Gender of Presenters at Ophthalmology Conferences between 2015-2017

Journal Pre-proof Gender of Presenters at Ophthalmology Conferences between 2015-2017 Sejal H. Patel, MD, Timothy Truong, MD, Irena Tsui, MD, Jee-Young Moon, PhD, Jamie B. Rosenberg, MD PII:

S0002-9394(20)30025-8

DOI:

https://doi.org/10.1016/j.ajo.2020.01.018

Reference:

AJOPHT 11205

To appear in:

American Journal of Ophthalmology

Received Date: 12 November 2019 Revised Date:

9 January 2020

Accepted Date: 13 January 2020

Please cite this article as: Patel SH, Truong T, Tsui I, Moon J-Y, Rosenberg JB, Gender of Presenters at Ophthalmology Conferences between 2015-2017, American Journal of Ophthalmology (2020), doi: https://doi.org/10.1016/j.ajo.2020.01.018. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2020 Elsevier Inc. All rights reserved.

Abstract Purpose: To analyze the proportion of females presenting at 9 major ophthalmology conferences over 3 years. Design: Retrospective observational study Methods: Conference brochures from 9 national ophthalmology conferences from 2015-2017 were analyzed. Genders of first author presenters of papers and non-papers (moderators, presenters at symposia, panel discussions, workshops/ instructional courses) were recorded. Comparisons were made to the gender ratio of board-certified ophthalmologists. Student’s t-test and Cochran-Armitage trend test was used for analysis, with significance at p<0.05. Results: Of 14,214 speakers, 30.5% were female, statistically higher than the expected 25.4% (p<0.001). Paper presenters were 33.1% females (p<.001) and non-paper presenters were 28.5% females (p<0.001). When stratified to general or subspecialty conference, general conferences had a higher proportion of females compared to the American Board of Ophthalmology (ABO) expected rates (p<0.001) for paper and non-paper presentations. The rates of female presenters increased over the 3 years only at Association for Research in Vision and Ophthalmology (ARVO) (p=0.009). Sub-group analysis showed that females presented 33.1% of papers but only 28.5% of non-paper presentations, which is lower than expected (p<0.001). Conclusions: Our results highlight positive trends: the overall proportions of female speakers exceed ABO estimates of female ophthalmologists. However, the gender gap remains at many subspecialty conferences, especially for non-papers, which are more likely to require invitations rather than being self-submitted. As demographics continue to change, further efforts are needed to assure equitable selection of conference presenters.

Title Page Gender of Presenters at Ophthalmology Conferences between 2015-2017 Suggested Short Title: Presenters’ Gender at Ophthalmology Conferences: 2015-2017 Sejal H Patel MD , Timothy Truong MD , Irena Tsui MD , Jee-Young Moon PhD , Jamie B. Rosenberg MD 1

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Montefiore Medical Center, Bronx NY BronxCare Health System, Bronx, NY 3 University of California, Los Angeles 4 Albert Einstein College of Medicine 2

Corresponding Author: Jamie Rosenberg, MD 3332 Rochambeau Avenue Bronx, NY 10467 718-920-7646 [email protected]

Title Page Gender of Presenters at Ophthalmology Conferences between 2015-2017 Suggested Short Title: Presenters’ Gender at Ophthalmology Conferences: 2015-2017 Sejal H Patel MD , Timothy Truong MD , Irena Tsui MD , Jee-Young Moon PhD , Jamie B. Rosenberg MD 1

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Montefiore Medical Center, Bronx NY BronxCare Health System, Bronx, NY 3 University of California, Los Angeles 4 Albert Einstein College of Medicine 2

Corresponding Author: Jamie Rosenberg, MD 3332 Rochambeau Avenue Bronx, NY 10467 718-920-7646 [email protected]

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Introduction In 2017, females represented over 50% of medical school matriculants for the first time. Rates of female ophthalmology residents have also increased over the past decade. However, there remains a gender gap in female representation across positions of academic prestige in many fields, including ophthalmology, such as senior faculty positions, chairpersons of academic programs, and participants at national conferences. While women are increasingly represented in academic ophthalmology, the rates decrease at higher levels of academic rank, with women making up 43% of assistant professors, but only 37% of associate professors and 15% of full professors. Additionally, only 0.08% (7 of 87) of ophthalmology department chairs are female. Shah et al. hypothesized that a combination of societal factors, less encouragement to apply for leadership positions, and the lack of appropriate female role models has led to a dearth of women in leadership roles. Increased representation at national conferences has also been found to be of particular importance in advancement. This report examines gender differences in speakers at ophthalmology conferences to characterize the gender gap in ophthalmology. 1

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Methods In this observational retrospective study, we analyzed nine national annual ophthalmology conferences over three consecutive years (2015-2017). Two of these conferences were general ophthalmology and vision research-focused: American Academy of Ophthalmology (AAO) and the Association for Research in Vision and Ophthalmology (ARVO); seven were annual meetings of the following organizations: American Association for Pediatric Ophthalmology and Strabismus (AAPOS), American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), North-American Neuro-Ophthalmology Society (NANOS), American Society of Cataract and Refractive Surgery (ASCRS), American Glaucoma Society (AGS), American Uveitis Society (AUS), and American Society of Retina Specialists (ASRS). Scientific programs were obtained from program documents, websites, or society hosts. Gender of first author presenters of papers (podium presentations of original work) and non-papers (moderators, named lecturers, presenters of symposiums, panel discussions, workshops/ instructional courses, and video programs) were recorded. To identify speaker gender, we used photos, biographies, news outlets, and queried conference conveners. Other presentations, including awards, breakfast/lunch/refreshment sessions, industry-sponsored sessions, general announcements, and poster presentations, were excluded. Hypothesis testing of proportion were used for statistical analysis, with significance set at p<0.05. Primary analysis was of the proportion of female paper presenters, non-paper presenters, and total presenters across the three years. The rates of female representation in each conference was compared to an expected rate of 25.4%, based on data from the American Board of Ophthalmology (ABO), obtained through personal communication with ABO. (Table 1) Subgroup analysis was then completed for each subspecialty conference compared to the respective percentage of women in each correlated specialty as reported by the ABO, using the following ten categories for comparison: comprehensive, pediatric ophthalmology and strabismus, oculoplastics and orbital surgery, neuro-ophthalmology, cataract, refractive surgery, cornea and external disease, glaucoma, uveitis/immunology and retina/vitreous. For the comprehensive conferences, analysis was compared against the overall ABO practice emphasis proportion of 25.4% female. Subspecialty conferences were analyzed individually against their respective ABO subspecialty data. Analysis was conducted using Cochran-

Armitage trend testing with significance set to p<0.05 to determine if there were any significant changes over the three years. Results Of 14,214 speakers, 30.5% were female, statistically higher than the expected 25.4% (p<0.001). Paper presenters were 33.1% females (p<.001) and non-paper presenters were 28.5% females (p<0.001). (Figure 1) When stratified to general or subspecialty conference, general conferences had a higher proportion of females compared to the ABO expected rates (p<0.001) for paper and non-paper presentations. On the other hand, subspecialties tended to have lower rates of female presenters. AAPOS (p=0.002), ASCRS (p<0.001), and AGS (p<0.001) had fewer female presenters compared to ABO rates for those specialties. For paper presentations, NANOS (p=0.044) and AGS (p<0.001) had fewer women compared to ABO rates. For non-paper presentations, AAPOS (p=0.001), ASOPRS (p=0.02), ASCRS (p<0.001), and AGS (p=0.005) all had fewer women than ABO statistics. (Table 2) There was no significant change over the three years in the proportion of female paper presenters (p=0.589) and presenters overall (p=0.074). However, there was an increase in nonpaper presenters who were female over that time period (p=0.014). Amongst all presenters, only ARVO demonstrated an increase in the proportion of female presenters (p=0.009). ASCRS had an increase in non-paper presenters (p=0.012) but a decrease in paper presenters (p=0.001) over the three years. Discussion We examined gender rates available from self-registered ABO databases and compared those numbers with rates of speakers at national meetings. Our results highlight positive trends: among both paper and non-paper presenters, the overall proportion of female speakers exceeds the ABO estimate of female ophthalmologists. Representation at comprehensive ophthalmology conferences was also higher than ABO certification rates. However, the gender gap remains at many subspecialty conferences. The gender gap was more prominent in the non-paper presentations, with AAPOS, ASOPRS, ASCRS, and AGS all having statistically significantly fewer non-paper presenters than expected. We hypothesize that this may occur because of the differing submission and acceptance process of paper and nonpaper presentations. These differences do not appear conference-specific, but are more reflected in the type of presentation: paper vs. non-paper. Paper presentations are often selfsubmissions, which then undergo an abstract review, often in a blinded fashion. Non-paper presenters are more often invitation-based and thus can be subject to biases of the inviter, perceived expertise of the speaker, and the tendency to invite prior speakers. Upon review of all conferences, there was no significant disparity noted in the representation of women as conference organizers or speaker recruiters. Our data on subspecialty conferences confirms previously reported accounts of speaker gender gaps in other fields of medicine. It is important to consider the next steps toward achieving gender balance at academic conferences. In an editorial by Martin, the author outlines rules to achieve such balance. Of these, the first step is to collect data and report the data, which was our goal with this report. The next step is instituting the subsequent rules, which include altering speaker policy, making the policy visible, establishing balance in program committees, and 5-9

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supporting women. These policies have been shown to substantially increase female representation and may also help with representation of racial minorities who continue to be under-represented. Additionally, Girod et al. showed that the documented preferences of both men and women for male candidates can be addressed through educational interventions that address these biases. As stated by Brem et al, this important issue is the responsibility of conference organizers, faculty members, sponsors, governmental agencies, journal and editorial boards, and the larger scientific community. Organizations such as Women in Ophthalmology and Women in Retina have already made a difference by providing mentorship and networking opportunities. 6

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Limitations We elected to compare overall data to the ABO time-limited certification rate of 25.4%, but with the current rate of female ophthalmology residents at 42%, we may be underestimating the expected rate of female presenters. Similarly, we are limited by rates of voluntary reporting of practice emphasis as supplied by the ABO. 2

Conclusion In our analysis of gender trends in nine national annual ophthalmology conferences over three consecutive years (2015-2017), we found that women overall and at comprehensive ophthalmology conferences tended to have greater rates of paper and non-paper presentations than estimates based on ABO statistics. However, the gender gap remained evident in subspecialty conferences, including AAPOS, ASOPRS, ASCRS, and AGS, especially in the non-paper presentations. We believe this disparity reflects the difference between paper and non-paper submissions, with paper submissions being self-submitted and non-paper submissions being more likely to require invitations. As more women continue to pursue medicine and ophthalmology, we expect to continue to see greater rates of female representation. We hope that this trend will be reflected in those selected to present at national conferences.

References 1. Association of American Medical Colleges. 2017 Applicant and Matriculant Data Tables. Association of American Medical Colleges; 2017. https://aamcblack.global.ssl.fastly.net/production/media/filer_public/5c/26/5c262575-52f9-4608-96d6a78cdaa4b203/2017_applicant_and_matriculant_data_tables.pdf. Accessed May 5, 2019. 2. Association of American Medical Colleges. ACGME Residents and Fellows by Sex and Specialty, 2015. https://www.aamc.org/data/workforce/reports/458766/2-2-chart.html. Published September 6, 2016. Accessed May 5, 2019. 3. Svider PF, D’Aguillo CM, White PE, Pashkova AA, Bhagat N, Langer PD, Eloy JA. “Gender Differences in Successful National Institutes of Health Funding in Ophthalmology.” Journal of Surgical Education. 2014 Sep. 71(5):680-688 4. Mehta S, Rose L, Cook D, Herridge M, Owais S, Metaxa V. The Speaker Gender Gap at Critical Care Conferences. Critical Care Medicine. 2018;46(6):991-996. doi:10.1097/ccm.0000000000003114.

5. Klein RS, Voskuhl R, Segal BM, Dittel BN, Lane TE, Bethea JR, Carson MJ, Colton C, Rosi S, Anderson A, Piccio L, Goverman JM, Benveniste EN, Bronx MA, Tiwari-Woodruff SK, Harris TH, Cross AH> “Speaking out about gender imbalance in invited speakers improves diversity.” Nat Immunol. 2017 Apr 18; 18(5):475-478 6. Brem AK, Lehto SM, Keeser D, Padberg F. “There is no magic in speaker policies: creating gender equality at brain stimulation conferences: Editorial II to the supplement from the 2nd European Conference on brain stimulation in psychiatry.” Eur Arch Psychiatry Clin Neurosci. 2017 Dec;267(Suppl2):113-114 7. Casadevall A. “Achieving Speaker Gender Equity at the American Society for Microbiology General Meeting.” MBio. 2015 Aug; 6(4): e01146-15 8. Moghaddam B, Gur RE. “Women at the Podium: ACNP Strives to Reach Speaker Gender Equality at the Annual Meeting.” Neuropsychopharmacology. 2016 Mar;41(4):929-31 9. Lopez SA, Svider PF, Misra P, Bhagat N, Langer PD, Eloy JA. “Gender Differences in Promotion and Scholarly Impact: An analysis of 1460 Academic Ophthalmologists.” Journal of Surgical Education. 2014 Nov;71(6):851-859 10. Shah DN, Volpe NJ, Abbuhl SB, Pietrobon R, Shah A. Gender Characteristics Among Academic Ophthalmology Leadership, Faculty, and Residents: Results from a Cross-Sectional Survey. Ophthalmic Epidemiology. 2010; 17:1, 1-6 11. The Association for Research in Vision and Ophthalmology. Conference Organizers. https://www.arvo.org/meetings/imaging-in-the-eye/organizers/ 12. Girod S, Fassiotto M, Grewal D, Ku MC, Sriram N, Nosek. BA, Valantine H. Reducing Implicit Gender Leadership Bias in Academic Medicine with an Educational Intervention. Academic Medicine, 91(8), 1143-1150. 13. Martin JL. Ten Simple Rules to Achieve Conference Speaker Gender Balance. November2014.https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1003903. Accessed May 5, 2019 14. Lett LA, Orji WU, Sebro R. Declining racial and ethnic representation in clinical academic medicine: A longitudinal study of 16 US medical specialties. PLoS One. 2018;13(11):e0207274. Published 2018 Nov 16. doi:10.1371/journal.pone.0207274

Table 1. Gender distribution of diplomates based on A) certification and B) practice emphasis from American Board of Ophthalmology as of Nov 19, 2018. Not included in this table are 1026 respondents who did not provide their gender.

Women

Men

Total

% of Women

Pediatric Ophthalmology & Strabismus

400

350

750

53.33%

AAPOS

Glaucoma

405

613

1018

39.78%

AGS

Cataract

689

1983

2672

25.79%

Cornea and External Disease

116

230

346

33.53%

Refractive Surgery

14

116

130

10.77%

248

466

714

34.73%

ASOPRS

450 26

1824 27

2274 53

19.79% 49.06%

ASRS AUS

62

75

137

45.26%

NANOS

1442

2589

4031

35.77%

-

58 1139 5106

108 6562 15004

166 7701 20110

34.93% 14.79% 25.39%

AAO, ARVO

Practice Emphasis

Oculoplastics and Orbital Surgery Retina and Vitreous Uveitis/ Immunology Neuro-Ophthalmology Comprehensive Ophthalmology Other Not Supplied Grand Total

Conferences Compared

ASCRS

Table 2. Percentage of female presenters at national ophthalmology conferences 2015-2017, stratified based on specific conference and type of presentation.

Conferences AAPOS AGS ASCRS/ASOA ASOPRS ASRS AUS NANOS AAO ARVO

n (Paper ABO Comparison Presenters) 53.33% 39.78% 26.02% 34.73% 19.79% 49.06% 45.26% 25.39% 25.39%

108 158 2238 234 279 95 120 363 2384

% Female Paper

p-value

n (Nonpaper Presenters)

% Female Nonpaper

p-value

n (All Presenters)

% Female All

p-value

51.85% 22.15% 27.97% 40.60% 19.71% 49.47% 37.50% 29.75% 38.34%

0.379 <0.001 0.982 0.97 0.487 0.532 0.044 0.071 <0.001

479 293 2844 130 465 264 2273 1483

46.35% 32.42% 20.64% 26.15% 17.63% 42.80% 31.15% 34.39%

0.001 0.005 <0.001 0.02 0.122 0.212 <0.001 <0.001

587 451 5082 364 744 99 384 2636 3867

47.36% 28.82% 23.87% 35.44% 18.41% 47.47% 41.15% 30.96% 36.82%

0.002 <0.001 <0.001 0.611 0.173 0.376 0.053 <0.001 <0.001

Figure 1. Percentage of female presenters at national ophthalmology conferences 2015-2017, stratified based on type of presentation and year.