Representation of Women Among Cardiology Grand Rounds Speakers in the United States

This cross-sectional study examines data for grand rounds lectures at 42 US institutions to gauge the representation of women among cardiology grand rounds speakers.

Key Points

Question

What is the representation of women among cardiology grand rounds speakers nationally?

Findings

This cross-sectional study with publicly available data for 3806 grand rounds lectures at 42 institutions found that about 1 in 5 were delivered by women. The proportion of women speakers increased steadily with each year with varying representation by subspecialty.

Meaning

Women remain underrepresented as grand rounds speakers for procedural cardiology and basic/translational science topics.

Abstract

Importance

Women are underrepresented in leadership positions in cardiology. Institutional grand rounds (GR) are platforms through which faculty can gain professional exposure and access to career development opportunities. The gender diversity of invited cardiology GR speakers has not been investigated.

Objective

To examine the representation of women among cardiology GR speakers in the United States.

Design, Setting, and Participants

This cross-sectional study reviewed all 626 internal medicine residency training program websites in the American Medical Association’s FRIEDA directory to identify publicly available records of cardiology GR. Grand rounds from September 1997 through December 2022 were included; GR with more than 1 speaker and trainee-led case conferences were excluded.

Exposures

Grand rounds speaker gender.

Main Outcomes and Measures

Data on GR topic focus, speaker gender, and academic rank were collected.

Results

A total of 3806 GR lectures at 42 institutions were included; 799 (21%) were delivered by women and 3007 (79%) by men. The proportion of women GR speakers increased by 1% per year and increased for each topic over time with the exception of electrophysiology and basic/translational science. Women were most likely to speak on women’s cardiovascular health (80 lectures [10.0%] vs 17 [0.6%] for men; P < .001).

Conclusions and Relevance

Women compose about 1 in 5 cardiology GR speakers with modest growth in representation over time but remain underrepresented as GR speakers for procedural cardiology and basic/translational science topics.

Introduction

Despite increased numbers of women entering medical school and internal medicine residency programs, women are less likely to enter cardiology and remain underrepresented in leadership positions in cardiology,¹ evidenced by the low numbers of women in institutional and clinical trial leadership and in leadership of professional societies.^2,3,4,5,6 Additionally, women are less likely to be chosen for awards by major cardiovascular societies.⁷

Institutional grand rounds (GR) are important platforms through which women can gain exposure and access to career development opportunities. However, data from other disciplines demonstrate that women are frequently underrepresented among GR speakers relative to the female composition of faculty workforces despite having career success similar to those of men.⁸ In 1 survey of neurology researchers, women were less likely to present research at GR than men despite having equivalent grant and research support.⁹ Gender diversity of cardiology GR speakers has not been previously investigated. Thus, we aimed to examine the representation of women among cardiology GR speakers at centers in the United States.

Methods

All internal medicine residency training program websites listed in the American Medical Association’s FRIEDA directory were reviewed to identify publicly available records of cardiology GR.¹⁰ Because we used publicly available data, institutional review board approval was not required.

Grand rounds from September 1997 through December 2022 were collected by 5 authors (E.M.D, S.M, G.K., J.H.H, N.R.) from program websites (eTable in Supplement 1). Lectures with more than 1 speaker or trainee lecturers and faculty meetings were excluded. Lecture date, title, speaker gender, speaker academic rank at the time of GR, and speaker home institution were collected. Speaker gender was assigned using data gathered from speakers’ institutional profiles. Lectures were categorized by topic; each lecture was only assigned 1 topic that was the most representative. For trend analyses, topics were consolidated into groups according to similarity: (1) interventional cardiology, valvular medicine, and vascular medicine; (2) heart failure (HF), adult congenital heart disease (ACHD), and cardio-oncology; and (3) medical education and quality improvement, innovation, and health systems research. Two authors (E.M.D and N.R) reviewed all lectures independently to ensure consistency of categorization; discrepancies were resolved by consensus.

Descriptive statistics for continuous variables were presented as medians (IQRs) and categorical variables as frequencies and percentages. To evaluate trends in the proportion of women GR speakers over time, we fit a linear regression model with GR lecture year as the independent variable (eFigure in Supplement 1). This was performed across the entire study period, and observations were weighted by the volume of GR lectures in a given year. To evaluate potential differences in GR speaker trends within topics in the contemporary era (January 2012–December 2022), we performed stratified linear regression models using the aforementioned topic groupings. For all trend analyses, 236 lectures were excluded because of the lack of a date (leaving n = 3570). For each linear regression model, β coefficients were presented along with P values. To evaluate the number of GR per unique speaker, we plotted the number of GR lectures per unique speaker separately by gender, computed medians, and compared groups using the Wilcoxon rank-sum test. Analysis and visualization were performed using Stata version 15.1/IC (StataCorp) and RStudio version 1.3.1093 (Posit).

Results

Of 626 programs, 42 institutions had data available for analysis. After exclusion criteria were applied, 3806 lectures were included; 799 (21%) had women speakers and 3007 (79%) men speakers. Women GR speakers were more likely to be assistant professors (137 women [17.1%], 334 men [11.1%]) or associate professors (183 women [22.9%], 475 men [15.8%]) and less likely to be professors (303 women [37.9%], 1362 men [45.3%]; P < .001) (Table). There were no differences in the proportions of men (1173/3007 [39.0%]) and women (334/799 [41.8%]) who delivered GR at their home institutions (P = .16).

Table. Characteristics of Cardiology Grand Rounds Lectures Stratified by Speaker Gender.

Characteristic	No. (%)		P value
	Women	Men
No. of lectures	799 (21)	3007 (79)
Speaker rank
Instructor	5 (0.6)	20 (0.7)	<.001
Assistant professor	137 (17.1)	334 (11.1)
Associate professor	183 (22.9)	475 (15.8)
Professor	303 (37.9)	1362 (45.3)
Nonacademic	33 (4.1)	115 (3.8)
Other	93 (11.6)	312 (10.4)
Missing	45 (5.6)	389 (12.9)
Topic
General cardiology	178 (22.3)	581 (19.3)	<.001
Interventional cardiology	36 (4.5)	210 (7.0)
Electrophysiology	46 (5.8)	313 (10.4)
Multimodality imaging	56 (7.0)	248 (8.2)
Heart failure	101 (12.6)	492 (16.4)
Vascular medicine	39 (4.9)	221 (7.3)
Valvular medicine	31 (3.9)	174 (5.8)
Basic/translational research	60 (7.5)	280 (9.3)
Medical education	19 (2.4)	51 (1.7)
QI, innovation, health systems	42 (5.3)	173 (5.8)
Adult congenital heart disease	35 (4.4)	28 (0.9)
Cardio-oncology	32 (4.0)	41 (1.4)
Women’s cardiovascular health	80 (10.0)	17 (0.6)
Cardiac critical care	11 (1.4)	62 (2.1)
Other	23 (2.9)	70 (2.3)
Missing	10 (1.3)	46 (1.5)
Speaker institutional origin
Extramural	465 (58.2)	1831 (61.0)	.16
Intramural	334 (41.8)	1173 (39.0)
Speaker geographic origin
United States	758 (94.9)	2855 (94.9)	.19
Canada	18 (2.3)	45 (1.5)
Europe	14 (1.8)	83 (2.8)
Central or South America, Caribbean	1 (0.1)	2 (0.1)
Asia	5 (0.6)	17 (0.6)
Africa	2 (0.3)	1 (<1)
Australia	1 (0.1)	4 (0.1)

Abbreviation: QI, quality improvement.

Over the entire study period, women delivered 23.5% of general cardiology, 14.6% of interventional cardiology, 12.8% of electrophysiology, 18.4% of multimodality imaging, 17.0% of HF, 15.0% of vascular medicine, 15.1% of valvular medicine, 17.7% of basic/translational research, 27.1% of medical education, 19.5% of quality improvement, innovation, health systems research, 55.6% of ACHD, 43.8% of cardio-oncology, 82.5% of women’s cardiovascular health, and 15.1% of cardiac critical care lectures (Figure 1). Women were more likely than men, respectively, to speak about general cardiology (178 [22.3%] vs 581 [19.3%]), medical education (19 [2.4%] vs 51 [1.7%]), ACHD (35 [4.4%] vs 28 [0.9%]), cardio-oncology (32 [4.0%] vs 41 [1.4%]), and women’s cardiovascular health (80 [10.0%] vs 17 [0.6%]). Conversely, women were less likely to speak about interventional cardiology (36 [4.5%] vs 210 [7.0%]), electrophysiology (46 [5.8%] vs 313 [10.4%]), HF (101 [12.6%] vs 492 [16.4%]), vascular medicine (39 [4.9%] vs 221 [7.3%]), valvular medicine (31 [3.9%] vs 174 [5.8%]), cardiac critical care (11 [1.4%] vs 62 [2.1%]), and basic/translational research (60 [7.5%] vs 280 [9.3%]).

Figure 1. Number of Cardiology Grand Rounds Delivered During the Study Period Stratified by Gender and Topic.

Data refer to cardiology grand rounds lectures delivered between September 1997 and December 2022. Topics categorized as other (n = 93) and missing (n = 56) are not shown. QI indicates quality improvement.

A total of 3570 lectures were included in the trend analyses. From 1997 to 2022, the proportion of women GR speakers increased by 1% per year (Figure 2). When analyzed by lecture topic in the contemporary era, the proportions of women speaking on general cardiology (2% per year); interventional/valvular/vascular cardiology (1% per year); multimodality imaging (2% per year); HF/ACHD/cardio-oncology (2% per year); medical education and quality improvement, innovation, and health systems research (3% per year); and women’s cardiovascular health (6% per year) increased significantly during the study period. However, the proportions of women speaking on electrophysiology and basic/translational research did not change.

Figure 2. Trends in Proportion of Women Cardiology Grand Rounds Speakers by Lecture Topic.

Data refer to cardiology grand rounds speakers from January 2012 through December 2022. The greatest proportion of women speakers delivered lectures on topics related to women’s cardiovascular (CV) health. Over time, there were significant increases in the proportions of women speakers in general cardiology, interventional cardiology, imaging, heart failure (HF)/adult congenital heart disease (ACHD)/cardio-oncology (cardio-onc), and medical education (med-ed)/health systems research. There were no significant changes in the proportion of women speakers on electrophysiology or basic/translational research topics.

To investigate the possibility that a select group of women were invited to deliver multiple GR, we evaluated the median number of GR per speaker (n = 3806). For both genders, the median number of GR was 1.0. The most GR lectures given by a single man was 14 and by a single woman speaker was 11. There was no significant difference in the number of GR given by unique men vs unique women.

Discussion

Herein, we evaluate representation of women among cardiology GR speakers at US institutions. We found that (1) women composed 21% of GR lecturers over a 25-year period, (2) the proportion of women GR speakers has increased over time, and (3) representation of women GR speakers varied significantly by cardiology subspecialty topic. These findings suggest improvement in the gender diversity of recognized thought leaders and educators in cardiology over the last 25 years and offer insights into these high-profile speaking roles.

Overall, women composed about a fifth of all GR speakers, and the proportion of women GR speakers grew by 1% per year. According to Association of American Medical Colleges (AAMC) 2018-2019 data, 21% of cardiology faculty at US medical schools were women,¹¹ though the percentage of women adult cardiologists in practice is estimated to be 12.6% to 14%.¹² Our data suggest that the proportion of GR lectures delivered by women is commensurate with the US cardiology workforce. The observed increase in women GR speakers over time may reflect increased awareness of the need for professional diversity. Consistent with prior data regarding the delay in promotion of women physicians in academic medicine,^11,13,14 we found that women who delivered GR were at lower academic ranks compared with men. It is possible that to achieve more equitable gender representation among speakers, women at more junior career stages are invited for speaking opportunities as there is a dearth of women cardiologists of senior rank.

Comprehensive information regarding cardiology workforce demographics is limited; AAMC data indicate that women composed 46.7% of ACHD, 10.2% of interventional cardiology, 11.6% of electrophysiology, and 31.2% of advanced HF fellows.¹⁵ Although women were less likely than men to deliver GR on topics in procedural subspecialties; they delivered 15% to 18% of lectures in these fields, which is consistent with the expected proportions based on demographics of these specialties. Still, the lack of change in representation of electrophysiology- and basic/translational research–focused GR speakers warrants attention.

Improving professional opportunities for women requires a multifaceted approach. In addition to encouraging more women to pursue cardiology, more support is needed to retain and promote women who are in practice. These interventions include increasing the number of women invited to speak at GR as well as increasing opportunities for women to participate in leadership roles. Our findings are important to guide cardiovascular society meeting planners to maintain diverse speakers. Additionally, GR organization committees should be composed of senior as well as junior faculty to ensure adequate representation. Our findings can serve as a benchmark for future progress and assessment.

Limitations

Because of the scale of the data collection, gender, which is just 1 metric of diversity, was not self-reported, and nonbinary gender identities may not have been captured. There is intersectionality between gender and race and ethnicity as they pertain to academic promotion, which was not explored in the current study. We did not collect professional status, though the vast majority of GR speakers were physicians. We were only able to analyze data for the speakers who ultimately gave GR lectures. Institutions without publicly available data were excluded, which may limit generalizability, though this analysis included more than 3000 lectures, which to our knowledge is the largest such investigation in cardiology to date.

Conclusions

Women compose approximately 20% of all cardiology GR speakers, and gender diversity in GR speakers has increased over time. Still, women speakers were of lower academic rank and were relatively underrepresented in certain subspecialties. Concerted efforts are needed to encourage promotion of women in cardiology and to promote diversity of GR speakers with respect to all dimensions of diversity.

Supplement 1.

eTable. Included Institutions with Geographic Location

eFigure. Trends in Proportions of Women Cardiology Grand Rounds Speakers over Time

Supplement 2.

Data sharing statement