Exploring the Challenges and Limitations in Participation of Women Nephrologists in Conferences

The landscape of women in medicine and nephrology is evolving, yet persistent gender disparities prevail, particularly in the realm of medical conferences.¹ Despite the increasing number of women in nephrology, their equitable representation as speakers, chairpersons, award recipients, and delegates remains suboptimal. Previous studies have shown that the proportion of female speakers at medical conferences, particularly in high-income countries (HICs) and across disciplines, such as cardiology and oncology, remains lower than that of male speakers.² Our research shifts the focus to women nephrologists across diverse settings, a group that has been making significant strides in academia and research. In this study, we explored the challenges faced by women nephrologists worldwide during nephrology conferences. A survey was designed consisting of 18 multiple-choice and open-ended questions. Women nephrologist members of the International Society of Nephrology social media education group, representing all country income categories and career stages, designed and validated the survey. It was piloted among 50 women (members of the International Society of Nephrology and Women in Nephrology-India) before finalization. The study was approved by the ethics committee of AIIMS Bhubaneswar, India. Email, WhatsApp groups, and personal messaging were used to disseminate the survey. Electronic consent was obtained from all participants, and a descriptive analysis was conducted. Chi-square test of independence was performed with Bonferroni correction for comparing responses between country income classes.

A total of 343 responses were received and distributed according to the World Bank classification³ as follows: 51.4% from low- and middle-income countries, 42.8% from HICs, and 5.8% from low-income countries (LICs). Half of the respondents were aged between 31 and 40 years, 26.2% were 41–50 years, and 25% were older than 50 years. Around 42% (N=144) of the women had been practicing nephrology for over 10 years, 21% (N=72) for 6–10 years, and 10% (N=34) were nephrology residents. One third (35%, N=120) worked in private practice and 18% (N=62) in government institutions. Regarding conference attendance, 80% (N=274) attended 1–4 conferences annually. Half (49.8%) reported that women encounter greater challenges in being accepted to present their work compared with men. Over half of respondents felt women were less likely to receive accolades and noted gender disparities in organizing committees. In addition, 62% faced social constraints, 70.5% sought on-site childcare, 30% observed credibility gaps, and 40% supported gender-specific conferences for career advancement. Around 30% had organized a nephrology conference. The distribution of the responses and comparison between the positive answers by category of country income are reported in Table 1.

Table 1.

Distribution of answers to survey questions by income setting

SL Number	Questions of the Survey	Total No. of Responses, N (%)	No. of Total Responses as “Yes,” N (%)	Affirmative Responses from HICs, N (%)	Affirmative Responses from LMICs, N (%)	Affirmative Responses from LICs, n (%)	P Value
1	Is there a perception that women face greater challenges in being accepted to present their work compared to men?	343 (100)	171 (49.8)	75 (51.7)	87 (49.4)	9 (45)	<0.001
2	Do you believe that men outnumber women at medical conferences?	340 (99.12)	86 (25)	30 (20.4)	44 (25)	12 (60)	<0.001
3	Have you ever encountered or witnessed instances of misconduct or inappropriateness at nephrology conferences?	300 (87.46)	12 (4.0)	5 (3.4)	6 (3.4)	1 (5)	0.63
4	Do you think women are excluded from informal gatherings at nephrology meetings?	343 (100)	102 (29.7)	42 (28.5)	53 (30.1)	n=7 (35)	0.007
5	Do you perceive yourself as being hindered from attending conferences due to social obligations, such as the provision of childcare and the fulfillment of familial responsibilities?	343 (100)	212 (61.8)	90 (61.2)	109 (61.9)	13 (65)	<0.001
6	Do you perceive a discernible discrepancy in the level of credibility accorded to women vis-à-vis men in the context of discussions conducted at conferences?	339 (98.8)	102 (30.08)	29 (20.7)	64 (36.3)	9 (45)	<0.001
7	Have you been involved (at any level) in organizing a nephrology conference?	343 (100)	132 (38.4)	70 (47.7)	55 (31.2)	7 (35)	0.02
8	Do you believe that persistent gender imbalances continue to prevail within the committee and framework of nephrology conferences?	340 (99.12)	171 (50.2)	33 (22.4)	127 (72.2)	11 (55)	<0.001
9	Do you opine that female nephrologists are comparatively less prone to being bestowed with orations and accolades at conferences?	330 (96.2)	192 (58.1)	66 (44.8)	114 (65)	12 (60)	<0.001
10	Do you prefer to have a gender-specific conference giving more options to advance their career?	343 (100)	137 (39.9)	60 (40.8)	68 (38.6)	9 (45)	0.21
11	Does strengthening on-site childcare services encourage you to attend conferences in person?	340 (99.12)	240 (70.5)	107 (72.7)	119 (67.6)	14 (70)	0.84

For question 1, significant differences were found between high-income countries and low- and middle-income countries (P < 0.001) and between low-income countries and high-income countries (P = 0.003). For question 2, both high-income countries versus low- and middle-income countries and low-income countries versus high-income countries showed significant differences (P < 0.001). Question 4 showed a significant difference between high-income countries and low- and middle-income countries (P = 0.002). Significant differences were also noted for question 5 (high-income countries versus low- and middle-income countries, P < 0.001), question 06 (high-income countries versus low- and middle-income countries, P < 0.001), and question 7 (high-income countries versus low- and middle-income countries, P = 0.007). In addition, for question 8, there was a significant difference between low-income countries and high-income countries (P < 0.001), and for question 9, a significant difference was observed between high-income countries and low- and middle-income countries (P < 0.001). HIC, high-income country, LIC, low-income country; LMIC, low- and middle-income country; SL Number, serial number.

This survey highlights significant challenges faced by women nephrologists worldwide in achieving equitable representation and recognition at medical conferences. Childcare and family commitments hinder conference attendance, especially for mothers, prompting calls for on-site childcare. Studies have shown parenthood in academia disproportionately affects women's career progression and participation in professional events.⁴ The findings of a survey performed at the American Society of Nephrology Kidney Week meeting (2022) showed that women in the audience asked significantly fewer questions than men and fewer than would be expected on the basis of their estimated representation.⁵ Such challenges can exacerbate imposter syndrome among women, potentially hindering their personal and professional success.⁶ Although responses from LIC were limited, differences in perceptions of gender ratios and women's credibility at conferences were evident. In HICs, a higher percentage of women (47.7%) were involved in organizing conferences.

Our survey has some inherent limitations. One limitation of our study is the imprecise wording of survey question 3, “Have you ever encountered or witnessed instances of misconduct or inappropriateness at nephrology conferences?” The vague phrasing of this question may have led to variability in respondents' interpretations and could have affected the consistency of the responses. Future surveys should aim to specify the types of misconduct or inappropriate behaviors to ensure more precise responses. In addition, external validation of the survey was lacking. We did not capture men's points of view either, and true gender equity in nephrology requires not only organizational efforts but also endorsement from and inclusion of men leaders. The survey lacked questions regarding financial challenges influencing conference participation potentially relevant to women from LICs. Finally, the survey did not assess whether women felt adequately trained in presentation skills, essential for understanding their confidence in conference presentations. Nonetheless, this survey, which presents the perspective of 343 diverse women nephrologists, should not be discounted and is an innovative effort in understanding the difficulties faced by them during nephrology conferences, with a focus on identifying potential areas for enhancement. To enhance female participation in nephrology conferences, key measures include setting diversity targets for leadership roles, such as conference organizers, panellists, and keynote speakers; offering women-specific travel awards; and providing family-friendly policies like childcare and breastfeeding areas. Mentorship programs, dedicated sessions for female achievements, and antiharassment policies are crucial.^6,7 Regular assessments and feedback are essential for continuous improvement. Further focused studies on women from LICs quantifying barriers to conference attendance will help gain deeper insights into their specific challenges.

Disclosures

Disclosure forms, as provided by each author, are available with the online version of the article at http://links.lww.com/CJN/C44.

Funding

None.

Author Contributions

Conceptualization: Priti Meena, Isabelle Dominique Tomacruz Amante, Mythri Shankar, Manjusha yadla.

Data curation: Priti Meena, Denisse Arellano-Mendez.

Formal analysis: Viviane Calice-Silva, Krithika Mohan.

Investigation: Anuja Java, Sabine Karam.

Methodology: Sibel Gokcay Bek.

Project administration: Fernanda Arce-Amare.

Resources: Fernanda Arce-Amare.

Supervision: Valerie luyckx.

Validation: Divya Bajpai, Valerie luyckx.

Visualization: Fernanda Arce-Amare.

Writing – original draft: Sabine Karam, Priti Meena.

Writing – review & editing: Sabine Karam, Kalida Soki, Valerie luyckx.

Data Sharing Statement

There are no data underlying this work.