harassment and discrimination to drive culture change. Peers and leaders alike, of all genders, can act as upstanders and speak up on behalf of targets of discrimination, both in the moment or after the fact. Gender inequities have persisted for far too long and can no longer be ignored. Diversifying the anaesthesia research community is essential to the future of the field.

Physician burnout and poor mental health are prevalent and often stigmatised. Anaesthetists may be at particular risk and this is further increased for women anaesthetists due to biases and inequities within the specialty. However, gender-related risk factors for and experiences of burnout and poor mental health remain under-researched and under-reported. This negatively impacts individual practitioners, the anaesthesia workforce and patients and carries significant financial implications. We discuss the impact of anaesthesia and gender on burnout and mental health using the COVID-19 pandemic as an example illustrating how women and men differentially experience stressors and burnout. COVID-19 has further accentuated the gendered effects of burnout and poor mental health on anaesthetists and brought further urgency to the need to address these issues. While both personal and organisational factors contribute to burnout and poor mental health, organisational changes that recognise and acknowledge inequities are pivotal to bolster physician mental health.

Keywords: confidence gap; gender bias; medical education; teaching; unconscious bias.

Abstract
Fellowships are competitive training posts, often in a subspecialty area. We performed a quality assessment of potential interviewer bias on anaesthesia Fellow selection. After research locality approval, we analysed interview scores for all Fellowship applications to our department over six years. Panel interviewers participated in a structured interview process, asking a series of standardised questions to rate applicants. A mixed model analysis of total applicant rating with crossed effects of applicants and interviewers was used. A total of 94 applicants were interviewed by 27 panel members, with between two and four panel members per interview, giving a total of 329 applicant ratings. The random effect of applicants accounted for 45.8% of total variance in ratings (95% confidence intervals (CI) for intraclass correlation (ICC) 35.8%-57.2%) while interviewer effects accounted for 13.4% of total variance (95% CI for ICC 5.3%-30.0%). We found no evidence of bias for most potential sources after analysing multiple applicant and interviewer factors. After adjusting for interviewer training programme, applicants from other training programmes were rated a mean of 1.87 points lower than Australian and New Zealand College of Anaesthetists (ANZCA) applicants (95% CI 0.62-3.12, P = 0.003) and 1.84 points lower than Royal College of Anaesthetists (RCoA) applicants (95% CI 0.37-3.32, P = 0.014). After adjusting for applicant gender, female clinicians rated applicants 1.12 points higher (95% CI 0.19-2.06, P = 0.019) on average than male clinicians. The observed differences in interview scores amongst male and female clinicians and lower scores in applicants from programmes other than ANZCA/RCoA were small, and require confirmation in independent studies.

Abstract
Background: Inequitable representation in journal editorial boards may impact women's career progression across surgical, anesthesia, and obstetric (SAO) specialties. However, data from Latin America are lacking. We evaluated women's representation on editorial boards of Latin America SAO journals in 2021.

Methods: We conducted a cross-sectional analysis, retrieving journals through Scimago Journal and Country Rank 2020. Journals were included if active, focused on SAO topics, and publicly provided information on editorial board staff. Editorial board member names and positions were extracted from journals' websites. Members were classified into senior (e.g., editor-in-chief), academic (e.g., reviewer), and non-academic roles (e.g., administrative office). Women's representation was predicted from first names using Genderize.io. The number of women SAO physicians per country was obtained from articles and governmental reports.

Results: We included 19 of 25 identified journals and analyzed 1,318 names. Three anesthesiology, seven obstetric, and nine surgical journals represented five Latin American countries. Women held 17% (224/1,318) of board positions [p < 0.0001; 95% CI(0.14, 0.19)]. Women held fewer academic roles (14.3%, 155/1,084) compared to senior [28.9%, 64/221 (p < 0.001)] and non-academic roles [38.4%, 5/13 (p = 0.042)]. Surgical journals had fewer women (7.7%, 58/752) compared to anesthesia [25.5%, 52/204 (p = 0.006)] and obstetrics [31.5%, 114/362 (p < 0.001)]. Women's proportion on editorial boards increased according to the number of women SAO physicians per country (p < 0.001).

Conclusions: Our study assessed the composition of editorial boards from Latin America SAO journals and demonstrated that women remain underrepresented. Our findings highlight the need for regional strategies to advance women's careers across SAO specialties.

Abstract
The Society for Pediatric Anesthesia launched the Women's Empowerment and Leadership Initiative (WELI) in 2018 to empower highly productive women pediatric anesthesiologists to achieve equity, promotion, and leadership. WELI is focused on six career development domains: promotion and leadership, networking, conceptualization and completion of projects, mentoring, career satisfaction, and sense of well-being. We sought feedback about whether WELI supported members' career development by surveys emailed in November 2020 (baseline), May 2021 (6 months), and January 2022 (14 months). Program feedback was quantitatively evaluated by the Likert scale questions and qualitatively evaluated by extracting themes from free-text question responses. The response rates were 60.5% (92 of 152) for the baseline, 51% (82 of 161) for the 6-month, and 52% (96 of 185) for the 14-month surveys. Five main themes were identified from the free-text responses in the 6- and 14-month surveys. Members reported that WELI helped them create meaningful connections through networking, obtain new career opportunities, find tools and projects that supported their career advancement and promotion, build the confidence to try new things beyond their comfort zone, and achieve better work-life integration. Frustration with the inability to connect in-person during the coronavirus-19 pandemic was highlighted. Advisors further stated that WELI helped them improve their mentorship skills and gave them insight into early career faculty issues. Relative to the baseline survey, protégés reported greater contributions from WELI at 6 months in helping them clarify their priorities, increase their sense of achievement, and get promoted. These benefits persisted through 14 months. Advisors reported a steady increase in forming new meaningful relationships and finding new collaborators through WELI over time. All the members reported that their self-rated mentoring abilities improved at 6 months with sustained improvement at 14 months. Thus, programs such as WELI can assist women anesthesiologists and foster gender equity in career development, promotion, and leadership.

Fifteen years of data from two large medical centers showed that anesthesiologists' technical performance was better when the provider was a woman, although the difference didn't translate to improved post-operative complication rates, a researcher said here.

Abstract
Background: Although the number of women in medicine has increased, women remain underrepresented in leadership positions, specifically in medical societies. Specialty societies in medicine are influential in networking, career advancement, research and education opportunities, and providing awards and recognition. The goals of this study are to examine the representation of women in leadership positions in anesthesiology societies compared to women society members and women anesthesiologists and to analyze the trend in women society presidents over time.

Methods: A list of anesthesiology societies was obtained from the American Society of Anesthesiology (ASA) website. Society leadership positions were obtained via the societies' websites. Gender was determined by images on the society website and images or pronouns on hospital websites and research databases. The percentage of women presidents, vice presidents/presidents-elect, secretaries/treasurers, board of directors/council members, and committee chairs was calculated. The percentage of women in society leadership positions was compared to the percentage of women society members when available, and the percentage of women anesthesiologists in the workforce (26%) using binomial difference of unpaired proportions tests. The trend of women presidents from 1980 to 2020 was analyzed using a Cochran-Armitage trend test.

Results: A total of 13 societies were included in this study. Overall, women held 32.6% (189/580) of leadership positions. 38.5% (5/13) of presidents, 17.6% (3/17) of presidents-elect/vice presidents, and 45% (9/20) of secretaries/treasurers were women. In addition, 30.0% (91/303) of board of directors/council members and 34.2% (90/263) of committee chairs were women. The percentage of women holding society leadership positions was significantly greater than the percentage of women anesthesiologists in the workforce ( P < .001), as was the percentage of women as committee chairs ( P = .003). The percentage of women society members was available for 9 of 13 societies (69%), and the percentage of women leaders was similar to the percentage of women society members ( P = .10). There was a significant difference in the percentage of women leaders between society size categories. Small societies had 32.9% (49/149) women leaders, medium had 39.4% (74/188) women leaders, and the single large society had 27.2% (66/243) ( P = .03). There were also significantly more women leaders in the Society of Cardiovascular Anesthesiologists (SCA) than there are women members ( P = .02).

Conclusions: This study suggests that anesthesia societies may be more inclusive of women in leadership positions compared to other specialty societies. Although in anesthesiology, women remain underrepresented in academic leadership roles, there is a higher proportion of women in leadership roles in anesthesiology societies than proportion of women in the anesthesia workforce.

Abstract
Despite progress made over the past decade, women are under-represented in positions of leadership in academic medicine. Women physicians face numerous challenges throughout their careers. Despite achieving leadership positions, women in leadership continue to experience the impact of those challenges. In this review, we describe four misconceptions about women in leadership, along with their impact and recommendations. First, we describe differences between mentorship and sponsorship, as well as their impact on attaining leadership positions. Second, the gender pay gap persists throughout women's careers, regardless of leadership positions. Third, we explore the role of self-efficacy in leadership in the context of stereotype threats. Fourth, gendered expectations of leadership characteristics place an undue burden on women, detracting from their leadership effectiveness. Organizations can address the challenges women face by creating robust mentorship and sponsorship networks, establishing transparent and equitable pay policies, promoting and normalizing a broader range of leadership styles, and improving work flexibility and support structure. Ultimately, such changes serve all members of the organization through increased retention and engagement.

Abstract
In the UK more women than men are practicing medicine, and for the first time in the history of the Royal College of Anaesthetists (RCoA), the president of the RCoA, Dean of the Faculty of Pain Medicine, and Dean of the Faculty of Intensive Care Medicine are all women. However, within the subspecialty of pain medicine, there are significantly more men practicing than women, with the most recent UK estimates identifying that only 26.7% of current pain physicians are women. Both historical and modern perspectives illustrate how women often prefer to be cared for by other women, highlighting the importance of increased representation of women in pain clinics and interventional suites. We discuss current trends in pain medicine recruitment within the UK, where most pain physicians are recruited from anaesthesia training programs, including the barriers to women's representation and reasons women enter the subspecialty. We advocate for speaker gender quotas at conferences, diversity considerate workforce planning, peer support groups, adjustments to training programs, and further research to help narrow the gender gap.

Abstract
Background: Although women and men have matriculated into medical schools in similar proportions since the 1980s, recent data indicate that anesthesiology is lagging in gender equity, especially in academic leadership roles.1,2 As promotion in academic medicine is strongly influenced by publications, understanding whether a lack of women authorship is contributing to this gender gap is crucial.3,4 This article aims to assess how woman authorship trends have changed in the last 16 years, including during the COVID-19 pandemic. Materials and Methods: The five highest impact journals in anesthesia were identified as Journal of Clinical Anesthesia, British Journal of Anaesthesia, Anesthesiology, PAIN, and Regional Anesthesia & Pain Medicine. Number of total authors, including women, men, and unknown gender authors as well as incidence of woman first and/or last author, was documented from articles published in 2005, 2010, 2015, 2020, and 2021. Results: This analysis shows that women are gaining representation in anesthesia publications. Overall, there was a statistically significant increase in the total number of women authors and women first and last authorship. However, as of 2021, women still only represented ∼40% of total and first authors and ∼24% of last authors. In addition, increase in first/last woman authorship was not present in all journals when stratified. Conclusion: These journal differences may suggest the editorial evaluation process as a potential source of gender bias. There was a statistically significant relationship between women senior authors and articles with 50% or more women authors, indicating that woman mentorship is contributing to closing equity gap. These data present a starting point for further investigations into gender disparities within anesthesia to continue the forward progression for women in academic medicine.

Abstract
Objective: Gender parity lags in academic medicine. We applied the Rank Equity Index (REI) to compare the longitudinal progress of women's academic medicine careers. We hypothesized that women have different rank parity in promotion by specialty based on the proportion of women in the specialty. Materials and Methods: Aggregate data by sex for medical students, residents, assistant professors, associate professors, and professors in nine specialties were obtained from the Association of American Medical Colleges for 2019-2020. Specialties were clustered into terciles based on the proportion of women in the field: upper (obstetrics and gynecology, pediatrics, psychiatry), middle (internal medicine, emergency medicine, anesthesia), and lower (surgery, urology, and orthopedic surgery). We calculated the percentage representation by sex by specialty and rank to calculate REI. Specialty-specific REI comparisons between each rank were performed to assess parity in advancement. Results: Only specialties in the upper tercile recruited proportionally more women medical students to residency training. All specialties advanced women for the resident-to-assistant professor with psychiatry, internal medicine, emergency medicine, anesthesia, urology, and orthopedic surgery that promoted women faculty at rates above parity. No specialty demonstrated parity in advancement based on sex for the assistant professor-to-associate professor or associate professor-to-professor transitions. Conclusion: Gender inequity in advancement is evident in academic medicine starting at the assistant professor-to-associate professor stage, regardless of overall proportion of women in the specialty. This suggests a common set of barriers to career advancement of women faculty in academic medicine that must be addressed starting at the early career stage.

Abstract
Women anesthesiologists face many challenges when trying to advance their careers and find balance in personal and professional endeavors. In this article, we introduce the reader to several concepts central to understanding the challenges faced by mid-career women anesthesiologists and highlight why these challenges become particularly pronounced when women enter the mid-career stage. We describe how lack of constructive actionable feedback combined with lack of mentorship and sponsorship negatively affects women in the workplace. We also outline barriers and bias that mid-career women anesthesiologists face in high-level leadership roles along with the disproportionally high burden of nonpromotable work. We present a discussion of mistreatment and burnout, which are compounded by concurrent demands of parenthood and a professional career. We conclude with the impact that these barriers have on mid-career women anesthesiologists and recommendations for mitigating these challenges. They include a systematic increase in mentorship and sponsorship, an individualized professional development strategy, and an improved and comprehensive approach to promotion.

Keywords: academic career; barriers; female anesthesiologist; gender equity.

Keywords: Gender equity; anesthesiology; feminist; gender discrimination; implicit bias; leadership; qualitative research.

Keywords: academia; anaesthesia; awards; gender equality; gender equity; leadership; women in medicine.

Keywords: anaesthesiology; gender bias; implicit bias; leadership; promotion; residency training; women in medicine.

Keywords: European Society of Anaesthesiology; anaesthesia; career development; gender; leadership; survey; women.

Keywords: confidence gap; gender bias; medical education; teaching; unconscious bias.

People of all genders must be given the same chances in the academic and in the family worlds. Instead of just enforcing gender quotas, a cultural shift is required to more evenly balance the mental load where possible and to recognize that this mental load and primary responsibilities are a reality for many women.

Keywords: anaesthesia; gender; randomised trial; research; sex.