Table 1.

Socio-ecological model: strategies for reducing barriers to sex- and gender-based inequity

Socio-ecological framework	Relevant themes identified in equity survey with representative quote		Prevention strategy for inequity
Individual	Reporting inequities	“Reported it to senior staff.”	▪Training to overcome implicit bias ▪Promote sex- and gender-neutral professional culture
	Staying the course	“Ignoring those attitudes and to work hard as if they were not there.”
Relationship / interpersonal	Seeking social support and mentorship	“Speaking to other females in cardiology provides inspiration and reassurance that it can be done. I speak to trusted friends and family about my feelings and experiences. I am driven and resilient.”	▪Foster enhanced representation of women in CV medicine ▪Encourage sponsorship and mentorship of female trainees into CV medicine, surgery, and science
	Dual responsibilities	“An expectation that I am able to accomplish at work what my male colleagues accomplish while at the same time fulfilling the duties that their wives fill at home.” “If you become a cardiac surgeon, you will never be a real Mom.”
Community/ organizational	Exclusionary cliques	“You could be “in” or “out” of the men’s club. Clearly as a woman I was out. Some conversations, jokes, and laughs when discussing patients left females out of the conversation.”	▪Enhance family, work, and social support networks ▪Adoption of the “3GD” principles for all task forces (leadership, guidelines, workshops, panels, etc.) ▪Promote inclusivity of all women in CV medicine ▪Effect institutional policies for work–life balance and sex- and gender-neutral culture
	Desire for respect and opportunity	“I have heard of females being ostracized for becoming pregnant and taking maternity leave. I have been told numerous times that certain specialties are not for females.” “…Females have to work harder in science than men to achieve the same level of success.” “Open disrespect from nurses (particularly female nurses who give respect to male residents).” “Search committee with female representation and efforts to look for female applicants.”
Societal/ public policy	Institutional barriers	“Not being paid equally…not being supported adequately for university promotion.” “…Doing merit-based activities (teaching/admin[istration]/mentorship) not recognized for promotion”	▪Mechanism for safe reporting without retribution ▪Address health, economic, educational, and social policies that create a gender gap by effecting change to reduce these inequities
	Accountability	“The problem is the system and there needs to be bold systemic changes to crack down on the misogyny in cardiovascular medicine. We are currently failing female trainees by allowing this to continue.” “[We need to] avoid exclusion of trainees from opportunity and obstruction by abusive and unprofessional conduct by staff by virtue of them leveraging the power imbalance between staff and trainees.”

CV, cardiovascular; 3DG, gender, generation, geography and discipline.