Division of Pulmonary, and Sleep Medicine, Kaiser Permanente Washington, Seattle, WA, USA.
Division of Pulmonary and Critical Care Medicine, Beaumont Hospital, Troy, MI, USA.
J Gen Intern Med. 2023 Jan;38(1):57-66. doi: 10.1007/s11606-022-07635-w. Epub 2022 May 23.
Women are underrepresented within internal medicine (IM). Whether women leaders attract women trainees is not well explored.
To characterize leader and trainee gender across US academic IM and to investigate the association of leader gender with trainee gender.
Cross-sectional study.
Leaders (chairs, chiefs, program directors (PDs)) in 2018 and trainees (residents, fellows) in 2012-2016 at medical school-affiliated IM and seven IM fellowship programs.
Leadership (chair/chief and program director; and, for resident analyses, fellow) gender.
Our primary outcome was percent women trainees (IM residents and, separately, subspecialty fellows). We used standard statistics to describe leadership and trainee gender. We created separate multivariable linear regressions to evaluate associations of leader gender and percent women fellows with percent women IM residents. We then created separate multivariable multilevel models (site as a random effect) to evaluate associations of leader gender with percent women subspecialty fellows.
Our cohort consisted of 940 programs. Women were 13.4% of IM chairs and <25% of chiefs in each fellowship subspecialty (cardiology: 2.6%; gastroenterology: 6.6%; pulmonary and critical care: 10.7%; nephrology: 14.4%; endocrinology: 20.6%; hematology-oncology: 23.2%; infectious diseases: 24.3%). IM PDs were 39.7% women; fellowship PDs ranged from nearly 25% (cardiology and gastroenterology) to nearly 50% (endocrinology and infectious disease) women. Having more women fellows (but not chairs or PDs) was associated with having more women residents (0.3% (95% CI: 0.2-0.5%) increase per 1% fellow increase, p<0.001); this association remained after adjustment (0.3% (0.1%, 0.4%), p=0.001). In unadjusted analyses, having a woman PD (increase of 7.7% (4.7%, 10.6%), p<0.001) or chief (increase of 8.9% (4.6%, 13.1%), p<0.001) was associated with an increase in women fellows; after adjustment, these associations were lost.
Women held a minority of leadership positions in academic IM. Having women leaders was not independently associated with having more women trainees.
女性在内科医学领域的代表性不足。女性领导者是否吸引女性学员尚未得到充分探索。
描述美国学术内科医学领域的领导者和学员的性别特征，并调查领导者性别的相关性与学员性别的关联。
横断面研究。
2018 年的领导者（主席、主任、项目主任）和 2012-2016 年医学附属内科医学和七个内科医学奖学金计划的学员（住院医师、研究员）。
领导（主席/主任和项目主任；对于住院医师分析，研究员）性别。
我们的主要结果是女性学员（内科住院医师，分别为专业研究员）的百分比。我们使用标准统计方法描述领导和学员的性别。我们创建了单独的多变量线性回归来评估领导者性别和女性研究员百分比与女性内科住院医师百分比的关联。然后，我们创建了单独的多变量多层模型（站点作为随机效应）来评估领导者性别与女性专业研究员百分比的关联。
我们的队列包括 940 个项目。女性在每个专业研究员领域（心脏病学：2.6%；胃肠病学：6.6%；肺病和危重病学：10.7%；肾病学：14.4%；内分泌学：20.6%；血液学-肿瘤学：23.2%；传染病学：24.3%）担任内科主席的比例为 13.4%，担任主任的比例不足 25%。内科项目主任为 39.7%的女性；研究员项目主任的比例从近 25%（心脏病学和胃肠病学）到近 50%（内分泌学和传染病学）。有更多的女性研究员（但不是主席或项目主任）与有更多的女性住院医师相关（每增加 1%的研究员，住院医师增加 0.3%（95%CI：0.2-0.5%），p<0.001）；在调整后，这种关联仍然存在（0.3%（0.1%，0.4%），p=0.001）。在未调整的分析中，女性项目主任（增加 7.7%（4.7%，10.6%），p<0.001）或主任（增加 8.9%（4.6%，13.1%），p<0.001）与女性研究员的增加有关；调整后，这些关联消失了。
女性在内科医学领域担任领导职务的比例较低。女性领导者的存在与女性学员的增加没有独立相关性。
