Role of Sex in Participation During Virtual Grand Rounds in Ophthalmology

Key Points

Question

Were female attendees at ophthalmology grand rounds less likely to ask the grand rounds speaker questions compared with male attendees?

Findings

In this cohort study including 31 virtual grand rounds sessions in the Department of Ophthalmology at the University of California, San Francisco, with 47% of the audience being female, male attendees were 3-fold more likely to ask one of the first 3 questions than female attendees.

Meaning

In this study, male attendees were more likely to ask questions during virtual academic grand rounds compared with female attendees.

This cohort study assesses the role of sex in participation during virtual grand rounds at a major academic center.

Abstract

Importance

Sex disparities exist in academia. Female attendees consistently ask fewer questions in scientific meetings than male attendees, even when they constitute half of the audience.

Objective

To assess the role of sex in participation during virtual grand rounds (GR) at a major academic center.

Design, Setting, and Participants

In this prospective cohort study, attendees of the Department of Ophthalmology at the University of California, San Francisco, GR from April 2020 to April 2021 were included. All GR were held via a synchronous live video communication platform. During each GR session, a predesignated attendee collected the sex of all attendees, sex of the GR speaker, and sex of each individual who asked a question to the GR speaker in order of inquiry. The GR speakers and audience were unaware of the study. Data were analyzed from June 2021 to April 2023.

Main Outcome and Measures

The main analysis assessed the association between being female and asking one of the first 3 questions.

Results

A total of 31 virtual ophthalmology GR sessions were observed. The sex of the GR speaker was female in 13 of 31 sessions (42%). The mean (SD) percentage of audience sex at each of the GR sessions was 47% (0.05) female, 45% (0.06) male, and 8% (0.03) unknown. Male attendees were more likely to ask one of the first 3 questions compared with female attendees (prevalence ratio, 3.1; 95% CI, 2.1-4.5; P < .001).

Conclusions and Relevance

Male attendees were more likely to ask questions during virtual ophthalmology GR compared with female attendees at an academic medical center. Strategies to encourage equal participation of sex in academic discourse should be encouraged.

Introduction

Sex-related inequities in science, medicine, and academia persist.^1,2 The reasons for these disparities are poorly understood.¹ As female students age, there is a decline in classroom participation.³ Similarly, in academia, women ask fewer questions than men,^1,4,5,6,7 regardless of their representation in the audience^4,5 and when adjusted for seniority of the question-asker.¹

The purpose of this study is to assess if sex is associated with grand rounds (GR) participation at a major academic center. GR are public, academic, departmental meetings that include a presentation by an invited expert within the field. The audience is primarily composed of physicians but can also include researchers, other health care workers, and students. The timing of the COVID-19 pandemic necessitated virtual GR during the study period. We hypothesized that, even on a virtual platform, female attendees are less likely to ask the speaker questions compared with male attendees.

Methods

This study was approved by the Institutional Review Board of the University of California, San Francisco (UCSF), complied with the Health Insurance Portability and Accountability Act, and followed the tenets of the Declaration of Helsinki. Informed consent was waived by the institutional review board secondary to the revised Common Rule, which covers research of observational public behavior. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

This prospective study took place between April 2020 and April 2021. All GR presentations were held via synchronous video conference (Zoom Video Communications). UCSF departments that allowed for interactive speaker questioning during GR presentation were invited to participate (Departments of Ophthalmology, Obstetrics and Gynecology [OBGYN], and Otolaryngology–Head and Neck Surgery [OHNS]). Departments were excluded if the designated resident was unable to collect the data; if GR were held in a format that excluded names of attendees; and if GR were held in a format where live, synchronous questioning by all attendees was not allowed (eg, webinar format).

Data collected included the sex of each GR attendee based on name or appearance (ie, male [including transgender man], female [including transgender woman], and unknown), sex of the GR moderator and GR speaker, sex of each attendee who asked a question in order of inquiry, and if the GR speaker was introduced as “doctor” when indicated. The GR speakers and audience were unaware of the study.

The main analyses were performed at the person level. The main outcome measure was whether a female GR attendee asked one of the first 3 questions, modeled in a log-binomial model with terms for sex and subspecialty and using Huber-White robust standard errors to account for nonindependence of data between GR sessions. χ² Tests were used for categorical variables and t tests for continuous variables. All P values were 2-sided, and significance was set at P < .05; P values were not adjusted for multiple analyses. Statistical analyses were conducted in R version 4.0 (The R Foundation) and Stata/SE version 15.0 (StataCorp). Results were calculated for all GR specialties, though the analysis and discussion focused on ophthalmology, since the sample size was higher.

Results

Overall, 46 GR sessions were observed, including 31 for ophthalmology, 10 for OBGYN, and 5 for OHNS. Of the 31 ophthalmology GR sessions (Figure), the speaker was female in 13 sessions (42%; 95% CI, 26-58). The GR moderator was female in 17 sessions (55%; 95% CI, 39-74). The mean percentage of female attendees at each GR was 47% (95% CI, 46-49). However, female attendees asked only 40 of 140 questions (29%; 95% CI, 20-35). The data observed for OBGYN and OHNS GR are shown in the eFigure in Supplement 1, but the small sample size precluded further analyses for those specialties.

Figure. Female Attendee Participation in Virtual Ophthalmology Grand Rounds.

The dots represent the mean percentage of female participants. Whiskers represent 95% CIs.

Over the course of 1 year, 140 questions were asked during virtual GR in the ophthalmology department. The Table depicts the characteristics of the GR sessions. On average, male attendees asked 3.2 questions (95% CI, 2.7-3.7) per GR and female attendees asked 1.3 questions (95% CI, 1.0-1.7) per GR. Of all questions asked per GR, female attendees asked 40 questions (29%; 95% CI, 20-35) and male attendees asked 100 questions (71%; 95% CI, 65-80). Male ophthalmology GR participants were more likely to ask the first question (prevalence ratio [PR], 1.7; 95% CI, 0.8-3.4; P = .16), one of the first 2 questions (PR, 2.6; 95% CI, 1.5-4.5; P < .001), and one of the first 3 questions (PR, 3.1; 95% CI, 2.1-4.5; P < .001). For asking one of the first 3 questions, results were similar regardless of whether the GR speaker was female (PR, 3.1; 95% CI, 1.8-5.2) or male (PR, 3.1; 95% CI, 1.7-5.4). Notably, 1 individual male participant in the Department of Ophthalmology asked a disproportionate number of questions (41 of 140 questions [29%]). When this individual was excluded, of the remaining 99 questions, 40 questions (40%; 95% CI, 31-50) were asked by a female attendee. The speaker was introduced as “doctor” in 28 of 31 Ophthalmology GR. Two female speakers and 2 male speakers were introduced with name only and no title.

Table. Characteristics of the Grand Rounds (GR) Sessions.

Characteristic	All GR sessionsa	Ophthalmology GR sessions
Sex of the GR speaker, No./total No. (%)
Female	21/46 (46)	13/31 (42)
Male	25/46 (54)	18/31 (58)
Sex of the audience at each GR, mean (95% CI), %
Female	56 (51-62)	47 (46-49)
Male	38 (33-43)	45 (43-47)
Unknown	6 (4-7)	8 (7-9)
Sex of the individual who asked any question, No./total No. (%)
Female	70/190 (37)	40/140 (29)
Male	120/190 (63)	100/140 (71)
Sex of the GR moderator, No./total No. (%)
Female	30/46 (65)	17/31 (55)
Male	16/46 (35)	14/31 (45)

^a All GR sessions includes virtual GR sessions of the Departments of Ophthalmology, Obstetrics and Gynecology, and Otolaryngology–Head and Neck Surgery.

Discussion

During virtual GR in the Department of Ophthalmology at UCSF from April 2020 to April 2021, female attendees constituted approximately half of the attendees and nearly half of the GR speakers, yet asked only about one-quarter of the questions. The findings in this study are consistent with others demonstrating that women in academia ask fewer questions than men.^1,4,5,6,7 This study demonstrates that differences persist even when academic meetings, such as GR, are held in a less formal online setting. Reasons explaining women’s lower rates of participation in academia are poorly understood.¹ It has been hypothesized that an age effect could contribute, where senior scientists ask more questions and are more commonly men.⁴ Age data were not collected in this study. Others postulate that women ask fewer questions due to an unwelcome climate experienced in the field and the discrimination encountered throughout their education and careers.¹

Dynamic interaction with colleagues at professional conferences is integral to career development, models productive academia, and publicly reinforces the credibility of the questioner. This study was conducted only in a COVID-19 pandemic–mandated virtual setting. Women in academia have been found to be especially vulnerable to inequities during the COVID-19 pandemic in part due to an unequal division of household labor and child care that threatens their academic productivity and professional development.⁸ Although we did not find evidence that the likelihood of female attendees asking a question differed based on the sex of the GR speaker, it is nonetheless possible that promoting diversity in GR speaker selection is important as it may influence who speaks up and engages in academic conversation during GR discussions.

Limitations

This study has limitations. This is a single center study. Ophthalmology GR sessions outnumbered OBGYN and OHNS GR sessions, precluding reliable comparative interpretations. It is not known how participation in GR varies between surgical specialties compared with medical-only specialties. As necessitated by the COVID-19 pandemic, this study reflects only participation of GR held online, not in person. Of note, broader departmental participation was limited by concern for potential backlash toward residents who collected this type of data. Additionally, our study greatly oversimplifies sex by assumption based on appearance or identification name.

Conclusions

In summary, this study showed that female attendees were significantly less likely to ask questions in an ophthalmology GR setting than their male counterparts. Strategies to encourage equal participation of sex in academic discourse should be encouraged.

Supplement 1.

eFigure. Female Attendee Participation in Virtual Grand Rounds of 3 Specialties

Supplement 2.

Data Sharing Statement